1. Case Study Quality and PerformanceRobert Wood JohnsonUniversity Hospital Presented by: Rick Bekanich Pete Brenkosh AmandadeepKaur Dee Walski

2. Outline Background on Robert Wood Johnson Hospital Customer satisfaction as it pertains to quality health care Has the organization been cited for poor quality ? Are there any ongoing quality initiatives at the hospital? Has the organization been cited for exceptional quality?

3. Introduction Robert Wood Johnson was founded in 1884 Located in New Brunswick NJ Academic medical center Partnerships between research facilities, teaching hospitals and clinics

4. Over 1,300 physicians and surgeons are affiliated with the hospital which includes the NCI- designated Cancer institute of New Jersey, the Child Health Institute of New Jersey and The Bristol Myers Squibb Children's Hospital Provides full range of health care Specialties include cardiac care, heart surgery and transplants, cancer care, pediatrics and maternal -fetal medicine

5. Earned significant national recognition for clinical quality and patient safety Ranked (NO. 36) heart surgery (NO.40 ) cancer and (NO. 50) for respiratory disorders according to U.S News & World report’s 2009 ranking of “America’s best hospitals” Harvard University identified RWJUH as one of the top 10 hospitals in the nation for clinical quality

6. Who Is a Customer? Actual , Potential or future user of the hospital or service Hospital customer different from regular customer Forced to be a customer Customer interacts with all parts of staff

7. What Is Customer Satisfaction? Customer satisfaction is a person’s feeling of pleasure or disappointment in relation to his/her expectations Customer satisfaction is ability to meet expectations of the patients Exceed the customers expectations to make him/her highly satisfied High satisfaction creates a bond with hospital High patient loyalty

8. Customer Satisfaction And Quality Healthcare Metrics Good quality medical care (successful surgeries) How are you treated by staff? Do they seem caring ? How long do you have to wait ? How good is the food ?

9. Has the organization been cited for poor quality? Source: Consumers Digest Leapfrog Dec 04

10. Issue of patient feedback systems at healthcare institutions Major reforms of Health insurance industry & health care delivery system ongoing trends toward greater transparency of quality of care & patient satisfaction are likely to accelerate. Private insurers adopt quality metrics, including Patient Satisfaction, as measures of performance and value, advancing pay to performance of an organization. Health insurance is moving toward reimbursement based on Quality. Organizations that don’t quickly improve performance will be at a competitive disadvantage.

11. What areas are specifically poor? Lack of effective feedback system made it difficult for patients to comfortably communicate with hospital about last visit. Hospital was not able to understand the concerns of patients and staff.

12. Consumers/Patients Paying higher cost of health care Shopping for value Use Hospital Compare – Federal Gov’tdatabase forquality and patient satisfaction Use Hospital Compare – Federal Gov’t database forquality and patient satisfaction

13. Trends Hospitals put even greater emphasis to listening to voices of patients. Direct correlation between high satisfied caregivers and satisfied patients that in turn leads to easier recruitment and retention of qualified doctors, nurses and technicians. Press Ganey research – Hospitals with high satisfaction ratings are the most successful financially. Satisfied patients will recommend the hospital to family and friends through “ word of mouth”.

14. Patient Feedback- Hospital Pulse Report 2009 Source: Press Ganey

15. How is quality measured for this particular product/service/process? Measuring Customer Satisfaction Dept C Dept B Dept E Dept D Dept A Dept F Dept G Patient Surveys Feedback Forms Paper or Email RWJ - Patient Relations

16. Problems with this type of quality measurement Paper base system Costly Time Consuming Hard to collect info from all touch points Not completely anonymous Turn around response not quick enough Problems could escalate Patients already discharged Employees solve problems on their own Management did not have enough information toaddress customers’ questions and concerns

17. Survey items are correlated to patient ratings of “Likelihood of your Recommending this hospitals to others” Represents the experiences of 2,985,690 patients treated at 2,021 hospitals nationwide between Jan 1 and Dec 2008 Survey Item Priority Rank Response to concerns and complaints made during your stay 1 Degree to which hospital staff addressed your emotional needs 2 Staff effort to include you in decisions about your treatment 3 How well the nurses kept you informed 4 Promptness in responding to the call button 5 Communication Issues National Inpatient Priority IndexSource: Hospital Pulse Report Press Ganey 2009

18. Source: Hospital Pulse Report Press Ganey 2009

19. Solutions for issues Patient Voice Employee Engagement

20. Patient Voice “Patient Voice provides RWJH with a real-time picture of what is happening in patient care, where problems are occurring, and how long problems are taking to resolve”.

21. Patient Voice Patient Voice provides RWJ Hamilton’s patients with a completely anonymous and confidential forum for submitting feedback and asking questions Customers can give their feed back during their stay or when they return back to their home They can visit the hospital’s website to submit their feedback and questions directly to the hospital’s Patient Relations Manager, who oversees the feedback management system

22. The patient relations manager then reviews each submission, and if necessary, routes the feedback to the staff member who is responsible for providing a timely and appropriate response

23. Employee Engagement RWJH believes that their employees know what our mission is, live the mission, and work together as a team to accomplish that mission.” Due to employee involvement employee feel that they are more engaged in an organization and less likely to search for another opportunity

24. RWJH rewards their employees with RWJ Dollars which can be used in the cafeteria, gift shop or to purchase gift cards. The senior leaders of RWJH take advantage of Managing up program with hand-written notes that personally recognize employees for acts of kindness and extraordinary service.

25. Benefits of the solution Source: allegiance.com Since implementing advanced engagement technology more than four years ago, they have continued to enjoy increasing patient satisfaction scores. Our excellent service has been recognized through numerous awards, including the Press Ganey Summit Award presented to the hospital’s Cancer Institute.

26. Quality Awards 2004 Malcolm Baldrige National Quality Award 2004 Governor’s Award for Performance Excellence-Gold 2004 Consumers' Choice Award

27. Malcolm Baldrige National Quality Award Named after Malcolm Baldrige, 26th Secretary of Commerce Established in 1987 to enhance competitiveness and performance. Started with Manufacturing, service companies and small businesses. Expanded to Non-profit organizations and Healthcare in 1999 80 companies have won the award since 1988 Information courtesy of http://www.baldrige.nist.gov/

28. Performance Criteria

29. Baldrige Assessment

30. Results Scoring Guidelines

31. Baldrige Results 15/30 program, which guarantees that patients coming into the emergency department will see a nurse within 15 minutes and a physician within 30 minutes Emergency department patient satisfaction is at 90%, exceeding the national benchmark New Jersey’s fastest growing hospital for the last five years and improved its market share while closest competitor’s share declined Charity Care Dollars increased from $5 million in 1999 to $23 million in 2003

32. Governor’s Award for Performance Excellence-Gold Presented by Quality New Jersey (QNJ) Highest and Most respected state-based Quality Award The award is comprised of six sectors Healthcare Education Service Manufacturing Environment Government

33. Consumers' Choice Award Survey’s for the award conducted by the Consumer’s Choice Institute Surveys conducted in Major Canadian and U.S. Cities Winners are determined by Consumers and not by panel of judges. Its purpose in to publicly identify establishments that have been voted by the consumer as their choice for excellence. Information courtesy of www.consumerschoiceaward.com

34. Questions?????