Starting From Scratch. The U.S. Department Of Veterans .

Starting From Scratch.The U.S. Department of Veterans AffairsPatient Experience Journey.Presented by:Jennifer Purdy, Acting Executive DirectorVeterans Patient Experience Program, Veterans Experience OfficeU.S. Department of Veterans Affairs1

About VA and VHA 374,000 Employees172 VA Medical Centers and 1,200Outpatient Sites of Care Community-Based Outpatient Clinics(CBOCs) Community Living Centers (CLC) Domiciliary (DOM) Substance Abuse Treatment BedsOver 9 million Veterans enrolled in the VAhealth care program.Over 120,000 trainees in over 40 heathprofessions disciplines, including: 41,000 physician residents, 23,000 medical students, 27,000 nurse trainees, and 27,000 other associated health disciplines.VA is affiliated with over 1,800 uniqueeducational institutions across over 7,000training programs.Over 70% of VA physicians have facultyappointments and spend some portion of theirtime in education and research activities.2

Veterans Experience Office (VEO)Background: Established in January 2015Direct reporting line to VA SecretaryLocal field and DC componentsVEOChief VEOVHAVAVBANCADeputy elInsight andDesignVBA/NCA CXVA PX3

VEO Resources for VA PX ProgramStrategic VHA Partnerships: VHA, Under Secretary for HealthVHA, Network Director ExecutivesVHA, 10N quarterly updateNational Labor UnionsAdvisory Board of VHA SeniorLeaders, monthly (21 VHA FTEE in Pentad positions)VAMC PX Champions, monthlyMonthly Community of Practice callsVA PX Operational Model:HCD Researchand DesignMeasurementConcurrenceof VHA PXleadersPilot and FieldImplementationOrganization of VA PX Directorate:32 FTE 100% devoted to VHA for PXChief VEOExecutive Director PXFront Office 4 FTEPX OperationalSupport Division4 FTEMeasurement &Policy Division4 FTEResearch andDesign Division6 FTEImplementationand Consultation14 FTEDivision Functions Change Mgmtand Comms VHA Programand facilityalignment Strategicplanning Operationalplanning Medallia CAHPS / SHEP PX NationalDirective PX NationalPD Project Mgmt Discovery forMoments thatmatter Private sectorbenchmarking Pilot testingnew solutions Partnershipwith programoffices Facility PXonsiteimplementation Deep DiveSAIL Visits forPX PX FieldConsultations4

Goal - Consistent Exceptional PXPhase 1 FY17: BuildDefine PXDesign PX forVHAGain Trust & PilotToolkitsPhase 2 FY18: tratedTouchpointsPhase 3 FY19: MatureAssess FacilityNeeds & PXMaturityPX CultureAccountability &Outcomes5

Phase 1: A Timeline of VA PX6

Who did we learn from?External Benchmarking Visits UCLA HCA Cleveland Clinic Univ. Pittsburg MC Stanford Kaiser Group Health Collaborative Mayo ClinicEmployee Research Visits San Francisco, CAVeteran Research Visits84 Veterans in 9 sitesInternal Benchmarking Visits New Orleans, LA Orlando, FL Grand Junction, CO Iowa City, IA Boston, MA Gainesville, FLFrameworks Beryl Institute VA Office of Patient CenteredCare and CulturalTransformation (OPCC&CT) VA National Center forOrganizational Development(NCOD)Prior Key Work with Influence Commission on Care Report A Day in Life of PC Narrative Office of Patient Centered Careand Cultural Transformation(OPCC&CT) VA Research Center report onAccess to Care VA Center for Innovation Innovators Network7

What is PX at VA?Patient Experience is not a project or a single initiative. Patient Experience is aPHILOSOPHY. It is an organizational alignment of people, processes, and culturetowards a common goal of providing exceptional experiences for all Veterans,their families, and caregivers - from the first touch point to the last.8

VA PX FrameworkPeople Engaged Leaders Engaged EmployeesCulture Caring and Friendly Environment Clear Patient Communication Orchestrated Touch PointsProcesses Measuring and Improving Hearing the Voice of the Veteran9

VHA Patient Experience Journey MapIdentifying the“moments thatmatter” toVeterans in theiroutpatientjourney.10

Designing PX Initiatives & ToolsDeployment Strategy:1. EngageLeaders2. EngageEmployees WECARERounding Own The Moment3. EstablishVisible PX Red CoatAmbassadors StandardPhoneAnswer EmployeeBadges11

Phase 2: Deploying PX in VHA Conducting three-day on-site implementation of the fivefoundational VA PX tools and programs. National Webinars/Training/Monthly Calls Providing consultation services.12

Engage LeadersLeaders must: Set the PX tone, Ensure a structure is in place to maintain PXas a priority focus, Be relentless in quest for experience, Be visible, Experience their healthcare systemsexperience during all shifts, Reward and recognize PX behaviors, and Coach or hold accountable behaviors notrepresentative of the VA WAY.13

Engaged Leadership BehaviorsWECARE Leadership Rounding: Rounding for Experience: Veteran and employee questionsfocused on PX and EE. (*This is not Environment of CareRounds or a Gemba Walk.) Recognition of employees you see representing ICARE valuesand WECARE behaviors (Cleveland Clinic/UCLA best practices). Allows leaders to build trust and connections with employeesand to remove barriers Track follow-ups to completion and publish widely.14

Engage EmployeesOwn the Moment (OTM)Veterans CustomerExperience WorkshopüüüüValuesBehaviorsService RecoveryGuiding Principles“The way we treatVeterans today is thereason they will CHOOSEVA tomorrow.”The VA WayICAREValues: The key tenetseach employeecommits to in serviceto Veterans and VA.WECARESALUTEBehaviors: Theactions and behaviorswe all do every timein each interaction.Service Recovery:Acknowledging errorsand making them rightto honor Veterans andtheir families to makesure their needs aremet.OTM PrinciplesPrinciples: The foundation and touchpoints for all of our decisions15

The VA ceWECARESALUTEWelcome with asmileSay hello &introduce yourselfExplain who you areApologize &empathizeConnect with theVeteranActively listen totheir needsRespond to theirneedsExpress gratitudeListen to theconcernUnderstand what isneededOTM PrinciplesConnect and Care(Emotion)Understand andRespond to Needs(Effectiveness)Guide the Journey(Ease)Take actionExpress gratitude16

Engaged Employee BehaviorsTell employees what is expected. (WECARE and SALUTE)Ensure they are trained. (Own The Moment)Remind them why. (Own The Moment)Recognize and highlight behavior you want to reinforce.(ICARE awards and WECARE Leadership Rounding) Understand what matters to employees and let them knowyou listened. (AES) Allow staff to feel valued, psychologically safe andempowered to do the right thing. (Servant Leadership) 17

PX Spread: Environmental ScanQuarterly Environmental Scan utilized to better understand the spread andpenetration of the PX toolkits and to track implementation across VHA.ToolkitFeb-18Jun-18Sep-18Jan-19(103 responses) (130 responses) (121 Responses) (135 Responses)OTM3690106122WECARE Leadership Rounding3685105116I Choose VA Badges72808390Red Coat AmbassadorProgram87120132137Standard Phone Greeting7194101122Green Glove13152231Change in Primary CareProvider Letter30505855Employee Recognition41818454MLMSN/AN/AN/A26Tracking Implementation: How many facilities have wevisited and trained? How many facilities are rollingout each of the solutions? Which facilities are rolling outthe solutions? How many facilities are notscheduled for training? How is implementation going? Do facilities need assistance? Identify Best practices andshare with other How can the PX programimprove?18

VHA Employees Trained in OTM per VISN60,000 FTEE FTEEFTEE Parti cipatedPercent Parti cipated in OTM19

Pulse Check: Modernization SurveyVHA Employee Responses: 21,308 (last 365 days as of 25 March 2019)Service Chief Conducts RoundingNo (55.43%) Yes (44.57%)Standard Phone GreetingNo (26.72%) Yes (73.28%)Red Coat Ambassador / Navigation AssistanceNo (14.13%) Yes (85.87%)Employees Treat Veterans with Courtesy and RespectStrongly Agree (63.86%) Somewhat Agree (29.71%)Somewhat Disagree (4.49%) Strongly Disagree (1.94%)20

Tracking PX DataSurvey of Healthcare Experience of Patients (SHEP) - Amarillo VA HCS21

Tracking PX DataVeterans Signals (VSignals) – Amarillo VA HCS (Amarillo, TX)22

Phase 3: Maturing PX in VHA23

2019 PX Self Assessment24

Maturing PX Culture in VHA10-4 In the Zone (Oklahoma City VAMC) - A model of how to Connect andCare, one of the Own the Moment guiding principles.On Stage Coaching Moments (Dallas VAMC) - Opportunity formanagers to promote “self-awareness” and make “on the spot corrections”with employees.Commit to Sit and Take Five (Dallas VAMC) - Outpatient Office VisitWelcome, Explain, Ask, Sit, and Time away from electronics.Own the Encounter (Dallas VAMC) - A workshop that consists of 4sessions. Each session is 50 minutes long (perfect for front line and clinicalstaff so they can continue to care for our Veterans!).PX Change Agent (Phoenix VAMC) - An initiative for employees that wantto lead change in his/her service line and throughout the organization. PXCAsspread the news about PX in his/her own service lines as a part of day-to-dayresponsibilities.Peer to Peer Recognition (Phoenix VAMC) - Employees recognizingEmployees who “Own The Moment”25

Conducting Inpatient ResearchSite Selection Criteria:Hospital Complexity Level/Star RatingPopulations ServedDischarge Volume and Length of StaySHEP Composites – Low and HighPerforming Facilities Innovation & PX Engagement Geographic Diversity VAMC Sites Discharge to HomeCleveland OHOmaha NELexington KYLebanon PAPortland ORSan Antonio TX HospitalizationAsheville NCBiloxi MSMarion ILSan Francisco CADallas TX11 VAMCs VISITED100 VETERAN INTERVIEWS (Home and VA)433 EMPLOYEE INTERVIEWS26

Identifying Inpatient “Moments that Matter”Who Did We Talk To? istSocial WorkPatient Centered CareCoordinatorPhysical TherapyNocturnist LPNMSA/ClerksDietitianInterdisciplinary TeamNODAssociate Chief Nurse ofMedicine & SurgeryEMSChief of MedicineCoding27

Developing Inpatient Tools & Solutions(1) Day ofDischargeChecklist(2) DischargeJourney Booklet(3) CaregiverCare PackagePilot Sites: Dallas and Atlanta VAMC28

PX Consultation ServicesAvailable PX Consultative Services Utilizing Human Centered Design Strategic Planning Experience Data Deep Dives and Analysis Provide concrete actionable recommendationsConsultative Services PX Program Reviews (two day initial visit) PX Coaching (single or multiple visits, coaching needs determined byfacility; ex: provider communication coaching). Strategic Planning (multiple visits, focus on developing a PX strategic planand action plans, may also include coaching and local toolkitdevelopment; ex: “Commit to Sit” w/ Dallas)29

Executive Performance Measures4d:Excellence inCustomerExperience(CX)Improve PatientExperience(CustomerServiceExperience)FS: Attendance of Medical Center Director at theVHA Patient Experience Symposium in December2018; complete the VEO Patient Experience selfassessment, and finalize a facility/VISN actionplan to improve Patient Experience.Exceeds FS: Successful implementation of thefacility/VISN action plan.Outstanding: Demonstrated effectiveness of thefacility/VISN Patient Experience Action Plan byimproved Patient Experience and EmployeeSatisfaction (Best Places to Work) metrics asmeasured by SAIL.See SECVA PolicyStatement of August22, ed.pdf30

Reporting to OMB A-11 Directive VHA CX Self AssessmentDeep Dive with OMBNext Steps: Develop Action Plan Participate in monthly OMB follow-upmeetings Finalize data submission for public reporting(Mar 2019) Check in for Action Plan development withOMB (May 2019) Action Plan Submission (June 2019)31

Patient Experience Symposium 2019 Assembled more than 450 VA healthcare decision-makers and clinicians,including most VA Medical CenterDirectorsDemonstrated current and new PXideas, practices, and processes atVAMCs across the countryShowcased 100 PX promising practicesfrom VAMCs across the countryHighlighted PX thought-partners,advocates, and practitioners sharingtheir expertiseOutcomes from PX Symposium 42 VAMCs volunteered to pilot inpatient tools 22 requested VA PX Consultation Services 41 VAMCs requested My Life My Story 6 requested VA Implementation Assistance32