Transcript:
Jordan Cooper 0:03
We’re here today with Erin Shipley from Cooper University Health care.
Erin is the VP of Consumer experience.
However, those who don’t know Cooper University Healthcare is an academic health system based in Camden, NJ, with 900 physicians and 663 beds.
So there’s a number of different initiatives will be covering today in our conversation, all pertaining to the consumer experience at Cooper University and the first, I’d like to discuss with you Erin today and for our listeners benefit is to Cooper experience excellent program.
Now I know that it’s focused primarily in your emergency department and your high volume inpatient units.
Tell me their listeners a little bit about this program.
It’s Genesis and what you’re trying to accomplish through it.
Shipley, Erin 0:52
Absolutely, Jordan.
So, you know, I think just like a lot of organizations across the country, we are we have very high volume emergency department.
You know we are struggling with.
We were struggling with some of that boarding and the throughput issues that are plaguing many of us and many of our organizations.
And it’s not just throughput and patients.
You know in the AED to be discharged, but it’s also those patients who are waiting for a bed.
We wanted to do something different.
We our tackling the throughput issues we are trying to you we use hallway beds on the Ed on the on the inpatient unit that all those things that everybody is doing.
But we wanted to create a program that looked at the challenges of care in the emergency department and a much more innovative way.
Jordan Cooper 1:42
OK.
Shipley, Erin 1:42
And we really started with our patient and family advisory councils and our patient experience data.
We have, of course, survey like pretty much everybody our patients and we wanted to look at those come we started with comfort needs information about their plan of care and then rather than putting the burden of those action plans on the clinical staff, that experience program is really designed as a way to have team other non clinical team members who can who can jump in and meet those needs of the patient more real time.
So we’ve got LPN’s and EMT’s who can serve as that first line of defense for some of that clinical information.
They can go right into the chart and they don’t have to ask someone they have access to that information to people that provide those patients and more proactive update.
We have greeters and a lobby.
Ambassadors we we know patients, you know, don’t wanna perk in the garage.
And so we partner with the greeter to be able to loop in ballet.
So if there’s a safer entrance to the emergency department and already we’re beginning to see improvement in their experience results and that that we have the sentiment of our team saying that this is good news for them, it’s making their jobs easier.
Jordan Cooper 2:53
Well.
So was this excellence program created in reaction to some to a poor performance on a HEDIS report?
What are the kind of the business drivers behind this excellence program?
And then how is it attached to the financials at the organization in terms of having dedicated staff and just coordinating resources to implement this program?
Shipley, Erin 3:23
Yeah, we’ll start with the first one.
I mean, I think anytime you are serving patients, you wanna, you wanna look at that data and knock it out of the park and it the the core experience results were not where we wanted it.
Jordan Cooper 3:34
And the.
Shipley, Erin 3:36
We want to be our goal at Cooper is to be what I would call top desk file and the nation, and to continue to improve.
We wanna be a destination of health care for our community.
We serve a very vulnerable group of patients in, in our Community, so that was really the Genesis less about the scores and more about doing what we can to see patients in our Ed and make sure we’ve got that throughput to be able to bed patients on the floor from the investment perspective.
Jordan Cooper 4:05
OK.
Shipley, Erin 4:09
You know, there’s there’s definitely a cost benefit to this when we see more patients through the emergency department, we are improving our scope and more new patients are gonna want to enter our health system and they have a positive experience in the emergency department.
It’s the front door to your hospital.
Jordan Cooper 4:27
It’s.
Shipley, Erin 4:29
And so when you have a negative experience in the Ed, you may opt out and choosing Cooper for your your scheduled surgery procedure that you need to have, or choosing a primary care physician or in your medical practice.
Jordan Cooper 4:38
So.
Shipley, Erin 4:44
So absolutely, there’s a people cost to this, but the return on investment is also a huge I don’t wanna also underestimate the the impact of doing the right thing by your team.
And when you’re physicians are providers and your staff have a more positive working environment, you’re gonna see that reduction in turnover.
And so you’re turnover costs and your employee costs are gonna go way down.
You’re gonna see a reduction in mortality.
Jordan Cooper 5:09
Yes.
Shipley, Erin 5:10
So when you have team members who are engaged and you have team members who stay, you have better outcomes and you can’t put a price on that, right?
Jordan Cooper 5:20
Like so, I love that we delve into a bunch of the kind of drivers of implementing this program and some of the operational mechanics of it.
I’d like to, since this is healthy data podcast, dive into the data component of how you facilitate this.
So you’re looking to free up.
Increased throughput put more heads in beds.
How is Cooper health aggregating, normalizing and integrating data from across different departmental data silos to facilitate their reporting of these KPIs?
You’re dealing with environmental services and registration, transport, the Ed.
How are you moving that data into a single dashboard or whatever you’re doing to monitor your progress and improve patient experience?
Shipley, Erin 6:04
So we have a very robust data analytics team.
You know, I believe these spoke to one of my colleagues.
Ladies and a previous podcast, you know that is the source of truth for all our dashboards.
Jordan Cooper 6:11
Is it?
Shipley, Erin 6:16
So we we really take all of that big data digested into a series of dashboards that are important to not just our leaders to be able to make the decisions for their departments, but the frontline staff who needs to use that information all the time.
Jordan Cooper 6:28
Then.
Shipley, Erin 6:31
So, specific to that, edx once program Art team is both people times a day looking at that throughput dashboard to see OK in the last four hours how many patients have we seen through the Ed yesterday as we look ahead to the next 4 hours, what can we anticipate and what do we need to do now to make sure that that’s a smoother piece.
Jordan Cooper 6:32
This.
It’s.
OK.
Shipley, Erin 6:59
We huddle with our environmental services, our transport team, our excellence ambassadors and again have that conversation.
I’m well.
What are we seeing in the in the back end?
Data around OK, we’re at capacity on the floor.
What changes do we need to do now to make sure we accommodate that so we don’t back up further those ships?
Jordan Cooper 7:20
So.
Shipley, Erin 7:21
A couple of examples.
Jordan Cooper 7:22
So you’re producing these dashboards with your analytics team, but you also have a digital front door through epics my chart correct?
Shipley, Erin 7:30
Yes.
Jordan Cooper 7:30
So to what?
And I believe that as part of this program, you publish wait times and delays in the ER.
And I’m wondering to what extent that information is being integrated and how it’s being integrated into epics my chart so that patients can see this data and then how is how are you seeing that affect patient decisions?
Are they saying?
Oh, well, you know.
Are you are you seeing kind of a flattening of patient volumes?
So maybe people are avoiding high volume time, kind of like a happy hour and synthesizing people to come at low volume times.
Shipley, Erin 8:03
Right.
Jordan Cooper 8:04
What’s how are you actually technically integrating and then what’s the impact?
Shipley, Erin 8:09
Well, I, you know, I think the we look at the integration of the data you know a lot of those those metrics are not, it’s not information that we’re we are sharing publicly in that my my Cooper way we my chart my Cooper way we really try to make sure that our patients are using that as a more two way communication channel where they’re feeling like they’re talking to a live caregiver not getting some kind of AI automated response not that that’s a bad thing you know I I think gone are the days where we you.
Jordan Cooper 8:23
Umm.
Shipley, Erin 8:44
Drive past a billboard that says ER wait time is dot dot dot.
I don’t think consumers really trust that.
I know I don’t trust that as a consumer, but there is innovation and it’s innovation that we’re looking at for on how do you leverage a patient facing app, whether it’s integrated with my chart or not.
That says something about what’s next for the patient because you know it’s not necessarily about how long am I waiting, but what’s the next step for me?
Do I know what my plan is here is and that’s where we can leverage the technology and the people to help build that gap.
Jordan Cooper 9:24
So there’s something else that you’re doing at Cooper Health, which is kind of related to what’s the next step for a patient.
So I know you are redefining patient rounding at Cooper health, kind of experimenting with different frequencies of rounding.
Umm, anticipating patient requests and documentation, patients are in the inpatient ward of the hospital, are awaiting.
What’s next?
Maybe there’s another test.
Maybe there’s a discharge, so how?
Tell me about this redefining patient rounding is Cooper Health shifting away from physicians towards Ppas and MPs operating at the top of their licenses for inpatient care?
What’s going on with patient rounding and how’s that affecting consumer experience?
Shipley, Erin 10:15
Yeah, I mean, all the rounds, right?
And so it’s really breaking it up the let’s just start with our frontline staff.
And so you you used a great term operating at the top of the license.
So when we think about our frontline nurses, our techs, this is about helping them to build their skill, to take advantage of their time that they do have the vet at the bedside.
There is great research and data that is continued that we continue to update around what we call purposeful rounding, which is like it’s not necessarily tied to the time no clinical person is gonna want to not have eyes on that patient every hour or so, right.
But it is about building their skill.
That when I’m there at the bedside, that I’m doing what I need to do in clustering my peer, I’m toileting patients proactively for your physicians and providers.
Jordan Cooper 11:07
Perfect.
Shipley, Erin 11:08
Absolutely.
We look at where leveraging nurse practitioners, PAs, we’ve got that team approach and we’re also an academic Medical Center.
So we also have learners who are part of that rounding process and helping to make sure that they all have the communication skills to say something.
And when we don’t have the information while waiting on a test, we want them to say something about it.
Hey, we know we’re waiting for the test results of your MRI to come back.
So because when you say nothing, patients are anxious, right?
They they make up a story of their head.
It’s evolves beyond just that frontline patient care piece that we’re also thinking differently about leadership rounding on patients.
Jordan Cooper 11:49
Yep.
Shipley, Erin 11:52
So you know, there’s two ways you validate the behavior of staff through direct observation and skill building and through asking a patient, tell us about your experience in the classic old sense.
Jordan Cooper 12:01
That’s.
Shipley, Erin 12:03
You know, we learned as a nurse leader, you should round on every patient, every day and on a 72 bed unit with one nurse leader.
That nurse leader would be running all day long.
So we’re really dividing and conquering.
We have an electronic pounding tool that we’re able to see our lives, census and and integrates with EPIC.
And so we’re able to see who’s been rounded on and who hasn’t.
And that’s 24 hour period and we have physician leaders who will round on casions.
Jordan Cooper 12:30
It’s.
Shipley, Erin 12:33
We’ve got a members of our essential services support services team who will wrap on patients, but we’re all doing it in our own bucket.
Like what’s in it for me as the lab leader or the Environmental Services leader to go in the room and say, hey, you’ve seen our housekeeper three or four times today.
Jordan Cooper 12:48
OK.
OK.
Shipley, Erin 12:52
Talk.
Talk to me a little bit about how well work Manning your room and then they’re putting that information in the tool not as a compliance marker, but more as a commitment to improve our services and care so that we can trend the data.
Jordan Cooper 13:06
I’m not sure how long this redefining a patient rounding has been implemented and has been an active program at Cooper Health, but do you have any kind of outcome measures on the impact of this either from patients satisfaction we I mentioned HEDIS earlier from NCQA or do you have measures on clinical outcomes or if you have any risk based sharing models like an ACL or shared savings if you have, you know capitated patients that you’re able to save on what has been the an, yeah, so I’ll leave it there.
Shipley, Erin 13:42
The outcomes at so you know what we know is that when patients have been rounded on and we see this in our own data.
So when patients say yes, I saw a leader during my stay, they will rate their experience of care on H caps, which you know because we don’t know the patient experience required survey from CMS, The Cooper data they say yes they rate their experience of care in the 90th percentile or above in the nation and that’s all hospitals who take the survey when they say no it’s much slower below the 25th we also see and when we think about innovation and data those patients are less likely to be readmitted because they we tie that data that.
Jordan Cooper 13:56
After that.
Huh.
Shipley, Erin 14:26
Rounding data to readmissions, and if that patient was rounded on during their stay and their readmitted, our experience team goes back and reviewed the rounding notes because that last leadership round is really a discharge planning round, right.
So if we have not done that, well, of course that could contribute to the readmission.
So we’ve seen the reduction of readmission through the rounding piece.
Also, the posted that call process, which is like around right, we called patients after discharge make sure that they’re safe and well.
Jordan Cooper 14:54
Umm.
Shipley, Erin 14:56
Of course we ask about their experience too, but that has we’ve seen an almost a 4% reduction of readmissions just over the last two or three years through the implementation and the consistency of this.
Jordan Cooper 15:10
Wow, that’s an incredible figure.
4% reduction of readmissions through this rounding reform, which definitely has an impact on the hospital’s bottom line.
And when the health systems bottom line and when you’re operating on A1 or 2% margin, that’s that’s significant.
Shipley, Erin 15:25
It’s huge.
Jordan Cooper 15:26
I I do want to pivot to the third topic and final topic will be covering today, which is actually somewhat unique and it’s quite interesting.
It pertains to the care of patients with a very complex set of chronic conditions, particularly innovations concerning the care of patients with intellectual and developmental disabilities.
I’ve done episodes before on hospital, at home.
I’d like to hear in particular what’s going on with your care of this particular patient population.
How are you managing their care?
What are you doing to innovate here?
Shipley, Erin 16:02
Yeah.
There, what we call in the experience.
Roll the silent population because often there’s not a they can’t speak for themselves.
There’s not an advocate or guardian who’s available to speak for them, so we’ve created through Epic what is called our it’s our disability support program with a an ethnic registry where we’re able to as we submit patients to the program that have one of those complex disability needs.
We will and they’re basically flagged.
We get a daily email from epic Art our disabilities team that not just shows the next seven days of appointments for those patients that the next 90 days of procedures that are out and above and our care coordination team calls those patients ahead of time when they hit the registry and our support program, we begin to understand what are those special needs that that are combinations that those patients would benefit from, things like a private waiting room, sensory resources, fidget tools do we can we coordinate some of their visits early in the program we had to.
Patient, who every day of the week had a an office visit in the same building.
Right.
And so those are all visits that we could consolidate together and for a critical population like this, you know, this is a chance for us.
If we’re gonna sedate that patient for a procedure, we should also do the dental cleaning.
We should do their OBGYN visit if we should clip their toenails.
And so all kinds of things that would cause stressor and then the eventual arm for the patient in the Wellness and we’re trying to coordinate that altogether.
You mentioned the hospital at home.
We have a we’re we’re launching our mobile program where we know it’s hard to get those patients into the office.
There’s a potential for violence, violence, but you know, behavior that we don’t want to see from patients and they don’t.
Jordan Cooper 17:53
Yeah.
Shipley, Erin 18:00
They’re well meaning right, but that when we can go into the patient’s primary residence or group home to do that care rather than having them come into the office, we not only create capacity in our offices because those tickets tend to take longer, but we’re creating Wellness for the patients in our team.
Jordan Cooper 18:11
OK.
Erin, you mentioned something interesting.
You I think you mentioned that you’re that the care teams are, you’ve dedicated care teams for this particular population.
They’re looking to anticipate certain sorts of visits by this population.
Did you have any leading indicators that Cooper is leveraging in order to anticipate those care visits?
Shipley, Erin 18:40
Well, you know, we start with our registry, right?
And so when when we look at, we’ve got over 1600 patients who have diagnosis codes that are linked to the support program.
So we we certainly track the intake of new patients into our support program.
We’re also tracking the contact rate as we are reaching out pre office visit pre procedure and afterwards because we wanna make sure that we’re getting to the right or send to help support that patient.
Jordan Cooper 19:12
1st.
And.
Shipley, Erin 19:14
Oftentimes one of the biggest reasons for cancellations for procedures is that we don’t have the Guardian signature and paperwork that we need.
Jordan Cooper 19:16
It’s.
OK.
OK.
Shipley, Erin 19:23
And so we’re really looking at reduction of no shows with the office visits.
We’re looking at office waiting and so as we on begin to improve and anticipate those experiences, we’re saying wait times go down and those offices and and we’re also beginning to look at decrease and emergency department and urgent care usage as we we launch our mobile program, we’re our patients and guardians are already telling us that they are wanting to use that for virtual urgent care.
How do we leverage telehealth in the future that they avoid coming in place?
Jordan Cooper 20:04
I appreciate that explanation.
You mentioned virtual urgent care and back to the topic of data, we’re approaching the end of the podcast episode.
I just want to wrap up this topic.
How would you?
You’ve mentioned the EPIC registry a few times.
You have a dedicated registry for this population.
How is that registry handling identity management and data deduplication while managing this?
These complex care plans that involve things that aren’t typically the responsibility of the hospital, like doing OBGYN and dental and nail clipping for an impatient for mental health.
Stay for this population.
So how are you?
Kind of ensuring that the right information the right data is technically available to the.
Care providers at the point of care.
Shipley, Erin 20:48
Yeah.
You know, I think this is the beauty of the care coordination.
Note you know we’re not.
We don’t require our clinicians to go in and look at it.
They want to go in and at it because it helps them to better deliver their care when we complete the care formation node for first time that we all we have to do is update it and so it’s not really our team didn’t see it as duplication because it’s part of the record, it’s secure and you know we when we can we’re trying to communicate with the individual patient.
We try to do that for my chart if we can, or through obviously secure ways to to communicate with that, but it’s it’s an exciting program or or teams are very excited about it.
Jordan Cooper 21:22
Right.
So I’d like to give you a final opportunity to speak to the listeners of this podcast right now.
Perhaps somebody’s listening?
Who says?
You know, I think it may be really interesting to do an excellence program where we’re trying to improve patient satisfaction and and reduce ER wait times.
Maybe we should change patient rounding.
I think that was an interesting part of the conversation.
Looks like there’s a reduction in I readmissions and that could improve our our payment, our dish payment or our payments from Medicare for for risk sharing agreements.
Or maybe I’m interested.
I also have a particular population we work with registries like to manage that.
What’s something that you would say to them?
Maybe there’s some challenge that you were able to overcome or some advice that you wish someone had given you when you started any of these three journeys.
What would you say to someone whistling?
Shipley, Erin 22:23
I I would say go back to your goals.
Go back to your goals.
I we in the past and experience world have been real big about setting targets against the survey metric and that’s not necessarily a bad thing.
But you know, look at more of those process measures.
What are your key performance indicators that speak to something that is within people’s control that we know what we have we can measure on and it’s govern entire goal to that it’s going to have it downstream impact on the place in experience results, something like did I have the opportunity to participate in bedside shift report, yes or no that a goal against that because when we know when patients are informed they’re going to write their experience.
Jordan Cooper 22:57
Well.
Yeah.
Here.
Shipley, Erin 23:08
If you’re better, they’re it’s less likely to be readmitted.
They’re going to know and trust what to do that so goal planning is a big thing and it’s it’s certainly innovation as well.
Jordan Cooper 23:17
OK.
Well, thank you very much for a listeners.
This has been Erin Shipley, of Cooper University Healthcare, the vice president of consumer experience.
Erin, I’d like to thank you for joining us today.
