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Patient Experience NewsletterT h e J o s e p h F. C u l l m a n , J r . I n s tit u t e f o r Pa ti e n t E x p e r i e n c eOctober 2015 Volume 1, Issue 3Meet The Cullman Institute TeamSwapan Prajapati, MPABusiness Analyst, Joseph F. CullmanInstitute for Patient ExperiencePatient Satisfaction: Scores, Reports,and DistributionI am the Business Analyst for TheJoseph F. Cullman, Jr. Institute forPatient Experience. After completing medical school in India, Idecided to pursue a master’s degree in Healthcare Managementfrom New York University. During my career at the MountSinai Health System, I have developed a deep interest in dataanalytics and its power to drive performance.In my role, I compile patient satisfaction data from the PressGaney Improvement Portal and analyze and create reportsStephen WeberDirector of Patient Experience,New York Eye and Ear Infirmaryof Mount SinaiNew York Eye and Ear Infirmary ofMount Sinai Participates in OASCAHPS ExperimentNew York Eye and Ear Infirmary of Mount Sinai (NYEE) is oneof 20 facilities from across the country selected to participatein the next round of CMS patient satisfaction surveys. TheConsumer Assessment of Healthcare Providers and SystemsOutpatient and Ambulatory Surgery (OAS CAHPS) survey is apatient experience of care survey for Medicare-certified hospitaloutpatient departments (HOPDs) and ambulatory surgerycenters (ASCs).The Centers for Medicare & Medicaid Services (CMS) and itssurvey contractor, RTI International, are implementing thefor health system leadership. Press Ganey stores our patientsatisfaction results in thousands of pages in its ImprovementPortal, sometimes making it very cumbersome for managers andleaders to locate the data they need and prepare reports to sharewith their teams. I synthesize and distribute 16 reports weekly,17 executive summaries monthly, and hundreds of physiciancomparison reports quarterly. The standardized formats withcharts and tables make reports easy to understand and explain,and ensures that all departments and areas are reviewing dataconsistently.My reports give an executive overview of our organization’scurrent performance across care settings, giving team membersthe ability to drill-down and pinpoint our most promisingimprovement opportunities. It makes me feel proud that mywork provides targeted insights into the voices of our patientsacross the entire continuum of care.next phase of the program, which includes a mode experiment(September 2015) and a voluntary national reporting program(January 2016). The goal of the survey development process isto identify and include dimensions of care that patients andother consumers want or need to inform their selection of anHOPD or ASC for surgery.As one of the selected voluntary participants, NYEE will assistRTI and CMS to assess the effects, if any, of using differentmethods to collect patient satisfaction data. The modeexperiment will test the effectiveness of mailed surveys, surveyscompleted via telephone, and mixed mode surveys (mail withtelephone follow-up).Participating in the mode experiment will provide NYEE anopportunity to understand our patients’ experiences before theprogram officially starts, and will enable NYEE to identify areasfor improvement in advance of national reporting.NYEE is proud to be working with RTI and CMS in thedevelopment of this next step in Health Care Reform.
T h e J o s e p h F. C u l l m a n , J r . I n s tit u t e f o r Pa ti e n t E x p e r i e n c eCullman Institute Team MembersFrom left,Catherine Calhoun andLuann DonnellyPatient ExperienceImprovement Coaches,Cullman InstituteThe Mount Sinai HealthSystem’s Joseph F. Cullman,Jr. Institute for PatientExperience is pleased towelcome Catherine Calhoun,LCSW and Luann Donnelly to their new roles as PatientExperience Improvement Coaches. Ms. Calhoun and Ms.Donnelly will conduct experiential-based skills training withfrontline staff using role play and simulated patient interactionsto facilitate the adoption of communication best practicesby caregivers.Ms. Calhoun joins us from The Mount Sinai Hospital’sAdolescent Health Center Outpatient Clinic. Her warmdemeanor and clinical social work experience enables her toquickly engage caregivers, expertly redirect conversationsas necessary, create an inclusive environment and providefeedback in a compassionate manner. Ms. Calhoun earned herBA in Psychology from Barnard College and her Master’s degreein Social Work from Columbia University School of Social Work.Ms. Donnelly joins our team from NYU Langone Medical Center,where she was a Patient Relations Specialist/Representativein the Department of Patient Experience. In this role, she ledan interdisciplinary team in the Emergency Department toimprove communication among caregivers that significantlyimproved patient satisfaction scores as measured by PressGaney. Ms. Donnelly earned her BA in Psychology from St.Joseph’s College and is pursuing her Six Sigma Green Beltdesignation through the City University of New York.From left,Silvia Wendt and,Ivelisse CorreaATA (American Translation Association), IMIA (InternationalMedical Interpreter Association) and CHIA (CaliforniaHealthcare Interpreter Association).Language Services andPatient Relations,The Mount Sinai HospitalIvelisse CorreaSilvia WendtSilvia Wendt started her career eight years ago as a volunteerSpanish Medical interpreter at the Avera McKennan Hospitalin South Dakota. Soon after, she earned a full-time position asan interpreter at Lutheran Social Services and trained over 40hospital interpreters. Ms. Wendt earned her medical interpreterand interpreter trainer certifications from Bridging the Gap, arenowned pioneer in the field of medical interpreter training,located in Seattle, WA. She recently relocated from SouthDakota to New York City, and became a volunteer at Mount SinaiSt. Luke's and Mount Sinai Roosevelt. Her passion is to bridgethe communication gap between Limited English Proficiency(LEP) patients and medical providers. She is a member of theIvelisse Correa is a long time employee of the Mount SinaiHealth System, and previously worked as a Health Educatorin the Adolescent Health Center where she provided healtheducation, counseling, and support services for at-risk youth.She began her career within the Social Work Department asan Administrative Assistant and later became a CommunityLiaison Worker. Ms. Correa has also spent time as a volunteerwith the SAVI program, providing crisis intervention tosurvivors of sexual assault and intimate partner violence.Ms. Correa currently resides in the East Harlem Communitywith her daughter and husband. She shares a passion for patientadvocacy and staff support and is eager to utilize her extensiveknowledge and experience to further contribute to the patientsteam and the Mount Sinai Health System.Key Communication Phrases Instead of responding with “No Problem,” try saying, “My pleasure!” or “You’re welcome!” Instead of asking “Can I help you?”, instead, ask, “How may I assist you?”, or “How may I help you?” It is human nature to become defensive when a patient or family member expresses a problem. When ithappens, the best way to respond is by saying “I’m sorry that happened to you. I can imagine how frustratingthat must have been. I am here now what can I do for you?”We often just walk into a patient’s room after knocking. Instead, ask if it is okay to enter the room. It may soundsomething like, “This is your nurse, Grace, I am here to do my hourly check. Is this a good time to come in?”2
October 2015 Volume 1, Issue 3Language Services at MSHSAs part of our continued commitment toour Limited English Proficiency (LEP)patients, we are piloting a programwith our over-the-phone vendor, PacificInterpreters (PI) to provide face-toface interpreting for the top languagesat four of our hospitals (MSBI, MSR,MSSL, and MSH). This, along withour staff interpreters, will improvecommunication with our LEP populationand lead to a more positive patientexperience. In addition, we continue toexpand our Video Remote Interpretingservice (VRI) for our patients whocommunicate using American SignLanguage (ASL). Our goal is to haveseamless communication when one ofour deaf patients presents to the hospital.They will have immediate access to anASL interpreter if they present to anyof our emergency departments and alsothroughout their hospital admission.The language services program continuesto provide in-service training to staffin all clinical areas to ensure that theyknow how to obtain an interpreter forpatients and their family members. Weare available throughout the year toprovide training to staff on how andEveryday Acts of Excellencewhen to utilize an interpreter as well ashow to document the transaction in themedical record. The Language ServicesProgram also offers medical interpretingtraining, three times a year, to qualifiedemployees and volunteers. Please contactyour language services representativewith any questions.Language Services Contact info:MSH Adriana Cifuentes 212-659-8990MSR/MSSL Roxana Lash 212-523-2187MSBI Cesar Fernandez 212-844-8555NYEE Sylvia DaBalsa 212-979-4093MSQ Denise Colon 718-267-4273MSB Roman Khait 718-951-3005side. Despite the gravity of the patient’s condition and thecommotion that ensued as physicians, nurses, and other teammembers responded, Officer Almonte kept his typical calm andprofessional demeanor. The patient was subsequently stabilizedand transported to an area hospital for additional appropriatemedical care.Robin AlmonteSecurity Officer, NYEEEveryday Acts of ExcellenceOn any given day, you will find themembers of New York Eye and EarInfirmary of Mount Sinai’s (NYEE)Security Team going above and beyond the call of duty tohelp keep patients, visitors, and staff members safe while inthe hospital.“This one example is part of the greater culture of patientsafety and experience that thrives at NYEE,” says StephenWeber, NYEE’s Director of Patient Experience. To recognizethese “everyday acts of excellence,” the leadership team at NYEEis developing a new Service Excellence Recognition Programthat honors NYEE employees. Officer Almonte recently receivedthe inaugural award at the NYEE monthly DepartmentHead Meeting.On July 7, 2015, NYEE’s Security Officer Robin Almonte didjust that as he raced to help a patient who had passed out ina hallway at the hospital while he was on duty. Without amoment’s hesitation, Officer Almonte began rendering aidand ensured that appropriate medical personnel were notifiedand responded, all the while never leaving the patient’s“The qualities displayed by Officer Almonte are the exactcharacteristics we wish to celebrate and recognize in all ofour staff, and specifically in my Security Staff,” said NormanLevine, Director of Security at NYEE.Manager Spotlight: James McDaniel and Rosa Peralta arepassionate nurse managers who have readily embraced the keyconcepts for coaching their staff on Hourly Patient Rounding in apositive and encouraging manner.JamesMcDanielRosaPeraltaNurse Managerat MSSLNurse Managerat MSRJames McDanielJames McDaniel is the nurse manager for 9E at MSSL, a cardiactelemetry inpatient unit, and celebrated his first anniversary inSeptember. Originally from Martinsburg, WV, James came toNew York City to pursue his dreams. He is currently working onobtaining a Doctorate of Nursing Practice (DNP) from WaldenUniversity. During his spare time, James enjoys dining out andtrying new restaurants. James has an 8-year-old lab/boxer dognamed Liberty.Rosa PeraltaRosa Peralta is the nurse manager for 11B, a postpartum unitat MSR, and has been in this role for the past 17 months. Sheenjoys sunny days by the beach with family and hosting BBQs.She has lived in the Dominican Republic, Providence, RI,Manhattan, and Brooklyn.9E (James McDaniel)11B (Rosa Peralta)Communication with RN HCAHPS Composite Data:Pre intervention data: Q4 2014 69.8% Top BoxPost intervention data: Q2 2015 (YTD May) 89.8% Top Box*An increase in Top Box of 20%Communication with RN HCAHPS Composite Data:Pre intervention data: Q4 2014 65.3% Top BoxPost intervention data: Q2 2015 (YTD May) 70.9% Top Box*An increase in Top Box of 5.6%3
T h e J o s e p h F. C u l l m a n , J r . I n s tit u t e f o r Pa ti e n t E x p e r i e n c eThe Volunteer Ambassador ProgramThe Volunteer AmbassadorProgram at The MountSinai Hospital had arobust student programthis summer, with 23high school and collegestudents participating. TheAmbassadors are at themain hospital entrances,welcoming patients andfamilies, helping themAmbassadors Nancy Kantor, Nancyfind out where they needRobins mentoring student Ambassadorto go, and then escortingNancy Leonthem there. They alsovisit inpatients for comfort rounds—providing coffee, tea, snacksand conversations. Two of our college students served volunteerinternships—Jason Darell (Amherst College) and Stephanie Ren(SUNY Binghamton), each completing more than 250 hours ofservice. The students allowed us to provide extra escorting services,including the lobby of 5 E. 98th Street; numerous comfort rounds inthe Emergency Department, Surgical Family Waiting Room, HeartHospital Ambulatory Center, and inpatient units; and to distributeice cream in the Surgical Family Waiting Room, AmbulatoryServices, and 5 E. 98th Street faculty practice. In June and Julythe Ambassador service hours were 750 hours above the previousyear. We could nothave accomplishedthis without the manyadult Ambassadorswho served as mentorsand teachers forthe students. TheAmbassadors fulfillthe Cullman Institutemission of improvingthe patient experiencefrom the moment apatient enters theHospital throughStudent Ambassadors Andrew Damas, Jamiedischarge.Ramos, Jackie Lucero, Myles Innis, and Ellie PolitiMSSL Hourly Rounding Champions Victor Pilapil, 6 East Elenida Rivera, 6 East Zara Roy, 6 East Corla Qawiyy, 9 East Myrna Rivers, Sty 6 Emma Subido-Dizon, 7 East Dwight Quilling, 9 East Joann Rodriguez, 7 West Ieshma Thomas, 8 West Deborah Quow, Sty 6 Lizzette Rodriguez, 8 East Florentina Villacorte, Sty 6Educational SeminarPurposeful Hourly RoundingChampionsStaff commitment to improving ourpatients’ experience was evident atMount Sinai Saint Luke’s InauguralPurposeful Hourly Rounding Championsprogram held Friday, July 31st. NataliaCineas, DNP, RN, NEA-BC, SeniorDirector, Patient Care Services, whospear-headed the program, described therole of the Purposeful Hourly RoundingChampions (“The Champs”) as “a teamof dedicated health care professionalswho are passionate about improving thepatient care experience.” Presentationsincluded a demonstration of simulationtraining by MSHS Patient ExperienceImprovement Coaches Grace MarinMSN, MBA, RN, Catherine Calhoun,LCSW, and Luann Donnelly; “HCAHPSData Review” by MSSL Nurse ManagersMaureen Sullivan, MS, RN and JamesT. McDaniel, MSN, RN-BC, CHPN;“What’s Working? Opportunities andChallenges, Incorporating Rounding intoWorkflow” by Medel S. Paguirigan, EdD,RN; and small workgroups led by GracePhelan, MSN, MPA, RN, MSSL SeniorNursing Education Manager. The Champsdiscussedand agreedupon nextsteps to shareHCAHPS scoreswith their peersand identifymethods tomotivate staff.The Champswill meetevery quarter to review HCAHPSpatient experience data and to developadditional strategies to make meaningfulconnections with our patients.“Championing a proactive approach to meet the needs of our patients”4
October 2015 Volume 1, Issue 3Comments from Patient Satisfaction SurveysMSSL“ The nurses were totally awesome & friendly in the cardiac unit.THE BEST nurses Peg O'Malley, Leslie, Becky, Neida were super,super awesome.”10E (cardiac)MSBI“Karen Gottlieb and PCA Elizabeth were very helpful when I hadanemotional breakdown one night.”10 Silver (surgical)MSQ“ The nurses were great, especially Dechen, Raul, and Elder.”4E (surgical)MSH“My experience with Vanessa Valdes was exceptional. With her skillsand encouragement I was able to reach a level of mobility I did notthink possible.”Outpatient RehabMSR“ This is the first time I have been an ER patient. I have accompaniedothers when they were patients at other hospitals and found thisexperience far superior to those in all respects.”EDMSSL“It was like being on vacation—except it wasn't—it was surgery!Obviously this is a well-run organization. I've never seen a New Yorkinstitution where everyone was so nice & professional.”General SurgeryNYEE“My physician, Dr. Maher, gave me a very accurate description ofthe surgery. She was incredibly competent, and even though I wasapprehensive about it, I trusted her because every single person Iencountered on the day of the operation—and there were at leasta dozen—checked to make sure I and my procedure were correctlyidentified. I had absolute confidence that everything would bedone correctly.”Ambulatory Surgery5
T h e B ro n x[;pWestchester7636Long Island495Mount Sinai BrooklynM a n h at t a n0015Queens22448 Miles8 KMJupiter957067064695A1A4681195954695B ro o k l y n2St at e n I s l a n dMount Sinai Health SystemThe Joseph F. Cullman, Jr. Institute for Patient ExperienceOne Gustave L. Levy Place, Box 1238New York, NY 10029TheCullmanInstitute@mountsinai.org
obtaining a Doctorate of Nursing Practice (DNP) from Walden University. During his spare time, James enjoys dining out and trying new restaurants. James has an 8-year-old lab/boxer dog named Liberty. 9E (James McDaniel) Communication with RN HCAHPS Composite Data: Pre intervention data: Q4 2014 69.8% Top Box
