HCAHPS A Patients Perception of Care Sarasota Memorial

HCAHPS- A Patient’s Perception of Care Sarasota Memorial Health Care System May 21, 2018 Hospital Board Luncheon Lorrie Liang, COO 1

HCAHPS Scores Inversely Related to Volume HCAHPS Domains (# Domains > 50 th Percentile; Out of 11) Average Daily Census 11 11 600 10 10 10 9 9 8 8 7 554 552 8 8 550 533 6 6 6 491 5 4 4 455 458 3 437 420 465 467 505 7 6 6 6 502 494 488 486 470 461 569 8 8 542 7 2 562 7 7 520 5 9 9 9 8 581 517 6 6 6 494 500 470 446 450 431 1 0 Fe Ja n_ 16 b_ M 16 ar _1 Ap 6 r_ M 16 ay _1 Ju 6 n_ 1 Ju 6 l_ Au 16 g_ 1 Se 6 p_ 1 Oc 6 t_ No 16 v_ De 16 c_ 1 Ja 6 n_ 1 Fe 7 b_ M 17 ar _1 Ap 7 r_ M 17 ay _1 Ju 7 n_ 1 Ju 7 l_ Au 17 g_ 1 Se 7 p_ 1 Oc 7 t_ No 17 v_ De 17 c_ 1 Ja 7 n_ 1 Fe 8 b_ M 18 ar _1 8 400 Source: Press Ganey 2

HCAHPS: Willingness to Recommend the Hospital (% "Definitely Yes") Percentile Rank 100 95 95 93 95 92 90 86 89 80 86, 5 85 87 85 90 90 85, 8 85, 3 81 83, 4 80 86, 4 84, 4 82, 6 85 85 87, 6 87, 7 84, 3 83, 5 90 88 86 86 85 85 85, 9 85, 1 83, 7 82, 3 87 88 84, 4 70 92 95 93 89 84 90 91 91 94 94 83 82, 7 83, 3 83, 9 82, 8 83, 1 75 70 80 77, 6 60 Ja n_ 1 Fe 6 b_ M 16 ar _1 Ap 6 r_ M 16 ay _1 Ju 6 n_ 1 Ju 6 l_ Au 16 g_ 1 Se 6 p_ 1 Oc 6 t_ No 16 v_ 1 De 6 c_ 1 Ja 6 n_ 1 Fe 7 b_ M 17 ar _1 Ap 7 r_ M 17 ay _1 Ju 7 n_ 1 Ju 7 l_ Au 17 g_ 1 Se 7 p_ 1 Oc 7 t_ No 17 v_ 1 De 7 c_ 1 Ja 7 n_ 1 Fe 8 b_ M 18 ar _1 8 75 65 97. 3%= Percent of patients in FY 18 (to date) that answered “Definitely Yes” or “Probably Yes” Source: Press Ganey 3

Hospital Consumer Assessment of Healthcare Providers and Systems: HCAHPS Report Card Current National Average FY 18 YTD (n=3, 729) Goal Gap 80 85 82 65 81 71 53 67 64 88 (4) (1) (4) (9) Discharge Information 73 72 80 69 82 75 62 66 66 87 Care Transitions Domain 53 58 FY 18 HCAHPS Results Overall Hospital Rating Recommend the Hospital Communication with Nurses Responsiveness of Hospital Staff Communication with Doctors Cleanliness of Hospital Environment Quietness of Hospital Environment Communication about Pain Communication about Medicines Number of Domains ≥ National Average (2) 6 FY 18 Target = 8/11 Source: Press Ganey, adult inpatient nursing units, visit dates: Aug 2017 – Feb 2018 4

Percent of Patients That Gave the Most Positive Response to the “Responsiveness” Domain Negative Correlation Between Patient Volumes and Rating of "Responsiveness" 75 70 72 65 68 6767 60 64 60 55 59 50 45 40 35 30 400 450 500 550 600 Percent of Patients That Gave the Most Positive Response to the “Cleanliness” Domain Average Daily Census per Month (Includes Inpatients and Outpatient Observations) 75 Negative Correlation Between Patient Volumes and Rating of "Cleanliness" 70 72 65 71 70 71 Negative Correlation Between Patient Volumes and Rating of "Quietness" 65 60 55 50 60 56 54 52 52 49 45 48 40 35 30 400 450 500 550 600 Average Daily Census per Month (Includes Inpatients and Outpatient Observations) HCAHPS Rating Scale 70 65 60 Percent of Patients That Gave the Most Positive Response to the “Quietness” Domain Correlation Between Patient Volumes and HCAHPS 4 – Always (Represented on graphs) 3 – Usually 2 – Sometimes 1 – Never 66 55 50 45 40 35 30 400 450 500 550 Average Daily Census per Month (Includes Inpatients and Outpatient Observations) 600 5

Responsiveness of Staff In comparison to 2017, 1, 773 more patients (63 pts/day) were seen in February 2018, with 54 less beds available Each admission per patient takes approximately 1 -2 hours of dedicated time by each admitting physician and nurse Physicians, nurses and housekeepers are pulled from routine tasks to provide support for each admission and discharge During the height of season, there can be 150 -200 total discharges per day, or 20 -25 discharges per unit, with subsequent admissions Conflicting priorities for physicians and nurses have impacted responsiveness for non-admission/discharge patients 6

Impact of Satellite Units • Due to increased volume this season, multiple satellite units were opened around the hospital to accommodate patients • HCAHPS scores of the patients on the satellite units were the lowest the hospital has seen; and therefore effected overall scores • Although the perception of care on the satellite units was lower than previous months, the patient’s willingness to recommend SMH remained unchanged 7

HCAHPS: Responsiveness of Staff Responsiveness (% "Always") Nat'l Avg 75 71, 5 90 72 72, 4 70 70, 2 70 68, 2 68 68 67, 5 67, 4 67, 5 65, 8 65, 1 64, 9 65 80 67, 2 67, 7 69 68, 3 67, 1 64, 6 69 70 66, 5 66, 2 66, 4 64, 8 60 63 62, 7 63, 2 60 50 61, 3 40 30 56, 8 55 20 10 _1 Ap 6 r_ M 16 ay _1 Ju 6 n_ 16 Ju l_ 1 Au 6 g_ 1 Se 6 p_ 1 Oc 6 t_ 1 No 6 v_ 1 De 6 c_ 1 Ja 6 n_ 1 Fe 7 b_ 1 M 7 ar _1 Ap 7 r_ M 17 ay _1 Ju 7 n_ 17 Ju l_ 1 Au 7 g_ 1 Se 7 p_ 1 Oc 7 t_ 1 No 7 v_ 1 De 7 c_ 1 Ja 7 n_ 1 Fe 8 b_ 1 M 8 ar _1 8 ar M b_ _1 Fe Ja n 16 0 6 50 92. 3% = Percent of patients in FY 18 (to date) that answered “Always Yes” or “Usually Yes” Source: Press Ganey 8

HCAHPS: Cleanliness (% "Always") Nat'l Avg 80 80 78 78 76 75, 1 74 74 72 71, 6 74 73, 6 72, 3 71, 6 71, 5 70, 1 69, 9 69, 3 69, 6 72 76 74 72, 7 71, 371, 1 72 70, 9 68, 7 69 69, 3 68, 3 70 68 67 66 75 74, 4 74, 2 72, 7 70 68 75, 4 66, 6 66 65, 4 64 62 62 60 60 Ja n_ Fe 16 b_ M 16 ar _1 Ap 6 r_ M 16 ay _1 Ju 6 n_ 1 Ju 6 l_ Au 16 g_ Se 16 p_ 1 O 6 ct _ N 16 ov _ D 16 ec _1 Ja 6 n_ Fe 17 b_ M 17 ar _1 Ap 7 r_ M 17 ay _1 Ju 7 n_ 1 Ju 7 l_ Au 17 g_ Se 17 p_ 1 O 7 ct _ N 17 ov _ D 17 ec _1 Ja 7 n_ Fe 18 b_ M 18 ar _1 8 64 90. 9%= Percent of patients in FY 18 (to date) that answered “Always Yes” or “Usually Yes” Source: Press Ganey 9

Sarasota Memorial’s Patient Experience Compared with Regional Competitors HCAHPS is a national survey that asks patients about their experiences during a recent hospital stay. The results shown here compare how patients rated hospitals on 11 important hospital quality topics. Source: http: //www. medicare. gov/Hospital. Compare/ April 2018 Public Report 10

Sarasota Memorial’s Patient Experience Compared with US News Best Hospitals 5 5 CMS Overall Star Rating (out of 5) 5 4 4 4 3 3 2 2 2 Johns Hopkins (Baltimore) 1, 091 beds Barnes Jewish St. Louis) 1, 252 beds 1 Sarasota Mayo Clinic Memorial 829 (Rochester) beds 794 beds Cleveland Penn Mass General Brigham & UCSF Stanford UCLA Clinic (OH) Presbyterian (Boston) Womens Medical Health Care Medical 1, 400 beds (Philly) 695 1, 034 beds (Boston) 777 Center (San (CA) 613 Center (CA) beds Fran) 600 beds 520 beds Source: http: //www. medicare. gov/Hospital. Compare/ April 2018 Public Report 11

Sarasota Memorial’s Patient Experience Compared with US News Best Hospitals Domains ≥ National Average (out of 11) 11 11 10 9 8 10 10 9 8 7 7 6 6 5 5 5 4 3 2 1 0 Mayo Clinic UCSF Medical UCLA Medical Cleveland Clinic Penn Sarasota (Rochester) 794 Center (San Center (CA) 520 (OH) 1, 400 beds Presbyterian Memorial 829 beds Fran) 600 beds (Philly) 695 beds Mass General (Boston) 1, 034 beds Brigham & Womens (Boston) 777 beds Source: http: //www. medicare. gov/Hospital. Compare/ April 2018 Public Report Johns Hopkins Barnes Jewish Stanford Health (Baltimore) (St. Louis) 1, 252 Care (CA) 613 1, 091 beds 12

Action Plan 1) Currently recruiting a new Executive Director of Hospitality/Guest Services – Recruiting in hotel and cruise industry – With focus in Food and Nutrition, cleanliness and guest amenities 2) Implementing a “Patient Room Trash Removal” pilot 3) Developing a Family/Patient Advisory Council – Will focus on octogenarians, the most HCAHPS critical patient cohort 4) Continuing our Private Room Strategy – $17. 7 million project approved by the Board in June 2017 to renovate 9 and 10 East Tower – 52 completely renovated and private rooms will open in December 2018 13

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