Evaluation of Healthcare Systems Survey Data in Mayo Clinic, Rochester, MN Essay

HCAHPS Scores for Rochester, MN

Mayo Clinic Hospital in Rochester, Minnesota is one of the largest and oldest hospitals in the US. It sports a high HCAHPS score, which allows it to maintain its dominant position and above-average quality of healthcare delivery. Its evaluation scores are as follows (CMS, 2020):

• Patient survey summary star rating: 5 stars;
• Patients reporting that nurses have always communicated well: 87%;
• Patients reporting that doctors have always communicated well: 86%;
• Patients reporting to have always received the help as soon as they wanted: 79%;
• Patients reporting to have received explanations of medicine before it was administered: 73%;
• Patients reporting the level of cleanliness of their rooms and bathrooms: 78%;
• Patients being satisfied with the level of quietness at night: 70%;
• Patients reporting to have received home care information upon discharge: 91%;
• Patients reporting to have understood the instructions they were given upon leaving the hospital: 64%;
• Percentage of patients to have rated the hospital as 9/10 or higher: 88%;
• Patients who would recommend this hospital to their peers and friends: 89%.

These scores will be analyzed in comparison to other hospital scores in the area, as

well as the state and national averages, to determine the comparative performance of the facility.

HCAHPS Score Comparison and Analysis

The comparative data for Mayo Clinic is presented in the table below (CMS, 2020):

The hospital’s average in nurse and doctor communication exceeds the national average by 3% and 1% respectively, delivers care upon request for 3% more patients, explains the use of medicaments to patients better by 4%, and provides a quieter place for recuperation in 1% more cases when compared to the state average (CMS, 2020). Similar situations are reported in providing better explanations and guidance upon discharge, thus making the hospital more popular among patients, earning them between 11%-14% better ratings and recommendation values (CMS, 2020). The only parameter that did not exceed the state average was that of cleanliness of patient rooms and the restrooms, where it fell short by 1%, but still maintained a 2% lead on the national average (CMS, 2020). The overall lead for various parameters of HCAHPS for Mayo Clinic over the national average varies between 2% (room cleanliness) to 17% (hospital recommendation rates) (CMS, 2020). Based on these parameters alone it could be concluded that Mayo Clinic in Rochester is a superior hospital to the majority, if not all hospitals in the state and the country.

Comparison with the other two hospitals in the surrounding area reveals a relatively high degree of competition the closer the proximity is between Mayo and other facilities. Olmstead Medical Center, when compared to Mayo, shows a break-even quality of care in most parameters, surpassing it in others, and falling short in the rest. For example, nurse communication scores between the two are rated at 87%, which is even with Mayo (CMS, 2020). In patient-doctor communication, the clinic has a solid lead of 4% compared to Olmstead (CMS, 2020).

Mayo is reported to be 2% quicker on providing help to patients as soon as they wanted, but loses out in the next three parameters, with the most significant issues being cleanliness (4% loss to Olmstead) and quietness (3% difference) (CMS, 2020). At the same time, Mayo has a commanding lead in the understanding of post-discharge home care by the patient, at 7% (CMS, 2020). The rest of the scores are more or less tied between the two. This level of competition could be explained by the fact that both hospitals are in very close proximity to one another (2 miles), thus allowing for patients to choose the better facility between the two.

The third hospital used for comparison is located circa 60 miles away, to show the difference between the presence or lack of competition. District One hospital loses out to Mayo in every parameter utilized by the HCAHPS score cited on the CMS page, with many parameters (explanation of medicine before usage, bathroom cleanliness, overall scores, and patient recommendation scores) being below even the national average, much less the more demanding state levels. Needless to say, District One Hospital loses out in the quality of care to Mayo in nearly all parameters, with the sole exception being the level of information given to patients to continue home care. However, that lead is small (1%) and is in a rubric where all hospitals scored above 90%. The overall popularity of District One hospital is 18% lower than that of Mayo. To conclude the hospital comparison section, Mayo Clinic is roughly tied with Olmstead Medical Center and is vastly superior to the District One Hospital.

At the same time, it could be argued that Mayo Clinic’s scores are more accurate than those of the other two clinics due to a higher response rate on the HCAHPS scale. CMS (2020) reports an average of 38% response rates for Mayo, whereas Olmsted has only a 13% response rate. District One hospital had only 25% of patients offered to pass the survey actually agree to do it. It can be speculated that Olmsted’s high-performance rates might not be entirely representative of the quality of care provided there. The number of completed surveys stands at 704 for Mayo Clinic, 194 for Olmsted Medical Center, and 257 for District One hospital.

According to the latest census, Rochester (MN) has a population of approximately 110,000 people, with over 42,000 individual households and about 27,000 families living in the city (Data USA, 2020). The population density is high, rated at approximately 2,000 individuals and 840 housing units per square mile (Data USA, 2020). The city is populated by predominantly white individuals of German-American or German-Norwegian ancestry, constituting about 82% of the racial makeup. The second-largest group is African Americans, at 6.3% (Data USA, 2020). Various Asian races (Indian, Cambodian, Chinese, Vietnamese, Japanese, and so forth) constitute about 6.8%, and various Hispanic races – 7.2%. Native Americans and other races make up 2.8% of the population (Data USA, 2020).

Out of all households, 32% have children living with them, and nearly half of the entire population are married (Data USA, 2020). The number of families with a single parent includes 9.5% for single female parents and 3.5% for single male parents. 37.6% of all individuals live solitary lives without being a member of a family unit (Data USA, 2020). The average household size is 2.4 individuals per household, and the average family size is 3 people (Data USA, 2020). The median age for all cities inhabitants is 35 years. Nearly 25% constitute individuals younger than 18, 8.5% of young adults, nearly 30% of middle-aged individuals (25 to 44 years of age) (Data USA, 2020). 25% of Rochester’s population are approaching elderhood (45 to 64 years of age), and 12.5% of people are 65 or older. The male to female ratio for Rochester is 48.9% to 51.1%.

The average household income during the latest community survey was 68,000 USD, but it has likely suffered a fall due to the recent spread of COVID-19 (Data USA, 2020). The poverty rate in Rochester is at 10.4%, and the unemployment rate – at 6.9%, having experienced an increase due to the crisis (Data USA, 2020). The student population in Rochester, MN, is heavily in favor of females, which constitute about two-thirds of the entire student pool. Rochester universities release about 1,600 students a year (Data USA, 2020). Around 65% of the Rochester population is religious, with the main faiths constituting various confessions of Christianity, with Catholic, Lutheran, and Methodist churches holding 46% of all faithful within their spheres of influence (Data USA, 2020). Islam and Eastern religions have a very minor presence, collectively contributing to about 0.5% of the entirety of Rochester’s religious population (Data USA, 2020).

Being one of the largest hospitals in Minnesota and the US in general, Mayo Clinic offers a full range of medical care, including the following branches (Mayo Clinic, 2020):

• Basic services: Short-term patient hospitalization, emergency care services, general and specialized Chirurgie practices, X-ray and radiology scans, laboratory and blood analysis services.
• Special and auxiliary services: Pediatric care, a greater variety of surgical specialties, physical therapy and rehabilitation, drug prescription, home nursing, nutritional services, mental healthcare, family support, social work, financial services, genetic counseling.

Environment and Community Influence on HCAHPS Scores

Cultural dynamics have the potential to influence HCAHPS scores in a positive or a negative manner. Normally, high scores are associated with higher fluency in the cultural component of service provision, whereas lower suggests that the hospital’s understanding of culturally-sensitive care is lower (Ray, 2016). One of the reasons why Mayo Clinic’s HCAHPS scores are very high when compared to the rest of the nation is because Rochester has a relatively homogenous racial makeup, with 82% of the population being white, and the predominant faith across all population groups (including black, Hispanic, and even Asian) being Christianity (Data USA, 2020).

Thus, the nurses and hospital staff do not require as much fluency in accommodating other cultures, languages, and religious practices, pondering to the predominant one (Ray, 2016). Nurse and doctor communication for Mayo Clinic is at 87% and 86% respectively, supporting the notion (CMS, 2020). Other hospitals, especially those working in areas where white presence is not as dominant, or where the diversity of races is more present, typically enjoy scores closer to the national average, as nurses need to be capable of accommodating the various attitudes and cultural nuances presented by black, Hispanic and Asian patients, following a diverse variety of religious taboos that may affect interaction, communication, and treatment (Ray, 2016).

Educational dynamics also have a possible influence on Mayo Clinic’s HCAHPS scores. Rochester is a large hub of medical care educational facilities, with nearly 14% of all students being released from Mayo Clinic School of Health Sciences (Data USA, 2020). Thus, the clinic has the benefit of raising its own cadres and then implanting them into their own workforce, resulting in lower turnover rates and higher retention when compared to the rest of the country (Fragkos, 2016).

In addition, the high percentage of individuals with medical or health sciences degrees means a higher percentage of respondents, as patients are more likely to understand the value of HCAHPS Fragkos, 2016). The general levels of population education also have an effect on how well do patients follow their treatment and understand explanations of medications. Both Mayo and Olmstead, located close to each other, enjoy a higher percentage of patients fully understanding their post-discharge care and medication usage, compared to other places (CMS, 2020). Finally, due to having graduated from Mayo, both patients and employees have a greater emotional connection to the hospital due to familiarity, which is likely to positively affect the recommendation and patient evaluation ratings. At the same time, patients visiting other hospitals are likely to compare them to Mayo and be extra critical of their performance by having a different facility to compare them to.

Socio-economic dynamics influence various parameters of public health and hospital performance and are tied to the previous parameters already mentioned. The better the income of the population – the more likely it is they would be able to afford a higher quality of care, have insurance, and be in a position to understand and contribute to their own well-being (Řimnáčová, Kajanová, & Břízová, 2018). At the same time, poorer populations are more likely to neglect their health, leading to exacerbated diseases, injuries, and poor healthcare outcomes (Řimnáčová et al., 2018). At the same time, citizens located lower in the socio-economic ladder are likely to be uninsured, leading to complications in the perceptions of care. As it stands, the poverty rate in Rochester, MN is at 10.4%, and unemployment – at 6.9% (Data USA, 2020). These are slightly below the national average, meaning that Mayo Clinic’s patients are likely to be capable of paying for services and supporting the hospital, enabling it to provide a higher quality of care, thus resulting in better HCAHPS scores.

Rochester’s dynamic of socio-economic wealth has been congruent with the national, with the degree of unemployment and poverty slowly declining from 2014, and the number of educated individuals rising (Data USA, 2020). Therefore, the higher performance of Mayo Clinic in Rochester can, in part, be explained by the improving conditions of the population over the years, reflecting on its HCAHPS rating. It should be noted that, due to the emergence of the COVID-19 threat, the overall wellbeing and socio-economic status of various populations have plummeted and might result in a drop in satisfaction ratings for the hospital for the next year.

Long-Term and Short-Term Financial Impacts on the Organization

As it stands, the short-term financial impact on Mayo Clinic is reasonably secure. Their performance exceeds that of the national average by a lot in many parameters, thus ensuring reimbursement on a federal level. That performance is matched by an impressive HCAHPS record on a state level, where the standards are higher, thus making sure that reimbursements on the state level are also going to keep coming. The high scores on patient satisfaction and recommendations will ensure short-term and long-term success.

At the same time, there are issues with patient quarters cleanliness, which can cause issues in the short-term by helping spread HAI (hospital-acquired infections) among patients, decreasing the perception of care, and cutting off some of the potential revenue from the organization (Herman-Bausier & Dufrêne, 2018). Not to mention, the treatment of HAI causes additional expenditures and increases the mortality rates in patients that are highly vulnerable to HAI, such as post-operative individuals as well as the elderly (Herman-Bausier & Dufrêne, 2018). The rate of patient understanding of medications as well as discharge instructions, though above that of federal and state levels, is still alarmingly low – every third patient reports not having understood them. These misunderstandings could result in an increase in rehospitalization rates within 30 days after discharge, complications, and financial losses for Mayo Clinic.

Some of the large long-term financial hurdles that the organization should be wary of include reaching the physical limitations of the quality of care, and the impoverishment of the local population as a result of economic and social crises. The first issue is tied not only to the state and national levels of excellence but also to the hospital’s own performance. As such, they will increase along with Mayo’s own performance growth. The slow-down in HCAHPS score growth can be expected in the following decades, leading to decreased reimbursement. As a result, prices will grow, patient numbers – decrease, and some nurses might be required to be re-scheduled. These intrinsic issues can be solved by setting new standards of quality by implementing cutting-edge technology and the most novel evidence-based practices, in order to retain and improve on the existing patient satisfaction and reimbursement levels.

The overall impoverishment of the population presents a danger to Mayo’s long-term perspectives on many levels. First, the patients will not be able to afford insurance and payments for services as readily as before, resulting in a lower effectiveness and lower care satisfaction (thus, lower HCAHPS scores). Second, a poorer population would reduce the number of students attending medical and health science universities. Thus – fewer nurses replace the current contingent of employees. Fewer nurses on shift mean a higher patient per nurse rate, resulting in burnout, care fatigue, and a higher chance of medical mistakes being committed, all of which have a negative influence on HCAHPS. Finally, the looming geriatric crisis is bound to happen in full swing during the next 20-30 years, which would only exacerbate the issues described above (Marć, Bartosiewicz, Burzyńska, Chmiel, & Januszewicz, 2019). One of the options for Mayo is to prepare for these external crises now, forming a strong and well-staffed facility ready to meet the challenges of the future.

Explaining the Existing HCAHPS Scores for Mayo Clinic, Rochester

Hospital cleanliness is the only score Mayo Clinic has that is below the state level. Although it is above the national level by 2%, it presents a danger to the organization and its patient, as cleanliness is the main barrier between acute care patients and HAI. Infections prolong patient stay, cause additional expenditures, and may cause unforeseen complications and even death. The causes of such an unnaturally low score in the US best clinic can be connected to its size and planning. By the same accounts, few bathrooms mean they will be used more often, thus requiring more and better cleaning, which cannot be always provided. Finally, there is a possibility of nurses underperforming in their cleaning duties, as such tasks are often seen as dirty, tedious, and unpleasant, sapping away motivation to perform them adequately.

A 70% quietness rate means that every third patient is being disturbed during sleep. Rest is an important part of the restoration process, and poor or disturbed sleep can mean lower healing rates, irate moods, and potential complications, especially for individuals in pain. The potential reasons for Mayo Clinic’s low HCAHPS score in this department could relate to large patient quarters housing many individuals, separated by only the most rudimentary barriers. Finally, nurses performing nightly duties can cause additional disturbances. Cleaning, paging, assisting others to go to the bathroom, and other activities can result in disturbing noises for the rest of the patients.

Finally, there is a low score among patients who understood their after-hospital care procedures. Debriefing upon discharge is an important part of hospital care that is often overlooked. Almost 40% of all patients have only a vague understanding of how to maintain their health after suffering a hospitalization. Some of the reasons for that could be the overall healthcare literacy rates across the US, coupled with the highly specialized nature of medical language. In addition, many patients either do not have or do not know how to access resources available to them. These factors may explain the relatively low HCAHPS scores for Mayo Clinic and other hospitals in the US in that particular parameter.

Organizational Strategic Plan

Organizational Changes.

Structure, Process, and Outcomes.

Improving Organizational Quality

Shared governance and evidence-based practices (EBP) are the backbones of the proposed solutions and the overall strategic plan. In the scope of the proposed solutions, EBP will do the following (Bend, 2016):

• Provide workable methods of decreasing noise in patient quarters, which could be safely and easily implemented in Mayo Clinic without undergoing additional expenses and restructuring;
• Allow for the development of a safer and more efficient cleaning routine for nurses that take care of bathrooms and patient quarters. These include the use of new compounds, the general standardization and simplification of the process, and the fight against burnout and care fatigue in relation to it being a daunting task;
• Assist in the development of a simple-language debriefing protocol for discharge nurses in order to improve patient understanding of what needs to be done to support their health at home after being discharged from the hospital. Additional EBP could be related to teaching practices to be used by nurses and on nurses during their training period.

Shared governance is a practice that suggests the incorporation of patients as well as nurses from different teams to hold shared responsibility for the success of treatment and the increase of the hospital’s HCAHPS scores. In the scope of the proposed solutions and in light of Mayo Clinic’s commitment to providing patient-centered care, patient scores and feedback will be the measure of success and the primary problem-finding tool. Multidisciplinary shared governance councils, including nurses from different departments, would be capable of formulating strategies to solve the issues under the framework of proposed solutions and organizing themselves to best use the time and resources available to them. These councils would allow nurses to adequately split responsibilities and be aware of what each department is doing.

Shared Accountability.

Technology Trends

For all three issues for HCAHPS problems in Mayo Clinic discussed in this paper, there are potential technological solutions that might be useful for improving the overall score and addressing issues of noise, cleanliness, and patient discharge education. There are many EBP-based noise-reduction technologies available to hospitals. Some of these include sound barriers. Acoustic surfaces can be used on walls, ceilings, and placed between individual patient beds in order to efficiently reduce noise levels for large quarters. At the same time, these techniques could be used to effectively sound-proof smaller ones. A study by Farrehi, Nallamothu, and Navvab (2016) reports that the use of acoustic surfaces significantly reduces the noises from steps, windows, opened doors, moving equipment, while being perfectly compliant with all national and state standards, thus viable for implementation at Mayo.

In order to improve bathroom and room cleanliness, hospital cleaners need to have a full view of contaminated surfaces. Langdon, Hoet, and Stull (2020) report the successful use of fluorescent lamps and tags when performing cleaning procedures on surfaces and on hands. Various instruments, such as blacklight, can be used to detect spills, frequently-touched surfaces, and other places that contribute to the overall perception of cleanliness as well as the physical disinfection of areas (Langdon et al., 2020). Boyse (2016) suggests using hydrogen-peroxide solutions, electrolyzed water, UV light, and automatic decontamination systems as means of improving the quality of cleaning and reducing workloads on nurses by partially automatizing the effort.

Finally, the issue of understanding debriefings can be solved by making debriefings and discharge procedures more interactive. Lefebvre et al. (2016) suggest the use of media, including images, films, and interactive web applications, as means of demonstrating to patients what is expected of them. It allows for overcoming nurse-patient and educational barriers, as non-verbal forms of communication are not limited as much by the recipient’s ability to understand the subject. These findings are supported by Chabner (2020), who also suggests the use of short, simple phrases and common terms as a means of describing medical practices to patients. According to the researcher, it leads to better understanding and a higher degree of willingness to follow instructions after hospital discharge (Chabner, 2020).

Improving the Care Delivery System.

Methods to Improve Financial Stability

Since Mayo Clinic is a non-profit medical organization with a mission to provide high-quality and affordable care to as many individuals as possible, the financial stability plan for it must revolve around three pillars, which are as follows:

• Achieving greater reimbursements from the government and paying organizations;
• Cutting costs by eliminating inefficiencies in the processes of provided care;
• Reducing expenditures resulting from HAI, rehospitalizations, medical mistakes, lawsuits, etc.

The first method, as demonstrated in this paper, revolves around achieving better

HCAHPS scores by focusing on areas where the grades, while passable, are still far from perfect. By getting all of these parameters above 80%, Mayo Clinic will be capable of improving its financial standing by receiving greater reimbursements. Inefficiency elimination would help save money by reducing materials lost, better nurse time implementation, and rational equipment usage. One of the potential solutions for Mayo Clinic would be the implementation of lean management on an organizational and logistical level (Farzadnia, Hosseini, & Riahi, 2017). Finally, reducing the number of rehospitalizations and other issues that bring patients back or prolong their stay is not only congruent with HCAHPS goals but also helps reduce the losses, workloads, and additional material required to deal with these issues.

Implementation Plan

Stakeholders Roles and Responsibilities.

Stakeholder Accountability and Involvement.

Training

Only two out of three proposed interventions require nurse training. The sound reduction plan largely revolves around making sources of sounds separated from the patients through logistical means. Thus, nurses are to be trained in providing simpler and more intelligible discharge instructions, as well as implementing the new substances and technologies in their cleaning procedures. The training phase will consist of three phases, in accordance with Kurt Lewin’s Freeze-Unfreeze model (Nelson‐Brantley & Ford, 2017):

• Explaining the necessity of change to nurses, thus undermining the position of existing practices (Unfreeze).
• Developing and implementing a training regimen, during which nurses would learn to implement simpler language as well as media to explain discharge procedures to patients. Cleaning specialists will learn to utilize UV, blacklight, and new chemical substances in their cleaning (Change).
• Once a sufficient level of understanding and excellence is achieved, their knowledge will become the standard, and old practices would be removed from use (Freeze).

The proposed classes would take place approximately once to twice a week, during days when nurses do not have a scheduled shift and will involve between 8 to 16 training hours in total.

Plan Implementation.

Evaluation of Strategic Plan Success

The evaluation of the success of the strategic plan would revolve around quarterly reviews of patient feedback, nurse feedback, and HCAHPS score, which is considered the final metric for the success or failure of the plan (Moule, Armoogum, Douglass, & Taylor, 2017). The primary tool for patient and nurse feedback would be the survey, with similar questions to provide a point of comparison between patient and nurse perceptions of care. Data will be extracted using statistical analysis methods as well as content analysis for free-form and open-ended questions (Moule et al., 2017). These surveys will be conducted every 3 months after the full implementation of the program. The HCAHPS score will be provided from the HCAHPS survey conducted every half a year as a means of acquiring Medicare reimbursement. The effectiveness of change organization and training implementation will be evaluated by analyzing meeting attendance and making adjustments to ensure that every one required is attending. These reviews can be done at the end of each month.

Involvement of Stakeholders and Communication of Results.

The communication of evaluation results to all interested parties as well as the general community can be achieved through internal or external means. Sensitive information will be imparted to individuals during meetings. Instructional information and additional questions will be answered by e-mail, whereas newsletters will provide updates on the progress without addressing anyone individually (Giddens & Morton, 2018). External means of communications, such as newspapers, social media, and hospital official websites will present the information pertinent to the community, without divulging sensitive details or elements bound to be changed (Giddens & Morton, 2018).

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