We're here today with Aaron Shipley from Cooper University

Health care.

Aaron 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 with you Aaron today and 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.

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.

OK.

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

Well.

that this is good news for them, it's making their jobs easier.

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?

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.

And the.

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

OK.

patients on the floor from the investment perspective.

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.

It's.

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

So.

physician or in your medical practice.

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.

Yes.

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?

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?

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

Is it?

truth for all our dashboards.

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.

Then.

So, specific to that, edx once program Art team is both people

This.

times a day looking at that throughput dashboard to see OK

It's.

in the last four hours how many patients have we seen through

OK.

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.

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?

So.

A couple of examples.

So you're producing these dashboards with your analytics

team, but you also have a digital front door through epics

my chart correct?

Yes.

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

Right.

times.

What's how are you actually technically integrating and then

what's the impact?

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

Umm.

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.

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.

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?

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.

Perfect.

Absolutely.

We look at where leveraging nurse practitioners, Ppas, 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

Yep.

rounding on patients.

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

That's.

old sense.

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

It's.

round on casions.

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

OK.

our housekeeper three or four times today.

OK.

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.

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.

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

After that.

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

Huh.

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.

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

Umm.

safe and well.

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.

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.

It's huge.

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?

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

Yeah.

know, behavior that we don't want to see from patients and

they don't.

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

OK.

take longer, but we're creating Wellness for the patients in our

team.

Aaron, 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?

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

1st.

that patient.

And.

Oftentimes one of the biggest reasons for cancellations for

It's.

OK.

procedures is that we don't have the Guardian signature and

paperwork that we need.

OK.

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?

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.

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

Right.

secure ways to to communicate with that, but it's it's an

exciting program or or teams are very excited about it.

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?

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

Well.

to participate in bedside shift report, yes or no that a goal

against that because when we know when patients are informed

Yeah.

they're going to write their experience.

Here.

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.

OK.

Well, thank you very much for a listeners.

This has been Aaron Shipley, of Cooper University Healthcare,

the vice president of consumer experience.

Aaron, I'd like to thank you for joining us today.