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Patient Satisfaction Blog Series for CRC 2012

Easier?  It can make my job easier?

You are now experts at improving the three physician-specific questions on the Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) survey:

  • During this hospital stay, how often did doctors treat you with courtesy and respect?
  • During this hospital stay, how often did doctors listen carefully to you?
  • During this hospital stay, how often did doctors explain things in a way you could understand?

I mentioned last week that this would make your job easier. How can that be? The following are some of the benefits that come from having satisfied patients:

  • Fulfills patient priorities and wants
  • Improves professional standing
  • Improves compliance with recommended treatments and follow up
  • Reduces liability risks and costs
  • Improves staff retention and satisfaction
  • Improves physician satisfaction
  • Reduces unnecessary calls, returns to the ED, and professional aggravation
  • Improves clinical outcomes and measures

There are other benefits as well. If you think back, you can probably find an example for each of the above from your own journey in the medical profession (as either a patient or provider). Happiness (satisfaction) is contagious!

Hopefully this series has whetted your appetite to do further reading, research, and reflection on improving patient satisfaction. Although “because the government says so” may be adequate motivation for some, the real motivation should come from our desire to provide the best patient care possible. After all, isn’t that what we are all about?

Editor’s note: William Mills, MD, MD, MMM, CPE, FACPE, CMSL, FAAFP, is a featured speaker at the 15th annual Credentialing Resource Center Symposium, May 10-11. He will be speaking on using patient satisfaction scores to drive improvement as well as how to privilege low- and no-volume practitioners. For more information, click here.

Patient Satisfaction Blog Series for CRC 2012

Blah, Blah, Blah?

As I mentioned in my last post, there are three physician-specific questions on the Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) survey:

  • During this hospital stay, how often did doctors treat you with courtesy and respect?
  • During this hospital stay, how often did doctors listen carefully to you?
  • During this hospital stay, how often did doctors explain things in a way you could understand?

This post will deal with tips to improve your scores on the explanation question. By now, I’m sure you would make Emily Post proud of how polite you are. (For those much younger than I, she was the queen of etiquette.) I also expect you have made some brilliant diagnoses as a result of your improved listening skills. Now it is time to focus on how you explain things to patients and increase those scores at the same time. Your patient shouldn’t feel like Charlie Brown talking to his parents and just hear “blah, blah, blah,” when you are explaining important health related issues.

Patients (those are the horizontal people in hospitals) are often not at their intellectual peak while hospitalized. Remember this is our workplace—not theirs—so we need to be a little more diligent when explaining complex, emotionally charged issues.  Here are a few pointers that will help you with your ability to explain what’s going on in a way that the patient may understand:

  • Provide more information than you believe is necessary
  • Provide the option of having another person in the room to hear the information, take notes, and ask questions
  • Encourage patients to write down their questions in between visits. This allows them the opportunity to think about the previous interactions and formulate questions that specifically address their fears and concerns
  • Ask patients if they need any more information

Remember that we often get caught up in our jargon and patients “appear” to understand as they don’t want to disappoint their physician or appear not so bright.  Ask follow-up questions that probe their understanding. You may be surprised by how much your patient did not understand once you start asking them these questions.

So go forth and improve the satisfaction of those we serve, while simultaneously improving quality, publicly reported measures and making your job easier. I couldn’t resist. This will make your job easier. Read next week’s post to see how.

Editor’s note: William Mills, MD, MD, MMM, CPE, FACPE, CMSL, FAAFP, is a featured speaker at the 15th annual Credentialing Resource Center Symposium, May 10-11. He will be speaking on using patient satisfaction scores to drive improvement as well as how to privilege low- and no-volume practitioners. For more information, click here.

Patient Satisfaction Blog Series for CRC 2012

I’m Sorry, What Did You Say?

As I mentioned in my last post, there are three physician-specific questions on the Hospital Consumer Assessment of Healthcare Providers and Systems HCAHPS survey. They are:

  • During this hospital stay, how often did doctors treat you with courtesy and respect?
  • During this hospital stay, how often did doctors listen carefully to you?
  • During this hospital stay, how often did doctors explain things in a way you could understand?

This post will deal with tips to improve your scores on the listening question.  Hopefully you have tried to be a little more respectful (as discussed in my last post) and have found it rewarding.  So let’s improve your listening skills now.

You have probably figured out this is a perception issue, and you are correct. The following tips have been shown to improve the patient’s perception that you are listening:

  • Sit down during the conversation portion of the visit
  • Ask open-ended questions and listen with empathy
  • Use “reflective” listening (paraphrase, clarify, ask for understanding)
  • Offer a physical gesture, such as a handshake, a touch on the shoulder, or a pat on the knee
  • Make eye contact with the patient and family
  • Pay attention to the patient and not the chart or cell phone

Although these tips improve the perception that you are listening, you actually do need to listen carefully.  Remember back to medical school when the wise attending said that the patient will tell you what is wrong with them if you will only listen?  My experience is that they were right.  How about your experience?

 

Editor’s note: William Mills, MD, MD, MMM, CPE, FACPE, CMSL, FAAFP, is a featured speaker at the 15th annual Credentialing Resource Center Symposium, May 10-11. He will be speaking on using patient satisfaction scores to drive improvement as well as how to privilege low- and no-volume practitioners. For more information, click here.

Patient Satisfaction Blog Series for CRC 2012

Courtesy and Respect? Don’t have to; I’m the Physician!

As I mentioned in my last post, there are three physician-specific questions on the Hospital Consumer Assessment of Healthcare Providers and Systems HCAHPS survey:

  • During this hospital stay, how often did doctors treat you with courtesy and respect?
  • During this hospital stay, how often did doctors listen carefully to you?
  • During this hospital stay, how often did doctors explain things in a way you could understand?

This post will deal with tips to improve your scores on the courtesy and respect question.  Hopefully you have bought into the concept that improving patient satisfaction improves quality.  If you haven’t yet, then try these suggestions and see what happens.

Since approximately 85% of communication is non-verbal, pay particular attention to your body language. We have all been in situations where the body language was so loud, that the spoken words could not be “heard.”  Clear your mind prior to beginning the encounter.

Brush up on your polite behaviors such as:

  • Knocking on the door before entering
  • Making eye contact with the patient and visitors
  • Introducing yourself and the members of your team
  • Addressing the patient by their preferred name

Also, do not discuss the patient in the third person when they are present.  They are not just the “gallbladder in room 203” but actually a person, too.

These are just a few of the proven methods to improve patient satisfaction and your score on this question.  Try these out this week; next week I’ll be sharing about listening skills.

Editor’s note: William Mills, MD, MD, MMM, CPE, FACPE, CMSL, FAAFP, is a featured speaker at the 15th annual Credentialing Resource Center Symposium, May 10-11. He will be speaking on using patient satisfaction scores to drive improvement as well as how to privilege low- and no-volume practitioners. For more information, click here.

Patient Satisfaction Blog Series for CRC 2012

Pat Sat/HCAHPS/P4P – Huh?

This is the first of a series of five postings that will attempt to make sense of some the above.  Patient satisfaction has risen to the top of many a list as the government and other payers are establishing pay for performance (P4P) initiatives. One of the reasons everyone is working on this is there is a clear connection between patient satisfaction and quality. Check out the New England Journal of Medicine for more information on this (2008; 359:1921-1931).

Because patients, payers, and politicians now care about patient satisfaction, the next three posts will provide tips for improving scores on the three physician specific questions on the HCAHPS questionnaire. The last post will tie it all together to show physicians and MSPs how patient satisfaction affects physician performance.

To start, what is HCAHPS? The Hospital Consumer Assessment of Healthcare Providers and Systems is a 27-question survey developed by Centers for Medicare and Medicaid Services with the following goals in mind:

  • To produce data about patients’ perspectives of care that allow objective and meaningful comparisons of hospitals on topics that are important to consumers
  • To create incentives for hospitals to improve quality of care by making public survey results
  • To enhance accountability in healthcare by increasing transparency of the quality of hospital care provided in return for public investment (also by making public the survey results)

Although this survey covers a number of areas, my blog posts will cover these three physician-specific questions:

  • During this hospital stay, how often did physicians treat you with courtesy and respect?
  • During this hospital stay, how often did physicians listen carefully to you?
  • During this hospital stay, how often did physicians explain things in a way you could understand?

Until next time, try to get your arms around the fact that improving patient satisfaction will improve quality.  For many of us, this fact will be difficult to swallow, but swallowing (internalizing) this will be critical for our success in the future.

Editor’s note: William Mills, MD, MD, MMM, CPE, FACPE, CMSL, FAAFP, is a featured speaker at the 15th annual Credentialing Resource Center Symposium, May 10-11. He will be speaking on using patient satisfaction scores to drive improvement as well as how to privilege low- and no-volume practitioners. For more information, click here.

Quality differences among hospitals

A recent HealthDay article reports that quality varies in the over 5,000 hospitals reporting outcomes to HealthGrades, a healthcare rating company providing information on physicians and hospital quality outcomes.

The report states that patients are 73% less likely to die at a five-star hospital than a one-star hospital (five-star is the highest rating and one-star the lowest).  As this data came from CMS calculations from this three-year study, it showed that 240,000 less Medicare patient deaths would have occurred if all the patients were treated at a five-star hospital.

Here we go again. Let’s fire up the public using data that may not necessarily be comparable.

Although the data may not be comparable, it does not negate the fact that we need to make our institutions safer and improve quality. We need to be constantly vigilant. We need to embrace evidence-based medicine, patient safety initiatives, and transparency. The public will not allow us to become complacent. Are you, or those at your institution, complacent?

Editor’s note: William Mills, MD, MMM, CPE, FAAFP, CMSL, will be leading a session on how physician leaders and MSPs can use patient satisfaction scores to assess and improve physician performance at the 15th annual Credentialing Resource Center Symposium, May 10-11, in Orlando. For more information on HCPro’s premiere credentialing event, click here.

Is the doctor a ‘doctor’?

A recent article in The New York Times raises some of the issues surrounding the use of the word “doctor.” We are all aware from our undergraduate days that there are many doctorate degrees offered in a large number of academic disciplines.

In the healthcare arena, the word doctor is generally understood to mean a physician with a M.D. or D.O. degree. However, that is now changing. We have doctors of pharmacy, physical therapy, psychology, and nursing to name a few. Yet, when someone wearing a white coat introduces themselves as Dr. Smith to a patient, the patient will most likely assume that person is a physician.

So why the push for so many types of doctorate degrees?  Is it the continual pursuit for knowledge and recognition of the same?  Is it the prestige of the word doctor in the healthcare setting?  Is it motivated by the thought that the word doctor means a higher salary?  Is it an attempt to confuse or mislead patients?  Is it an attempt to allow non-physician healthcare workers an increase in scope of practice and autonomy?

Some states are creating legislation to control the use of the word doctor. Should that have to happen? Or should we, the healthcare providers, decide how to proceed? As you can see, I have raised many more questions than answers. What do you think?

Palliative care in the emergency department?

A recent Washington Post article titled “Hospitals make palliative care a priority to improve patients’ quality of life,” raises the issue of providing palliative care in the emergency department.  This notion is a far cry from the standard ED mentality of fix it all—and quickly. But when you consider that a large percentage of patients presenting to the ED arrive with a flare up of chronic severe illnesses or significant injury that can be life altering, then maybe discussions about end of life care and the institution of palliative care measures should not be such a foreign concept. If we truly strive to be patient-centric, shouldn’t we be abiding by our patients’ wishes and helping them with the tough decisions?  In the fast-paced world of the ED, shouldn’t we be using a checklist to make sure we are addressing more of the patient’s needs than just the presenting symptom? Is our bias that since palliative care grew out of the hospice movement that this should be something addressed by the oncologist or PCP, and not the ED physician?

New York State recently enacted a regulation requiring physicians to discuss and document their interactions with patients about palliative care and end of life issues.  What does that say about healthcare providers being pro-active and patient-centric? So palliative care in the ED—you bet!  But it should not stop there; it should be addressed in every healthcare setting.  To quote an anonymous 16th century writer, our job is to “Cure seldom, relieve often, and comfort always.”

My hospital’s palliative care committee is working hard to ensure that patients are getting what they need, when a “cure” is not possible. How about yours?

Does unhappy = underpaid?

An April 28, 2011 piece in The Washington Post raises the issue of patient satisfaction as it relates to the value based performance initiative from the Centers for Medicare & Medicaid Services (CMS). CMS’ recent proposal will allow Medicare to withhold 1% of its payments to hospitals starting in October 2012—for those of you who are counting, that is $850 million in the first year. That money will go into a pool and be doled out to hospitals that perform better than average on patient satisfaction and quality care measures. Only 30% of the withhold is based patient satisfaction; the other 70% is related to quality metrics.

Given these upcoming changes, what do you think about physicians’ role in patient satisfaction? Should hospitals allow physicians who have below-average satisfaction scores to remain on staff? Is it not the right and responsibility of a hospital’s board to do whatever it can to maintain financial stability, even if it negatively affects physicians?  Should the credentials committee review patient satisfaction in a similar fashion that it reviews physician quality metrics?  Is there a correlation between quality and satisfaction?  Our hospitals are now reviewing patient satisfaction scores at the time of reappointment, and a subgroup is evaluating what should be the acceptable score and what should be done about physicians who fall below that target.  Isn’t it time we really took patient satisfaction seriously? How about your hospital? What are you going to do?

For better or for worse: Waivers for patient online reviews

When I first moved to a new city, I knew no one, including a primary care physician (PCP), gynecologist, dentist, no one. I asked friends of friends and my PCP from my old city for recommendations, but unfortunately, they didn’t have any for me. As a patient, I did the next logical step in my research and Googled physicians who belonged to my insurance network. I came across glowing reviews, as well as a few sour ones. Those online reviews were extremely helpful in selecting who my physicians would be.

A new trend, however, is putting a stop to those online reviews. More physicians are asking their patients to sign waivers restricting them from posting reviews online. Known as mutual privacy agreements, these documents are typically batched with other HIPAA agreements and initial patient paperwork that patients fill out before their examination.

User-generated reviews, written by patients, themselves, are open for public view. Patients can rate their physicians and appointment experience, both positively and negatively. Ratings and comments can include information about the physician’s licensure, schools attended, office location, disciplinary records, and even bedside manner. Some user-generated review websites include the following:

[more]

Do patients really understand the physician-hospital relationship?

A man who underwent a cardiac procedure at Middle Tennessee Medical Center claims that the staff at MTMC refused to let him see his regular cardiologist during his stay, reports The Tennessean. The patient’s cardiologist, however, had only consulting privileges at MTMC since she moved her practice 40 miles away. According to the article, “They just plain, flat-out, bald-faced lied to me,” the patient said of the MTMC staff.

After being discharged, the patient spoke to his regular cardiologist who said that she regularly visits her patients whenever they are admitted to the hospital even though she only has consulting privileges. Some claim that this miscommunication was an intentional ploy by MTMC to gain more business, but barring any questionable behavior, this story begs the question of whether patients really understand the relationship between physicians and hospitals.

Patients may not understand that they can’t pick a hospital out of a hat and expect their physician to be able to treat them there, but do physicians explain that? Do they explicitly say to patients, “If you ever have an emergency, go to XYZ hospital because I can treat you there. I can’t treat you at ABC Hospital because I don’t have privileges there.” This may be less of an issue in rural areas where there may only be one hospital, but here in Massachusetts where you can’t throw a rock without hitting a hospital, it may be thoroughly confusing for patients who simply want to see the physician with whom they have a relationship. Patients are increasingly asked to take charge of their healthcare, so if they are going to be in the driver’s seat, physicians need to teach them the rules of the road.


Patient amenities – Is this the answer?

In the December 2, 2010 New England Journal of Medicine, “The Emerging Importance of Patient Amenities in Hospital Care” gives us pause to think about what hospitals are really all about – quality or patient experience/satisfaction. Is market share being driven by the experience and not the clinical outcomes? “Patients themselves said that the nonclinical experience is twice as important as the clinical reputation in making hospital choices,” states the article. One hypothesis posited by the authors as to why amenities matter so much is that patients may not understand clinical quality. “Data on clinical quality are complex, multidimensional, and noisy, and they have only recently become systematically available to consumers. Consumers may be making choices on the basis of amenities because they are easier to understand.”  So, with healthcare reform looming on the horizon, should we be focusing on quality or amenities? Is there a way for hospitals to balance and afford both? I’m interested in your thoughts.