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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.

Featured webcast: Assessing the competence of low- and no-volume practitioners

Create strategic solutions to privileging low- and no-volume practitioners with advice from two leading medical staff and credentialing experts. In this online program, Yisrael M. Safeek, MD, MBA, CPE, FACPE, an experienced physician leader and former Joint Commission surveyor, and Sally Pelletier CPMSM, CPS, a national credentialing and privileging expert, walk medical staff leaders and medical services professionals through steps to develop a working strategy to establish competency for low- and no-volume practitioners.

Take a peek at the agenda:        

  • Contributing factors to the increase of low- and no-volume practitioners
    • Governance documents that hamper the hospital’s ability to effectively manage low- and no-volume practitioners (i.e. link membership and privileges)
  • How does low volume affect competence
  • Matching privileges with competence
  • Building a strategic approach to low- and no-volume practitioners (e.g. intended practice plan, medical staff development plan)
  • Working strategies to address low- and no-volume
    • A medical staff culture that feels an obligation to the low- and no-volume practitioners
  • Types of data sources
  • How to compile and present the data in a meaningful way

This webcast will be presented on Tuesday, February 21 at 1 p.m. To learn more or to register, 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.

Holy Moly, He Wants to Come Back!

Okay, here are the questions:

  • What do you do when the physician requests his privileges be restored after he returns from rehab for his cocaine and sexual addictions?
  • What do you do when the 67-year-old internist, who retired five years ago, has just been hired by administration to be your new hospitalist?
  • What do you do when your favorite cardiologist returns from a medical leave of absence after suffering a significant stroke?

Of course, these scenarios cause more questions than answers. You suddenly wish you had declined the invitation to be chief of staff of your medical staff. The fact remains that demographics apply to physicians as well as the general public.

Alcohol and substance abuse is 12-14% in the general population and is the same or somewhat higher in the physician population. (P Hughes, Prevalence of Substance Abuse Among US physicians, JAMA, 1992) Sexual addiction, especially cyber addiction to pornography, is present in 6-8% of the general population and one out of five are women. (Carnes, Am J Prev Psychology Neurology, 1991, 3:16-23) Dementia is present in 13.9% of individuals 71 and older and 9.7% of these have Alzheimer’s disease. (Plassman, et al, Neuroepid, 2007) Stroke recovery is possible, but of course, varies widely depending on age, severity of the injury, rehabilitation efforts, and support to name a few. None of us are immune from these possibilities.

Okay, now a few answers. Patients are more important than physicians. Don’t get caught in the trap of treating physicians as “special people.” First and foremost, you should have a concrete policy for dealing with all of the above possibilities. It must be iron clad, fair and equitable, be consistent with HIPPA and the American Disability Act, should be patient-safety focused but also allow for the physician to return to your medical staff. This begins with a viable and credible Physician Health Committee, an engaged credentials committee, OPPE and FPPE plans on steroids, legal advice, and a “Fitness to Work” evaluation from an objective and independent physician.

Want more from Dr. White? R Dean White DDS, MS, of Dean White Consulting, will be speaking about how to create a physician re-entry process at the 15th Annual Credentialing Resource Center Symposium, May 10-11. For more information, click here. 

Centralization of physician performance data

The structure for collecting and trending practitioner data varies from organization to organization. In many, all FPPE and OPPE data is collected, tracked, and trended by medical staff services departments. Incident reports related to patient grievances or other clinical concerns may be tracked and trended through the risk management department while peer review and individual practice deviations may be tracked and trended through the quality review department. In addition to hospital performance, division chiefs may keep division files on any issues that are reported and/or addressed by them.

It is important for organizations to have a clear picture of a practitioner’s performance. Centralizing where practitioner data is tracked will eliminate the possibility that there is performance data missing when conducting performance reviews. Although different departments may handle and/or address different issues related to performance, there should be one central repository for physician data. Departments should then forward all data to this area for safe keeping and filing in the practitioners quality file.

One of the first steps in developing a central repository for practitioner performance data is education. Organizations should spend time educating their division chiefs on how to address concerns that are brought to their attention; when collegial intervention is appropriate and when an issue must be escalated or forwarded to another department and/or a formal medical staff committee. Division chiefs should be educated on how to document performance issues and how to document the steps that they have taken to resolve the concerns. Ensuring that all concerns are well documented helps protect the division chief as well as the organization should an issue arise later which requires further scrutiny or results in due process.

Should an investigation be initiated, having all data centralized saves time and ensures a more thorough review. Having a one-stop shop for all incident reports, collegial interventions, peer review referrals, and all other clinical performance data allows the committee conducting the review to have a full picture of the practitioner’s performance. Organizations should also include all positive feedback in the quality file and should always respond to a practitioner when a review is conducted and the care he or she provided is deemed to have met or exceeded the standard.

Centralization of practitioner performance data not only benefits the committees or division chiefs conducting performance reviews, but also helps protect the organization from claims of negligence should they conduct reviews without all of the information available.

Celebrate National Medical Staff Services Awareness Week with HCPro

Have you ever stopped to think about how your hospital would operate if the MSSD no longer existed? Who would prepare the hundreds of credentials files? Who would make sure the hospital’s privileging forms were up to date? Who would coordinate the next medical staff leadership retreat? And most importantly, who would remind you when it was time to submit your own credentialing and privileging reapplications?

You may not even be aware of all of the work that goes on in the MSSD. But this week is your chance to find out and to thank the members of your MSSD for their hard work. In 1992, President George Bush declared the first week of November as National Medical Staff Services Awareness Week.

In honor of this, HCPro is offering you and your colleagues a 15% discount on all of HCPro’s medical staff and credentialing products from Nov. 6-12. Visit the HCMarketplace and enter EO107658A during check out to receive your discount.  And don’t forget to thank your MSPs!

Featured webcast: Managing adverse actions

Adverse actions are a serious matter that requires serious attention. From prevention to investigation to reporting, how can you ensure your organization has the best processes in place? In the 90-minute live webcast, “Adverse Actions: Steps to Prevent, Manage and Report,” Joanne Hopkins, JD, and Anne Roberts, CPCS, CPMSM, will discuss how deal with an adverse action from beginning to end. Listeners will learn how to prevent adverse actions through education, how to prepare for an investigation, how to set clear guidelines and expectations for the peer review committee, what types of corrective action can be used, due process obligations, and reporting obligations.

Sponsored by the 15th Annual Credentialing Resource Center Symposium, the webcast will be held on Thursday, Oct. 27 at 1 p.m. EST. Participating in the live webcast or purchasing the CD to listen to at a later date cost just $159.20. For more information, click here.

Oops! Wrong leg-Sorry

Wrong site surgeries are performed up to 40 times per day, according to an article in the Jun. 29 Orange County Register. Or at least that is the number reported to the Joint Commission.  

On January 1, 2003, the Joint Commission issued National Patient Safety Goal 4 which aimed to, “to eliminate wrong-site, wrong-patient, and wrong-procedure surgery using a preoperative verification process to confirm documents, and to implement a process to mark the surgical site and involve the patient/family.”   

It’s now 2011, so how can wrong site surgeries still be happening?

Recently, we reviewed our universal protocol (time-out) policy at one of our hospitals. We didn’t revise the policy because it was incorrect—we revised it to raise awareness of the policy. Certainly doing the same thing, the same way every time can enhance quality, but it can also become a nonthinking habit. We’re not making widgets; we are caring for people, so we always need to be thinking. Checklists should serve as reminders, not as a mindless task. Physicians and nurses are smart people, so why can’t we get this right 100% of the time? Certainly our patients (and we) think we should.  Is this really that much harder and more complex than it looks?

What are you doing to raise awareness to prevent wrong-site surgeries? How do you keep something that is mundane fresh?  How do you make sure you do the right thing for every patient every time? One of the things we do is revise policies and make a big deal about them again. I’m interested in your thoughts and approaches. Please sure in the comments below.

Is developing privileging criteria always a struggle?

It doesn’t have to be! Join HCPro on February 9 at 1:00 ET for “Step-by-Step Guide to Developing Privileging Criteria,” a 90-minute Webcast hosted by Sally Pelletier, CPMSM, CPCS and Christina W. Giles, CPMSM, MS. During the program, Sally and Chris will walk you through best practices for privileging criteria development following the below agenda:

  1. When do you need to develop privilege criteria (when is something a new privilege vs. an extension of an existing privilege)?
  2. What internal and external sources are available?
  3. How do you create equivalent criteria for procedures that cross specialty lines?
  4. What elements should be considered when defining the criteria?
  5. Case studies that reflect various settings, examples of forms, and sources you can use to develop criteria
  6. Live Q&A

To purchase access to the Webcast, please click here.

Ageism or activism?

A January 24, 2011 article in The New York Times, “As Doctors Age, Worries About Their Ability Grow” raises a poignant issue: physicians’ mental and technical abilities may decline as they age.  Physicians are well acquainted with the effects of aging as it relates to their patients, but they are less aware of the affect of aging on themselves.  The article mentions a 2005 study that found that the rate of disciplinary action by a state medical board was 6.6% for physicians out of medical school more than 40 years compared with 1.3% for physicians out only 10 years. A 2006 study found higher mortality rates for complicated surgeries when the surgeon was more than 60 years old.  Obviously physicians can become impaired at a young age, or remain at the top of their game well past 70, but should the medical staff be more proactive? Should we protect our colleagues and patients by more aggressively evaluating the aging physician for mental and physical impairments? Should the medical staff bylaws, rules, regulations, or policies address special conditions for the aging practitioner that includes a provision for fitness-for-work evaluations? Ours do.

New York Times shines light on the aging physician issue for the general public

Here at HCPro, we’ve been discussing the issue of aging practitioners for years and offering our customers tips, strategies, and policies to help them usher aging yet valued physicians into retirement. However, the general public may not be as acutely aware of the issue as our customers are. Many mistakenly think that there are foolproof mechanisms in every hospital to protect them from doctors who are no longer competent to practice, reports a January 25 article in The New York Times. Jonathan H. Burroughs, MD, MBA, FACPE, CMSL, senior consultant with The Greeley Company, a division of HCPro, Inc., in Danvers, MA, was quoted in The New York Times article. He emphasizes the need to screen aging physicians early to allow them to modify their practices and enter retirement with dignity, rather than having their licenses taken away after an embarrassing or deadly event.