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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

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?

Connect the dots

I have been spending most of my time reviewing admission documentation for hospitals across the country, and it is surprising to me that rather few physicians will commit to a diagnosis for incoming patients.  I see “dyspnea” instead of “CHF” or “pneumonia,” “diarrhea” instead of “gastroenteritis” and “dysuria” instead of “urinary infection.”

Emergency physicians seem to be especially reticent to make a diagnosis, but hospitalists are not far behind. It creates a problem for the hospital because medical necessity for inpatient services is based on the presence of a condition that may incur significant morbidity or mortality, and the prescription of a treatment regimen appropriate for the condition. Determining necessity is more certain when a specific diagnosis is made. No one dies from shortness of breath, but one can certainly die from CHF or pneumonia, and there are well-established courses of treatment for those diseases.

I suspect that we started down this slippery slope because the definitive diagnosis of myocardial infarction can be difficult, even when the electrocardiogram and enzymes are abnormal.  This led to the term “R/O MI” as an admitting diagnosis. Ruling out a medical condition is really an observation service. Reticence to commit to a diagnosis can cost the hospital money. If you believe that the chest pain is related to heart disease, why not describe it as “acute coronary syndrome?” If the patient has fever, cough, and hypoxemia, it is appropriate to connect the dots and call it pneumonia, even if the x-ray is unclear. It is understood that admitting diagnoses may differ from the discharge diagnosis as more information becomes available. There is nothing to lose and much to gain from making your best estimate of the patent’s disease on admission.

Drug shortages: The government “fix”?

If your hospital is anything like mine, you have been struggling recently with the unavailability of various pharmaceuticals. One has to wonder why intravenous furosemide (Lasix) is not available. Maybe you could understand why some chemotherapeutic agents are in short supply—or maybe you can’t. Something is really wrong with the system when patients can’t receive critical, potentially life-saving treatments because the pharmaceutical industry isn’t manufacturing the necessary quantity.  An Oct. 31 article in The New York Times addresses an executive order by President Obama to “fix” the problem. He is instructing the FDA to do the following three things:

  • Broaden reporting of potential shortages of certain prescription drugs
  • Speed reviews of applications to begin or alter production of theses drugs
  • Provide more information to the Justice Department about possible instance of collusion or price gouging

That’s certainly telling them Mr. President. And if this doesn’t work, maybe we should threaten to ground them, or better yet, spank them and send them to bed without dinner. Is he serious? Are we supposed to treat cancer with a governmental report?

If Big Pharma is the issue, maybe a plan with some teeth is in order. If the delay is bureaucratic, maybe we need to streamline that process. I think it is time for quick action—not political rhetoric. We are all trying to be efficient patient care advocates so let’s us stop wasting money on trying to track down necessary medications.

So I expect you get my drift.  At our hospital we realize that a governmental fix is not in our immediate future, so here are a couple of things we have done to help patients get what they need:

  • We have connected with our sister hospital that has a different pharmaceutical supplier. Although shortages are national, sometimes one supplier will have more than another.
  • We have also borrowed from other hospitals in our region and returned the product when our supply is better.
  • Then there is the age old “hoarding” that hospitals and pharmacies have done throughout the ages. Although this can be selfish, we do share with others.

Do you have any other suggestions until this crisis is corrected?

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.

The sleep doctor question

An article in the July 1, 2011 Los Angeles Times, titled “Limiting resident physicians’ work hours to save lives” again raises the question of whether resident fatigue affects patient care. I assume there is no coincidence that the article appeared the day that the newly minted physicians began training. The article, co-authored by Lucian Leape, MD, chair of the Lucian Leape Institute and adjunct professor of health policy at Harvard School of Public Health and Helen Haskell, founder of Mothers Against Medical Error, cites studies that go back at least 40 years demonstrating that fatigued residents make more mistakes than well-rested residents.

New rules limit first year residents to shifts no longer than 16 hours, and more senior residents to 28-hour shifts. When I was in training, my surgical brethren and I thought that if you were only on call every other night, you missed half of the interesting cases. I wonder whether today’s residents are as “tough” as we were back in the day. Should slave labor be reintroduced? Or are folks like Dr. Leape right?  Back in the day, we assumed our patients were safe and received quality care—were we right?  I don’t think so. So is 16 hours right?  Should it be 12?  Should it be less?  Should residency programs add a year to training programs so that residents can get the necessary experience, and still get some sleep?  What do you think?

Free-standing emergency departments on the rise

Free-standing emergency departments are on the rise, according to Physician News Digest. The majority of patients currently visit emergency departments for non-urgent and semi-urgent care, and visiting a free-standing emergency department, which is not attached or associated with a hospital, can save them money and reduce wait times in hospital-associated emergency departments. They aren’t the best choice, however, for true emergencies, such as heart attacks, and it’s difficult for patients to know which facilities offer which services, say critics.