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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.

Autopsies: A dying procedure?

A May 16, 2011 article in the Washington Post reports that autopsies are now performed on only approximately 5% percent of patients who die, compared to roughly 50%  in the 1960s.  According to some experts, this decline is unfortunate because “details about the cause of death can be illuminating for both families and hospitals, even if they don’t turn up an undiagnosed ailment or other new information about the cause of death.” A 1998 JAMA article (JAMA. 1998;280 [14]:1273-1274) reported that autopsy results showed that clinicians misdiagnosed the cause of death up to 40% of the time. How do you and your hospitals balance academic curiosity, research, family needs for closure, and the risk of medical liability? At our institutions, we perform very few autopsies. When asked, the majority of physicians working in the community believe they “know” the cause of death, and therefore an autopsy is an unnecessary burden on an already fragile healthcare system. But when pushed, they often answer that they don’t want to know if they missed anything for fear of a malpractice suit. Is that wrong? Are we letting fear of malpractice stifle our pursuit of excellence and knowledge? 



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?

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.

The downside to patient satisfaction scores

There is a theory of publicity that contends, “It doesn’t matter what you say about me, as long as you spell my name correctly.” Hospitalists have gotten lots of publicity over the years, and the name is usually spelled correctly. Most of the articles have been positive, including one that appeared in the New York Times on May 26. What was startling is the comments posted by readers. Nineteen readers reported negative experiences with hospitalists involving themselves or a family member. Two readers reported a favorable experience. One reader described an unfavorable experience when managed by a subspecialist and would have preferred to have a hospitalist. The concerns basically stem from poor communication with the patient, the family, and the primary physician. This is consistent with the generally low patient satisfaction scores reported for hospitalists.
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Doctors and patients are often not on the same page

Physicians report that they communicate well with patients, but a study in the Archives of Internal Medicine indicates otherwise. The study, “Communication Discrepancies Between Physicians and Hospitalized Patients,” measured the perceptions of 89 inpatients and 43 physicians. Although 63% of respondent physicians thought that patients knew their names, only 18% of patients correctly named their physician. Seventy-seven percent of physicians thought that patients knew their diagnoses, but only 57% of patients did. Almost all physicians said that they sometimes address patient’s fears, but only 54% of patients said that their physicians addressed their fears. If those statistics aren’t enough to make you cringe, 90% of patients who received new drugs while hospitalized said they were never educated regarding adverse side effects of these medications.

Another study in the Journal of General Internal Medicine, “How Well Do Doctors Know their Patients? Factors Affecting Physician Understanding of Patients’ Health Beliefs,” has similar findings for the outpatient environment. Researchers studied 207 patients and 29 primary care physicians from 10 outpatient clinics and found that “physicians’ perceptions of their patients’ health beliefs differed significantly from patients’ actual beliefs.” Physicians often thought that patients’ beliefs were more aligned with their own than they actually were. They also had more trouble assessing patient’s beliefs when the patient was of a different race.  

More facilities stepping up to give LGBT community equal rights in the healthcare setting

According to the Human Rights Campaign Foundation’s Healthcare Equality Index 2010, the majority of healthcare facilities in the United States do not have policies in place to guarantee lesbian, gay, bisexual, and transgender (LGBT) individuals the right to receive their preferred visitors and designate surrogate decision makers during medical emergencies. According to the report, only 58% of the nation’s largest hospitals protect patients from discrimination based on their sexual orientation or gender identity. 

However, the tides may soon change. Kaiser Permanente updated its patient bill of rights on June 7 to prevent LGBT patients and their families from experiencing discrimination. This bill of rights applies to Kaiser’s entire network of 36 hospitals and paves the way for other organizations to follow. Other organizations that have recently updated their policies to address sexual orientation and gender identity include Bay State Medical Center, Dana-Farber Cancer Center, and The University of Texas MD Anderson Cancer Center.

 The Healthcare Equality Index comes on the heels of President Obama’s memorandum to the Secretary of Health and Human Services (HHS) dated April 15, 2010 calling for equal visitation and medical decision making  rights for the LGBT community. The memorandum directs HHS to make rules that require all hospitals that receive Medicare and Medicaid funds to protect the LGBT community’s rights when it comes to visitation and decision making.

Patient Satisfaction: Can patients accurately judge technical skill?

As I wrap up this blog series on improving Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) scores, I thought it was important to cover one last area that the survey measures: Physicians’ skills.   

This area measures the extent to which the physician does what the patient expects him or her to do from a clinical standpoint. Many physicians do not believe that a non-clinician can or should judge the clinical competence of a physician and therefore have a difficult time accepting this particular question on the HCAHPS survey as valid. Physicians believe that this should be left in the hands of other clinicians or specialty societies that set professional standards. 

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Patient Satisfaction: A smile a day keeps CMS at bay

Over the past several weeks, I’ve delved into the various questions posed to patients on the Centers for Medicare & Medicaid Services’ Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) survey. I’ve offered suggestions for how to improve scores on questions relating to how much time physicians spend with patients, how well they display their concern, and how well physicians keep patients informed. Another critical question on the HCAHPS survey addresses how friendly and courteous physicians are.    

Measuring a physician’s friendliness and courteousness is not only highly subjective, but also patient specific. Thus, I cannot offer a single best practice for improving scores in this area. When undertaking improvement efforts in this area, keep in mind that patients judge an individual’s friendliness based on his or her verbal and nonverbal communication skills. They judge courtesy on an individual’s manners and politeness.

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