service recovery in healthcare: movement from reactive … · ©2015 mfmer | slide-1 service...

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Service Recovery In Healthcare: Movement From Reactive To Proactive

Sandhya Pruthi, MD, Medical Director for Patient Experience, Mayo ClinicChrissy VerNess, Patient Experience Coordinator, Mayo ClinicSheila Stevens, Patient Experience Coordinator, Mayo Clinic

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Service Recovery in Healthcare: Movement From Reactive to Proactive

Sandhya Pruthi, MDSheila Stevens, MSW

Christina VerNess, MHAMayo Clinic, Rochester, MN

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Objectives• Describe the development of a pilot program at Mayo

Clinic (Rochester) to address and resolve patient complaints by frontline staff

• Discuss the importance of addressing service breakdowns at the point of service

• Describe empathic strategies utilized for service delivery and service recovery

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Let Me Introduce You to My Patient…

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Patient Experience Definition

An unparalleled patient experience is the result of inspired and dedicated employees demonstrating excellence, compassion and respect by partnering with patients, family and colleagues to continuously

improve the healthcare service experience.

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MetricsService recovery

Mayo Clinic PX Model

Accountability

Consultation

Recognition & reward

Monitoring & control

Patient Experience

Service values & behaviors

Education & training

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Rights and responsibilities Hospitality

First impressions Professionalism

Other Important Elements

Patient family-

centered care

Respect for diversity Health care literacy

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Patient Experience Team• An identified entity at Mayo Clinic Enterprise• An internal consulting resource trained in the field of

Patient Experience, an emerging field• Sites: Arizona, Florida, Mayo Clinic Health System,

Rochester• Overarching goal – to improve the overall Patient

Experience at every “touch point” of care

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Pilot Overview • Leadership from the following areas requested participation in pilot:

• Urology• Neurology• GIM• Outpatient Pediatrics• Neurosurgery

• Total Trained • Providers – 107• Allied Health - 779

• Educate staff • Service delivery (AIDET)• Service recovery (LEAD)• Online Tracking Tool (Midas)

• Timeline• June 2014 through December 2014

• Patient Experience Champions

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Evolution of PilotBeginning

• Provider & AHS together• GIM• Outpatient Pediatrics (still need

recovery training)

• Training time 2.5 hours

• 80% didactic - 20% interactive

• Session 1 title – Service Delivery

• Session 2 title – Service Recovery

End• Provider & AHS separate

• Urology• Neurology• Neurologic Surgery

• Training time 1.5 hours(Combined & Revised Curriculum)

• 50% didactic – 50% interactive

• New title – Empathic Communication

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Service Recovery ProcessPatient communicates concern

staff

Staff able to resolve the concern

Offer apology, thank you, goodwill gesture (if appropriate)

YES

Review algorithm with escalation process

NO

Document in Tracking

Tool/Midas

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Leadership contact order: (example)• Supervisor• Ops Manager• Administrator

Patient communicates concern

Frontline staff able to resolve?

Preferred method of communication

No

Yes

Decision Tree: Local Level Complaint HandlingQuestions or Concerns – Office of Patient Experience, 507-284-4988

Communicate w/patient: their concern will be

shared with your supervisor for follow-up

Speak to someone right now Call back Letter

Contact appropriate leadership staff

Available? YesTransfer to leadership

for resolution of concern

No

Contact next available leader

Frontline staff documents patient concern and contact

info. and e-mails to supervisor

Offer an apology, parking or food

voucher

Document in MIDAS before the end of

your shiftClose

Leadership able to resolve

Follow-up w/patient, offer an apology, parking or

food voucher

Document in MIDAS

Close

YesNo

OPE - review MIDAS documentation provided

by local level staff

Follow-up w/patient, offer an apology, parking or

food voucherDocument in MIDAS

Close

Leadership Review Process:• Review concern as shared w/ you

by frontline staff• Discuss concern (in-person, e-

mail) w/ provider, administrator or supervisor

• Contact patient or family member w/ resolution after investigation

• Document investigation and follow-up in MIDAS

Types of Concerns:• Access• Wait times• Communication w/ department staff• Scheduling error• Lost or destroyed records• Environment / Cleanliness• Concerns specifically related to your area • Second opinions w/in depart.

Types of Concerns:• Confidentiality Breaches• Amendment Requests• Concern outside the

department• Pt. refuses to speak w/

leadership• Unable to be resolved by local

leadership• Alleged abuse or

inappropriate touch• Second opinions outside dept.

Leadership - document steps taken in MIDAS

Leadership - offer OPE as option; provide OPE

location & phone number

Patient makes contact with OPE

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What do you expect as a patient?

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25

18

8

7

6

3

3

3

2

20 5 10 15 20 25 30

Communication

Access

Shared Decision Making (SDM)

Clinical Quality and provider knowledge and skills

Physical environment

Patient Education

Electronic Medical Record (EMR)

Pain control

Discharge process

Preventive services

Number of Studies

What Patients Say…

Mohammed, et al.

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AIDETSM = Five Essential Communication Behaviors

I Introduce

D Duration

E Explanation

T Thank You

A Acknowledge Decreased anxiety

Improved health outcomes & satisfaction

+

=Increased compliance

©2007 Studer Group

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Challenging Communication

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Empathically Redirecting

• Orient with name and sound• Ask permission to jump in• Reflect, validate, summarize• Redirect to mutual goal

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What is Service Recovery?

Mayo ClinicAn empathic approach

to quickly respond andfairly resolve patient concerns,

in a way thatmakes them feel satisfied

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Just the Tip of the Ice BergRich information used for improvement opportunities

96% will not complain, leave us and tell 25 others

Only 4% complain

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Listen Empathize Apologize Do something

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Service Recovery Paradox Effect

The Service Recovery Index, AboutFace

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Standardized Service Recovery Tool Kit

• Cafeteria Vouchers• $10 per voucher

• Parking Passes• All day pass

• Message/Note Cards

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Intended Outcomes

• Enhance patient satisfaction • Identify trends• Develop standardized recovery methods• Improve employee communication• Enhance employee morale• Identify Pt Champions to reinforce message

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Lessons Learned

• AIDET & LEAD into one session• Identified a need for empathic redirection• Small classroom setting for interaction is crucial• Need leadership buy-in prior to execution• Re-evaluate delivery of provider trainings based on

feedback• Re-visit tracking tool methods

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Benefits of Patient SatisfactionClinical outcomes • Lowers patient stress• Improves decision-making • Improves patient

compliance

Profitability / financial sustainability• Increase in patient volume• Improved reimbursement rates• Fewer malpractice lawsuit

Brand• Improved patient retention

and referrals

Employee satisfaction• More productive staff• Better morale

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Back to Sheila’s patient…

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Summary• AIDET – Service Delivery• LEAD – Service Recovery• Empathic Communication

• Disconnect between expectations and reality• Service Breakdowns• Noncompliance

Original quote by Maya Angelou

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References/Resources

Bendall-lyon, Dawn. Powers, Thomas. (2001). The role of complaint management in the service recovery process. : The joint commission.

Doyle, C., Lennox, L. & Bell, D. (2013). A systematic review of evidence on the links between patient experience and clinical safety and effectiveness. British Medical Journal, 3(1)doi:10.1136/bmjopen-2012-001570

Hsu, I, et al. (2012). Providing support to patients in emotional encounters: A new perspective on missed empathic opportunities. Patient Education Counseling. 88(3) 436-442. doi:10.1016/j.pec.2012.06.015.

Mohammed, K., et al. (2014). Creating a patient-centered health care delivery system: A systematic review of health care quality from the patient perspective. American Journal of Medical Quality. doi: 10.1177/1062860614545124

Types of Customer Experience Research. (n.d.). Retrieved December 31, 2014, from http://aboutfacecorp.com/wp-content/uploads/2014/07/Promo-ServiceRecoveryPlan-AboutFace-7-11-14.pdf

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Next…

Community Dialogue on Improving Patient Experience throughout the Continuum of

Care

4:00-5:00 PMDallas D-H