Scripps Patient Experience: Physician Communication

Scripps Mercy Grand Rounds

RJ Salus, MPH, MSWGhazala Sharieff, MD, MBA

Why is this important

• VBP• Legal consequences• Other quality indicators – readmissions• Loyalty - repeat business and referrals• Only sustainable market differentiator

Program Overview

Clinical Process

Domain Score

Patient Experience

Domain Score

Outcome Domain Score

Efficiency Domain Score

Total

Total Performance

Score+ =+ +

3

HCAHPS Facts:

•Designed and implemented by CMS

•Mandatory

•Part of Values Based Purchasing Score and will impact Medicare reimbursement

•Used as measurement for Success Shares for Scripps Employees

Highlighted HCAHPS questions• How often did doctors treat you with courtesy

and respect?• How often did doctors listen carefully to you?• How often did doctors explain things in a way

you can understand?Never, Sometimes, Usually, Always

• On a scale from 1-10, what number would you use to rate this hospital during your stay?

Other Press Ganey Questions

• Waiting time to see doctor• Doctors concern to keep you informed about

treatment• Doctors concern for your comfort• Likelihood to recommend

Patient is discharged from a Scripps Facility

Scripps transmits patient data to Press Ganey headquarters in Bend, Indiana

(2 weeks post discharge for record to be coded properly)

Within 48 hours, Press Ganey prints a survey and mails* it to the patients home. The survey has a cover letter from the site executive and carries the Scripps logo on the envelope and survey.

The survey is delivered. This can take up to a week as it is mailed from Indiana

The survey usually sits in the patients home for 1-2 weeks before it is completed and mailed back to Press Ganey.

Press Ganey scans the survey into their databases and makes the scores available to Scripps via their online tool.

Reports compiled based on discharge dateStandard system reports compiled at corporate office.

The Survey Process

Timeline from DC to Report: 6-8 wks*Surveys mailed to all inpatients and a sample of outpatients from our Emergency Departments, Clinics, Urgent Care Centers, Surgery Centers, Radiology Departments, and Rehabilitation Departments.All patients may write comments for us and leave their phone number to call them back

2-3 wks 2 days 1 wk 1-3+ wks 1-2 days

The Big 3 Behavioral Drivers

• Knock• Sit• Ask about patient concerns

M. J. Stahl, PEMBA: SEA, 01/10 10

‘Culture eats Strategy for lunch, every day.’

Patient Comment Analysis – All Hospitals

1

“All it takes is one doctor who thinks she 'knows it all' to make a stay an '8' & not a '9' or '10.‘”“Noise level of people working at night was pretty much the same as during the day”“Be conscientious of patients in pain. Don't tell them to ‘toughen up’”“Don't gossip in the hallway, the patients can hear you”

Tom Peters“The Circle of Innovation”

“If the other guy's getting better, then you'd better be getting better faster than that other guy's getting better...or you're getting worse."

The Psychology of Waiting – David Maister• Occupied Time Feels Shorter Than

Unoccupied Time• Anxiety Makes Waits Seem Longer• Uncertain Waits Are Longer than Known,

Finite Waits• Unexplained Waits Are Longer than

Explained Waits• Unfair Waits Are Longer than Equitable Waits

Embraced measurement as a means of differentiating itself in a crowded market and to make a bigger difference to hospital clients

Substantial improvement might come through hospitalists efforts to improve their communication, along with hospital efforts to improve care coordination, team communication, and other system issues

Steps were simple: Sit down. Touch patients on the shoulder. Greet them by name. Give them a business card with your photo on it.Explain how you work with their PCP. Explain what’s keeping them in the hospital. Give them a brochure explaining what hospitalists do. Say “We’re on call 24 hours a day.” Deliver test results as soon as possible.

The Talking Cure for Health Care:Wall Street Journal - April, 2013

5 Simple Habits Can Help Doctors Connect With PatientsNPR – January 11, 2014

• Sitting down can make a big difference in patient satisfaction.

• Introducing oneself to the patient • Explaining your role in the patient's care.• Touching the patient — handshake or a

gesture of comfort.• Asking open-ended questions, like, "How

are you feeling today?"

Memorial Hospital and Health System, South Bend IN

Initial patients' 'likelihood to recommend' score was 81.5. After 90 days of asking “what is your greatest fear or concern around your hospitalization?” the score increased to 83.5 and is currently 85.5.

Percentile Rank 10 20 25 30 40 50 60 70 80 90 99

% Always 73.8 76.1 77.2 78.1 79.3 80.5 81.8 83.3 84.7 87.3 92.8

Moving the Dial Percentage to Percentile

To Sit or Not to Sit?Johnson R etal. Ann Emerg Med 2007

• Sitting: time overestimated 15%• Standing: time underestimated 7%• Providers overestimated time 6%

Use Key Words• “What is your greatest concern?”• “Out of courtesy for you”• “Out of respect for your comfort”• “I want to keep you informed”• “I would like your input/feedback about your

care plan”• Is there anything I can do for you right now ?”

Adverse Events After Discharge from Hospital

Annals of Internal Medicine, February 2003

• 400 pts surveyed• 19% had adverse events

Do Patients Know When They Don’t Understand?,Engel Et al Ann Emerg Med. 2008

• 78% did not have full understanding• 80% of that 78% did not understand that

they did not understand!

Malpractice Suits- How Do They Relate to Patient Satisfaction?

Stelfox HT etal. Am J Med 2005

• Each one point decrement in patient satisfaction scores is associated with a:

• 6% increase in complaints (<.0001)• 5% increase in risk management episodes

(p<.008)

Malpractice Suits- How Do They Relate to Patient Satisfaction?

Stelfox HT etal. Am J Med 2005

• Lower performing physicians were at greater

• risks for lawsuits (p<.019)• 75% of complaints were related to

communication issues

Communication=> Compliance=> Quality Medical Care: August 2009 - Volume 47 - Issue 8 pp 826

• Physician communication correlates STRONGLY with adherence rates by patients in acute and chronic disease.

• Compliance with treatment regiments has significant influence on quality measures in chronic disease and outcomes.

Call Backs

MD vs Others… it does make a difference!Courtesy of Jay Kaplan, MD

Quick Self AssessmentBehavior Never Sometimes Usually Always

When, I enter a patient room, I knock and wait for a response

I sit, face the patient, and make eye contact

I am caring about the patient, their health and ask about their “greatest concerns”

I great patients and family warmly; introducing myself and role; smile; and apologize if the patient has been waiting to see me

I listen carefully and do not interrupt the patient

I give the patient information and thoroughly explain what is happening and when things will occur if possible

I involve the patient in care planning, ask for the input and seek their agreement

I ask the patient or family if they need more explanation after each major point, make them comfortable asking questions, and if there are any barriers or concerns about plan before I leave the room

I summarize the treatment plan avoiding medical jargon and inform the patient of next steps

I introduce the next caregiver and speak positively about all hospital staff to patients

I thank the patient / family for their patience, for choosing us;

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The Bottom Line

People may not remember what you did to them.

They may not remember what you said to them.

But they will always remember how you made them feel.

Sharieff.Ghazala@scrippshealth.orgSalus.RJ@scrippshealth.org