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Studer Spotlight: Patient Communication that Builds Trust in Advance Practice Providers

Posted on Wed, Apr 13, 2016
Studer Spotlight: Patient Communication that Builds Trust in Advance Practice Providers

Since 2010, EmCare has maintained a strong partnership with Studer Group to improve clinical and operational results for our client hospitals. As a result of this partnership, Studer Group has provided access to exclusive content only available on StuderGroup.com. Each month, one of Studer Group's insightful articles will be made available to Emcare.com blog readers. For more information about EmCare's partnership with Studer Group, click here. For more exclusive content, including webinars, learning labs, networking opportunities and more, visit StuderGroup.com.

By Josh Kosowsky, M.D., FACEP

Over the past two decades, advance practice providers (APPs) have been growing both in sheer number of jobs and in their importance to the delivery of healthcare. U.S. labor statistics estimate that more than 90,000 physician assistants and 122,000 nurse practitioners are practicing today with growth rate estimates ranging from 33 percent to more than 50 percent over the next decade.i

Healthcare reform continues to drive demand for APPs, not just in primary care, but across all inpatient and outpatient specialties as organizations respond to the convergence of physician shortages, cost reductions and increased demand for services.

While healthcare organizations are expanding the roles of APPs, patients' understandings of these roles has not evolved as quickly. As leaders, we can't afford to wait for public perception to catch up. It's up to us to manage patient expectations, and in turn the patient experience, by leveraging proven communication techniques.

Nowhere is this more true than for APPs practicing in the emergency department (ED) setting. While the scope of practice for a nurse practitioner or physician assistant will vary depending on the ED, APPs play an increasingly significant role in emergency departments big and small, rural and urban, academic and community-based. Whether performing advanced triage, providing fast-track coverage, overseeing an observation/clinical-decision unit, or seeing patients alongside physicians in the main treatment area, APPs have become ubiquitous to the point where at some EDs the average patient is more likely to have contact with an APP than with a physician.

Because they often tend to see lower acuity patients, APPs have an outsized impact on the perceptions of patients who end up being discharged from the ED. And it is those discharged patients who will receive the Emergency Department Patient Experiences of Care (EDPEC) survey. Because survey questions place an emphasis on the quality of communication with providers, we need be sure that our APPs are well versed in tools and techniques such as AIDET® (Acknowledge, Introduce, Duration, Explanation, Thank You).

How can APPs make patients feel confident they are in good hands?

For a lot of patients, there is confusion and apprehension around the role of APPs within the ED care team. The AIDET® framework is proven to reduce patient anxiety and build trust with patients. In particular, AIDET® is important for APPs when it comes to "I" - Introduction.
 

A     Acknowledge      Provider smiles and greets the patient and family members/friends in the room.

"Good evening, Ms. Jones. Who is here with you today?"
I Introduce

"My name is John Smith. I've been a physician assistant - or PA -in this Emergency Department since 2012. I'll be the provider taking care of you today."

If working alongside a medical doctor, either directly or indirectly, the PA would continue: "I'm working with a fabulous team, including Dr. Meltzer, the attending physician on duty today."

D Duration "Dr. Meltzer will be in to see you after we have your x-ray results. Typically, that takes about 45 minutes."
E Explanation "I want to be sure we're not missing anything, so I'm going to review your case with Dr. Meltzer and ask him to come take a look at that rash".
T Thank You "Thank you for trusting us to care for you."

In a less careful introduction, a patient might hear "nurse practitioner" and think "nurse," or, in the case of a physician assistant, they might hear "physician". In either instance, this confusion can impact the patient's perception of care of their entire visit. For example, it is not unusual to read survey comments from EDs that utilize APPs, where patients complain "I was never seen by a doctor" or "there were different doctors coming in and out of the room, but I couldn't tell who was in charge." These anxieties can influence a patient's overall perception of care even when their experience has been excellent in every other area.

With the increasing prevalence and expanding roles of APPs in ED settings, their impact on patients' perceptions of care will continue to grow. Focusing on key words for APPs, particularly around how they are introduced, is something you can start doing today to make a difference for your ED and for your patients.

Josh Kowosky

Dr. Josh Kosowsky is coach on Studer Group's Emergency Department Services team. He is Vice Chair and Clinical Director of Emergency Medicine at Brigham & Women's Hospital in Boston and holds an appointment as Assistant Professor of Emergency Medicine at Harvard Medical School.


iBureau of Labor Statistics http://www.bls.gov/oes/current/oes291071.htm and http://www.bls.gov/oes/current/oes291171.htm
 

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Physician Emphasizes Importance of Saying Thank You

Posted on Sun, Nov 01, 2015
Physician Emphasizes Importance of Saying Thank You

Doctor reports feeling deeper connection to his patients; improvement in patient satisfaction score

(HealthDay News) -- The importance of thanking patients for coming to see you, the physician, is described in an essay published online in Medical Economics.

The article discusses implementation of AIDET in a large multispecialty group practice. The acronym stands for the action words that comprise the patient visit: acknowledge the patient and associated family; introduce yourself; describe what you are going to do; explain what you did and what will happen next; and finally, say thank you.

The author notes that despite having good scores overall for the patient experience, after making an effort to say thank you, his scores increased further, reaching 90 percent. As well as seeing an objective improvement, the author describes the feeling of having made a deeper connection to more of his patients, noting their smiles as they left the exam room.

"To paraphrase Abraham Lincoln, you can please all of the patients some of the time, and some of them all of the time. But you can't please all of the patients all of the time," the author writes. "But you can try to thank all of them, all of the time, for coming to see you."

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Studer Spotlight: Improving Patient Access- Easier Access, Better Health

Posted on Wed, Feb 11, 2015
Studer Spotlight: Improving Patient Access- Easier Access, Better Health

Since 2010, EmCare has maintained a strong partnership with Studer Group to improve clinical and operational results for our client hospitals. As a result of this partnership, Studer Group has provided access to exclusive content only available on StuderGroup.com. Each month, one of Studer Group's insightful articles will be made available to Emcare.com blog readers. For more information about EmCare's partnership with Studer Group, click here. For more exclusive content, including webinars, learning labs, networking opportunities and more, visit StuderGroup.com. 


High quality healthcare delivery depends on great access to care and information. We know that promoting access into our care and services is requisite to both attaining and retaining patients in a practice.  Consumers want to know that they can get care when and where they need it.

Spurred by increased demand resulting from healthcare reform measures, looming workforce shortages, and concerns about access and barriers to care, many leaders are focused on transforming the delivery of healthcare.

New measures evaluating patient access are included in the Clinician and Groups Consumer Assessment of Health Providers and Systems (CG CAHPS) and Patient Centered Medical Home certification process (shown in Table 1) and continue to push for improved access to care, often focusing efforts on same day or timely access.
 

Element A: Patient-Centered Appointment Access (MUST-PASS)
 
The practice has a written process and defined standards for providing access to appointments, and regularly assesses its performance on:
 
1. Providing same-day appointments for routine and urgent care. (CRITICAL FACTOR)
2. Providing routine and urgent-care appointments outside regular business hours.
3. Providing alternative types of clinical encounters
4. Availability of appointments.
5. Monitoring no-show rates.
6. Acting on identified opportunities to improve access.
Table 1. NCOA Patient Centered Medical Home Access during office hour's requirements

Questions from the CG CAHPS survey relating to access include:

“When you phoned this provider's office to get an appointment for care you needed right away, how often did you get an appointment as soon as you needed”
“When you made an appointment for a check-up or routine care with this provider, how often did you get an appointment as soon as you needed?”

To meet the challenges of patient access while maintaining high quality, patient-centered care, here are a few tips that can make a big impact:

Set objective and targeted goals that measure your strategy of success

Many healthcare organizations have learned an important lesson from other service industries and are re-adopting the premise that access and service must be designed from the customer’s perspective. For example, an emerging definition of excellent access is: “The ability of a patient to seek and receive care with the provider of choice at the time the patient chooses.” Coupled with this definition must be metrics that measure and monitor ongoing progress related to patient access. Determine which measures will be used followed by setting targets.

Communicate the strategy of access to providers and staff

Access-related strategies are not likely to be successful if they are not effectively communicated to those who must implement them: the providers and staff. To accomplish this goal, many venues are available to you to ensure the message is heard loud and clear. Utilize employee forums, Leader Development Institutes (LDIs), monthly supervisory meetings, individual rounding on providers and employees, staff meetings, daily huddles, and communication boards to name a few.

When communicating the strategy of access, start with the why. Simon Sinek, author of the book “Start with the Why,” comments that “People don't buy what you do; they buy why you do it. And what you do simply proves what you believe”. When communicating the why supporting your strategy for improved access, clearly articulate that easier access leads to better outcomes.

Train staff to communicate your strategy of access to patients

Begin offering every appointment on the day a patient calls, regardless of the reason for the visit. Consistent with the concept of doing today’s work today, a posture that seeks to provide same day access to patients is not only perceived positively, but it has been found to improve the efficiency of the office. Remember also, if patients do not want to be seen on the day they call, schedule an appointment of their choosing.

Develop Key Words for schedulers to further probe the symptoms and potential urgency of patient complaints. Simply asking the patient if they “would like to be seen today” positions scheduling as a patient centered process and one of great satisfaction to patients.

Subsequent to developing Key Words, maximize validation techniques including real time coaching to support, recognize and continuously improve the skill and competence of scheduling team members. Utilize the framework of AIDET® with specific key words or phrases that comprise the full scheduling script, including the statement, “would you like to be seen today?” When validating, listen to and observe scheduling team members using these key words and capture notes on a standardized validation form allowing for skill assessment and feedback.

The significance of this challenge and more importantly, the impact on quality of care cannot be overstated. Just this week as I was working with a healthcare organization, we learned from a patient the difficulties he is having accessing care. Having recently moved back to his home town, he called to schedule an appointment with a primary care provider and was told it would be several months before he could be seen. Within the same week, he made 2 visits to the local Emergency Department with the second visit resulting in his admission for antibiotics to treat an infection.

While healthcare organizations focus on improving access to care, creating a strategy with inclusion of goals, communication of the why supporting the strategy and communicating to patients the attitude we’ve adopted, “would you like to be seen today?” will lead to better access and health for those we serve.

 

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IMPROVING PATIENT ACCESS- EASIER ACCESS, BETTER HEALTH

Posted on Wed, Feb 11, 2015
IMPROVING PATIENT ACCESS- EASIER ACCESS, BETTER HEALTH

Since 2010, EmCare has maintained a strong partnership with Studer Group to improve clinical and operational results for our client hospitals. As a result of this partnership, Studer Group has provided access to exclusive content only available on StuderGroup.com. Each month, one of Studer Group's insightful articles will be made available to Emcare.com blog readers. For more information about EmCare's partnership with Studer Group, click here. For more exclusive content, including webinars, learning labs, networking opportunities and more, visit StuderGroup.com. 

By: Dave Brown     Posted: November 03, 2014

High quality healthcare delivery depends on great access to care and information. We know that promoting access into our care and services is requisite to both attaining and retaining patients in a practice.  Consumers want to know that they can get care when and where they need it.

Spurred by increased demand resulting from healthcare reform measures, looming workforce shortages, and concerns about access and barriers to care, many leaders are focused on transforming the delivery of healthcare.

New measures evaluating patient access are included in the Clinician and Groups Consumer Assessment of Health Providers and Systems (CG CAHPS) and Patient Centered Medical Home certification process (shown in Table 1) and continue to push for improved access to care, often focusing efforts on same day or timely access.

Element A: Patient-Centered Appointment Access (MUST-PASS)

The practice has a written process and defined standards for providing access to appointments, and regularly assesses its performance on:

   1. Providing same-day appointments for routine and urgent care. (CRITICAL FACTOR)
   2. Providing routine and urgent-care appointments outside regular business hours.
   3. Providing alternative types of clinical encounters.
   4. Availability of appointments.
   5. Monitoring no-show rates.
   6. Acting on identified opportunities to improve access.

Table 1. NCQA Patient Centered Medical Home Access during office hour’s requirements 

Questions from the CG CAHPS survey relating to access include:

“When you phoned this provider's office to get an appointment for care you needed right away, how often did you get an appointment as soon as you needed”
“When you made an appointment for a check-up or routine care with this provider, how often did you get an appointment as soon as you needed?”

To meet the challenges of patient access while maintaining high quality, patient-centered care, here are a few tips that can make a big impact:

Set objective and targeted goals that measure your strategy of success

Many healthcare organizations have learned an important lesson from other service industries and are re-adopting the premise that access and service must be designed from the customer’s perspective. For example, an emerging definition of excellent access is: “The ability of a patient to seek and receive care with the provider of choice at the time the patient chooses.” Coupled with this definition must be metrics that measure and monitor ongoing progress related to patient access. Determine which measures will be used followed by setting targets.

Communicate the strategy of access to providers and staff

Access-related strategies are not likely to be successful if they are not effectively communicated to those who must implement them: the providers and staff. To accomplish this goal, many venues are available to you to ensure the message is heard loud and clear. Utilize employee forums, Leader Development Institutes (LDIs), monthly supervisory meetings, individual rounding on providers and employees, staff meetings, daily huddles, and communication boards to name a few.

When communicating the strategy of access, start with the why. Simon Sinek, author of the book “Start with the Why,” comments that “People don't buy what you do; they buy why you do it. And what you do simply proves what you believe”. When communicating the why supporting your strategy for improved access, clearly articulate that easier access leads to better outcomes.

Train staff to communicate your strategy of access to patients

Begin offering every appointment on the day a patient calls, regardless of the reason for the visit. Consistent with the concept of doing today’s work today, a posture that seeks to provide same day access to patients is not only perceived positively, but it has been found to improve the efficiency of the office. Remember also, if patients do not want to be seen on the day they call, schedule an appointment of their choosing.

Develop Key Words for schedulers to further probe the symptoms and potential urgency of patient complaints. Simply asking the patient if they “would like to be seen today” positions scheduling as a patient centered process and one of great satisfaction to patients.

Subsequent to developing Key Words, maximize validation techniques including real time coaching to support, recognize and continuously improve the skill and competence of scheduling team members. Utilize the framework of AIDET® with specific key words or phrases that comprise the full scheduling script, including the statement, “would you like to be seen today?” When validating, listen to and observe scheduling team members using these key words and capture notes on a standardized validation form allowing for skill assessment and feedback.

The significance of this challenge and more importantly, the impact on quality of care cannot be overstated. Just this week as I was working with a healthcare organization, we learned from a patient the difficulties he is having accessing care. Having recently moved back to his home town, he called to schedule an appointment with a primary care provider and was told it would be several months before he could be seen. Within the same week, he made 2 visits to the local Emergency Department with the second visit resulting in his admission for antibiotics to treat an infection.

While healthcare organizations focus on improving access to care, creating a strategy with inclusion of goals, communication of the why supporting the strategy and communicating to patients the attitude we’ve adopted, “would you like to be seen today?” will lead to better access and health for those we serve.

 

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HOW TO: Flip the Complaint-to-Compliment Ratio in a rural ED

Posted on Wed, Jul 10, 2013

This Genesis Cup 2012 runner-up presentation by Medical Director, Harry "Tripp" Wingate, MD and Shayne Middleton, RN, RDCS describes the process used at EMH ED to “flip” the complaint to compliment ratio – a crude measure of customer service performance in a rural ED. The presentation details steps from training on AIDET to the key issues in providing effective feedback to ED staff. Special emphasis is given to the tricky issue of email communication and compliance with HIPAA. New web-based tools (WinZip.com and MyFax.com) for safe email communication are introduced to the audience with comments on benefits and usage.
 

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