Menu

Blog Posts

HCAHPS

Studer Spotlight: The Patient Experience: Does this Really Matter?

Posted on Wed, Jun 22, 2016
Studer Spotlight: The Patient Experience: Does this Really Matter?

By Dan Smith, MD, FACEP

This short list includes just a few of the terms and tactics around patient experience. These previously uncommon phrases are now forefront in our healthcare playbook of goals and strategies. Let's explore the questions below:

Are the efforts to drive patient experience grounded in medical science?

A growing collection of peer-reviewed literature exists that supports the notion of patient perception of care as a marker of care quality. The CRUSADE trial studied over 6,000 acute myocardial infarction (AMI) patients and examined the mortality of this cohort as a function of their perception of care scores (Glickman et al, Circulation 2010). They also measured guideline adherence. In risk-adjusted cohort comparisons, patients with higher patient experience metrics showed lower mortality from AMI. Interestingly, their adherence to treatment guidelines was higher.

Studies looking at factors influencing hospital readmissions suggest that patient perception of care is an important predictor of readmission (Boulding et al, American Journal of Managed Care 2011). Lastly, a large systematic review of patient experience literature led by Doyle et al in BMJ Open found linkage of patient experience to favorable quality outcomes and reduction of complications of care in >77 percent of international studies (22 percent of studies found a neutral association).

The mounting data supports the notion that patient perception of care and our ability to communicate and connect with patients is an important driver of patient quality outcomes, adherence to medication and treatment regimens, and avoidance of readmissions and complications.

Will patient experience efforts help us thrive in the complex and changing world of healthcare?

Healthcare models of care have evolved and how we enumerate performance has changed:
 

Past Future
volume volume + value
health maintenance organization (HMO) Accountable Care Organization (ACO) / physician-hospital organization (PHO) /Clinical Integrated Network (CIN)
paternalistic mutualistic
usually always
effort performance
care care + perception of care

We now practice in a world of ever-increasing transparency and accountability where process of care, outcome of care and perception of care are scrutinized. Those who embrace the change, align and outperform on these evidence-based measures will not only receive full payment for services but also value-based bonuses. The recent replacement of Medicare's sustainable growth rate with the MACRA program that will be implemented over the coming years further emphasizes transparency and accountability to patients. As envisioned, MACRA has a heavy emphasis on rewarding those physicians and medical groups that receive high patient experience scores and other quality (value) measures. Those that are unable to focus on these core competencies will see significant reimbursement reductions. In a new reality of reduced operating margins from risk-withholds and complication/readmission penalties, enterprises that coach and train staff and providers to thrive in the new age will appreciate loyalty and growth, risk reduction, favorable bond ratings and market differentiation.

How can a provider accept and embrace the change?

Think about this through the lens of our customer, the patient. We are driven to understand the complexities of science and medicine and apply technical and cognitive mastery to the healing arts. Patients may not understand clinical explanation at our level but they sense kindness and empathy, which can often act as proxies to care quality and ratings of care.

Don't traverse the change alone. If you feel you received little to no training on communication skills and don't know where to begin, reach out to subject matter experts who know the evidence-based skillsets that will elevate your game in communication and connection to patients.

Embrace it, accept it and get it done. Keep it in perspective though. Truth is, you still assess and treat the patient. You still order appropriate testing and treatment. You will formulate a differential and ultimate diagnosis. Do we have to think differently about the way we communicate and behave? Yes, we do, and this is not a soft skill: the physician domain remains one of the most difficult "top box" composites in CG CAHPS and HCAHPS to elevate and sustain. Pay attention to the skill sets that beget performance on patient experience, deploy a couple tactics to improve communication (AIDET® is one) and be consistent in their use. With some practice and time, this will become the new way you communicate. Soon after, you will receive positive feedback from patients and families and you can even save time in patient interactions.

Dr. Smith has practiced since 1998 in the emergency departments of Baptist Health System, San Antonio, TX. He directed Patient Experience for Emergency Physiciansʼ Affiliatesʼ from 2007-2015. Dr. Smith is a diplomate of the American Board of Emergency Medicine and a Fellow of the American College of Emergency Physicians. He completed a residency in Emergency Medicine at William Beaumont Hospital in Royal Oak, MI where he was chief resident.

Share    

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.

 

Share