Golbus: We now print out an after-visit summary, or AVS. It is a synopsis of the patient's visit, listing their diagnoses, medications, and the doctor's plan. It requires a physician to click the AVS icon in the electronic medical record to print. Many initially viewed that as a frivolous "button-pushing" exercise. While it took extra time, we explained that our patients asked for this information, as it helps them understand their medical problems. The AVS should lead to improved care. In connecting the tactic more clearly to our long-term goals, the physicians were willing to take the extra step. Furthermore, it was a data-driven decision based on patient surveys. We didn't make it up. That too helped sell the process.
Bethancourt: We've addressed this by promoting relationship-centered care—not only the relationship the physician has with the patient, but also the relationship the physician has with the staff regarding the patient and the professional relationships. There have been a number of studies in relational care that show that when everyone on the team understands their role toward the patient, the outcomes are better.
Peer: One of the key components of patient satisfaction is how you deal with things that don't go well. What explanation is given to the patient? Is the issue covered up? Are random excuses made? My experience is the more honest you are, the better the outcome tends to be. Service recovery has to be a key element of an organization's culture.
Golbus: The irony of mistakes is that if you fix them in a way that exceeds expectations, you enhance loyalty.
Morgan: What you see here is the importance of leadership, whether it is physician leadership or administrative leadership. Without the appropriate leadership to navigate through today's and tomorrow's toughest issues, you're not going to get the results you need to build and sustain a profitable practice, hence the importance of the new practice leader.
Bethancourt: Going forward, that is going to be hugely important when we're looking at bundled care. Once the patient has trust in their primary care physician, they will have sufficient trust to follow recommendations.
HealthLeaders: What other "soft" issues are we missing in developing patient loyalty and satisfaction?
Golbus: Over the years we've looked at thousands of our patient surveys with an eye toward learning what physician behaviors and activities correlate best with patient loyalty and practice success. Interestingly, the best correlate of loyalty is the physician who scores highest on "looks me in the eye and knows me by name." Obviously, it gets at the importance of interpersonal relationships. And the great thing about knowing that is not only can we train for it, but we can select for it when we're hiring.
Peer: That's one of the challenges that hospitals and private practices are running into. They'll buy a practice of a physician who has been in the community for 10 or 15 years, and who has a wonderful reputation, great culture within the practice, and the first thing they want to do is change the personality of the practice—something that's been very successful. So part of our challenge is how do you not alter the culture of a practice that's been very successful but may have some financial challenges, and bring it into an integrated system without destroying the wonderful things patients love about the practice?
HealthLeaders: Let's talk about office staff and physician extenders. What challenges are you seeing there?
Peer: One of the best labor pools that we have available to us is the baby boomer generation, but many of them are leaving full-time employment in search of other career options that may offer a higher quality of life, such as interim work. To obtain optimal results, it is really important to attract and retain these sophisticated individuals, even if it is on an interim basis.
Bethancourt: It is getting more and more difficult to find someone who has the compassion, has the educational ability to pick up the IT and work with the EMR, and is willing to work long hours.