Time to Put Patients First

Gienna Shaw, for HealthLeaders Magazine , May 12, 2010
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President and CEO Kip Hallman says the business is built on core values dubbed "Insight PRIDE." Each letter in the word pride refers to a core value, the first of which is "patients first." (The other letters stand for "do the right thing," "encourage innovation," "deliver on commitments," and "enjoy what we do.")

"We strive to deliver what we call a 'patients-first experience,'" Hallman says. "If everything you do starts from the same basic root of the core values, then the question is, 'What's the right thing to do for the patient?'"

The company starts to seek the answer to that question with an e-mailed survey to measure patient satisfaction—asking patients a series of postvisit questions. The organization's bonus structure is based, in part, on scoring a 95% positive response to two questions—whether the patient would return to the center for another exam and whether he or she would recommend the center to a friend or family member. The average for all of the questions is more than 90%.

The busiest centers often have lower patient satisfaction scores, with patients complaining about the wait times, Hallman says. To address that, Insight Imaging recently started testing a patient navigator program at its largest centers—those that see 100 or more patients a day. The navigators guide patients through their entire appointment. They explain processes and what to expect and keep them informed about wait times. "We've gotten very good feedback on our patient satisfaction surveys that people appreciate being kept in the loop," he says.

The organization used existing patient-facing staff to fill the navigator roles, so there was no added personnel cost. In fact, Hallman says, because the navigators are keeping patients informed, behind-the-counter staff get fewer interruptions. Improving patient satisfaction in turn improves relationships with referring physicians—account executives share patient satisfaction data with them—and that improves profitability, Hallman says.

"We think it pays for itself and we'll see as we roll that out more broadly, but we do think that this is an important thing for us to be doing."

The common bond: Hiring and training
All Insight Imaging patient service representatives, center managers, and technologists go through patients-first training. The idea is to teach them not about the technology or processes, but caring for patients. The idea of the perfect employee has changed over the years, Hallman says. It used to be that the top priority was to find a patient service representative who was detail-oriented and who understood insurance requirements and billing procedures. Now it's more important to find someone who knows how to work with people.

Like Hallman, Feinberg says hiring practices at UCLA now favor employees who are patient-centric. They also use a screening tool—about half of the people who would have been hired in the past don't score high enough to get the job today, he says.

It's a common theme among organizations that are working to deliver patient-centered care. "We feel like we can teach skills, but you can't teach caring. That has to be embedded into your personality," says Brennan. You have to "have faith in your frontline people—to believe in them, to allow them to problem solve. They know what to do, and we have to give them the opportunity to do it. And you'll see the results that you want to see," she says.

The VHA hospitals that are "at the top of the pack," says Gelinas, are those that invesed in training and people, even during a down economy.

To help ensure every patient is treated consistently, UCLA uses scripts for employees at all levels, teaching them how to greet patients at check-in and introduce themselves, for example. Every employee signs a commitment to care. Training DVDs developed by the staff cover best practices such as washing your hands upon entering a room, telling patients that you won't be working over the weekend, and handing off a patient to another caregiver.

Physicians, of course, are another kind of challenge.

A small group of doctors out of the roughly 2,000 on staff get a disproportionate number of complaints, UCLA's Feinberg says. Intervention includes showing doctors the data—the number and categories of complaints they've received. They also benchmark that data against a national database, comparing apples to apples—or spine surgeons to spine surgeons, as the case may be. "We ask them to 'please bond with the data,'" Feinberg says. "That's it. We show them the data and walk away."

He says most change their habits without further intervention. The rest? "It's just not tolerated," he says. "You would end up moving out on your own, because you would be so uncomfortable here . . . We've had very little turnover."

"One of the things we always look for is how physicians interact with other physicians and other business leaders," says DeMeo, who has an MD and an MBA. He says medical schools don't put the same emphasis as business schools on group dynamics, problem-solving, and evaluation. Medical schools and nursing programs "breed very independent individuals who don't particularly work well with each other, nor do they work well within organizations," he says, adding that the healthcare industry needs to place more emphasis on cooperation and integration.

"Caretakers have to be more educated on group dynamics and group projects and understand the value of them … You have to bring in a team to inform and basically draw on other people's core competencies to create a better solution,since you can't be good at everything," DeMeo says. "Most physicians . . . have a really hard time coordinating their efforts and coming up with a common goal. In terms of healthcare innovation, that's something that really has to change."

Gienna Shaw is senior technology editor for HealthLeaders Media. She may be contacted at gshaw@healthleadersmedia.com.
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