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Doctors' Challenge: Boost Patient Satisfaction, Maintain Clinical Excellence

 |  By jcantlupe@healthleadersmedia.com  
   August 30, 2012

Hospitals are finding that excellent clinical outcomes don't always translate into patient satisfaction. A top notch surgery track record can be trumped by a lousy bedside manner. In a split second, a shift change or some other personnel move, can alter the patient's experience from "great" to "get-me-out-of-here." 

As hospitals try to improve their satisfaction scores, physicians are playing a crucial role to bridge that clinical and patient satisfaction gap, with many federal dollars at stake.

David Fox, president and CEO of the 326-bed Advocate Good Samaritan Hospital in Downers Grove, IL, attributes his facility's high clinical and patient satisfaction scores to long-term planning for improved clinical and patient satisfaction. Thomson Reuters (now Truven Health Analytics) named the 326-bed Advocate Good Samaritan Hospital as being among the nation's top healthcare systems.

Fox connects much of the hospital's success to an intense concentration on training and hiring staff, particularly doctors and nurses. As the hospital evaluates the potential staff, Fox says there also is a major focus on how a prospective employee might impact patient attitudes. "We, as human beings, can have a tendency to remember the negative and it overwhelms the positive," Fox told me.

"So we've gotten very focused on who gets to work here, and how we train them on customer service. We used to hire for skill and pray for attitude and cultural fit. Now we screen for skill, but hire for cultural fit and attitude. As a result, we get many wonderful letters from patients in almost all categories."

Advocate Good Samaritan uses "peer" interviewers, including physicians, to screen job applicants. At least 450 employees within the system are trained to conduct behavioral-based interviewing, he adds. In that way, the hospital targets potential employees who would be a good fit in their organization, those who will demonstrate a terrific attitude and focus about the job.

When peer reviewers have a "bad feeling about the employee, they would tell the manager to try again," Fox adds. "It gives an extra check on the person we are bringing in, and it creates some ownership for the employees they help hire. It also gives us strong behaviors and a good cultural fit," Fox says.

From his C-suite position, Fox spends nearly two hours a week getting to know new hires. "About eight years ago, if I spoke to 30 people (newly hired), there might have been 10 in the room who were physically present but not really engaged. It used to drive me crazy," Fox says. "That has changed. If someone doesn't have 'life behind their eyes,' we don't hire them anymore."

The hiring process is one of the first steps for Advocate Good Samaritan and others to bring together the clinical and patient outcomes, with an eye on improving HCAHPS  scores. Under the government's value-based purchasing program, the Centers for Medicare and Medicaid Services plans to pay bonuses from an $850 million pool to hospitals that score "above average" on certain quality measures. In 2014, patient satisfaction scores will determine 30% of the bonuses, while clinical process of care will make up 70%.

For Advocate Good Samaritan and other hospitals, once a staff is assembled, weekly rounds have become increasingly important—not only to improve clinical work, but also to improve patient satisfaction.

Improved education programs also are important for physicians and nurses, with hopes of making these healthcare professionals more sensitive to the needs of patients, and aware of the patient concerns. Physicians, in particular, are being advised to exhibit a better bedside manner by sitting near the patients' beds, possibly holding the hand of an older patient and looking him or her in the eyes.

Obviously, communication is an integral part of the program, but that's easy to say. For hospitals and healthcare systems, it's how that value is implemented. 

The Iowa Health System is another system that is not only examining its clinical improvements, but also focusing on HCAHPS scores through a Patient Experience Team, says Gail A. Nelson, director of learning and innovation for the Iowa Health System, based in Des Moines. The system includes 10 hospitals in Iowa and one in Illinois. The team, which includes physicians and nurses, emphasizes that patients should be communicated with in ways that they understand.

While HCAHPS surveys are important, they only go so far. "We have a broader focus on patient satisfaction and experience than what we can learn from surveys," she adds. "In this work, we have defined for each Patient Care Unit the meaning of 'ideal care' – what our patients and families will say to us (is) the care they want and need," Nelson says.

"These skills are spreading from our hospitals to our home care agency and physician practices across the state," she says. Nelson adds that the hospital uses the adaptive design initiated by John Kenagy, MD,  author of Designed to Adapt: Leading Healthcare in Challenging Times, that emphasizes creating solutions to problems "as they happen on the front line."

"We are extremely pleased about our work with adaptive problem solving. It changes culture, engages everyone, reduces harm to patients and alters the way we think about moving patient experience and satisfaction scores," Nelson says. "It isn't about chasing HCAHPS scores; it's about smoothing processes, working together as teams and delivering on ideal care. Patient satisfaction and experience scores have improved as teams and clinical units improved their process of problem solving and focus on ideal care."

In essence, the health system is exploring ways to "improving care delivery across the continuum," says Alan Kaplan, MD, MMM, FACPE, FACHE/ VP and chief medical officer, Iowa Health System and President of Iowa Health Physicians.  In discussions with patients, physicians and nurses "ask if they have the help they need at home, and whether patients receive information on symptoms (about their conditions) to look for after they leave the hospital," Kaplan says.

After those conversations, the hospital compiles data on whether that communication was successful or whether "targets are not achieved or we are trending in the wrong direction," Kaplan adds.

In this month's Health Leaders Media Intelligence report, 54% of health leaders say HCAHPS is not an effective measure of patient experience. Although some health leaders I've spoken to aren't thrilled about HCAHPS, they find that the surveys are effective in pushing hospital systems in the right direction.

HCAHPS are but one of many data points that health systems are measuring for clinical and patient outcomes. As health systems evaluate all of them, they must decipher what is the best fit. 

"We have CMS, and they have certain metrics important to them. When we talk about ACOs (Accountable Care Organizations), each commercial insurer has their own sets of metrics, and then state Medicaid programs may come with their own set of metrics," says Kaplan.

Achieving good outcomes "has been a major focus for us, with all of our internal meetings, the meetings of the executive board and the meetings with community stakeholders," he says. "Ultimately, we need to deliver the service that matches our science."

Fox of Advocate Good Samaritan Hospital says sometimes it's that "moment in time" that makes all the difference in how a patient feels about the hospital experience, including relationships with physicians and nurses.

"For the patient, on average, they spend 3.7 days at a time in a hospital and may interact with 70 people, possibly," he says. "If one employee isn't doing a good job, or a physician, then the patient is going to go away probably with a good experience, but probably not an overwhelmingly great experience."

Joe Cantlupe is a senior editor with HealthLeaders Media Online.
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