University of Utah Health, a patient experience transparency pioneer, has raised its national patient satisfaction score from the bottom to the top quintile.
University of Utah Health used data sharing both internally and externally to lift its Press Ganey patient experience ranking from the 18th percentile in 2008 to the 84th percentile last year.
"We have more compassionate, connected care for patients, and a more satisfying workplace for providers where they get feedback from patients," says Mari Ransco, the Salt Lake City-based health system's director of patient experience.
She attributes the long-term gain to three milestones dating back 15 years:
- 2003: Patient experience data was shared internally with clinic leaders
- 2008: Patient experience data was shared internally with physicians
- 2012: Patient experience data was shared with the public on the UUH website
When the health system launched the transparency initiative in 2003, patient experience data shared with clinics revealed relatively basic, but extremely important, shortcomings, Ransco says.
The data showed patients were concerned about long wait times in waiting rooms and exam rooms, subpar courtesy at clinic front desks, and difficulty making an appointment. Addressing shortcomings at the clinic level was relatively easy compared to tackling issues at the physician level, she says.
"We started with the things that were easy—bureaucratic and system process failures."
The sharing of patient satisfaction data with physicians that started in 2008 was rolled out in two phases.
"Initially, it was anonymous, but you could see how your peers scored relative to you," she says. "Eventually, it was unblinded after a couple of years."
A key element of the physician transparency effort was a higher degree of access to patient experience data, Ransco says. For inpatient services, the health system started collecting data at the patient level that could be attributed to a particular physician.
The data was collected with Press Ganey medical practice surveys. The surveys were mailed to patients after their visits and included a visit identifier that tied the data to the health system's electronic medical record, which matched patients with specific clinicians.
Publishing patient reviews online
The decision to publish patient experience data and reviews online in 2012 was a giant leap for transparency at UUH, which posted $1.67 billion in total operating revenue for the fiscal year ending June 30, 2016.
Physicians were skeptical about making the information readily available to the public, Ransco says.
"It was very hard. Ultimately, we had a strong leader who pushed it, supported it, and believed it was in the best interest of patients and healthcare in general," she says.
Vivian Lee, MD, PhD, the UUH senior vice president for health sciences, has been a crucial transparency champion at the organization.
In addition to strong leadership, many UUH physicians were open to sharing patient experience data online because the data had been shared with growing intensity internally for a decade.
An external factor also helped physicians embrace publishing UUH-generated patient reviews online, she says.
"There were many other websites—Healthgrades and Vitals—that were publishing one or two patient comments about our physicians that were negative, and it was detrimental to those physicians' reputations."
Just as in 2008, new access to a wealth of data was a key factor in the decision to publish patient experience data online, Ransco says. In 2011, the health system pioneered Press Ganey's all-electronic survey, which generated more data at a faster pace.
Today, UUH receives about 3,000 patient experience surveys electronically per week, and the health system publishes both positive and negative reviews.
"Patients are typically satisfied with their healthcare experience," she says. "And when they don't have something positive to say, you can put that online because people are savvy about what they see online. It builds trust."
The health system has "exclusion criteria" that disqualify some reviews for publication online. These criteria include:
- Reviews that reveal the identity of patients
- Reviews that question a diagnosis or prescribed medications
- Patients who criticize clinicians who are not their providers
For physicians who oppose reviews that appear online, there is an arbitration process to determine whether the reviews should be removed. Members of the arbitration panel are medical providers.
Lessons learned
Commitment to patient experience transparency is an ingrained value rather than a matter of employee training, Ransco says.
"We offer training when people request it and when people want it, but elevating patient experience has really been a cultural shift, with pressure within departments and within clinics that this is really something that is important to everybody."
At UUH, strong physician leadership has helped cement the culture change, she says.
"We have had a series of physician leaders who have talked about this authentically [and] not as a way to earn more market share, [or] to improve the overall standing of the university. They have shown what it means to them personally and how it fits with why they chose to go into medicine."
Christopher Cheney is the CMO editor at HealthLeaders.