Management: Vital Role
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Written by Matt Bolch   
Sunday, 01 November 2009
Management: Vital Role
For superior patient satisfaction scores, every factor from housekeeping to care coordination must be spot on—and that includes the physician-patient relationship.
Increasingly, a quality outcome isn’t enough to trigger a high patient satisfaction rating. Patient expectations are higher than ever and expected to further increase during the next decade.

The advent of consumer-directed healthcare options, health savings accounts, walk-in clinics, and other innovations have put more power in the hands of consumers, and they will no longer tolerate business as usual. Hospitals are facing increased competition, vying for the same pool of patients in a geographic area who can compare quality ratings and prices for many tests and procedures on the Internet.

To increase satisfaction ratings, hospital executives are exploring all options, including engaging physicians to enhance the patient experience, the subject of a white paper in the winter 2009 edition of “Journal of The Center for Health Innovation,” produced by Noblis.

“Hospitals are getting better every day in terms of clinical quality, but patient satisfaction is not as far along,” said Kathy Sullivan Clark, national practice director for strategy in Noblis’ Center for Health Innovation. Clark co-wrote the article, “Engaging Physicians to Enhance the Patient Experience,” with Susanna Krentz, director of private healthcare at the nonprofit, which uses science, technology, and strategy to serve the public good.

Beyond the clinical
Delivering a superior patient experience requires effort on the clinical side to improve quality and on the customer service side to increase patient satisfaction. Of course, physician engagement mainly has been on quality side through the adoption of evidence-based practice standards, safety initiatives, and such technology enablers as computerized physician order entry and electronic medical records.

But since the interpersonal nature of the doctor/patient relationship is a key factor in satisfaction, physicians play a vital role in the overall experience, whether or not they consider it a priority. According to the article, however, physicians often view patient service satisfaction as the domain of facilities, IT, administration, nursing, and other facets of the healthcare delivery system that are beyond their control.
“Outcome and satisfaction are often linked, with those who are more satisfied being more engaged in the healing process,” Clark said. “To engage physicians in the satisfaction process, it has to be made meaningful to them.”

Krentz and Clark identify six factors that play essential roles in patient service satisfaction, everything from hospitality aspects to clinical care not related to overall outcome:

  • Access. Patients’ ability to obtain clinical services when and where they want them.
  • Look and feel. The character of the physical environment and the overall ambiance of the organization.
  • Bedside. The patient experience in the bed, chair, exam table, or wherever they receive care.
  • Coordination. How care steps and activities are coordinated for the patient.
  • Communication. The caliber of the communication a patient experiences during a care episode.
  • Hassle factor. The degree of inconvenience a patient experiences in obtaining needed care.

Six lessons to increase engagement
Krentz and Clark outline six lessons hospitals can adopt to engage physicians in the patient care experience. The first is to employ data to show the value of patient satisfaction.

For quality measures, it’s easier to get buy-in from physicians because they can look at empirical evidence of how one treatment works against others. For a more nebulous concept such as patient satisfaction, empirical data can be hard to come by. Fortunately, the Centers for Medicare and Medicaid Services Hospital Consumer Assessment of Healthcare Providers and Systems (http://bit.ly/2YUPWy) provides a good starting point in the evidence-gathering process.

The HCAHPS survey is composed of 27 items: 18 substantive items that encompass critical aspects of the hospital experience (communication with doctors, communication with nurses, responsiveness of hospital staff, cleanliness and quietness of hospital environment, pain management, communication about medicines, discharge information, overall rating of hospital, and recommendation of hospital); four items to skip patients to appropriate questions; three items to adjust for the mix of patients across hospitals; and two items to support reports mandated by Congress.

“If you want to get people ready for change, it has to be made meaningful to them,” Clark said. “You have to make a compelling case, so the data piece is incredibly important.” Individual physicians can be made aware of the care received by one of their patients to make the situation personal, she noted.

Another idea is to enlist the help of a few physician champions who enhance the patient experience in their areas and share the results. In settings where hospitalists are used, they can be an ideal starting place. The third is to be specific about the desired changes. Generic calls to improve patient satisfaction likely will fall on deaf ears. Many hospitals have taken to using coaching programs, teaching physicians to ask certain open-ended questions to address the patient perception that physicians do not
listen to them.

Lesson four centers on the role that hospitals must play to effect meaningful change. One hospital that wanted to encourage physicians to spend more time communicating with patients discovered that many patient rooms had no place for physicians to sit. Adding chairs solved the problem.

Hospitals must, of course, realize that physicians form only one part of the patient experience. Interactions with nurses and other caregivers, food service, housekeeping, and the physical plant all shape perceptions.

Finally, savvy hospitals embrace both clinical outcomes and patient satisfaction as equally important to a facility’s continued success. Many meaningful changes can be relatively simple
to make while having a large impact on satisfaction.    

“The most successful organizations take a holistic view of engagement,” Clark said. “They don’t do it to engage physicians only; they recognize that many things have to be done and that everyone needs to do his/her part.”

Matt Bolch, This e-mail address is being protected from spam bots, you need JavaScript enabled to view it , is a freelance writer based in Atlanta.
 
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