By Hugh Greeley and Mike Greeley
This is an 11-week series on both improving and maintaining great patient satisfaction with physician services. MSPs and those responsible for the growing numbers of employed physicians will find that relatively simple actions will positively affect patient satisfaction and thus their facilities’ Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) scores, which we now know affects reimbursement. Those not completely familiar with the HCAHPS program should review the material available by clicking here.
Those responsible in whole or in part for the hospital’s HCAHPS program might find Hugh and Mike Greeley’s top ten tips (plus their addendum on persistence) useful and easily implementable. Hugh and Mike Greeley first presented this material at a Press Ganey conference in Chicago some years ago. The tips have proven valuable in many organizations and have assisted medical staffs in markedly improving both patient satisfaction in general and satisfaction with certain “problem docs” in particular. Both Hugh and his brother Mike may be reached at the Digest.
Tips published to date:
1) SCRIPTING WORKS. SUCCESSFUL PERFORMERS HAVE DEMONSTRATED YEAR IN AND YEAR OUT THAT SCRIPTING WORKS!
Hospital staff members can be taught how to help patients establish positive perceptions about the medical staff and hospital.
Here are just a few examples of ways to help your staff promote the positive behaviors/attributes of your medical staff:
A. In the ER, the nurse can say, “Dr. Jones will be with you soon. She’s really great with kids”
B. On the patient care unit, the aide or nurse can say, “I see Dr. Peterson will be stopping by for your cardiology consult. He’s very thorough.”
C. In radiology, where invasive procedures are performed, the technologist can say, “Dr. Hyde will be right here. You’ll find him to be very sensitive about properly addressing any pain you may experience during the procedure.”
D. Even the “grumpiest” docs can get some “good press,” such as, “Oh, I see Dr. Greeley is your doctor. He has a very large practice here. Many people trust their care to him. He can be a little abrupt, but when you get to know him, he’s great.”
Implementation hint: In-service is necessary in order to accomplish this step. Role play, have fun, run the drill many times, suggest that this technique be reinforced during the shift change
2) DON’T ASSUME YOUR PHYSICIANS KNOW “THIS STUFF.” TEACH, REINFORCE & RECOGNIZE.
Physicians should know that they can easily improve patient satisfaction; after all, the test is OPEN BOOK—you know what questions your patients will be asked on the survey.
A. Here are the standard physician questions:
1) Time your physician spent with you
2) Physician concern for your questions/worries
3) How well your physician kept you informed
4) Friendliness/courtesy of your physician
5) Skill of your physician
Make sure your medical staff members know on what questions they are being rated.
Post them (or your own questions) in the doctors’ lounge, in the surgery lounge, in the cath lab dictation area, in the medical records dictation area . . . everywhere they might be seen by members of the staff.
B. Perhaps of greater help would be to print the questions on a business-size card and give one to each physician. Leave a stack in the doctors’ lounge (providing you still have one).
C. Share the “question specific” advice that organizations like Press Ganey make available on their websites with all of your physicians. Send it to them one small bit at a time, periodically, so they feel you are trying to help them. Implementation hints: DO NOT overload physicians. It is far better to make this program continuous and ongoing. Loading up physicians with information in the beginning will only create difficulty later on. Use your patient satisfaction information as a source of specialty-specific feedback for targeted physicians on staff.
D. Nurse managers, medical directors, administrators and CEOs absolutely should be making rounds on a regular basis to accomplish many goals, one of which is to collect positive stories about physician interactions so that they then can send these physicians a hand-written note letting them know the difference they have made with their patients! This is no different than your acknowledging and celebrating (over and over) your child’s first learning to use the toilet . . . or first learning to routinely FLUSH the toilet . . . or first routinely remembering to bring the garbage cans in from the street (the ones you put out before going to the office in the morning) . . . or first learning to say “please” or “thank you.” Positive reinforcement works, and it works with physicians.
Hint: Research has demonstrated that, for every piece of negative feedback, there should be five pieces of positive feedback.
3) BE THE BROKEN RECORD.
At (nearly) every executive committee meeting, service line or quarterly medical staff meeting, make sure someone is reviewing the HCAHPS results of the medical staff with them. Keep them informed of how they are performing. Have fun with it. Break it into “medicine physician” results vs. “surgeon” results. (There will be a difference. Who do you think generally scores better in our experience? Surgeons!)
Medical staff members who never hear about how they may be performing have no reason even to consider (let alone implement) changes in their bedside behavior. In short, you have to talk, talk, talk about this stuff and let members of your medical staff know that you are observing, that it’s important, and that right here, on your own medical staff, you have some of the highest rated physicians in the country. Every medical staff will have some.
4) PUBLICLY RECOGNIZE YOUR “TOP RATED” DOCS.
After recognizing them at a medical staff meeting (for performing at or above the 90th percentile), get all six of your top rated docs together and print their pictures in the local newspaper and/or your hospital newsletter with some recognition about their national ranking. This really will get the notice of the remainder of physicians under your direction or on your medical staff. Then do the same with your ED group and maybe even your anesthesia group. In other words, predispose your public—prior to its ever needing your hospital or ED services—to believe that you have some of the best-rated physicians in the country, as rated by your hospital’s patients. Put this information on your DocFinder website.
Implementation hint: It will be far more effective if you publicize the success of a few physicians periodically than do so for the entire staff at once. Create interest in the issue and promote a little professional competition.
5) ONE PATIENT REPRESENTATIVE CAN DO GREAT THINGS.
Establish the position of “patient representative”. Organize it so he or she visits every new admission every day of the week (Saturdays and Sundays are optional). The representative absolutely can leverage the reputation of the medical staff and give some impartial, non-threatening advice to your physicians about what worries/scares/angers their patients. The relationships these staff members can create are—with patients, staff and physicians—well worth the hourly wage you pay them. The typical hospital with an average daily census of 150 patients will be well served with only one FTE employee!
Add an additional patient representative if you have a lot of admits through your ED. Not only can this staff member help “manage” issues that the clinical staff doesn’t have time to resolve, he or she can visit patients who were admitted through the ED and may have had a difficult experience. Think of the impact an ED patient representative has when he/she shows up the next day in the patient’s inpatient room and says, “Good morning, my name is Linda. I don’t know if you remember me, but I was with you and your family last night in the emergency department and I just wanted to stop by and see how you are doing.”
Having an employee in this position will be seen by your hospital and ED staff, as well as by your physicians, as a benefit for them. You’ll know these representatives have made an impact when ED physicians and nurses start calling them to come “help with a patient.”
6) PROVIDE YOUR DOCS WITH THEIR SPECIFIC HCAHPS AND SATISFACTION SURVEY RANKING.
Make sure you provide your medical staff with at least quarterly reports of how they score and rank on the physician questions of the survey. Be certain to provide the other scores and ranks for all other members of the section and staff, but omit the names of the other physicians—just provide their comparative data. Most physicians are hungry to know how they compare with their peers. This can be an enormously powerful and motivating strategy. They will react to it, just as they did when their medical school professor posted the scores on an important exam for all the students to see. Understand that this tactic also will cause some dissent and objection among a minority of your staff.
Implementation hints: Put each physician’s “doctor number” on your satisfaction survey labels so your system can begin to capture physician-specific information. Periodically send physician ratings to particular physicians with a “thought you would be proud to see what your patients think” hand-written note attached. Even better, figure out how to compliment a physician’s husband or wife on the work of his or her spouse. Consider sending these notes to their homes.
7) IT’S REALLY ALL ABOUT CULTURE.
Let your organization know that you are not trying to improve “scores” . . . you’re trying to improve your culture (which will improve your scores). Service improvement, if you want it to stick, is about improving the culture. Focus on the importance and power of relationships, not slogans, buttons, or gimmicks, but long-term strategies that put people first and raise people’s self-esteem and sense of self-worth.
8) IMPROVE EMPLOYEE and PHYSICIAN MORALE.
Press Ganey can tell you, and the Health Care Advisory Board, summarized nicely that there is a direct link between patient satisfaction and employee/physician satisfaction. There is little question in our minds that there is a similar direct link between patients’ satisfaction with the hospital staff and how satisfied employees/physicians feel about working at your hospital.
9) ASK PHYSICIANS TO HELP YOU!
Personally approach just a few physicians in your section or service line whom you feel may have the interest to meet periodically (buy them lunch!) to review the overall results for the medical staff. This group can become your “physician customer service task force”. When you present new strategies or initiatives that you would like the medical executive committee to endorse or approve, you honestly can say “the recommendations from our physician customer service task force include the following….” A side benefit for the physicians who become task force members is that they will get to see the satisfaction scores for all of their peers. After all, this group must know what they are up against if they are going to be able to recommend solutions to help their peers improve their performance.
10) WHEN ALL ELSE FAILS, DON’T BLAME YOUR PHYSICIANS.
If all else “fails” and you just can’t seem to generate interest, excitement or attentiveness to a service initiative or movement among your medical staff, don’t fret! But don’t use this reality as a serious justification (or excuse) to explain why your hospital’s overall percentile rank is lagging. As many hospitals have demonstrated, you clearly can achieve impressive percentile rankings, even without consistently impressive physician scores. However, great physician satisfaction with the hospital will help, as will great patient satisfaction with physicians.
Remember: The primary key to all of the above is
P = Persistence. You must work constantly to achieve the culture you desire.
E = Energy. This is not a simple task. You must recognize that it will take effort and much more than mere exhortations.
R = Resistance. Expect that some of your physicians will resist all efforts to encourage them to change their behavior. You must determine what represents sufficient “cause” for them personally.
S = Sincerity. This is a must. Your job is to be sincere about this effort. You must practice what you preach, and you must post your score, even if it is not as high as you wish.
I = Ingenuity. At times you must invent ingenious methods to encourage continuing efforts. One physician leader in Hanford, California made a habit of sending a short note with a single rose to physicians’ spouses, thanking them for their husband’s or wife’s contribution to a great hospital and medical community.
S = Shout. Proclaim your successes from the rooftops. Publish your successes. Thank the staff (both physicians and others).
T = Tangible. You must make your recommendations to your staff members as direct and tangible as possible. Simply encouraging them to treat your patients nicely is not nearly as powerful as suggesting constantly that they practice the 5 Basic Rules:
- Stand, or better yet, sit at the head of the bed.
- Make eye contact with the patient.
- Touch the patient.
- Let patients know that you care about them and their families.
- Before you leave, ask the patient if there is anything you might do to make him or her more comfortable. (Say, “I have time. Right now you are my most important patient.”)
Note: This is easy for surgeons, but tough for hospitalists. However, it is not impossible!
E = Enthusiasm. If you are unable to muster up genuine enthusiasm for this effort, deputize another champion to carry the day for you.
N = Notifications. Notifications are vital. Put a column addressing the “HCAHPS Tip of the Month” in your medical staff “in touch” newsletter and send out short notes about successes and near misses. (“Hey Bill, I noticed that you just missed the 90th percentile this quarter. Keep up the good work.”)
C = Continuous. Achieving great HCAHPS or patient satisfaction scores is not a sprint or a high jump or a one night play. It is series of triathlons, or a long-running Broadway hit. It needs a coach or director, a great script, terrific actors and a supportive crew, practice and a full commitment. (You can almost hear the applause!)
E = Empathy. You must have empathy for those with whom you are working and the patients with whom they are working. Without this, all efforts will be viewed as shallow attempts just to improve scores, a very trivial matter.
The final word: What gets your attention will get their attention. If this is not part of your continuous improvement philosophy, it will not be high on your staff’s radar.
If you have input into the bonus structure of those physicians who have opted for employment, make sure that HCAHPS score success is a big contributor to their quarterly bonuses.
Mike Greeley is Vice President of Operations at the Lexington Medical Center in West Columbia, SC.