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A ROADMAP TO CREATING THE IDEAL AMBULATORY PATIENT AND FAMILY EXPERIENCE
UHC CONFERENCE: PREPARING ACADEMIC MEDICAL CENTERS FOR CG-CAHPS
JULY 11, 2014
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PRESENTERS
S. Scott Davis Jr., M.D. Alan Dubovsky Redge Hanna
Associate Professor, Director, Corporate Director,
General Surgery Customer & Physician Engagement Service Performance
Emory University School of Medicine Emory Clinic Emory Healthcare
emoryhealthcare.org
AGENDA
• Organizational Overview
• Emory Healthcare’s Patient Experience
• Emory Clinic’s Patient Experience Story:
• Case Study: General Surgery Improvements
• A Physician’s Perspective On The Patient Experience
2011:
The Patient Experience Challenge
2012:
Creating The Ideal Service
Team
2013:
Establishing Meaningful
Service Programs
2014:
Accelerating Service
Improvements
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DONABEDIAN EQUATION
(THE EMORY VERSION)
S + P + C = O
Structure + Process + Culture = Outcomes
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2009:
Defining Our New Culture
2010:
Creating The Ideal
Team Conduct
2011:
Establishing Accountable
Metrics
2012:
Accelerating Metrics
Improvements
2013:
Establishing The Ideal
Brand
2014:
Accelerating The Ideal
Brand
ALIGNING OUR CULTURE
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2011:
The Patient Experience Challenge
2012:
Creating The Ideal Service Team
2013:
Establishing Meaningful Service
Programs
2014:
Accelerating Service
Improvements
emoryhealthcare.org
2011:
The Patient Experience Challenge
2012:
Creating The Ideal Service
Team
2013:
Establishing Meaningful
Service Programs
2014:
Accelerating Service
Improvements
Observations; Benchmarking;
Planning Discussions
Focus Groups With Customers
Pilot Phase
Finalized Structure
NEED NEW ROLE
Greater line of sight engagement with staff
SERVICE AMBASSADOR
More concise and consistent patient feedback
PATIENT FEEDBACK ANALYST
Dedicated service training and coaching
SERVICE TRAINING SPECIALIST
2011:
The Patient Experience Challenge
2012:
Creating The Ideal Service Team
2013:
Establishing Meaningful Service
Programs
2014:
Accelerating Service Improvements
emoryhealthcare.org
PATIENT EXPERIENCE AT EMORY
Emory Healthcare
Medical Practice Inpatient
Nursing-Led Efforts
Service Improvement:
- Ambassadors - Patient Advocacy - Service Training - PSAT
Emory Clinic Department of Service Management
Patient Experience:
- Volunteers - Guest Services
- Access Emory/Emory International
Patient Feedback:
- Press Ganey - STARS Patient Complaint & Grievances - Secret Shopping
2011:
The Patient Experience Challenge
2012:
Creating The Ideal Service Team
2013:
Establishing Meaningful Service
Programs
2014:
Accelerating Service Improvements
A New Welcome
Guest Services Improvements
Emory Clinic Volunteers Service Ambassadors
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PATIENT FEEDBACK IMPROVEMENTS
1. Improved Survey Process:
2011 2013
46 question survey 29 question survey
Mailed only Electronic only
6-8 week turnaround time
from visit to survey return
Average turnaround time
= 48 hours
Fewer than 3% of patients
able to complete a survey All patients eligible
Fewer than 25 responses per
site/month
300% increase in returned
surveys
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PATIENT FEEDBACK IMPROVEMENTS
2. Ensured Consistent, Transparent Data:
a. Conducted thorough Clinic-Wide education
b. Centralized all reporting
c. Updated reports (Clinic-Wide, Departmental, Role-Specific)
d. Addition of weekly comments report
3. Updated Goal Setting:
a. Selected UHC benchmarking group across Emory Healthcare
b. Simple Green or Red performance indicators
4. Began CG-CAHPS surveys in 2013 to establish a baseline
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2011:
The Patient Experience Challenge
2012:
Creating The Ideal Service
Team
2013:
Establishing Meaningful
Service Programs
2014:
Accelerating Service
Improvements
emoryhealthcare.org
ACCELERATING AMBULATORY PATIENT
EXPERIENCE IMPROVEMENTS
Step 1 – Focusing On Our Priorities:
a. Ease Of Scheduling
b. Ease Of Getting Clinic On The Phone
c. Wait Time At Clinic
d. Sensitivity To Patient’s Needs
Step 2 - Targeting The High Opportunity Departments
Step 3 – November 2012: Launch Of PSAT (Patient Satisfaction Acceleration Team)
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PSAT
1. Modeled after Emory’s Quality Acceleration Team.
2. Meets every 2 weeks, for 2 hours, with all key
members in attendance.
3. Benchmarking is critical.
4. Constant use of data to drive discussions and
decisions.
5. Leave every meeting with decisions and specific
action items.
6. Track all tests of change to establish best practice.
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EMORY CLINIC’S PATIENT SATISFACTION SUCCESS STORY
87.7 87.9
88.7
90.0 90.3
90.7 90.4
90.9 91.1
86
87
88
89
90
91
92
2006 2007 2008 2009 2010 2011 2012 2013 2014TD
Medical Practice Mean Score Trend: 2006 - 2014
To the 75th Percentile… and Beyond!
From the 29th
Percentile…
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THE ROADMAP TO THE IDEAL
AMBULATORY PATIENT AND FAMILY
EXPERIENCE
Create The Ideal Service Team
Establish Meaningful
Service Programs
Accelerate Service
Improvements
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CASE STUDY:
PATIENT EXPERIENCE IMPROVEMENTS:
EMORY CLINIC GENERAL SURGERY
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GENERAL SURGERY IN 2012
89.3 88.6
88.3
87
88
89
90
FY10 FY11 FY12
General Surgery Medical Practice Mean Score
1. Downward trend in patient satisfaction. 2. Lack of engagement from physicians and staff. 3. Consistent areas of concern from patient feedback:
a. Promptness in returning calls; b. Information about delays; c. Sensitivity to patient’s needs.
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2013:
1. New administrative leadership.
2. Increase in physician engagement.
3. Volunteered to join inaugural PSAT group.
4. Formed section-based PSAT team.
= Renewed focus on
patient experience improvements
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GENERAL SURGERY INITIATIVES
Ease Of Scheduling:
• Lag Time Reduction (goal of reducing from over 20
days to 10 days). Tests of change include:
– Never Say No barriers removed.
– Master schedule simplification- rules eliminated
preventing barriers to appointment.
– Overbooking opportunities.
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GENERAL SURGERY INITIATIVES
Ease Of Getting Clinic On The Phone:
• Medical Secretary Direct Contact:
– Return patients are given direct phone numbers to Medical Secretaries.
– No voice mail allowed, overflow routes to call center.
• Same Time Implementation:
– Tool used by clinical staff and call center to improve communication.
• Live Nurse Call Handling:
– Phone tree option added to speak to a member of the care team: agent routes directly to nurses in clinic.
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GENERAL SURGERY INITIATIVES
Wait Time At Clinic:
• First Time Starts:
– Tracked all first time starts.
– Data presented to faculty at Division meetings.
• Master Schedule Template changes:
– Schedule optimized for accurate length of visit
by type.
– Time study analysis in progress- breaking down
parts of visit.
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GENERAL SURGERY INITIATIVES
Sensitivity To Patient’s Needs: • Forms And Posters For ‘Questions On Your Visit’.
• Profile screens placed in main lobby.
– Physician profiles;
– Administrator profiles.
• Service Management training with clinic staff.
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GENERAL SURGERY IMPROVEMENTS
89.3 88.6
88.3
89.6
91.7
87
88
89
90
91
92
FY10 FY11 FY12 FY13 FY14TD
General Surgery Medical Practice Mean Score
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A PHYSICIAN PERSPECTIVE ON THE
PATIENT EXPERIENCE
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Quality
Cost
Value
PHYSICIAN PERSPECTIVE
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PHYSICIAN PERSPECTIVE
• Satisfaction surveys generally distrusted:
– Survey delivery/response : • Low response rates
• Selection bias in responders
• Low sample size
• Narrow effective measurement range
– Higher scores associated with worse patient outcomes and increased cost. • Fenton, JJ. Arch Int Med. Mar 2012
– Individual responsibility (personal and financial) for intangible factors.
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Value
Medical Care
Administrative Service
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INCREASING VALUE LEADING TO
IMPROVED PATIENT SATISFACTION
SCORES • Better physician communication.
• Optimized scheduling:
– Wait times highly cited complaint, balance against productivity
• Technology:
– Medical records;
– Phone systems;
– Patient reminders;
– Guided scheduling;
– Communication alternative to phones.
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PHYSICIAN PERSPECTIVE SUMMARY
• We are not making Teslas or iPads. We have bad news to deliver.
• Most interested in delivering evidence based care.
• Current patient satisfaction tools are:
– Created to increase volume;
– Not evidence based;
– Blunt instruments with low sensitivity and operational challenges.
• Easier to over treat than correct operational issues out of our control.
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PHYSICIAN PERSPECTIVE SUMMARY
• Patients – our customers – deserve a voice.
• Surveys are here to stay.
• There is useful information to be found in results.
• Physicians need to be engaged in the process to
help mold it with our interests in mind.
