Sunday, March 1, 2015

What's in a name?

by Dr. Trina E. Dorrah

Have you ever noticed the reaction you get when you mention the patient experience? Undoubtedly, you’re met with a few providers who demonstrate frustration, anger, and disgust. You may even hear them say that it doesn’t matter how well the doctor treats a patient as long as he or she is competent. These beliefs confuse me, especially when these same providers face their own health crises, then complain about the lack of empathy they, their partner, or child received. Do you notice the irony? When asked to focus on the patient experience, these providers dismiss it. Yet, when their doctors don’t communicate with them or show compassion, they are frustrated.

The truth is, doctors and other health care providers really do care about the patient experience. I think the frustration arises from the connotation associated with the phrase.  For some reason, many providers think of the patient experience as catering to unreasonable demands or ignoring the importance of clinical competence. That’s simply not true. When I think about what the patient experience is and is not, the following list comes to mind.

The patient experience is about…

  • ·      Listening
  • ·      Showing compassion
  • ·      Treating patients as we ourselves would want to be treated
  • ·      Explaining so our patients understand
  • ·      Spending time with our patients
  • ·      Asking for and answering questions
  • ·      Helping to facilitate care
  • ·      Working with our staff to streamline processes
  • ·      Continuing our commitment to maintain clinical competence
  • ·      Practicing according to evidence based standards
  • ·      Taking time to explore patient fears
  • ·      Engaging in collaborative goal setting
  • ·      Discussing difficult issues in a compassionate way

The patient experience is NOT about…

  • ·      Catering to every whim and desire
  • ·      Turning physicians into concierges
  • ·      Choosing treatment options that go against evidence based medicine
  • ·      Buying patients’ loyalty through rewards and perks
  • ·      Refusing to discuss difficult issues
  • ·      Only making recommendations that are pleasing to hear
  • ·      Prescribing unnecessary medications
  • ·      Subjecting ourselves to verbal abuse
  • ·      Devising treatment plans that completely exclude patients/families from the decision making process
  • ·      Creating an environment where one must work within our health care system or know someone who does to have a good patient experience

In the end, I believe if providers have a better understanding of what the patient experience truly is (and what it is not), they’ll be more willing to embrace it. If everyone in health care commits to this goal, doctors, nurses, and providers won’t feel the need to name drop/intervene/call in favors for our loved ones simply to ensure they have a good patient experience.  

Thursday, November 20, 2014

Want to improve your patient experience scores? Don’t forget to “Check the SATS”.

By Dr. Trina E. Dorrah

S = Sit down

A = Avoid medical lingo

T = Teach back

S = Summarize

There are numerous patient experience improvement tips that you can share with your doctors. The problem is, no one can remember that many tips at once. If you want to help your doctors improve the patient experience, less is more. Focus on a few hi-yield tips, and emphasize them frequently.

SATS can help

Encouraging your doctors to “Check the SATS” is one easy way to help your doctors improve the patient experience. It’s practical, catchy, and doable. When done consistently, these 4 tips will go a long way towards helping your doctors focus on behaviors that truly make a difference to their patients.

SATS explained

S = Sit down; encourage your docs to sit at some point during each patient encounter.  This helps your doctor appear more relaxed and accessible. It also increases your patients’ perception of time spent with the doctor.

A = Avoid medical lingo; remind your doctors to explain using clear and simple language. Encourage them to avoid medical terminology unless followed by an explanation. As a physician, I can tell you that we are so used to speaking in medical terminology that we often do not recognize when we do it.

T = Teach back; ask your doctors to utilize the teach-back method to improve their patients’ understanding. The doctor explains the concept to the patient, and the patient explains it back in his or her own words. Your doctor then has the opportunity to clear up any confusion and re-teach as needed.

S = Summarize; your doctors can summarize at various times. After the patient tells his or her story, encourage your doctor to summarize to ensure he or she heard correctly. Your doctor can also use this technique to summarize the diagnoses and treatment plan at the end of the visit.

Next steps

Meet with your doctors now and encourage them to “Check the SATS”. We are all working to improve the patient experience. Providing your doctors with practical tools such as SATS is one way to partner with them to improve your patient experience.  In the end, patients want to be listened to, treated with courtesy and respect, receive clear explanations, and have enough time with their doctor. Having your doctors “Check the SATS” for each patient accomplishes this goal.

Sunday, October 12, 2014

Health Care Lessons…as taught by the Dallas Cowboys Cheerleaders
by Dr. Trina E. Dorrah

I’ll admit it. I like reality TV. In fact, one of my favorite reality TV shows is Dallas Cowboys Cheerleaders: Making the Team. It shows what it takes to become a Dallas Cowboys Cheerleader. Why am I talking about cheerleading in a health care blog? Because the Dallas Cowboys Cheerleaders put more effort into hiring cheerleaders than most health care organizations do in hiring doctors. If you’ve read any of my previous blog posts, you know I spend a lot of my time training doctors on specific things they can do to improve the patient experience. Physician training is a common tactic in health care, but when those efforts fail, health systems spend a lot of resources trying to help their habitually low performing doctors. Lately, I’ve been thinking we should try a different approach. Why not focus more attention on hiring for the patient experience from the start?

How does this relate to the Dallas Cowboys Cheerleaders? In health care, we aspire to hire the best. The Dallas Cowboys Cheerleaders are one of the country’s best professional cheerleading teams, but they didn’t gain this distinction by solely focusing on dance skills. Instead, they have created an audition process that ensures they select cheerleaders who embody the mission and values of the organization. I think health care should follow their lead.

3 hiring tips … taken straight from the Dallas Cowboys Cheerleaders

1.    Redesign your hiring process to produce the results you want.
·      DCC: To become a Dallas Cowboys Cheerleader, you must be able to do more than just dance. The interview process puts applicants through a variety of situations, all designed to ensure candidates have what it takes to uphold the values and vision of the Dallas Cowboys Cheerleaders.

·      Health care: In health care, we are often understaffed, so we fall into the trap of hiring the first competent physician who applies for the job. The problem with this approach is we really don’t know how well they communicate with patients, if they are empathetic, or if they connect well with others. Health care needs doctors who are excellent clinicians and patient experience advocates. Unfortunately, we’re really good at assessing technical competence, but we’re lousy at assessing the more subtle qualities that make or break a patient’s experience.

2.    Focus on your core values.
·      DCC: In order to become a Dallas Cowboys Cheerleader, you have to repeatedly show the judges that you posses the values and characteristics they desire. Because the interview process spans several weeks, it’s easy to know who is genuine and who is simply faking it.

·      Health care: We all have a code of conduct we want our doctors to adhere to and we all have a set of core values we expect them to possess. However, few health care systems have a reliable way to gauge during the interview process if a doctor can or will live up to these standards. Even when we ask, we take the doctor’s word for it without ever verifying if his or her prior actions demonstrate hostility towards improving the patient experience.

3.    Assess communication skills.
·      DCC: To become a Dallas Cowboys Cheerleader, you must demonstrate that you are a good communicator by performing well in a Q&A interview session. If an applicant fails to communicate effectively, she gets cut.

·      Health care: In health care, our interview process does assess general communication skills. However, communicating to an interviewer is entirely different than the communication that is required for effective patient care. Being able to communicate things in a way patients understand is critical for providing a good patient experience, and health care currently does little to evaluate this skill when hiring.

Now that I’ve mentioned some of what’s missing from health care’s current hiring process, let me explain what I think we should do to change it. Yet again, the Dallas Cowboys Cheerleaders have already figured out the solution.

“Assess applicants’ skills before offering the job.”

What does it take to be a Dallas Cowboys Cheerleaders? Their website outlines the following steps: 1) Complete the application, 2) Preliminary Audition, 3) Semi-Final Audition, 4) Personal Interview, 5) Written Test, 6) Final Talent Auditions, and 7) Complete training camp. Notice how many steps I listed - seven! The last step alone takes several weeks. In health care, most interviews last 1-2 days max, and although applicants speak with several interviewers, they are rarely asked to demonstrate one of the most important things – their commitment to the patient experience.

3 ways to assess patient experience skills before offering the job

1.     Review prior patient experience survey results – virtually every health care organization measures the patient experience. Review your applicant’s prior results. If you’re planning to hire a physician who consistently scored at the bottom of his or her peer group, or who consistently had more patient complaints, consider hiring someone else.

2.     Focus on the patient experience throughout the hiring process – this should begin as soon as a physician submits an application. For example, put a video on your website explaining your organizations’ commitment to the patient experience, and require applicants to review it before they can submit an application. Likewise, the patient experience should be discussed throughout the interview process.

3.     Interact with patients – before you make an offer to a new doctor, observe his or her interactions with patients. You can work with your legal department to use real patients under the direct supervision of a staff physician. You can use volunteers, members from a patient advisory council, or paid secret shoppers. The point isn’t to judge the doctor’s diagnostic or technical skills, but to observe their body language, emotional intelligence, and communication skills.

In the end, not every physician will be a good fit for your organization. By learning to hire better, you can hire physicians who embrace your organization’s commitment to the patient experience. This is much easier than trying to correct behavior after the fact. What do you think?

Dr. Trina E. Dorrah (@drtrinadorrah) is an internal medicine physician/hospitalist and the author of Physician’s Guide to Surviving CGCAHPS & HCAHPS. She can be reached through

Saturday, September 13, 2014

Me first! behavior: why health care turns patients from nice to nasty

by Dr. Trina E. Dorrah

What is Me first! behavior?

Recently, I read an article in USA Today by Christopher Elliott entitled, “Me first! Why is selfish behavior on the rise?” When I saw the title, I immediately thought, this article must be about health care. In fact, my friend and I were just discussing the fact that since we initially became physicians 10+ years ago, we’ve seen a definite increase in selfish behavior among patients and families. Who’s to blame? The health care industry, whose increasing prices and cost-shifting strategies frustrate so many? Doctors and health care professionals, who have lost some of the public’s respect and trust over the years? Or do we blame the patients themselves, and attribute it to unrealistic expectations fueled by the increased focus on patient engagement?

Before you think, “She’s just a doctor who cannot handle having an empowered patient,” let me stop you right there. In addition to being a physician, I am a strong advocate for improving the patient experience. When I talk about selfish, Me first! behavior, I’m not talking about the knowledgeable patient who plays an active role in his or her health. Nor am I talking about patients who prefer to have a collaborative relationship with their doctor. Most physicians agree – these are the patients we love taking care of because they are motivated to work with us to improve their health.

Me first! behavior describes patients who act as if their illness takes precedence above anything else their doctor is doing or any other patient their doctor is seeing. Patients or families who display Me first! behavior are often frustrated, and as this frustration grows, it turns to anger. Unfortunately, the doctors and medical staff are on the receiving end of this anger. This leads to a situation where the very people who have dedicated their lives to helping patients and families through illness are the ones being yelled at and disrespected.

How did we get to this point, and what can be done to correct it? Interestingly, Christopher Elliott’s article was about selfishness among airline travelers, but in my opinion, his observations perfectly explain why health care has seen a similar increase in Me first! behavior.

Why the increase in Me first! behavior?

1.     Selfish behavior flares during times of high anxiety. When people are stressed, they lapse into survival mode, and they primarily focus on themselves.
o   Being ill, especially if you are hospitalized, is one of the most stressful experiences in life. In addition to their normal stressors, patients and families are also dealing with the added stress and uncertainty of illness. This increased stress causes many people to revert to survival mode, where they are incapable of caring about anyone or anything other than themselves. As one of my attending physicians told me in residency, “Trina, you must always remember - the people we care for are not at their best.”

2.     The industry adds stress through surprise fees and unanticipated hassles.
o   As employers decrease their health insurance contributions, patients are being asked to pay a higher portion of the cost. In addition, many clinics and hospitals have become more aggressive in terms of bill collection, and they require higher payments up front. Most patients are not used to this model of cost-sharing, so being asked to increase the amount for which they are financially responsible is a huge stressor.

3.     Customers are outside of their comfort zones.
o   No matter how much patients consult the Internet, navigating through the health care system is difficult. Delays, medical complexity, and communication barriers are only some of the factors that make health care frustrating. Even when patients are engaged in their care, the doctor is still the medical expert. In fact, patients educate themselves not to annoy their provider, but in part to ease the anxiety that comes from being in an unfamiliar situation.

4.     Customers often have unrealistic expectations.
o   When patients enter our health care system, they do not just compare us to other health care organizations. Patients compare us to any other business they’ve interacted with. Our society has evolved, and customers increasingly have the ability to make their opinion known. However, health care is different in some very important ways from other service industries. For example, in the business world, the customer is always right. In health care, the patient cannot always be right, because what the patient wants may lead to illness, injury, or even death. It is up to the medical community to educate our patients and help them set realistic expectations.

Now that we know the causes, what can health care providers do to prevent patients from engaging in Me first! behavior?

What can health care providers do to prevent Me first! behavior?

1.     Communicate – more than anything, I believe frustration arises from a lack of knowledge and understanding. When patients feel like they are not listened to or communicated with, they become defensive. They feel like they have to protect themselves above all others, and they slip into the destructive patterns of Me first! behavior. Through communication, patients feel that they know what is going on, and their anxiety is decreased. One easy way for doctors to improve communication is to end the visit by asking patients for questions. This gives patients the opportunity to clarify anything they do not understand.

2.     Engage in collaborate relationships – when patients feel like their health care provider values their opinion, they have a better patient experience. Even though the doctor has the medical expertise, patient input is vital to reaching the collective goal of caring for that patient. One way to improve collaboration is to ask patients their one or two top concerns that they want to addressed, then have the doctor address those concerns that matter most to the patient before ending the visit.

3.     Educate our patients – patients need to know what to expect so they can have realistic expectations. A great deal of stress and frustration can be averted when patients know, and education helps patients to better prepare for their health care experience. One easy way to improve education is to engage patients with technology. Numerous medical apps and websites exist that can be used to increase patients’ education and understanding about their illness.

4.     Show them we care – in the end, being compassionate and showing patients we care goes a long way toward creating a positive patient experience. When patients know their doctors truly care about them, they are much more willing to deal with the inevitable stress that illness brings. One of the best ways to demonstrate empathy is to simply stop and listen. Ask patients how they are doing. Find out what’s going on in their lives. Patients know their doctors are busy and pressed for time, but when you take an extra moment to show you care, you’ll be surprised by how quickly Me first! behavior disappears.

Dr. Trina E. Dorrah is an internal medicine physician/hospitalist and the author of Physician's Guide to Surviving CGCAHPS & HCAHPS. She can be reached on Twitter @drtrinadorrah or through her website