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

By Dr. Trina E. Dorrah     http://www.drtrinadorrah.com

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.

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 www.drtrinadorrah.com.

“Doc, can I ask you one more thing?”

These words are classic symptoms for those patients suffering from the “One More Thing” syndrome. We’ve all been there. The visit has ended, your hand is on the doorknob, and you’re about to leave the room. Precisely at that moment, your patient stops you and says he has “one more thing” to discuss. You think to yourself, No! I almost made it out of the room on time! You now have a decision to make. Do you tell your patient he is out of time and will have to wait until your next visit? Do you sit down again knowing you are already running late? It feels like a no win situation. If you end the visit without acknowledging the additional concern, your patient will be upset. If you run too late, your next patient will be frustrated by the wait. You begin to wonder if it is truly possible to maintain a good patient experience despite a schedule filled with patients suffering from the “one more thing” syndrome. Absolutely!

We all know the patient experience is a hot topic within healthcare for both inpatient and outpatient providers. Like me, you’ve probably been asked by your employer to create definitive ways to improve your patients’ experience. What can you do? The following tips show you things you can do RIGHT NOW, so the next time your patient says, Doc, can I ask you one more thing?, you can definitively say, Yes.

Tips to maintaining a great patient experience even when patients have
“one more thing” to discuss.

1.    Be proactive

One way to discourage patients from saving important topics until the end is to ask them what they want to discuss before the visit begins. There are several ways to do this. You can ask your nurse or medical assistant to gather this information for you when they register or room the patient. You can ask your staff to give all patients a Patient Agenda Form. This form asks patients to prioritize and record exactly what they want to discuss during the visit. It can be downloaded for free here: www.drtrinadorrah.com. Finally, most patients have a smartphone, so encourage them to use it to keep track of their questions and concerns.

2.    Stand

Throughout our training, we are taught that sitting increases our patients’ perception of time spent with them. I completely agree. However, when trying to combat the “one more thing” syndrome, I advocate for standing. The reality is that doctors simply do not have time to spend another 15-30 minutes in the room. Unless it truly requires extended time, I recommend you address your patient’s additional concern while standing. Your patient is still happy that you addressed their concern, but standing acts as a visual reminder that the visit is over.

3.    Address at least one additional concern

If your patient has several additional concerns, you will have to use your medical judgment to prioritize. Explain why you chose that particular concern as the priority so your patient understands your rationale. Other times, your patient only has one additional complaint, but the differential is huge. Take ‘fatigue’ as an example. Multiple things cause fatigue, but you can quickly order a couple of tests to begin the workup. Ordering a CBC or TSH only takes an extra minute, but your patient will feel like you cared.

4.    Follow the leader

     Signal to your patients that the visit is over by inviting them to follow you out of the room. Offer to walk them to the lab or checkout desk. If your nurse needs to enter the room after you, let your patient know that you need to find your nurse to proceed to the next step of their visit. These strategies still allow you to leave the room, but it sends a message to the patient that you care about them and are still working on their behalf even after you step out.

Dr. Trina Dorrah is an internal medicine physician/hospitalist who is passionate about helping providers improve their patients' experience. She is the author of Physician’s Guide to Surviving CGCAHPS & HCAHPS.

Get Ready for CG-CAHPS

by Trina E. Dorrah, MD, MPH

I get it. It is a little strange. In fact, some people even think I’m crazy. Why? I’m a physician, but in my free time, I love helping my colleagues improve their patient experience. Lately, I’ve spent a lot of time discussing a patient experience survey known as CGCAHPS (Clinician & Group Consumer Assessment of Healthcare Providers and Systems). I’m sure it doesn’t surprise you to learn that CGCAHPS is a topic that produces little excitement. In fact, if you ever want to end a party early, start talking about the patient experience. I understand, but like I tell my coworkers, focusing on the patient experience is here to stay. So if you can give me a couple minutes of your time, I’ll explain why this is so important, and give you 3 things you can do today to begin improving your patients' experience.

  

What is CGCAHPS?

CGCAHPS is a standardized outpatient survey that various organizations, including Medicare, are using to assess your patients’ experience with the clinic visit. In case you’re wondering, the terms patient satisfaction and patient experience are often used interchangeably. In reality, they are actually  different. For example, if you diagnose Mr. Thomas with diabetes, he won’t be happy, but he can still be satisfied with the overall clinic experience. The CGCAHPS survey tries to differentiate the care experience from the patient’s emotions. This is helpful because it’s easier to improve an experience. 

There are seven questions on the CGCAHPS survey that specifically relate to you, the provider. When your patients complete the survey, they are asked to rate you in these seven categories.

1.     Did this provider explain things in a way that was easy to understand?

2.     Did this provider listen carefully to you?

3.     Did this provider give you easy-to-understand information about these health questions or concerns?

4.     Did this provider seem to know the important information about your medical history?

5.     Did this provider show respect for what you had to say?

6.     Did this provider spend enough time with you?

7.     Using any number from 0 to 10, where 0 is the worst provider possible and 10 is the best provider possible, what number would you use to rate this provider?

When the scores are reported, you only get credit for the most favorable response. For example, if the survey gives your patients three choices (yes, definitely; yes, somewhat; no), you only get credit for the number of patients who choose the highest score (yes, definitely).

Why should you care?

As physicians, we all want to improve the care we provide our patients. This is what we do every day, so we don’t need a survey to make us do the right thing. However, the Affordable Care Act has increased the stakes by requiring physicians to use the CGCAHPS survey to assess the patient experience. The eventual goal is that all providers who participate in fee-for-service Medicare will measure their patients’ experience with the CGCAHPS survey. This information will be publicly available on the Physician Compare website. Once the survey is implemented, the next step will be to link the survey responses to reimbursement through the Physician Value-Based Payment Modifier. The Physician Value-Based Payment Modifier is a way for Medicare to tie pay to performance. Doctors who perform well on certain quality and cost metrics, including the patient experience, will be paid more than those doctors who do not. How will the patient experience be measured in this program? You guessed it…through CGCAHPS.

So we’ve come full circle. Create a standardized patient experience survey (CGCAHPS), require its use (through legislative reform), link reimbursement to the patient experience (via the Physician Value-Based Payment Modifier), then differentiate between providers based on the patient experience through a standardized survey (CGCAHPS).

What can you do to prepare?

Begin working to improve your patients' experience now. For starters, follow the 3 tips listed below. The first phase of the Physician Value-Based Payment Modifier begins in 2015. You do not want to be caught unprepared.  

1.    Learn as much as you can about the CGCAHPS survey.

·     There are several books, articles, and websites about CGCAHPS. Pick one and begin learning all you can.

2.    Incorporate patient experience improvement tips into your daily practice.

·     Find a book, article, or website that gives suggestions for improving the patient experience. Choose a few helpful tips, and immediately incorporate them in your practice.

3.    Involve your entire clinic staff in your improvement efforts.

·     Educate your staff on the CGCAHPS survey and challenge them to find ways to improve your clinic’s scores. Improvement is a joint effort, and involving your staff will ultimately improve your scores, too.

Trina E. Dorrah is an internal medicine physician/hospitalist and author of Physician's Guide to Surviving CGCAHPS & HCAHPS.