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.

Why is there so much hostility toward the patient experience?

by Dr. Trina E. Dorrah

Whenever I talk about the patient experience, I notice a general hostility from my colleagues toward the subject. Recently, since I’ve started blogging about the patient experience, the angry opinions have become even more noticeable. The other day, I was discussing the different comments I’ve received from my blog posts with my friend, who is also a physician. He noted that he understood the hostility, because that is also how he feels. He asked me why he should have to change his practice to pander to the ridiculous whims of patients?

That got me thinking. I asked him if he thought it was OK for doctors to explain a diagnosis or treatment plan to a patient without using medical lingo? After all, how many patients can be expected to know what metabolic acidosis is? I then asked him if he thought it was fine for doctors to give patients the results of their procedure in the recovery room while they are still altered from the drugs used for sedation? I chose these two examples because they are both things I have seen providers do throughout my career as a doctor. In both instances, my friend answered no. He said of course doctors should explain things in ways patients can understand, and of course doctors should treat patients with courtesy and respect by discussing test results when their patients are coherent.

Interesting. I didn’t tell him this, but guess what? He just advocated for providing a good patient experience. Given that most physicians feel as he does, why have we turned the conversation about the patient experience from providing thoughtful care for our patients to catering to their unreasonable demands? When I hear this, I always ask, “What is so unreasonable about wanting to understand what your doctor is saying?” “What is so unreasonable about wanting to know your test results?” In fact, when we all eventually become patients, we will all want to know these same things.

I think the issue is that instead of focusing on what it truly means to have a good patient experience, we’ve allowed ourselves to be swayed by people who equate the patient experience with patient dictatorship. In reality, the two were never meant to be the same thing. I agree that we should advocate against any movement whose goal is to create a culture where the patient is always right. As physicians, we know that simply is not in the best interest of our patients. In fact, if patients truly understood how dangerous the patient is always right mantra is to their health, they would abandon it. Thus, instead of trying to discredit the patient experience, I would challenge us as health care professionals to return the patient experience movement back to what it was intended to be. It was never supposed to be about patients threatening doctors or making unreasonable demands. Nor was it ever intended to be about doctors prescribing unnecessary medications, tests, or treatments.

The patient experience movement was and still should be about showing kindness, empathy, respect, listening, explaining, and doing what’s in the best interest of our patients. As health care providers, we need to reeducate our patients, administrators, and the general public on what providing a good patient experience is truly about. The public needs to know it is not about the patient always being right. It is not about making doctors feel as if their jobs or salaries are on the line unless their survey scores are always high, regardless of the possible unintended consequences. Both of these positions take away from what focusing on the patient experience is truly about – empowering doctors to work collaboratively with their patients to do what is right for the patient each and every time.

We all went into medicine to help our patients, and focusing on the patient experience does exactly that. In the end, it’s not the patient experience that’s the problem…it’s the way in which it’s often interpreted and implemented. The next time you hear your colleague mention the patient experience, instead of showering him or her with cynicism, remember what it’s truly about. When doctors are able to collaborate with patients to do what’s right for the patient, the patient experience flourishes. Who can argue with that?

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.

What one of my favorite restaurants taught me about patient satisfaction

by Dr. Trina E. Dorrah

A few weeks ago, my husband and I took my parents to dinner at one of my favorite restaurants. I was excited to go because the food is excellent and the customer service is top notch. In the past, I’d always had a great experience…until then.

That night, the restaurant was packed as they were offering ½ priced desserts. My husband and I arrived first. I noticed when we ordered our appetizer that our waiter seemed to be in a hurry, but I didn’t think much of it. However, when he came back to take my parents’ order, they hesitated. As they took a moment to glance back at the menu, the waiter said, “Are you ready to order or not? I’ve got 4 other tables so I don’t have time to wait.” I was stunned. I remember thinking, “I can’t believe he just said that,” followed by, “He obviously doesn’t care if he gets a good tip.”

Fortunately, his attitude improved throughout the rest of our dinner. He did his job, and although I would never say he was friendly, he was competent. When it came time to pay the bill, my husband and I left an acceptable tip (he worked hard so we did not want to shortchange him). However, it wasn’t the 20+% that we normally give. This got me thinking. What did this experience teach me about patient satisfaction, and what did I learn that I can share with you?

1. Patients come to us expecting to have a great experience

One reason providers distrust patient satisfaction is because they feel their patients are determined to find something to complain about. Although this may be true for a few patients, most patients enter our healthcare system expecting to have a great experience. They have had positive healthcare experiences in the past, so they see no reason why this interaction would be different. This is also how I felt. Based on my past experiences, I arrived at the restaurant expecting to have a great time. Unfortunately, my waiter’s actions changed my perception. Instead of confirming what I felt was true, his attitude forced me to reevaluate my opinion of the restaurant. In this same way, our patients come to us believing that they will have a positive experience. Through our actions, we have the power to either confirm or destroy this belief.

2. We do have control over how our patients view us

Another reason providers distrust patient satisfaction is because they do not feel it is within their control. I have heard many providers express the belief that patients judge them based on preconceived notions that the provider is powerless to change. Again, this may be true for a few patients, but most patients are more open-minded than this. In general, patients formulate their opinions of doctors in that moment, so we definitely have the ability to impact their views. When I walked into the restaurant, I fully expected to tip my waiter my usual amount of 20+%. However, my waiter’s negative attitude immediately changed my opinion of him. Prior to his comments, I had no problem with him. However, his words and attitude directly changed my opinion of him.  When it came time to pay the bill and evaluate his work, his tip was negatively affected.

3. Attitude is as important as competence

One final reason providers distrust patient satisfaction is because it asks us to concentrate on something besides clinical expertise. Patient satisfaction asks us to focus on how our patients feel and what they think. This is burdensome in the midst of a busy day. To be honest, I think that’s how my waiter felt. It was extremely busy and he was simply trying to make it through the day. Providing a pleasant customer experience was not his top priority. It was, however, one of mine. Don’t get me wrong…I definitely appreciate the fact that the restaurant was clean, my food was cooked properly, and that I never developed food poisoning. However, when you think about it, those are basic expectations that every restaurant should meet. That’s how our patients feel about us. They expect all physicians to be knowledgeable and skilled, and they take this as a given. Instead, patients choose doctors based on things such as if we listen to them, spend enough time with them, and communicate in ways they can understand. These are all characteristics that patients care about. They are the fundamental principles of patient satisfaction.

In the end, I still love that restaurant and I would definitely go back again. However, if I end up having the same waiter, I hope he’s having a better day. If not, maybe I’ll slip him my card. I’m always happy to share a few customer service tips.

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 through www.drtrinadorrah.com. Follow her on Twitter: @drtrinadorrah

“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.