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CAHPS – It's NOT About Patient Satisfaction!
November 17, 2014
Jeff Morris MD, MBA, FACS StuderGroup Physician Coach & Speaker Jeff.Morris@StuderGroup.com
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Choosing a doctor or hospital…
• Only 5% have rated a doctor themselves online
• 1/3 paNents who viewed online sites sought out or avoided physicians based on their raNngs
• Personal reference from family and friends sNll more important to most people (as was whether a physician was accepted by the pa9ent’s health insurance policy)
Public Awareness, Perception & Use of Online Physician Rating Sites JAMA 2014;311(7):734-735
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“The future viability of our organizaNon will be dependent on our ability to deliver service excellence.”
Mayo Clinic
“And importantly . . . A commitment to excellence will not manifest without the leadership, support and example set by physicians.”
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It is not about …..
Fluff
Flavor of the day
Kissing butt
Satisfying patients
Pandering
Being nice
The Pa'ent Experience is NOT About Pa'ent Sa'sfac'on!
Smile school Soft
The “scores”
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The Pa'ent Experience is NOT About Pa'ent Sa'sfac'on!
• How the paNent experiences & reports your care (percepNon)
• Clinical outcomes
It is the ONLY thing that:
• differenNates YOU from other providers • gives YOU a COMPETITIVE ADVANTAGE and what
differenNates YOU from other providers?
And this is determined by:
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“ Cou l d a g r e a t e r miracle take place than for us to look through each other's eyes …for an instant?” Henry David Thoreau
CAHPS -‐ The Eyes & the Voice of the PaNent
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The Business Case for the PosiNve PaNent Experience
According to a Harris Poll (WSJ – Sept/04)
“People place more importance on doctors’ interpersonal skills than their medical judgment or
experience; and doctors’ failings in these areas are the overwhelming factor that drives pa8ents to switch
doctors.”
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Pa9ents’ ra9ngs of quality are more predicted by their ra9ng of our ability to communicate than technical care. * Annals of Internal Medicine
*Chang et al., Ann Intern Med. 2006;144:665-‐672
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The Difference between PercepNon and Reality
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Like it or not ….. People are saying things about how they perceive you and the care you provide!
• Healthgrades.com
• RateMDs.com
• Angie’s List
• Vitals.com
• Beierdoctor.com
• Drscore.com
• RateYourDoc.com
• Hospitalcompare.gov; PhysicianCompare.gov
• Facebook, Twiier & other Social Media
• ……. etc .
Understanding Understanding Understanding Reference: http://www.aamc.org/advocacy/061107update.pdf
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Would a Consumer Choose You?
• 93.8% reported being willing to go out of their way (drive further, reschedule appointments)
• 83% of consumers are very/somewhat concerned about hospital quality
• 64.9% said they would pay more to seek care at a more highly-‐rated hospital
• 60.7% feel the federal government should pay highly-‐performing hospitals more
Source: HealthGrades, Inc. 2010 survey
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A Dose of Reality in this CompeNNve Marketplace • Loyal pa9ents are the most vocal in telling others about posi9ve experience; greatest impact on revenue (repeat visits & referrals)
• Loyal pa9ents more tolerant of minor problems
• Loyal pa9ents less likely to sue
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MalpracNce Risk MalpracNce LiNgaNon -‐ Cited Reasons
• Didn’t listen
• Didn’t return phone calls
• Showed liile concern or respect for paNent condiNon • Rude
• Didn't spend enough Nme
• Didn’t answer quesNons adequately
Patient Complaints and Malpractice Risk, JAMA 2002
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MalpracNce Risk
• Significantly correlated with their physicians communicaNon skills (coefficient = 1.73, 95% CI 1.10 – 2.35; p = .00)
• Not correlated with quality of care, as determined by chart reviews that inves9gated whether the standard of care was met (coefficient = 0.03, 95% CI -‐0.12 -‐ -‐0.18;p = .68)
Chang, JT et al, Annals of Internal Medicine 2006; 144: 665 – 672
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Taking You and Your Organization to the Next Level © 2011 Studer Group®
Pay for Performance is
Here
Now*
*Performance Period is July 1, 2011-‐ March 31, 2012
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The New Paradigm – Value Based Purchasing
Outcome = Income
Service Quality = Medical Care Quality
Service and Care Quality are inseparable
What does it mean to be a “good doctor?”
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Enhanced CommunicaNon = PosiNve PaNent Experience = Beier Compliance = Improved Quality
There are now over 100 observaNonal and 20+ experimental studies published demonstra9ng the correlaNon of communicaNon (paNent experience) with compliance …….. and
"Compliance with treatment regimens has significant influence on quality measures in chronic disease and outcomes.
Medical Care: August 2009 -‐ Volume 47 -‐ Issue 8 -‐ pp 826
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Behaviors that contribute to paNent adherence to care plan "The interacNon between the paNent and his or her physician is the first, and, arguably, the most important interacNon in ensuring adequate medicaNon adherence." Harmon, Lefante & Krousel-‐Wood
(Current Opinion in Cardiology 2006, 21:310–315)
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Physician Empathy
• "Our results show that physicians with high empathy scores had beier clinical outcomes than other physicians with lower empathy scores"
good control* (A1c<7.0 percent) • Higher Empathy
Good Control • Lower Empathy
Poor Control moderate control* (A1c≥ 7.0% and
A1c≤ 9.0%)
poor control* (A1c>9.0 percent)
good control* (LDL<100mg/dL)
moderate control* (LDL≥ 100 and ≤
130 mg/dL)
poor control* (LDL>130 mg/dL)
Em
pathy *Source: Thomas Jefferson University, Physician's Empathy Directly Associated With Posi8ve Clinical Outcomes In Diabe8c Pa8ents Acad Med. 2011;86:359–364.
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Physician Empathy
Em
pathy
Conclusions These results suggest that physician empathy is significantly
associated with clinical outcome for paNents with diabetes
mellitus and should be considered an important component
of clinical competence.
Acad Med. 2012;87:1243–1249.
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High PaNent PercepNon of Care equals Lower Preventable Readmissions
Moving inpa8ent percep8on of care correlates to a decrease in readmissions.
Source: The American Journal of Managed Care; Rela8onship Between Pa8ent Sa8sfac8on With Inpa8ent Care and Hospital Readmission Within 30 Days; 2011; Vol. 17(1)
2.3% Pneum-‐onia
3.1% Heart Failure
2.6% Acute MI
New!
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Clear ConnecNon between PaNent-‐Centered Care and Clinical Quality Outcomes Compared Hospital Quality Alliance (HQA) scores for the Quality of Clinical Care to HCAHPS Global Ra9ng for 2,429 hospitals
HCAHPS RaNng AMI CHF PNA Surgery
Lowest quar9le 93.5 82.7 88.5 82.8
Second quar9le 94.5 85.2 90.1 84.3
Third quar9le 94.6 85.9 90.7 85.2
Highest quar9le 95.3 86.0 90.8 85.7
P value for trend <0.001 <0.001 <0.001 <0.001
Source: Jha et al. New England Journal of Medicine 359, no. 18 (2008): 1921-1931.
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The Alphabet Soup of CAHPS & PECS
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As Hospital’s ED Percentile Ranking Increases, So Does Its HCAHPS “Overall” Percentile Ranking
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ED PECS: ED Patient Experiences with Care Survey
Will ask pa9ents about their experiences with
• arriving at the ED • during ED care • awer being admilng to the hospital or discharged from the ED
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ED PECS: ED Patient Experiences with Care Survey
Currently three dram versions of the survey being tested:
• one for pa9ents discharged to the community
• one stand-‐alone version for pa9ents admiied to the hospital
• another version for pa9ents admined to the hospital that will be administered as a supplement to the exisNng HCAHPS survey
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CG CAHPS Core Questions & Composites 15 questions grouped in 5 composites
Getting Timely Appointments, Care, and Information (Access)
• Getting appointments for urgent care • Getting appointments for routine care or
check-ups • Getting an answer to a medical question
during regular office hours • Getting an answer to a medical question
after regular office hours • Wait time for appointment to start
Rating of the Provider (Doctor)
• Overall rating of your Provider
Provider (Doctor) – Patient Communication
• Provider explanations easy to understand • Provider listens carefully • Provider gives easy to understand instructions • Provider knows important information about
medical history • Provider shows respect for what you have to
say • Provider spends enough time with you
Courteous and Helpful Office Staff
• Clerks and receptionists were helpful • Clerks and receptionists treat you with
courtesy and respect
Test Results
• Follow up on Test Results
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Common Sense CommunicaNon Skills
Verbal and Non Verbal
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Published in 1936 Studies on career success & financial rewards revealed that: • 15% anributable to "specialized knowledge" in the field
• 85% due to skill in "human engineering" (rela9ng well to people)
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Tools & TacNcs
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Albert Mehrebian’s Work on EffecNve CommunicaNon
When discussing maiers of feeling and axtude, effecNve communicaNon is a funcNon of:
Verbal Content: 7% Vocal Expression: 38% Visual Cues: 55%
What is important is "CONGRUENCE"
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AIDET®
Acknowledge
Introduce
Duration
Explanation
Thank you
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Key Words at Key Times
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Anesthesiologists and PerioperaNve CommunicaNon Kopp, Vincent J. M.D. Shafer, Audrey M.D.
Anesthesiology:August 2000 -‐ Volume 93 -‐ Issue 2 -‐ pp 548-‐555
• Literal meaning of “profession” = “speaking forth”
• Facility with a variety of communicaNon skills signifies highly developed professionalism.
What Does Professionalism Have to do with CommunicaNon Skills?
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Professionalism Requires EffecNve CommunicaNon
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Speaking v.
Communicating
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COMMUNICATING
is about listening and getting a message across that we want others to hear and be
receptive to.
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Advantages of AIDET® & Key Words
Decrease anxiety with increased compliance
= Decreased Anxiety
Improved Compliance +
Better clinical outcomes, more positive patient experience and
greater professional
fulfillment
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The Difference may be in the PresentaNon
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They may not remember what you said… They may not remember what you did… They always remember how you made them feel.
Maya Angelou
ConnecNng at a "gut level"
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Challenges
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Challenge: We are Creatures of Habit We are creatures of habit (omen bad habits)
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“There is no need for any individual to have a computer in their home.”
~ Ken Olsen, president of Digital Equipment Corp., 1977
Recognize that “Change” Can Be Uncomfortable
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Recognize that “Change” Can Be Uncomfortable
“Who the hell wants to
hear actors talk.” ~E.A. Warner,
Warner Bros., 1927
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Recognize that “Change” Can Be Uncomfortable
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“People wish to be se[led; but only as far as they are unse[led, is there any hope for them.”
Ralph Waldo Emerson
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Organiza9onal culture is not one that supports direct communica9on
Challenge: OrganizaNonal Culture
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• When you first start doing anything, you may not do it well.
• Almost never will anyone do something right the first 9me.
• Experts become experts through prac9ce.
Remember . . . The Ark was Built by Amateurs, the Titanic by Professionals.
Challenge: I am not an “expert”
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Challenge: Technology
HOW?
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Challenge: Technology
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EHRs and CPOE: Best PracNces § Scribes § Manage-‐up advantages
– Real-‐9me – Remote access (on-‐call and amer-‐hours
retrieval) – Safety
§ MiNgate impersonal nature (“narrate”) – “Know that I am hearing all that you say…I
may occasionally record items in the system while we are talking…”
§ Make the paNent an engaged and informed parNcipant of the EHR – Posi9oning of monitor – Sharing of PACS/Test Results – Sharing of consult request – Sharing of e-‐prescrip9on feature – Pa9ent viewing of test results remotely
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Embrace technology but …. there is sNll a place for paper
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But one more reason to be concerned about the paNent experience ….
…… it negaNvely or posiNvely impacts your personal life and your professional saNsfacNon
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Professional “Burnout”
Arch Intern Med. Published online August 20, 2012. doi:10.1001/archinternmed.2012.3199
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Professional “Burnout”
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The Cost of Burnout -‐ Impairment:
• Threatens paNent safety
• Reduces consistency of excellence
• Decreases collaboraNon
• Increases costs
• Adversely affects collegiality
• Reduces empathy -‐ “compassion faNgue”
• Increases liability risk
• Drives away high performers
• Increases recruitment costs
• Makes healthcare and the organizaNon less airacNve
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Burnout Busters -‐ What Can Professionals Do? Reconnect to purpose, worthwhile work and
making a difference.
H E A R T M I N D
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It is not about smile school
It is not about “being nice”
It is not about “fixing the scores”
It is not about “giving them what they want”
The Clinical & Business & Personal & Professional Case For the PosiNve PaNent Experience – connecNng the dots ……
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It is about proven evidence based behaviors that are requisites for clinical effecNveness, marketplace
compeNNveness, malpracNce protecNon and the quality of work & personal life.
The Clinical & Business & Personal & Professional Case For the PosiNve PaNent Experience – connecNng the dots ……
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What Determines Our Success?
“Success is neither magical or mysterious. Success is the natural consequence of consistently applying the basic
fundamentals.” Jim Rohn
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“It isn’t hard to be good from Nme to Nme; what’s tough is being good every day.”
Willie Mays
It is about Building a Culture of Consistency
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Make a commitment to be personally accountable and hold each other accountable for improving the paNent care experience and communicaNng beier with paNents, staff and each other
It is about Building a Culture of Accountability
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It is about Building a Culture of CollaboraNon & Teamwork
• Physicians • Nursing • ExecuNve Leadership • Access / EVS • Allied Health Services • Pastoral Care • Board of Directors • NutriNon / Lab / Rad / Pharm
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An “almost home-‐run” ……
…… unNl you touch all the bases
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Now that’s a home run!
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“ Cou l d a g r e a t e r miracle take place than for us to look through each other's eyes …for an instant?” Henry David Thoreau
CAHPS -‐ The Eyes & the Voice of the PaNent
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The Eyes & the Voice of the PaNent
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It always seems impossible un8l it
is done.”
Nelson Mandela