Emergency medicine physicians at a Massachusetts medical group relied on data sharing and individualized coaching to dramatically improve patient satisfaction scores.
From 2011 to 2012, First Physician Corp., a 23-physician emergency medicine group that staffs the emergency department (ED) at Charlton Memorial Hospital, Fall River, Mass., raised its patient satisfaction scores from less than 20 percent to 99 percent—and has sustained its high marks ever since. Leaders credit their success to approaching physicians with the right attitude and giving them the tools they need to succeed.
“What makes it work for us is that we have removed the value judgment,” says Brian Tsang, MD, FACEP, president of First Physician and medical director of the emergency department at Charlton Memorial Hospital, part of Southcoast Health System, New Bedford, Mass. “We treat patient satisfaction like any other part of our job, just like shoulder reductions, emergency vascular access, or fluid management in a septic CHF [congestive heart failure] patient. Some people are naturally better than others at any one of these skills. But that doesn’t make them better doctors or better people. If they are naturally good at one of these, then there are probably five other skills they have to struggle to get good at.”
Recognizing that many physicians need help improving how they interact with patients, leaders at First Physician have created an environment that taps their competitive nature and desire to learn.
Getting Physicians Engaged
Back in 2011, hospital leaders expressed concern about First Physician’s low Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) scores, which were consistently below the 20th percentile among ED physicians.
The main culprit was lack of physician engagement and understanding, says Lissa B. Singer, RNP, MBA, CPC, First Physician’s chief quality officer. “I don’t think physicians saw the connection between our patient satisfaction scores and the viability of our contract with the hospital,” she says. “Also, many of our physicians were trained to provide good medicine but not necessarily to make patients happy. As ED physicians, they thought good medicine was enough.”
Before launching an initiative to improve patient satisfaction, Tsang and Singer asked the hospital to invest in a larger sample size for their surveys so the results would have more credibility with physicians. Based on advice from their HCAHPS survey vendor, they requested 30 completed surveys per clinician per quarter.
Once they had more extensive data in hand, they shared the unblinded data with the entire group—a practice they have continued every quarter via email blasts. “You need to get the right data and enough of it to convince people that it is valid,” Tsang says. “Once you get it, you need to show the data to everyone. We physicians have been competing all our lives, and once you get us to believe in the data, then we will get the numbers to move.”
Leaders decided to give physicians a three-month interim period before the unblinded data would be shared with the entire group. For the first month, they published the scores without names attached. The next month, only the physicians could view the physician scores, and only the nurse practitioners and physician assistants could view their scores. The following month, leaders allowed all clinicians to view their own scores before they were unblinded and shared with the entire group. “That was one of the biggest motivators,” Singer says. “It became a healthy competition but also provided an opportunity for others to offer support and promote teamwork.”
Robert “Bo” M. Snyder, Jr., FACHE, president, Bo Snyder Consulting, Inc., Kalamazoo, Mich., agrees that unblinded data can help spark providers to change. “Healthcare leaders often make the mistake of thinking that they can motivate physicians to improve patient satisfaction,” he says. “But only physicians can motivate themselves—it has to come from within.”
Dealing with the Productivity Problem
“Most physicians’ No. 1 concern was that improving patient satisfaction meant they would get stuck in a room talking with each patient for a very long time,” Singer says. To mitigate this issue, physicians were encouraged to build one-minute “speed bumps” into each patient visit. During these breaks, the physicians would let patients talk about issues that might not be related to their medical problem, without interrupting them. “Eventually, physicians realized that one minute wouldn’t make or break their productivity, and patients really appreciated it,” she says.
Physicians also viewed data from colleagues who performed well in both productivity and patient satisfaction. “A lot of times, data can help address objections,” Snyder says. “When you plot all of the physicians in a group on both productivity and satisfaction, you will find some physicians who do both well. Groups can use that data to lessen the objection and help those physicians become role models for others.”
Leaders at First Physician also used data to show that physicians can often improve patient interactions without harming their own production numbers. “If you give a little on productivity, you can gain a lot on patient satisfaction,” Snyder says.
Tsang, Singer, and Snyder offer the following advice for group practice leaders who want to improve their patient satisfaction scores without alienating physicians.
Don’t use aggregate group or departmental patient satisfaction scores that include other factors. “This gives physicians an out,” Tsang says. “They can say poor scores are the nurses’ fault, or registration’s fault, or the lab’s fault, or other physicians’ fault. That is why we only focused on the individual doctor’s scores.” Holding physicians accountable only for the four physician-related HCAHPS questions was essential to gaining and maintaining buy-in.
Bring in experts. Tsang says physicians should learn the tricks of the trade from consultants and other physicians who are naturally good at working with people. In fact, many physicians appreciate the opportunity to improve these competencies, he says. “We all went into this profession because it provides a lifetime of opportunities to learn, teach, and improve our skills,” Tsang says. “Once our group decided that this skill was no different, we were able to tap into the energy and enthusiasm that we bring to most everything else we do.”
Create a cadence to share data regularly—at least quarterly—and keep the issue top of mind. “Our physicians have learned to anticipate when the data are coming and will even ask how they are doing a few days before the reports are released,” Singer says. Some practices may choose to share HCAHPS data more often by making patient satisfaction scores a regular agenda topic during monthly staff meetings.
Use mentoring to sustain success. Providers with First Physician who drop below the 80th percentile in one quarter are required to spend four hours of their own time shadowing a physician who scored above the 90th percentile. If their scores slide for two quarters in a row, the time commitment increases to eight hours. First Physician offers a small stipend to mentors for their time.
Create individualized improvement plans. Some of the key issues that can drive down patient satisfaction scores include not acknowledging what the patient says and not explaining recommendations and the logic behind them, Snyder says. At the start of the initiative, Snyder shadowed each ED physician for at least one shift and developed individualized improvement plans for each. “Improving patient satisfaction may require that physicians relearn their routine with patients,” Snyder says. For example, a physician often can make interactions more meaningful to patients simply by slowing down and asking, “Is there anything I can do to make you more comfortable?”
Ask physicians to address just one or two issues at a time. “Physicians are overachievers and want to make several changes all at once,” Snyder says. As part of his coaching, Snyder asked physicians to pick one or two behavior changes to master for a few weeks before they moved on to the next change. For example, one physician spent several weeks focusing on listening to the patient without doing other activities, such as starting the clinical exam.
Reward high performers. Many groups use patient satisfaction scores to incentivize compensation. However, rewards for high patient satisfaction scores do not need to be financial, Snyder says. For example, the clinician with the highest patient satisfaction scores may get first dibs on vacation days.
Have the right attitude. “Practice leaders should always approach projects like these with an air of positivity and helpfulness,” Snyder says. “Make sure physicians understand that the practice will invest in them to help them get better.”
Laura Ramos Hegwer is a freelance writer and editor based in Lake Bluff, Ill.
Quoted in this article: Brian Tsang, MD, FACEP, president, First Physician Corp., and medical director of the emergency department at Charlton Memorial Hospital, Fall River, Mass.; Lissa B. Singer, RNP, MBA, CPC, chief quality officer, First Physician Corp., Fall River, Mass.; Robert “Bo” M. Snyder, Jr., FACHE, president, Bo Snyder Consulting, Inc., Kalamazoo, Mich.
This article is based in part on a presentation at the 2016 ACHE Congress, held in March in Chicago.