WAYS TO IMPROVE PATIENT EXPERIENCE

1. WAYS TO IMPROVE PATIENT EXPERIENCE Rebecca Bloch, MD

2. Myths • “It’s all about wait times” • Biased population • 49% comments negative at d/c • Not enough data

3. Why care about patient satisfaction? • Impact on clinical outcomes • Ethical argument- “The right thing to do” • Effective risk management strategy

4. 1% decrease in pt sat scores correlates to • 6% increase in complaints • 5% increase risk management episodes • Lower performing physicians are at greater risk for lawsuits Stelfox HT, et al, The American Journal of Medicine 2005; 118: 1126 – 1133

5. “Snowball effect” • Better patient satisfaction and staff satisfaction are correlated. Staff satisfaction decreased turnover (JAMA 1999;282(13):1281) • Happier patients = happier staff= 2 for 1

6. WAYS TO IMPROVE PATIENT EXPERIENCE 10. DECREASE PERCEIVED WAIT TIME

7. Press Ganey, 2010

8. The psychology of waiting…

9. A manager must pay attention not only to how long a customer waits in a queue before his service begins, but also to how the customer feels while waiting. The Psychology of Waiting Lines, David Maister, Harvard Business School Teaching Note

10. Unoccupied time feels longer than occupied time • Pre-process waits feel longer than in-process waits • Anxiety makes waits seem longer • Uncertain waits seem longer than known, finite waits • Unexplained waits feel longer than explained waits • Unfair waits seem longer than equitable waits • Solo waits feel longer than group waits David Maister, The Psychology of Waiting Kirk Jensen, EDDA 2013

12. If you can’t decrease the wait, keep them informed! • Patients who received “good” or “very good” information about delays were significantly more satisfied, even if they spent >4hrs in ED • Communication about wait time may be just as important as actual wait time • Often our natural response is to ignore negatives such as wait time…we need to change this culture!

14. Decrease time to see provider • The number most strongly correlated with satisfaction • Provider at triage • Triage as a process, not a place-bedded triage • Letting them know you know

15. WAYS TO IMPROVE PATIENT EXPERIENCE 9. SHOW EMPATHY

16. Definition Empathy:  the power of understanding and imaginatively entering into another person's feelings. The practice of making someone feel important

17. We expect patients to share intimate details of their lives with complete strangers • Often repeatedly • At a stressful time • And it becomes commonplace for us

18. The Four Cs • Convenience • Care • Caring • Cost

19. Can I teach empathy???

20. Empathy- How? • How do you show empathy? • Body language • words 7% • vocal quality 38% • non-verbal 55% • Positioning • Sitting vs standing by the door • Listening face • Eye contact • “Name that feeling” • Make a non-medical connection

21. Physicians' Empathy and Clinical Outcomes for Diabetic Patients • Academic Medicine, 2011 • Hgb A1c and LDL levels • The hypothesis of a positive relationship between physicians' empathy and patients' clinical outcomes was confirmed, suggesting that physicians' empathy is an important factor associated with clinical competence and patient outcomes.

22. WAYS TO IMPROVE PATIENT EXPERIENCE 8. IMPROVE COMMUNICATION

23. Most common cause of complaints • Failed communication (72%) • Patients judge on compassion and ability to connect, not clinical skills • This is what they know

24. Do internal medicine interns practice etiquette-based communication? A critical look at the inpatient encounter. • J Hosp Med, 2013 • 5 key communication strategies: • Introducing self (40%) • Explaining role (37%) • Touching the patient (65%) • Asking open-ended questions (75%) • Sitting down (9%)

25. We will not solve this all today • Throughout the patient visit • Beginning in waiting room • Through evaluation/work-up • Discharge • Follow-up • Between all parties • Staff communication • Caretaker-patient/family communication

26. Communication can be taught! • Smile and greet warmly • Tell your name, role, and what to expect • Actively listen/assist • Rapport building • Thank and answer questions

27. Strategy • Let patients know what is going to happen • This is not a secret! • Anxiety makes waits seem longer • Uncertain waits seem longer than known, finite waits • Unexplained waits feel longer than explained waits

28. When explanation and teaching is offered in an accessible manner, the patient feels better, and stress and anxiety is reduced Customer Service in Health Care, Baird, 2000

29. Benefits/Burdens • Tell patients benefits • Let them know what you are providing • can be scripted • Tell them the benefits of what they are getting! • Explain burdens • Explain why, expected timeframe

30. Manage Expectations • People want to know what to expect • Create expectations you can meet or exceed • Align patient expectations with patient experience!

31. Satisfaction Defined • Pre-purchase expectations are met or surpassed

32. We create expectations we know we will not meet! • “The doctor will be in in a few minutes” • “I will be right back” • “Just go to the ED and get a quick x-ray” • WE CREATE DISSATISFACTION!

33. Tell them how long it will take • Under-promise and then over-deliver • People love to feel like they gamed the system!

34. Post-visit phone calls • Patient contacted <72 hrs after discharge • Confusion over discharge instructions is one of the top 8 patient dissatisfiers

35. Discharge Instructions • Engel K, Heisler M, Smith D, Robinson C, Forman J, Ubel P, “Patient Comprehension of Emergency Department Care and Instructions: Are Patients Aware When They Do Not Understand?,” Annals of Emergency Medicine. July 11, 2008 78% did not have full understanding 80% of that 78% did not understand that they did not understand

36. Post-visit phone calls • 19% patients report adverse events following discharge • Adverse drug event • Procedure-related • Fall • Other • 48% of events were preventable! Annals if Internal Medicine, 2003

37. Post-visit Phone Calls Save Lives, Improve Clinical Outcomes, and Decrease Readmissions(J Emerg Nursing 2010:36;256-9) • Benefits of Follow-up calls: • Higher patient satisfaction • Increased understanding of discharge instructions • Lower readmission rates • Higher employee engagement • Fewer patient complaints • Greater patient loyalty

39. WAYS TO IMPROVE PATIENT EXPERIENCE 7. FOCUS ON PAIN MANAGEMENT

40. Pain Control • Studies on the prevalence of pain in the ED range from 52% to 78% of patients • Frequently an afterthought, overlooked, or encumbered by fears of creating addiction or supporting drug seeking behaviors http://www.ebmedicine.net

41. Pain Control • Ask early, ask often • Scripting! • Provider at triage or nursing protocols • know the average wait time for pain control at your institution • Non-narcotic options • Make this as big a priority as diagnosis!

42. WAYS TO IMPROVE PATIENT EXPERIENCE 6. INCREASE STAFF SATISFACTION

43. People perform best and deliver the best customer service when they like what they do.

44. Celebrate successes • Publicly • Compliment management system • balance the process! • Start a chain reaction

45. Appreciate each other • Powerful • Free • Makes everyone happy!

46. Create a healthy work culture

47. Happiness Framework • Vision and meaning • Perceived control • Perceived progress • Connectedness

48. WAYS TO IMPROVE PATIENT EXPERIENCE 5. REVIEW PATIENT COMMENTS/COMPLAINTS

49. Themes: • Wait times • Lack of expectations/updates • Communication • Among staff • With patients • Compassion/respect

50. “I’ve learned that people will forget what you said, they will forget what you did, but people will never forget how you made them feel” -Maya Angelou