The Patient Experience: What are they telling us?
We care greatly about the quality of care we provide to our population. We do very well at it. We measure it, and it shows. Our competitors are getting better and better at it too. We MUST continue to improve. Recently, a provider challenged the validity of our surveys citing an article in Forbes stating that high patient satisfaction scores don’t necessarily correlate with great outcomes. I consulted with Dr. Stephen Beeson (a recent speaker at our Medical Staff meeting regarding physician engagement and practicing excellence) about how he would respond, and below are a few thoughts he had:
Here is the NEJM response to the Annals article: http://www.nejm.org/doi/full/10.1056/NEJMp1211775?query=TOC&&&. (They came out with a 180 reversal of the Annals/Forbes piece.)
I would ask this physician to describe what an extraordinary physician does…
Is it important that physicians listen to the patient history without interruption? (75% interrupt in 17 seconds) - History is where the diagnosis resides.
Here is an interesting OpEd from the New York Times from last week: https://www.nytimes.com/2015/01/05/opinion/doctor-shut-up-and-listen.html
Is there value in engaging patients in shared decision making and setting goals together? (There is strong evidence for benefit here.) - 90% of decisions are made for patents without including the patient.
Is there value in explaining medications in a way patients understand? (We do not do this well.)
Is there value in explaining a diagnosis so the patient understands the diagnosis, natural history, treatment, and return precautions? (More than 50% of patients leave the hospital without knowing their diagnosis.)
Is there value in expressing empathy in patients that are going through tough times? (We are NOT good here… http://www.ncbi.nlm.nih.gov/pubmed/18809811?dopt=Abstract&holding=f1000,f1000m,isrctn.)
Lastly… is there value in feedback from patients as to whether we do these things or not? The measurement of the patient experience is simply a frequency response… did these happen or not? Additionally, physicians radically overestimate what they do (Sometimes a 3-4X differential on what we think we do versus what the patient experienced with us). Bottom line, physician self-assessment on “How did I do?” is magnificently flawed.
I could go on and on, but I would focus on: “Can we get better on the very things I know both of us care about?” I would also respectfully request that the voice of the patient and their experience is vital feedback for us as a patient-centered organization, and the impact of a physician that dismantles the channel methods of that voice has a substantially negative impact on others that see the measure as feedback for their work.
So, the bottom line is that we are life-long learners in the business of health care. We must not forget that we do a great job and, also, just because we are being pushed to improve doesn’t mean we are doing a poor job. Without measuring (i.e., surveys), we would not have the information needed to see where we need the most improvement and provide the resources to grow. I get it; trust me. The talk about surveys can be a bit maddening. Nevertheless, they are super important. I can tell you that the physician I’m referring to today cares deeply about quality and service. I want him and all of our providers to know they are fantastic, and we are blessed to have them.
…real ongoing, lifelong education doesn’t answer questions; it provokes them. ~ Luci Swindoll
-Dr. Michael Hurt, CMO