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Patient experience is next measurement in value-based care

Looking beyond solely on whether patients are satisfied, the movement focuses on defined protocols that are designed to reduce stress and make for better outcomes.

By Sue Ter Maat — Posted March 4, 2013

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While “patient satisfaction” has been a well-known term for a while, it's being replaced or augmented by the “patient experience.”

Patient satisfaction is about what patients think about their treatment. The patient experience — focusing on care coordination, communication with caregivers and staff responsiveness — is about protocols designed to reduce patient stress, experts said. The patient experience movement has been growing for years, but it has gained momentum, thanks in part to the Affordable Care Act and a push to tie payments increasingly to value and quality of care.

Physician organizations, including the American Medical Association, are offering doctors insight on how to create the best patient experience. Some hospitals are more proscriptive, outlining what actions their employed physicians must take at every visit for the best patient experience.

Formalizing patient communication

Communication is the key component to the patient experience movement, said James Merlino, MD, Cleveland Clinic's chief experience officer. He helped start the nonprofit Assn. for Patient Experience, which holds an annual Patient Experience Empathy and Innovation Summit each spring.

The patient experience is not just about how doctors communicate with patients about their medical conditions. It's also about communicating expectations to patients, Dr. Merlino said.

For instance, at Cleveland Clinic, patient surveys showed that the call light was causing significant patient anxiety. That's because patients assumed that when they pressed the buttons, nurses would come running to their bedsides. When this didn't occur, they were worried about what might happen during emergencies. By explaining how the call light worked, and discussing patients' expectations when they enter the hospital, patients felt less stressed and had a better experience, he said.

The UCLA Health System has implemented patient experience protocols that doctors must follow, said David Feinberg, MD, president of UCLA Health Systems and CEO of UCLA Hospital Systems.

When meeting patients, doctors are required to knock on the doors before entering. They must call patients by their last names, with courtesy titles, until told to do otherwise. They must introduce themselves and tell patients what their roles are before communicating what they will be doing and responding to questions. When exiting, doctors must explain that they are leaving and what to expect next.

The health system takes these protocols so seriously that it uses undergraduate medical students to pose as patients to ensure doctors are following the protocol, he said.

“If you can't follow it, you don't work here,” Dr. Feinberg said. “It's not the place for you.”

The American Academy of Family Physicians has no policy on the patient experience, but it's very much engaged in anything that is patient-centered, said AAFP President-elect Reid Blackwelder, MD. The academy recognizes the transformation of how doctors and staff interact with patients, becoming more focused on certain behaviors that are designed to increase communication and respect for patients.

“We are expecting patients to be responsible for their own health care,” Dr. Blackwelder said. “The best way to get people on board is to show them respect, so we expect them to be part of the team.”

The AMA has collaborated with consulting firm Press Ganey Associates to offer a Web-based tool to determine satisfaction as it relates to the patient experience. RealTime collects and evaluates patient feedback. The AMA also has designed practice assessment steps so doctors can improve the patient experience. The Association recommends that physicians looking to improve the patient experience focus on such elements as the convenience of hours and access, online medical consultation and services opportunities, staff knowledge, bedside manner and patient education.

AMA policy “encourages physicians to be sensitive to the goals and values of patients, and efforts should be continued to improve the measurement of patient satisfaction and the documentation of its relationship to favorable outcomes and other criteria of high quality.”

The concept of the patient experience is not new, but it's becoming more important, because some health care payments are becoming more associated with it, said Pat Ryan, Press Ganey's CEO.

“Doctors got into medicine to make a difference in life,” Ryan said. “By focusing on listening to patients, it will drive better clinical outcomes because of better patient experiences and will be more effective financially. If I'm a small private practice, I want to know what drives all the key indicators.”

Although communication with doctors and staff is important to patients, care coordination is another prong of the patient experience, Ryan said. That's because uncertainty creates anxiety for patients. Ensuring that patients and their families understand how their care is being managed now and in the near future should decrease stress and increase better outcomes, he said.

The patient experience movement has been gaining more steam recently, said Nancy Foster, American Hospital Assn.'s vice president for quality and patient safety policy. More often, significant portions of hospital executives' pay is based on these measurements, she said.

“Most hospitals are expected to ramp up their patient experience protocols as Medicare becomes more related to [value-based] payments,” Foster said. “A substantial portion of value-based purchasing is linked to outcomes.”

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ADDITIONAL INFORMATION

AMA suggestions for improving the patient experience

The AMA says doctors should consider online medical consultation, e-mail communications with patients, wellness brochures, and practice websites with hours, doctors' biographies and contact information to improve patient communication.

By assessing practice hours and access, staff knowledge, bedside manner and patient education opportunities, doctors can enhance their relationships with patients, according to the AMA.

The AMA also collaborated with Press Ganey Associates, a health care consulting firm, to create RealTime, a Web tool that measures satisfaction as it relates to the patient experience. It offers an outlet for patient feedback about office experiences so doctors can use the electronic surveys to reduce wait times and increase patient communication. As part of the RealTime package, doctors receive materials from the AMA's Practice Management Center and have access to related webinars.

The AMA has created 10 assessment points focused on patient satisfaction. They include:

  1. Do you offer convenient hours — before and after regular business hours?
  2. Do you offer same-day appointments?
  3. What is your procedure for urgent patient concerns after hours? Is a physician on call and readily available?
  4. When patients call your practice, can they speak directly to a nurse or physician? Will the nurse or physician return their calls promptly? How soon do you return calls and address patient issues?
  5. Do you offer to call or send prescriptions directly to the pharmacy so patients can pick them up without having to wait?
  6. Do you accept credit cards and automated clearinghouse debits to facilitate patients' payments due?
  7. Do you offer online medical consultations?
  8. Do you offer education to help patients understand their bills?
  9. Does your practice have a website? Does it offer online appointment scheduling and convenient access to patient registration and other patient forms?
  10. Do you survey patients to assess how well your practice is meeting their needs?

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External links

American Medical Association resources on patient satisfaction/patient experience (link)

Assn. for Patient Experience (link)

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