Improving Patient Satisfaction Scores in the ED and IP SettingRyan Sundermann MDTracy Reittinger MDSt Luke’s Hospital Cedar Rapids, IA

Improving Pt Satisfaction in the ED at St Luke’s Hospital

Ryan Sundermann MD

St Luke’s Satisfaction DataThen vs Now

St Luke’s ED Provider Satisfaction Data

St Luke’s ED Provider Satisfaction Data

Breaking Down Physician Scoring• Courtesy: what do you do when you enter the room• Took time to listen: sitting down, leaning forward,

repeating what the patient says• Took my problem seriously: “My job is to think of

the 5 worst things this could be.”• Kept me informed/Re-evaluated: Fly-bys, providers

go over D/C with all patients• Concern for comfort: water, blankets, coffee for

EVERYONE.▫(Note: what happens in between #3 and #4? Have

you ever been there????? Can you say ANXIETY!)

Engaging Providers • Must be top down: Must come form the CEO as part of

the Mission Statement• Must have a true believer/evangelist for satisfaction:

Who is this in your facility?▫Oldest doc, director, youngest doc, respected doc?

• Hire well and train early: Old dogs, new tricks adage applies, but not impossible. “Embrace their skills, but empower change.”

• Get rid of misconceptions▫Drug seekers are not the ones that move the bar (docs

with bad scores feel that they might have to hand out vicodin to improve scores)

▫Lots of evidence on the PG website

Engaging Providers •Must have reliable data

▫Just like D2Doc, LWOBS, etc▫Must be specific to doc, not overall number▫May not be accurate, but must be precise

to find outliers•Its about GOOD CARE, not MARKET

SHARE▫But you might be surprised how one follows

the other

Hit’em in the Pocketbook• Make bonus contingent on perfomance

▫How much?• What is the target

▫65%ile• How often

▫Quarterly with rolling 12 month• What if they don’t meet for one period

▫Hold for 1 qtr, use 2 qtr bonus to pay for Satisfaction CME

• What if they don’t meet repeatedly (or ever)▫Jack Welch theory on “C players”

Where do you send them?•Jay Kaplan/ Studer Group- looks at whole

facility, front door to back-he will also come to you

•Stephen Beeson-focuses primarily on the patient/doctor experience-will come to you

•Crucial Conversation/Confrontations-awesome, awesome course

Other Measures•What can you do as a physician leader

▫Physician Rounding▫How do you handle patient complaints

•Staff Survey: careful how you present this data▫Present Rank or score with average

must know your providers to decide thisComments can be a very touchy subject

Good Scores For Dr BED provider surveyDr B

Answer Options 1 2 3 4 5 Response Count

Sum of Scores

Average Score

Ranking

Initially sees and treats patient in a timely manner 0 0 3 13 54 70 331

4.728571 1

Evaluation and treatment done in a timely manner 0 0 4 11 55 70 331

4.728571 1

Has the ability to move patients efficiently and prioritizes well 0 1 4 17 47 69 317

4.594203 2

Is immediately available/communicates his/her location when not present 0 0 3 16 51 70 328

4.685714 1

Treats ED staff in professional and courteous manner 0 0 0 2 68 70 348

4.971429 1

Effectively communicates to staff and is easily approachable with questions 0 0 0 2 68 70 348

4.971429 1

Shows caring and concern for patient/their families 0 0 0 4 66 70 346

4.942857 1

Explains the problem and treatment to patient and/or family satisfactorily 0 0 1 4 65 70 344

4.914286 1

Is able to remain calm under stress and is able to handle crises well 0 0 1 4 65 70 344

4.914286 1

Overall rating of healthcare provider's clinical judgment/technical skill 0 0 0 6 64 70 344

4.914286 1

Overall rating of the total care of the patient by this healthcare provider 0 0 0 8 62 70 342

4.885714 1

Overall rating of the ease of working with this healthcare provider 0 0 0 3 67 70 347

4.957143 1

Comments 27 58.20849 1

answered question 70skipped question 26

Bad Comments for Dr X• Dr. X has very poor communication when

treating pts and does not communicate the plan of care to the nursing staff. Dr. X does not move pts through the ED in a timely and does not move pts through the ED in an effective manner.

• Dr X is not approachable in a learning environment. She can be rude when working together. ▫BE VERY CAREFUL WITH COMMENTS.▫ SCREEN HEAVILY AND ONLY PRESENT THE

OVERALL THEMES.

Other Factors•Appearance of Facility-less important than

you think•Appearance of docs: best to dress all the

same•Convenience of Facility-more important

than you think (coat hangers, blankets, parking)

•Wait times▫What is your process for getting them in?▫What is your process for getting them out?▫Do your providers know their metrics for

both?

Other FactorsIf Disney ran your ED

“Under-promise, Over Deliver”

Other Factors• Concierge service: Guest Relations, Valet

parking•Housewide:  “Standards of Excellence”

signed by CEO•Work with other departments to improve

interaction so you all look like you have the same agenda: radiology, lab,

•Some of this starts to blend into Process Improvement….but that’s ok. It’s the adoption of an overall mentality

Tid-Bits•Business cards/Bio cards•Follow-up calls•Protocols for pain/nausea: We don’t do

this but some places find it successful. •Work from blinded, to unblinded provider

data•Adaptive Design: the world’s problems

can be solved using this system. If you don’t use it in your facility, you should start tomorrow. Great way for providers to solve their own problems.