San Diego, CA—Do survey rankings have you worried? Do you need to improve your own service performance as well as the performance of your staff members? Meryl D. Luallin, owner and partner of SullivanLuallin Group, San Diego, CA, developed a patient satisfaction survey system for physicians and administrators who were dissatisfied with their low patient satisfaction scores. Ms Luallin works with physicians and administrators, sometimes as a “shadow coach,” to identify their limitations and to help improve their survey rankings.
Coming to a Practice Near You
Pay-for-performance will be coming to a practice near you within the next 3 to 4 years. This news should not come as a surprise to anyone in healthcare, but many are not clear about the implications. At the 2013 Medical Group Management Association annual conference, Ms Luallin translated: “It’s [measuring] patient engagement, patient satisfaction, care coordination, and health outcomes.”
In 2017, which may seem a long way off, pay-for-performance will apply to all payments made to individual providers. Knowing that your pay will be based on what patients have to say about you can be daunting.
Ms Luallin recommended transitioning as soon as possible from whatever survey a practice might be currently using to the Consumer Assessment of Healthcare Providers and Systems Clinician & Group Surveys (CG-CAHPS), a standardized tool that will measure how patients perceive the care they receive from physicians in an office setting.
A value-based modifier pilot program will be tested in some states. Ms Luallin strongly urged practices to modify their current surveys using, as an example, the SullivanLuallin Group’s survey. “Start now to insert questions into your current survey that would be appropriate for the CG-CAHPS. Over a period of years, you will have adopted the entire required list of questions,” she urged. Ms Luallin also recommended putting the survey questions in order, starting with the most positive choice in the beginning to the most negative choice at the end.
Ms Luallin further recommended running a linear regression analysis, or finding someone who can do this for you, to identify which survey questions promise the highest likelihood of improving your scores. “To know where to go, you first need to know where you are,” she noted. “Doing so will help you focus your priorities and help identify which items, if they are improved, would increase your survey score.” The 4 areas where practices are most likely trying to improve include:
- Patient satisfaction with patient experience
- Overall satisfaction with the practice
- The likelihood of recommending the provider to others
- Overall rating of care from your provider.
Although waiting times are important, she noted that this is not a driver that can boost survey scores. “Problems with long waits will arise, but it is important to make the wait palatable,” she noted. Ms Luallin recommends that doctors arrive 15 minutes before their first appointment to avoid getting started late. To avoid the patient who says, “By the way, there is something else…” just as the physician is leaving the examination room, consider asking patients for the 2 most important issues that have brought them in to meet with the doctor.
She further noted that physicians can raise their scores by being CLEAR:
- Connect. Establish a rapport with a patient. Connect with patients throughout an encounter. Come across as though you care about the person. Allow the patient to speak. Show compassion. Be sympathetic. Shaking hands is a nice touch, if it is appropriate. Otherwise, pat a patient on the shoulder. “But never shake hands with a patient while wearing rubber gloves,” Ms Luallin warned.
- Listen actively to patients and caregivers. The practitioner must show they are listening and do so while sitting, if possible. Studies show that patients perceive that their practitioner has spent more time with them if the practitioner was seated during the session.
- Explain the diagnoses, directions, and instructions clearly. It is often necessary to explain why you recommend a certain procedure or avenue or diagnosis or whatever course of treatment you are proposing. Never ask a patient if he or she understands. They might be too embarrassed to tell you that they do not.
- Ask key questions at key times. The practitioner must ask the patient specific questions to get all of the necessary information. Instead of asking “Do you have any questions?” ask, “What questions do you have for me?”
- Reconnect with the patient before ending each part of the visit. And, importantly, caution your team not to say, “Have a nice day.” Ms Luallin observed, “If a man in his mid-50s comes in and learns that his PSA [prostate-specific antigen] is inordinately high, indicating a very aggressive form of prostate cancer requiring radiation therapy plus hormonal therapy amounting to chemical castration, he is not going to have a nice day.”
Making the Wait Palatable
Always go out of your way to make your patients feel comfortable. Ms Luallin related an experience she had in a reception area at an urgent care center. The receptionist asked her if she would like a cup of coffee and alerted her that there might be “a little bit of a wait.” Ms Luallin declined, and was then offered tea, which she also declined.
When the receptionist finished registering another patient, she asked all of the patients in the waiting room again, “Can I get anyone a cup of tea?” When everyone responded, “No, thank you,” she offered hot chocolate, to which everyone responded, “Yes.” Without further ado, the receptionist went to the kitchenette and brought all of the patients hot chocolate, to their great joy.
During the same visit, Ms Luallin, who was scheduled for an x-ray, anticipated a cold and dim imaging room, but she was in for another surprise. True to form, the imaging room was indeed cold and dim. She furthermore expected the examination table to be cold and hard, but the table in this imaging department had a 1-inch foam pad. She noted out loud how comfortable it was, and the x-ray technician said, “I know. We like to make our patients comfortable.” When Ms Luallin asked the technician if she was scripted to say that, the technician smiled and repeated, “We like to make our patients comfortable.”
Before your contented patients leave, be sure to ask them to fill out a survey of their experience while they are still at your office or clinic. Remember, a happy patient is less likely than a disgruntled patient to go out of his or her way to fill out a survey.