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Optimizing Your Practice
Through Service Values
Jonathan W. Berlin MD, MBA
ARRS 108th
Annual Meeting
Business & Practice M...
Disclosure of Commercial
Interest
Neither I nor my immediate family
members have a financial relationship
with a commercia...
Presentation Overview
• Changing Landscape: Increasing Patient Consumerism,
Quality as A Prerequisite
• Quality and Servic...
Changing Healthcare Landscape
• The healthcare landscape is changing
• Gradual shift from employee based
healthcare insura...
Shift in Healthcare
• “Traditionally, employers selected health
care products for their workers and paid
for most of the s...
Increased Expenses Are Driving
the Change
• “The underlying force propelling (the
movement toward increasing individual
re...
Increasing Healthcare Costs for
Corporations
• General Motors now spends about $1,525
on health care for every car it prod...
Increased Utilization of Imaging
• On average, between 1998 and 2001,
utilization per Medicare enrollee increased
16% per ...
Utilization of Radiology Services
is Increasing
• Diagnostic imaging services paid under
Medicare’s physician fee schedule...
Percent Growth in Medicare Spending Per
Beneficiary Controlled for Price, 1999-2003
0
5
10
15
20
25
30
35
40
45
Major Proc...
Increasing Co-Payments and Out
of Pocket Expenses
• Increasing corporate expenditures can be
addressed by increasing out o...
Percentage of Healthcare
Expenses in Individual Hands
• “By 2011 the fate of $550 billion to $600
billion of premiums will...
Trends To Individual Spending
Producing Greater Transparency
• This is leading to trends to facilitate
decision making for...
Mission of the US Dept. HHS
Value Driven Website
• Health care transparency provides
consumers with the information and th...
Is This Change Irreversible?
Don’t Rely on Government
• “It is highly unlikely that the health care system
will ever retur...
Where Does Radiology Fit In?
• Radiology co-pays are increasing at the
same time that consumers are becoming
more consciou...
Quality as Measured by
Radiologists
• Quality as Measured by Radiologists:
 Appropriate Ordering by Clinicians (ACR
appro...
How Radiologists Measure
Quality
• Patient Examination: Complication Rate
• Interpretation of Exam: Accuracy,
Standardized...
Adapted Mayo Clinic Quality Map
• Is Communication to Referring Physicians
Accomplished in a Timely Manner? Are
Referring ...
The Essential Nature of Quality
• Quality Measures such as these are
ESSENTIAL for any radiology practice,
and they are ad...
Quality Measures
• Quality Measures will Increasingly
Become a Prerequisite for Radiology
Practices
• They are essential f...
Lingering Questions About
Quality and Health Care
• To examine this question requires asking
some additional questions:
 ...
2006 Airline Quality Rating
2006 Airline Quality Rating
http://aqr.aero/aqrreports/AQR2006final.pdf Accessed 3/7/07
2006 Airline Quality Rating
• Flights On – Time
• Denied Boarding
• Mishandled Baggage
• Customers Complaints: Over sales,...
What is Missing From This
Rating System?
Airline and Airplane Safety Data
is Absent
• Airline Safety Data
 Number and Frequency of Crashes
 Number and Frequency ...
Pilot Safety Data is Missing
• Pilot Safety Data:
 Age and Experience of Pilots
 Number of Pilots in Airline with Substa...
Reasons For Airline Data To Be
Missing
• Why is airline safety data missing?
 Because it is not really questioned by cust...
Patients Do Not Measure
Efficacy
• In the same manner, healthcare quality data is
not as readily accessible by customers f...
Efficacy Versus Experience in
The Hospital Setting
• “Hospitals spend their efforts in clinical
results and process improv...
Importance of Experience
• “Patients will make clinical decisions
based on non-clinical information.”
• Case of the “Dead ...
Is Proven Clinical Efficacy
Enough?
Experience and Service
Increasingly Important
• “I’ll tell you what keeps me awake at night. The
quality of our clinical c...
How are We Doing?
• How are health care organizations and
providers doing in addressing the patient
experience?
Quality and the Patient’s
Perception – The Case of Gerald
• “Too often when I speak with my son’s
doctors, we end up talki...
The Subjective Nature of The
Health-Care Experience
• “It’s rare that I walk away from one my
family’s doctor appointments...
Introducing Patient Loyalty
• Why is the patient experience important?
• Because it correlates to patient loyalty.
• Loyal...
Examining Customer Loyalty
Economics
• Two companies: one with customer retention
rate of 95%; the other with retention ra...
The Loyalty Effect
• 1. Loyal customers insure steady growth
• 2. Sustainable growth enables the organization
to attract a...
The Importance of Loyal Patients
• Healthcare may be different than the car
business
• However, it does stand to reason th...
Measuring Loyalty
• The question then
becomes:
 How do we measure
loyalty?
• Among our patients
• Among our staff
 How d...
Physician – Patient Relationship
Most Important Factor
• The overwhelmingly powerful determinant
of patient satisfaction a...
Increasing Patient Contact in
Radiology
• What does this mean for radiology?
• How often do we introduce ourselves to
pati...
Patient Preferences for Test
Results from Radiologists
• Over a 10 day period at University of Texas, patients in body
ima...
Patients and The Internet
• According to recent surveys,
approximately 79% of patients have
internet access
• Of those, 70...
Things To Think About For
Radiology?
• Does the average patient in our
department:
 Know what a radiologist is?
 Know wh...
Prerequisites for Adequate Care
• “As with non-healthcare industries, the
number one reason for patient
dissatisfaction is...
Zagat and Wellpoint Physician
Evaluation System
• Zagat Survey and Wellpoint Health Insurance
launching free on-line consu...
Wellpoint – Zagat Collaboration
• The four qualities of trust, availability,
communication, and office environment mirror
...
Word of Mouth Customer
Satisfaction
• “More consumers are asking for
information about what other consumers
think about th...
US Dept HHS Hospital Service
Website
• New survey website on hospitals sponsored by
the US Department of Health and Human
...
US Dept of Health and Human
Services Survey Site
• How often did nurses communicate
well with patients?
• How often did do...
Details on HHS Website
• Website will give you percent comparison
of patient responses such as, “How often
were the hospit...
Satisfaction Does Not Equal
Loyalty
• How do we measure patient loyalty?
• Patient satisfaction scores by themselves
are i...
Reasons for “5” Equating to
Loyalty
• Fred Lee: The Hotel Analogy:
• “After receiving an evaluation of a hotel I
stayed at...
Ways to Increase Patient
Loyalty: Basic is Not Enough
• Meeting basic and spoken requirements is
expected. Going beyond wh...
What Does This Data Mean
for Radiology?
Possible Suggestions for
Radiology – Patient Loyalty
• Radiologists should think about increasing
our interactions with ou...
Six Weeks Later……
Plus a Thank You Note to the Department!!
Unexpected Outcome as
Imprinting
• To build loyalty, a failure can be a
success.
• This patient certainly was not happy to...
Other Ways to Build Loyalty
 Taking the time to coordinate their
radiology care if an abnormality is found
 Explaining t...
Chronic Abdominal Pain
Precontrast Early Post-Contrast
Excretory Phase
Post-Contrast
Listening to the Patient and
Personalized Service Can Make
a Huge Difference
Two weeks of pelvic pain
What if We Don’t Have Time to
Personally See Patients?
 Consider adding physician assistants to
personally explain radiol...
Other Means of Increasing
Service
• Web-based scheduling…
• Encouraging patients and/or families to
write down questions b...
Wait Times and Patient
Satisfaction
• Communicating with patients about wait
time and letting them know their time is
valu...
Minimizing Wait Times
• More efficient scheduling & convenient
office hours
• Activities to Minimize wait –
• educational ...
Privacy and Patient Experience
 Privacy:
• Important both in the radiology department
and the hospital at large. Waiting ...
Patient Observations
• Billing:
 Being asked for your insurance card and
social security number every time you step in
th...
Building Patient Loyalty Through
Employee and Physician Loyalty
• In addition to increasing service for
patients to gain l...
Employee and Patient
Satisfaction Linked
http://radio.weblogs.com/0143030/2005/02/06.html#a47 Accessed 3/10/07
Table from ...
Importance of Loyal Employees
• “You can’t achieve high patient
satisfaction when your staff is unhappy.
Patients can easi...
Sentiments Reflecting Employee
Loyalty (1)
• Gallup Organization has found high
agreement with the five following
sentimen...
Sentiments Reflecting Employee
Loyalty (2)
 The mission or purpose of my organization
makes me feel my job is important
...
Improving Employee Satisfaction
• What can we do to improve employee
loyalty?
 Improve communication by administration an...
Physician Engagement
• “The solution to (the problem of poor
physician engagement) is simple -- ask
physicians for their o...
What Does Patient Loyalty and
Service Values Mean for
Radiology and Radiology
Practices?
Factoring Service Values Into
Our Own Radiology Practices
• How do we address the increasing need
for service?
• Factor se...
Staff Interaction
• Staff Interaction:
 Rewarding staff for “beyond the call of duty”
service, which may include an
ackno...
Patient Privacy
• Patient Discretion
 The need for patient privacy and concerns for
patient safety cannot be over-emphasi...
Billing Factors to Increase
Service
• Billing:
 Storing patient demographic information so it doesn’t
need to be repeated...
The Role of Radiologists
• To keep up with service, the interactions
between patients and radiologists will
increase. This...
Increasing Staff Loyalty
• Loyalty among physicians and non-physicians in
radiology practices should be cultivated as well...
How Do We Do It All?
• Even though the
stakes continually get
higher with quality
and service
requirements, the
needs for ...
The Future
• By focusing on patient loyalty we can
insure viability of our profession and
prevent commoditization of our p...
Optimizing Your Practice Through Service Values
Optimizing Your Practice Through Service Values
Optimizing Your Practice Through Service Values
Optimizing Your Practice Through Service Values
Optimizing Your Practice Through Service Values
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Transcript of "Optimizing Your Practice Through Service Values"

  1. 1. Optimizing Your Practice Through Service Values Jonathan W. Berlin MD, MBA ARRS 108th Annual Meeting Business & Practice Management Seminar April 13, 2008
  2. 2. Disclosure of Commercial Interest Neither I nor my immediate family members have a financial relationship with a commercial organization that may have a direct or indirect interest in the content of this presentation.
  3. 3. Presentation Overview • Changing Landscape: Increasing Patient Consumerism, Quality as A Prerequisite • Quality and Service  Differing Perceptions of Patients & Providers • Quality Versus Loyalty  Their differences & Importance of Loyalty • What Does This Mean for Radiology?
  4. 4. Changing Healthcare Landscape • The healthcare landscape is changing • Gradual shift from employee based healthcare insurance to greater individual choice, and expense.  Greater co-pays and deductibles  More non-covered healthcare services.
  5. 5. Shift in Healthcare • “Traditionally, employers selected health care products for their workers and paid for most of the services. • Increasingly…those costs are being passed on to individuals, who now decide what products to buy, as well as where, when, and how to buy them.” http://www.mckinseyquarterly.com/article_page.aspx? ar=1951&L2=12&L3=63&srid=17&gp=0 Accessed 3/15/07
  6. 6. Increased Expenses Are Driving the Change • “The underlying force propelling (the movement toward increasing individual responsibility) is medical inflation, which is rising two to three times faster than general inflation, so companies are increasingly reluctant to bear the full cost of health care.” http://www.mckinseyquarterly.com/article_page.aspx? ar=1951&L2=12&L3=63&srid=17&gp=0 Accessed 3/15/07
  7. 7. Increasing Healthcare Costs for Corporations • General Motors now spends about $1,525 on health care for every car it produces - or roughly $6 billion in 2005. • Ford spends more on health care than on steel • Starbucks spent more on health insurance for its employees in 2005 than on raw materials needed to brew coffee. http://www.rightreality.com/articles/ health_care_neither_you_nor_your_company_can_afford_it.html Accessed 4.9.07
  8. 8. Increased Utilization of Imaging • On average, between 1998 and 2001, utilization per Medicare enrollee increased 16% per year for MR imaging and 7%– 15% per year for CT, US, interventional radiology, and nuclear medicine, while that for radiography increased 1% per year. • Which radiology procedures cost more? Radiology 2005;234:824-832.
  9. 9. Utilization of Radiology Services is Increasing • Diagnostic imaging services paid under Medicare’s physician fee schedule grew more rapidly than any other type of physician service between 1999-2003. • Evaluated another way, the average growth of physician services during this period was 22% -- for imaging it was 45%. http://www.medpac.gov/publications/congressional_testimony/031705_ TestimonyImaging-Hou.pdf, Accessed 12.4.07
  10. 10. Percent Growth in Medicare Spending Per Beneficiary Controlled for Price, 1999-2003 0 5 10 15 20 25 30 35 40 45 Major Proc. E & M Minor Proc. Tests Imaging % Increase, 1999-2003 http://www.medpac.gov/publications/congressional_testimony/031705_ TestimonyImaging-Hou.pdf, Accessed 12.4.07
  11. 11. Increasing Co-Payments and Out of Pocket Expenses • Increasing corporate expenditures can be addressed by increasing out of pocket expenses for healthcare. • People who have to pay for their healthcare use less and are more discerning.
  12. 12. Percentage of Healthcare Expenses in Individual Hands • “By 2011 the fate of $550 billion to $600 billion of premiums will be in the hands of individual decision makers, not employers or the government.”  McKinzie Quarterly, March 2007
  13. 13. Trends To Individual Spending Producing Greater Transparency • This is leading to trends to facilitate decision making for healthcare consumers • These changes include:  a greater emphasis on healthcare quality  transparency of health care quality & outcomes data  Transparency of price data
  14. 14. Mission of the US Dept. HHS Value Driven Website • Health care transparency provides consumers with the information and the incentive, to choose health care providers based on value. • Consumer choice…motivates the entire system to provide better care for less money. http://www.hhs.gov/transparency/ Accessed 3/7/06
  15. 15. Is This Change Irreversible? Don’t Rely on Government • “It is highly unlikely that the health care system will ever return to a more wholesale environment. • The biggest impediment is the under-funded Medicare liability of $30 trillion—more than 2.5 times the US gross domestic product. • This liability makes it extremely difficult for any government to assume responsibility for rising health care costs.” http://www.mckinseyquarterly.com/article_ page.aspx?ar=1951&L2=12&L3=63&srid=17&gp=0 Accessed 3.15.07
  16. 16. Where Does Radiology Fit In? • Radiology co-pays are increasing at the same time that consumers are becoming more conscious of quality and service. • Our insurance: outpatient radiology services only covered at 90% in 2008, 95% in 2007, and 100% in 2006 • How is radiology responding? Imaging Economics February 2007 p. 35
  17. 17. Quality as Measured by Radiologists • Quality as Measured by Radiologists:  Appropriate Ordering by Clinicians (ACR appropriateness criteria)  Protocol Selection: Type of Protocol and Contrast Usage Adapted from Mayo Clinic Radiology Quality Map Events and Metrics, Imaging Economics February 2007
  18. 18. How Radiologists Measure Quality • Patient Examination: Complication Rate • Interpretation of Exam: Accuracy, Standardized Report, Usefulness of Information in Report to Clinicians • Finalization of Report: Typographical or Textual Error Rate in Report, Timeliness of Report Signings Adapted from Mayo Clinic Radiology Quality Map Events and Metrics, Imaging Economics February 2007
  19. 19. Adapted Mayo Clinic Quality Map • Is Communication to Referring Physicians Accomplished in a Timely Manner? Are Referring Physicians Satisfied with the level of Communication? • Outcomes: Is the Health Outcome Improved for Patients? Adapted from Mayo Clinic Radiology Quality Map Events and Metrics, Imaging Economics February 2007
  20. 20. The Essential Nature of Quality • Quality Measures such as these are ESSENTIAL for any radiology practice, and they are admirable as well. • Swenson: Three Reasons for Greater Attention to Quality:  Differentiation Among Providers  Quality Measures Will Increasingly Be Required by Payers  Moral Imperative: The Physician’s Role Quality: The Differentiator in a Flat World, Imaging Economics February 2007
  21. 21. Quality Measures • Quality Measures will Increasingly Become a Prerequisite for Radiology Practices • They are essential for survival and not optional • However…are they enough??
  22. 22. Lingering Questions About Quality and Health Care • To examine this question requires asking some additional questions:  Do patients and Health Care Providers have the same means and experience to assess quality? Do they measure the health care experience the same way?  Are adapting quality measures enough, or should health care organizations also pay attention to other factors such as patient “experience”?
  23. 23. 2006 Airline Quality Rating 2006 Airline Quality Rating http://aqr.aero/aqrreports/AQR2006final.pdf Accessed 3/7/07
  24. 24. 2006 Airline Quality Rating • Flights On – Time • Denied Boarding • Mishandled Baggage • Customers Complaints: Over sales, Fares, Refunds, Animals, Customer Service, False Advertising, Discrimination, Reservations / Ticketing / Boarding 2006 Airline Quality Rating http://aqr.aero/aqrreports/AQR2006final.pdf Accessed 3/7/07
  25. 25. What is Missing From This Rating System?
  26. 26. Airline and Airplane Safety Data is Absent • Airline Safety Data  Number and Frequency of Crashes  Number and Frequency of Near Misses  Number of Fatalities and Injuries from Crashes • Airplane Safety Data  Age of Airplane Fleet  Maintenance Records of the Fleet
  27. 27. Pilot Safety Data is Missing • Pilot Safety Data:  Age and Experience of Pilots  Number of Pilots in Airline with Substance Abuse Problems  Exam Scores of Pilots  Age and Type of Simulator Equipment Airline Pilots Trained On
  28. 28. Reasons For Airline Data To Be Missing • Why is airline safety data missing?  Because it is not really questioned by customers. As a generalization, customers assume competency of the airline, the pilot, and the equipment.  Other Industries are Similar to This – Competency is Generally Assumed • Auto Industry: When we rent cars do we specify those with low crash rates? • Elevators / Escalators • Bridges / High Rises / Balconies / Porches / Fire Safety
  29. 29. Patients Do Not Measure Efficacy • In the same manner, healthcare quality data is not as readily accessible by customers for clinical efficacy or outcomes. • That doesn’t mean it’s not important – it only means that customers notice other qualities as well, and these other qualities impact on them, sometimes in a more personal and up-front manner.
  30. 30. Efficacy Versus Experience in The Hospital Setting • “Hospitals spend their efforts in clinical results and process improvement (which) can be measured objectively. The patient, however, judges quality by his or her perceptions, something that … cannot be verified in the same way as outcomes. The patient is judging the overall experience of being in the hospital.” Lee F. If Disney Ran Your Hospital, Second River Healthcare Press, 2004
  31. 31. Importance of Experience • “Patients will make clinical decisions based on non-clinical information.” • Case of the “Dead Fish” in the waiting room aquarium – the patient thinks, “If they can’t take care of a fish, how can they take care of me?” Gabriel BA. Your Complete Guide to Patient Service, Physician’s Practice, March 2008
  32. 32. Is Proven Clinical Efficacy Enough?
  33. 33. Experience and Service Increasingly Important • “I’ll tell you what keeps me awake at night. The quality of our clinical care is …proven and we’ve been able to attract patients from great geographical distances because of it. But…all our trend data shows that consumers are becoming more demanding and will continue to be. It’s in our best interests to offer the service levels and experience that patients are starting to seek.” • Phyllis Marino, Associate Director of Marketing, Cleveland Clinic http://www.interplaygroup.com/docs/Beyond_Patient_Satisfaction_ An_Interplay_Whitepaper.pdf Accessed April 2007
  34. 34. How are We Doing? • How are health care organizations and providers doing in addressing the patient experience?
  35. 35. Quality and the Patient’s Perception – The Case of Gerald • “Too often when I speak with my son’s doctors, we end up talking about him as if he’s not even there. (At one) doctor visit… his pediatrician was so clearly pressed for time that she worked on (my son) like she was part of a race-car pit crew.” Cullen T. The Wall Street Journal. 2/22/07. Putting “Care” Back in Health Care
  36. 36. The Subjective Nature of The Health-Care Experience • “It’s rare that I walk away from one my family’s doctor appointments or dental visits with a good feeling. It’s not that my family is in poor health or that we’re not receiving proper treatment. Rather, it’s feeling that our health-care providers just don’t have time to care about my family.” Cullen T. The Wall Street Journal. 2/22/07. Putting “Care” Back in Health Care
  37. 37. Introducing Patient Loyalty • Why is the patient experience important? • Because it correlates to patient loyalty. • Loyalty: A patient's likelihood to return to a healthcare facility (Gallup) http://www.bartleby.com/61/44/L0274400.html Accessed 4.9.07, www.gallup.com Accessed 4.9.07
  38. 38. Examining Customer Loyalty Economics • Two companies: one with customer retention rate of 95%; the other with retention rate of 90% • Both companies acquire new customers at 10% per year • The company with 95% customer retention increases net customers by 5% per year and can double in size in 14 years; the company with only 90% customer retention does not change its customer amount in that same time. Reichheld FF. The Loyalty Effect 1996 Harvard Business School Press
  39. 39. The Loyalty Effect • 1. Loyal customers insure steady growth • 2. Sustainable growth enables the organization to attract and retain the best employees • 3. Loyal employees reduce costs and improve quality • 4. Loyal customers insure steady volume so that profits can be put back into the system Reichheld FF. The Loyalty Effect 1996 Harvard Business School Press
  40. 40. The Importance of Loyal Patients • Healthcare may be different than the car business • However, it does stand to reason that loyal patients will seek further care, if needed, at the same facility. • Additionally, loyal patients have the power to suggest referrals, increasing business.
  41. 41. Measuring Loyalty • The question then becomes:  How do we measure loyalty? • Among our patients • Among our staff  How do we increase loyalty? • Among our patients • Among our staff
  42. 42. Physician – Patient Relationship Most Important Factor • The overwhelmingly powerful determinant of patient satisfaction and loyalty in the group practice setting…is the interaction between the patient and the physician. Our studies have shown that this factor does more to explain patient satisfaction and loyalty than all other factors combined. The Satisfaction Monitor Jan/Feb 2001 Drivers of Patient Satisfaction in the Group Practice Setting Jerry Seibert, MA, President - Parkside Associates http://www.pressganey.com/products_services/readings_findings/satmon/article.php?article_id=186 Access 3/7/07
  43. 43. Increasing Patient Contact in Radiology • What does this mean for radiology? • How often do we introduce ourselves to patients? How often do we call patients with results? How often do we go over exams with patients? • Have we ever had experiences with patients where they were upset that we called them? • Should we be increasing our patient contact? • Could these changes foster patient loyalty?
  44. 44. Patient Preferences for Test Results from Radiologists • Over a 10 day period at University of Texas, patients in body imaging, mamms, and ultrasound were asked the following:  Did they want the radiologist to tell them if the results were normal  If the results were abnormal, did they prefer to hear the results from their primary care doctor or did they feel entitled to an immediate explanation of their test results. • 92% of patients wanted the radiologist to tell them if the results are normal. • If the results are abnormal 87% wanted the radiologist to tell them. • CONCLUSION. Most patients prefer to hear the results of imaging examinations from the radiologist at the time of the procedure rather than to hear them later from the referring physician, regardless of the findings. Disclosure of imaging findings to patients directly by radiologists: survey of patients' preferences. AJR Am J Roentgenol. 1995 Aug;165(2):467-9
  45. 45. Patients and The Internet • According to recent surveys, approximately 79% of patients have internet access • Of those, 70% would like to have access to their medical test results on line. • Are we as radiologists doing enough to communicate with patients? Gabriel BA. Your Complete Guide to Patient Service, Physician’s Practice, March 2008
  46. 46. Things To Think About For Radiology? • Does the average patient in our department:  Know what a radiologist is?  Know who is interpreting their study?  Talked to any of the radiologists in the department?
  47. 47. Prerequisites for Adequate Care • “As with non-healthcare industries, the number one reason for patient dissatisfaction is lack of courtesy, respect, and attention... Merys RM. The Importance of Service in the Healthcare Setting: Building a Patient Friendly Practice. Medical Group Management Association
  48. 48. Zagat and Wellpoint Physician Evaluation System • Zagat Survey and Wellpoint Health Insurance launching free on-line consumer ranking of doctors available to select members in its Blue Cross and/or Blue Shield licensed subsidiaries. • Qualities doctors will be evaluated on:  Trust  Communication  Availability  Office Environment http://www.chicagotribune.com/features/chi-1104_zagat_d_r_nnov04,1,1307466.column Accessed 11/5/07 http://phx.corporate-ir.net/phoenix.zhtml?c=130104&p=irol-newsArticle_general&t=Regular&id=1065430& Accessed 11/5/07
  49. 49. Wellpoint – Zagat Collaboration • The four qualities of trust, availability, communication, and office environment mirror the Zagat restaurant guide of food, décor, service, and cost • The rating system is “solely designed to reflect a consumer’s experience with a physician and not to reflect the quality of the care they received.” • “It gives consumers the power to make smart decisions about selecting doctors based on other people’s experiences.” Nina Zagat http://www.chicagotribune.com/features/chi-1104_zagat_d_r_nnov04,1,1307466.column Accessed 11/5/07 http://phx.corporate-ir.net/phoenix.zhtml?c=130104&p=irol-newsArticle_general&t=Regular&id=1065430& Accessed 11/5/07 http://www.usatoday.com/money/industries/health/2007-10-21-wellpoint-zagat_N.htm Accessed 11/5/07
  50. 50. Word of Mouth Customer Satisfaction • “More consumers are asking for information about what other consumers think about their doctors to help them make better choices.” – Jason Gorevic, Chief Marketing Officer, Wellpoint Insurance • One of every nine Americans is a member of a WellPoint health plan. http://www.medicalnewstoday.com/articles/86306.php Accessed 11/5/07 http://phx.corporate-ir.net/phoenix.zhtml?c=130104&p=irol-newsArticle_general&t=Regular&id=1065430& Accessed 11/5/07
  51. 51. US Dept HHS Hospital Service Website • New survey website on hospitals sponsored by the US Department of Health and Human Services • Government will start withholding portions of Medicare funding if hospitals don’t participate • “Most questions…deal with whether the hospital always meets service expectations” • “Survey resembles restaurant guides that rate waiters attentiveness, dining rooms’ attractiveness and the quality of culinary experiences.” http://www.chicagotribune.com/news/chi-hospital-ratings_11apr11,0,3129797.story Accessed 4.13.08
  52. 52. US Dept of Health and Human Services Survey Site • How often did nurses communicate well with patients? • How often did doctors treat you with courtesy and respect? • How often were patients' rooms and bathrooms kept clean? • How do patients rate the hospital? • Would patients recommend the hospital to friends and family? http://www.hospitalcompare.hhs.gov/Hospital/Static/Data-Consumers.asp?dest= NAV|Home|DataDetails|ConsumerInfo#HCAPHSMain Accessed 4.13.08
  53. 53. Details on HHS Website • Website will give you percent comparison of patient responses such as, “How often were the hospital rooms kept clean?” • These responses can be graphed and compared to other hospitals. http://www.hospitalcompare.hhs.gov/Hospital/Search/compareHospitals.asp Accessed 4.13.08
  54. 54. Satisfaction Does Not Equal Loyalty • How do we measure patient loyalty? • Patient satisfaction scores by themselves are insufficient, as a satisfied customer does NOT mean a loyal customer • As customer expectations increase in healthcare, scores of 1-4 on a scale of 5 in customer satisfaction will not be sufficient.
  55. 55. Reasons for “5” Equating to Loyalty • Fred Lee: The Hotel Analogy: • “After receiving an evaluation of a hotel I stayed at for several days…I think back and remember nothing special and nothing bad…Everyone was polite, my room was clean, everything worked. What would I put on the survey? Probably a four- satisfied…..Loyalty is generated by memorable things that we didn’t expect.” Lee F. If Disney Ran Your Hospital, Second River Healthcare Press, 2004
  56. 56. Ways to Increase Patient Loyalty: Basic is Not Enough • Meeting basic and spoken requirements is expected. Going beyond what is expected makes the patient’s experience memorable, differentiates physicians, and builds patient loyalty. http://www.pressganey.com/products_ services/readings_findings/satmon/article.php?article_id=238 Accessed 3/7/07
  57. 57. What Does This Data Mean for Radiology?
  58. 58. Possible Suggestions for Radiology – Patient Loyalty • Radiologists should think about increasing our interactions with our customers. • This may mean:  Introducing ourselves  Reviewing results with patients / referring physicians more  Calling patients at home with discrepancies if they don’t have primary care doctors
  59. 59. Six Weeks Later…… Plus a Thank You Note to the Department!!
  60. 60. Unexpected Outcome as Imprinting • To build loyalty, a failure can be a success. • This patient certainly was not happy to have a missed finding, but she did not expect a personal call from the radiologist the next morning. • This unexpected situation made an imprinting.
  61. 61. Other Ways to Build Loyalty  Taking the time to coordinate their radiology care if an abnormality is found  Explaining the patient’s condition to them  Helping the patient take the next step in finding a doctor
  62. 62. Chronic Abdominal Pain
  63. 63. Precontrast Early Post-Contrast Excretory Phase Post-Contrast
  64. 64. Listening to the Patient and Personalized Service Can Make a Huge Difference Two weeks of pelvic pain
  65. 65. What if We Don’t Have Time to Personally See Patients?  Consider adding physician assistants to personally explain radiology procedures and call patients before and after they come to the radiology department to answer questions
  66. 66. Other Means of Increasing Service • Web-based scheduling… • Encouraging patients and/or families to write down questions by providing pens and notepads in the waiting area… and then having someone in our office answer them • Think about small steps to improve patient experiences http://www.pressganey.com/products_services/readings_findings/satmon/article.ph p?article_id=238 Accessed 3/7/07
  67. 67. Wait Times and Patient Satisfaction • Communicating with patients about wait time and letting them know their time is valuable is key to a positive office visit. • Keeping the patient informed about wait time may be more important than the length of the wait itself. http://www.galluppoll.com/content/?ci=14935 Accessed 4.3.07
  68. 68. Minimizing Wait Times • More efficient scheduling & convenient office hours • Activities to Minimize wait – • educational DVD about procedure • Jigsaw Puzzle in waiting room • Massage chairs in waiting room • Work spaces with internet hook-up • If long delay unavoidable, front-line employee should apologize & re-schedule http://jacksonorganization.com/site/english/KnowledgeNetwork/ PatientDiscoveries/TopPerformOutpatient Accessed 3.10.07 Gabriel BA. Your Complete Guide to Patient Service, Physician’s Practice, March 2008
  69. 69. Privacy and Patient Experience  Privacy: • Important both in the radiology department and the hospital at large. Waiting rooms where patient name was visible or said out loud are not desirable.  Consider other ways of identifying patients (pagers or first names)
  70. 70. Patient Observations • Billing:  Being asked for your insurance card and social security number every time you step in the door is disconcerting.  Solution: Attempt to solicit billing information before the patient’s visit – possibly on-line  What is covered? A point person coordinating this would be helpful.
  71. 71. Building Patient Loyalty Through Employee and Physician Loyalty • In addition to increasing service for patients to gain loyalty, organizations need to build employee and physician loyalty. Why?
  72. 72. Employee and Patient Satisfaction Linked http://radio.weblogs.com/0143030/2005/02/06.html#a47 Accessed 3/10/07 Table from Press-Ganey Satisfaction Monitor
  73. 73. Importance of Loyal Employees • “You can’t achieve high patient satisfaction when your staff is unhappy. Patients can easily detect the dysfunctional atmosphere bred by a team of quarreling, dissatisfied employees.” Gabriel BA. Your Complete Guide to Patient Service, Physician’s Practice, March 2008
  74. 74. Sentiments Reflecting Employee Loyalty (1) • Gallup Organization has found high agreement with the five following sentiments correlate best with employee loyalty:  I have the materials and equipment to do my job right  At work, I have the opportunity to do what I do best every day www.gallup.com
  75. 75. Sentiments Reflecting Employee Loyalty (2)  The mission or purpose of my organization makes me feel my job is important  My associates or fellow employees are committed to doing quality work  This last year, I have had opportunities at work to grow www.gallup.com
  76. 76. Improving Employee Satisfaction • What can we do to improve employee loyalty?  Improve communication by administration and management  Solicit the opinions of employees about their work environment  Help employees feel pride in the work they do http://radio.weblogs.com/0143030/2005/02/06.html#a47 Accessed 3.10.07
  77. 77. Physician Engagement • “The solution to (the problem of poor physician engagement) is simple -- ask physicians for their opinions, listen to what they have to say, act on the information, and tell them what actions have been taken”. www.gallup.com Premium Content Accessed April 2007
  78. 78. What Does Patient Loyalty and Service Values Mean for Radiology and Radiology Practices?
  79. 79. Factoring Service Values Into Our Own Radiology Practices • How do we address the increasing need for service? • Factor service values into your own practices and mission statements! • Patient Convenience  Ease of Scheduling  Minimizing Wait Times / acknowledging problems and informing patients as to why there is a wait (if there is one)
  80. 80. Staff Interaction • Staff Interaction:  Rewarding staff for “beyond the call of duty” service, which may include an acknowledgement and reward for an unsolicited thank-you note  Point person to answer questions about the radiology procedure  Follow-up call after the radiology procedure to answer questions
  81. 81. Patient Privacy • Patient Discretion  The need for patient privacy and concerns for patient safety cannot be over-emphasized.  Letting patients know their privacy and safety are paramount
  82. 82. Billing Factors to Increase Service • Billing:  Storing patient demographic information so it doesn’t need to be repeated with each visit  Acquiring information before the patient comes in the door as much as possible  Consider hiring a point person to work with patients and answer their billing questions. This may include a follow-up call to answer questions about forms they may have received from their insurance carriers about coverage.
  83. 83. The Role of Radiologists • To keep up with service, the interactions between patients and radiologists will increase. This may encompass:  Introducing ourselves to patients  Meeting with patients before & after exam to answer questions  Having a staff member hand patients a form with the radiologist scheduled to read their exam if exam was performed off hours  Follow-up calls by radiologists
  84. 84. Increasing Staff Loyalty • Loyalty among physicians and non-physicians in radiology practices should be cultivated as well. Similar factors increase loyalty in both groups:  Regular Meetings to discuss work environment  Focus on identifying strengths of all group members and attempt to foster those strengths  Forums displaying actions based on employee suggestions
  85. 85. How Do We Do It All? • Even though the stakes continually get higher with quality and service requirements, the needs for these attributes only increases.
  86. 86. The Future • By focusing on patient loyalty we can insure viability of our profession and prevent commoditization of our product.
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