The University of Patient Satisfaction

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In the new era of Value Based Purchasing, sustained improvement requires a systematized focused approach. Immersing the organization in data, turning that data into decisive action, celebrating success, and staying the course are all required elements to achieving and sustaining meaningful gains. Learn how to frame and deploy an effective, all-inclusive, organization-wide patient experience strategy. Deal with the good, the bad and the ugly. Eliminate organizational silos and commit to cultural transformation. Discover how an organization can truly become “all immersed” in improving the patient experience.

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The University of Patient Satisfaction

  1. 1. COVER STORY THE UNIVERSITY OF PATIENT SATISFACTION A Total Immersion Approach to Raising the Bar in the Era of Value-based Purchasing The University of Patient Satisfaction By Todd Sloane, Editorial Manager, O Press Ganey Associates ne recent Tuesday morning, questions, at your HCAHPS questions. Have managers, directors, frontline staff a very simple plan of action. Communicate and some physicians gathered in the plan day in and day out. Devote 10 hours a garden-level room at the University of Toledo every month to patient satisfaction. Work with Health Science Campus. Though they were every single patient. Be nice to patients, to one there to hear about statistics and watch a another, to yourself. Can we do this, folks?” PowerPoint presentation, the meeting had the Some murmurs of “yes” came from the crowd. air of a religious revival meeting. “I didn’t hear that. Can we do this?” Duca “Extraordinary times take extraordinary people, asked again. and you are those folks!” Ioan Duca, the service excellence officer for the University and its “Yes!” came the reply, much louder this time. Medical Center, exhorted the crowd. “In the last There is method to Duca’s madness. He six months, our HCAHPS global dimensions has been attending some unusual events to have moved from the 50th to the 62nd percent. enhance his already well-developed ability We are so close to our goal! So take charge to proselytize, including a local church and of your area, take a look at your Press Ganey Texas A&M University’s freshman orientation, a 22 Partners | January/February 2012
  2. 2. HCAHPS “RATE HOSPITAL 0-10” 2011 DATA BY MONTHtotal cultural immersion that Duca says leaves The centerpiece of the project is iCAREstudents “Aggies for life.” university, which stands for communication,“I am really focused on creating a church-like access, respect and excellence. iCARE hasenvironment here,” he said in an interview coursework and hands-on training in patientlater that day in his office at the University of satisfaction for everyone at the University.Toledo Medical Center (UTMC). “We want a total The larger initiative includes a weekly patientcultural transformation. I want that Disney-like satisfaction lineup meeting attended by leadersexperience, the Ritz Carlton experience, the and representatives of all departments.Texas A&M experience. I want that kind of true “What we are doing here is a first of its kindbelief. When people really believe in something, across the nation, where you have a hospitalthey will risk everything to get it done.” within a university and the university, itself,Duca’s role has expanded to encompass a targeting cultural transformation,” Duca said.patient satisfaction and student experience “We are shaking this place up, top to bottom.”improvement initiative involving 9,000employees and 27,000 medical, nursing andother students. Partners | January/February 2012 23
  3. 3. COVER STORY THE UNIVERSITY OF PATIENT SATISFACTION He came to Toledo after leading a similar Scarborough said the challenge for UTMC is to To further signal its change of approach, UTMC transformation at Oakwood Healthcare System match its stellar reputation for clinical quality rewrote its mission statement from a full in southeastern Michigan. Bryan Hinch, MD, with an equal reputation for customer service. paragraph to just one sentence: “Our mission an assistant professor of internal medicine and “We have always had great clinical outcomes, at the University of Toledo Medical Center is pediatrics at the UT medical school, worked and recently we received an honor from U.S. to improve the human condition by providing at Oakwood right after his residency, and was News and World Report, which ranked us No. 1 patient-centered, university-quality care.” impressed by Duca’s efforts there. “I came in in the Toledo area, but our patients sure weren’t Inside the ‘University’ after everything was better. You got a sense seeing us that way. We looked at where we of mission starting right away at orientation. stood in the state of Ohio, and we were 140th iCARE University is housed in a new training Everything was very patient-satisfaction- out of 147 hospitals on HCAHPS. We were facility that includes a small classroom, oriented. When I left to go work at other saving people’s lives, yet they were walking a medical exam room and a simulated organizations, I started to see what the real away angry. We had to learn how to save lives business office. In the exam room, clinicians world was like without that focus. So I was glad and still treat people like human beings.” are evaluated on their active listening, the to see Ioan come on board here at UTMC.” effectiveness of their efforts to reduce anxiety, their clarity of communication, and their ability A New Mission The project in Toledo really dates back more than a year and a half, when senior executives of UTMC looked at the organization’s dismal patient satisfaction scores and decided to do something about them. They traveled to The Dalles, Ore., to meet with officials at Mid- Columbia Medical Center, the first hospital to fully embrace the patient-centered Planetree philosophy. They had Mid-Columbia’s former CEO, Mark Scott, the author of the book, The Courage to Be First, come to UTMC. “We were told this is a three-year journey to turn this thing around,” said Scott Scarborough, PhD, the medical center’s senior vice president and executive director. “Things really got moving only a year ago when we brought in the best patient experience director we could find in Ioan Duca.” In Duca’s first week on the job in November 2010, he joined into a special event called “A New Day,” where the new mission of patient- centered care was announced by Scarborough. Part of the event was to unveil a common uniform – scrubs with the university’s colors. “We wanted to look more professional and more The UTMC project dates back more than a year and a half, when senior executives looked at the organization’s dismal patient satisfaction scores and decided to do something about them. like a team, not people with SpongeBob Square Pants scrubs,” Duca said. 24 Partners | January/February 2012
  4. 4. “We have always had great clinicaloutcomes … but our patients sure weren’tseeing us that way. We were savingpeople’s lives, yet they were walking awayangry. We had to learn how to save livesand still treat people like human beings.”Scott Scarborough, PhDSenior Vice President and Executive Director, UTMCto focus on the patient, not their own stress. Training modules are customized based on theIn the office, registration staff and others who needs of each department. “We looked at whatgreet patients on arrival at the hospital or is appropriate communication with a patient andambulatory care clinics are evaluated on some what isn’t, what constructive criticism of eachof the same skills. other looks like,” Schiavone said.Joseph Schiavone, a service excellence Currently, the AIDET (acknowledge, introduce,specialist and one of three people responsible duration, explanation and thanks) process,for hands-on training, said his department a form of scripting that guides each patientkicked things off with the basics, teaching about interaction, is being rolled out across theHCAHPS, Press Ganey scores and value-based hospital. The service excellence team is layeringpurchasing. “We set the table, so when staff on additional scripting.members go to the weekly lineups, they knowwhat is going on,” he said. Partners | January/February 2012 25
  5. 5. COVER STORY THE UNIVERSITY OF PATIENT SATISFACTION Action Plans Unfold Scarborough stresses that the changes have On the floors, the nursing staffs are buying to emanate from the top. “Part of my role and into the iCARE process, says Kelli Chovanec, responsibility is to ensure that people know my RN, MSN, assistant nursing director on emphasis on these issues. In every talk I give, the orthopedics and rehab unit. Her team I lend my voice to what Ioan is doing, giving has fostered the mentality that everyone is him the verbal support he needs to move the responsible for every patient. “We take frontline mountain that he is being asked to move, staff at least once to the weekly lineup. We have creating the environment in which he can really interactive, good discussions about what be successful.” patient-centered care really looks like.” Bringing in the Docs The unit has a specific action plan around two Duca is now zeroing in on physicians. He has HCAHPS questions – communications about done one-on-one sessions with almost all of medications and response of hospital staff. them about the basics, including the validity Nurses use scripted language when speaking of Press Ganey data and the fact that HCAHPS about medications during administration, is now tied to Medicare reimbursement under provide clear and concise descriptions of the the Hospital Inpatient Value-based drugs, discuss potential side-effects, avoid use Purchasing Program. of confusing medical terminology, and always He is now moving on to the next phase, where end with, “Do you have any questions about each physician is receiving his or her individual your medication?” scores. “A lot of them are in shock, saying, There is hourly rounding, with nurses taking Ioan Duca wants to create a church-like reverence for ‘Are you kidding me? This is me?’ My answer even hours, aides doing odd hours. All have customer satisfaction at UTMC. is, ‘Yes, that is you, now let’s work on how to scripting cue cards in their pockets. fix that,’ ” he said. The next phase of iCARE is “Accountability is a huge part of changing targeted education aimed at physicians, with our culture,” Chovanec said. “We personally modules being developed. investigate every single patient issue that Scarborough has been pleasantly surprised arises, and we do pull nurses in. We also years to renovate the main hospital entry area that it has been a fairly easy sell thus far to get evaluate every staff member and rate them and create all private rooms. A new food service physicians to buy into the patient experience. high, medium or low on customer satisfaction. vendor was brought in, and the medical center “We could see a little more resistance once we We did one-on-ones with lower performers and is hiring its first executive chef. At the front push them on the training in iCARE University, told them, ‘Hey, you have to raise the bar.’ ” door, a new, more customer-centric valet but so far, they are more resistant to the Changes Everywhere service is provided. electronic medical record than they are to improving the patient experience.” The changes under way at the campus – which “We even worked with our volunteers to make has three hospitals with a total of 320 licensed sure the friendliest people greet you inside the UTMC’s most recent union contract builds in beds; a Level One trauma center; centers door,” Duca says. “More than anything, you just incentive compensation tied to improvements devoted to orthopedics, cancer and rehab care; see a difference in how employees look. They in HCAHPS scores. “Ultimately we are going and numerous clinics – are also physical. About used to look down when they walked, now they to judge everybody on how they meet the two $50 million is being spent over the next few are looking up.” parts of our mission statement – quality care and patient satisfaction,” he says. 26 Partners | January/February 2012
  6. 6. At a recent weekly patient satisfaction meeting, Duca (with mic) honors food service workers for their efforts to improve the quality of customer service.With a wry smile, Duca referred to another key buy into the ideology, who see this place asinitiative: strategically beginning to incorporate sacred, a part of their lives and not just a job,patient satisfaction into the University’s medical is key. Look, this is not some Hallmark concept,school curriculum. “As part of a week-long not about teaching people how to smile andcourse as a bridge course from second year say hello. It is not even about giving someoneof med school to the third year, we also taught the right drug or how well they recover fromon key patient satisfaction concepts as well surgery. It is about treating the entire person;as the overall patient experience. The vision it is about the environment in which we treatis to develop a unique patient satisfaction them. When you walk in and show somecurriculum, with a course every year of medical compassion, every single human being, evenschool. And I will love to teach those classes.” the meanest person, will react well to that. ThatNot all of the selling of patient satisfaction has is medicine at its best.”gone smoothly. Duca says that some staff havechosen a different career path because they“simply couldn’t hack it” on patient satisfaction.“Investing into and hiring the right people, who If you have suggestions for future articles for Press Ganey Partners, please email us at partners@pressganey.com Partners | January/February 2012 27

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