Cincinnati Children's Hospital conducted experience mapping interviews with physicians who refer patients to better understand their referral journey and identify opportunities to improve the physician experience. Key findings included the need for more consistent communication such as appointment confirmations and treatment updates. Referring physicians also wanted resources for patients and families about traveling to Cincinnati Children's and expected timely appointments and respect as fellow experts. The experience mapping provided insights to help enhance the referral process and relationships with referring physicians.
Physician experience management requires an understanding of functional and emotional needs, key activities and touchpoints. This case study highlights the successes at Cleveland Clinic in creating an exceptional physician experience.
This presentation by Gelb Consulting performed during the annual NACCDO-PAN conference outlines howto manage referrer relationships. In this presentation, the case study revolves around OSUCCC-James - The James began an initiative to seek insight on the experience provided to referring physicians as well as glean key drivers for referrals and satisfaction. The James' goals included an action-based physician relations management program and ultimately increasing referrer loyalty.
This is a copy of my presentation from the 2012 AAM GIA Professional Development Conference in Palm Springs, California. The topic is marketing to referring physicians. Presenters: Dan Dunlop and Jill Lawlor.
10 Must Know Techniques for Managing Physician Relations in Today's Digital W...Endeavor Management
10 Must Know techniques for managing physician relations is Today’s digital world including 4 techniques to help you increase physician engagement, 3 ideas for enhancing strategic planning and 3 tips on demonstrating program effectiveness.
The 3rd Physician Liaison Summit – Chicago provides real-life examples and strategies for liaisons to strengthen their programs, capture referrals, and increase hospital/health system revenue. This meeting provides proven methods and best practices from your local peers who are leaders in the field as they share insight and tips on how to adapt and implement these same methods into your hospital/health system. Conveniently located, this Midwest Summit is a must-attend meeting for all physician liaisons – whether new to the role, or in a leadership position with years of experience.
Discover how to use analytics to drive objectives and results.
Establish value both internally and in referrers' offices.
Prepare for the future of the liaison role.
http://www.worldcongress.com/events/HL14020/
Physician experience management requires an understanding of functional and emotional needs, key activities and touchpoints. This case study highlights the successes at Cleveland Clinic in creating an exceptional physician experience.
This presentation by Gelb Consulting performed during the annual NACCDO-PAN conference outlines howto manage referrer relationships. In this presentation, the case study revolves around OSUCCC-James - The James began an initiative to seek insight on the experience provided to referring physicians as well as glean key drivers for referrals and satisfaction. The James' goals included an action-based physician relations management program and ultimately increasing referrer loyalty.
This is a copy of my presentation from the 2012 AAM GIA Professional Development Conference in Palm Springs, California. The topic is marketing to referring physicians. Presenters: Dan Dunlop and Jill Lawlor.
10 Must Know Techniques for Managing Physician Relations in Today's Digital W...Endeavor Management
10 Must Know techniques for managing physician relations is Today’s digital world including 4 techniques to help you increase physician engagement, 3 ideas for enhancing strategic planning and 3 tips on demonstrating program effectiveness.
The 3rd Physician Liaison Summit – Chicago provides real-life examples and strategies for liaisons to strengthen their programs, capture referrals, and increase hospital/health system revenue. This meeting provides proven methods and best practices from your local peers who are leaders in the field as they share insight and tips on how to adapt and implement these same methods into your hospital/health system. Conveniently located, this Midwest Summit is a must-attend meeting for all physician liaisons – whether new to the role, or in a leadership position with years of experience.
Discover how to use analytics to drive objectives and results.
Establish value both internally and in referrers' offices.
Prepare for the future of the liaison role.
http://www.worldcongress.com/events/HL14020/
Patient’s experience, improve the quality health3zsaddique
Putting patients first requires more than world-class clinical care – it requires care that addresses every aspect of a patient’s encounter with Hospital, including the patient’s physical comfort, as well as their educational, emotional, and spiritual needs. A team of professionals should serves as an advisory resource for critical initiatives across the Hospital health system. In addition, it should provide resources and data analytics; identify, support, and publish sustainable best practices; and collaborate with a variety of departments to ensure the consistent delivery of patient-centered care.
Bookends of the Patient Experience: Improvement Strategies from Admission to ...TraceByTWSG
Yvonne Chase has a strategy. She shows how hospitals can prepare for the paradigm shift of value-based purchasing. She has the exact revenue cycle tools and processes used to streamline patient access, coordinate patient care and conduct patient follow-up post discharge – all while monitoring patient interactions to ensure clear and accurate communication from the first point of contact to the last.
Managing the hospital in-patient experience | Understanding where to investSiegel+Gale
Few would argue the importance of delivering a quality patient experience, but how do you determine where improvements would have the greatest impact?
Siegel+Gale's Rolf Wulfsberg, PhD, Global Director of Quantitative Insights, shares a unique analysis of patient experience data from a national study of hospital patients.
+ Gain insights into the findings of our recent PinPoint™ study that examined the experiences of 500 hospital patients nationally
+ Learn how it is possible to segregate the impact of different touch points on the overall patient experience
+ See patient experience strategy maps that help inform investment decisions
+ Understand how the drivers of patient acquisition differ from the drivers of retention (e.g., word of mouth recommendations to others)
+ Learn some specific steps that can be taken to improve the hospital experience
Siegel+Gale is a global strategic branding firm committed to building world-class brands through elegantly simple, unexpectedly fresh strategies, stories and experiences. We deliver comprehensive services in brand development, simplification, research and digital media. Since our founding by brand sage and simplification pioneer Alan Siegel in 1969, Siegel+Gale's mantra has been "Simple is Smart."
Patient satisfaction is about the Total Quality of the Patient Encounter (TQE). TQE is the sum of Patient Experience (as defined by CMS) plus Patient Satisfaction as defined by all of the non CMS related touchpoints.
Overview of Patient Experience Definitions and Measurement ToolsInnovations2Solutions
This publication will provide an overview of patient experience, how it is measured, and how to achieve it optimally within the healthcare setting. Sodexo’s definition of Patient Experience will also be explored.
Patient’s experience, improve the quality health3zsaddique
Putting patients first requires more than world-class clinical care – it requires care that addresses every aspect of a patient’s encounter with Hospital, including the patient’s physical comfort, as well as their educational, emotional, and spiritual needs. A team of professionals should serves as an advisory resource for critical initiatives across the Hospital health system. In addition, it should provide resources and data analytics; identify, support, and publish sustainable best practices; and collaborate with a variety of departments to ensure the consistent delivery of patient-centered care.
Bookends of the Patient Experience: Improvement Strategies from Admission to ...TraceByTWSG
Yvonne Chase has a strategy. She shows how hospitals can prepare for the paradigm shift of value-based purchasing. She has the exact revenue cycle tools and processes used to streamline patient access, coordinate patient care and conduct patient follow-up post discharge – all while monitoring patient interactions to ensure clear and accurate communication from the first point of contact to the last.
Managing the hospital in-patient experience | Understanding where to investSiegel+Gale
Few would argue the importance of delivering a quality patient experience, but how do you determine where improvements would have the greatest impact?
Siegel+Gale's Rolf Wulfsberg, PhD, Global Director of Quantitative Insights, shares a unique analysis of patient experience data from a national study of hospital patients.
+ Gain insights into the findings of our recent PinPoint™ study that examined the experiences of 500 hospital patients nationally
+ Learn how it is possible to segregate the impact of different touch points on the overall patient experience
+ See patient experience strategy maps that help inform investment decisions
+ Understand how the drivers of patient acquisition differ from the drivers of retention (e.g., word of mouth recommendations to others)
+ Learn some specific steps that can be taken to improve the hospital experience
Siegel+Gale is a global strategic branding firm committed to building world-class brands through elegantly simple, unexpectedly fresh strategies, stories and experiences. We deliver comprehensive services in brand development, simplification, research and digital media. Since our founding by brand sage and simplification pioneer Alan Siegel in 1969, Siegel+Gale's mantra has been "Simple is Smart."
Patient satisfaction is about the Total Quality of the Patient Encounter (TQE). TQE is the sum of Patient Experience (as defined by CMS) plus Patient Satisfaction as defined by all of the non CMS related touchpoints.
Overview of Patient Experience Definitions and Measurement ToolsInnovations2Solutions
This publication will provide an overview of patient experience, how it is measured, and how to achieve it optimally within the healthcare setting. Sodexo’s definition of Patient Experience will also be explored.
These slides have been designed for healthcare leaders and managers to enable them to run an Making Every Contact Count (MECC) introductory session within their organisations. It may be delivered to teams and individuals prior to them undertaking MECC training.
Patient Activation for Quality: Identifying Champions and Developing ExpertsAdam Thompson
A presentation aimed at supporting organizations in identifying patients for involvement in quality management activities and identification of needed capacities for meaningful involvement.
This presentation was used for the Ryan White Part B Quality Management Committee to support more effective recruitment of patients for quality management activities
Experience Management for Referring Physicians - WHPRMS ConferenceEndeavor Management
A recent presentation at the WHPRMS Conference on how you can step into the physicians shoes and design an engaging experience to increase referrals and grow advocacy.
The Clinician's Role in Developing a Patient Experience StrategyRenown Health
Learn how clinicians and marketing consultants can work together to develop a patient experience strategy that enables team to work at the highest levels and achieve outstanding results.
Client's experiences with behavioral health services are shaped by all of their interactions with us, across the continuum of care. While we can assume what our clients want, need and experience in receiving services from us, it is valuable to use their direct feedback to understand their functional (what we do) and emotional (how we do it) needs throughout their experience. In this webinar conducted with Sovereign Health, we discuss the foundations of customer experience management, provide examples of tools and resources that you can use to understand client's experiences and address opportunities for improvement, and discuss a variety of implications in behavioral health settings.
NIRVAN has initiated workshops to train doctors in the following areas:
Effective Doctor-PatientRelationship.
Essential soft skills requirement in relationship focused profession. Medico –Marketing tools to build medical practice.
Similar to Build referring physician loyalty with experience (20)
Physician schedule optimization model - Endeavor AnalyticsEndeavor Management
How can you meet organizational revenue needs while addressing physician preferences? In this presentation, we review our approach to creating an physician schedule optimization model that assembles and predicts the impact of schedule changes on patient revenue against a series of constraints and variables.
It's like a dating site to match physicians and consumers.
In this presentation, our approach to patient volume modeling is reviewed. This model is used for marketing and operations strategic decision making.
As hospitals and healthcare systems are trying to increase commercial revenue (non-government funded) to sustainable profitability, many are unable to address this problem strategically due to data dispersion and the analytical model required to establish cause and effect relationships. Endeavor Analytics’ digital tool assembles, models and predicts the impact of market changes, marketing and operational activities on all-payer patient volumes.
In this white paper, we review the critical success factors for maintaining a highly successful contact center, ensuring each interaction enchants callers to schedule appointments, participate in fund raising events and refer patients.
Avoid PRM failures by avoiding ensuring it's not simply a repository for documenting simple tasks. PRM failures occur when the IT solutions only serves to document activities instead of serving to streamline the physician experience.
2017 digital engagement webinar marketing360 - gelb consultingEndeavor Management
This presentation highlights things every healthcare marketer should know about how to measure healthcare marketing ROI, how to design a healthcare marketing dashboard the right way, and what’s possible in today’s digital age.
Managing a trusted brand in the oil & gas industry requires a variety of tools for understanding and successful implementation. This document outlines various Endeavor Management capabilities such as Brand Trust Measurement, Message Mapping, Sales Training and Culture Design.
How do you operationalize a culture and strengthen employee trust? Gelb's experience mapping frameworks can be used to effectively examine the holistic employee experience and create advocates out of your teams!
Ever had this nagging feeling you just weren't sure why a physician referred his or her patients to a competitor over you? You have the advanced technology, latest clinical trials, and maybe even a top-notch team of liaisons. Outside of insurance, there are many other functional and emotional factors affecting physician referral behaviors. Most of these can be indicated by leakage reports, but these don't explain the WHY behind them.
In this presentation, given with St. Jude Children's Research Hospital, we explore the combined use of experience map and decision factors research to get at the heart of the issue...which ultimately drives clinical volume.
How to apply speed dating techniques to persona developmentEndeavor Management
We had the privilege of leading this workshop recently along with SG2 and Roswell Park during the Annual PAMN Conference. This presentation outlines the importance and application of segments and templates you can use to accelerate your customer insight development. Personas are used to inform strategic decisions by putting the customer in the room. Learn how this technique can be used for your initiatives related to brand/marketing management, customer experience, and product/service innovation.
Strategic imperative digital transformation in capital projectsEndeavor Management
Radical changes to megaproject delivery will bring first adopters a distinct competitive edge, while writing the epitaph of those who stay stuck in legacy ineffective practices. Whether you are an operating asset owner or an EPC, you are confronted with reinventing the core of your capital projects delivery through digital solutions. Such strategic transformation requires holistic change that focuses not only on installation of a new software application, but also on people and work processes to achieve a sustained, culturally intrinsic result from new technology .
2017 Physician Strategies Webinar Series - Physician Relations StructureEndeavor Management
Acquire insight into how to develop a more strategic and operational approach that can grow your organization’s physician referral base in a continually evolving accountable care environment.
This white paper discusses physicians’ medical training and its relationship to effective leadership qualities, and demonstrates how the soft skills associated with emotional intelligence are essential in guiding physicians in the practice of leadership.
Why is physician engagement strategically important? How can you design a strategy that is laser-focused on increasing clinical demand by ensuring your medical staff is aligned?
This presentation highlights key data, a framework for focusing your efforts with an aim statement and developing a programmatic approach to physician engagement.
Why is physician engagement strategically important? How can you design a strategy that is laser-focused on increasing clinical demand by ensuring your medical staff is aligned?
This presentation highlights key data, a framework for focusing your efforts with an aim statement and developing a programmatic approach to physician engagement.
Traditionally development of digital tools was solely an IT initiative, but today it is a customer-needs driven initiative. Digital experiences are often times the first impression that potential customers have of you, and the first tools they turn to when they have questions or needs throughout their journey.
Best practices for developing digital tools exist, and it is common to partner with an advertising or web development agency for this purpose. However, each market and healthcare brand are unique, necessitating the inclusion of voice of the customer insight to ensure that digital tools are being built around the real (not just assumed) needs and priorities of users. So how can marketing and digital teams engage users in order to develop the digital strategy and deliver the ideal digital experience? In this paper, we present a proven process and research-based tools for obtaining direct user feedback about digital needs, preferences, and priorities.
Hiring an experienced, trusted advisor can be the difference between success and failure. That’s why the members of our Healthcare Expert Advisory Group have been there, done that.
Our Healthcare Expert Advisory Group members have served as system leaders, successfully designing and implementing strategic solutions to healthcare’s ever-changing challenges. We’ve been in your shoes and understand the intricacies of the most complex organizations. Our team has overseen, from the inside, how strategy is designed and successfully implemented. Whether you’re looking for operational excellence, strategic planning, financial strategy, or leadership development, our experts have the experience and expertise to help you achieve results.
Physicians are rapidly adopting social media tools such as Twitter and LinkedIn as part of their approach to keeping up to date with the latest developments in healthcare. As the use of these digital tools becomes increasingly commonplace and mobile apps gain acceptance for supporting healthcare interactions, the physician liaison team can leverage digital tools and social media to improve the efficiency and effectiveness of the delivery of information. Digital tools can serve as a pathway to providing easier and more direct access to information and tools that help to strengthen relationships with referring doctors and their practice staff.
In this paper, we present a best practices from around the country in using digital tools to connect with referring physicians. When used appropriately, digital tools can configured and applied to improve relationships, grow referral volumes, and increase the efficiency and effectiveness of your physician liaisons.
You never get a second chance to make a first impression.Endeavor Management
The contact center is the first step in the ideal experience for patients and physicians. In this brief presentation, Gelb will illustrate best practices in contact centers created by national leaders in healthcare. We will examine the differences between functional needs (what must be done) and emotional needs (how patients and physicians feel about your contact center). How does your contact center rate on the 9 Dimensions of call center strategy? Does your contact center engage and enchant callers?
Report Back from SGO 2024: What’s the Latest in Cervical Cancer?bkling
Are you curious about what’s new in cervical cancer research or unsure what the findings mean? Join Dr. Emily Ko, a gynecologic oncologist at Penn Medicine, to learn about the latest updates from the Society of Gynecologic Oncology (SGO) 2024 Annual Meeting on Women’s Cancer. Dr. Ko will discuss what the research presented at the conference means for you and answer your questions about the new developments.
Anti ulcer drugs and their Advance pharmacology ||
Anti-ulcer drugs are medications used to prevent and treat ulcers in the stomach and upper part of the small intestine (duodenal ulcers). These ulcers are often caused by an imbalance between stomach acid and the mucosal lining, which protects the stomach lining.
||Scope: Overview of various classes of anti-ulcer drugs, their mechanisms of action, indications, side effects, and clinical considerations.
The prostate is an exocrine gland of the male mammalian reproductive system
It is a walnut-sized gland that forms part of the male reproductive system and is located in front of the rectum and just below the urinary bladder
Function is to store and secrete a clear, slightly alkaline fluid that constitutes 10-30% of the volume of the seminal fluid that along with the spermatozoa, constitutes semen
A healthy human prostate measures (4cm-vertical, by 3cm-horizontal, 2cm ant-post ).
It surrounds the urethra just below the urinary bladder. It has anterior, median, posterior and two lateral lobes
It’s work is regulated by androgens which are responsible for male sex characteristics
Generalised disease of the prostate due to hormonal derangement which leads to non malignant enlargement of the gland (increase in the number of epithelial cells and stromal tissue)to cause compression of the urethra leading to symptoms (LUTS
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ARTIFICIAL INTELLIGENCE IN HEALTHCARE.pdfAnujkumaranit
Artificial intelligence (AI) refers to the simulation of human intelligence processes by machines, especially computer systems. It encompasses tasks such as learning, reasoning, problem-solving, perception, and language understanding. AI technologies are revolutionizing various fields, from healthcare to finance, by enabling machines to perform tasks that typically require human intelligence.
Ozempic: Preoperative Management of Patients on GLP-1 Receptor Agonists Saeid Safari
Preoperative Management of Patients on GLP-1 Receptor Agonists like Ozempic and Semiglutide
ASA GUIDELINE
NYSORA Guideline
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New Directions in Targeted Therapeutic Approaches for Older Adults With Mantl...i3 Health
i3 Health is pleased to make the speaker slides from this activity available for use as a non-accredited self-study or teaching resource.
This slide deck presented by Dr. Kami Maddocks, Professor-Clinical in the Division of Hematology and
Associate Division Director for Ambulatory Operations
The Ohio State University Comprehensive Cancer Center, will provide insight into new directions in targeted therapeutic approaches for older adults with mantle cell lymphoma.
STATEMENT OF NEED
Mantle cell lymphoma (MCL) is a rare, aggressive B-cell non-Hodgkin lymphoma (NHL) accounting for 5% to 7% of all lymphomas. Its prognosis ranges from indolent disease that does not require treatment for years to very aggressive disease, which is associated with poor survival (Silkenstedt et al, 2021). Typically, MCL is diagnosed at advanced stage and in older patients who cannot tolerate intensive therapy (NCCN, 2022). Although recent advances have slightly increased remission rates, recurrence and relapse remain very common, leading to a median overall survival between 3 and 6 years (LLS, 2021). Though there are several effective options, progress is still needed towards establishing an accepted frontline approach for MCL (Castellino et al, 2022). Treatment selection and management of MCL are complicated by the heterogeneity of prognosis, advanced age and comorbidities of patients, and lack of an established standard approach for treatment, making it vital that clinicians be familiar with the latest research and advances in this area. In this activity chaired by Michael Wang, MD, Professor in the Department of Lymphoma & Myeloma at MD Anderson Cancer Center, expert faculty will discuss prognostic factors informing treatment, the promising results of recent trials in new therapeutic approaches, and the implications of treatment resistance in therapeutic selection for MCL.
Target Audience
Hematology/oncology fellows, attending faculty, and other health care professionals involved in the treatment of patients with mantle cell lymphoma (MCL).
Learning Objectives
1.) Identify clinical and biological prognostic factors that can guide treatment decision making for older adults with MCL
2.) Evaluate emerging data on targeted therapeutic approaches for treatment-naive and relapsed/refractory MCL and their applicability to older adults
3.) Assess mechanisms of resistance to targeted therapies for MCL and their implications for treatment selection
Title: Sense of Taste
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the structure and function of taste buds.
Describe the relationship between the taste threshold and taste index of common substances.
Explain the chemical basis and signal transduction of taste perception for each type of primary taste sensation.
Recognize different abnormalities of taste perception and their causes.
Key Topics:
Significance of Taste Sensation:
Differentiation between pleasant and harmful food
Influence on behavior
Selection of food based on metabolic needs
Receptors of Taste:
Taste buds on the tongue
Influence of sense of smell, texture of food, and pain stimulation (e.g., by pepper)
Primary and Secondary Taste Sensations:
Primary taste sensations: Sweet, Sour, Salty, Bitter, Umami
Chemical basis and signal transduction mechanisms for each taste
Taste Threshold and Index:
Taste threshold values for Sweet (sucrose), Salty (NaCl), Sour (HCl), and Bitter (Quinine)
Taste index relationship: Inversely proportional to taste threshold
Taste Blindness:
Inability to taste certain substances, particularly thiourea compounds
Example: Phenylthiocarbamide
Structure and Function of Taste Buds:
Composition: Epithelial cells, Sustentacular/Supporting cells, Taste cells, Basal cells
Features: Taste pores, Taste hairs/microvilli, and Taste nerve fibers
Location of Taste Buds:
Found in papillae of the tongue (Fungiform, Circumvallate, Foliate)
Also present on the palate, tonsillar pillars, epiglottis, and proximal esophagus
Mechanism of Taste Stimulation:
Interaction of taste substances with receptors on microvilli
Signal transduction pathways for Umami, Sweet, Bitter, Sour, and Salty tastes
Taste Sensitivity and Adaptation:
Decrease in sensitivity with age
Rapid adaptation of taste sensation
Role of Saliva in Taste:
Dissolution of tastants to reach receptors
Washing away the stimulus
Taste Preferences and Aversions:
Mechanisms behind taste preference and aversion
Influence of receptors and neural pathways
Impact of Sensory Nerve Damage:
Degeneration of taste buds if the sensory nerve fiber is cut
Abnormalities of Taste Detection:
Conditions: Ageusia, Hypogeusia, Dysgeusia (parageusia)
Causes: Nerve damage, neurological disorders, infections, poor oral hygiene, adverse drug effects, deficiencies, aging, tobacco use, altered neurotransmitter levels
Neurotransmitters and Taste Threshold:
Effects of serotonin (5-HT) and norepinephrine (NE) on taste sensitivity
Supertasters:
25% of the population with heightened sensitivity to taste, especially bitterness
Increased number of fungiform papillae
- Video recording of this lecture in English language: https://youtu.be/lK81BzxMqdo
- Video recording of this lecture in Arabic language: https://youtu.be/Ve4P0COk9OI
- Link to download the book free: https://nephrotube.blogspot.com/p/nephrotube-nephrology-books.html
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Prix Galien International 2024 Forum ProgramLevi Shapiro
June 20, 2024, Prix Galien International and Jerusalem Ethics Forum in ROME. Detailed agenda including panels:
- ADVANCES IN CARDIOLOGY: A NEW PARADIGM IS COMING
- WOMEN’S HEALTH: FERTILITY PRESERVATION
- WHAT’S NEW IN THE TREATMENT OF INFECTIOUS,
ONCOLOGICAL AND INFLAMMATORY SKIN DISEASES?
- ARTIFICIAL INTELLIGENCE AND ETHICS
- GENE THERAPY
- BEYOND BORDERS: GLOBAL INITIATIVES FOR DEMOCRATIZING LIFE SCIENCE TECHNOLOGIES AND PROMOTING ACCESS TO HEALTHCARE
- ETHICAL CHALLENGES IN LIFE SCIENCES
- Prix Galien International Awards Ceremony
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Couples presenting to the infertility clinic- Do they really have infertility...Sujoy Dasgupta
Dr Sujoy Dasgupta presented the study on "Couples presenting to the infertility clinic- Do they really have infertility? – The unexplored stories of non-consummation" in the 13th Congress of the Asia Pacific Initiative on Reproduction (ASPIRE 2024) at Manila on 24 May, 2024.
3. Situation Overview
Cincinnati Children’s Hospital
• Nonprofit pediatric academic medical
center established in 1883, located in the
mid-west
• 577 Registered Beds
• 2nd highest recipient of NIH grants for
pediatric research
• 1516 active medical staff members, of
which 784 are employed
• 558 resident/fellows in training
• 12654 total employees
• Served patients from 50 countries and 48
states in FY11
4. Previous Experience with
Physician Satisfaction Measures
• Physician Liaison program since 1994
– Local market
– Primary Care Providers
• Surveyed referring physicians (600)
bi-annually since 2000
• Survey random specialists annually
• Expand Physician Liaison—regional &
national
5. Conventional Wisdom
• Referring providers want &
expect updates about the
patients they refer
• Understand why referring
providers select Cincinnati
Children’s Hospital
• Our referral process is
straightforward and simple
• There are always opportunities
to improve the ―physician
experience‖ however, not
everyone makes this a priority.
6. But We Still Had Questions…
• Do referring specialists expect the same frequency/type
of communication as primary care providers?
• How do specialists learn about our services and what
factors determine repeat business?
• What process do specialists use to refer their patients?
What are the barriers to that process?
• How can we improve the physician experience and which
division(s) will be our ―test of change‖
7. Alternatives Considered
Mystery Shopping
?
Best Guess
Physician Survey Patient Survey
Physician Advisory Board
8. Our Choice
Experience Mapping
• Evaluates the entire experience—from the
moment a decision is made to refer to the stage
of transitioning care back to the referring
provider
• Creates the framework for an action plan
• Assigns accountability for each area
10. Experience, Culture and Brand
Experience • Culture and brand promise are linked
through the experience
delivered, supported by leadership
Deliver Ideal Experience Exceptional Experience
• Leaders translate customer
expectations through the brand and
Internal Brand desired experience into employee
Culture Promise behavior
Desired Employee Behaviors Physician Expectations • This alignment creates an exceptional
experience and a sustainable
competitive advantage
Leadership • We call this desired state
―enchantment‖
12. How Enchantment is Different
Loyal Physicians Enchanted Physicians
Satisfied and refer again Raving fans and spread the word
• Will recommend you if asked • Go out of their way to recommend you
• But won’t give you a second chance • They forgive you for missteps
• Have minimum investment in your future • Demonstrate a strong commitment
• See you as a choice among many • They are part of your future
13. Difference in Drivers
Functional Needs Emotional Needs
NUMBERS STORIES
What we do… How we do it…
– Services offered – Inclusion in treatment
– Clinical outcomes – ―Feel‖ of the interactions
– Transfer efficiency – Subjective quality judgments
– Scheduling delays – Feeling valued
14. Enchantment Cycle
Reinforce the
Listen to
promise and deliver Reinforce Listen customers, their
in all communications
influencers and other
& interactions
stakeholders
Physician
Deliver Define
Define how your
Deliver flawlessly on
organization will meet
the Promise
or exceed needs
Promise
Communicate a
resonant Promise
15. Shifting the Perspective
“Customer experience is bigger than customer
service in that it is the full, and end
experience. It starts when you first hear about
Amazon from a friend and ends when you get
the package in the mail and open it.”
-Jeff Bezos, CEO, Amazon.com
16. Experience Mapping:
Fitting it All Together
Experience Mapping is an in-depth qualitative research technique that
utilizes a visual cue (the experience map) to help patients, staff, and other
influencers recall specific episodes in their journey. It provides:
Assessment of the total experience
• Expectations- before first encounter
• Activities and Touchpoints
• Changes in attitudes, if any
Framework for action
• Experience stewards who are responsible for delivery
• Steward can appreciate the relationship of their actions to the rest of the journey
• Interactions or “touchpoints” are categorized at each step
17. Scope
• Airway Reconstruction and Aerodigestive
& Sleep Center
– 15 current referrers
An interviewee is designated as a current
– 3 non-referrers referrer if he/she has currently or previously
referred a patient to Cincinnati Children’s;
non-referrers have never referred a patient to
• Perinatal Institute Cincinnati Children’s OR have never referred
to the respective program.
– 20 Current Referrers
• Gastroenterology, Hepatology & Nutrition Center
– 15 current referrers
– 3 non referrers
17
18. Subspecialist Experience Map
Scheduling/ Transition of
Awareness Need Treatment
Transfer Care
Perceptions of Diagnosis Initial contact with Coordination of care Discharge summary
Cincinnati Children’s referral facility with Cincinnati
Evaluation and Coordination of
Children’s specialist
Knowledge about selection of treatment Scheduling/transfer on-going care
Cincinnati Children’s providers process Progress notes and
Ongoing patient
methods of
Marketing or Discussion with Timing and ease of care/support
communication
educational resources patients process
Call-backs for
from Cincinnati (diagnosis, referral Family feedback about
Managing insurance assistance
Children’s options) their clinical
requirements,
experience
Ideal relationship with Preparing patients for accommodations or
Cincinnati Children’s what to expect travel for families Support offered to
family
Methods of Communication (In each phase)
19. Imparting the Insights
Referral Stages: Ideal Outcome:
“Cincinnati Children’s is my best resource.”
Day in the Life:
• Cincinnati Children’s provides the best care
possible for my patients and their families
Touchpoint Performance:
• Cincinnati Children’s provides great care to
patients, but does not keep me informed
Electronic communications,
telephone communications, • I prefer to refer patients to other facilities
facility, written communications, because of bad experiences with Cincinnati
interpersonal communications Children’s
19
20. Communication Communication Coordination Care
• I only refer patients out of state if there is no way to provide care locally; a major hurdle
is overcoming insurances restrictions as certain providers will not
cover care provided out of state (although Cincinnati Children’s accepts more types of insurance
than other facilities that I have worked with and helps with the paperwork)
21
21. Communication Communication Coordination Care
• I only refer patients out of state if there is no way to provide care locally; a major hurdle is
overcoming insurances restrictions as certain providers will not cover care provided out of
state (although Cincinnati Children’s accepts more types of insurance than other facilities that I have
worked with and helps with the paperwork)
• I am confident in using Cincinnati Children’s for certain diagnoses (such as airway, cardiovascular
or GI), but I may pick another facility for other issues (such as hearing problems or general
as I am unsure what unique benefits Cincinnati
prematurity),
Children’s would offer my patients compared to a
facility closer to home
22
22. Communication Communication Coordination Care
• I only refer patients out of state if there is no way to provide care locally; a major hurdle is
overcoming insurances restrictions as certain providers will not cover care provided out of
state (although Cincinnati Children’s accepts more types of insurance than other facilities that I have
worked with and helps with the paperwork)
• I am confident in using Cincinnati Children’s for certain diagnoses (such as airway, cardiovascular
or GI), but I may pick another facility for other issues (such as hearing problems or general
prematurity), as I am unsure what unique benefits Cincinnati Children’s would offer
my patients compared to a facility closer to home
• I receive mailed information from many pediatric facilities, and feel that Cincinnati Children’s is equal
I particularly appreciate information
to, or better than, others;
about their referral process, outcomes and unique
research/clinical techniques
23
23. Current Importance to
Category Details (Why/What/How) Performance Referrers
Establishing Continue CME offerings , conferences,
High 1
Expertise distribution of outcomes and research updates
Visit referring physician offices or host Grand
Outreach High 2
Rounds at their facility
Program-specific mailed resources, including
Resources contacts for initiating a referral, include Moderate 3
messaging “we make it easy for you to refer”
Out-of-state Promote resources that provide help with
Low 4
challenges insurance restrictions and travel resources
Provide resources that outline array of services
Resources offered and focus on benefits for patients ; focus Moderate 5
on “Why Choose Cincinnati Children’s?”
24
24. Coordination Communication Coordination Care
• To initiate a referral, I find the phone number on the Web site, in a mailed newsletter, or have been
I call the physician or
given a direct number to one of the physicians;
department coordinator and they take care of
everything from that point, which is exactly what I want – it is easy
26
25. Coordination Communication Coordination Care
• To initiate a referral, I find the phone number on the Web site, in a mailed newsletter, or have been
given a direct number to one of the physicians; I call the physician or department
coordinator and they take care of everything from that point, which is exactly what I
want – it is easy
• I’m never
Even though I trust the patient’s appointment has been appropriately scheduled,
really sure when their appointment is and would like
an appointment confirmation; this confirmation could also include contact
information so that everyone involved knows who to contact with questions
27
26. Coordination Communication Coordination Care
• To initiate a referral, I find the phone number on the Web site, in a mailed newsletter, or have been
given a direct number to one of the physicians; I call the physician or department
coordinator and they take care of everything from that point, which is exactly what I
want – it is easy
• Even though I trust the patient’s appointment has been appropriately scheduled, I’m never really
sure when their appointment is and would like an appointment confirmation; this
confirmation could also include contact information so that everyone involved knows who to contact
with questions
• The post-treatment communication is critical to me and a determiner of whether or not my referring
experience is a positive one; I
sometimes receive communication from
Cincinnati Children’s, but it is inconsistent (and I wonder if it is
being sent to another doctor) and sometimes arrives too late
(after I have already seen the patient)
28
27. Coordination Communication Coordination Care
The scheduling process is easy and timely, which is ideal for referrers. To their
knowledge, patients typically receive appointments in a appropriate time frame;
if the patient expresses concern about the
timing, the referrer is able to call to obtain
an earlier appointment.
30
28. Coordination Communication Coordination Care
The scheduling process is easy and timely, which is ideal for referrers. To their
knowledge, patients typically receive appointments in a appropriate time frame;
if the patient expresses concern about the timing, the referrer is
able to call to obtain an earlier appointment.
Many do not receive any updates during treatment and would like notes after
Discharge summaries are
important milestones.
critical for on-going care, sometimes received after the
referrer has already seen the patient – or not at all. Electronic (or telephone)
updates are preferred for speed; mailed for formal record-keeping.
Referrers also suggest appointment confirmations (faxed or electronically) that
include the day/time of the appointment, who to contact with questions and the
name of the patient’s doctor; this would be helpful for them to stay updated about
their patient’s care and to answer questions the family may have.
31
29. Coordination Communication Coordination Care
The scheduling process is easy and timely, which is ideal for referrers. To their
knowledge, patients typically receive appointments in a appropriate time frame;
if the patient expresses concern about the timing, the referrer is
able to call to obtain an earlier appointment.
Many do not receive any updates during treatment and would like notes after
important milestones. Discharge summaries are critical for on-going
care, sometimes received after the referrer has already seen the patient – or not
at all. Electronic (or telephone) updates are preferred for speed; mailed for
formal record-keeping.
Referrers also suggest appointment confirmations (faxed or electronically) that
include the day/time of the appointment, who to contact with questions and the
name of the patient’s doctor; this would be helpful for them to stay updated about
their patient’s care and to answer questions the family
may have.
32
30. Coordination Communication Coordination Care
―It’s always challenging transferring someone
out of state because there’s a lot that goes ―I get practically nothing from
into it. There are some things that help, such Cincinnati Children’s after the
as knowing that I can pick up the phone and baby has gone to the
talk to someone at Cincinnati.‖ NICU, and this is similar to
-- ENT Current Referrer other places that I refer babies
to…I won’t give anyone I work
with higher than a C for
―I don’t like the way the NICU attending never communication. It tends to fall
calls me back, but I have no choice. Fair off into a black hole and if I
warning -if another group comes into town, I want to know any specifics, I
will be calling them instead…it’s only a matter have to call and extract the
of time because we get more competition in information from them.‖
this area.‖ -- Perinatal Referring Physician
-- Perinatal Referring Physician
33
31. Care Communication Coordination Care
• Families are anxious about going to a large
hospital, especially if it is out of state, so directing me to resources
such as maps, a list of travel resources, contact numbers for families to call, and information about
what they can expect would be helpful
35
32. Care Communication Coordination Care
• Families are anxious about going to a large hospital, especially if it is out of
state, so directing me to resources such as maps, a list of travel resources, contact numbers for
families to call, and information about what they can expect would be helpful
• I want to feel respected as a fellow expert – after all, I am a
specialist and not a general family doctor – so I expect them to always accept patient transfers, give
my patients appointments within an timeline that I deem appropriate, and listen to the background
information that I can offer
36
33. Care Communication Coordination Care
• Families are anxious about going to a large hospital, especially if it is out of
state, so directing me to resources such as maps, a list of travel resources, contact numbers for
families to call, and information about what they can expect would be helpful
• I want to feel respected as a fellow expert – after all, I am a specialist and not a general
family doctor – so I expect them to always accept patient transfers, give my patients appointments
within an timeline that I deem appropriate, and listen to the background information that I can offer
• I know it’s difficult for Cincinnati Children’s physicians to call me as they are busy, but if I really
want to get in touch with them, I often don’t know who to call and would like a means to contact my
ideally, they would initiate a call to me
patient’s care team – and
for urgent situations
37
34. Care Communication Coordination Care
• Families are anxious about going to a large hospital, especially if it is out of
state, so directing me to resources such as maps, a list of travel resources, contact numbers for
families to call, and information about what they can expect would be helpful
• I want to feel respected as a fellow expert – after all, I am a specialist and not a general
family doctor – so I expect them to always accept patient transfers, give my patients appointments
within an timeline that I deem appropriate, and listen to the background information that I can offer
• I know it’s difficult for Cincinnati Children’s physicians to call me as they are busy, but if I really
want to get in touch with them, I often don’t know who to call and would like a means to contact my
patient’s care team – and ideally, they would initiate a call to me for urgent situations
• I want to have a relationship with someone there who knows my
name and can help me navigate the system, and I appreciate being part of
outreaches and offered opportunities to strengthen my skills (through CMEs and the specialist’s
willingness to explain things to me and answer my questions)
38
35. Care Communication Coordination Care
Functional
Needs
How these needs are met…
I am confident in their clinical Conferences, journals, hosting CME,
care and outcomes mailed updates, publishing outcomes
I can quickly access them and Priority Link, minimal hold times, quick
initiate a referral/transfer transfer process
I receive a discharge Immediate summary upon
summary and on-going care discharge, clear plan for next
plan steps, ability to contact specialist for
questions
I am updated throughout the Updates post-admission and weekly
process
40
36. Care Communication Coordination Care
Functional
Needs
How these needs are met…
I am confident in their clinical Conferences, journals, hosting
care and outcomes CME, mailed updates, publishing
outcomes
I can quickly access them and Priority Link, minimal hold times, quick
initiate a referral/transfer transfer process
I receive a discharge Immediate summary upon discharge,
summary and on-going care clear plan for next steps, ability to
plan contact specialist for questions
I am updated throughout the Updates post-admission and weekly
process
41
37. Care Communication Coordination Care
Functional
Needs
How these needs are met…
I am confident in their clinical Conferences, journals, hosting CME,
care and outcomes mailed updates, publishing outcomes
I can quickly access them and Priority Link, minimal hold times, quick
initiate a referral/transfer transfer process
I receive a discharge Immediate summary upon
summary and on-going care discharge, clear plan for next
plan steps, ability to contact specialist for
questions
I am updated throughout the Updates post-admission and weekly
process
42
38. Care Communication Coordination Care
Functional
Needs
How these needs are met…
I am confident in their clinical Conferences, journals, hosting
care and outcomes CME, mailed updates, publishing
outcomes
I can quickly access them and Priority Link, minimal hold times, quick
initiate a referral/transfer transfer process
I receive a discharge Immediate summary upon discharge,
summary and on-going care clear plan for next steps, ability to
plan contact specialist for questions
I am updated throughout the Updates post-admission and weekly
process
43
39. Care Communication Coordination Care
Emotional
Needs
Don’t question necessity of transfers, ask
I am respected questions and respect medical opinion, call to
discuss updates, assure they did a good job
caring for the baby
I am included in the process Updates and discharge
summaries, communication with transfer team
They appreciate my Explicit “thank you” and “how can we do better?,”
referrals outreach, resources to make it easy to initiate a
referral
They make me look good to Inclusion in on-going care plan, reverse transfer
families when possible
I can develop my Educational outreach, allowing them to ask
professional expertise questions about specific patients
45
40. Care Communication Coordination Care
Emotional
Needs
Don’t question necessity of transfers, ask
I am respected questions and respect medical opinion, call to
discuss updates, assure they did a good job
caring for the baby
I am included in the process Updates and discharge summaries,
communication with transfer team
They appreciate my Explicit “thank you” and “how can we do better?,”
referrals outreach, resources to make it easy to initiate a
referral
They make me look good to Inclusion in on-going care plan, reverse transfer
families when possible
I can develop my Educational outreach, allowing them to ask
professional expertise questions about specific patients
46
41. Care Communication Coordination Care
Emotional
Needs
Don’t question necessity of transfers, ask
I am respected questions and respect medical opinion, call to
discuss updates, assure they did a good job
caring for the baby
I am included in the process Updates and discharge
summaries, communication with transfer team
They appreciate my Explicit “thank you” and “how can we do better?,”
referrals outreach, resources to make it easy to initiate a
referral
They make me look good to Inclusion in on-going care plan, reverse transfer
families when possible
I can develop my Educational outreach, allowing them to ask
professional expertise questions about specific patients
47
42. Care Communication Coordination Care
Emotional
Needs
Don’t question necessity of transfers, ask
I am respected questions and respect medical opinion, call to
discuss updates, assure they did a good job
caring for the baby
I am included in the process Updates and discharge summaries,
communication with transfer team
They appreciate my Explicit “thank you” and “how can we do better?,”
referrals outreach, resources to make it easy to initiate a
referral
They make me look good to Inclusion in on-going care plan, reverse transfer
families when possible
I can develop my Educational outreach, allowing them to ask
professional expertise questions about specific patients
48
43. Care Communication Coordination Care
Emotional
Needs
Don’t question necessity of transfers, ask
I am respected questions and respect medical opinion, call to
discuss updates, assure they did a good job
caring for the baby
I am included in the process Updates and discharge
summaries, communication with transfer team
They appreciate my Explicit “thank you” and “how can we do better?,”
referrals outreach, resources to make it easy to initiate a
referral
They make me look good to Inclusion in on-going care plan, reverse transfer
families when possible
I can develop my Educational outreach, allowing them to ask
professional expertise questions about specific patients
49
44. Program Summary
Program Awareness Need Scheduling Treatment Transition
Perinatal Program is well- Common to split Transfer process is Few receive Discharge
Institute known, but other referrals, and send efficient, but treatment updates, summaries are
options are closer to you only complex physicians don’t some track down received
home; building cases always feel included doctor themselves inconsistently, but
relationships via needed for ongoing
outreach is crucial care
Airway Re- Capabilities and Top referral choice Scheduling Patients are well- Some receive ample
construction specialists are for airway , but split process is easy; cared for, but follow-up, but
and Aero- well-known; most referrals for other seek progress reports are others receive none
digestive and receive mailed issues; insurance is a appointment inconsistent and are unsure why
major hurdle
Sleep Center information confirmation
and patient
resources
Gastro- Most have heard Expertise is well- The process is easy Generally happy Most receive follow-
enterology, of program and known, but local and efficient, but with updates; need up communication
Hepatology receive mailed care is preferred and appointment contact #s when but it’s often late –
& Nutrition information; CME few know about confirmations are questions arise after follow-up visit
travel resources suggested
Center in Aspen is
popular
High Performance Moderate Performance Low Performance
51
45. Program Summary
Program Awareness Need Scheduling Treatment Transition
Perinatal Program is well- Common to split Transfer Few receive Discharge
Institute known, but other referrals, and process is treatment updates, summaries are
options are closer send you only efficient, but some track down received
to home; building complex cases physicians don’t doctor themselves inconsistently, but
needed for ongoing
relationships via always feel
care
outreach is crucial included
Airway Re- Capabilities and Top referral Scheduling process Patients are Some receive
construction specialists are well- choice for is easy; seek well-cared for, ample follow-
and Aero- known; most receive airway, but split appointment but progress up, but others
digestive and mailed information referrals for confirmation and reports are receive none
patient resources
Sleep Center other issues; inconsistent and are unsure
insurance is a why
major hurdle
Gastro- Most have heard of Expertise is well- The process is Generally happy Most receive
enterology, program and receive known, but local easy and with updates; follow-up
Hepatology mailed information; care is preferred efficient, but need contact communication
& Nutrition CME in Aspen is and few know appointment #s when but it’s often
popular
Center about travel confirmations questions arise late – after
resources are suggested follow-up visit
High Performance Moderate Performance Low Performance
52
46. Program Summary
Program Awareness Need Scheduling Treatment Transition
Perinatal Program is well- Common to split Transfer process is Few receive Discharge
Institute known, but other referrals, and send efficient, but treatment summaries are
options are closer to you only complex physicians don’t updates, some received
home; building cases always feel included track down inconsistently,
relationships via
doctor but needed for
outreach is crucial
themselves ongoing care
Airway Re- Capabilities and Top referral choice Scheduling process Patients are well- Some receive ample
construction specialists are well- for airway , but split is easy; seek cared for, but follow-up, but
and Aero- known; most receive referrals for other appointment progress reports are others receive none
digestive and mailed information issues; insurance is a confirmation and inconsistent and are unsure why
major hurdle patient resources
Sleep Center
Gastro- Most have heard of Expertise is well- The process is easy Generally happy Most receive follow-
enterology, program and receive known, but local and efficient, but with updates; need up communication
Hepatology mailed information; care is preferred and appointment contact #s when but it’s often late –
& Nutrition CME in Aspen is few know about confirmations are questions arise after follow-up visit
popular travel resources suggested
Center
High Performance Moderate Performance Low Performance
53
48. Our Key Take-Aways
• Developing direct relationships with
specialists is key
• Referring providers want to be included in
the team and expected updated
communication
• Communication is sporadic and inconsistent
• Challenges exist with the referral process
• Referring providers want to learn about
―other services‖ available
• Coordination of transition care could
improve
49. Action Categories
Communication Coordination Care
Awareness and Outreach
+
Exceptional Referral Coordination
=
Lasting relationships
50. Refresh Communication Coordination Care
• Physician liaison materials update
• Priority Link promotion
• Sub-specialist web pages
• First appointment notifications
• Hospital transfer information for parents
54. Streamline Communication Coordination Care
• Capture referring physician information in EPIC
• HIPAA guidelines and second opinions
• EPIC access for specialists
• Discharge summary for next steps in on-going care
• Integration between CRM and EPIC
55. New Standards Communication Coordination Care
• Hospital transfer improvement
• Coaching with Physician Priority Link staff
• Perinatal inpatient care nurse liaison
56. Results to Date
• Positive engagement with targeted service lines
– Staff now engaged in service recovery with physician liaisons
– Reviews of reports with faculty
• Expansion to national scope
– FTEs plus travel budget increases
– Marketing creating national campaign
• Activity increases
– Registrants to physician portal
– Volume
57. Inpatient Discharges
(Regional and National)
FY 2000 FY 2005 FY 2010
Regional National
58. Inpatient Days
(Regional and National)
FY 2000 FY 2005 FY 2010
Regional National
59. Short Stay Discharges
(Regional and National)
FY 2000 FY 2005 FY 2010
Regional National
60. Outpatient Visits
(Regional and National)
FY 2000 FY 2005 FY 2010
Regional National
61. Referrals from WV specialists that
Physician Services met with* in 2011
20
18
16
14
Number of Referrals
12
10
8 IP Referrals
6
OP Referrals
4
2
0
ENT Cardio Hem/Onc Neuro Endo Plastics Rheum
Divisions receiving referrals
*Specialists from ENT, Hem/Onc and Cardio
62. In Our Plans
• Further optimize EPIC for
transition of care
• Identify ways to improve the
communication process
• Other specialty programs
are seeking our assistance
• CME department now
working with divisions to
heighten awareness
63. Lessons Learned
• Make sure you have lists ready
• Engage the clinical leaders early
• Get buy-in from other process owners (e.g., IT)
• Ensure alignment on deliverables and action
64.
65. John McKeever Patty Branson
President Sr. Director Physician Services
Gelb, An Endeavor Management Company Cincinnati Children’s Hospital
1011 Highway 6 South, Suite 120 3333 Burnet Avenue
Houston, TX 77077 MLC 5002
Cincinnati, OH 45229-3039
281-759-3600 513-636-6033 (office)
www.endeavormgmt.com 513-636-7431 (Fax)
jmckeever@endeavormgmt.com Patty.Branson@cchmc.org
Editor's Notes
PB: Share information about Cincinnati Children’s, significant changes over the last 15 years, and why we began this journey of the physician experience.
PB: Historically share information about the data collected and the processes for gathering data. What led to our next steps.
PB: What we thought we understood and knew
PB: Will discuss the work of our group and the decision process
We knew we needed market feedback – somehow engaging physicians—PB can address each of theseThe Physician Advisory Board is a distinguished group of independent practicing physicians who provide advice on issues of importance to doctors
Why our decision led to working with Gelb
Talk about experience starting BEFORE they call you and ends after they leaveFrom the customer perspective – that’s what most important – we often fail to recognize that
Comment on length of interviews, discussion format
Review the distinctions across each areaWhy this empathy building is key for staff to take action
Reference what’s most important
Review highlighted comments
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Review these pieces as a set up for the next section
Comment on this framework shaping the way priorities are set