Patient satisfaction with hospital physicians

Hospitalist Best PracticeJ Rush Pierce Jr, MD, MPH

January 29, 2014

Objectives

1. Agree to adopt 2 or 3 interventions designed to improve patient satisfaction with hospital physicians at UNMH

2. Implement these interventions this Spring

3. Report measurements back to group in June

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Agenda• First part (25 minutes)– Review (again) where we are– Review the literature– Review corporate strategies– Review suggested interventions from retreat

• Second part (25 minutes)– Discuss and select 2 or 3 interventions to

implement – Discuss strategies for implementation

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Where are we at UNMH?

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4-West Press-Ganey patient satisfaction surveys (2012, N = 117)

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5-West Press-Ganey patient satisfaction surveys (07/2013)

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Physician satisfaction: Press-Ganey

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Some negative comments• One of the physicians was very rude• Doctor said he would call my son in Germany

and never did• They would tell me one thing and then never

process the order• Lack of attention and respect• Doctors could have smiled more• The “team approach” led to a lot of confusion

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Comments from nursing

• Team says they will check back in afternoon and then don’t

• Lack of communication about change in pain meds

• Pts made NPO long time and then procedure cancelled

• Poor communication about daily plan• Poor communication about discharge

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What does the literature say?

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Basic literature search strategy

• PubMed searches– “patient satisfaction” [Title] AND “physician” [Title

and Abstract] 340 manuscripts– “patient satisfaction” [Title] AND “physician” [Title

and Abstract] and “hospital” [Title and Abstract] 82 manuscripts

• Reviewed all abstracts for relevance

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Types of studies

• Simple patient surveys

• Patient surveys correlated with observations of physicians (real or video-taped)

• Intervention followed by patient surveys (before-after, some controlled trials)

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Outpatient literature

• Satisfaction with physician NOT correlated with:– Physician specialty (FM vs. IM)– Physician ethnicity– Physician gender– Physician attire– Physician courtesy– Physician use of “chatting”– Physician offered prayer– Physician use of eye contact, body position and

physical contact

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Outpatient literature (contd) • Patient satisfaction with physician associated with

certain interviewing styles– Perceived physician empathy– Use of open-ended questions; patient-centered

communication– Including psychosocial questions in hx– Time spent on education– Gender specific non-verbal cues: loudness of voice,

closeness of seating, “gazing”– Physician certainty

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Outpatient literature (contd)

• Patient satisfaction with physician also associated with– Shorter wait times– Increased interview length (real and perceived)– Longer interview than anticipated– Personally informing pts of transfer of care– Physician happiness

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Inpatient literature – no correlation

Intervention Setting

Follow-up phone call from staff Large multi-hospital system in MidWest

Post-op anesthesia visits Anesth Dept at academic health center

Use of physician business cards ED at academic health center

Being seen by nurse vs. physician ED in Jamaica

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Inpatient literature – positive correlation

Intervention Setting

Perceived empathy by physician Teaching hosp in Korea

Patient-centered communication style General academic inpatient service in US

Perceived nurse/physician collaboration Teaching hosp in England

Not wearing mask Teaching hosp in China

Patient not in isolation Teaching hosp in China

Post visit phone call or email from MD ED in academic health center in US

Native Spanish-speaker vs. interpreter ED in academic health center in US

Providing an antibiotic prescription to pt with respiratory sxs

8 ED’s in large multi-hospital system

Multidisciplinary outpt clinic consultation vs. inpatient oncology consultation

Newly dxd breast cancer patients at academic health center

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Inpatient literature – positive correlation (contd)

Intervention Setting

Customer training satisfaction of staff ED in academic health center in US

Use of bedside vs. radiology ultrasound ED in academic health center in US

Shorter waiting time ED in academic health center in Iran

Shorter total through-put time ED in academic health center in US

Robotic telerounding in afternoon Johns Hopkins Urology service

Employing a patient communicator Pediatric academic hospital service in US

Use of RSMI vs. live interpreter Large multi-hospital system in MidWest

Use of patient whiteboards Stanford Hospital

Putting student, resident and attending photos in patient room

Internal Medicine hospital service at Mayo Clinic

Attending continuity Nonteaching hospitalist services at Northwestern Hospital

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Robotic Telerounding

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Mayo Clinic Proceedings. 76(6):604-608, June 2001.

Patient satisfaction and provider photos

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Patient satisfaction and physician continuity

J Gen Intern Med. 2014 Jan 17. [Epub ahead of print]

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What are suggested corporate strategies?

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Seven Corporate strategies to Improve Patient Satisfaction

1. Smooth the admitting process2. Communicate test results promptly3. Respond quickly to the patient4. Keep the patient informed5. Coordinate provider communication6. Promote a quieter/more restful environment7. Speed discharge process

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Seven Corporate strategies to Improve Patient Satisfaction

1. Smooth the admitting process2. Communicate test results promptly3. Respond quickly to the patient4. Keep the patient informed5. Coordinate provider communication6. Promote a quieter/more restful environment7. Speed discharge process

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What ideas came out of our retreat?

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Retreat ideas

• Communication with patients (general): – Decrease use of medical jargon.– Don't interrupt patients when they are speaking.– Don't use derogatory terms.– Ask permission before you examine patients.– Find some common interest with patients especially

when you have other problems connecting with them.– Ask patients how they are doing.

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Retreat ideas (contd)

• Communication with patients (specific):– Discuss discharge plan daily with pt and/or family.– Sit down when speaking with patients.– Tell patients when you're going off service.– AIDET (Announce, introduce, duration,

explanation, thanks) model– Call families regularly with an update– Afternoon check in rounds.– Give patients a business card.

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Retreat ideas (contd)

• Care Coordination– Communicate plans on a regular basis to the

nursing staff.– Use Whiteboards– Readdress NPO orders BID

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What will we choose?

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How and when will we implement this?

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