scripps patient experience: physician integration...scripps patient experience: physician...

Scripps Patient Experience:

Physician Integration

Chris Van Gorder FACHE

Ghazala Q. Sharieff MD, MBA

About Scripps Health

Not-for-Profit, Integrated Health Care System in San Diego, California

Operating Two of San Diego’s Six Trauma Centers

$3.1 BILLION IN REVENUE

15,000EMPLOYEES

3,000PHYSICIANS

2,000 IN INDEPENDENT PRACTICE

2Scripps Patient Experience: Physician Integration

Physician Leadership Cabinet- MD to MD


Awards & Recognition

CEO & Senior Director, Patient Experience & Medical Management

5


Why Scores are So Important

VBP

Legal consequences

Quality indicators –ex: readmissions

Loyalty – repeat business & referrals

The patient’s experience is the ONLY market differentiator

Program Overview

20%100%

80%

60%

40%

20%

0%

VBP Year and Program Contribution

FY15

(1.50%)

FY16

(1.75%)

FY17

(2.0%)

Dom

ain

Weig

hts

(%

)


30%

30%

20%

25%

25%

20%

25%

5%

25%

25%

40%

10%

Total Performance

Score

Clinical Process

Domain Score

Patient Experience

Domain Score

Outcome

Domain Score

Efficiency

Domain Score

Safety

+

+

+

+

FY 2017 VBP For Patient Experience

Domain Measures

CMS Performance

StandardsEncinitas Green La Jolla Mercy

BenchmarkAchievement

ThresholdScore Points Score Points Score Points Score Points

Nurses always communicated well 86.6% 78.2% 75% 0 82% 4 80% 3 75% 0

Doctors always communicated well 88.8% 80.5% 77% 0 87% 8 82% 2 79% 0

Responsiveness of hospital staff 80.0% 65.1% 60% 0 68% 2 66% 1 59% 0

Pain management 78.3% 70.3% 69% 0 75% 5 74% 5 70% 0

Communication about medicines 73.4% 62.9% 61% 0 69% 6 65% 2 61% 0

Hospital cleanliness and quietness 79.4% 65.3% 61% 0 66% 1 68% 2 59% 1

Discharge Information 91.2% 85.9% 84% 0 87% 2 85% 2 84% 1

Overall rating of the hospital 84.6% 70.0% 71% 1 79% 6 78% 5 66% 0

Consistency Points 15 20 19 14

FINAL FY17 Score 16 of 100 54 of 100 41 of 100 16 of 100

Patient Experience

VBP DomainEncinitas Green La Jolla Mercy

Scripps

Hospitals

Actual VBP Impact $13,653 $183,629 $25,696 $3,972 $226,950

Potential VBP Impact(with domain score of 100%)

$360,116 $508,202 $569,699 $651,111 $2,089,128

Public Reporting


Public Reporting of Physician

Patient Experience Scores

“If the other guy's getting better, then

you'd better be getting better faster than that

other guy's getting better or you're getting worse."

10

Tom Peters

Scripps Patient Experience: Physician Integration

“The Circle of Innovation”

The Major Difference

11

2% 3%

9%

28%58%

1% 2%6%

25%

66%

Torrey Pines

Very Poor

Poor

Fair

Good

Very Good

Encinitas


12

Culture eats

strategy

for lunch,

every day.


13

Knock1. Knock 2. Sit 3. Ask...

What is your greatest concern?

The Three Key Behavioral Drivers


To Sit or Not to Sit?


Johnson R etal. Ann Emerg Med 2007

Sitting time

overestimated15%

Standing time

underestimated7%

Providers

overestimated time6%

Likelihood to Recommend Score

Memorial Hospital and Health System, South Bend, IN


Likelihood to

Recommend Score

Initial Patient Survey 81.5

After 90 Days Asking

“What is your greatest fear or concern

around your hospitalization?”

83.5

85.5

Moving the Dial- Percentage to Percentile


Percentile Rank

Perc

en

t A

lways

95%

85%

75%

65%

10

73.8%

20

76.1%

25

77.2%

30

78.1%

40

79.3%

50

80.5%

60

81.8%

70

83.3%

80

84.7%

90

87.3%

99

92.8%

HCAPS Score

Malpractice Suits – How Do They Relate to Patient Satisfaction?


Stelfox HT etal. Am J Med 2005

Increase in complaints (p<.0001)

200 vs 492 per 100,000 discharges!

Increase in risk management

episodes (p<.007) 29 vs 56 per

100,000 discharges.

Top to bottom third patient

satisfaction scores is

associated with:

Malpractice Suits – How Do They Relate to Patient Satisfaction?


Stelfox HT etal. Am J Med 2005

Lower performing

physicians were at greater

risk for lawsuits (p<0.019)

110% higher than those in

the top third!

75% of complaints were

related to communication

issues

MD Contact and Patient Satisfaction Scores

Patel PB, Vinson DR. Ann Emerg Med 2013

Scripps Patient Experience: Physician Integration 19

Mean Patient Satisfaction Score

• Crossover study from May 1, 2010, to June 30, 2010, at two community EDs

• 42 physicians either e-mailed or telephoned their patients within 72 hours of the ED visit for one month

• Alternate month - no contact

MD Contact and Patient Satisfaction Scores

Patel PB, Vinson DR. Ann Emerg Med 2013


Mean Patient Satisfaction Score

• Crossover study from May 1, 2010, to June 30, 2010, at two community EDs

• 42 physicians either e-mailed or telephoned their patients within 72 hours of the ED visit for one month

• Alternate month - no contact


PILOT STUDY RESULTS

Pilot Study #1: Urgent Care


Two staff meetings which included all members of team

Kicked off meetings with a patient’s perspective of care

Data and survey process reviewed

Simple tips reviewed

Follow-up team meetings held on how to improve both patient

and family experience

No additional resources allocated

Managing Up

• “Laura is your nurse today and she’s the best we have.”

• “Mrs. Smith, I am going off duty, I want to introduce Sarah who will be taking over for me. I told her all about you and she will take great care of you.”

• “Our Hospitalist, Dr. Strauser will be taking care of you and she is fantastic.”

• “Our doctors and nurses really care about you.”

• “Our radiology department is outstanding.”


Facility2014 ED

Percentile Rank

Sustained

2016 ED

Percentile

Rank

Torrey Pines 25th 53rd

Mean Scores and Percentile RanksEDCAHPS scheduled for 2016

Mean Scores and Percentile Ranks


Moving the Dial- Mean Score to Percentile Ranking

25

Percentile Rank

Mea

n S

core

85%

80%

75%

70%

10

79.6%

20

81.7%

30

83.3%

40

84.3%

50

85.4%

60

86.3%

70

87.2%

80

88.4%

90

89.6%

99

91.8%


Emergency Department MD Percentile Scores

90%

One-on-One Coaching: MD to MD

MD to MD Coaching

• Review of reports

• Shadowing with patients-no forms!

• Bedside discussion with patients

• Real time tip implementation

27

Physician specific reporting with comments


Example of Monthly MD Specific Surgeon Report


Attending

Physician

Survey

Count

Doctor Overall

(% Always) Percentile Rank

Doctor Explains in a

Way You Understand

(% Always)

Doctor Listens Carefully

to You (% Always)

Doctor Treats with

Courtesy and Respect

(% Always)

7368 72 70.67% 4 65.22% 70.59% 76.06%

4880 61 75.96% 18 68.85% 75.41% 83.61%

3918 10 76.67% 21 80.00% 70.00% 80.00%

6142 67 77.89% 28 73.13% 74.63% 86.15%

6182 18 79.63% 41 83.33% 72.22% 83.33%

7227 67 81.09% 52 74.63% 82.09% 86.57%

2928 8 83.33% 70 75.00% 75.00% 100.00%

1427 91 86.72% 87 84.44% 63.33% 92.31%

4973 46 87.68% 90 78.36% 86.96% 97.83%

8068 28 88.10% 91 85.71% 89.29% 89.29%

8927 18 88.89% 93 83.33% 88.89% 94.44%

9214 59 89.27% 94 89.83% 86.44% 91.53%

Attending

Physician

Survey

Count

Doctor Overall

(% Always) Percentile Rank

Doctor Concern to Keep

You Informed

Doctor Concern for Your

Comfort Courtesy of the Doctor

1. 116921 80 79.51% 7 79.5% 78.9% 81.7%

2. 360578 106 86.44% 51 85.7% 85.9% 87.6%

3. 368274 10 87.30% 60 87.2% 86.5% 88.0%

4. 132464 50 87.66% 64 86.1% 87.5% 89.0%

5. 235226 18 88.38% 70 87.3% 89.0% 89.0%

6. 441279 67 89.93% 82 89.7% 89.6% 90.0%

7. 258251 8 90.16% 83 88.2% 88.8% 91.2%

8. 364646 91 91.00% 89 91.4% 89.6% 92.0%

9. 120857 46 91.62% 92 91.0% 91.8% 92.9%

10. 398420 28 92.38% 95 91.0% 92.7% 93.5%

11. 441261 18 94.81% 98 95.1% 93.8% 95.1%

12. 129338 59 96.38% 99 96.4% 95.9% 96.4%

Example of Monthly MD Specific Report: Self Improvement



“I want to make sure that I keep you informed so I will let you

know when the results are back.”

“What is your greatest concern?”

“Out of respect for your comfort/privacy…”

“Out of courtesy for you…”

Use Key Phrases

“Thank you for your kind words. You may receive a survey in the

mail. It would mean a lot to me if you would fill it out.”

Key Phrases

30

What Not to Say A Better Way

We are doing our best; or

We are really busy right now.

I really apologize for the wait; or

Sorry for making you wait, but I am here

now and promise you my full attention.

I have done this before. I am sorry you feel that way.


What’s you emergency today?What brings you to the Emergency

Department today?

Key Phrases

31

What Not to Say A Better Way

My hands are tied. What do you want me

to do?Let’s work together to find a plan that fits

your needs.

Say nothing.You seem very frustrated (angry).

Can we discuss this? What can I do to

make this better?


Do you have any questions? What questions do you have for me?

Examples of MD “ Self Interest” Average Increase 53 Percentile!

Physician Timeframe MeanAll PG DB

Percentile Rank

7210

PRE: Dec13-Nov14 80.6 8

POST: Dec14-Nov15 89.6 77

1170

PRE: Dec13-Nov14 76.2 2

POST: Dec14-Nov15 88.8 69

5235

PRE: Dec13-Nov14 90.9 35

POST: YTD 95.7 90

9338

PRE: Dec14-May15 89.1 79

POST: YTD 95.7 99

3202

PRE: Sept14-Aug15 91.2 18

POST: YTD 97.1 94

4429

PRE: Sept14-Aug15 72.5 1

POST: YTD 95.2 82


14 physicians in pilot

MD Scores with “Forced” Coaching

Physician Timeframe Question Mean n

All PG DB

percentile rank

CC MDPRE: Oct14-Mar15 Standard: Care Provider 84.9 27 6

POST: Apr15-Sep15 Standard: Care Provider 88.3 29 15

EG MDPRE: Nov14-Apr15 Standard: Care Provider 92.0 67 50

POST: May15-Oct15 Standard: Care Provider 90.8 78 33

MG PA-CPRE: Oct14-Mar15 Standard: Care Provider 93.9 19 81


AIt MDPRE: Nov14-Apr15 Standard: Care Provider 91.2 60 40

POST: May15-Oct15 Standard: Care Provider 91.8 110 50

AS MDPRE: Oct14-Mar15 Standard: Care Provider 87.4 63 14



• Average increase only 5 percentile

• 2 decreased scores!!

Dr X Scores Pre & After Coaching: 2016


Medical Practice Report

SC – Carmel Valley (FY 2015) infoEDGE

Medical Practice Report

Pre-Coaching

Std Care Provider 1

Std Nurse/Assistant 121

2

1 Std Care Provider 92

Std Nurse/Assistant 99

After Coaching

9

9

9

2

Facility

FY 2015 ED

Percentile

Rank

+ MD specific reports

FYTD 2016 ED

Percentile

Rank

+ MD specific reports + 2 staff

sessions

Rancho Bernardo 69th (88.5) 86th (90.7)

Mean Score Percentile Rank for Doctors Section RB

Based on the Press Ganey All PG Database ER/ED Means & Ranks for time periods evaluated

PILOT #3: Mean Scores and Percentile Ranks After Staff Training


3


FY 16 FY16

percentile

rank

FY17 YTD FY17 YTD

Percentile Rank

Global rating (1-10) 66.1 20 74 54

Cleanliness 67.7 18 78.9 74

Hospital Score for

Comms about meds

62.7 37 65 60

Understand purpose of

meds

61 49 66.8 79

Nursing Manager on Pilot Floor

“We managed to make meaningful connections with our patients and their families. I saw

a change in the interactions between staff and our patients, a change in culture. That is

what I am most excited about.”

37Slide Footer

Coaching Conversations


Doc: “When I started

med school in 1989

there was none of this. I

just don't understand

how any of this equals

better medical care.”

MD to MD Interaction


Dr S: “It is actually

related - if you don't

make the patient feel

cared for and they can't

feel your empathy, it

makes no difference how

good your diagnostic

skills are. Much of what

we do is not rocket

science.”

Dr S: “It's what

differentiates a good

doctor from an

exceptional one”

Doc: “I know. Ok, I'll try harder! Thx. Love you.” 12th percentile to 87th

Doc: “Why don't you round with us and see what we do. I think it will help understand our service. Your comments are patronizing.”

MD to MD Interaction


Dr S: “Hi. had I not met

you a couple times in

person, I would think

that your email using

the word "patronizing"

was extremely rude.

However, I am hoping

that you did not mean

to come across this

way.”

Dr S: “If you have a

better idea for

improving scores,

please let me know

but I would hope that

we can have collegial

exchanges going

forward ”

Doc: “I apologize. Let's talk in person”

MD Challenges – Triple Aim

1 2 3

Improving the

patient experience

of care (including

quality and

satisfaction).

Improving the

health of

populations.

Improving the

per capita cost

of healthcare.


MD Emails Regarding Coaching

“What I’m most impressed with after we

started receiving our monthly scores, is that

most everyone in the group appears to be

improving.” Dr. L


“All I can say is that paying attention to the

tips has made me a better and a happier

doctor. I have good interactions with almost

all of my patients, even the drug-seekers,

and I feel like I care about them more.”

Dr. R

“I'm more satisfied at the end of every shift

than I was 10 years ago, and I have more

days where I feel like I have the best job in

the world. "Fake it till you make it" was

certainly true in my case.” Dr. N

MD Coaching Emails

Sent: Wednesday, June 01, 2016 4:19 PM

From: [email protected]

Subject: RE: ER meeting

Have you been treating everyone with courtesy and respect and

listening carefully?

--------------------------------------------------------------------------------------

Received: Wednesday, June 01, 2016 4:33 PM

From: Dr G

Absolutely…

43

unless I don't like them.


Learn Today, Improve Tomorrow

• Keep message and tips simple

• Use genuine key phrases

• Use evidence based articles to explain the “WIFM” message

• MD to MD communication is imperative


The Bottom Line

People may not

remember what

you did to them.

They may not

remember what

you said to them.

But they will

always remember

how you made

them feel.

Maya Angelou


46

Ghazala Q. Sharieff MD, MBA

[email protected]


scripps patient experience: physician integration...scripps patient experience: physician...

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