Patient satisfaction with hospital physicians

1. Patient satisfaction with hospital physicians Hospitalist Best Practice J Rush Pierce Jr, MD, MPH January 29, 2014

2. Objectives • Agree to adopt 2 or 3 interventions designed to improve patient satisfaction with hospital physicians at UNMH • Implement these interventions this Spring • Report measurements back to group in June UNM Hospitalist Best Practice: Patient satisfaction with hospital physicians

3. 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 UNM Hospitalist Best Practice: Patient satisfaction with hospital physicians

4. Where are we at UNMH? UNM Hospitalist Best Practice: Patient satisfaction with hospital physicians

5. 4-West Press-Ganey patient satisfaction surveys (2012, N = 117) UNM Hospitalist Best Practice: Patient satisfaction with hospital physicians

6. 5-West Press-Ganey patient satisfaction surveys (07/2013) UNM Hospitalist Best Practice: Patient satisfaction with hospital physicians

7. Physician satisfaction: Press-Ganey UNM Hospitalist Best Practice: Patient satisfaction with hospital physicians

8. 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 ofattention and respect • Doctors could have smiled more • The “team approach” led to a lot of confusion UNM Hospitalist Best Practice: Patient satisfaction with hospital physicians

9. 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 UNM Hospitalist Best Practice: Patient satisfaction with hospital physicians

10. What does the literature say? UNM Hospitalist Best Practice: Patient satisfaction with hospital physicians

11. 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 UNM Hospitalist Best Practice: Patient satisfaction with hospital physicians

12. 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) UNM Hospitalist Best Practice: Patient satisfaction with hospital physicians

13. 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 UNM Hospitalist Best Practice: Patient satisfaction with hospital physicians

14. 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 UNM Hospitalist Best Practice: Patient satisfaction with hospital physicians

15. 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 UNM Hospitalist Best Practice: Patient satisfaction with hospital physicians

16. Inpatient literature – no correlation UNM Hospitalist Best Practice: Patient satisfaction with hospital physicians

17. Inpatient literature – positive correlation UNM Hospitalist Best Practice: Patient satisfaction with hospital physicians

18. Inpatient literature – positive correlation (contd) UNM Hospitalist Best Practice: Patient satisfaction with hospital physicians

19. Robotic Telerounding UNM Hospitalist Best Practice: Patient satisfaction with hospital physicians

20. Patient satisfaction and provider photos Mayo Clinic Proceedings. 76(6):604-608, June 2001. UNM Hospitalist Best Practice: Patient satisfaction with hospital physicians

21. Patient satisfaction and physician continuity J Gen Intern Med. 2014 Jan 17. [Epub ahead of print] UNM Hospitalist Best Practice: Patient satisfaction with hospital physicians

22. What are suggested corporate strategies? UNM Hospitalist Best Practice: Patient satisfaction with hospital physicians

23. Seven Corporate strategies to Improve Patient Satisfaction • Smooth the admitting process • Communicate test results promptly • Respond quickly to the patient • Keep the patient informed • Coordinate provider communication • Promote a quieter/more restful environment • Speed discharge process UNM Hospitalist Best Practice: Patient satisfaction with hospital physicians

24. Seven Corporate strategies to Improve Patient Satisfaction • Smooth the admitting process • Communicate test results promptly • Respond quickly to the patient • Keep the patient informed • Coordinate provider communication • Promote a quieter/more restful environment • Speed discharge process UNM Hospitalist Best Practice: Patient satisfaction with hospital physicians

25. What ideas came out of our retreat? UNM Hospitalist Best Practice: Patient satisfaction with hospital physicians

26. 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. UNM Hospitalist Best Practice: Patient satisfaction with hospital physicians

27. 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. UNM Hospitalist Best Practice: Patient satisfaction with hospital physicians

28. Retreat ideas (contd) • Care Coordination • Communicate plans on a regular basis to the nursing staff. • Use Whiteboards • Readdress NPO orders BID UNM Hospitalist Best Practice: Patient satisfaction with hospital physicians

29. What will we choose? UNM Hospitalist Best Practice: Patient satisfaction with hospital physicians

30. How and when will we implement this? UNM Hospitalist Best Practice: Patient satisfaction with hospital physicians