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Case: Never on Wednesday

Service Recovery Making it Right Rebuilding Confidence Learning from our Patients and Reducing Malpractice Risk Gerald B. Hickson, M.D. Associate Dean for Clinical Affairs gerald.hickson@vanderbilt.edu. Case: Never on Wednesday.

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Case: Never on Wednesday

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  1. Service RecoveryMaking it Right Rebuilding ConfidenceLearning from our Patients and Reducing Malpractice Risk Gerald B. Hickson, M.D.Associate Dean for Clinical Affairsgerald.hickson@vanderbilt.edu

  2. Case: Never on Wednesday • Daughter reported: “the resident my mom was to see entered the continuity clinic acting agitated… talked down to girl at desk: “Answer my questions immediately with a yes or no…don’t need any extra conversation…I’m here to see one of my patients.” Receptionist replied “no,” and said, “but there’s the consult we calledabout.” Res became even more upset…

  3. The story continues: • “Sensing that the doctor was in a hurry, I said that my mom was ready to be seen. Res. whirled toward me, made a “T” sign with his hands and barked, ‘Time out! It’s not your turn to talk!’ Turning back to the receptionist, he demanded, ‘Who consulted me?...’”

  4. The doctor walks out • “Res yelled so the whole area could hear, ‘You didn’t do anything wrong. The staff did!...You need to go where they know what they are doing…I don’t do consults on Weds… months before I can book you an appt.’” • “Then he turned and left me standing there. I don’t think that was very professional.” • What mightyou do if you witnessed this event?

  5. Service Recovery …To promote exemplary patient care… when dissatisfaction occurs… “making right what went wrong”

  6. So aren’t we always goingto make some patients unhappy?Yes … but …

  7. Tip of the Iceberg • Consumer and medical literature indicate voiced complaints represent only a small fraction • For every pt/fm that complains there are many more … Annandale. Accounts of disagreements with doctors. Soc Sci Med 1998. Carroll. Characteristics of Families that Complain Following Pediatric Emergency Visits. Ambulatory Pediatrics. 2005. "Consumer Complaint Handling in America: An Updated Study for the U.S. Office of Consumer Affairs," 1986.

  8. Spectrum of Patient Dissatisfaction (tip of the iceberg) Lawsuits Voiced Complaints Errors Drop out Non adherence

  9. Capturing complaints also allows us to be proactive

  10. Patient Observations • The patient was offended by Dr. _____’s attitude and comment “get both thundering thighs into the paper shorts for an exam.” • Pt. states “MD sent frustrated e-mail to his secretary…must have inadvertently hit ‘Reply to All’…e-mail stated… ‘Can you get this crazy woman’s chart?’”

  11. Do these complaints represent some sort of pattern?And what else can we learn?

  12. 9% of MDs Accounted for 50% of Complaints(6-year study period) % of Complaints % of Physicians Hickson GB, et al. JAMA 2002;287:1583-1587.

  13. Predictors of Risk Outcomes(logistic regression) • Gender • Physician specialty • Volume of service • Unsolicited patient complaints Predictive concordance of risk models ranges from 81-92% Hickson GB, et al. JAMA 2002;287:1583-1587.

  14. This document is confidential and privileged pursuant to the provisions under State peer review statutes. DO NOT DISSEMINATE WITHOUT PERMISSION. Incurred $s By Risk Category * In multiples of lowest risk group

  15. Disruptive Behavior Pyramid Level 3 "Disciplinary" Intervention No ∆ Pattern persists Level 2 "Authority" Intervention Apparent pattern Level 1 "Awareness" Intervention Single “unprofessional" incidents(merit?) "Informal" Intervention Mandated Issues Vast majority of doctors—no issues

  16. PARSsm Level 1 Intervention* • Peers (mostly) agree to share the info • Make high complaint MDs aware of data via correspondence and personal visit • Use graphic displays, peer-based data comparisons and all complaint reports • Encourage creative systems thinking • Continue ongoing assessments to promote accountability *VUMC Policy, Pt Complaint Monitoring Committee

  17. Top 10 Surgeons* Means for surgeons *Complaint Index is a function of the number of reports filed with the Office of Patient Relations and the number of specific complaints embedded within those reports over the previous four year period. Recent reports count more heavily than those more than a year old. This document is confidential and privileged pursuant to the provisions of O.C.G.A. Sections 31-7-131,133.

  18. Interim Observations • Over ~800 interventions completed • No one killed (yet) • <2% responded with hostility • Professional: • Asked PAO to shadow, give ideas • Went to Chief: Asked for resources • Reorganized the unit • Level 2 Interventions • Follow-ups ongoing

  19. Teamwork When patients are angry or upset, they see each of us as representatives of the entire Medical Center.

  20. Special Skills Studies show that more than half of all efforts to respond to customer complaints actually reinforce negative reactions to service. Hart, CWL. Service breakthroughs: changing the rules of the game, 1990.

  21. H-E-A-R-T Protocol • Hear the patient • Empathize • Apologize* • Respond to the problem • Thank the patient/family member for sharing their concerns * Really acknowledge and sometimes apologize

  22. Summary • Service recovery is about doing the right thing • For every expression of dissatisfaction, there are numerous unexpressed dissatisfactions… • Responding appropriately requires thoughtfulness and certain skills (H - E - A – R – T) • May reduce your time in court

  23. Service Recovery empowers YOU to act as an advocate for your patients & their families Thank you for your dedication to continuous improvement

  24. Questions now or later? www.mc.vanderbilt.edu/cppa Gerald.Hickson@Vanderbilt.edu Jim.Pichert@Vanderbilt.edu

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