November 19, 2009
Hospitalists and patient satisfaction: Another value-added metric?
I just returned from the 2009 Press Ganey client conference in Washington where the speakers ranged from Newt Gingrich to our own Dr. Wachter. In a word: interesting.
While many have noted the inherent limitations of ranking physician performance, it is quite clear that transparency in health care generally translates to improvement in the care delivered. And subject to little debate, Press Ganey is the market leader in generating data that underscores the transparency of patients' opinion about the quality of the care they were provided.
So what did I glean from this conference? First, hospitalists have rapidly become one of the company's top data producers, and Press Ganey is very interested. Of the three major initiatives that the company announced for the coming year, one is designed to better measure the impact of an institution’s hospitalist program. Regardless of your attitude toward being measured by your patients, you should take some pride in the fact that you can no longer say "patient-centered health care" without including hospitalists in that discussion.
Second, Press Ganey scores matter now—a lot—and they will matter even more in the future. Obviously, every health care organization wants to improve the quality and safety of care delivered. Some do it better than others, some worse. And nothing speaks more to the C-suite about such objectives than data, especially data that come right from the customers.
Furthermore, leadership types know well that nothing drives performance like money, no matter how altruistic health care providers may be. Adding one and one together, it should come as no surprise to hospitalists that the people who work around you, from nurses to senior level management, are being bonused on the hospital’s patient satisfaction scores. If your bonus isn’t already determined in part by these scores, it may very well be in the immediate future.
With that primer out of the way, what did I hear from the people attending the conference, mostly hospital CEOs, CMOs, medical directors and VPs of almost every stripe? I learned that hospitalists (and, for that matter almost all doctors) like to push back when it comes to patient performance scores and that the C-suite is looking for answers to counter our opposition.
Here's the No. 1 pushback they hear from hospitalists: “Press Ganey doesn’t accurately reflect our performance because the scores reflect only the attending of record, not the five consultants who interacted with the patient.” Or said another way: “The general surgeon ruined my patient satisfaction score!”
The answer given: “Look at the distribution of the bell curve over time.” If the same physicians are consistently scoring higher than other doctors, the cofounding noise created by consultants (both literal and figurative) will no longer matter. What is difficult to resolve is that your scores compared to those of hospital X, Y and Z will be worse if your hospital’s consultants are, to put it gently, “Not a People Person”.
Pushback No. 2: “Traditional internists and other primary care doctors, even consultants, will always have higher scores because their patients know them.” Well, I believe the new Press Ganey initiative may resolve this. Future surveys are reportedly going to be more specific to our job description with focused questions on how well care was coordinated both in the hospital and at discharge. More specialty-specific questions will also allow for an apple-to-apple comparison between your hospitalist group and mine.
Pushback No. 3: “Our absolute score is 81% but our relative score is terrible.” Well, bell curves matter, and they especially matter to those who pay you. This is not to say you can’t be an advocate for reason. If your scores are currently in the 1st percentile, progress is getting to the 10th percentile. Be prepared to tell your CEO that while the goal is always the 99th percentile, you are a doctor and not a magician (unless you do happen to be both).
Maybe that isn’t enough for some, but a good hospitalist leader should be able to sell incremental progress. As important, we need to explain that if all hospitalists demonstrate equal improvement in their patient skills, your team’s spot on the bell curve will not budge, despite a better absolute score. Said another way, average relative scores that don’t get worse might actually be considered a victory, given the fact that a growing percentage of us list patient satisfaction as important as RVU production and core measure compliance.
That leads me to my best words of advice after attending the conference. Script and Sit™ (Press Ganey, care to buy my newly-minted slogan?). All of us should be scripted on how best to introduce ourselves to our patients, similar to the way people in most service industries currently are. The key points to clarify are not surprising: who you are, what your role is as a hospitalist in providing an outstanding care experience, and a description of how you will coordinate care both inside and outside of the hospital.
In explaining my role, I like to tell patients that, "I am the quarterback of your health care team." You can choose your own analogy, but it takes very little effort and pays big dividends. At our hospital, we reinforce this script with a brochure because most patients remember less than 10% of what they are told when ill. And when it comes to the effort-to-payoff ratio, nothing beats sitting in the patient’s room.
Just like hospitalists, patient satisfaction scores are not going away. If anything, they're just going to become more important. I believe it is time for hospitalists to take full ownership of their hospital’s scores. While many other specialties will continue to argue about the importance of these rankings, we should attempt to demonstrate that this is yet another way we bring value to the hospital.
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About Erik DeLue, MD
Erik DeLue, MD, examines the challenges of running and reinventing a hospitalist program. He is medical director of the hospitalist program at Virtua Memorial, a hospital in Mt. Holly, N.J.
This is the third community hospital program that Dr. DeLue has worked for in his nine years as a hospitalist. Join in the dialogue on issues that range from compensation and 24/7 scheduling to how to work with competing hospitalist groups.
The opinions expressed by Dr. DeLue are his own and do not necessary reflect the opinions of his employer or Today's Hospitalist.
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