The mechanisms for how hospitals will be paid based on quality measures — and  how HCAHPS will fit into those calculations — has left much of the industry watching the unfolding health care reform debate with bated breath. If we keep waiting, we’re in danger of passing out. That is not to say that meaningful payment reform or answers to the many unanswered questions won’t occur in the near future. It’s just that we need to be careful about what we put off doing while we are waiting for definitive answers.

I just returned from the National Quality Forum’s spring meeting. I always find it an interesting mix of perspectives and updates, with many of the key figures and veterans in health policy and health reform present and exchanging ideas. This time I was struck by a theme that seemed to emerge again and again: There are changes to the health system that are taking place now or may occur without — or in spite of — the end game on Capitol Hill.

Janet Corrigan, president and CEO of the National Quality Forum, opened the meeting with remarks about the state of the reform debate. She talked about the three core elements of reform that need to go forward regardless of what happens legislatively. It was no surprise that aligning payment with value was one of those key elements.

Susan Dentzer, editor -in-chief of the policy journal Health Affairs, gave an evening keynote and described changes at play in health care that are bigger than any legislated reform — shifts in consciousness that once raised can’t be put back in the bag. She described a top 10 list of those ideas, including the growing recognition that the U.S. health care system isn’t always the best in the world, the emphasis on building a wellness system instead of just a sickness system and — not surprisingly — the concept that incentives matter and we get what we pay for.

The current reform legislation — which is basically the Senate-backed bill — is still awaiting action by the House. It describes a process by which 2% of hospital reimbursement ultimately would be withheld, with the opportunity to earn back those monies based on the hospital’s level of attainment (how well they are performing) and improvement (magnitude of positive year-over-year change). We know that HCAHPS is planned to be a part of the model along with clinical measures and infection rates, with efficiency measures to be added later. The proposal suggests that 2010 be the baseline year of implementation with 2013 being the first year that monies would be withheld. And the amount to be withheld would start at 1% and scale upward a quarter of a percent each year to the maximum of 2%. What we don’t yet know is what will happen to the funds that are retained — will they be redistributed to higher-performing hospitals or will they represent cost savings to total health care spending? 

The other thing that we know is that hospital organizations are not in the same state of bated breath as the pundits might be; they simply don’t have that luxury. Each day patients are cared for and challenges are faced and surmounted. One health care executive I’ve spoken with commented that he’s pretty sure that if reform occurs he’ll have lower reimbursement and if reform doesn’t occur he’ll still have lower reimbursement. His prediction may not come true, but it points to a pragmatic attitude of buckling down to continue to get the job done.

At the National Quality Forum, Michael J. Dowling, president and CEO of North Shore-Long Island Jewish Health System, gave a passionate acceptance speech upon receiving the NQF National Healthcare Quality Award. He described the never-ending effort of his staff to care for patients. The national health care system may not be perfect, he said, but it doesn’t mean that in ways large and small, providers aren’t striving to improve. There are endless examples of incredible personal care being delivered. He reminded the audience that “we are all reformers; we are all change agents.” It’s clear how much he recognizes and encourages incremental change within his organization, and that he is not waiting or holding his breath. And after some discussion of the question of health care reform noted that the question we should be asking is, “Can we do better for the patient? And the answer had better be ‘Yes.’”

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When revisions to the Grievance Interpretive Guidelines first came on the scene back in 2004-2005, there was much anxiety surrounding the definition of a patient grievance and how comments from patient satisfaction surveys fit into the rules under the Medicare and Medicaid Conditions of Participation.

The Society for Healthcare Consumer Advocacy worked extremely hard with representatives from the Centers for Medicare and Medicaid Services (CMS) to clarify and ultimately agree to changes in the final guidelines around the question of survey comments as well as other provisions. The revised Interpretive Guidelines were released in September of 2005 and require a formal process that is manageable for hospitals.

For those questioning how survey comments are to be treated, the definition of “patient grievance” is: “A written or verbal complaint (when the verbal complaint about patient care is not resolved at the time of the complaint by staff present) by a patient, or the patient’s representative, regarding the patient’s care, abuse or neglect; issues related to the hospital’s compliance with the CMS Hospital Conditions of Participation; or a Medicare beneficiary billing complaint related to rights and limitations provided  by 42 CFR 489.”

 And regarding patient satisfaction surveys, the Interpretive Guidelines state: “Information obtained with patient satisfaction surveys does not usually meet the definition of a grievance. If an identified patient writes or attaches a written complaint on the survey and requests resolution, then the complaint meets the definition of a grievance. If an identified patient writes or attaches a complaint to the survey but has not requested resolution, the hospital must treat this as a grievance if the hospital would usually treat such a complaint as a grievance.”

I think there is a more important issue here and an opportunity for a hospital that is often missed when trying to determine what constitutes a grievance versus a complaint, and meeting the CMS guidelines for written responses within a seven-day time frame and the other requirements. That is, what do we do with the data that is gathered to improve the experience of our patients and prevent complaints and grievances? The CMS guidelines also state that “data collected regarding patient grievances, as well as some other complaints that are not defined as grievances (as determined by the hospital) must be incorporated in the hospital’s Quality Assessment and Performance Improvement Program.”

Although CMS survey procedures remind reviewers to determine if the hospital applies what it learns from the grievance as part of its continuous quality improvement activities, it seems to me that the majority of the review process is focused on the process involved in responding to the grievance itself.

There is powerful information in the analysis of patient grievances, complaints and survey comments (positive and negative). Identifying trends in types of complaints, location, patient segment, individuals involved and a host of other possibilities is what gets us to the ultimate goal of eliminating those complaints and providing a better patient experience.

As a former patient relations professional, I can tell you that the types of complaints (or grievances) received are aligned with satisfaction data and comments received on patient satisfaction surveys. When complaints and grievances tell you that communication with patients about their treatment plan and providing information and involving them in decision making are issues; priorities from satisfaction data show the same items as the best opportunities for improvement, and survey comments provide additional confirmation.

Taking this information and acting upon it to prevent the recurrence of the same or similar kinds of complaints is where the real power of grievance processes and complaint handling lies. Armed with data from many sources of the voice of the customer takes us from reacting to the problems to being proactive and preventing problems, and leads to innovation.

It seems to me that the real power of the CMS guidelines and the process for responding to patient grievances and patient complaints is in what we do with that knowledge to create the best patient experience possible.

“Excellence is the unlimited ability to improve the quality of what you have to offer.”
Rick Pitino

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Okay, this may not be a news flash to most, but as industries go, the hospital industry is not widely recognized for its innovative business practices.

I learned this early on in my career as a hospital strategic planner in Texas. My boss, a brilliant and creative thinker, would often pull me aside and school me on the many insights he learned over the years as first a city and then a hospital planner. “Look at other industries,” he’d often say. “See what they’re doing, what they’re planning for and how that applies to us.” 

Indeed, his favorite industry to follow was the banking industry. He claimed that banking was 10 to 15 years ahead of hospital planners, and then would tick off all the changes in the banking industry that we in hospitals were just addressing or had yet to address. (A fact that haunts me with all the bank failures we’ve seen this past year.)

Another one of the industries I would often watch was the pharmaceutical industry. Pharma, with its emphasis on channel marketing (promoting their products via physicians), has many (positive and negative) innovative practices that hospitals should study. This is especially true for physician recruitment efforts.

If you’re involved in recruiting physicians for a hospital, then you’re all too aware of the challenges in getting prospective physicians to consider your hospital. To help differentiate their recruitment efforts in a hypercompetitive market, hospital recruiters should leverage the network of their current medical staff in promoting the hospital to prospective recruits. It’s at this point where the worlds of pharma and hospital recruiters converge. Both industries can and have used physicians in promoting their products.

So what’s happening in the pharmaceutical world that could help hospital recruiters plan for the future?  To me, one of the most significant things we should be looking at surrounds trends in the word-of-mouth messaging of physicians.

TNS Healthcare, a pharmaceutical market research company that monitors physician-channel marketing, has noticed an uptick in the percentage of U.S. physicians (from 12% to 19%) who are willing to speak negatively to others about a pharmaceutical company and/or product. This trend has a lot of pharmaceutical executives worried as they are questioning the effectiveness of the physician channel as a means of promoting their product to the marketplace. In response, many drug companies actively monitor the ratio of positive word-of-mouth physicians to negative in order to assess the effectiveness of using physicians for channel marketing purposes. The argument being that the stronger the headwind, the harder it is to make progress with your customer base.

So do we see the same thing with physician word-of-mouth regarding hospitals? Should we have the same concerns? 

Taking a page out of the pharmaceutical industry’s playbook, I decided that hospital recruiters should have a similar type of metric as their pharmaceutical peers. Physician recruiters need to know the prevailing winds from the medical staff they are working with/against in promoting the hospital to candidates. So I have adapted what I call the Physician Endorsement Index (PEI) to assist recruiters in determining how their medical staff stands as positive or negative word-of-mouth partisans of the hospital.

The PEI is based on the responses of active medical staff members to the following two questions in Press Ganey’s Physician Partnership Survey:

• “Recommendation you would give for this facility to other physicians”
• “Overall satisfaction with this facility”

Physicians who respond to both questions with “very good” on a 5-point scale (“very poor” to “very good”) are categorized as positive hospital partisans, while those who respond with “very poor” or “poor” are deemed to be negative hospital partisans. All other physicians are classified as “passive.”

In analyzing the distribution of responses to the two questions composing the PEI in 2008, the vast majority of physicians (67%) are found to be passive toward the hospital, suggesting that recruiters cannot rely upon the word-of-mouth recommendations of physicians to promote the hospital to physician recruits. The data also reveal that positive partisans compose approximately 30% of the medical staff, while negative partisans only comprise 3.3% of physicians.

At first blush, this is good news, at least until you realize that the number of messengers does not necessarily equate to the frequency of messages. The Physician Endorsement Index therefore takes message frequency into consideration by weighting negative physician partisans by a factor of six (there is a strong basis to assume that a physician will tell a negative story to six peers but a positive story to only one peer). A PEI score is generated by comparing the weighted ratio of positive physician partisans to negative physician partisans. A Physician Endorsement Index score of 1 or less is optimal because hospitals in this range have at least six physicians willing to speak positively about the hospital for every physician working against them. The higher above 1 the Physician Endorsement Index rises, the more negative word-of-mouth that is being generated by members of the medical staff.

Applying the Physician Endorsement Index model to the 2008 Press Ganey medical staff database yields a score of .66, meaning that in general, hospital physician recruiters operate within a fairly resistance-free environment. While most physicians are fairly inert in recommending the hospital to a professional peer, the word-of-mouth that does emerge tends to favor the recruiter’s efforts.

Moreover, the 2008 word-of-mouth environment represents an improvement over 2007 (Physician Resistance Index of .73). Encouraging news as it suggests that hospital recruiters may increasingly depend upon the word-of-mouth recommendations of physicians to support their efforts.

Interestingly, only two types of physician groups showed signs of resistance to the hospital’s recruitment efforts in the 2008 database: Physicians representing surgical specialties (PEI of 1.08) and physician “splitters” who admit less than 80% of their patients to one hospital (PEI of 1.15). While the latter group is of little surprise, the resistance from surgeons speaks of the tension that exists between hospital administrators and surgeons electing free-standing ambulatory surgery centers over a hospital’s surgical services.

While hospital recruiters operate with a physician marketing channel that is much friendlier than what our friends in the pharmaceutical industry experience, we shouldn’t be lulled into thinking that this is our birthright. Recent findings suggest that doctors are increasingly closing their doors to drug reps and other parties who would use physicians as a channel for promoting their products/services. The fight for a physician’s time will only intensify and we will need a compelling case to get on their calendars. 

There are many more insights from the pharmaceutical industry that I look forward to sharing and exploring with you in this blog. I welcome your thoughts and questions.

Read Lorren’s full bio.

“I‘m an OR nurse.”
“I’m a lab tech.”
“I’m a pharmacist.”
“I work at Memorial.”
“I work at Saint Francis.”
“For nine years.”
“For 14 years.”
“Since 1984.”

Most people who work in health care are deeply involved in their work. For many, it’s part of who they are – a nurse, a doctor, an ultrasound tech. And they take pride in working at well-known, highly respected health care organizations. Like me, many in health care have faced forks in the road where we could have worked in another field, but chose to stay where we felt we could truly touch lives. (One of my early forks was choosing a job in a multispecialty physician group practice over an offer to create promotional materials for a TV station.)

I always feel somewhat sad when I read those stories about the large numbers of employees who feel their work is a dead end or have little pride in their jobs. We in health care are blessed to spend our careers in places where we can affect the decisive moments of other people’s lives. 

It’s not surprising then that the data coming in from Press Ganey’s new employee partnership survey show that health care employees are highly engaged at work. They believe in the value of what they, their teams and their organizations are doing. Their concerns revolve more around satisfaction issues; this is the pattern we see in almost every hospital with which we work.

The notion that employees are generally satisfied with their workplace and that engagement is the tougher challenge isn’t borne out by our findings specific to health care. Rather than being a pyramid where engagement is built on top of satisfaction, health care employers will find both engagement and satisfaction to be critical if they’re going to succeed in developing a truly dedicated group of employees.

So what are the key issues we’re seeing?

One of the biggest priorities of health care employees is the opportunity for input into decisions, to influence the direction of a unit, division or organization. When I started in health care, I got a “To Do” list from my supervisor and started checking off the tasks. No one, including me, wants to do that anymore. Regardless of age, experience or job title, we all want to feel respected and to know that someone is listening. We want to participate, not just carry out. This is a different dynamic from being personally engaged in health care itself. A nurse can be deeply committed to caring for patients, but she can do that down the street at another hospital just as well. Dialogue and input in the workplace are “deal breakers” these days.

Another priority we’re seeing is a need for a genuine dialogue with senior leaders – to feel our leaders really listen to employees, that a work group’s opinions matter and that excellent performance is recognized. That means leadership needs to be seen and heard on the floors. As a result, I’ve seen more and more leaders starting blogs like this one to write about what they hear from patients and employees, as well as their personal observations in a hospital.

“Employees don’t leave their company; they leave their supervisor.” That saying has been around a long time. Our data are confirming how important a direct supervisor is to an employee. Our top opportunities for improvement among employees nationally include the desire for supervisors to provide more individualized coaching, to recognize their employees’ ideas for improvement and to communicate well. Employees also want to have supervisors who are good at organizing a team’s efforts. Clearly, the supervisor is a differentiator. How much so? Even more so than pay.

We find that the engagement issue that health care employees see as organizations’ highest priority for improvement nationally is the opportunity to be creative and innovative in their work. This seems to reflect a desire by employees to invest even more of their talents and ideas in the organization.

We also sometimes see lower engagement when employees believe their co-workers aren’t being held to a consistently high standard of accountability. “Cut the slackers!” was a comment I read at one hospital. 

The summary message we’re finding as we look at data and listen to associates is that most health care employees care deeply about the work that they do. For the most part, they believe in their co-workers’ commitment to excellent patient service and to the needs of others. They believe in the quality of care and values of their organization. What they’re looking for is:

• An organization that offers them the opportunity to help shape their workplace and recognizes excellent performance.
• A direct supervisor who helps them grow and promotes collaboration.

One of the holy grails of health care is creating a workforce of dedicated employees that will set a facility apart. We know skilled, engaged employees are critical to patient and physician satisfaction, quality, safety and efficiency. What we’re seeing is that creating a culture of transparency, collaboration, excellence and innovation is the means to attracting, developing and retaining dedicated employees.

Teresa formerly served as the CEO of a 70-physician, 500-employee, multi-specialty group. Read her full bio.

By Todd Sloane, Senior Writer, Press Ganey Associates

The snowstorms that hit Washington earlier this month were an all-too-easy metaphor for the fate of health care reform. Just as the storms shut down the government and caused traffic gridlock, a rising tide of partisanship and the inability of the Democratic majority to achieve consensus in its ranks brought reform to a standstill. The loss of the Democrats’ Senate supermajority after a Senate election in Massachusetts came after much of the damage had already been done.

There are a number of scenarios under which reform may be resurrected in 2010. It may be a pared-down bill that attracts a few Republican votes in the Senate. There may be concessions to Republican points of view on malpractice reform and the taxation of health benefits. Or the Senate bill could be passed by a party-line vote in the House and its more egregious problems “cleaned up” in a complex process called budget reconciliation. Each option is fraught with difficulty.

But here is the real story, glaringly obvious but somehow forgotten in the furor over the details of reform legislation: Doing nothing is really not an option. Either we fix the problems of health care now, or the problems will soon force the kinds of choices nobody wants to make—drastic budget cuts, rationing of care and providers seeing their business slip away.

Just as the obituaries on the current House and Senate reform bills were being written, a key report was published by actuaries at the Centers for Medicare and Medicaid Services that went all but unnoticed. CMS estimated that health care spending grew to nearly $2.5 trillion in 2009 and now stands at 17.3% of the U.S. gross domestic product. It was the largest one-year jump in health care as a share of GDP since the government started keeping such records half a century ago.

The long-term outlook is far gloomier. Total health care spending as a share of GDP will reach 22% in 2020, according to the Congressional Budget Office.

As baby boomers morph into seniors, private health coverage cost increases may subside, but public spending will leap into the stratosphere, gobbling up more and more of the federal budget. The public share of health spending will amount to 52% by 2019, CMS predicts. By 2080, projections show that absent reform, rationing of care or some unforeseen new technologies, the government would be spending about as much on Medicare and Medicaid as a share of GDP as it spends on everything today.

Costs have a more immediate effect on average folks. Between 1999 and 2008, employer family health insurance premiums rose by 119%, while the median family income rose by less than 30%. Some 75 million adults—42% of people aged 19 to 64—were either uninsured or underinsured in 2007, up from 35% in 2003, according to the Commonwealth Fund. More than half of all personal bankruptcies are attributable to medical debt, even among insured citizens, the fund reports.

Already, we are seeing significant budget cuts in state health programs. Absent reform, that is the near-term future at the federal level, as attention will soon shift to soaring budget deficits. And what has been a steady erosion of employer-sponsored coverage may soon become an earthquake.

Is health care delivering value equal to the dollars being spent? The short answer, unfortunately, is not really.

To be sure, some quality indicators are rising, the direct result of public reporting on established metrics. For example, hospitals participating in the CMS-Premier hospital value-based purchasing demonstration project raised their overall quality by an average of 17.2% over four years based on their delivery of more than 30 nationally established and recognized care measures to patients in five clinical areas. Patient satisfaction scores spiked upward following the onset of public reporting in March 2008, the largest increase since Press Ganey began tracking such data more than two decades ago.

A number of highly integrated health systems such as Geisinger in Pennsylvania, Cleveland Clinic and Intermountain Healthcare in Utah are proving that you can improve quality and reduce costs at the same time. These providers are managing chronic conditions and using some evidence-based medicine and electronic health records. And they avoid unnecessary care.

Unfortunately, the rest of the picture is not so uplifting:

• Infant mortality in the United States is 6.8 per 1,000 births, more than twice as high as in Japan, Norway and Sweden and worse than in Poland and Hungary.
• Care quality is highly variable. For years, the Dartmouth Atlas project has tracked Medicare spending and quality of care, and the findings consistently show that higher spending does not equal better care. More recently, the Congressional Budget Office has followed up with similar research findings.
• Depending on the study, anywhere from 20% to 45% of all medical interventions fail to meet standards of care.
• Well over 100,000 people die needlessly each year as a result of preventable medical errors. According to the Centers for Disease Control and Prevention, 1.7 million Americans acquire infections while in the hospital and nearly 100,000 of them die from them.
• Despite widespread evidence of the value of surgical checklists, most providers have failed to incorporate this low-tech, low-cost intervention.
• One out of five Medicare beneficiaries discharged from the hospital is readmitted within 30 days, and half of non-surgical patients are readmitted to the hospital without having seen an outpatient doctor in follow-up, according to study published last year in the New England Journal of Medicine. All told, unplanned re-hospitalizations cost Medicare more than $17 billion annually, the study found.

The question remains whether this round of health care reform will join its predecessors as classic examples of the failure of political will, or whether our nation’s leaders will awaken to the need to act now to solve health care’s many problems of access, cost and quality before they leave our nation with dwindling choices, none of them good.

A patient is any person who receives medical attention, care or treatment. The person is most often ill or injured and in need of treatment by a physician or other health care professional, although one who is visiting a physician for a routine check-up may also be viewed as a patient.

—Wikipedia

There is a growing trend inside and outside of health care to use the terms “patient” and “customer” almost interchangeably. As far as I can tell, it isn’t done to demean anyone; many people of good will have begun calling patients customers to emphasize the need to pay more attention to the consumer side of the patient experience. By that we mean many of the things that Press Ganey tracks, such as cleanliness of rooms, ease of scheduling and noise on patient floors. I also understand why some people use the phrase “consumer-driven health care” in seeking the kind of information about quality and price of hospital and physician services that is available for other consumer products. And yet, while I see the point of this nomenclature, referring to patients as customers does a disservice to patients and providers alike. It doesn’t adequately represent the emotional nature of the relationship.

It is possible to meet the needs of a customer without making any personal connection. The interaction is transactional, financial in nature. Yet as a clinician, I know that it is impossible to participate in the care of an individual without some degree of personal investment. I don’t know any physicians who talk about treating their “customers.” No neonatal intensive care nurse I have ever met would say she treats her “customers” with kindness and empathy.

Let me use a recent consumer experience I had to illustrate my point. On Jan. 27, the Southeast Iowa Municipal Airport in Burlington, Iowa, launched a new commuter service offering daily flights to Chicago and St. Louis. An exciting new adventure, the expanded service represented growth and potential for the tiny airport.

It was my great fortune to have been the first and only passenger on that maiden voyage to Chicago and as such, at the center of the excitement and attention.

 At 7:15 on that bright and very cold morning in Iowa, the airport manager, regional manager, airline representatives, Transportation Security Administration personnel, airport custodial and other flight support staff all gathered to celebrate launching the new service. There was handshaking, picture-taking and a personal escort to the plane by the co-captain. As we left the ground, I waved from the window to a group of proud and excited individuals. They had made me a part of their special occasion and created a memory for me that I will keep and share.

While I most certainly was a customer of that airline, the $89.99 cost of the flight was less important to them than their focus on me as the passenger. After all, their goal and purpose is to create the best experience possible while providing a trip that is safe, efficient and comfortable.

A smooth landing at Chicago’s O’Hare International Airport brought to a conclusion a most pleasant flight. I was met on the ground by an airline representative who carried my bag and escorted me inside the airport. Later in the day as I reflected back, it occurred to me that everything that happened had been about my being there early that morning as the passenger, without whom the flight would not have taken place; that had defined the relationship.

This experience and the health care experience do have some commonalities. In health care, our goal is to create the best experience possible while providing the optimum care and attention for those who present to us in need – our patients.

And yet, there is also a difference. As great as my flight experience was, it was not about me as an individual. We want, expect and need our doctors and nurses to make that emotional investment in us as patients. Often, that personal investment makes the difference in the quality of care that is provided.

Airlines and hospitals must both place the customer at the center of their business, but in health care, the connection with the patient is, well, on a different plane.

Barbara Burnes has worked in a variety of health care settings, including as a director of patient services for a large, multi-specialty physician clinic. See her full bio.

“Employee-reward programs can be so unrewarding. The plaques, tchotchkes with logos, goofy contests and ham-handed presentations tend to backfire. It’s not that they’re all bad, but too often they seem like empty gestures supported by upper management, administered by a less-than-enthused middle management and received by underwhelmed staffers. All when an honest thanks would have gone further.”

–Jared Sandberg, The Wall Street Journal

Many of the hospitals I work with believe recognition is important. Most have formal reward/recognition programs. In almost every hospital that has conducted an employee survey, recognition is one of the top opportunities for improvement, as comments indicate that employees do not feel appreciated. So why is appropriate recognition such a challenge?

Perhaps the most significant barrier to successful recognition is the hectic pace of the health care environment. Managers must keep up with documentation, meet organizational metrics, do performance appraisals, attend meetings and work a shift or two. Staff members have little time for meaningful interaction, and race out the door at the end of 12-hour shifts just grateful for the chance to get off of their feet. Senior leaders struggle with physician issues, quality and financial metrics and board governance. In the course of day-to-day work, simple human gestures of thanks fall off the radar.

Most hospitals throw some type of recognition program together, but these are often haphazard. In other cases, programs are more formal with committees, policies and a long list of requirements. There are forms for nominating co-workers for a “Hero Award” or “Caught You Caring” award. Properly designed and run, these programs can energize employees through friendly competition and the thrill of achievement. Nominations from co-workers can amount to a victory in their own right. An annual awards dinner is often a treat for winners and non-winners alike.

And yet, they are not equal to the power of a heartfelt, timely thank-you, which often provides the inspiration to help most people make it through a tough day.

But when was the last time senior leadership stopped by the ED at 3 a.m. to thank the staff? Or, when was the last time the CEO dropped into the housekeeping department to let the staff know she noticed that their patient satisfaction scores improved dramatically over the last quarter?

Your hospital’s chaplain may just be “doing her job,” but did you thank her for coming in at 3 a.m. to comfort a mother who lost a child? How about the social worker whose heart is overwhelmed as she tries to balance needs of the patient with the needs of the hospital to reduce length of stay?

The information technology department is the frequent recipient of enraged, frustrated phone calls, but did you thank the IT staff member who came in late at night to repair a server issue? And speaking of physicians, did you recognize the anesthesiologist who missed his daughter’s piano recital last weekend because he was called in to help with that emergency C-section?

Often, we recognize people when they have done something dramatic or out of the ordinary. We hear moving stories about how health care workers have touched the lives of others in an amazing way. These stories are wonderful and they remind us that in health care we have the opportunity to make a difference.

But it’s easy to get discouraged just “doing the job.” We begin to think that perhaps we don’t matter, that we haven’t made a difference in a while and that the extra hours we give to the hospital are just not appreciated. A word of thanks on a rough day, when the job has not felt rewarding, means far more than a trinket, meal ticket or chocolate bar.

The world’s best recognition program seems empty if it isn’t part of an organizational culture where appreciation is expressed every day, face-to-face. Don’t let formal programs take the place of a genuine “thank-you.”

For more about Principal Consultant Elaine Bobo, read her bio.

One of the biggest challenges for most organizations is how to improve performance over time. Of course that includes financial results, but it also includes customer and employee satisfaction, service quality, customer outcomes and operational performance. 

In reality, meaningful improvement depends on meeting a number of key challenges:

Focus. The organization needs to clearly identify the key priorities to bring about improvement, rather than getting lost in trying to do too many things at once. That’s the reason we at Press Ganey developed a Priority Index that helps our clients identify focus areas that are both highly correlated with overall performance and offer the biggest payoff for improvement in relation to peers.

Insight. Quantifiable performance metrics are the first step to insight. But it is important to move beyond just the numbers to the meaning and sentiment behind the numbers from the customers’ perspective. A careful review of customer comments can both add nuance to the numbers and provide better insights into necessary changes. The danger is reacting anecdotally to the comments or getting overwhelmed by their sheer number. That is why adding more structure to the process of gauging consumer sentiment is essential to identify and organize the broader themes that may not be immediately apparent.  My recent post on sentiment analysis delves more deeply into this arena.

Best practice by name. Identifying where to improve is much easier than identifying how to improve. That is where true best practices become most relevant. Knowing that a similar organization has been able to achieve what you are looking to accomplish makes it a much less daunting endeavor. The keys are to know that organization’s name (not just that the top 10% performance is at X level) and to communicate in detail with that organization about what it actually did. It can also be helpful to quantify the benefits for your organization of meeting the benchmark for that best practice to provide the right perspective on the resources needed to improve.

Motivation. People need to be motivated to move past the status quo in order to improve performance. Monetary incentives certainly can be effective if appropriately tied to responsibility and accountability, but one shouldn’t underestimate the power of personal or team recognition, even in the absence of monetary incentives. At Press Ganey, our clients frequently mention the motivational effect of winning our Summit Awards and other honors we bestow for excellent performance and of having the opportunity to have their pictures taken with our founders, Irwin Press and Rodney Ganey. Recognition works wonders.

Interrelationships. Improving performance is usually not one-dimensional. We know that it is quite difficult to improve patient satisfaction without engaged doctors, nurses and other staff. That is why we encourage clients to measure patient, physician and staff satisfaction and evaluate the links among them. But it goes beyond those measures to interrelationships among satisfaction, clinical outcomes such as mortality and complications and operational outcomes such as waiting times and patient flow. My next blog post will offer some statistics about these interrelationships.

Improvement Portal. While the concepts I’ve discussed above are critical to successful improvement, it would also be helpful to have all the components of improvement together in one place within an organization. That is exactly what we are committed to doing at Press Ganey for our clients through our soon-to-be released Improvement Portal. This gateway will not only serve as a dashboard for numerical performance across multiple metrics, it also will bring together sentiment analysis, named best practices, benefit quantification and online solutions/resources. Finally, and very importantly, it will facilitate client-to-client interaction through an online community.

How important is all of this to Press Ganey? It means everything to us. We are now measuring ourselves internally across our organization on how much our clients improve their performance. Meeting all of these challenges and helping clients reach their benchmarks is our raison d’être.

Bob Dylan’s lyrics may apply just as well today as they did in the ’60s. And patient satisfaction is one area where the conversation is changing in our hospitals, medical practices, and other care settings.

Let’s go back three or four years and listen in on some comments about patient satisfaction that were pretty common back then.

“Patients don’t understand what we do as providers of care. Their opinions really don’t matter. All they can tell is if the quality of the food is good or whether things are clean. How is that relevant?”

“If it takes a long time for someone to get an appointment at our medical practice, or if they have to wait an hour in our waiting room before being seen, that’s a good thing. It means we’re in demand, and they should be happy they are on our schedule.”

 “You can’t compare one hospital to another in terms of patient satisfaction. Our patients are different. Our facility is older than our competitor’s. We have a union. We are short of nurses. Our doctors aren’t engaged in working at our hospital.”

 “And what does it really matter anyway? Patient satisfaction information will never be publicly reported and it certainly won’t affect our reimbursement.”

Those kinds of statements aren’t quite as common today, are they? Instead you are likely to hear comments such as:

 “As a member of the executive team, a good portion of my bonus is tied to patient satisfaction.  How can we move the needle and improve?”

 “With public reporting, it’s not possible for us to hide our patient satisfaction scores anymore.  We need to make this a top priority.”

 “I’m very concerned that we could lose millions of dollars in reimbursement under the pay for performance rules likely to come out of health reform. We just can’t take that kind of a hit to our bottom line because our patient satisfaction isn’t where we want it to be.”

“You know, patients really are good judges of what is going on in a hospital. They are not clinicians, but they can tell if quality and safety are not up to par. They deserve the best, and we can and must get better. It really comes down to happy doctors, happy nurses, and happy patients.”

 So where is the conversation about satisfaction headed in the future? My guess is that it will be about how patient, physician, and employee satisfaction are inevitably intertwined and all strongly linked to clinical outcomes and financial success. And that satisfaction is only part of the equation: engagement of patients, physicians, and staff is the other part. Satisfaction and engagement together will be a powerful force for improving our heath care system.

 Yes, the times they are a-changin’.

An August 24 New York Times article carried the headline, “Mining the Web for Feelings, Not Facts.” It stated: “An emerging field known as sentiment analysis is taking shape around one of the computer world’s unexplored frontiers: translating the vagaries of human emotion into hard data.” When you think about it, the comments people make on patient satisfaction surveys represent perhaps the most comprehensive and meaningful database of human emotion in the world. What could be much more poignant and ultimately actionable than people’s honest feedback on the health care they receive in the hospital, the ED, a doctor’s office, or during a home health visit?

For years, we at Press Ganey have been making individual patient comments available to our clients to help them identify areas for improvement. And our hospital, physician practice, and home health agency clients take those comments very seriously. Numerical ratings are critically important for peer comparisons, but comments can be much more real and compelling. Historically, we classified those comments as positive, negative, mixed, or neutral and highlighted those comments that have certain key phrases that require immediate attention. You can probably guess what some of those key word combinations are!

But we have just scratched the surface in terms of sentiment analysis. Wouldn’t it be helpful for improvement if we could get more sophisticated in our categorization of patient feelings? That is exactly an initiative that we are currently working on at Press Ganey.

A couple of examples might help explain what I mean. Would it be helpful for a hospital to know not only how often patients have issues with pain management but also whether those issues arise because of physician or nurse responsiveness, insufficient explanation of what to expect, or varying treatment protocols? Or, would it be useful to know when patients are concerned about long waiting times, what do they feel is the cause of those waits and potential solutions? I’m continually impressed with the insights that patients have about the failures of our health care processes, failures that providers sometimes don’t fully appreciate. Sentiment analysis using sophisticated software will enable us to move from individual anecdotal comments to insightful patterns of feelings.

Last week, I described our new directions on sentiment analysis at our National Client Conference just outside of Washington, an event attended by 1,800 health care professionals, including 300 CEOs. Not surprisingly, there was a lot of excitement about the possibilities. Please stay tuned for turning those possibilities into a reality that helps transform the millions of patient feelings into real improvements in the health care experience.