1. Improving Patient Satisfaction Scores in the ED and IP Setting Ryan Sundermann MD Tracy Reittinger MD St Luke’s Hospital Cedar Rapids, IA

2. Improving Pt Satisfaction in the ED at St Luke’s Hospital Ryan Sundermann MD

3. St Luke’s Satisfaction Data Then vs Now

4. St Luke’s ED Provider Satisfaction Data

6. Breaking Down Physician Scoring Courtesy: what do you do when you enter the room Took time to listen: sitting down, leaning forward, repeating what the patient says Took my problem seriously: “My job is to think of the 5 worst things this could be.” Kept me informed/Re-evaluated: Fly-bys, providers go over D/C with all patients Concern for comfort: water, blankets, coffee for EVERYONE. ▫(Note: what happens in between #3 and #4? Have you ever been there????? Can you say ANXIETY!)

7. Engaging Providers Must be top down: Must come form the CEO as part of the Mission Statement Must have a true believer/evangelist for satisfaction: Who is this in your facility? ▫Oldest doc, director, youngest doc, respected doc? Hire well and train early: Old dogs, new tricks adage applies, but not impossible. “Embrace their skills, but empower change.” Get rid of misconceptions ▫Drug seekers are not the ones that move the bar (docs with bad scores feel that they might have to hand out vicodin to improve scores) ▫Lots of evidence on the PG website

8. Engaging Providers Must have reliable data ▫Just like D2Doc, LWOBS, etc ▫Must be specific to doc, not overall number ▫May not be accurate, but must be precise to find outliers Its about GOOD CARE, not MARKET SHARE ▫But you might be surprised how one follows the other

9. Hit’em in the Pocketbook Make bonus contingent on perfomance ▫How much? What is the target ▫65%ile How often ▫Quarterly with rolling 12 month What if they don’t meet for one period ▫Hold for 1 qtr, use 2 qtr bonus to pay for Satisfaction CME What if they don’t meet repeatedly (or ever) ▫Jack Welch theory on “C players”

10. Where do you send them? Jay Kaplan/ Studer Group- looks at whole facility, front door to back-he will also come to you Stephen Beeson-focuses primarily on the patient/doctor experience-will come to you Crucial Conversation/Confrontations-awesome, awesome course

11. Other Measures What can you do as a physician leader ▫Physician Rounding ▫How do you handle patient complaints Staff Survey: careful how you present this data ▫Present Rank or score with average must know your providers to decide this Comments can be a very touchy subject

12. Good Scores For Dr B ED provider survey Dr B Answer Options12345 Response Count Sum of Scores Average Score Ranking Initially sees and treats patient in a timely manner 003135470 331 4.72857 11 Evaluation and treatment done in a timely manner 004115570 331 4.72857 11 Has the ability to move patients efficiently and prioritizes well 014174769 317 4.59420 32 Is immediately available/communicates his/her location when not present 003165170 328 4.68571 41 Treats ED staff in professional and courteous manner 00026870 348 4.97142 91 Effectively communicates to staff and is easily approachable with questions 00026870 348 4.97142 91 Shows caring and concern for patient/their families 00046670 346 4.94285 71 Explains the problem and treatment to patient and/or family satisfactorily 00146570 344 4.91428 61 Is able to remain calm under stress and is able to handle crises well 00146570 344 4.91428 61 Overall rating of healthcare provider's clinical judgment/technical skill 00066470 344 4.91428 61 Overall rating of the total care of the patient by this healthcare provider 00086270 342 4.88571 41 Overall rating of the ease of working with this healthcare provider 00036770 347 4.95714 3 1 Comments 27 58.2084 91 answered question70 skipped question26

13. Bad Comments for Dr X Dr. X has very poor communication when treating pts and does not communicate the plan of care to the nursing staff. Dr. X does not move pts through the ED in a timely and does not move pts through the ED in an effective manner. Dr X is not approachable in a learning environment. She can be rude when working together. ▫BE VERY CAREFUL WITH COMMENTS. ▫ SCREEN HEAVILY AND ONLY PRESENT THE OVERALL THEMES.

14. Other Factors Appearance of Facility-less important than you think Appearance of docs: best to dress all the same Convenience of Facility-more important than you think (coat hangers, blankets, parking) Wait times ▫What is your process for getting them in? ▫What is your process for getting them out? ▫Do your providers know their metrics for both?

15. Other Factors If Disney ran your ED “Under- promise, Over Deliver ”

16. Other Factors Concierge service: Guest Relations, Valet parking Housewide: “Standards of Excellence” signed by CEO Work with other departments to improve interaction so you all look like you have the same agenda: radiology, lab, Some of this starts to blend into Process Improvement….but that’s ok. It’s the adoption of an overall mentality

17. Tid-Bits Business cards/Bio cards Follow-up calls Protocols for pain/nausea: We don’t do this but some places find it successful. Work from blinded, to unblinded provider data Adaptive Design: the world’s problems can be solved using this system. If you don’t use it in your facility, you should start tomorrow. Great way for providers to solve their own problems.