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

2. Objectives 1.Agree to adopt 2 or 3 interventions designed to improve patient satisfaction with hospital physicians at UNMH 2.Implement these interventions this Spring 3.Report measurements back to group in June 1/29/2014 UNM Hospitalist Best Practice: Patient satisfaction with hospital physicians 2

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 1/29/20143 UNM Hospitalist Best Practice: Patient satisfaction with hospital physicians

4. Where are we at UNMH? 1/29/2014 UNM Hospitalist Best Practice: Patient satisfaction with hospital physicians 4

5. 4-West Press-Ganey patient satisfaction surveys (2012, N = 117) 1/29/2014 UNM Hospitalist Best Practice: Patient satisfaction with hospital physicians 5

6. 5-West Press-Ganey patient satisfaction surveys (07/2013) 1/29/2014 UNM Hospitalist Best Practice: Patient satisfaction with hospital physicians 6

7. Physician satisfaction: Press-Ganey 1/29/2014 UNM Hospitalist Best Practice: Patient satisfaction with hospital physicians 7

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 of attention and respect Doctors could have smiled more The “team approach” led to a lot of confusion 1/29/2014 UNM Hospitalist Best Practice: Patient satisfaction with hospital physicians 8

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 1/29/2014 UNM Hospitalist Best Practice: Patient satisfaction with hospital physicians 9

10. What does the literature say? 1/29/2014 UNM Hospitalist Best Practice: Patient satisfaction with hospital physicians 10

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 1/29/201411 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) 1/29/2014 UNM Hospitalist Best Practice: Patient satisfaction with hospital physicians 12

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 1/29/201413 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 1/29/201414 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 1/29/201415 UNM Hospitalist Best Practice: Patient satisfaction with hospital physicians

16. Inpatient literature – no correlation InterventionSetting Follow-up phone call from staffLarge multi-hospital system in MidWest Post-op anesthesia visitsAnesth Dept at academic health center Use of physician business cardsED at academic health center Being seen by nurse vs. physicianED in Jamaica 1/29/201416 UNM Hospitalist Best Practice: Patient satisfaction with hospital physicians

17. Inpatient literature – positive correlation InterventionSetting Perceived empathy by physicianTeaching hosp in Korea Patient-centered communication styleGeneral academic inpatient service in US Perceived nurse/physician collaborationTeaching hosp in England Not wearing maskTeaching hosp in China Patient not in isolationTeaching hosp in China Post visit phone call or email from MDED in academic health center in US Native Spanish-speaker vs. interpreterED in academic health center in US Providing an antibiotic prescription to pt with respiratory sxs 8 ED’s in large multi-hospital system Multidisciplinary outpt clinic consultation vs. inpatient oncology consultation Newly dxd breast cancer patients at academic health center 1/29/201417 UNM Hospitalist Best Practice: Patient satisfaction with hospital physicians

18. Inpatient literature – positive correlation (contd) InterventionSetting Customer training satisfaction of staffED in academic health center in US Use of bedside vs. radiology ultrasoundED in academic health center in US Shorter waiting timeED in academic health center in Iran Shorter total through-put timeED in academic health center in US Robotic telerounding in afternoonJohns Hopkins Urology service Employing a patient communicatorPediatric academic hospital service in US Use of RSMI vs. live interpreterLarge multi-hospital system in MidWest Use of patient whiteboardsStanford Hospital Putting student, resident and attending photos in patient room Internal Medicine hospital service at Mayo Clinic Attending continuityNonteaching hospitalist services at Northwestern Hospital 1/29/201418 UNM Hospitalist Best Practice: Patient satisfaction with hospital physicians

19. Robotic Telerounding 1/29/201419 UNM Hospitalist Best Practice: Patient satisfaction with hospital physicians

20. Mayo Clinic Proceedings. 76(6):604-608, June 2001. Patient satisfaction and provider photos 1/29/201420 UNM Hospitalist Best Practice: Patient satisfaction with hospital physicians

21. Patient satisfaction and physician continuity J Gen Intern Med.J Gen Intern Med. 2014 Jan 17. [Epub ahead of print] 1/29/201421 UNM Hospitalist Best Practice: Patient satisfaction with hospital physicians

22. What are suggested corporate strategies? 1/29/2014 UNM Hospitalist Best Practice: Patient satisfaction with hospital physicians 22

23. Seven Corporate strategies to Improve Patient Satisfaction 1.Smooth the admitting process 2.Communicate test results promptly 3.Respond quickly to the patient 4.Keep the patient informed 5.Coordinate provider communication 6.Promote a quieter/more restful environment 7.Speed discharge process 1/29/2014 UNM Hospitalist Best Practice: Patient satisfaction with hospital physicians 23

24. Seven Corporate strategies to Improve Patient Satisfaction 1.Smooth the admitting process 2.Communicate test results promptly 3.Respond quickly to the patient 4.Keep the patient informed 5.Coordinate provider communication 6.Promote a quieter/more restful environment 7.Speed discharge process 1/29/2014 UNM Hospitalist Best Practice: Patient satisfaction with hospital physicians 24

25. What ideas came out of our retreat? 1/29/2014 UNM Hospitalist Best Practice: Patient satisfaction with hospital physicians 25

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. 1/29/2014 UNM Hospitalist Best Practice: Patient satisfaction with hospital physicians 26

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. 1/29/2014 UNM Hospitalist Best Practice: Patient satisfaction with hospital physicians 27

28. Retreat ideas (contd) Care Coordination – Communicate plans on a regular basis to the nursing staff. – Use Whiteboards – Readdress NPO orders BID 1/29/2014 UNM Hospitalist Best Practice: Patient satisfaction with hospital physicians 28

29. What will we choose? 1/29/2014 UNM Hospitalist Best Practice: Patient satisfaction with hospital physicians 29

30. How and when will we implement this? 1/29/2014 UNM Hospitalist Best Practice: Patient satisfaction with hospital physicians 30