Turning Spare Change into Great Experience: Using Change Management Concepts to Improve the Patient Experience James Park, MD, MHA Chief Medical Officer Valley Medical Center
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Images and Impressions tell stories
Valley Medical Center
Jul-14 Aug-14 Sep-14 Oct-14 Nov-14 Dec-14 Jan-15 Feb-15 Mar-15 Apr-15 May-15 Jun-15 Jul-15 Aug-15 Sep-15 Oct-15 Percent who answered "Yes, definitely" Willingness to recommend 95% Patient Experience Survey Clinic Network - "Willingness to Recommend" Top Box Score 94% 93% 92.9% 93.2% 93.4% 92.4% 92.7% 92.3% 92.0% 92% 91% 91.0% 91.2% 91.3% 91.4% 91.4% 90% 89% 89.6% 88.9% 89.2% 89.5% 88% 87% 86% 85%
Change continuum
Kubler Ross Stages of Patient Experience Denial: These scores don t reflect my true performance! Anger: I never give 9s or 10s! This is impossible! Bargaining: Do you want satisfaction or quality? Depression: How long do I have until retirement? Acceptance: Ok- I get it. But how can I improve?
Kubler Ross - Denial Use websites to explain survey methodology http://www.surveysystem.com/sscalc.htm Group scores are reliable.someone has to own it! Encourage continued improvement Reflect back to providers your own experience with them.
Kubler Ross - Anger 95% of patients rate providers 7 and above Difficult patients don t fill out many surveys Task is not to satisfy the impossible patients, but to go from good to great
Kubler Ross - Bargaining Experience is different than Satisfaction Patients can not be satisfied, but still have a good experience Goal is for great quality with a great experience
Kubler Ross - Depression Important to recognize Burnout is real Autonomy, Mastery, Purpose required for and engaged workforce Dan Pink Drive https://www.youtube.com/watch?v=u6xapnuf jjc
Kubler Ross - Depression Physicians losing Autonomy Cookbook Medicine New ability to measure performance causes loss of Mastery Feedback + Change = Improvement Losing sight of purpose Patient story
Kubler Ross - Acceptance Time to learn!
Change Tools: Informing Data: Transparency Awareness to Understanding Stories: Cleveland Clinic video Personal stories Goals: Incentive Plan- 6 ways to win!
Change Tools: Education Provider Coaching Clinic Group Coaching Provider Workshops Outreach video Good to Great https://www.youtube.com/watch?v=qhb0_jheonk &feature=youtu.be
Group Work Discuss Change Management Continuum Think of a current project involving the need for physician change Place your CAVEMAN on the curve What specific strategy can you use to help change behavior?
Change Tools: Education Provider Workshops 2 hour workshops Started in October 2014 Clinic Network providers first, followed by non-employed medical staff Focus on the basics of the patient interaction Hospital CEO appeared at each workshop
Change Tools: Education Workshop Example-Introduction You only get 1 chance to make a good first impression Judgment is passed in the first few moments Need to convey compassion, intelligence, confidence, and commitment to the well being of the patient Examples of good and great
Change Tools: Education Key Elements of a Visit Prepare for the visit First Impression Patient Centered Interview Announce exam Convey exam findings
Change Tools: Education Key Elements of a Visit Provide patient information Patient-Provider Collaboration Discuss follow up Close the visit
Change Tools: Education Workshop feedback Overall 157 attendees 80% completed the evaluation 89% rated Extremely Useful or Very Useful
Change Tools: Education Specific comments Best part is sharing among providers For a beginning workshop, this was great and definitely exceeded my expectations I thought this would be a total waste of time..but it was actually really helpful! A few did not enjoy the 7 am start One person wanted to be paid to attend Several requested more workshops
Change Tools: Education Specific feedback to providers Learning collaborative Goals Top Box Percentile Willingness to Recommend 92% 70 Access to Care 66% 60 Overall Provider Satisfaction 84% 70 Provider 1 Name Top Box Percentile Willingness to Recommend 78% 8 Access to Care 58% 31 Overall Provider Satisfaction 66% 8 Willingness to Recommend Improvement Plan: Question # 21, During your most recent visit, did this doctor show you respect for what you had to say? 3 No, 2 Somewhat, 41 Yes. Area of improvement: Provider communication 1. Let the patient know that you have reviewed the chart in advance of walking into the room. 2. Set the agenda for the visit with the patient. Start with I see you are here for. 3. Review, note and comment on any new care team connections. (recent visit to U/C, Hospitalization, New Dx) 4. Relay back to the patient what you think they have said and meant. Perceptions matter. Question # 17, During your most recent visit, did this doctor listen carefully to you? 2 No, 3 Somewhat, 41 Yes. Area of improvement: Provider communication 1. Do not interrupt let the patient talk until finished. Whatever you hear, do not take it personally. 2. Sit down and make good eye contact. 3. One of the best ways to communicate to patients that they have been heard is by reflecting. Which you may do this include: Paraphrasing, Using Teach Back, Reflecting back feelings and content clarifying, Summarizing the major issues. 4. Be mindful of your surroundings and the situation as well as your body language. attentive and face the patient. Demonstrating empathy is a key skill that affects a patient's perception. Engage, Empathy, Educate and Enlist.
Change Tools: Committing Provider Recruitment Provider Onboarding New Employee Orientation Provider meetings with key leaders New providers at workshops Champions Senior leader engagement
Change Tools: Committing Kurt Lewin Change Model
Change Tools: Committing Leadership rounding Dyad partnership (spreadsheets) Leadership talking with clinics about what is working so as to reinforce behavior Leadership collaboratives Building leadership bench strength Physician engagement = Staff engagement
What story do we want to tell? We are Competent We Listen We Care
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