Improving the Patient Experience: MMS Certificate Program with Cleveland Clinic

By 2009, Cleveland Clinic CEO Delos “Toby” Cosgrove, M.D., knew that something had to change. A few personal experiences had driven home the importance of compassionate health care. That realization, coupled with his organization’s disappointing scores on patient satisfaction surveys, spurred his decision to embark on a three-year organization-wide effort to put the patient experience front and center.

Earlier this fall, Cleveland Clinic, in collaboration with the MMS, brought its lessons learned to the two-day Patient Experience Summit: A Physician Leadership Certificate Program. The goal of the program, which included both didactic and skills training sessions, was to teach participants relationship-centered communication strategies to improve the patient and physician experience — which the literature says is directly linked to quality and safety.

The major lessons conveyed to the audience were:

  • Patient experience isn’t the same as patient satisfaction
  • Effective communication is a primary driver of patient experience
  • Good communication is linked to numerous positive consequences for patients and caregivers
  • What physicians say to patients is often less important than how they say it
  • Patient satisfaction surveys can be very effective if used correctly

The Cleveland Clinic’s Transformation

Cleveland Clinic Chief Experience Officer, neurologist Adrienne Boissy, M.D., kicked off the program talking about some of the ways her organization transformed itself, beginning with Dr. Cosgrove’s edict to make patient experience a strategic priority.

The Clinic trained all of its 44,000 employees — from housekeepers to nurses to department heads — to put themselves in their patients’ shoes and communicate better. Dr. Cosgrove created the first patient experience czar in the country — the role Dr. Boissy now fills — and made patient survey data about individual caregivers and units available to everyone. Same-day appointments became common, nurses began rounding hourly and countless small changes were instituted, including posting the caloric content of food and redesigning the “johnny.”

“Hospital choice is based on the emotional experience,” Dr. Boissy told attendees. “These are things that often come out at the Thanksgiving table during a conversation about how Aunt Mae was treated.” Boissy’s assessment is confirmed by a 2007 McKinsey and Company report she cited, looking at the factors influencing hospital choice. Respondents deemed patient experience — clean rooms, on-time appointments, good communication — twice as important as a facility’s clinical reputation.

Dr. Boissy emphasized that patient experience isn’t always synonymous with patient satisfaction. “As an MS specialist, my role is not to make my patients happy,” she noted. “My patents often hate coming to see me because they have to watch people come into the waiting room on gurneys and in wheelchairs and wonder if they’ll be like that eventually. My role is to walk with them on this incredible journey.” She added that cancer patients have some of the highest patient satisfactions scores.

Communication is King

When Cleveland Clinic analysts dug into the patient satisfaction scores of respondents who gave the organization low ratings,

they found that poor communication — patients not feeling listened to or communication gaps among staff — was at the root. Communication problems are also the most common issue brought to the Clinic’s ombudsman office and its ethics committee, according to Dr. Boissy.

Co-presenter Kathleen Neuendorf, M.D., medical director of the Center for Excellence in Healthcare Communications at the Cleveland Clinic Foundation, talked about the critical importance of communication and how the content of doctors’ conversations with patients is less important than the delivery, quoting Maya Angelou: “… people will forget what you said, people will forget what you did, but people will never forget how you made them feel.”

And there’s countless studies confirming the downstream effects of good communication, pointed out Dr. Boissy, including improved treatment adherence and health outcomes, enhanced physician and patient satisfaction and reduced caregiver burnout and malpractice claims. The inextricable link between patient satisfaction, a byproduct of effective communication, and quality and safety must be an important part of the message to hospital staff, emphasized Dr. Boissy.

Don’t Forget the Doctors

Dr. Boissy talked about the clear link between patient satisfaction and staff satisfaction and that fostering caregiver engagement should be an important institutional goal. She cited a study showing that the amount of time physicians spend working on the activities most meaningful to them was strongly related to their risk of burnout. “Putting patients first doesn’t mean putting caregivers second,” she asserted. “It’s important that we put a lot of attention on both sides.”

Dr. Neuendorf said that at Cleveland Clinic, the ideal care is what they call relationship-centered care. “It’s not all about me — the physician — or you — the patient —, but rather what we’re doing together,” she said. This type of care requires emotional connection, mutual respect for the other’s experience and expertise, a shared commitment to the patient’s health and well being, and an understanding of the patient’s perspective and psychosocial context. It doesn’t require friendship, agreeing on everything, or unlimited time, she said.

But can relationship-building be taught? she asked. “How can I ask a physician to do one more thing and how effective is it to tell people they’re poor communicators and their patient surveys are telling me this?” It’s important to emphasize to physicians that relationship-centered communications training ultimately improves their own experience and has related benefits as well, including saving the provider time, she said.

Patient Experience by the Numbers

Carmen Kestranek, senior director of intelligence within the office of patient experience at Cleveland Clinic, offered insights into his organization’s use of patient surveys, including the Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS). HCAHPS is the patient satisfaction survey mandated by the Centers for Medicare and Medicaid Services.

Among Kestranek’s suggestions:

  • For internally developed patient surveys, shoot for between 30 and 40 questions
  • Patients are more likely to respond to a survey post-discharge if their physician mentions it to them beforehand
  • Ensure that reporting methodologies are standardized. Provide dashboards so clinicians can easily drill down into the data and see their specific strengths and weaknesses
  • Provide several years of patient experience data so individuals and units can see their progress
  • Encourage internal transparency so individuals and units can compare performance. He admitted there was a lot of pushback when Cleveland Clinic began publicizing scores. But once scores became transparent, they rose significantly, according to Dr. Boissy
  • Hold meetings to discuss survey results and strategize improvements

The importance of patient satisfaction surveys will continue to grow, said Kestranek, and by 2017 will affect a greater portion of hospitals’ Medicare revenue.

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