In medicine, we talk about quality a lot. But most of the time that we are talking about it, we're really not talking about quality at all. You see, quality...
Last week, I attended a breakfast that our medical center put on for physicians ranking in the top 10% nationwide for patient satisfaction. The remarkable thing is that last year, no one invited me to breakfast. Not even close. In fact last year, my patient satisfaction scores were abysmal. Did I change my doctor-patient interactions? No… I’m 58 years old and I don’t change anything very easily. So what happened?
Outpatient satisfaction scores are derived from a series of questions on the CG-CAHPS survey (Clinician and Group – Consumer Assessment of Healthcare Providers and Systems). This is a questionnaire is a cousin of the HCAHPS questionnaire used for hospital satisfaction and it is based on a 1-10 rating scale; only 9’s and 10’s really count so in other words, you have to get an “A+” grade every time. One of the questions is: “In the last 12 months, when this provider ordered a blood test, x-ray, or other test for you, how often did someone from this provider’s office follow up to give you those results?” The questionnaire is sent to patients one week after they are seen in the office.
In our clinic site, we found that we were not always getting results to patients before they got their CG-CAHPS questionnaire. It is pretty easy when patients are computer-savey and sign up for the “MyChart” account on our electronic medical record, because with a mouse click, I can release blood test results to the patient’s account and they get an email telling them that there are test results available so they should log-in and check their MyChart account. There were three problems:
- A lot of the blood tests that I order have to be sent out to reference labs and they can take 2-3 weeks to come back. These results aren’t available when the patients get their CG-CAHPS questionnaire in the mail 7 days after their office visit and so they haven’t been contacted by anyone in my office with lab results.
- For some of my patients, our hospital is not in their insurance network so when I order labs, those tests have to be done at another hospital and it can often take many days for me to get results by mail. So, if I see a patient on December 1st and order labs, the patient gets their labs drawn at another hospital on December 5th, and then I get the results in the mail on December 9th, then no one from my office will have called the patient with results on December 7th, when the patient gets the CG-CAHPS survey in the mail because I don’t have the results yet.
- Because of the nature of my practice, a lot of my patients are taking immunosuppressive medications that requires monitoring lab tests every 1 or 2 months. Because many of my patients are from out of town, they get their labs drawn at their local doctor’s office or lab and then the results are mailed to me for review. The results are then scanned into our electronic medical record system and my office staff call the patient to tell them that the labs are OK. Many of these patients are used to being able to see all of their test results on their MyChart account when those tests are done at our hospital’s lab. However, scanned PDF files (of outside hospital labs) are not visible on MyChart. These patients were frustrated because they expected that the labs drawn at their primarily care physician’s office, often in a different state than Ohio, would show up on their MyChart account just like those labs from our hospital.
So, what was the solution? Well, all we did was to add a phrase onto the patients printed after-visit-summary (AVS). The AVS is a printed document that we give the patients after their office visit that goes over their medications, future appointments, etc. We added to the AVS:
“If you had blood tests today, many of those blood tests can take up to 3 weeks to complete; our office will contact you when those results are available. If you have an OSU MyChart account, we will release results to your account within 24 of when we receive those results; if you do not have an OSU MyChart account, we will mail you the results and it may take several extra days for you to receive them by mail. If you have blood tests done at non-Ohio State laboratories, these results will not be available on your OSU MyChart account and the results of these tests may take an extra 1-2 weeks to get back, depending on the mail.”
With this simple change to the AVS, I went from having 91.4% of patients rate me with either a 9 or 10, to having 98.1% of patients rate me with either a 9 or a 10. Because there is a tremendous amount of grade inflation with the CG-CAHPS survey, the difference between a 91.4% and a 98.1% is the difference between significantly below average and being in the nationwide top 10th percentile.
The lesson is that patient satisfaction is all about expectations and if we set the expectations, in this case, of when lab tests become available, then we can impact patient satisfaction. My patients didn’t know that when they had an anti-strongyloides antibody, that it takes 3 weeks to get the results back. To the patient, the anti-strongyloides antibody wasn’t any different that a CBC (that results come back in a few hours).
Ultimately, however, medicine is a team effort and even though I’d like to think that my patient satisfaction is high because I’m a good doctor, the reality is that the physician’s patient satisfaction is a reflection of the entire team. So, if you as a physician want to have a high patient satisfaction score, get good nurses, friendly registration staff, responsive housekeeping staff, and plenty of convenient parking at your office. Because the doctor’s patient satisfaction scores really aren’t just about the doctor.
December 11, 2016