Leadership -
What Makes Doctors Value Patient Feedback - Sun and Planets Spirituality AYINRIN
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Collecting
and using patients’ evaluations of their providers has been a work in
progress for the last thirty years — but the “progress” aspect is
suddenly moving into high gear. The original goal of surveying patients
was quality assurance — making sure nothing terrible was amiss. Today,
the goal is actual quality improvement,
and, as a result, the use of patient-generated data has become much
more charged, especially when it comes to providing feedback to
individual physicians. This could create a gulf between physicians and
management. But, done right, it can actually align them.
The
breakthrough has come in the last two years as the move to full
transparency — the continuous posting of patients’ numeric and verbatim
evaluations — has helped doctors and administrators come together
around their shared purpose: improving outcomes, patient trust, and
market share in a competitive environment.
Not
so long ago, that assessment might have elicited eye-rolls from most
physicians, who have often questioned the validity of patient
evaluations of care. With good reason, they have asked: How can a score
based on input from a handful of patients represent my value as a
physician? How can data from six months ago be used to determine whether
I will receive a bonus (or a penalty) today? Why should we rely on
these data if it’s possible that only disgruntled patients respond? How
can a patient with no medical training accurately evaluate their
physician’s skill and the quality of their interaction?
Insight Center
These
are legitimate questions. But as more and more organizations embrace
transparency, they’re learning how to design programs that diffuse these
concerns and deliver benefits that clinicians themselves can see. When
the idea was first broached at all of these organizations – including
Boston’s Beth Israel Deaconess Medical Center, the University of Utah Health System, and NorthShore-LIJ
(soon to be Northwell Health) — physicians expressed fears that they
will be misjudged and their reputations damaged. But in our work with
dozens of providers on their transparency initiatives, we find that the
process of preparing for transparency leads to meaningful measures to
address these concerns and ultimately improves trust between physicians
and leadership. Often, after considerable fuss, the controversy dies
down, and transparency becomes a point of mutual pride.
How
does this change occur? It boils down to addressing concerns about the
quality of data — its timeliness, robustness, and relevance — and
illuminating the upsides of careful data collection.
Clinicians
and management know that data on physician performance is valuable only
if patient sample sizes are large enough and the data are current.
Having a handful of year-old comments is all but meaningless in terms of
numeric ratings. Typically, organizations will want to have a minimum
of 30 to 50 patient evaluations for each physician, and ensure that data
is continuously collected and then updated on patient-facing sites.
Not
only do large sample sizes convince physicians that the data are solid,
they assure that the provider organization’s physician ratings will
rise to the top in any search. Thus when consumers search on a
physician’s name, they’ll be steered to robust physician ratings rather
than the less solid reporting often found on sites that rely upon fewer
and less complete data. This benefit aligns physicians and leadership
around aggressive collection of thorough, current data.
Many
organizations are now engaging in census-based surveying augmenting
traditional mail or phone surveys with emailed surveys. This approach
helps give every patient a voice — a laudable end in and of itself that
also ensures sample sizes that are large enough that physicians and
patients find them trustworthy.
The nature of
the data collected is also important in engaging both physicians and
patients in transparency programs. Numeric ratings (such as ranking a
doctor’s communication effectiveness on a 1-5 scale) are important for
data robustness, standardization, and statistical analysis; subjective
patient comments provide engaging stories that attract patients to a
provider’s website and encourage them to contribute their own
perspectives. Consumers are hungry for first person reports of
experiences from others like themselves. Patients’ comments meet this
need and, as long as they’re unedited by the provider, increase the
perceived legitimacy of the overall ratings
A
large number of current, unedited patient comments also motivates
clinicians to improve. There are no statistical considerations about a
patient comment that a physician might take issue with — it happened.
Praise is a strong reinforcer of positive behaviors and a means to
remind physicians of their ultimate mission to reduce suffering.
Critical comments, meanwhile, remind physicians of how important each
interaction is for the patient, and provide feedback that’s necessary
for improvement.
The
good news for physicians, as well as their organizations, is that the
majority of patient survey responses nationally (80 to 90%) are
positive. Verbatim comments are often filled with gratitude. This
dispels physicians’ anxiety that only dissatisfied patients will leave
comments, and it allows physicians to be more open to learning from the
occasional critical comment.
These
infrequent negative comments also send a powerful message to consumers
that the data aren’t sanitized and, so, can be trusted. By first
addressing the more methodological issues that concern physicians,
leaders can now broach the topic of whether patients are a good judge of
the value being offered.
Finally,
and critically, leadership must emphasize that patients are not rating
physicians’ technical skill. The key measures used in transparency
efforts relate to issues of clarity of communication, involvement in
shared decision making, and the confidence patients have in their care
provider. Not only are patients legitimate judges of such concepts,
they are the only true source of these outcome measures.
By
committing to transparency, providers are acting on several key
beliefs. First, they are reaffirming that patient evaluations are
legitimate and important elements in evaluating quality of care. Second,
they are establishing that sharing such feedback is good for both
providers and the communities they serve. And finally, they are
embracing the idea that such self-imposed accountability is key to
serving patients’ needs and, ultimately, reducing suffering.
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