Disclosure. Mayo Clinic. Quality Gets You in the Game, Service Helps You Win ***** How to Give Great Care and Feel Better at the End of Your Day

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1 Quality Gets You in the Game, Service Helps You Win ***** How to Give Great Care and Feel Better at the End of Your Day Jay Kaplan, MD, FACEP President-elect, American College of Emergency Physicians Practicing Clinician and Director, Patient Experience, CEP America Disclosure I, Jay Kaplan, M.D., F.A.C.E.P., do not have any relationship(s) with commercial interests. A commercial interest is any entity producing, marketing, re-selling, or distributing health care goods or services consumed by, or used on, patients. Mayo Clinic The future viability of our organization will be dependent on our ability to deliver Service Excellence. 1 Jay Kaplan, M.D. 2015

2 Upfront Question What is Service Excellence in Healthcare? Caveat #1: What Brought Us to this Dance... Ain t Going to Get Us to the Next One.... Minute Clinics Abound 2 Jay Kaplan, M.D. 2015

3 Direct to Consumer Mobile Video Visits Now anyone with a camera-equipped smartphone, tablet, or computer can conduct a video visit with a physician for $49 assuming you live in a state that doesn t prohibit it. Caveat #2 The Best Definition of Madness is To keep doing things the same way and expect different results... Caveat #3 How Most of Us Approach Change 3 Jay Kaplan, M.D. 2015

4 Caveat #4: To Get Quality Anything Systems People Process Outcomes Staff Patients Physicians Caveat #5: It s About The Team While we give care seemingly individually, The Patient and Family Experience is dependent upon the coordinated actions of all members of the team... From the moment they walk in, to the moment they walk out or on... If it s not always... It s not great... Caveat #6: Where There s No Gardener, There s No Garden No one is going to create a great place for us to work or for our patients to receive care unless we help make it so... 4 Jay Kaplan, M.D. 2015

5 ER Where We Are How We Need to Feel... What We Need to Do The Burning Platform Making All of What You Hear About Quality Personal Is Teamwork Important to Quality and Patient Safety? Is Communication Important to Quality and Patient Safety? Is Communication Important to Teamwork? 5 Jay Kaplan, M.D. 2015

6 What is Quality? Some Would Say... Clinical Quality is the real deal, the hard stuff. Service Excellence is the fluff stuff. Higher Patient Satisfaction = Communication = Compliance = Quality Physician communication correlates STRONGLY with adherence rates by patients in acute and chronic disease. There are now over 100 observational and 20+ experimental studies published demonstrating the correlation of communication (patient satisfaction) with compliance. Compliance with treatment regimens has significant influence on quality measures in chronic disease and outcomes. Medical Care: August Volume 47 - Issue 8 - pp 826 British Medical Journal Patient experience is positively associated with clinical effectiveness and patient safety. Associations appear consistent across a range of disease areas, study designs, settings, population groups and outcome measures Positive associations 429 studies (77.8%) No association 127 studies (22%) Negative association 1 study (0.2%) 6 Jay Kaplan, M.D. 2015

7 Relationship between patient satisfaction, complaints and lawsuits Each one point decrement in patient satisfaction scores is associated with a 6% increase in complaints (RR 1.06, 95% CI ;p<.0001) 5% increase in risk management episodes (RR 1.05, 95% CcI ;p<.008) Lower performing physicians were at greater risks for lawsuits (RR = 2.10;p 95% CI ; p<.019) 75% of complaints were related to communication issues Stelfox HT, et al, The American Journal of Medicine 2005; 118: Hourly Rounding - Call Light Study (American Journal Nursing Sept 2006) Operational Efficiency: Call lights reduced 37.8% Patient Satisfaction: Increased avg. 12 pts (78.8 -> 90.8) n=10 % Excellent ratings increased 41.8% (38.2% -> 81.0%) n=2 Clinical Quality: Falls reduced 50% (average cost of fall $19,440-$22,000) One year after study, 85% of units still doing the practice, 92% had spread practice to other units A Service Behavior - Hourly Rounding (ED) Operational Efficiency: Call lights reduced 34.7% Operational Efficiency: Patients/Families approaching the nursing station reduced 39.5% Finance: LWOBS reduced 23.4%, LAMA 22.6% Clinical Quality: Falls reduced 58.8% Patient Satisfaction: Increased 20%ile in already high-performing ED s 7 Jay Kaplan, M.D. 2015

8 Annals of Internal Medicine, May 2006 Better Communication Was Associated with Higher Global Ratings of Health Care Quality in the Government s Eyes The Transparent Environment During your hospital stay, how often did doctors /nurses: treat you with courtesy and respect? listen carefully to you? explain things in a way you could understand? Never/Sometimes/Usually/Always 8 Jay Kaplan, M.D. 2015

9 The Patient Experience Global Rating Question 23. Using any number from 0 to 10, where 0 is the worst care possible and 10 is the best care possible, what number would you use to rate this visit? 0 Worst care possible Best care possible Payment Tied to Quality - Tiering Under the VBM Value Based Payment Modifier Amounts CY2017 PY2015 Cost/Quality Low Cost 10 th percentile Average Cost High Cost 90 th percentile Low Quality 10 th percentile Average Quality High Quality 90 th percentile +0.0% +2.0x* +4.0x* -2.0% +0.0% +2.0x* -4.0% -2.0% +0.0% Simple Truth #1: We Live in a Service Economy 9 Jay Kaplan, M.D. 2015

10 Key Words for Us Satisfy to please, to be adequate to an end in view, to meet an obligation Astonish to strike with sudden and usually great wonder or surprise Memorable worth remembering Simple Truth #2: We All Believe We Give Great Service We assume Patient = = Satisfaction Employee Satisfaction Simple Truth #3: We think we re doing better than we actually are Jay Kaplan, M.D. 2015

11 Wall Street Journal April 8, 2013 Doctors need to work on their people skills... It s something patients have grumbled about for a long time... Doctors don t listen. Doctors have no time... Simple Truth #4: No Rest For The... If the other guy s getting better, then you d better be getting better faster than that other guy s getting better... or you re getting worse. -- Tom Peters The Circle of Innovation The Big Question How can you, as a medical team, create a consistent high quality compassionate experience for your patients, despite: Staff Diversity Different approaches/training Different years of experience Different and rotating personnel The pressures for doing more with less Time Time Time???? 11 Jay Kaplan, M.D. 2015

12 Please Note... A Great Patient Experience It is not about our Intent.... It is about our patients Perception... And it is an outcome of Great Teamwork. People - For Our Patients Think Bakery Think Baseball Think Football Use the Phone Think Bakery 12 Jay Kaplan, M.D. 2015

13 What Do Our Patients See? 13 Jay Kaplan, M.D. 2015

14 Take a Fresh Look Change the Signs What Do Our Patients Feel? 14 Jay Kaplan, M.D. 2015

15 Sit Down To Sit or Not to Sit? (Annals Emerg Med 2007)) Sitting: time overestimated 15% Standing: time underestimated 7% Providers overestimated time 6% Patient Education Counseling 2012 Feb;86(2): Effect of Sitting vs. Standing on Perception of Provider Time at Bedside Surgeon on post-operative visits (admitted for elective spine surgery) patients RCT to sit vs. stand, rest of visit same Results: Position Actual time Perceived time - Stand Sit *Positive patient feelings: sit= 95%, Stand = 61% 15 Jay Kaplan, M.D. 2015

16 What Do Our Patients Hear? People (Patients) will not hear all of your words... Use Key Words or Phrases to express your caring. Use Key Words For your safety For your privacy For your comfort To safely control your pain Would you repeat back what I just told you so that I can make sure you understand? What questions do you have? Is there you would like for me to go over again? Do Not Assume Our Patients Know... Who we are; How good we are; How much we care How long some process takes; What the process will involve; What will follow. 16 Jay Kaplan, M.D. 2015

17 Key Strategy #2: Think Baseball - Touching All the Bases - Communication Educate Every Patient Interaction Has a... Beginning Middle End or seen in another way... It s about... Relationship Task Relationship Relationship Task Relationship A I D E T Acknowledge patient and significant others Introduce self and anyone else on team with their titles and/or roles Inspire confidence by managing up Do These Things: Sit down Active Listening Paraphrasing Demonstration of empathy Articulation of physical findings Explain in a way that is understandable to the patient and family; include expected duration of workup/illness/healing process Teach Back to ensure that patient and family understand Thank patient/family for their involvement in their care Jay Kaplan, M.D. 2015

18 Key Strategy #3: Think Team Collaborative Rounding Inpatient Care Is there anything you want to tell me about the patient? Do you have any questions about his/her illness? Would you like to round with me? Key Strategy #3 for the ED: Rounding Old Way: See the patient, order your diagnostic tests, wait for all the results to come back, go tell the patient what you found. New Way: Touch base with your patient as often as possible, no less than every 30 mins. As results return, advise the patient. Pollinate the Rooms Patient Perception Quality 18 Jay Kaplan, M.D. 2015

19 Key Strategy #4: Follow Up Phone Calls - Quality Nearly 1 in 5 patients * 400 patients surveyed 76 (19%) had adverse events after discharge Nosocomial Infection Fall Type of Adverse Events 4% 5% Other 13% Procedure Related 16% 62% Adverse Drug Event * Adverse Events After Discharge from Hospital, Annals of Internal Medicine, February 2003 * 81 events occurred in 76 patients Follow Up Phone Calls Engel K, Heisler M, Smith D, Robinson C, Forman J, Ubel P, Patient Comprehension of Emergency Department Care and Instructions: Are Patients Aware When They Do Not Understand?, Annals of Emergency Medicine. July 11, % did not have full understanding 80% of that 78% did not understand that they did not understand Post Visit Calls Likelihood of Recommending - ED Percentile Rank Likelihood of Recommending ED No Call Call Source: New Jersey Hospital, Total beds = 775; 3Q2007 2Q Q 2Q 3Q 4Q 1Q 2Q 3Q 4Q 1Q 2Q 3Q 4Q 1Q 2Q Jay Kaplan, M.D. 2015

20 Follow Phone Calls: 6 Reasons Why Quality Risk management Patients love it You will love it (lots of kudos) You will be a better clinician Decreased return visits/hospital admissions Actionable Behaviors Re: The Patient Sit Down at the bedside Use Key Words/5 Fundamentals (AIDET ) Collaborative Rounding/Team Care Follow Up Phone Calls Self Test for Emergency Physicians/APP s 20 Jay Kaplan, M.D. 2015

21 Self Assessment Self-Test for Emergency Nurses Self-Test for Emergency RN s and other staff 21 Jay Kaplan, M.D. 2015

22 Summary We live in an experience economy. Satisfy is not enough. If the other guy s getting better... Quality gets you in the game. Service helps you win. It s about the TEAM. Next Steps Answer the question: What is one thing I am going to do differently to create a memorable experience for my patients today? Thanking you... Jay Kaplan, M.D., FACEP jaykaplanmd@gmail.com Jay Kaplan, M.D. 2015