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    Molly M. Schmid, CMPE, SHRM-CP

    If we expect our team members to understand the true mission of our healthcare organization, we must ensure they are educated and trained in the skills needed to achieve it. All team members should espouse the organization’s mission, but because physicians and advanced practice providers (APPs) are the most crucial for the patient experience, it is important that we prioritize their training. Setting them up for success will positively impact patient retention, engagement and loyalty.

    In the Press Ganey Patient Experience survey, there are six key provider communication questions:

    1. During this visit, did this provider explain things in a way that was easy to understand?
    2. During this visit, did this provider listen carefully to you?
    3. During this visit, did this provider give you easy to understand information about your health questions or concerns?
    4. During this visit, did this provider seem to know the important information about your medical history?
    5. During this visit, did this provider show respect for what you had to say?
    6. During this visit, did this provider spend enough time with you?

    Communication is the most common “medical procedure” performed but it is the least studied and trained. Yet provider communication is the top reason patients cite for recommending our practice and is the main factor that impacts the likelihood-to-recommend score. Therefore, we place much emphasis on the patient-provider relationship and good communication techniques.

    While improving our patient’s experience with us may be the right and noble thing to do, there are many other reasons why it is important. There is increasing evidence that the patient’s experience is linked to other measures/outcomes that are critical in our healthcare industry today. The Agency for Healthcare Research and Quality (AHRQ) has highlighted the following five reasons to improve the patient-provider relationship.1

    1. Health outcomes

    The patient experience positively correlates with care processes in prevention and disease management. Communication with providers influences adherence to medical advice and treatment plans, particularly among patients with chronic conditions, emphasizing the importance of patient-provider commitment for positive outcomes. For example, positive interactions between providers and diabetic patients enhance self-management skills and quality of life.

    “Additionally, improved patient care experiences are associated with better health outcomes, as demonstrated in studies examining heart attack patients. Specifically, in one study, those who reported more positive care experiences exhibited superior health outcomes one year after discharge.”[1]

    2. Financial implications 

    As our system participates with the Medicare Shared Savings Program (MSSP), how we perform on our patient experience surveys impacts any shared savings we may receive from this program. Being able to participate in this value-based purchasing program saves us tens of thousands of dollars each year.

    In addition, many health plans (i.e., Priority Health, Blue Cross Blue Shield) have begun to incorporate patient experience performances into pay-for-performance incentives and reimbursable measures.

    3. Physician comparison websites 

    There are existing and forthcoming requirements from the Centers for Medicaid & Medicare Services (CMS) for medical practices to report and externally post patient experience results, requiring our healthcare systems to be transparent in our performance to participate in CMS programs. Consumers will have access to more information to make educated decisions when choosing their providers while using onsite physician comparison website and ranking websites.  

    4. Safer patient environment 

    Patient experience is also linked to patient safety. By measuring how our patients perceive the care they received, it often reveals other areas needing improvement, such as delayed test results, gaps in care and delayed communication loops. All these components affect our performance around providing safe care.

    Another correlation exists between positive patient experience and lower medical malpractice risk. A 2009 study found the likelihood of a provider being named in a malpractice lawsuit increased by 21.7% for each drop along a five-step scale in patient-reported scores, from very good to very poor.2 

    5. Greater employee engagement 

    When there are concerted, team-based efforts to improve patient experience, it results in higher employee satisfaction and loyalty once improved work processes and systems are in place to make care delivery more effective and focused. One study found a hospital’s patient experience work resulted in a 4.7% reduction in employee turnover.3

    As a healthcare organization that hires hundreds of providers each year, we tried several methods to train new providers on the importance of patient experience and their role in shaping it. We previously provided an annual, off-site, six-hour communication training for all providers. While the training yielded initial positive results, we found that providers did not retain or build upon what they learned after a few months. A team of four improvement specialists met with each new provider to go over the basics of the patient experience; however, it was not sustainable because of the extreme time commitment required. Therefore, we produced the idea of educating new providers during onboarding.

    Using the Plan-Do-Study-Act (PDSA) improvement process and a PDSA worksheet from the Institute of Healthcare Improvement (IHI),4 we broke down the work into steps, eventually evaluating the outcome and working to improve upon it.

    Plan

    In February 2022, the idea was born, and we documented our plan. We knew educating providers on the importance of communication — which is oftentimes overlooked in medical school — was crucial to setting new providers up for success. We did not want these providers to think it was just about “being nice” to patients or “giving them the answers they want.” The patient experience is much more encompassing than that.

    Do

    We used the key concepts we usually cover with providers in our one-on-one meetings to design an education piece that went with each one. We knew that we needed a variety of teaching methods to keep providers engaged — this included PDF tip sheets, videos (created in house and externally), articles, research reports and external websites. The mix of reading, viewing and listening meant we were creating rich and engaging educational content.

    The educational pieces we created stressed the overall importance of patient experience and included the specific provider communication questions asked on the Press Ganey Patient Experience survey.

    The information below documents our content and timeline:

    The next step in this process was integrating with our human resources system to ensure that any new provider would receive this pushed education after starting with us. The education is set up to push out at a certain number of days after the provider’s start date in five emails. In addition, each new provider’s peer guide features patient experience as a checklist item, so they are aware this education will be coming.

    Example of emails sent:                                                                   

    Study

    The patient experience provider onboarding program began in August 2022, and it included any provider hired on or after Jan. 1, 2022. We solicited feedback from providers who received the education to assess how effective it was and if they had any changes or improvements to offer. While we only received feedback from a dozen providers, we did change the cadence of when this education is pushed out based on provider feedback that the education could be split up further, with more rapid intervals and less content in each one.

    At the end of the provider’s first year, they are sent a survey about this onboarding program. The first anniversary of the program will soon be upon us, and we are anxious to receive this feedback to continue improving our content and process.

    We also track how we are doing on our patient experience surveys and look at trends. Over the past five years across our medical group, we have seen fluctuations in both the measures of LTR and provider communication. This past year, we have seen steady increases in both areas and can attribute our provider onboarding program as one of the factors helping in these successes (Figures 1 and 2).

    Figure 1.

    *Trend graph of LTR scores with benchmark lines

    Figure 2.

    *Trend graph of provider communications scores with benchmark lines

    Additionally, we are tracking the voluntary turnover rate for our providers and have seen a downward trend (Figure 3). Preparing our providers for their first year at our organization and having frequent check-ins has made a difference.

    Figure 3.

    Act

    We will review the results of feedback from providers after this year of education. In our next cycle, we will implement changes based on suggestions and continue to study providers’ feedback. Additionally, we will track overall improvements in our Press Ganey survey scores around provider communication.

    We are also working to expand this program to more than 150 new residents and fellows who start with us each July.

    Notes:

      1. CAHPS. “Section 2: Why Improve Patient Experience?” AHRQ. Available from: https://bit.ly/3OFLPj3.
      2. Fremont AM, Clearly PD, Hargraves JL, et al. “Patient-centered processes of care and long-term outcomes of acute myocardial infarction.” J Gen Intern Med 2001;14:800-8.
      3. Meterko M, Wright S, Lin H, et al. Mortality among patients with acute myocardial infarction: The influences of patient-centered care and evidence-based medicine.” Health Serv Res 2010 Oct;45(5):1188-204.
      4. IHI. “Plan-Do-Study-Act (PDSA) Worksheet.” Available from: https://bit.ly/43O2OEk.

    Written By

    Molly M. Schmid, CMPE, SHRM-CP

    Molly M. Schmid, Lead Improvement Specialist – Patient Experience, Corewell Health, can be reached at Molly.Schmid@corewellhealth.org.


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