PATIENT EXPERIENCE

Transparency Shines a Light on the Good and Improves CAHPS Scores
Surveying Team Essential to Success

It was an idea that was not without peril. In fact, the plan seems equal parts audacious and risky. But working with the right partner, and getting enthusiastic buy-in from crucial medical personnel, helped the plan succeed well beyond expectations.

Suzanne Hendery, MA, APR, chief marketing, communications and customer experience officer of Renown Health, a large nonprofit health care system headquartered in Reno, Nevada, wanted to improve the hospital’s patient experience numbers from the CG-CAHPS (Clinician & Group Survey-Consumer Assessment of Healthcare Providers and Systems) survey. Question number 18 on the national CG-CAHPS survey asks patients to rate their provider on a scale of 0 to 10, with national credit being given only to scores of 9 or 10.

Renown Health had tracked its patient experience numbers before and found that they were lacking. “Certainly not meeting the Western states’ average,” said Hendery. “And certainly not leading in the country.” But all that would change with the implementation of a better surveying system and willingness to go for broke with a completely transparent approach.

Surveying Gets an Upgrade
Renown Health had been using a surveying company that relied on the time-tested pad-and-pencil approach—a method whose return of about 8% was sparse. In addition, in a market where 30% of their patients speak Spanish, there was a glaring lack of information coming from non-English speaking consumers, which Hendery identified as a problem.

To address this deficiency, she turned to Professional Research Consultants (PRC) of Omaha, Nebraska, a surveying company now in its fifth decade that eschews the pad-and-pencil approach and instead performs telephone surveys. In addition, its group of more than 400 professional interviewers includes a team of over 100 bilingual interviewers who are native Spanish speakers.

As Jan Gnida, senior vice president of Renown, explained, the surveyors are trained to quickly establish an understanding for the reason behind the call and ask whether they should proceed in English or Spanish. “If we get the patient on the phone, we can get them to complete a survey nearly 90% of the time,” Gnida said. “They are generally happy to share their story, and if they feel their responses are going to be valuable in order to improve health care, then they feel like they are contributing to the community.”

When Hendery proposed this new surveying approach to President and CEO of Renown Health Tony Slonim, MD, DrPH, FACHE, he decided to run a test where both paper and phone surveys were performed independently. He stated, “Showing the comparison of both systems was key, as it was a board goal and we were concluding the fiscal year reporting cycle. We saw a positive difference between 4 and 9 percentage points with the phone surveys, with patients surveyed saying, 1) yes, they would give the provider/hospital a highest rating of a 9 or 10 on a 10 scale, and 2) yes, they would ‘definitely recommend’ the hospital.”

“What Renown Health leaders found — over one quarter — by splitting the discharged hospital patient sample, was significant. In every area, the scores improved with the real-time call methodology, which for CMS [the Centers for Medicare & Medicaid Services] was enough to put us into the category of excellent patient satisfaction,” Hendery said. “If we had stayed with the old survey vendor, we would still have looked like we were not making the grade. So, this made all the difference in the world.”

Renown Health now ranks among the best nationwide in physician communication, which is a key indicator of overall patient satisfaction.

Key Principles
Hendery delineated four key principles that led to the success of the program: transparency, group inspection, adaptation and change in data collection.

Many of these goals are met by PRC’s unique approach, which provides “transparency,” since providers can see all their scores and comments; “group inspection,” since providers can also see other providers’ scores; and the “change in data collection,” which is the switch from paper to telephone surveying.

As Gnida explained, “PRC has a targeted number of interviews to complete for each provider, which in the case of Renown was 50 interviews a year—or, roughly a patient a week. The beautiful thing is that the results are available online on our website, virtually right away.”

“We have multiple visualizations and reporting formats that aggregate the data,” Gnida said. “Practitioners can look at their own scores or all the providers in a specialty, or even across the entire medical group. There is also a feature called “EasyView to You” where the provider can receive regular reports via email.”

Sharing individual physician scores with every other practitioner in the Renown Medical Group might create internal dissent or jealousy, or even outright rebellion against the effort. But in a vital first move, Hendery obtained enthusiastic buy-in from Chief Medical Officer Rahul Mediwala, MD, before the project was formally initiated. In addition, Hendery identified a few physician champions who supported the project, and she engaged in a weekly call with PRC during the planning phase, so that any provider who had questions could call in and ask whatever they wanted. Gradually, initial skepticism about the program eased. 

A Carrot, Not a Stick
The first key principle, transparency, is perhaps the most fraught with risk. Not surprisingly, some physicians were not initially on board with the idea, but a private conversation with the CMO or chair of the department usually sufficed. Both the CEO and CMO were strict about physician adherence to the program: Opt-outs were not allowed. All practitioners had to participate. “We’re all in or we’re not in at all” was the theme. Renown Health practitioners were reminded that the hospital cannot engage in insurance contracts without participating in this national survey.

“The great majority of the comments from the telephone surveys were very positive and absolutely glowing,” Hendery said. “Practitioners began to appreciate the positive comments and started to print them out, post them on their refrigerator, show their kids, etc., because for the first time they got live feedback on how great they were doing.”

What could have been a stick turned out to be a carrot.

Providers could click on links from the PRC website and not only see the data from the surveys but actually “hear” the patient as they made their comments. “You can hear their voice and you can hear the passion and the intonation,” Hendery explained. This capability allowed listeners to understand the depth of feeling of some comments that were not wholly positive, and this proved to be a key driver for the last of the four elements: adaptation.

“As an example,” said Hendery, “we had patients say that their 10 minutes or so with Dr. X went by too quickly, and that they wished they had more time with the doctor. We got back so many comments that patients wanted more time that Renown Medical Group leaders actually increased the time allocated to each patient.”

The comments served as a feedback loop to administrators who could act on the comments, thereby likely improving the future patient experience.

If a provider is a relatively poor performer compared with his or her peers, coaching is an option. “We have coached people with heavy accents, for example, with vocal coaches so that they can project and communicate better with their patients,” Hendery said. “We have also coached some people who just have a rough exterior and explained to them how to demonstrate a softer approach.”

In the end, what was at one point viewed with trepidation is now embraced by most members of the staff. “We have more departments asking to participate in this,” Hendery said. “We have a clinically integrated network of independent private providers, and they want to be involved. And we have a health plan called Hometown Health, and those providers want to see their results and how they compare.”

Now, Renown Health is one of the best in the country for physician communication with patients. Step number one in this successful program was to get the right surveying organization. “PRC is the gold standard for patient satisfaction surveys, and their methodology and their personal surveyors are amazing,” Hendery said.

“We could not have done this without them. It’s a partnership. They provided the tool and, through that, the data. They were absolutely instrumental.”

This article features interviews with: 

Suzanne Hendery, MA, APR
Chief Marketing, Communications and Customer Experience Officer
Renown Health
Reno, Nevada

Jan Gnida
Senior Vice President
Professional Research Consultants
Omaha, Nebraska