Strategies for Improving Patient Experience Skills

Transcription

1 Physician Executive Council Strategies for Improving Patient Experience Skills From Our 2013 National Meeting

2 5 Transforming the Acute Care Enterprise The Physician Executive Council s 2013 National Meeting Research Research Agenda Engaging Physicians in Patient Experience Beyond HCAHPS Scores Building the Evidence-Based Organization Supporting System-Wide Clinical Practice Change Realizing the Full Benefit of Palliative Care Service Optimization and Strategic Growth All research is available online via on-demand webconferences. Additionally, toolkits and ready-made powerpoint presentations are available to help operationalize the recommended strategies. Visit advisory.com for more information or contact your Advisory Board representative.

3 6 Engaging Physicians in Patient Experience Three-Part Webconference Series 1 The Influencer in Chief : Rethinking the Physician Role in Patient Experience Learn about physicians unique role in driving patient experience and explore trends in commercial and public payers use of patient experience metrics Available on-demand from advisory.com 2 Practical Levers for Raising Physician Engagement in Patient Experience Address physician skepticism of the value of patient experience initiatives Available on-demand from advisory.com 3 Strategies for Improving Patient Experience Skills; Cone Health Case Study Cover strategies for improving patient experience performance; learn about Cone Health s patient experience transformation May 14 th, 2014 Source: Physician Executive Council interviews and analysis.

4 Strengthening Physicians Patient Experience Skills 7

5 Skill Development 8 Securing Physician Influence To Support Experience Implementation Strategy for Building Patient Experience Culture Among Physicians Leading Institutional Change Patient experience supported by executive leadership, instituted as a cultural norm Engaging Influencersin-Chief All new staff participate in basic patient experience training and onboarding Key staff groups prioritized for further training Leveraging Physician Data Real time feedback leveraged to expedite physician improvement process Adds legitimacy to system, leader, physician efforts Mitigates pushback Reinforces Institutional Commitment Strengthening Physician Skills Workshops target and develop physician patient experience skillset Develops physicians as patient experience leaders Targets low performers and provides additional training, shadowing/ coaching program Physician Investment and Commitment Source: Physician Executive Council interviews and analysis.

6 9 Starting with Bedrock Competencies Building Empathy and Ability to Connect Physician and Patient Perceptions of Emotional Comfort Two Key Interpersonal Skills 98% 46% 1 Creating Patient Context Strategies for developing empathy Tools to develop understanding of patient s history and circumstance Physicians Who Reported Addressing Patients Fears and Anxieties Patients Who Believed Physicians Addressed Their Fears and Anxieties 2 Making Interactions Meaningful Refining communication and behavioral skills to maximize patient interaction Practicing techniques to build patient rapport Source: Olson DP, et al., Communication Discrepancies Between Physicians and Hospitalized Patients, Archives of Internal Medicine, 2010, 170(15): ; Physician Executive Council interviews and analysis.

7 Interpersonal Skill #1: Creating Patient Context 10 Knowledge-Based Physician Training Targets Empathy MGH and Massachusetts Eye and Ear Test Innovative Curriculum Program Objectives Share the scientific foundation for the neurobiology and physiology of empathy training Increase physician awareness of the physiology of emotions during typical and difficult patient-physician interactions Improve skill in decoding subtle facial expressions of emotion Teach empathic verbal and behavioral responses with self-regulation skills utilizing diaphragmatic breathing exercises and mindfulness practices Training in Brief: Neuroscience-Based Empathy Training for Physicians Physicians trained to detect subtle non-verbal signs of emotion in themselves and in their patients; neurobiological explanation part of training Source: Reiss, H. Kelley, JM et al. Empathy training for resident physicians: a randomized controlled trial of a neuroscience-informed curriculum J Gen Intern Med Oct;27(10): Epub 2012 May 2. Massachusetts General Hospital, Boston, MA; Physician Executive Council interviews and analysis.

8 11 Neuroscience-Based Empathy Training Study in Brief: Increasing Physician Empathy Through Neurobiological Training Massachusetts General Hospital and Massachusetts Eye and Ear Institute and Infirmary, 950-bed medical center located in Boston, Massachusetts Residents and fellows participate in empathy training protocol based in neuroscience education Program training goals: 1. Improve physician awareness of patients emotional verbal and non-verbal communications 2. Respond to these communications with empathic understanding 3. Increase physician emotional and physiological self-awareness and self-regulation 4. Use these skills in challenging patient interactions Participants randomized into control group or training program of three 60 minute training modules Training delivered over four weeks to groups of six to 15 residents and fellows in the inpatient and outpatient settings Empathy training group showed greater changes in patient-rated CARE Score than control group Source: Reiss, H. Kelley, JM et al. Empathy training for resident physicians: a randomized controlled trial of a neuroscience-informed curriculum J Gen Intern Med Oct;27(10): Epub 2012 May 2. Massachusetts General Hospital, Boston, MA; Physician Executive Council interviews and analysis.

9 12 Illuminating Empathy from Many Angles Program Thoroughly Explores Patient and Physician Experience Components of Empathy Training Video-Based Module Videos of clinical interactions with realtime physiological responses Physicians see concordance between themselves and their patients, including physiological activation by attitudes Didactic Module Introduction and context for empathy training Neurobiology and physiology of emotion Empathetic and patient-centered delivery of bad news Experiential Module Non-verbal communication of emotion Decoding facial expressions Physician self-regulation exercise and discussion Source: Reiss, H. Kelley, JM et al. Empathy training for resident physicians: a randomized controlled trial of a neuroscience-informed curriculum J Gen Intern Med Oct;27(10): Epub 2012 May 2. Massachusetts General Hospital, Boston, MA; Physician Executive Council interviews and analysis.

10 Training Improves Physician Empathy, Relational Skills Physicians Self-Report Improvement through MGH/Mass Eye & Ear Program 13 Self-Assessed Improvements Among Training Participants Pre Post Change Scores by Treatment Group Listening carefully to patients without interrupting Making meaningful eye contact Interpreting non-verbal cues Greater self-awareness and ability to manage physiological and emotional reactions to challenging patients Measure Training Group Control Group P-Value CARE Neuro <0.001 Ekman < ) CARE = Consultation and Relational Empathy measure. The principal outcome measure was the patient-rated CARE score. 2) Neuro=Neurobiology and Physiology of Empathy Test. 3) Ekman=Ekman Facial Decoding Test. Empathy training group showed greater change in patient-rated CARE scores than control (difference 2.2; p=0.04) Attributable to decline in empathy during residency Source: Reiss, H. Kelley, JM et al. Empathy training for resident physicians: a randomized controlled trial of a neuroscience-informed curriculum J Gen Intern Med Oct;27(10): Epub 2012 May 2. Massachusetts General Hospital, Boston, MA; Physician Executive Council interviews and analysis.

11 14 Personalizing the Patient Environment Ronald Reagan UCLA Medical Center Patient Poster Initiative Getting to Know You Poster at UCLA Designated fields personalize patient by capturing family, background, hobbies, preferences Prominent placement near patient bedside serves as conversation starter for caregivers Poster travels with patient across inpatient stay, providing sense of continuity, comfort Poster content informs plan of care by highlighting patient s goals after hospitalization Source: Ronald Reagan UCLA Medical Center, Los Angeles, CA; Physician Executive Council interviews and analysis.

12 15 Patient Posters Develop Clinician Empathy Case in Brief: Ronald Reagan UCLA Medical Center 520-bed academic medical center located in Los Angeles, California Frontline caregiver introduced Getting to Know You posters on ICU in October 2008 as part of Advisory Board Talent Development s Frontline Impact program; currently in place on three units Posters distributed to all patients, families at admission; completed posters kept in Plexiglass frames at patient bedside, travel with patient across inpatient stay Source: Ronald Reagan UCLA Medical Center, Los Angeles, CA; Physician Executive Council interviews and analysis.

13 16 Realizing Returns from Patient Posters at UCLA Percentage of Patients With Completed Getting to Know You Posters on ICU 1 Percentile Ranking for Patient Confidence and Trust in ICU Nurses 75% 95% 84% 99% 29% 19% Nov 2009 Mar 2010 Oct 2011 Q Q Q Source: Ronald Reagan UCLA Medical Center, Los Angeles, CA; Physician Executive Council interviews and analysis.

14 Interpersonal Skill #2: Making Interactions Meaningful 17 Well-Known Frameworks Abound Example Physician-Patient Communication Frameworks AIDET Scripting Framework GIIFT Patient Experience Framework Kaiser s Four Habits of Highly Effective Doctors Acknowledge Introduce Duration Explanation Thank You Greet patient and family Introduce your role on the team Information sharing Feedback ask patients for feedback on their care 1. Invest in the beginning 2. Elicit the patient s perspective 3. Demonstrate empathy 4. Invest in the end Transfer of care explain the next time patient will see physician Source: Stanford Hospital and Clinics, TeamCards and Simple Scripts: Toolkits Piloted to Help Busy Physicians Communicate, available at: accessed June 19, 2013; The Permanente Journal, Getting the Most out of the Clinical Encounter: The Four Habits Model, available at: accessed June 19, 2013; The Studer Group Toolkit, H-CAHPS, available at: Physician Executive Council interviews and analysis.

15 18 Peer-Led Effort Seeks to Drive Greater Engagement Train-the-Trainer Model Develops In-House Expertise, Fosters Ownership Overview of Physician Facilitator Role Role and Responsibilities Important Competencies Additional Criteria Utilized in Selection Facilitate peer training sessions for eight hours every other month Serve as role model for best practices in patient-provider communication Participate in additional skills workshops for ongoing development Compensated with hourly stipend for services Respected by peers Ability to facilitate group discussions Ability to create a positive tone for group sessions Ability to lead role play activities Ability to incorporate feedback effectively Clinical background, specialty Tenure Gender Relationship with the rest of the medical staff Source: Experia Health, Improving Physician Communication, available at: Mayo Clinic Florida, Jacksonville, Florida; Mission Health, Asheville, North Carolina; Physician Executive Council interviews and analysis.

16 19 Peer-Led Effort (cont.) Case in Brief: Mayo Clinic, Florida 214-bed hospital located in Jacksonville, Florida Specially trained physician cohort facilitated patient experience communication training for all 350 physicians on the medical staff Case in Brief: Mission Hospital 750-bed hospital, located in Asheville, North Carolina; part of Mission Health Specially trained physician cohort facilitated patient experience communication training for one-third of medical staff in six months Plan to train remaining medical staff over the next year Source: Experia Health, Improving Physician Communication, available at: Mayo Clinic Florida, Jacksonville, Florida; Mission Health, Asheville, North Carolina; Physician Executive Council interviews and analysis.

17 20 Emphasizing Patient-Centered Communication Multi-Faceted Program Trains Entire Medical Staff Comprehensive Training Rolled Out to All Physicians Physician Communication Training Education Tools Presentations on communication skills Training consists of two, four-hour group sessions of physicians All medical staff members required to participate as outlined in credentialing standards Videos illustrating physician-patient interactions Role play activities Source: Experia Health, Improving Physician Communication, available at: Mayo Clinic Florida, Jacksonville, Florida; Mission Health, Asheville, North Carolina; Physician Executive Council interviews and analysis.

18 21 Patients Voice Approval for New Care Standard Mayo Clinic Florida s Physician Ratings Improve After Coaching Peer-Led Communication Training Yields Impressive Results Mayo Clinic Florida Press Ganey Physician Percentile Rank 75% 90% Expansion of Peer Coaching Model Based on success of the program: Training rolled out to rest of the clinical and non-clinical staff at Mayo Training adopted by non-affiliated hospitals participating in regional Florida collaborative Source: Experia Health, Improving Physician Communication, available at: Mayo Clinic Florida, Jacksonville, Florida; Mission Health, Asheville, North Carolina; Physician Executive Council interviews and analysis.

19 22 Sustaining Performance Through Coaching Full-Time Coach Offers Dedicated Support Dedicated Physician Service Excellence Coach at Prevea Coach Hired by Service Excellence Department Conducts coaching sessions per year Collects and monitors physician level satisfaction data Provides coaching, shadowing for physicians, including all new hires Shadows select high performing physicians each month to identify best practices Source: Prevea Health, Green Bay, Wisconsin; Physician Executive Council interviews and analysis.

20 23 Sustaining Performance Through Coaching (cont.) Case in Brief: Prevea Health 200-physician multispecialty medical group based in Green Bay, Wisconsin Began coaching program in 2009 with a pilot group consisting of department chairs Pilot coaching program became model for broader adoption and was first offered to lower scoring physicians, but eventually expanded to all physicians National ranking on Press Ganey surveys increased by ten points within one year following implementation of physician service excellence program

21 24 Structured Shadowing Offers Targeted Feedback Follow-up Occurs at Regular Intervals to Provide Continued Support Overview of Prevea s Patient Experience Shadowing Process Coach shadows physician in office for three to four patient encounters 1 Coach sends physician observation report outlining next steps, physician satisfaction data Coach meets with physician to give brief real-time feedback Coach follows-up with physician at 3, 6, 9, and 12 months to monitor progress, provide continued guidance 1) All patients informed about observation visit by coach; provided with option to decline coach attendance during visit. Source: Prevea Health, Green Bay, Wisconsin; Physician Executive Council interviews and analysis.

22 25 Coaching Model Delivers Results Prevea Health Patient Experience Scores Press Ganey Overall Patient Experience Percentile Rank 44% 75% Press Ganey Physician Communication Percentile Rank 1 48% 76% Individual Turnarounds Significant improvement also observed at individual level: one physician who received coaching improved from the 15 th percentile to the 80 th percentile within six months 1) Domain looks at provider s use of clear language. Source: Prevea Health, Green Bay, Wisconsin; Physician Executive Council interviews and analysis.

23 26 Identifying the Right Person For the Job Who is the Physician Coach? Key Characteristics of the Physician Coach 1 2 Holds credibility with hospital s physicians; possibly an retired physician Excellent understanding of both physician role and patient experience in the hospital We have been doing physician coaching for over a year now. The docs were initially skeptical, but now they love it. We have a great emeritus physician who shadows docs who are having a hard time. He has credibility among the physicians and is also widely recognized as a leader in the soft-skills department. He just really gets it, both the patients and physicians. It s working really well for us. 3 Excellent teacher; track record as effective teacher with physicians Chief Medical Officer Source: Physician Executive Council, interviews and analysis.

24 Case Study: Cone Health 27

25 28 Cone Health Elevates Patient Experience Implements System-Wide Hospitalist Training to Improve Performance Case in Brief: Cone Health and Triad Hospitalists Cone Health: Six-hospital health system located in Greensboro, North Carolina Triad Hospitalists: 45-physician hospitalist practice serving hospitals of Cone Health; culture focused on engagement and accountability, quality and outcomes Over 11,500 employees; more than 1,000 physicians system-wide In June 2010, system initiated a cultural transformation focused on transforming health care and creating measurably superior triple aim performance In June 2011, developed a system-wide patient experience project for system s 45 hospitalists Program involved development of a service excellence committee, broad-based messaging at department meetings, shared reading, 1-1 rounding, and a half-day training comprised of focus group discussions and skills based simulation training Post-training, patient satisfaction data individually shared with each hospitalist; high performers acknowledged and praised, low performers targeted for coaching In one year, system-wide hospitalist patient satisfaction scores moved from the 4 th to 31 st percentile, 89 th percentile for a specific site Since partnering with Cone Health, Triad Hospitalists have seen 10.5 mean score patient satisfaction improvement (75.9 to 86.4) for the question physician overall, 0.64 day reduction in LOS (5.20 to 4.56), and 14.6 mean score improvement in referral satisfaction (58.3 to 72.9) Source: Cone Health, Greensboro, NC; Cone Health Code U Newsletter, April 2013, available at: Physician Executive Council interviews and analysis.

26 Step 1: Launching Health System-wide Initiative 29 System-wide Cultural Transformation Sets the Stage Cone Health Moves to Transform Patient Experience System-wide Cultural Transformation System initiates a cultural transformation focused on transforming health care and creating measurably superior triple aim performance New Identity as Patient-Centered System aims to move employee perception of organization from financially driven to patient-centered Leaders Selected Across System Application process selects 19 Breakthrough Masters, leaders focused on breakthrough unprecedented results across the system Cultural Transformation Ambassadors Breakthrough Masters serve as cultural transformation ambassadors, make two year commitment, dedicate 10-15% of time Source: Cone Health, Greensboro, NC; Cone Health Code U Newsletter, April 2013, available at: Physician Executive Council interviews and analysis.

27 Step 2: Sharing Physician-Level Hospitalist Data 30 Broaching Issues in Hospitalist Performance System-wide Patient Experience Performance Early Steps in Hospitalist Patient Experience Transformation June % 1 New Service Excellence Committee selects hospitalist performance as focus area 4% All Physicians Hospitalists Hospitalist Patient Experience Performance 2 Share patient experience data at hospitalist department meetings 24% 3 Propose hospitalist-specific training program 4% 1% 1% System A 1 B 1 C 1 1) A, B, C representative of campuses in the Cone Health system. Percentile achievement in Press Ganey survey. Source: Cone Health, Greensboro, NC; Cone Health Code U Newsletter, April 2013, available at: Physician Executive Council interviews and analysis.

28 31 Hospitalists Play Critical Role in Patient Experience Factors Making Hospitalists a Crucial Group for Improvement Support Admit about 50% of hospital s patients more than any other specialty HCAHPS scores often lower than any other subset of physicians Hospitalist Challenges in Patient Experience Autonomy reduced by structural barriers, environmental factors No relationship to patient prior to admission Source: Physician Executive Council interviews and analysis.

29 Step 3: Committing to Hospitalist Support and Evaluation 32 Investing Leadership Focus on Hospitalist Challenges Investigation Deepens Understanding of Problem September, 2011 December, Rounding Executive Director, Office of Patient Experience, does 1-1 rounding with hospitalists in order to observe, discuss, and coach on most difficult conversations and challenges Rounding Unearths Challenges, Highlights Skill Deficits Research from rounding drives future of program, incorporated into future skills training and development of simulation lab Laying Foundation for Group Accountability Practicing Excellence -S. Beeson In addition to discussing patient experience performance at department meetings, all 45 hospitalists read and discussed Beeson s Practicing Excellence, focused on leadership, conduct, and physician performance Source: Cone Health, Greensboro, NC; Cone Health Code U Newsletter, April 2013, available at: Physician Executive Council interviews and analysis.

30 Step 4: Investing in Hospitalist Training 33 Training Elevates Hospitalist-Patient Interaction First Annual Hospitalist Simulation Training March 2012 Four-Hour Mandatory Training All 45 system hospitalists participate in half-day skills-focused training Group Story Sharing (Two Hours) Hospitalists broken into groups of 6-8 Service Excellence Committee physician member serves as facilitator for each group Groups discuss most difficult conversations they have had with patients and toughest challenges they have faced Simulation-Based Skills Training (Two Hours) Issues surfaced during 1-1 rounding revisited in simulation lab All 45 hospitalists participate in simulation exercises designed to improve patient communication skills Groups debrief each simulation and coached post simulation Source: Cone Health, Greensboro, NC; Cone Health Code U Newsletter, April 2013, available at: Physician Executive Council interviews and analysis.

31 34 Follow-up Cements Hospitalist Performance Gains Post-Simulation Training Follow-up After simulation training, hospitalist patient experience performance scores shared, unblinded, at individual level Pre-Simulation Training Performance Before simulation training, hospitalists patient experience performance reported at group level Physicians receive rolling reports on their patient experience performance; verbatims from discharge calls included in reports Administrative hospitalist director acknowledges hospitalists who are excelling and follows up with those who are having difficulty Source: Cone Health, Greensboro, NC; Cone Health Code U Newsletter, April 2013, available at: Physician Executive Council interviews and analysis.

32 Hospitalist and System Performance Improve Together 35 Hospitalist and System Performance Improvements in Patient Experience March 2012 December 2012 Hospitalist Patient Experience Performance 31% System-wide Inpatient Satisfaction Scores 73% System-wide Patient Experience Performance Mean Score % % Before After Before After Before After Source: Cone Health, Greensboro, NC; Cone Health Code U Newsletter, April 2013, available at: Physician Executive Council interviews and analysis.

33 36 Planned Strategy Achieves Performance Improvement Major Milestones in Development of Cone Health Hospitalist Patient Experience Training Program June 2011 Executive Director, Office of Patient Experience, develops Service Excellence Committee Department Chairs begin sharing patient satisfaction data at department meetings Concept of training program introduced to hospitalists March 2012 All 45 system hospitalists participate in first annual skills training Training lasts four hours and combines focus group discussion and skill development in simulation lab setting 2013 System-wide inpatient satisfaction scores have moved from 27 th to 73 rd percentile June 2010 Cone Health initiates cultural transformation to refocus mission on patient-centered care and away from being financially driven September December rounding, Executive Director, Office of Patient Experience and hospitalists All 45 system hospitalists read Practicing Excellence, by S. Beeson, MD December 2012 System-wide hospitalist patient satisfaction scores have moved from 4 th to 31 st percentile System-wide patient experience performance mean score has moved from 84.4 to 87.4 Source: Cone Health, Greensboro, NC; Cone Health Code U Newsletter, April 2013, available at: Physician Executive Council interviews and analysis.

34 37 Coda Toward True Patient Centeredness

35 38 Integration Required for Market Success Keys to Health System Performance in a Value-Based Market System Coordination Hardwired evidence-based pathways resulting in highquality, low-cost outcomes Seamless communication across sites of care to avoid duplicating, missing steps Physician Integration Physicians serve as strategic partners sharing goals for performance of health system Multidisciplinary, top-oflicense care team deployment standard across medical staff Patient Engagement Engaging and activating patient in care to ensure smooth recovery, ongoing management Encouraging informed patient to select appropriate treatment options and self-manage Health Care Advisory Board Competing on Patient Engagement: Forging a New Competitive Identity for a Value-Driven Marketplace Board/Studies/2012/Competing-on-Patient-Engagement Source: Physician Executive Council, interviews and analysis.

36 39 A Phased Mandate for Improving Patient Engagement Elevating Engagement in Episodes of Care Driving Engagement in Ongoing Management Transforming Community Health Adding Value through Population Health Improvement New Performance Baseline Recovering Lost Value in Today s System Focus on individual patients and individual episodes Fixing problems in today s system around care delivery and coordination to ensure a complete, highquality episode of care Creating New Value in the Health System Focus on targeted groups such as high-risk patients or chronic condition management Building system for proactive management, low-acuity access and ongoing patient self-management Focus on opportunities to impact population and community health Identifying opportunities to spur community groups in health activities and drive broader population health Source: Physician Executive Council, interviews and analysis.

37 40 Operationalizing The Culture Shift Four Key Steps to Transform Patient Experience 1 Build an institutional culture around patient experience through all staff training, communication dissemination, and incenting executive leadership 2 Develop physicians as influencers-in-chief; mandate training for key physician groups like hospitalists 3 Leverage real-time data to expedite physician improvement in patient experience skills and practice; normalize data transparency and expectations for physician performance 4 Strengthen physicians patient experience skills through targeted workshops, coaching, and shadowing; elevate physician awareness of and commitment to patient experience Source: Physician Executive Council interviews and analysis.

38 41 Questions For Executives? Where are we today on physicians ability to set the standard in patient experience? What resources could we put towards improving in this area; who could we tap to lead and support this campaign? What would be our specific goal, and by when could we reasonably achieve it? Source: Physician Executive Council interviews and analysis.

39 42 Elevating Patient Experience Performance Resources Available to Support Physician Skill Development Physician Executive Council Resources Advisory Board Resources Delivering on Value: Positioning Quality for Success in an Evolving Performance-Based Environment Section III Elevating Patient Experience Performance Enhance patient-physician interactions and increase patient and family engagement in care delivery Codified Patient Experience Expectations Physician Service Excellence Development Program Talent Development s Physician Engagement Initiative Offers Excel-based tool designed to help organizations map out a comprehensive plan for driving survey response rates Toolkit outlining the five key success factors for launching an effective communication strategy Southwind s Patient Experience Partnership Patients are surveyed on a continuous basis via telephone or Real time survey results are available via the Southwind online reporting portal Ratings and comments are reported at the group, specialty, office/location and provider level, and can be segmented by demographic variables Source: Physician Executive Council interviews and analysis.

40 43 Broader Resources on Physicians and QI Resources Available on Physician Clinical Quality Performance Improvement Physician Leadership Effectiveness Compendium Access 16 best practices for promoting physician leadership success in five key areas: Growing the leadership base Advancing leadership development Providing ongoing leadership support Delivering structured performance reviews Aligning compensation with performance goals The New Quality Compact Develop a comprehensive process for conducting effective physician PI conversations Implement strategies for promoting the adoption of evidence-based practice Assess opportunities for aligning physician incentives through performance-based practice Evaluate approaches for engaging ambulatory-based providers in PI initiatives Physician Performance Improvement Discussion Guide Includes talking points for leading discussions about physician performance improvement Helps address physician concerns about data integrity Sets direction for future PI conversations Source: Physician Executive Council interviews and analysis.

41 44 For More Information Contact the Advisory Board s Physician Executive Council Chloe Lewis Senior Analyst lewisc@advisory.com (202)

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