Prevea Health Key Roles in the Patient Experience

Prevea Health Key Roles in the Patient Experience Kathy Fett, MSN, MBA - Vice President of Quality Eric Dordel, MS, PHR - Director of Customer Service Christine Riley, RN, BSN, MS - Customer Service Coordinator/Physician Coach

Physician Owned Hospital Partnered 20 Health Centers 50+ Specialties 1100+ Employees 200+ Providers 500k Annual Visits

Agenda: How to define a customer service philosophy based on measurable behaviors. How to build an internal brand to engage your employees and build instant awareness of customer service endeavors. Learn about a 5-Year plan that will engage your workforce and improve the patient experience.

Defining a Customer Service Philosophy

Challenges Many Subcultures 25 th Percentile Rank No Specific Strategy No Definite Service Accountability Education Recognition Getting better, but too slow Billing Vs. Nursing Opportunities Obvious Priority Index Areas Many Specific Patient Comments Dedicated Leadership Willingness to Change Employees Asking for Guidance Customer Service Manager & Committee

Pre-Work 1. Review your History 2. Talk to your Employees 3. Consult your Mission & Vision 4. Give your Service STRUCTURE

Review your History What have we done before? Why did we do it? What did we accomplish? Would we do it again? What mistakes can we avoid? What would cause us to lose credibility with employees?

Flavors of the Month

This too shall pass

Talk to your Employees They know service best. Gather their wish lists. Ask what works well & what to toss. The more you get them involved, the more they will back the program. Give them credit for knowing our patients.

Service Definitions.

Consult Your Mission & Vision Your overall purpose. Driving principles. Match or mismatch? A shared future or just a statement?

Our Mission To take care of people with passion, pride, and respect. Our Vision The best place to get care. The best place to give care.

Give your Service STRUCTURE Use collected employee information Universally applicable Totally understandable Observable & measurable This is the way we do business.

The Prevea Promise

What is the Prevea Promise? Our Customer Service Philosophy Standardized service approach to: Patient service Patient treatment Coworker interactions Team dynamics Strategic planning Our competitive edge in the healthcare market Expected of leaders, physicians & staff

The Patient Experience The Four Promises Ripples

Components of the Promise The Four Promises Our Core Service Principles Ripples Listen, Understand, Share, Recognize Layers of affect in our organization that originate with the customer Physician/Employee, Department, Leadership The Patient Experience Everything the patient experiences as a Prevea customer Mission & Vision Statements Service Moments Service Standards Service Recovery Each component depends on and reinforces one another in a continuous flow of patient contact, information, and service. Your individual role may differ from your neighbor, but not your service philosophy.

The Four Promises

The Four Promises Every employee of is asked to make "The Prevea Promise" and to live that promise each day. I Promise to... Listen to your concerns Understand your needs Share compassionate service Recognize and respect your individuality

Listen Listen to Your Concerns Listening is a Skill Eye contact Focus on the person completely Positive body language Do not interrupt Ask brief questions Be aware of the non-verbal

Understand Understand Your Needs Demonstrate that you understand Paraphrase Verify the facts Summarize Ask questions Understand the core issue.

Share Share Compassionate Service Build a relationship Share yourself! Share information Share in decisions Share options & opinions

Recognize Recognize and Respect Your Individuality Three main types Recognizing the success or failure of the patient experience Recognizing the success or failure of communications Recognizing staff for their efforts

Ripples

Ripples Result of patient contact Waves of natural effect Information flow Service responses

Employee & Physician Listen to the Patient and your Team Understand Patient Needs and Goals Share Your Service, Opinions, and Decisions Recognize Outcomes, and Thank Each Other

Department Listen to the Team and Patient Flow Understand Service, Quality and Efficiency Measures Share Strategies, Forecasts, Progress Reports Recognize Everyone for their Service

Leadership Listen to Employee Opinions, Patients, Business Environment, Legal Issues Understand Strategic Goals and Forecasts Share Information and Direction Recognize All Staff with Praise, Salary and Benefits

The Patient Experience

The Patient Experience Everything the Patient perceives from making an appointment until they pay their bill.

The Patient Experience Mission & Vision Service Standards Service Moments Service Recovery

The Patient Experience Mission & Vision Statements Our reason for business, and aspiration for the future Service Standards Operational priorities for service Service Moments Moments of Truth for every patient to which behavioral standards have been assigned. Service Recovery Predetermined responses for when patient experiences go bad.

Service Standards Prioritize details of service delivery Operational priorities Ensure consistent delivery Set parameters for decision making SAFETY QUALITY COMPASSION EFFICIENCY

Service Moments First Impressions Telephone Standards Responding to Patient Phone Messages/Requests Informing Patients About Delays Explanation and Notification of Procedure/Test Results Greeting and Patient Check-In Verifying Demographics and Insurance Asking for Money Making An Appointment Confirming An Appointment The Patient Exam During Procedures

Service Recovery When we fail to keep The Prevea Promise. Listen to the Concern Understand the Need Share an Apology Recognize the Resolution

Building an Internal Brand

The greatest problem in communication is the illusion that it has been accomplished. Daniel W. Davenport

Branding Tell everyone! Templates Internal memos, PowerPoint, e-mails, etc. Intranet site Department meetings Customer Service standing item Supervisor instructions Specific direction for shared experiences

ST R Program Listen to the person next to you. Understand what you can do to make someone's job easier. Share courtesy beyond your job description. Recognize conflict and offer resolutions.

Branding Stay the Course! Don t sacrifice condition for creativity! Theme: Employee presence of mind Avoid Trash Triage

Improving the Patient Experience in 5-Years (or Less)

Customer Service 5-Year Plan: 2007 Development and Rollout 2008 Awareness and Recognition 2009 Accountability and Process Improvement 2010 Raise the Bar 2011 Restructure the Patient Experience

2007 Prevea Promise Development Branding Strategy & Communication Channels All-Staff Cascade Training 1st Annual Customer Service Week A Brand New Day in Customer Service Development & Roll-Out

Making your first ripples. Development & Roll-Out

2008 Customer Service Presence Strategic Plan, Newsletters, Intranet Standardized Departmental Reporting New Hire Orientation Waiting Areas Standardization Awareness & Recognition

2008 Priority Focus Teams 9 Teams for 9 Questions Employee, Friends & Family Survey STAR Program Service Recovery Rebuild & Install Awareness & Recognition

2009 Transparency Scores posted on intranet Physicians Viewable only by peers & leaders Department All access Ranked against Prevea peers Single page custom report Accountability & Process Improvement

2009 Physician Service Coach Personalized Visit Real-time observations Improvement strategies Partnered decision making Tracked & reported over time Accountability & Process Improvement

2009 Pulse Check Employee Rounding Managers, Directors & Leadership Customer Service Audits Supervisors Real-time cultural database Accountability & Process Improvement

2009 Department 90s Plans Department specific improvement plan Prepared by each team Mystery Shopping Internal Customer Service Training Workplace preferences & flexibility Accountability & Process Improvement

2010 Achieve a lofty goal Targeted areas/departments that need intervention Increased accountability standards Departments who maintained auditing standards scored 11 to 20 ranks higher than those who did not. Raise the Bar

2011 Needs/Wants patient analysis Listen, Understand, Share, Recognize Exceed standards of patient communication/expectation Best Practice Implementations Physician Annual Training 2% improvement across the board Restructure the Patient Experience

Physician Coaching

Coaching Process Started with pilot group (dept chairs) June 2009 After pilot started with lowest scoring docs and working up Visits are set up with MD s (no punitive method of selection) Press Ganey data reviewed prior for background information and focus areas Observations performed 1-2 days 1:1 meeting with doctor to review observations/give recommendations/review PG data Follow up meeting scheduled for 3 months to review scores/concerns/questions Formal report is made and sent to MD/physician leadership Quarterly follow up as needed

Background Resources Press Ganey Solution Starters & white papers Studor Group resources Practicing Excellence A Physician s Manual to Exceptional Healthcare, by Stephen C. Beeson, MD Resources specifically related to medical interviewing Talk with nursing staff very valuable resource

Physician Patient Observation Report for John Bently, MD Prepared by Christine Riley, RN, MS Observation Dates: June 8, 2011 Report Date: June 21, 2011 I visited Dr. Bently s office on the above date at the St. Mary s location. Dr. Bently was very welcoming and open to the shadowing experience and worked with me to find a day that would be optimal for shadowing. It is fortunate to have a provider that reaches out to our Hmong community and I am sure his patients appreciate having someone that understands their language, social structure and customs, religious beliefs and support systems. Providing culturally competent health care in this population continues to be a challenge in the region; it was not hard to understand why his patients feel connected and loyal to him. I was able to shadow four different patients, all English speaking with a good variety of cultural backgrounds and medical concerns. It was a fascinating session and it was great to witness the strong connection that Dr. Bently had with all of his patients. Introduction/Greeting: Dr. Bently offered a very friendly environment and focused on eliciting and responding to the patient s personal experience of his illness or concerns. He started out with non-medical conversation and employed a strong emphasis on communication and building provider-patient relationships. For example, during a physical with his first patient he inquired about how he was coping with his wife s death and how his 14 year old daughter was doing. He knew the personal stories of all of his patients and often told me a little bit about their background personally and medically before the visit. His communication and respect toward the patients signified positive regard, trust and caring. Care was tailored to the individual patient, according to the unique attributes of their personality.

National Percentile Rank, Dr. Bently Question Rank Before Rank After Change Std Care Provider 11 40 29 Friendliness/courtesy of CP 24 15-9 CP explanations of prob/condition 14 61 47 CP concern for questions/worries 9 62 53 CP efforts to include in decisions 9 26 17 CP information about medications 5 27 22 CP instructions for follow-up care 10 41 31 CP spoke using clear language 15 24 9 Time CP spent with patient 4 23 19 Patients' confidence in CP 16 53 37 Likelihood of recommending CP 10 62 52 Mean Score, Dr. Bently Question Mean Before Mean After Change Std Care Provider 87.9 91.8 3.9 Friendliness/courtesy of CP 93.1 91.7-1.4 CP explanations of prob/condition 88.9 93.3 4.4 CP concern for questions/worries 87.5 93.3 5.8 CP efforts to include in decisions 86.8 90.0 3.2 CP information about medications 84.4 89.6 5.2 CP instructions for follow-up care 86.8 91.1 4.3 CP spoke using clear language 90.3 91.7 1.4 Time CP spent with patient 83.3 88.3 5.0 Patients' confidence in CP 90.3 93.3 3.0 Likelihood of recommending CP 87.5 93.3 5.8

Dr. Bently, National Rank 6/22/09-9/22/09 Rank Before Rank After 61 62 62 53 40 41 24 26 27 24 23 11 15 14 9 9 10 15 16 10 5 4 Std Care Provider Friendliness/courtesy of CP CP explanations of prob/condition CP concern for questions/worries CP efforts to include in decisions CP information about medications CP instructions for follow-up care CP spoke using clear language Time CP spent with patient Patients' confidence in CP Likelihood of recommending CP

Dr. Bently, Mean Score 6/22/09-9/22/09 Mean Before Mean After 87.9 93.1 91.8 91.7 88.9 93.3 93.3 87.5 86.8 90.0 89.6 86.8 91.1 91.7 90.3 88.3 90.3 93.3 93.3 87.5 84.4 83.3 Std Care Provider Friendliness/courtesy of CP CP explanations of prob/condition CP concern for questions/worries CP efforts to include in decisions CP information about medications CP instructions for follow-up care CP spoke using clear language Time CP spent with patient Patients' confidence in CP Likelihood of recommending CP

What Next? Acknowledge accomplishments continue to motivate! No improvement in scores try different tools (many available) and continue follow up every 3 months Look deeper into the department level If scores continue to decline research other resources; physician leadership assistance and recommendations

Summary: April 2010 thru April 2011 (74 physicians) Average mean score increase = 1.8 Average national rank increase = 10.7 6 months ending June 2011 (45 physicians) Average mean score increase = 2.4 Average national rank increase = 22.4 All this done without taking any time away from doctors schedule/production time

Prevea Health s Return on Investment

Prevea Overall Mean Score 92 91 90 89 88 91.5 91.5 91.5 90.2 90.1 90.4 90.2 90.6 91 90.9 89.7 87 86 88.5 88.5 88.8 88.8 88.8 88.9 88.1 87.6 87.8 85 Q4 2006 Q1 2007 Q2 2007 Q3 2007 Q4 2007 Q1 2008 Q2 2008 Q3 2008 Q4 2008 Q1 2009 Q2 2009 Q3 2009 Q4 2009 Q1 2010 Q2 2010 Q3 2010 Q4 2010 Q1 2011 Q2 2011 Q3 2011 QTD Overall Mean Score

Some Results. Organizational records almost every month 50% increase in +/- comment ratio 156% Nursing increase 106% Visit increase 4-5% annual decrease in reported wait times Annual drop in Fair, Poor & Very Poor

Mean Score Increases - Q4 2006 to Q1 2009 Overall Assessment Personal Issues Care Provider Nurse/Assistant Repeat Patients First-Time Patients Visit Access Overall 0 0.5 1 1.5 2 2.5

Employee Opinion Survey Results 100% 98% 90% 89% 90% 92% 80% 70% 72% 72% 75% 60% 50% 51% 40% 30% 20% 10% 0% 2006 2007 2008 2009 Prevea Leadership Prevea is a Great Place to Work

93.0 92.0 Care Provider Complaint Groups 2007 - Sept 2009 92.0 92.2 91.0 Average Mean Score 90.0 89.0 88.0 87.0 86.0 85.9 89.3 85.0 84.0 83.0 82.0 10 & Above 5 to 9 1 to 4 None Number of Complaints

Care Provider Mean vs. Complaints 2007 - Sept 2009 35 100 30 80 25 Mean Score 60 40 20 15 Number of Complaints 10 20 5 0 Physicians 0 Mean Score # Complaints

Patients won t remember what you said to them, Patients won t remember what you did to them, But they will always remember how you made them feel.