No medical group or health system can last long without satisfied patients. If your patients don't have good experiences with their physicians or the office staff, they may well search for another practice to provide their care. In the worst-case scenario, they'll share their perceptions on popular physician review sites such as HealthGrades.com.
When you have a patient satisfaction problem, but you may not be able to fix it easily. Author and speaker Stephen Beeson, MD, a board-certified family medicine physician with Sharp Rees-Stealy Medical Group, San Diego, Calif., has spent the last 10 years teaching other physicians to improve their patient satisfaction with evidence-based methods. His own patient satisfaction ranks him in the 99th percentile nationwide in the Press Ganey database.
At the MGMA 2009 Annual Conference in Denver on Oct. 12, Beeson will present his strategies in a Masters Series session: "Practicing Excellence: A Guide to Physician's High Performance." Here, he gives us a sneak preview of the topic. (We caught him on the road, so the podcast's initial audio quality is a little spotty.)
Listen to our full podcast interview with Beeson or read the transcript below:
MGMA: Can you give us a sneak peek of some simple tactics that physicians can do to improve patient satisfaction?
Beeson: Most of what I've been doing over the last 10 years, in addition to practicing medicine, is coaching and training physicians. Basically we're defining a physician-to-physician coaching model that works to improve objective measures of patient satisfaction and patient performance. I think there's a number of different "interventions," if you will, that have been done historically that have not changed the patient perception of care in a sustainable and transformational way. But we've come up with some, I think, unique aspects of how we can change the patient experience.
Behavioral training is certainly a component of it, and what we do during that portion of the curriculum is show what we call evidence-based behavior. We create a collaborative treatment model to improve clinical outcomes, and we reconstruct the patient encounter using tactics that are "time neutral" so physicians don't have to spend any more time, because we know that we don't have any more time. [We want to] be able to do things and exceed patient expectations by doing certain things with every patient, every time.
MGMA: How should an administrator address a physician whose bedside manner is negatively affecting patient satisfaction?
Beeson: One of the first things that we do with physicians who struggle with patient satisfaction is to create a model of physician-to-physician intervention. We find that physicians are far more receptive to a respected physician colleague approaching them than an administrator saying, "You need to improve your bedside manner."
A lot of this is about helping physicians, and creating physician insight and willingness to do things differently. The pathway that we use to do this is to rely on a robust, objective, scientific measurement of the patient experience.
Physicians see real data presented in a comparative database, and if they land in the bottom in regards to a) how they explain the medications, b) including patients in their decisions and c) did they spend adequate time with the patient. We use that comparative measurement to make the argument for doing things differently. And once we have physicians convinced that there is a need, then we provide them with these tactics, guidance and help.
We find that less than 20 percent of all physicians have had sufficient training on communication. And 85 percent of physicians believe that communication is as important as technical skill in creating clinical outcomes. We're in this paradox, in terms of communicating with patients. It's so important, but most of us [physicians] have never received any training on how to get it done.
And I have to tell you, having coaching and trained physicians for the last 10 years, I have yet to meet a single physician who's able to articulate why patients say what they say about them.
MGMA: Patients love doctors who spend a lot of time with them, but administrators are focused on the practice's productivity. Any ideas for balancing patient satisfaction with the need to see more patients?
Beeson: I think there is a difference between those physicians that are at the very top of the database, in terms of patient loyalty and patient satisfaction. And it's not been extensively studied, but the difference between those physicians at the top and bottom of the database is somewhere just south of 60 seconds per clinical encounter. Meaning, it is a real difference, but it's not as significant a difference as one might think.
As I implied earlier, much of the coaching and training we provide has got to be time neutral, not taking any more time than physicians do currently, because there is a tremendous productivity component in our ability to see the patients that need to be seen. I have found that it's much more important in how we communicate, and can we convey that sense of caring and develop trust between patients and physicians using these evidence-based behaviors.
When patients sincerely trust us by virtue of how we've treated them historically and longitudinally over a relationship, then the amount of time that we must spend with them is less. Typically if there is a lack of trust, patients tend to doubt the agenda of the physician, then the clinical encounter gets bogged down and time inefficient.
MGMA: Can you share any success stories of medical practices after physicians implemented these strategies?
Beeson: The one I'm most proud of is my own organization, the Sharp Rees-Stealy Medical Group in San Diego, Calif. I have seen and been witness to really and truly a transformation in terms of what we provide to patients. I think it goes well and beyond my own personal opinion.
There was a time eight, nine years ago where we dipped as low as the 6th percentile in a national database in the measurement of patient satisfaction. Our physician group is now approaching the 90th percentile and has actually been ranked the number one medical group in the state of California by the Blue Cross Quality Health Care Report Card for the past three years in patient satisfaction. It's been a real transformational journey.
I think our result from Sharp Rees-Stealy has drawn interest from similar groups who want to do similar things like pay for performance, HCAP, transparency and other regulatory changes... so groups with objective performance measures in a comparative database will land at the top and maintain their own liability.
MGMA: Do you have anything else to add about why people should attend your session at the MGMA Annual Conference?
Beeson: I'm very excited about coming there and sharing some of the information. I like to bring information that's from the front lines, things that are proven and backed by data and experience. I've had the amazing opportunity to not only be a champion within our own system, but to coach and train some of the best health care systems in the country. I was at Baylor, Vanderbilt and Kaiser and other health care systems that are vested in providing better care to patients, and figuring out how to create the physician behavioral change which is a complex topic. I feel as though we have things that are proven to work.
Read an excerpt of Beeson's book Practicing Excellence. A Physician's Manual to Exceptional Health Care.
And don't forget to mark your calendars to attend his session Monday, Oct. 12 8 a.m.-noon at the MGMA 2009 Annual Conference.