Playing Archimedes: Using Levers to Deliver Consistently Exceptional Patient Experiences

A Case Study

Fairview Health Services (FHS) has operations in metro, suburban and rural areas throughout Minnesota. FHS consists of:

  • 7 hospitals/medical centers (including University of Minnesota Academic Medical Center and U of M Physicians)
  • Over 20,000 employees
  • 3,000+ credentialed physicians
  • 40 primary care clinics
  • 55 specialty clinics
  • 47 senior housing locations
  • 30 retail pharmacies

In 2009, 400+ employed providers were pulled into one operating unit from several hospital-centered care systems to form Fairview Medical Group (FMG). Led by Dr. Brent Asplin and Dr. Patrick Herson, Senior Executive Medical Director, FMG consists of 40 primary care clinics, all of which are certified health care homes by the Minnesota Department of Health.

FMG has four standing committees, one of which is the Patient Experience Committee (PEC). The PEC has the explicit charter to create and sustain a culture centered on patients and families. With the patient and family as the priority, the PEC set the goal to achieve and sustain 90th percentile performance on Clinician and Groups Consumer Assessment of Healthcare Providers and Systems (CG- CAHPS) overall rating of provider within 5 pilot clinics. FMG was struggling with low performance on CG-CAHPS results and significant variability among providers, and some clinics were even persisting

in the CG-CAHPS bottom quartile. “The PEC sees itself as a ‘culture’ inoculating our clinics and providers, we figure reaching this goal this will take at least 5 years” Dr. Herson explains. The committee knew that they needed a plan in order to accomplish their goals. Together the committee built 3 primary levers to support their ambitious improvement efforts.

THREE LEVERS TO SUCCESS

  1. Establish a Patient-Centered Culture
  2. Engage and Train Providers and Staff
  3. Create Accountability Through Timely, Individualized, and Transparent Patient Feedback

LEVER 1: ESTABLISH A PATIENT-CENTERED CULTURE

“It is all about the purpose-why we are working in healthcare in the first place.” Dr. Herson states. In an effort to establish a patient- centered culture, FMG worked with TruthPoint, a real-time patient feedback improvement system, to provide actionable and timely patient insights at the clinic and individual provider level. Clinic level feedback was reviewed at monthly clinic leadership meetings and individual results within clinics were reviewed monthly at provider and staff meetings.

Tying in financial incentives, compensation for primary care providers within FMG was now
tied to performance on CG-CAHPS. Key driver reports had shown that the patient-provider relationship is the primary driver for outpatient satisfaction results. In this model, 10% of the primary care provider salary would be tied directly to each care provider’s clinic’s ‘rate your provider’ result. FMG clinics performing well can earn up to 50% in additional compensation.

LEVER 2: ENGAGE AND TRAIN PROVIDERS AND STAFF

To help engage and train providers and staff, FMG enlisted the services of Nancy DeZellar Walsh, Principal of DeZellar Walsh Consulting who had already been working within FMG to help improve patient experience. Based on leader feedback and observations, DeZeller Walsh was successful at facilitating an improvement model that involved localized design, behavior-based training, measurement and training reinforcement.

Due to variability between clinic sites, there was value in conducting most of the design and training work at the site level. Working in a cohort and adding the requirement to “report out” to peers was a motivator to keep this work moving forward. Efficiencies sharing the work across a Dyad (Clinic Administrator and Medical Director), as was done for two of the cohort clinics. A key success factor was engaging clinics that shared a passion to improve their patient experience efforts. Clinics that were actively using TruthPoint were selected to participate, considering they were already using real-time feedback they were more likely to be committed to this improvement model. The Master Patient Index along with CG-CAHPS scores were considered in the selection process

“We wanted to assume that all clinics will need to get to top decile eventually – we all need to do it, so let’s roll it out in our neighborhoods and get going!”, states DeZeller Walsh to identify clinics in the lower percentiles, with the goal of moving some of the low and middle performers up.

A crucial piece to the success was the fact that provider and staff training was mandatory. DeZellar Walsh Consulting leverages a proprietary behavior-based training model focusing on 12 core behaviors conducive to a positive patient encounter. DeZellar Walsh and Dr. Herson went to each clinic for in person training. “We found face to face training to be much more effective than using a web conference as it allows the providers and staff to role play with each other and relieve anxieties.”

LEVER 3: CREATE ACCOUNTABILITY THROUGH TIMELY, INDIVIDUALIZED AND TRANSPARENT PATIENT FEEDBACK

The following is the process used within the clinic cohort to solicit feedback directly from patients
and their families. At the beginning of the patient encounter, each patient was asked if they were willing to provide anonymous feedback about their experience at the clinic that day. If the patient agreed the provider, rooming staff, and receptionist names were entered into the TruthPoint application on the in room computer so that responses could be tied to all members of the care team.

To ensure HIPAA compliance, the TruthPoint application would only run once the Electronic Medical Record was completely closed. At the end of the visit, the last person in the room would remind the patient to provide feedback about their experience before the patient left. Once completed, the feedback is immediately encrypted and sent directly to TruthPoint. Targeted and individualized reports were sent directly to each provider, rooming staff, and receptionist and included only relevant results for only patients for which they provided care.

patient feedback

PATIENT FEEDBACK COMMUNICATION FUNNEL

Personalized feedback was key to hardwiring and reinforcing the behavior-based training and understanding what patients liked and disliked about their clinic visit. Each clinic team member received a weekly individualized report and monthly graphic trending report to monitor their improvement over time.

After a few months when CG-CAHPS scores started to rise, several clinics approached Dr. Herson’s team, asking if they could receive the same support to help their sites improve. “We found that those especially interested were providers who score well on CG-CAHPS individually but work in a clinic that struggles overall.” Dr. Herson recalls.

THE RESULTS

results

All clinics within the cohort began their patient experience improvement journey near the 70th percentile on CG-CAHPS overall rating of provider and within a 2 months, 4 out of the 5 clinics reached the 90th percentile. Moving forward, a detailed plan was put into place for replication over the remaining 35 FMG clinics. As of today, all clinics have received the behavior-based training and are receiving individualized reports for how their patients are perceiving their care and service. Positive behavior changes have now expanded throughout all FMG clinic locations and as a result, patients and their families are receiving a better quality of care.

SUMMARY

Organization
Fairview Medical Group Clinics

Challenge
Low performance on CG-CAHPS results and significant patient experience variability among providers

Solution Levers

  • Establish patient-centered culture
  • Engage and train providers
  • Create accountability through timely, individualized and transparent patient feedbackResults

Results
All providers within the improvement program moved into top decile within 4 months and sustained improved results