emergency department directors academy phase i fall 2019 · ganey, prc, the american college of...

Emergency Department Directors Academy Phase I Fall 2019 Customer Relations and Patient Satisfaction DESCRIPTION Do you know who your customers are and what they really want? Hospital leadership is placing increasing emphasis on patient satisfaction survey scores. Emergency department leaders are being held accountable to be able to interpret scores and develop and implement an action plan to improve scores on an ongoing basis. This presentation will offer a discussion on developing a work team, motivating and training staff, survey development, monitoring, and implementing responsive programs to address issues in a timely and effective manner as they arise. OBJECTIVES

• Determine specific emergency department patient expectations; facility, environmental, staff performance, medical care, and patient flow.

• Identify key patient issues creating satisfaction and dissatisfaction. • Examine strategies to meet, change, or exceed patient expectations. • Describe development and implementation of a customer relations program. • Evaluate key components of customer satisfaction surveys, telephone surveys, and patient focus groups. • Determine whether to make or buy a survey tool. • Determine strategies to analyze and interpret data from satisfaction surveys. • Develop strategies to provide timely and pertinent feedback to key staff members. • Customer Relations and Patient Satisfaction

11/11/2019, 3:00 PM - 4:15 PM FACULTY: Thom A. Mayer, MD, FACEP BIOGRAPHY: Dr. Mayer is Founder of BestPractices, Inc., the Medical Director for the NFL Players Association, a Medical Director for Studer Group, and Clinical Professor of Emergency Medicine at George Washington University and a Senior Lecturing Fellow at Duke University. He is one of the most widely-sought speakers on healthcare patient experience, leadership and management, hardwiring flow, trauma and emergency care, pediatric emergency care, EMS/disaster medicine, and sports medicine. His work in each of these areas has resulted in changing the very fabric of patient care. He has published over 100 peer-reviewed articles, 100 book chapters, and has edited or written 20 textbooks, including Leadership for Great Customer Service: Satisfied Employees, Satisfied Patients: 2nd Edition, Leadership for Smooth Patient Flow, Hardwiring Flow, The Patient Flow Advantage, and Strauss and Mayer’s Emergency Department Leadership. Tom Peters, the internationally acclaimed leadership guru, has referred to his work as “gaspworthy.” Dr. Mayer was named the ACEP Outstanding Speaker of the Year in the second year the award was given and has twice been named ACEP’s “Over-the-Top” award winner. Leadership for Smooth Patient Flow won the ACHE’s James Hamilton Award for the best healthcare leadership book in 2008. In sports medicine, his work at the forefront of changing concussion diagnosis and management in the NFL has changed the way in which these athletes are diagnosed and treated. USA Today name him one of the “100 Most Important People in the NFL” in recognition of his influence. He is currently nominated for the Pro Football Hall of Fame in Canton, Ohio. Dr. Mayer served as Chairman of the Department of Emergency Medicine at Inova Fairfax Hospital from 1989 to 2002, taking a community ED to one of the most renowned and innovative emergency departments in the nation, winning numerous awards, including the Robert Woods Johnson Urgent Matters grant and Innovation of the Year Runner-Up awards and awards from Press-

Ganey, PRC, the American College of Emergency Physicians, the American Public Health Association, and the American College of Healthcare Executives. He has served on the Inova Health Care System Foundation Board since 2000. When asked about these awards, he simply says, “I have only one talent. I know how to hire people who are not only better than me, but much better than me. They won the awards, not me.” On September 11, 2001 Dr. Mayer served as one of the Command Physicians at the Pentagon Rescue Operation, coordinating medical assets at the site. The BestPractices physicians at Inova Fairfax Hospital were the first to successfully diagnose and treat inhalational anthrax victims during the fall 2001 anthrax crises, and Dr. Mayer has served on the Department of Defense on Defense Science Board Task Forces on Bioterrorism, Homeland Security and Consequences of Weapons of Mass Destruction. Despite these accomplishments, he continues to push the envelope of innovation in emergency medicine, sports medicine, and indeed healthcare itself. DISCLOSURE: (+) No significant financial relationships to disclose

American College of Emergency PhysiciansEmergency Department Directors Academy

PRESENTS

LEADERSHIP FOR GREAT PATIENT EXPERIENCE

THOM MAYER, MD, FACEP, FAAP, FACHEMEDICAL DIRECTOR, NFL PLAYERS

FOUNDER AND CEO, BEST PRACTICES

The Most Important Slide?

thommayermd@gmail.com

Patient Experience-A New World

• Reputations used to move at the speed of sound…

• Now they move at the speed of light!

• Patients and family are posting and texting from the room

• Hospitals are beginning to monitor social media

Physician Experience increased by 600 %

0

10

20

30

40

50

60

70

80

90

100

Mar-

16

Apr-16

May

-16Jun-16

Jul-16

Aug-16

Sep-16

Oct-16

Nov-16

Dec-16

Jan-17

Feb-17

Mar-

17

Apr-17

May

-17Jun-17

Jul-17

Press Ganey Percentile Ranking - Doctors Overall

Percentile Rank Adult ED

Discussions start regarding improvements

ToolkitIndividual Coaching

Individual MD CommentsPhysician call backs

Individual PG ScoresAccountability Enforced

Call backs

GOAL

I Hate Being Rated!

Key Questions

• Are patient satisfaction scores statistically significant?

• Isn’t the “n” too small?

• Do they really measure satisfaction?

• Do they measure quality of care?

• Don’t they always give them to homeless people, drug-seekers, and psych patients?

GET OVER IT !!!!!!

Understanding Expectations Is The Key

• ExceededCompliment (A-team)Patient Loyalty

• Expectations “Merely” Satisfied

Complaint (B-team)Service Recovery

• Disappointed

Let Them Know You Expected Them!

“We knew you were coming in today – we just didn’t know your name!”

There Are Only TWO Issues…

1. WHY customer service?2. HOW customer service?

The #1 reason to get customer service right Is…

It Makes Your Job Easier!

Do you offer good customer service?

It Depends!

A Team Members

• Positive• Proactive• Confident• Competent• Compassionate• Communication• Teamwork• Trust• Teacher• Does whatever it takes• Sense of humor• Moves the meat

B-Team Members

• Negative• Reactive• Confused• Poor communication• Lazy• Late• Constant complainer• BMW club• Can’t do • Always surprised• Nurse Ratched• Dr. Torquemada

How many B-team members does it take to destroy an entire shift?

The Power of “One”

• One doctor…• One patient…• One family…• One team…• One choice…• You will make a

difference…• What will the

difference be?

Search for them(Compliment analysis)

A Team Accentuate themBehaviors (Hire Right-train right)

Reward them(Reward your champions)

Search for them(Complaint analysis)

B Team Delineate themBehaviors (Deal with B-Team employees)

Eliminate themThe remedial course, or Fire Right)

There are also A- and B-team processesWhat do B Team processes do to A Team

Members?

Are you an A-team member?

The B-team members are doing a job that isn’t theirs to do.

Deep Joy, Deep Need…

“ One more step in the journey of discovering where your deep joy intersects the world’s deep needs.”

Thom Mayer, MD

All meaningful and lasting change is driven by INTRINSIC motivation… 28

LOST !!!!!!

• Small brown dog• Partially blind• Part of left ear missing• Has only three legs• Tail has been broken three times and

hangs at an unusual angle• Recently castrated• Answers to the name…

LUCKY !!!!!!

The Open Book Test Approach• “Huddle up – 1st Down” – within groups (MD-MD, RN-RN,

registration, lab, radiology)

• Develop scripts and processes directly responsive to the questions

• Huddle up – 2nd Down – exchange questions and scripts (MD-RN, RN-MD, etc.)

• Huddle Up – 3rd Down – Hardwiring Flow into the equation

What’s A “Good Doctor?” – PG

•Doctor’s courtesy•Doctor took time to listen•Doctor informative•Doctor’s concern for comfort

EDPECS is Coming!

EDPECS-People Who Took Care of You

1. Courtesy and Respect2. Listen Carefully to You3. Explain Things in a Way You

Could Understand

EDPECS-During this ER Visit

1. Did the doctors and nurses ask about all of the medicines you were taking?

2. Before giving you medicine, did the doctors or nurses tell you what the medicine was for?

3. Before giving you medicine, did the doctors or nurses describe possible side effects to you in a way you could understand?

4. During this emergency room visit, did the doctors or nurses talk with you about how much pain you had?

5. During this emergency room visit, did the doctors or nurses give you as much information as you wanted about the results of the tests?

EDPECS-Leaving the ED1. Before you left the emergency room, did a doctor or nurse tell you that you

should take any medicine at home?2. Before you left the emergency room, did a doctor or nurse tell you what the

medicine was for?3. Before you left the emergency room, did the doctors and nurses give you as

much information as you wanted about how to treat your pain at home?4. Before you left the emergency room, did the doctors or nurse talk with you

about the things you could do at home to reduce your pain other than take medicine?

5. Before you left the emergency room, did the staff talk with you about follow-up care?

6. Did emergency room staff give you information about how to get the follow-up care you needed?

7. Before you left the emergency room, did staff give you information about what to symptoms or health problems to look out for at home?

EDPECS-Overall Experience

1. Using any number from 0 to 10, what number would you use to rate this emergency room visit?

2. Would you recommend this emergency room to your friends and family?

A New Beast…and a Nasty One!

Press Ganey Points1 Very Poor 0

2 Poor 25

3 Fair 50

4 Good 75

5 Very Good 100

HCAHPS-EDPECSNever

Sometimes

Usually

Always

“Always” Surveys

• Have you always been a good…

• Mother/Daughter• Father/Son• Wife/Husband• Boss/Employee ?

“Always” vs. “Always Trying!”

The Power of “One”

• One doctor…• One patient…• One family…• One team…• One choice…• You will make a

difference…• What will the

difference be?

What’s The Point?

People won’t remember what you did to them. They won’t remember what you said to them. But they will always remember how you made them feel.Maya Angelou

The Patient – CustoMeter

Patient Customer

The more horizontal you are,the more you’re a patient.

The more vertical you are, the more you’re a customer.

Good Patients?

Good Patients?

• Intubated

• Paralyzed

• On a ventilator

• Orphan (no family)

• Speaks “OUR” language

• Doesn’t come back

• In and out fast

• Wants only one thing

• Compliant (wants it OUR way)

3 Survival Skills Core Competencies

1. Making the customer service diagnosis and offering the right treatment

- Anticipating experiences from the customer’s viewpoint

- Treating power and control options

2. Negotiating agreement and resolution of expectations

3. Building Moments of Truth into the Clinical Encounter

Examples

Clinical Dx CS Dx

Fever Meningitis

Chest pain MI attack

Abdominal pain

> 50 years

Appendicitis

Customer Service Dx and Rx

Communicate Reasonable Expectations1. Introduce yourself in a professional

fashion

2. Address family members – bring them into the encounter

3. Establish a high level of professionalism and courtesy

4. Provide information as it becomes available – frequent updates

5. Check the patient’s progress (multiple, brief encounters)

6. Never underestimate the value of pillows, blankets, water, OJ

7. Sit down

You are a Performance Artist!

• You are the Chief Story Teller of the ED !

• The didn’t wake up and say, “Great day! Off to the ED!”

• The faster and more effective you are at making yourself a “solution” instead a part of the bad experience, the easier the job

• It isn’t just LOS or TAT or intervals. It’s the perception of flow that matters!

• It’s not just how much time you spend, it’s how you spend the time!

• Onstage-offstage• Expectation Creation

The Three A Team Behaviors

1. Sit down, smile, touch the patient, use Open Body Language

2. Active Listening

3. Making a Blameless and Effective Apology

“We are what we repeatedly do. Excellence is not a virtue, but a habit.” Nicomachean Ethics

Taxi, Take-Off, Flight, Landing

Taxi

• Emergency Physicians are “Performance Artists”

• You are the Chief Storyteller for the patient

• Review the nurses’ notes

• The Power of One• Open Book Test

Take-OffEnter with a flourish!• Introduce yourself clearly

and reproducibly• Sit down and touch them • “We want to make this the

best possible ER visit.”• “What’s the most important

thing I can do to meet your expectations?”

• Make the patient part of the team

• Individualized Patient Care• Get to the “Solutions Side”

Flight Plan• Pilots know-and we

should, too-what the flight plan is ahead of the flight

• Flight plans differ, depending upon the mission-so should ours

• Don’t wing it-think about expectations and the flight plan ahead of time

Abdominal Pain Flight Plan• CS Dx vs. Clinical Dx• “It’s scary to have so

much pain…”• “We’re giving you this

IV fluid/ pain meds/zofran because…”

• “These tests will tell us…”

• 10 days of work in 6 hours

• Expectation Creation

Chest Pain flight

• “Heart Attack” vs. our DDx

• “What’s you biggest fear/concern?’

• “Your initial EKG is normal-that’s good.”

• Here’s our (flight) plan..• “I’ll let your Doctor

know”

The Pain Flight-Concern for Comfort“Did the staff do everything they could to help you

with your pain?” “Well-controlled?”• Scripts-Evidence-Based

Language-AIDET• “I’m sorry you are in pain.

We’ll do everything we canto help you with your pain.”

• “Your pain is an 8-is 4 a reasonable goal?”

• Avoid “Will/will not” use “can/cannot”

• “How’s that medication working?”

• Explain ice, elevation, anti-emetics, etc.

Landing-Discharged

• Summarize the journey (Chief Story Teller)

• “These tests/ treatments showed…”

• Druckenbrod’s Queries• “Have I met your

expectations?”• “Any other questions?”• “How did we do?”• Discharge instructions with

Active Listening• Sign-Out Rounds at Bedside

Landing-Discharged

Druckenbrod’s Queries• “Have I met your

expectations?”• “What questions do you

have?”• “How did we do?”• Sealing the Deal• “Are you comfortable with

what we’ve discussed?”• “Is there anything I can

explain better?”• “Thanks for coming to see

us!”

Landing-Admitted

• Summarize the journey (Chief Story Teller)

• “These tests showed…”• Druckenbrod’s Queries• “Have I met your

expectations?”• “Any other questions?”• “How did we do?”• Leading Up• Rounding on Next

Open Book Test

Doctors & Nurses1. Courtesy & Respect

Tactics• Knock before entering the room• “Hi, it’s Dr. Mayer and the team

caring for you. May we come in?”• Make the patient a part of the

team-IPC• Eye contact• Sit down! Alter the Angle• “I’m sorry this happened to you,

but I’m glad I’m here to take care of you.”

• What questions do you have?

Open Book Test

Doctors & Nurses1. Courtesy

2. Listened Carefully to You? The 18 Second Rule

Tactics• Chief Story Teller• Expectation management• Sit down• Consistent communication• Previews• Manage/lead up• Active Listening• White Boards• Physician notepads

Open Book Test

Doctors & Nurses1. Treat you with courtesy

and respect?

2. Listen carefully to you?

3. Explain things in a way you could understand?

Tactics• “It’s very important to me

that you understand every element of your care.”

• Active Listening-DDx• T&T-Tests and Treatment• Previews• Time Frames-Expectation• Patient as a Part of the

Team-What they do?• Show time! COWS

Open Book Test

Doctors & Nurses1. Treat you with courtesy

and respect?

2. Listen carefully to you?

3. Informative regarding treatment?

4. Concern for Comfort?

Tactics• “It’s very important to me

that we make you as comfortable as possible.”

• “I’m sorry you’re uncomfortable-how’s that pain medication working?”

• Explain ice, elevation, compression, fluids, anti-emetics

• “Can/cannot”

The Most Powerful Tool?Shadow Shifting

• Could you do this in your ED?

• If not, you will probably not get much better

• A Team with B Team works best

• 2-4 hours is plenty• “I’m Dr. Mayer and this

is Dr. Schmitz, who is one of my partners. You get 2 docs today!”

Negotiating Agreement & Resolution Of Expectations

3 Negotiation Steps

1. Discover YOUR expectations

2. Discover THEIR expectations

3. Invent options for mutual gain

The 3rd Survival Skill –Building Moments Of Truth Into The Clinical Encounter

• Jan Carlzon and SAS• “50,000 moments of truth per day”• Do you think your patients know how many …• They know you!• To them, you are the institution

The A Team Toolkit1. Empowerment

• Point of impact intervention• Patient loyalty and service recovery• Leading up

2. Dealing with B Team Patients and B Team Members3. Shadow Shifting and Focused Coaching4. Rounding – Yours, Next, Sign Out, Callbacks5. EBL and SBL – Take 5 for a 5!6. Hire right – Screen for the Gene7. Taking 4s to 5s8. Flow and the Psychology of Waiting9. Reward your Champions10. Leave a Legacy

Dr. Mayer, What are the Key “Hows”?

1. Survival Skills Core Competencies-3 A Team Behaviors

2. Chief Story Teller-The Power of One3. Taxi, Take-Off, Flight Plans, Landing4. Develop Consistent Flight Plans5. Druckenbrod’s Details-How Did We Do?6. Shadow Shifting, Focused Coaching, Post D/C

Phone Calls7. A Team Toolkit

Tool # 10

Leave a Legacy

What’s Your Legacy?

The Star Thrower