1

The Patient Experience: Physician Coaching

Paul Pritchard, MD, Vice President and Chief of Quality

Eric Dordel, MS, PHR – Executive Director of Customer Service,

Prevea Health

Agenda:

–Review Prevea Health’s challenges and starting point

–Outline The Promise model and 90’s Plan

–Describe the Physician Coaching program and its effect on the Patient Experience

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•Physician Owned

•Hospital Partnered

•25 Health Centers

•50+ Specialties

•1300+ Employees

•200+ Providers

•500k Annual Visits

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.

3

Where We Started

• Many Fragmented Subcultures

• 37th Percentile Rank

• 61% Top Box Overall

• No Specific Strategy

• No Standards

• Data Denial

• This is the “best we have to offer”

• Goal Fatigue

• No reward for effort

The Four Promises

Ripples

The Patient Experience

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What is the Prevea Promise? • Our Customer Service Philosophy

• Standardized service approach to:

– Patient service

– Patient treatment

– Coworker interactions

– Team dynamics

– Strategic planning

• Expected of leaders, physicians & staff

Components of the Promise • The Four Promises

– Our Core Service Principles • Listen, Understand, Share, Recognize

• Ripples

– 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.

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Department 90s Plans

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Goal Setting Theory

• Difficult goals can lead to higher performance levels

• Specific goals lead to higher performance

• People need to be aware of the goal

• Participation in goal setting leads to acceptance and commitment

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Notables:

• All Departments are expected to participate

• Care Providers have a separate plan

• Focus Questions are selected in part via the Press Ganey Priority Index

• Focus Questions do not change often

• Leaders are forbidden from making the decisions.

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Physician Coaching

Coaching Process

1. Coach & Physician Initial Meeting

2. Shadowing Visit

3. Feedback Session & Improvement Plan

4. 3-Month Improvement Plan Efforts by Physician

5. Follow-Up Shadowing Visit (if needed)

6. Documentation/Goals Review

7. Evaluation

8. Awarding of CME Credit Earned

9. Physicians are included in the 90’s plan

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Physician Patient Observation Report for

John Bently, MD Prepared by Physician Coach

Observation Dates: June 8, 2013 Report Date: June 21, 2013

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. BentlyQuestion 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. BentlyQuestion 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

10

91.3

92

91.6

91.9

92.5

93.2 93.3

93.8

94.5

89

90

91

92

93

94

95

2006 2007 2008 2009 2010 2011 2012 2013 2014YTD

M

e

a

n

S

c

o

r

e

Physician Overall Performance

Std Care Provider

Physician Coaching Started mid 2009

Prevea Health’s Return on Investment

11

79 77

79

82

76

80 81

88

92

89

97

90.5

91.0

91.5

92.0

92.5

93.0

93.5

94.0

94.5

50

55

60

65

70

75

80

85

90

95

100

Q1 2012 Q2 2012 Q3 2012 Q4 2012 Q1 2013 Q2 2013 Q3 2013 Q4 2013 Q1 2014 Q2 2014 Q32014TD

Nat

ion

al P

erce

nti

le R

ank

Prevea Health Patient Satisfaction Trend

Overall National Rank

National Rank Mean Score

93.3 93.5 94 94

93.5 93.9 93.7 93.6 93.4

94 93.7

94.1 93.7

94.2 94.5 94.3 94.4

94.7 94.8 94.9 95.1 94.7

95.2 95.1 95.4

95.1 95.3 95.3

95.9 96.3

95.7

81.4 81.7 81.9

82.9 82.8

83.6 83.6

82.9

84.2 84.1 83.9 83.9 83.4

83.8

84.5

85.2 85.3

84.3

86.7

86.1 86.6

87 86.9 86.8

87.4 87.2

88.1 88.1

88.7

89.6 89.8

88.7 88.9 89.2

89.5 89.4 89.7 89.7 89.7 89.8

90.2 90.1 90.4

89.7 90.2

90.6 91 90.9

91.5 91.5 91.5 91.8 91.8 91.7 91.7

92.1 91.8

92.3 92.4 92.9

93.5 93.2

80

82

84

86

88

90

92

94

96

98

Q42006

Q12007

Q22007

Q32007

Q42007

Q12008

Q22008

Q32008

Q42008

Q12009

Q22009

Q32009

Q42009

Q12010

Q22010

Q32010

Q42010

Q12011

Q22011

Q32011

Q42011

Q12012

Q22012

Q32012

Q42012

Q12013

Q22013

Q32013

Q42013

Q12014

Q22014

Qu

es

tio

n M

ea

n S

co

re

Mean Score Range

High Score Low Score Mean Score Linear (High Score)

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93.293

93.5 93.4

93 93 93.1

93.7

93.2

93.5

93.8

94.2

94.6

94.3

94.9

91.5 91.5 91.5

91.8 91.8 91.7 91.7

92.1

91.8

92.3 92.4

92.8

93.3 93.2

93.5

89

90

91

92

93

94

95

96

'1/1/11 3/31/11'

'4/1/11 6/30/11'

'7/1/11 9/30/11'

'10/1/11 12/31/11'

'1/1/12 3/31/12'

'4/1/12 6/30/12'

'7/1/12 9/30/12'

'10/1/12 12/31/12'

'1/1/13 3/31/13'

'4/1/13 6/30/13'

'7/1/13 9/30/13'

'10/1/13 12/31/13'

'1/1/14 3/31/14'

'4/1/14 6/30/14'

'7/1/14 9/30/14'

Me

an

Sco

re

Quarterly Received Date

Prevea Health Patient SatisfactionImpact of Care Provider 90s Plans

Care Provider Prevea Overall

Care Provider 90s Plans

Thank You.

Any Questions?