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Hospitals, Practice Administrators and Clinicians: You Gotta Learn to Love Patient Ratings



April 25th, 2012

You are increasingly being held accountable for the outcomes of the health care you deliver. Pay for performance; shared savings in ACOs; public report cards…the list of strategies to monitor and measure the effects of your efforts is lengthening. Many of you seem dismayed by the increased weight accorded to the patient experience of care ratings embedded in most of these programs.  Here’s why you should embrace them: The care you deliver cannot improve our health outcomes or even maintain passable ones without the knowledgeable, active participation of us patients and our families.

If we don’t connect with at least one trusted clinician, show up when we need to, get the tests we agree on, use effectively the drugs and devices you recommend, carefully follow directions after a hospital stay and try our damndest to lose the weight and walk around the block more often, medical interventions are squandered. Our suffering continues. Time and money are wasted: yours and ours.

Most of us are not very engaged in our care right now. And we will not transform ourselves into involved, vigilant patients unless we get a clear message from you that it is important: that we probably won’t get better unless we do.  We will not make changes unless we know that it is possible to take on what is now required of us; we need to know what to do when we leave your office or hospital. And we will not assume this new role until we are confident that it is safe for us to do so, that we will not be punished for asking questions or expressing preferences and that we won’t be asked to take on responsibilities that we can’t handle, given our age, resources and cognitive or health status.

Our participation in our care must be invited, valued and supported by you – individuals and institutions alike.

Patient experience surveys have the potential to illuminate the extent to which we feel this when we are in your hospital, practice or clinic.  Our responses to such surveys serve as indicators of just how much we will be willing to engage with you in our care.

How plausible is it that we will gladly join with our clinician in finding good solutions – and follow through on them – if:
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  • Our clinicians don’t listen carefully to us and explain things so we understand them?
  • Our clinicians don’t answer our questions so that we know how to care for ourselves at home?
  • We are dismissed and treated disrespectfully by staff or our clinicians?
  • The facility is dirty: the bathrooms are messy, paper on the examining table is left over from the previous patient; the floor is littered with discarded gloves and wrappers?
  • We leave messages requesting an appointment or advice but our calls are not returned?

Such negative experiences might spur increased engagement among some of us, but that engagement tends to be angry and oppositional. The rest of us adjust. Some of us go online and/or ask for help from friends or people like us. Some of us seek care elsewhere. Some of us begin to doubt the recommendations of professionals and don’t bother to follow them.  Many of us shrug, say “What’re ya gonna do?” and stick to our familiar passive role. We are, after all, not feeling well and don’t want to risk alienating those who might offer relief.

Patient experience ratings are designed to reflect our overall impression of our care in your facility. We are acutely sensitive to the messages transmitted by the physical setting of care and our interactions with everyone associated with it – administrators, staff and clinicians.  And we take our cues from those impressions about whether our participation in our care is welcome and possible here – or not.

No, patient experience ratings are not sufficient to assess the success of your efforts to support our engagement in specific aspects of our care. And yes, there are some measures that might skew overall ratings, such as our satisfaction with pain management. And there are probably a few of us –though I’m skeptical about this – who mistake the request to rate our experience in the hospital for a query about whether our treatment met hotel standards. None of these are reasons to dismiss the importance of patient experience ratings for us or for you.

Patient experience surveys provide critical intelligence for hospitals, plans and practices as you work to improve patient outcomes.  These scores indicate to you whether is it remotely likely that those of us treated in your facility by your clinicians will be willing to risk joining in the effort to end our discomfort and return us to a life without illness. And they show you where to target your efforts to increase that likelihood.

We are mutually dependent on one another to succeed in improving our health outcomes.  Patient experience ratings can help you modify the way you deliver care to make it possible for us to work actively with you toward this aim.

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1 Trackback for “Hospitals, Practice Administrators and Clinicians: You Gotta Learn to Love Patient Ratings”

  1. April 26, 2012 | Opinions | Healthcare News | Health Insurance News | Healthcare Informatics | Care411
    April 26th, 2012 at 5:06 am

2 Responses to “Hospitals, Practice Administrators and Clinicians: You Gotta Learn to Love Patient Ratings”

  1. felixgreaves Says:

    I couldn’t agree with this more, but I’d take it further. We need to pay more attention to the ratings patients are leaving online (in the ‘tripadvisor’ model), not just through formal surveys. Our latest work at Imperial College London show how these ratings are associated with traditional survey of patient experience and clinical outcomes.

    I think these new online ratings have a real place in the landscape of quality metrics.

    http://qualitysafety.bmj.com/content/early/2012/04/19/bmjqs-2012-000906.full

    http://archinte.ama-assn.org/cgi/content/full/172/5/435
    (with apologies that neither is open access)

    Felix Greaves
    Imperial College

  2. James Rickert Says:

    I was asked to lecture on patient centered care at this year’s annual meeting of the American Academy of Orthopedic Surgery. Of course, one can’t talk about patient centered care without discussing the need for feedback from our patients. I recommended, based on plenty of evidence from the literature, surveys addressing just the kind of topics that are discussed in this article. From comments at the meeting and written feedback I received later on, it’s clear that there is deep unease among many specialists to the notion that patients should rate our performance as doctors.

    This is in contrast to the response I’ve received to such ideas from primary care audiences. At this point, many specialists do not accept the validity of patient feedback as a measuring stick of their abilities. Only if such feedback is tied in some way to compensation will many specialists pay attention to patient surveys or such feedback.

    James Rickert, MD
    President, The Society for Patient Centered Orthopedics
    http://www.thepatientfirst.org

    Please follow this link to a Health Affairs blog post to read about the centrality of patient feedback to achieving high quality care:
    http://healthaffairs.org/blog/2012/01/24/patient-centered-care-what-it-means-and-how-to-get-there/

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