Hello, and welcome to our live webcast, The Patient Experience, CG CAHPS and Physician Communication. Thank you for joining us. My name is Gary, and I will be the operator for today's presentation. Before we get started, I'd like to take a moment to acquaint you with a few features of this web event technology. On the right-hand side of your screen, you will see the Q&A window. To send a question, click on the text box and type your text. When finished, click the Send button or push Enter. All questions that you submit are only seen by today's presenter. Your questions will be responded to in the order in which they were received, and will be addressed throughout and at the end of the presentation. At the conclusion of today's program, we ask that you complete a brief post-event survey. Please take a moment to complete the survey as it will help us plan future web events. We are joined today by our moderator, Leslie Rickey, and our speaker, Dr. Adam S. Holtzberg. At this time, I'd like to turn things over to Leslie for opening remarks. Thanks, Gary. I would like to welcome all of you to our next installment of our AUG's virtual forum web-based lecture series. This is a series of presentations by experts in our subspecialty from across the country, focused on topics based on the SPMRS learning objectives, as well as relevant practice-related topics. The virtual format also provides AUG members the opportunity to interact with the speakers in real time. This presentation will then be captured and be made available for view at any time on the AUG's website. For this evening's presentation, it is my pleasure to introduce Dr. Adam Holtzberg. He is Division Head of Female Public Medicine and Reconstructive Surgery, and also Program Director at Cooper University Healthcare. And he is going to be speaking tonight on the patient experience, CGCA-HPS, and physician communication. Thank you. All right, thank you, Leslie. All right, thank you. I want to thank AUG for allowing me to give this presentation on this pretty timely topic. For those of you that are not familiar with some of those initials, you will be by the end of this presentation. And even if I had not given this presentation, you will probably become familiar because most of your institutions will be talking about these patient satisfaction-type surveys coming in the very near future. So let's get started. So patient experience, right? So most of us think of patient experience as maybe patient satisfaction, but we don't always like to use that word. But it's the sum of all interactions shaped by an organization's culture that influence the patient's perception across the continuum of care. So from the minute they walk in the door, from the minute they walk in your office or in the hospital, the patient experience begins. And it doesn't end when they leave. It ends really never, as long as they continue the care to be under your care. And it's not really about satisfaction. That's not totally what we care about. It's not about what your scores are in your surveys. It's not all about satisfying the patient. It's not about the fluff. It's not about the smile. It's not about pandering or kissing butt. It's really about giving the patient the right experience to, in the end, have better patient outcomes. And we'll talk a little bit more about how having a better patient experience can give a better clinical outcome. So what is the value of physician communication? Well, the most important part of anything is the why. Why should we even be worried about this? Why should we even be thinking about it? We'll talk a little bit about the what and how to accomplish improving the patient experience as we progress, but let's first talk about the why. So most of you are probably familiar with the why. So most of you are probably familiar with the Triple Aim. Most institutions now have some sort of department or institution of population health, which consists of, the Triple Aim is population health, experience of care, and per capita cost. So we are moving from a fee-for-service system in this country to a value-based care. And value-based care includes, an important part of that is quality and patient experience. So many people might say, but we don't get many complaints here at our institution or here in our office. We may only get two or three a month, but for every one person who complains, 20 dissatisfied customers don't complain. And the average wrong customer will tell 25 others about their bad experience. So if you have three people who gave complaints per month, that means that you might have 63 dissatisfied customers who then tell each 25 people, and in the end, over 1,500 people can hear about that poor experience, only three actually complaining. So just because you might not hear specifically about those complaints, remember, it can turn into many more hearing about that bad experience. So it's important to realize that even if you have a low number of people complaining, many more will hear about it. It costs 10 times as much to attract new customers as it does to keep the current ones. So if you have a customer, you wanna keep that customer. You don't wanna worry about losing that customer and then having to get more, because getting more customers costs more money. And changing a poor customer service image takes 10 years on average. So improving the patient experience requires a pretty intense partnership, and that partnership needs to occur between the physician and the organization they often work for. It takes teamwork. It takes work between the administration and the C-level suite executives and the physicians to work together to accomplish this goal. Back in 2014, there was an article in the New York Times stating, can doctors be taught how to talk to patients? We all know now we're moving to when we interview our medical students and our residents, we're doing type of behavioral interviews, giving them situations to see how they would react and what their answers would be, because it's not all about the grades and all about how well they do on their boards and all about the smarts, but it's also how these candidates can talk and how they can interact, because how they do that is what often influences the patient experience. So what do patients want? Patients want a provider who will treat them with dignity and respect, listen carefully to their health concerns, have a physician who's easy to talk to or a provider that's easy to talk to, takes their concerns seriously, is willing to spend enough time with them, truly cares about their health, and believe it or not, lastly, the ability to treat and diagnose a medical condition. So you might say, well, wait a minute, why is that on the bottom? Isn't that why they're going to their provider? Yes, but believe it or not, what's above the ability to treat and diagnose the medical condition that they're actually going to that provider for is on the bottom of the list compared to these other items. So patient experience, like I alluded to earlier, is positively associated with clinical effectiveness and patient safety. So you might say, well, how could that be? Almost any study that has looked at patient experience has found that with an increased patient experience comes a better clinical outcome. Associations appear consistent across a range of diseases, study designs, and settings, and looking at outcome measures. There are hundreds of studies looking at a positive association between the patient experience and the clinical outcome, a few showing no association, and only one study to date that actually shows a negative association. So it's pretty overwhelmingly, overwhelming evidence to say that if a patient has a good experience, they will have a better clinical outcome. So Thomas Jefferson University looked at diabetes and the patient experience and showed that higher empathy led to better control of their diabetes, lower empathy, worse control. And you can see the specifics of the hemoglobin A1Cs when there was higher empathy versus lower empathy. Physician communication is highly correlated with better patient adherence. There's a 19% higher risk of non-adherence among patients whose physicians poorly communicate than those who communicate well. And with physician training, the odds of a patient adhering are 1.62 times higher. So what that means is we can teach physicians to be better communicators. All hope is not lost if you are a poor communicator. There are many methods and ways to learn how to be a better communicator. So another study looked at the differences in patient and physician perspectives. So many physicians will say, well, wait a minute, my patients understand what I'm saying. I've addressed most of their concerns. But if you look at this study, the first column there shows, first chart shows physicians discuss patients' fears and anxieties. So if you talk to that physician, they would say 98% of physicians would say, yes, I discussed my patients' fears and dealt with their anxieties. The same, the patient who saw that physician would ask the exact same question, and the patient response rate was 54% versus 98%. So the perception is often a little bit different. So most providers will think that they did this when really half of the patients will say they didn't. Patients know their diagnosis. So will they walk out of that office knowing what their diagnosis? 77% of physicians say, oh, yeah, they thought the patient knew the diagnosis. And then 57% said that they did not. So what you think you do is not always how the patient perceives it. And it doesn't mean you didn't do it. It just means you didn't do it in a way that the patient understood it well. So why do we deal with all this? So this is Medicare.gov Physician Compare. This website is live and running, although you will have to log in to Physician Compare. This website is live and running, although you will not get specific data yet. But eventually, and there's still a little bit of talk on this, eventually any patient can go on Medicare.gov, the actual Medicare website, slash Physician Compare, and be able to see information about you, what your scores are, what your patient experiences are, what your CG-CAHPS scores are, your H-CAHPS, probably just CG-CAHPS at this point. But it's still, they keep putting off when that's actually going to happen, but we'll talk a little bit more about those specific surveys and patient satisfaction scores. But this is not going away. This is part of reimbursement for you based on quality and patient experience. And it's going to be something, just like when we go to a restaurant and we go to Yelp to see what the ratings are for that restaurant, patients are going to be going on very reputable, they do it now with websites, but this is going to be the Medicare website, which is our government-based website. So it is not going away. We all know for many years that malpractice concerns can be lessened by better patient communication. Reducing malpractice claims through more effective patient-doctor communication is something that we've all known for many years, that if you address patients' concerns, if you don't dismiss them, if you treat them with the respect that they deserve, oftentimes they'll be very understanding to things happening. But when you have poor communication and patients have a difficult time getting to your office, difficult time finding you or somebody on call for you, it makes them upset, makes them disturbed, and oftentimes can result in a higher risk for malpractice claims, even if they're not warranted. Malpractice litigation is often cited for many reasons. Oftentimes they're because they thought the physician was rude, they didn't listen to them, they didn't return the phone calls, they didn't spend enough time with them, they didn't answer their questions, or they showed little concern or respect for their condition. So better communication can lead to less malpractice claims. Significantly correlated with their physician's communication skills, so better communication resulted in less malpractice claims. Usually not correlated with the quality of care. We all think, well, malpractice claims have to do with quality of care. Most of the time, not. Most of the time it has to do with patients being upset or angry because of poor communication. So the magic bullet, communication matters because it improves clinical effectiveness, we've talked about that, and treatment adherence. It improves clinical outcomes and safety. It improves patient satisfaction. It increases the patient loyalty It improves the CAHPS performance, which we'll talk about in a little bit, and reduces malpractice risk. And believe it or not, it has been proven that with better communication with the patient comes better physician satisfaction. Patients enjoy their day more, they get more out of what they're doing on a daily basis, they get patients often reacting to them in a much more positive way, and makes the physician's experience more positive as well. So let's talk a little bit about the what now. So patient experience is measured by a standardized survey called CAHPS, which stands for Consumer Assessment of Healthcare Providers and Systems. It is basically a patient experience scorecard. It is separated into two types of surveys, and these are standard surveys developed by the U.S. government, and HCAHPS is the hospital-based survey, and CG-CAHPS is the outpatient, or outpatient and group survey. So HCAHPS, during the hospital stay, the patient will be asked amongst other questions, did the doctor treat you? And I'm gearing more towards the physician part of these questions, not with the other aspects that will be asked on some of the other sections of the HCAHPS. But did the doctor treat you with courtesy and respect? Did the doctor listen carefully to you? Did the doctors explain in a way you could understand? And then CG-CAHPS, with the office-based, will ask during your office visit, did the doctor's explanations, were they easy to understand? Did they listen to you carefully? Did they give easy-to-understand instructions? Did the doctor know important information about your medical history? Did they show respect for what you have to say? And did they spend enough time with you? So these are the physician communication portions of both HCAHPS and CG-CAHPS. The biggest difference between these two are CG-CAHPS can be attributed to a single doctor, right? A patient comes to your office, you see them, they go home, they get a survey, CG-CAHPS survey, you know it was you that provided that care. HCAHPS can be a little bit less attributable to one single person because when a patient is in the hospital, they get contact with many, many providers, residents, medical students, attendings, so it's not quite as easy to attribute that to a single person. So this is more of the general CG-CAHPS survey. We talked about the provider portion, so the physician communication portion, but this shows some of the other parts of it regarding the office itself, getting appointments in a timely fashion, getting answers to their medical questions, getting returned calls, was the clerks and the receptionist helpful, did they treat you with courtesy and respect, did they follow up on test results? So there's much more to CG-CAHPS than just the physician communication part, but the part that you can control the most is physician communication. You certainly have influence on the other aspects of the CG-CAHPS survey, but the one that you can influence directly the most is the physician communication portion. So you should be able to, if your institution is giving these surveys out, which most are, you can get these surveys. Usually they're administered through, Prescani is one of the more popular companies that will administer the survey. They're not actually the creator of the surveys, although Prescani does have their own surveys as well, but now they administer the survey. And you can get very specific data regarding the results of these surveys, and you should ask your institution if they're already doing this, and I'm sure many of you listening will already be familiar with these surveys. You can look at it by physician, or you can look at it by total division, by division or group, by department, by location. There's many ways that you can slice and dice this data once you get it. Our institution actually gives scorecards. So we simplify the data so that every month, every employed physician institution gets a scorecard with the specific physician communication giving how many surveys were answered, what their top box percentage was, and what their percentile rank was. And I'll get a little bit more into that in a minute. So there's a lot of different ways this data can be reported, and there are a lot of reports that can be generated with this information. We chose to keep it fairly simple on a daily basis so that our physicians can see their own scores and then their division scores, so their specific scores and then their actual division scores. So we talked a little bit about top box. So there's a percent of top box versus a percentile rank. So you'll see right here, this shows the top box score versus here showing the percentile compared to others. And this is an important difference because you'll see there's often an important difference in these scores. So top box is what's in the green here. So if a question is a yes or no question, you don't get any credit for no, you only get credit for yes, which certainly makes sense when there's only two choices. Top box is only going to be yes. But then we get to questions that are rated from 1 to 10. Top box is 9 and 10. If you get anything below a 9, you get a 1 is as good as an 8. Unfortunately, the only thing that gets measured is top box. If you have a question that asks yes, definitely, yes, somewhat, or no, the only answer that will give you a top box score is yes, definitely. And in the last column, you'll see always, usually, sometimes, never. It doesn't matter what, even a usually is just as, however good or bad, as a never. If you don't get always, it's not top box and will not count towards your top box percentage. So using any number from 0 to 10, where 0 is the worst provider possible and 10 is the best, what number would you rate this provider? As I said, 9 or 10 is the only top box. Responses of always will only be considered top box, yes, definitely, yes or no, only yes counts as top box. So it is important that you learn these aspects of patient communication not in order to get a top box score, but to be a better communicator and result in certainly better patient experiences and better patient outcomes. Like I said, this isn't going away. This is going to be publicly reported data that your patients will be looking at. So we can argue the fairness of it. We can argue whether it's done correctly. This is what's currently being done, and these are the scores that people are going to see. It's a very transparent environment out there, right? We know right now health grades, RateMD, BetterDoctor.com, RateYourDoctor, Facebook, social media, it is a very transparent environment. People are saying what they want to say and how they feel and are letting everybody know about it. So all of these things are going to be readily available to others. So how do others see us? Through these websites, through commercials, through Facebook, that's how they see us. Social media is the way we are perceived, and if people go on these websites and Facebook and put comments, everybody is going to see them. If they say things were horrible, everybody is going to see they were horrible. So it's important to realize this and to be receptive to learning how we can improve the patient's experience through better communication. It doesn't mean we're a bad doctor. It doesn't mean we don't give good clinical care, but if we are not communicating to the level we should, it will result in patients sometimes going on these social media sites, going on these rate MD-type sites and health-grade sites and writing things that you will likely not be happy about. I'm sure we've all gone on these sites to see what people are saying about us, and sometimes there are comments that we're totally shocked and surprised about, but it is a transparent environment. So how do we choose a doctor or a hospital? Well, 5% have rated a doctor online, a third of patients who viewed online sites sort or avoided a physician based on those ratings, and reference from a family and friends still is more important to most people as to whether a physician was accepted by the patient's health insurance policy. So there are many aspects to how patients choose a physician or choose a hospital, and oftentimes it's the same way we choose what restaurant to go to. There's a very competitive market out there. We're all in areas where we have hospital on top of hospital or offices on top of offices and specialties on top of specialties. So if the other guy's getting better, then you'd better get better faster than that other guy's getting better, or you're getting worse. So this is a pretty well-known saying that we're all going to try to get better, but we need to get better than the other guy's getting better. Loyal patients are the most vocal in telling others about positive experience. So if you have a loyal patient, if you have good relationships, they are going to be your best advertising by far. You can put an ad in every paper and billboard and newspaper in the world, but your patient is your best advocate. And if you have a patient that is loyal to you and has a good experience with you, they are going to be your best free advertising you could ever get. Loyal patients are more tolerant of minor problems, and they're less likely to sue. So we want loyal patients. So who out there thinks they are above average? Well, guess what? We're all probably Type A physicians who all did very well in school, and all think we are well above average. Unfortunately, when you shake things out on a lot of these scores, we're not quite above average, because now we're being compared to ourselves. And when you're compared to each other, or to each other, I should say, when you're compared to each other, the competition is quite stiff. And the difference between getting a percentile rank of 95% versus 75% could be two or three people that did not give you top box scores. Because most patients rate their doctors very high, it takes one patient that gives you top-box scores to bump your percentile when you're comparing yourself to others in your academic settings or if you compare to all doctors around the country. So it is a very, very steep curve. So let's talk about how we can make some of these scores better. There is a tool called AIDIT, which is a tool for improving patient outcome through effective communication. So the IHI considers AIDIT a bundle. What is a bundle? It's a structured way of improving the processes of care and patient outcomes. A small, straightforward set of evidence-based practices, generally three to five, that when performed collectively and reliably have been proven to improve patient outcomes. So AIDIT is a bundle. And we'll get into what AIDIT is in a second. AIDIT improves patient outcomes through effective communication. It decreases the patient's anxiety. Most patients will come to our office quite anxious. And it will increase their compliance. And when you decrease a patient's anxiety and you increase their compliance, it results in an improved clinical outcome and increased patient and physician satisfaction. So it's not all about what you say. There are a lot of nonverbal cues that can affect the patient experience. Your appearance, eye contact with the patient, proximity to the patient, hand washing, as we all know, is very, very important. The patient watches whether you wash your hands or not. Appropriate touch and receptive postures and gestures. So the difference between talking to a patient at the bedside, standing, versus sitting. Patients are more comfortable when you sit. They feel more intimidated when you stand. And certainly there are the verbal cues, right? The tone in which you speak, the rate in which you speak, what you have to say, certainly, reinforcing statements that are important, paraphrasing, and teach-back, right? So you're asking the patient to teach back to you what you just said to them. That is the best form of being sure that a patient understands what you said. I use my experience all the time as a medical student many years ago, hearing physicians, and we've all had this experience, talk to a patient, and not only did you not understand what that physician said, but certainly the patient did not understand what that physician said. It was too complicated. It was too wordy. It was too medical jargon. And I promised myself then that I would not do that, and it is now, interestingly, many years later, become such an important part of the patient experience and being sure that you explain things in easily understandable, clear way that will result in a better experience for that patient and a better clinical outcome, right? Whoever thought that if we give our patients a better experience that they'll actually get better? And they will. And most studies have shown that to be true. So there's five fundamentals of AIDID, acknowledge, introduce, duration, explanation, and thank you. So focusing on the A and the I shows courtesy and respect to people. Focusing on the D and the E keeps people informed. So let's see what we mean by that. So does AIDID work? Is this just another, you know, kind of thing that's really not going to help and it's just another gimmick that we're telling physicians to do to try to see if we can get more customers? Well, this shows, there's a group called Studer Group, which you've seen on some of these slides. It's a consulting company that is one of many companies that can come into institutions to help improve the patient experience. And they did a study looking at their partners and looking at what improves after AIDID teaching. And in the lighter blue, you see after eight quarters of using and teaching AIDID versus three quarters, what the ratings or communication was. So nurses always communicating well, certainly did much better the more AIDID was taught and was instituted. Pain was always well controlled. Doctors always communicated well. Staff explained about medicines before giving them to patients. Patients were given information about what to do during their recovery. Patients always receiving help as soon as they wanted. Patients who gave a rating of nine or a ten. And patients who definitely recommended the hospital as a yes. The more that AIDID was reinforced, the better those scores were. So A, acknowledge. So acknowledge the patient, make them feel that they're important, and that you respect them. Knock before entering in a patient's room or a colleague's office. Acknowledge people by name when appropriate. Not only introduce yourself to the patient, but if they have people with them, make sure you introduce yourself to them and see who they are. Acknowledge, as I said, everyone in the room with eye contact or a smile or a nod. And take the initiative to make eye contact, smile, or say hello in hallways, right? We all know the ten and five rule, if we all know that. If you're ten feet from somebody that you're walking by, you should probably acknowledge them with eye contact or a nod. Once you get within five feet of them, you should say hello. That practice is instituted in companies across the country and the world, not just in healthcare. And that ten, five rule, ten feet, five feet rule is often promoted in every aspect of business. And you'll notice that at places like Disney and the, you know, very high-end hotel lines, that if you get within ten feet, they will acknowledge you in some way with a smile or a nod or eye contact, and then as you get closer to them, they will actually say hello to you. This is something that should be instituted even in the healthcare field as you're walking through the hospital. Research shows the importance of a greeting. Seventy-eight percent of patients want their physicians to shake their hands. Ninety-one percent of patients want to be addressed by their name. So I makes people, patients think that you can count, they can count on you. Provide your name and role on the team. Let them know who you are. Let them know, hi, I'm Dr. So-and-so. I'm the division head here at, you know, at this hospital. I've been here for ten years, and we're going to take great care of you today. Validate the name of the person you're interacting with. Tell him or her if you have any special skills. Like I said, how long you've been doing what you do. And manage up. Talk about yourself. If you've been there for many years, if you're the head of a division or a department, let them know that. That puts the patient's minds at ease. I know it's uncomfortable to brag. You're not bragging. You're letting the patients know what your experience is, how well you're going to take care of them. And manage up the people around you. I know you just, you know, spoke to my medical assistant Peggy today. Boy, she's great. She's been with me for many years, and she takes such great care of our patients. Patients usually love her. So managing up is very important. Managing down is very bad, right? When you're in the – when you walk into a patient's room and they seem frustrated, don't start blaming every other service as to why they're still in the hospital. Oh, they're so busy. They never get to the patient, you know, quickly. They have so many patients to round on. You don't want to manage people down. You want to manage them up. Oh, our orthopedic service is so busy because they give the best care, and they're very well respected and renowned, and they're going to get to you because they're going to provide the best care possible to you, and they're going to give you as much time as they give everybody else. So manage up, never manage down. So as I said, why should you manage up? Because it reduces anxiety. Coworkers will have a head start in gaining that customer's confidence when they follow you. It demonstrates a united team. An RN and ancillary staff have been educated in this realm. Usually it's – when a consultant comes in to talk about many of these topics, everybody understands that they do it for each other, and it focuses on what's right. It aligns positive behavior with positive energy with vocal, verbal, and visual cues. Managing down or what not to say, as I already said. Your other doctor did what? I wouldn't have done that. Certainly not a thing to do. The pharmacy sent the wrong medication. We're always short staffed, but administration could care less as long as they could save a buck. These are things we don't want to say to the patient. It certainly will not improve the patient experience. Duration, right? Duration signifies that you respect that patient's time. I will always say to a patient, how long will you be working with the person? Let them know what the time frame is going to be. If there is a delay, how long will that delay be? How long will the process take or the test take? How long will the person be on hold? These are all – patients want to know. I usually tell a patient, a new patient, this visit today is going to take approximately 20 to 30 minutes. To be respectful of your time, please let me know if you have anywhere to be today so we can make sure that we expedite the visit if that's necessary. If not, I want to give you all the time you need to get through your visit today. Those types of things show the patient that it's not just that they respect your time by sitting in that waiting room, but that you respect their time once they're there to see you. Make sure you say – if you're going to say a minute and it's five minutes, you are going to have a very upset patient. You want to give either an accurate time, so if it's five minutes and you say five minutes, okay, the patient is going to be pretty satisfied, but guess what? If you think it's going to be five minutes and you say it's going to be ten minutes and they see you in five minutes, you've now exceeded their expectations. Don't say we'll be with you in a minute. Say we'll be with you in the actual time it's going to likely take, and you're better off overestimating than underestimating. Hope. Hope is not a strategy and is a word that we usually recommend never to use, right? Hopefully undermines confidence. Hopefully we'll get to this. We'll get to you as soon as possible. Well, that's – there's no clarity on that. It should be pretty quick. The test should be pretty quick, according to whom. Probably fails to make any kind of commitment, and in a few minutes, the context may be different between what you and the patient perceive as a few. So try to be more specific in your time frame. So an explanation, right? I want you to understand so you feel safe and confident. So limit the medical jargon. We all know patients don't understand medical jargon. Use words that patients understand. I do it when I talk to patients. I do it when I consent patients for surgery. All of my consents have the medical jargon as well as the lay jargon on the consent to be sure that that patient truly understands what they're having done. So in every aspect of care, whether you're explaining to them about their prolapse and incontinence or whether you're consenting them for surgery, it should not be medical jargon. Say what you're about to do before you do it, right? We all know that and why you're doing it. Set the proper expectations and always offer an opportunity to ask questions after you explain something, right? When you do that, make sure you say what questions do you have for me, not do you have any questions. When you say do you have any questions, it's a setup for them to say no. You're basically asking them to say no. But when you say what questions do you have, it encourages them to ask a question. So if there's one thing you learned from this lecture or this talk today, it's to say what questions do you have, not do you have any questions. Always ask if you need more of an explanation and always use teach back to confirm understanding. What we talk about with prolapse and incontinence is often very overwhelming, a lot of information all at once in a short period of time. So you should ask that patient to teach back to you some of the things that you talked about to make sure they truly understand. And the last key... Adam? Yes. Hi, this is Leslie. If it's okay, I wanted to ask a question real quick just because it's timely to what you're talking about right now. Absolutely. It's one of the participants. And the question is how do you address patients with unreal expectations and I think this is saying failing to appreciate scheduled times. In other words, I think like not, you know, we've been told in our institution sometimes to tell the patient, okay, we have 30 minutes, you know, kind of giving some time limits on their expectations also. So could you comment on that? You know, I think that's somewhat of an individual practice. I think that setting the timeframe from the start is important and say, okay, you know, this visit should take about 30 minutes today. Sometimes it would require you'd say to the patient, well, you know, it might... If we don't feel like we get enough done during the timeframe we have today, I certainly would like you to come back so we could talk about it some more. You know, I also answer that question in the sense that when you're running late or behind in a session, I often tell my patients, you know, I apologize for having them wait. I explain to them that I try to give all of my patients the time they need, which I will also do with you. And sometimes that can set me back depending on the problem and I say a patient needed more time than I expected. If you give that explanation and you show that you respect that patient's time and you show that you're going to give them the same time they need as you gave to the patient prior to them, they're usually pretty understanding and it gives them... It disarms them a little bit when you walk in that room, you know, with that kind of look of, you know, oh my God, I've been sitting here for 20 minutes waiting for you. But as far as the length of time from the visit, you know, you have to set the expectation. There are always going to be patients that just don't accept that. And you try to manage that as best you can, manage up the situation as opposed to managing down the situation. But I think setting the expectations from the start, giving an explanation to them as to maybe why you're running late and being honest with them is always the best policy in my opinion. Thank you. And the thank you. So you will be shocked. I never said thank you to patients until probably the last year. And you will be absolutely shocked of the reaction you get when you thank a patient. When you say to the patient, thank you for allowing me to take care of you today. Thank you for continuing to allow me to take care of you. Thank you for choosing me. I know you have many options. You'll first of all, oftentimes get a thank you back. And you'll get a look on the face of that patient of, oh my God, that physician just thanked me for allowing them to take care of me. They appreciate that more than you can ever know. And they leave with a very positive thought that that physician thanked me and really, you know, appreciated the fact that I came to them as opposed to somebody else. It provides a very positive closing, as I said, and as I gave examples of, thanks for letting me help you today. Thanks for your patience or your courage today. Thank the family for their support if they're there with them. So Maya Angelou said, they may not remember what you said. They may not remember what you did. But they always remember how you made them feel. And it could not be more true in really any communication with anybody for any reason, but certainly in our field of medicine, it could not be more true. So physician engagement. So engagement may be thought of as the physician's appraisal of their perceived work environment, emotional experiences, and attachment to the workplace. I don't know if any of you have institutions out there that focus on physician engagement. I am actually in charge of physician engagement at my institution, which allows me to see things from many different perspectives and allows me to be able to communicate. We have a committee of physicians whose responsibility is to find out why do you walk in these doors each day with ankle weights? What can make your life easier? What obstacles can we remove from you in order to give better patient care and a better patient experience? That's what physician engagement is all about. So physician engagement involves involving physicians in goal-setting, right, allowing the physician to select the goals with administration, following up with the physician, and communicating the goals with the physician. There's very little we want as physicians, but one of them is we want to be part of the process. We want to be part of the decision-making process. So physicians want to be involved in the goal-setting in their practice or institution, rounding on us, meaning checking in on us to see what is working well for us, what is not working well for us, how can things be fixed. And if things can be fixed, we don't want to just tell you what's wrong, but we want follow-up, right? Even as I said, a good no is as good as a yes, meaning if I say yes to something or administration says yes to something, great, we got it. But sometimes they say no, but if they say at least there was follow-up with a no and an explanation behind it, because oftentimes physicians will ask for something or say they need something or have a suggestion but have no follow-up. Well, that's the worst scenario, and that's what frustrates us the most. Aid it, obviously performing that aid it, and we want a little bit of reward and recognition. It has been found in most studies that physicians who are more engaged often provide a better patient experience, right? And that makes sense, right? To put it simply, if we're happier, the patient's likely going to have a better experience. If we're miserable, the patient's not going to have a very good experience. So physicians go where they are welcome, they remain where they are respected, and they grow where they are nurtured. So that's the bulk of my talk today. I hope that you got something out of what we talked about. I hope you understand these surveys and how the patient experience is measured and how important it's going to be to our future. It is going to be in every aspect of care that we give all around the country. There's no place that's really going to be removed or immune from this, and I'm happy to answer any questions that anybody has at this point. This is Leslie. I'll give people a chance to type in some questions, but I have one. If there's people listening to this now or in the next coming weeks and they say, you know, gee, I've noticed some areas for improvement in my practice, do you have any advice for how they can go about evaluating some of the deficiencies, improving them? Is it something that, you know, you have found there's hospital resources for, is it something they have to do on their own? What would be your advice for someone wanting to get started on making some of these quality improvements? Well, there's a lot of, I mean, if you start just with AIDIT, which I gave an AIDIT handout, which most of you should be able to get once this is posted on the site for people who are looking at this later, but I think AIDIT alone and what things to say, not say, and doing that process will be the best method of improvement right off the bat, but there are many resources. Studer is one. Studer has a great website, studergroup.com, but there's a lot of resources out there on improving the patient experience, and if you do searches on patient experience or improving the patient experience, it's not just that company. I have no connection with that company, but that is just the one that our institution is using at the current time, but there are many other companies. Disney is one that does it for healthcare. I think Ritz Carlton, I think, has a company that does it for some healthcare institutions because these are companies that are known for their customer experience, so they have – so there are many ways to do it on your own through web searches, but if you get AIDIT alone, if you do that with every patient, you'll see a big difference. So we have Adam on the line. If nobody else has any questions, we could probably go ahead and wrap this up. Let me just check again real quick. I don't want to leave anybody out. I think that's it. So I think we could go ahead and conclude today's program. I really want to thank Dr. Holtzberg for speaking about this. I really appreciate the way sometimes some of these new quality measures and new things from the government can get a little wordy with all the letters, and it's really hard to understand. I think you put it in really understandable language and also gave some concrete examples for how to do this in our practices, so I really appreciate that. I've heard some of these talks where you leave more confused than when you started, and I don't feel like that with this talk, so I think that's a great skill that you have. Yeah, I gave good communication, I guess. That's right. You've learned well, with doctors also. We're probably a tougher crowd than the patients in terms of when they should ask us that. We need to teach that also. So I just want to thank you again. I think we really learned a lot. I also want to thank our participants for being on the call today, for carving time out of your schedules as well. Remember, as Gary said at the beginning, upon completion of this program, you'll be prompted to provide feedback, so please do share your thoughts and impressions with us, and we will let you all know soon what our January topic will be. So everybody have a safe and happy holiday, and we will see you next month. Thank you, everyone. Thank you, Leslie and Dr. Holtzberg. Thank you very much. On behalf of AUGS, I'd also again like to thank everyone for your participation in today's event. As Leslie just mentioned, a post-event survey will appear requesting your feedback. Please take a moment to complete the survey, as it will help AUGS plan future web events. This concludes today's program. Again, we thank you, and have a great night.

patient experience

CG CAHPS

physician communication

patient satisfaction

clinical effectiveness

adherence to treatment

AIDIT bundle

physician engagement