Can the leaders of patient care organizations really engage physicians in understanding the costs of patient care and in changing elements of their practice to improve value? Many would think that an absurd proposition. But as Charlton Park, chief analytics officer at the Salt Lake City-based University of Utah Health Care, explained it on Tuesday, that is just what happened at that integrated health system.
Park gave a presentation, entitled “Creating a Data-Driven Organization through Physician Engagement,” to an audience gathered at the Health IT Summit in Miami, sponsored by the Institute for Health Technology Transformation (iHT2—a sister organization to Healthcare Informatics through parent company the Vendome Group LL).
On Feb. 2, Park shared with his audience at the Ritz-Carlton Coconut Grove the narrative around his organization’s journey into value, and the role that physician engagement has played in it.
At the core of that narrative has been a commitment from the health system’s executive leaders on down to push forward into improving the value that the organization was providing through its care delivery—value that involves a constant attempt to optimize high levels of clinical outcomes and lowered cost, along with increased efficiency.
Moving ahead has meant being transparent about all the processes involved. Quoting another healthcare executive, Park said he believes in the statement, “Everyone wants transparency to be a trick. It isn’t a trick. Transparency doesn’t start with the outside, it starts with the inside.”
Fundamentally, when it came to value, Park told his audience, “Our journey started with patient satisfaction. We had to leave the attitude that we were the academic hospital on a hill, and patients were lucky to be treated with us. We needed to change our patient satisfaction scores.”
So, Park, said, “We started with data transparency. Most clinicians had no idea we even were keeping scores” prior to the initiative, Park reported. “We transitioned away from snail-mail surveys with few responses; we needed more data to make it meaningful. So we were among the first academics to begin e-mailing satisfaction surveys on their first visit to their clinic. And physicians are scientists, so if they see an ‘n’ of 13, they’ll say, this is meaningless, we need more data. So the first step was gathering more data, making it meaningful, and then making it transparent. So the first step was internal transparency, explaining and educating the physicians.
Taking it step by step
Knowing that it would be a complex journey to engage physicians around quality, cost, and value, Park told his audience, “We started off with peer-to-peer data in blinded form: Dr. Smith, compared to everyone else, on satisfaction. Then we took baby steps forward, as the doctors became more acclimated and accepting of the transparency. We were the first academic to provide online reviews” of physicians by their patients,” he noted. If you go to healthcare.utah.edu, you can look up any provider and see their patient satisfaction scores, and it’s unfiltered except for derogatory comments or profane language. And that was a huge step,” he underscored. “We got comments from physicians saying, ‘You’ll ruin us!’ But to change our satisfaction scores, we needed not only to be transparent internally, but externally as well.”
In fact, when Park and his colleagues at the University of Utah Health Care started out, their organization started out only in the 29th percentile in a nationwide patient satisfaction ranking, so there was a long way to go.
First, he said, they began by providing physicians with twice-yearly individual physician scorecards for patient satisfaction, based on patient judgments coming in over a rolling 12-month period. The next step was peer-to-peer scorecards, in which an individual physician would see his or her satisfaction scores, compared with other physicians in her or his specialty, though the other physicians’ names were blinded to the individual. Over time, University of Utah leaders have moved to a system of scorecards that are offering both interdepartmental and individual outcomes comparisons. A key help here has been physicians’ natural competitiveness, Park says. Showing a slide in which ten doctors’ outcomes are compared and the doctors are described as Doctors A, B, C, D, E, F, G, H, I, and J, And Dr. A has the best documented outcomes along a particular dimension, he underscored that “Physicians, like most of us, are a competitive bunch. And they all want to be in first place. They all want to be Dr. A.”
After these developments, Park said, “Finally, we went to public scorecards. That is a transition that took about five years. But it’s now part of our culture, and [the participation in the scorecard process] is an expectation for all of our physicians. Still, it took quite a while to turn this ship around, and required a lot of investment.”