Recently, I participated in medical grand rounds at several hospitals. The primary topics of all these grand rounds were focused on delivering better care. One of these sessions was presented by Dr. Margaret Cary at Georgetown University Hospital on the topic of coaching, the role of active listening, and asking phenomenally good questions. These behaviors result in tremendous improvements in effectiveness for doctors, as well as improved satisfaction for everyone they deal with, patients, peers and staff alike! Dr Cary wrote a terrific essay on the value of presence here. My previous blog on this subject is here.
During the course of one of the exercises, I shared in a private one-on-one discussion that my career involved helping use HIT to improve the quality of care. I pointed out that, prior to the establishment of "meaningful use," the rate at which healthcare encounters including adequate documentation of the patient's current medications and problems was very low. Clearly, not concordant with anyone's definition of quality. And, furthermore, how can a patient be satisfied with their providers if those providers don’t reliably know the patient’s story and concerns?
A very experienced, talented physician pushed back on my point. For him, the use of any form of IT in the exam room always decreased the extent to which the physician expressed care to the patient. The use of computers decreased or eliminated eye contact. Computers, according to the doc, took the physician's focus away from patients and their needs, and moved it to the needs of completing some sterile and defocusing form within the computer. I was reminded by him that “Everyone knows computers dramatically increase the documentation burden, with negligible value, if any, created for the physician doing the documenting.” His position was that to the extent information technology in the exam room had some positive impact, it was at most minor. And in any event, the net of HIT applications was negative for both patient and provider satisfaction.
Improving patient satisfaction with healthcare has become the top priority for many provider organizations. There isn't a hospital or clinic CEO today who doesn't know their HCAHPS scores and who doesn't have initiatives in place to achieve top status (link). HCAHPS, the Hospital Consumer Assessment of Healthcare Providers and Systems survey, is the first standardized, survey of patients' opinions of hospital care. It’s a 27-item data collection methodology for measuring a patient’s perception of their hospital experience, enabling comparisons of hospitals nationwide.
There are, of course, wonderful programs to improve patient satisfaction that often focus on acknowledging patients as people for example, the Studer Group’s AIDET training, or Ritz Carlton programs for health systems. Such programs ensure patients are consistently treated personally, given adequate explanations of diagnostic and therapeutic issues, and thanked for their efforts. They also provide open probe offers to ensure we ask if there is "anything else we can do for you today we haven't already addressed?"
Are these expressions of caring and focus on patient satisfaction being built into the implementation and optimization of care delivery at your institution? As I stated in my opening paragraph, some of the non-IT related behaviors, like coaching, are receiving new and overdue attention. Are the process and performance improvement initiatives leveraging IT enablement at your institution to directly improve the patient’s experience? I trust they are, so the critical question becomes, are we doing enough?
What do you think?
Joseph I Bormel, MD, MPH
Healthcare IT Consultant