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Access
Communication
Courtesy
Care Coordination

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Exceptional Patient Experience Made Simple

MAKING CHANGES MAKES A DIFFERENCE

Improvement is possible with focused effort. Even top performers and those originally performing well can make noticeable increases in their scores. Usually, those with the lowest original scores show the greatest improvement.

Access Brochure (PDF)

CAHPS^® (Consumer and Access Availability Assessment of Healthcare Providers and Systems), QHP (Qualified Health Plan) Enrollee Survey, and Access Availability

Provider Impact

There are specific survey questions related to patients getting timely access to care.

Access and Availability Impact

Impact on Getting Appointments and Care Quickly is one of the provider driven CAHPS and QHP composites.

Marketplace Survey Questions

Getting Needed Care

In the last six months, how often did you get an appointment to see a specialist as soon as you needed?
In the last six months, how often was it easy to get the care, tests, or treatment you needed?

Getting Care Quickly

In the last six months, when you needed care right away, in an emergency room, doctor‘s office, or clinic, how often did you get care as soon as you needed?
In the last six months, how often did you get an appointment for a checkup or routine care at a doctor’s office or clinic as soon as you needed?

Timely Appointments Care and Information

Essential Behaviors

Empathy - Acknowledge concerns, demonstrate caring
Compassion - I hear you and this is what I can do
Listen - Invite questions and actively listen
Manage Anxiety - Recognize anxiety and mitigate
Offer Options - Empowerment through choice and autonomy

Processes and Operations

Expectations - Set patient expectations by creating responses and assist front office staff to discuss delays, walk-ins and scheduling patients
Open Schedule - Dedicated space for scheduled appointments and walk-ins
Extended Hours - Before 8:00 am and after 5:00 pm some days during the week and weekends
Provide Options - Other physicians, offices, advanced practitioner, etc.
Tele-triage Nurses - Manage urgent calls and situations

Talking Points for Providers

Communicate with Courtesy, Respect, and Listening

Discuss and observe best practices– then focus on those behaviors patients/members share about their interactions with their providers

The Art of Caring

SCIENCE

Balancing the time spent successfully addressing the clinical care of the patient.

ART (HEART)

A patient believing they have made a connection with the caregiver is often reflected in positive experience ratings.

Essential Behaviors

56 SECOND CONNECT

Behavior to go beyond the diagnosis and learn about the person

SIT DOWN

When you sit down eye-to-eye with patients, they feel like the provider has spent more time with them

ACTIVE LISTENING

Let patients tell their whole story without interruption

Access and Telehealth Appointments

Reduce Risk - Same day appointments for members’ urgent needs decreases the risk of Urgent Care and ED visits, and symptom increase due to lack of treatment

Same Day Appointments

Improve patient satisfaction and reduce Urgent Care and ED visits.

Risk of Cancellation

Appointments with lead times greater than 2 weeks are more likely to turn into no shows and canceled appointments

No Show Appointments Opportunities

Improve Access and Utilization

No Available Appointments - Patient calls to schedule an appointment, if nothing is available within the next day or two:

Options

Wait list - Would you like to be placed on a wait list and called if an appointment becomes available?
Would you prefer a tele-visit to an in-person visit?
Cancel equals Wait list - Patient calls to cancel = utilize wait list to fill spot based on visit type preference

Expand Telehealth For Routine Care

IT’S MORE EFFICIENT

With telehealth, the following tasks are removed from the visit process. This makes for efficient use of time and can be a smoother experience for the member

TAKE THESE TASKS OFF YOUR LIST

Read Vital Signs
Patient Check-In
Recording Weight

Increase Appointments, Efficiency, and Revenue

Revenue Changes

Three 10 minute telehealth visits vs two 15 minute in office visits

Medication and Telehealth

New medication checks
Medication refills
Discuss test results

Commitment to Best Practices

CHECKLIST

This checklist will be used to identify the interventions your practice commits to implementing within the next 30 days. Note that the goal of each intervention is listed below the intervention itself.

Follow up on status of implementation, including successes, challenges and next steps needed will be conducted during next month’s coaching session.

Goal: Leverage assessment tools (i.e. provider scorecards) to identify process and/or educational opportunities to boost patience experience.

Goal: Turn missed appointments into a scheduling opportunity for members unable to schedule within their desired time frame

Goal: Increase efficiency for providers and reduce hassle for members

Goal: Improve access to care for members with limited availability

Goal: Maximize opportunity to identify member access needs and ensure member knowledge of after-hours resources

Assessment or Tools Selected

CHECKLIST

This checklist will be used to identify the tools your practice commits to use for training and/or assessment purposes. Note that the goal of each tool is listed below the tool name itself.

Commitment to use the tool indicates a commitment to work towards the specific goal the tool is targeted towards within the next 60-90 days.

Goal: Increase knowledge around intervention to boost member experience. Opportunity to learn from other provider groups in attendance.

Goal: Utilize public social media reviews to identify improvement opportunities and recognize practice accomplishments

Goal: Health Plan analysis of Top Box data from CAHPS Mock Survey identifies strengths and opportunities for change

Goal: Provider education that can be delivered online or by the Health Plan, intended to increase provider knowledge around the annual CAHPS survey and provider impact on member perception of experience.

Goal: Education of provider support staff to increase knowledge around annual CAHPS survey and ways support staff can impact member perception of experience

Performance Improvement and CMS QHP Survey

Here are ways you can improve your patients’ experience and help with upcoming QHP Enrollee Experience survey that your Marketplace patients may receive from March through May this year.

ACTIONS TO TAKE

Before Appointments

Offer convenient appointment times by keeping blocks of time open for same-day, weekend, and early morning/evening slots.
Consider offering telemedicine service (by phone or video chat) as an alternative to in-person appointments.
Confirm appointments with patients one day prior to visit by text message, a live call, or an automated call messaging system.
Provide options for registering in advance either by a patient portal or set up an online scheduling system so patients can provide their information before coming in.
Have patients’ records ready and reviewed, and obtain any prior authorizations ahead of visit to expedite care.
Notify patients early if long wait times are expected or if there are any last-minute requests for lab work.

During Appointments

Do your best to see patients within 15 minutes of their appointment time.
Review patients’ prescriptions, make sure they understand the importance of their medications, and alert them any possible adverse drug interactions.
Communicate when patients’ test results will be available and set reminders to review results with patients in a timely manner.
Ask patients if they have any questions or concerns regarding their care.

End of Appointments

Immediately schedule patients’ follow-up appointments to ensure continuous care.
Account for specialist care by making sure specialist appointments were made or help patients schedule appointments if needed.
Encourage patients to use the patient portal, which lets them access their health records and ask providers questions.
Share health records with patients’ other providers to keep everyone up-to-date.

Communicate with Courtesy, Respect, and Listening

MAKING CHANGES MAKES A DIFFERENCE

92.4% of consumers use online reviews to guide most of their ordinary purchasing decisions.
60.8% of patients say they’ve avoided doctors based on negative reviews
59.9% of patients say they’ve selected a doctor based on positive reviews
Doctor’s online reputation is very important – more than any other industry
- 3 times more than Hotel Reviews
- 2 times more than Restaurants & Bars

Communication Brochure (PDF)

Personal Doctor Communication Survey Questions

In the last six months, how often did your personal doctor explain things in a way that was easy to understand?

In the last six months, how often did your personal doctor listen carefully to you?

Talking Points for Providers

Communicate with Courtesy, Respect, and Listening

Discuss and observe best practices– then focus on those behaviors patients/members share about their interactions with their providers

The Art of Caring

SCIENCE

Balancing the time spent successfully addressing the clinical care of the patient.

ART (HEART)

A patient believing they have made a connection with the caregiver is often reflected in positive experience ratings.

Essential Behaviors

56 SECOND CONNECT

Behavior to go beyond the diagnosis and learn about the person

SIT DOWN

When you sit down eye-to-eye with patients, they feel like the provider has spent more time with them

ACTIVE LISTENING

Let patients tell their whole story without interruption

Behaviors, Processes, and Operations

BEHAVIORS

Show interest as a person, allow time to tell their story and tailor communication based on the individual

Repeat the patient’s own words in responses, use Parroting – also called Teach-Back or Show-Me

Repeat instructions and demonstrate key points to increase patient comprehension, avoid jargon

Assess patient capabilities and consent to do so

PROCESSES & OPERATIONS

Visual Aids improve patients’ understanding
A picture is worth a thousand words— use 3D Models and illustrations
Provide a medication calendar complete with clear instructions

Give patients something in writing to refer to after the visit. Keep it short and simple and highlight key messages.

Enlist high-performing providers to mentor colleagues and help them improve. Share patient experience survey
results during meetings or huddles.

Power Listening with Empathy

Raise Your EQ (Empathy Quotient)

Empathy Statement: Use a descriptive word to restate your patient's feelings.
Stop: Take a moment of silence and give your patient time to think and speak.
Probe: Ask open-ended questions and allow your patient to tell their story.

Build an Empathy Statement

Introduction - linking word - name the emotion
Examples:

I can imagine that this is very frustrating
I can see why you're anxious
I can hear how upset you are
It sounds like you're very disappointed

Sticky Teachable Moments

THE TEACH-BACK (PARROTING) METHOD

Make it Memorable: Parroting also called Teach-Back or Show-Me is a method used to confirm a patient (or caretaker) understands what their provider has told them. If a patient can repeat or parrot back what their provider has told them, then we know they understand.
RX is a Key Driver: Medication management is a key driver in patient experience scores.
Make Medication Management a Daily Practice: In daily practice, use the Teach-Back method to help patients understand their medication routine

In Less than a Minute

Did you know?

It only takes 56 seconds to make a meaningful and personal connection with your patient?

Go-to Communication Approach

WHAT’S YOUR STYLE?

	Positive	Negative
Solve	Allows you to quickly address the patient’s issue	You may not have identified the real issue
Criticize	Caution: To do this well, TRUST must exist	Elevates emotions or forces patient to withdraw
One-Up	When personal, may help you “connect” with patient	Over time patient becomes frustrated. Feels they can’t “win”
Prove	Allows you to get the answers you seek	May not be the right question
Empathize	Helps to manage patient emotions and open up communication	Can sound insincere if listener is not committed to this approach

Exceptional Patient Experience Made Simple

MAKING CHANGES MAKES A DIFFERENCE

Courtesy and Respect Brochure (PDF)

Courteous, Helpful Staff

ESSENTIAL BEHAVIORS

Patient Enters

15 feet: Make eye contact
10 feet: Greet the patient

Use the 15/10 Rule

Make eye contact when patient is 15 feet away and greet the patient at 10 feet away
Thank patients for visiting the practice prior to their departure
Try to answer questions in an affirmative way including alternatives if the request cannot be accommodated

Give Patients Instructions

Provide guidance in obtaining additional tests and treatments
Walk them through the logistics to schedule an appointment, where the facility is located, what prior steps are needed, etc.
Ask if any questions or concerns
Avoid jargon

Train Staff NOT to multitask with patients

Staff should look up from the computer when someone approaches the desk/reception area
Body language should make people feel welcome

PROCESSES AND OPERATIONS

Train all staff to schedule patient appointments

Establish on-line registration service - Demonstrate how the process works and the service benefits

Review check-in, check-out, referral & scheduling process for redundancies - Being asked for the same thing is frustrating, so explain redundancies needed for safety

Grant front-line staff the authority to say “Yes” - Immediate decisions will solve problems and provide good customer service

Develop service standards for staff - Hold staff accountable for standards for patients and colleagues alike, including physicians

What's Your Go-To Approach

	Positive	Negative
Solve	Allows you to quickly address the patient’s issue	You may not have identified the real issue
Criticize	n/a	Elevates emotions or forces patient to withdraw
One-up	When personal, may help you connect with the patient	Over time, patient becomes frustrated, feels they can’t win
Probe	Allows you to get the answers you seek	May not be the right questions
Empathize	Manage emotions and open communication	Sounds insincere if you’re not committed to approach

Follow Through Gaps

THE POWER OF FOLLOW-THROUGH

Sometimes patients are not happy with services and information you provided, and they express dissatisfaction to us.

Based on intensity of expressions, when we speak to patients we can identify if their response needs fall into one of three types, each requiring different response (red, orange, blue).

Whether an individual has a Red, Orange, Blue reaction depends on:

The size of gap between expectations and reality
Impact of the service failure
Personal reaction tendencies

RED ANGRY

Feels angry and frustrated
Believes she/he isn't the victim
Reacts emotionally

ORANGE ANNOYED

Feels annoyed
Believes experience has fallen short of expectations
Expresses irritation

BLUE AGREEABLE

Appears to roll with the situation
Looks for resolution
Does not express emotion

CUSTOMER SERVICE TURN AROUND STEPS

If the patient is responding Red, they need empathy:

Allow venting
Listen actively
Plan follow up

If the patient is responding Orange, they want a sense of urgency:

Recognize members’ need to fix the issue
Provide options

If the patient is responding Blue, they need assurance:

Be truthful
Never blame others

Listening and Language Builds Trust

BUILD TRUST BY FOLLOWING THE ABCs OF ACTIVE LISTENING

Listen for verbal cues

Who
What
Where
When
Why

Actively Listen, Lead with Empathy, Minimize Distractions, Refrain from Interrupting.

Communicate your goal to understand
Summarize

CHOOSE POWERFUL WORDS WHEN SPEAKING WITH PATIENTS

Powerful Words

Let me make sure I understand
In my experience
I will ...
You are welcome ...
It’s my pleasure
I would be happy to do that for you

Trigger Words

I don't know
No ...
I can't
Our policy is ...
No problem ...
You’ll have to ...
We’re understaffed ...

Every Patient is Unique

SAME QUESTION, DIFFERENT PATIENT

Because you’ve heard the same question 10 times a day (2,500 times/year), it’s easy to forget that the patient in front of you is asking that same repetitive question for the very FIRST TIME.

Even though you’ve answered Patient A that doesn’t mean Patient B knows.

At this especially vulnerable time, patients are bombarded with situations, terminology, and spaces, etc. that are totally unfamiliar. Many may not even have initial questions because they don’t know where to start.

But all patients have questions - expressed or unexpressed

Daily Huddles Improve Patient Experience

The Daily Huddle is the #1 most effective method to improve patient experience by focusing everyone on the patient.

Care Coordination Brochure (PDF)

Things to Keep in Mind

To prepare for the day and to look forward to the next 1-2 days to ensure an excellent experience by patients and team members

Private area with sufficient space

Identify 1-3 huddle champions in your specific organization to review this information and start the daily huddle process with the broader team

Encourage staff to provide feedback for improving the huddles and ensuring their value

Huddle Best Practices

Determine Timing and Frequency

Good - First thing in the morning for 5 to 8 minutes
Better - Morning and afternoon huddles
Best - Every change of shift or every 4 hours

Clear Roles and Responsibilities

Good - Everyone participates - Providers, Clinical, and Non-Clinical Team Members
Better - Provider or practice leader facilitates
Best - Everyone takes turns facilitating huddles

Defined Agenda

Good - Defined agenda for each huddle
Better - Use technology to identify patients with specific needs
Best - SBAR format for huddle conversations

Topics Covered

Good - Address patient and day’s schedule
Better - Address schedule, staffing, call backs, gap closure, patient needs
Best - Close with things that we need to know, change, and do differently

Huddle Agenda Template

Use the Daily Huddle Agenda:

Agenda:
- No Shows and Cancellations from the pervious day
- Today's Patients
  - Staffing and capacity
  - Patients with chronic conditions
- Tomorrow's Patients
  - Follow-up on test results and consults
  - Outreach based on clinical complexity
  - Orders needed to be entered

Pre-visit Planning and Implementation

10 STEPS TO SAVE TIME, IMPROVE CARE, AND INCREASE SAFETY

Re-appoint the patient at the conclusion of the visit
Use a visit planner checklist to arrange the next appointment
Arrange for laboratory tests to be completed before the next visit

Perform visit preparations
Use a visit prep checklist to identify gaps in care
Send patients appointment reminders
Consider a pre-visit phone call or email

Hold a pre-visit care team huddle
Use a pre-appointment questionnaire
Hand-off patients to the physician

Process and Operations Considerations

Providers dedicate time to review medical records

Demonstrate to patients that their visits were anticipated

Conduct post-visit calls

Determine when and who will make the call and an escalation process for immediate needs

Ensure office staff knowledgeable of test results time frames

Help staff in managing patient expectations

Offer patients simple and thorough printouts/handouts

Detailed, easy-to-read information on referrals or medication including pharmacy instructions

Conduct daily huddles

Day-of, pre-visit planning to align office staff and providers

Potential Challenges

Setting aside dedicated time to review medical records
Conducting post-visit calls
Referral process
Coordinating with other providers
Alignment of office staff and providers

Care Coordination Needs Solid Processes

Referring Provider

Needs to understand:

Who to refer patients to
How long is the wait to be seen
What information is needed for any prior authorizations
Medical group referral
How to follow up on referrals

The Patient

Needs to agree:

The referral is the best treatment option

Needs to know:

What they need to do
Find their own specialist?
Schedule their own appointment?
Work with their Health Plan to get prior authorization

Specialist

Needs to have a process for:

Getting referrals
Getting information back to the referring provider

Need to assure:

Prior authorizations have been completed

Need a process for:

Scheduling an appointment with provider and/or additional services

Patient Facing Behaviors

To prepare for the day and to look forward to the next 1-2 days to ensure an excellent experience by patients and team members

Consider effects on whole person and their needs, not just the disease, "Which of the options that we just discussed work best for you?”

Avoid - “We’ll let you know if there is a problem.”

Instead - “Let’s plan to connect either by phone or in person when your test results come in. It usually takes about two days for those to come back. I will have staff schedule that for you.”

Follow-up and follow-through on commitments to patients and family, “We will help you schedule cardiology appointment with Dr. Smith. It may take 4-6 weeks to get an appointment and that is OK. Call the office at this number if you have questions or anything changes before your appointment."

Care Coordination Checklist

Use a checklist to assure patients get all needed information at the end of their appointment

Instructions about where to direct questions arising post-visit
Provide reminders of upcoming appointments
Summarize their care plan overview, invite questions, and validate understanding
Show them how to access the portal and inform them about how it can be used
Reminding patient of symptoms to watch for should a problem worsen

Appointment Action Steps

BEFORE APPOINTMENT

Offer convenient appointment times by keeping blocks of time open for same-day, weekend, and early morning/evening slots
Consider offering telemedicine service (by phone or video chat) as alternative to in-person appointments
Confirm appointments with patients one day prior to visit by text message, a live call, or an automated call messaging system
Provide options for registering in advance either by a patient portal or set up an online scheduling system so patients can provide their information before coming in
Have patients’ records ready and reviewed, and obtain any prior authorizations ahead of visit to expedite care
Notify patients early if long wait times are expected or if there are any last-minute requests for lab work

DURING APPOINTMENT

Do your best to see patients within 15 minutes of their appointment time
Review patients‘ prescriptions, make sure they understand the importance of their medications, and alert them of any possible adverse drug interaction
Communicate when patients’ test results will be available and set reminders to review results with patients in a timely manner
Ask patients if they have any questions or concerns regarding their care

END OF APPOINTMENT

Immediately schedule patients’ follow-up appointments to ensure continuity of care
Account for specialist care by making sure specialist appointments were made or help patients schedule appointments if needed
Encourage patients to use the patient portal, which lets them access their health records and ask providers questions
Share health records with patients’ other providers to keep everyone up-to-date

MARKETPLACE SURVEY QUESTIONS

In the last six months, when you visited your personal doctor for a scheduled appointment, how often did he or she have your medical records or other information about your care?
In the last six months, when your personal doctor ordered a blood test, X-ray, or other test for you, how often did someone from your personal doctor’s office follow up to give you those results?
In the last six months, when your personal doctor ordered a blood test, X-ray, or other tests for you, how often did you get those results as soon as you needed them?
In the last six months, how often did you and your personal doctor talk about all the prescription medicines you were taking?
In the last six months, did you get the help you needed from your personal doctor’s office to manage your care among these different providers and services?
In the last six months, how often did your personal doctor seem informed and up-to-date about the care you got from specialists?

Patient Experience Learning Series

Exceptional Patient Experience Made Simple

CAHPS® (Consumer and Access Availability Assessment of Healthcare Providers and Systems), QHP (Qualified Health Plan) Enrollee Survey, and Access Availability

Provider Impact

Access and Availability Impact

Marketplace Survey Questions

Timely Appointments Care and Information

Essential Behaviors

Processes and Operations

Talking Points for Providers

Communicate with Courtesy, Respect, and Listening

The Art of Caring

SCIENCE

ART (HEART)

Essential Behaviors

Access and Telehealth Appointments

Same Day Appointments

Risk of Cancellation

No Show Appointments Opportunities

Improve Access and Utilization

Expand Telehealth For Routine Care

IT’S MORE EFFICIENT

TAKE THESE TASKS OFF YOUR LIST

Increase Appointments, Efficiency, and Revenue

Revenue Changes

Medication and Telehealth

Commitment to Best Practices

CHECKLIST

Enhanced Observation Checklist

Wait Lists

Expand Use of Telehealth for Routine Care

Non-Traditional Hours of Practice

Incorporate Access Talking Points into Standard Operations

Assessment or Tools Selected

CHECKLIST

Attend CAHPS Provider Summit

Social Media Analysis

Deep Dive of CAHPS Top Box Data

CAHPS Provider Training

Provider Facing Customer Service Training

Performance Improvement and CMS QHP Survey

ACTIONS TO TAKE

Communicate with Courtesy, Respect, and Listening

Personal Doctor Communication Survey Questions

Talking Points for Providers

Communicate with Courtesy, Respect, and Listening

The Art of Caring

SCIENCE

ART (HEART)

Essential Behaviors

Behaviors, Processes, and Operations

BEHAVIORS

Patient-centered communication techniques

Use reflective communication techniques

Speak in simple language

Allow family members or caregivers to play and active role

PROCESSES & OPERATIONS

Visual Aids

Written Material

Communicate Data

Power Listening with Empathy

Raise Your EQ (Empathy Quotient)

Build an Empathy Statement

Sticky Teachable Moments

THE TEACH-BACK (PARROTING) METHOD

In Less than a Minute

Did you know?

Go-to Communication Approach

WHAT’S YOUR STYLE?

Exceptional Patient Experience Made Simple

Courteous, Helpful Staff

ESSENTIAL BEHAVIORS

Patient Enters

Use the 15/10 Rule

Give Patients Instructions

Train Staff NOT to multitask with patients

PROCESSES AND OPERATIONS

Cross Training

Digital

Hassles

CAHPS^® (Consumer and Access Availability Assessment of Healthcare Providers and Systems), QHP (Qualified Health Plan) Enrollee Survey, and Access Availability