| Monday, January 01, 0001
Overall, the "Triple Aim" approach to the improvement of healthcare is sound. In accordance with the concept, physicians are to provide the highest level of care, patients are to have the best possible healthcare experience and the service itself is to be provided at the lowest cost. While the last corner in the Triple Aim triangle is a continuing challenge for physicians (and politicians), this article will focus on the first two, that of physician productivity and of patient satisfaction.
In a Permanente Journal article entitled Patient Experience and Physician Productivity: Debunking the Mythical Dividecontributors describe a preconception which many physicians hold when it comes to "Triple Aim" healthcare as a zero-sum game. That is to say that, for many physicians, the concepts of "patient satisfaction" and "physician productivity" operate like disproportionately weighted participants on a see-saw. Any improvement in one area leads to an overall dis-improvement in another area and vice versa. Essentially, improvement in one area can only come at the expense of another.
A 2012 study conducted by HealthPartners Inc. (St Paul, MN) took this popular physician apprehension to heart as they constructed a study which charted groups of physicians in four specialty departments (podiatry/foot and ankle surgery, gastroenterology, general surgery and vascular surgery) and sought to find correlative behaviors between physicians with "strong" levels of productivity and those with "strong" levels of patient satisfaction. All of the studied physicians worked in a similar environment and under similar conditions, for example, all studied physicians in the field of gastroenterology saw the same kinds of patients, had similar workloads and had the same type of facility and support staff. Though admittedly small in scope relative to the entire healthcare landscape in the country, the study did find some key correlations between physician behavior and patient satisfaction, and found that the two end goals aren't necessarily mutually exclusive.
In her TalkChart article 5 Biggest Barriers to Physician Productivity (Surprise: They're Not All Electronic Medical Charting) Andrea Jacques outlines some of the most frustrating physician "bottlenecks" which put an efficient practice in a daily stranglehold. These obstacles range from so called "schedule busters" in which a steady stream of attention-needing walk-in patients throw off a tightly planned schedule to that of time-intensive patient encounters. For example, seeing elderly patients may take a physician much longer to visit with than a young adult, and if there's a steady stream of elderly patients, it can have a tremendous effect on a physician's level of productivity.
Other factors, like the patient panel size, general workflow obstacles which can come up (such as a new electronic medical records system) and the general disruption of time-consuming, yet important, established routines, can all chew into a physician's overall productivity, and require much time and effort to handle.
When it comes to a quick fix or an easy cure-all for productivity woes, Jacques simply says "there isn't one." The fact is, there will always be changes and variables in the day to day workings of a practice, and there's no sure-fire way to prevent anything from going awry. Streamlined efficiency and productivity is often achieved only after time and a careful evaluation of end goals and some on-the-job practice. However, this isn't to say that the end goal of upping both patient satisfaction and physician productivity is hopeless.
This isn't to say that the end goal of upping two antes is hopeless in a practice though. Improving physician productivity may be a time-intensive practice, but it doesn't have to come at the expense of improving patient satisfaction. At least, that's what the Health Partners Inc. study shows. In a nutshell, the organization plotted studied physicians into quadrants on a scattergram. Strong performers in the quadrant of "productivity" were plotted into one area, while strong performers in "patient satisfaction" were plotted into another, while those who carted weak in both areas were plotted accordingly.
The study found many physicians who excelled in both areas simultaneously and, through further investigation, found that different levels of success on their chart came as the result of different in-office characteristics.
Strong Productivity and Strong Patient Satisfaction Skills
The HealthPartners Inc. study found, among other things, that those physicians who scored high in both areas had a general "personable" relationship with their patients. These physicians were adept at conveying warmth from the beginning of a visit and could deliver cogent information clearly and in a controlled manner. These physicians also put a high premium on "teaching" their patients, giving them adequate time to ask questions while ensuring that their own explanations were understood. They proved able to recap a patient's history and could generally be heard beginning statements with "I read your chart..." so as to establish common ground and understanding with their patients. These physicians were described as "confident, but not arrogant," they finished their dictation and coding each day and had clinical staff to enter orders and prepare an after-visit summary where applicable.
Those who scored low in both areas were described with a lack of "being there" emotionally, no smiling, and acting abruptly. They didn't greet patients with handshakes (when culturally appropriate), they made no attempt to match the patient's energy during the visit, they kept patients waiting and wondering and while trying to get a diagnosis, they created a sense of "interrogation."
Not Mutually Exclusive
On the surface, what made high performing physicians chart well with patient satisfaction, is that they put more of a personal energy into each visit. Perhaps this seems problematic to many physicians who hold true to apprehensions like "I can only achieve strong productivity or strong patient satisfaction - I can't do both" or "If I had more time to spend with my patients, I would have greater patient satisfaction." Furthermore, it may seemingly violate the idea that physician productivity and patient satisfaction can't be achieved in tandem, that only by cutting into productivity (i.e. longer patient visits) can they see an upswing in patient satisfaction.
However, the subtext of the study indicates that when patients feel comfortable and that their needs are being addressed with care, they are more apt to report high levels of satisfaction. When they understand what is being said to them, and can see a physician who is not rushing through a diagnosis and an explanation, but who is taking time to go through and address concerns bit by bit, on an emotionally available level, they leave the office feeling empowered and willing to comply. When patients can see that, amidst a busy schedule, a physician is able to address them personably and with warmth, they feel at ease. They speak more fluidly and more easily, they share their own medical histories more willingly, and ultimately, the process is made more streamlined, and ultimately? They're more willing to comply.
Physician productivity isn't strictly related to the number of patients they see every day, but is also a function of the thoroughness with which they provide healthcare. Perhaps breaking out of a routine and implementing a few new measures in each visit will take some time, and may initially cut down on the number of patients they can see each day. It goes without saying that there will always be days in which things don't go according to plan. However, by putting a little bit more into each patient visit, just a few minutes more, what a physician might lose in time, they'll more than make up for in healthy patients, high satisfaction scores and a clear and honest physician/patient relationship with more instances of healthy and complying patients. These all result in higher long term productivity yields in the big picture, as fewer patients will need to come back for non-compliance issues. Productivity and patient satisfaction come together in this equation, as they provide the highest and most efficient level of thorough and personalized healthcare coupled with the best patient experience possible.
Boffeli, Troy J., DPS, FACFAS, Kerri L. Thongvanh, MBA, Sarah Jay Horst
Evans, MA, and Clay R. Ahrens, MHA.
"Patient Experience and Physician Productivity: Debunking the Mythical
Divide at HealthPartners Clinics." The Permanente Journal. The
Permanente Journal, Fall 2012. Web. 14 Oct. 2013.
Jacques, Andrea. "5 Biggest Barriers to Physician Productivity (Surprise: They're Not
All Electronic Medical Charting)." TalkChart.com. Talkchart, 26 Apr. 2013.
Web. 14 Oct. 2013.
Wilkins, Stephen. "Physicians With High Productivity And Satisfaction Scores
Employ Strong Patient-Centered Communication Skills." Physicians With High
Productivity And Satisfaction Scores Employ Strong Patient-Centered
Communication Skills. Smart Health Messaging, 6 May 2013. Web. 14 Oct.
Dylan Chadwick is a graduate of Brigham Young University where he earned a Bachelor of arts in English and a minor in Spanish. Though spending his formative years in Cardiff Wales, he came to adolescence in Elizabethtown Kentucky, and considers it his home. He received the Eagle Scout Award, served a voluntary humanitarian mission to inner-city Los Angeles from 2007 to 2009, and once met Alan Alda on a golf course. He's an avid writer who cut his teeth contributing to student papers and continues writing for various print magazines, blogs and web resources. A ravenous fan of baseball, rock music and Dan Aykroyd-era Saturday Night Live, he plans on one day utilizing these interests in a Masters degree in American Studies and Literature. He also maintains a freelance illustration company on the side.