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Patient and provider satisfaction outreach in therapy clinics: An expert speaks

Part B News recently reported on how patient and employee outreach efforts, which some managers treat as nice-to-have extras, can actually improve practices’ bottom line and care performance. We talked to occupational therapist Rafael E. Salazar II, MHS, OTR/L, and president & CEO of Rehab U Practice Solutions, about patient and provider outreach in the therapy world, particularly as he experienced it while working at the Charlie Norwood VA Medical Center (CNVAMC) in Augusta, Ga. in the Rehab Service Line in the outpatient Specialty Clinic, treating veterans and coordinating clinical education for the occupational therapy department. Here are some of his thoughts:

On surveys, their uses and limits. There is a good article published [in the Oman Medical Journal] in 2014 that showed a positive impact of patient satisfaction surveys on the quality of patient care delivery. Part of this is that patient satisfaction reflects a patient’s subjective sense of their involvement in decision making and their role as “partners” in improvement of the quality of the healthcare service.

Your patients want to feel valued, heard, and listened to. In the rehab world we talk about building a therapeutic relationship (or building rapport) – you see the patient two, three times a week for weeks on end, so building trust is huge.

But if all you plan to do is run a patient satisfaction survey, it won’t be much benefit. You should have a full quality improvement system where you’ll end up with actionable quantitative data. With pre- and post-treatment surveys, you should be able to say, “Scheduling gets a lower score,” “referrals take too long,” “patients say not enough manual therapy,” etc.  You should notice consistent trends that can be used to formulate a comprehensive performance improvement plan.

Defining relationship-based care. During my time at Charlie Norwood, I was selected for a leadership development program. Part of that program involved project management and implementations. I was assigned to the project on “relationship-based care.”

In order to improve patient responses, you start with culture of the staff, fostering open communication lines between departments. The idea is to create a work culture where everyone is aimed at the same higher purpose, and are there to support each other in working towards that end: Building trust between clinicians, staff, and departments to improve not only patient satisfaction, but ultimately the quality of healthcare delivery.

At the [Veterans Administration] we had reps for each department that met every week… Meetings involved the leadership [team]. Basically, we spitballed ideas, an informal process. Then we brought it to the service line chiefs who would draft a policy.

What were the friction points? We had friction over the timeliness of referrals from a certain department. Procedural norms included wait times that seemed very arbitrary before you got a referral — all patients had to go through a course of one kind of therapy before they could get to [orthopedics], which made patients feel like they were on a hamster wheel, because they had to take a roundabout way.

Through our meetings, we got the rehab and the ortho specialties departments to examine those policies and begin to change them in a way that made sense for everyone. Instead of a blanket 6-8 week therapy rule for ortho referral, we came up with a case-by-case basis, under which some patients might go to ortho first for an injection or even surgical repair.

Recommended: Simon Sinek’s Leaders Eat LastSinek writes a lot about how building a work culture around trust improves employee engagement, productivity, and the quality of the work — the idea being that, in a competitive market, there is enough danger in the outside world from other competing firms, organizations, etc., and if you add on top of that the idea that employees need to “perform” or “outperform” their colleagues in order to prevent layoffs, then employees spend most of their productive time covering their own tails rather than doing top-quality work.  

Sharing a common vision. If you’re a therapist and you’re treating shoulders all day, you might get to think it’s just another shoulder or whatever, but it’s different if you’ve been sold on whatever the vision is.

At the VA, the theme was “serve those who served us.”  When that purpose or mission is the focus, you’re not there to “treat shoulders,” you’re there to help them throw the baseball with their son; that higher purpose affects how the clinicians treat the patient. For other healthcare clinics or organizations, it may be “to help people get back to doing the things they love,” or “helping people recover from heart surgery,” or whatever it is.

But at the end of the day, your clinic or organization needs to have a higher purpose or mission — not just to write down in a business plan or some marketing brochures. That purpose needs to be regularly and confidently articulated, both to employees and to patients/potential patients; and it should be consistent. Everything that the clinic or organization does should point to that purpose. If you do that, then patient satisfaction is a natural progression, because it will help your clinic/organization better achieve that purpose.

Blog Tags: quality of care
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