The University of Patient Satisfaction

22 Partners | January/February 2012

THE UNIVERSITY OF PATIENT SATISFACTION

ne recent Tuesday morning, managers, directors, frontline staff and some physicians gathered in

a garden-level room at the University of Toledo Health Science Campus. Though they were there to hear about statistics and watch a PowerPoint presentation, the meeting had the air of a religious revival meeting.

“Extraordinary times take extraordinary people, and you are those folks!” Ioan Duca, the service excellence officer for the University and its Medical Center, exhorted the crowd. “In the last six months, our HCAHPS global dimensions have moved from the 50th to the 62nd percent. We are so close to our goal! So take charge of your area, take a look at your Press Ganey

questions, at your HCAHPS questions. Have a very simple plan of action. Communicate the plan day in and day out. Devote 10 hours every month to patient satisfaction. Work with every single patient. Be nice to patients, to one another, to yourself. Can we do this, folks?”

Some murmurs of “yes” came from the crowd.

“I didn’t hear that. Can we do this?” Duca asked again.

“Yes!” came the reply, much louder this time.

There is method to Duca’s madness. He has been attending some unusual events to enhance his already well-developed ability to proselytize, including a local church and Texas A&M University’s freshman orientation, a

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The University of Patient Satisfaction

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23Partners | January/February 2012

total cultural immersion that Duca says leaves students “Aggies for life.”

“I am really focused on creating a church-like environment here,” he said in an interview later that day in his office at the University of Toledo Medical Center (UTMC). “We want a total cultural transformation. I want that Disney-like experience, the Ritz Carlton experience, the Texas A&M experience. I want that kind of true belief. When people really believe in something, they will risk everything to get it done.”

Duca’s role has expanded to encompass a patient satisfaction and student experience improvement initiative involving 9,000 employees and 27,000 medical, nursing and other students.

The centerpiece of the project is iCARE university, which stands for communication, access, respect and excellence. iCARE has coursework and hands-on training in patient satisfaction for everyone at the University.

The larger initiative includes a weekly patient satisfaction lineup meeting attended by leaders and representatives of all departments.

“What we are doing here is a first of its kind across the nation, where you have a hospital within a university and the university, itself, targeting cultural transformation,” Duca said. “We are shaking this place up, top to bottom.”

HCAHPS “RATE HOSPITAL 0-10” 2011 DATA BY MONTH


THE UNIVERSITY OF PATIENT SATISFACTIONCOVER STORY

He came to Toledo after leading a similar transformation at Oakwood Healthcare System in southeastern Michigan. Bryan Hinch, MD, an assistant professor of internal medicine and pediatrics at the UT medical school, worked at Oakwood right after his residency, and was impressed by Duca’s efforts there. “I came in after everything was better. You got a sense of mission starting right away at orientation. Everything was very patient-satisfaction-oriented. When I left to go work at other organizations, I started to see what the real world was like without that focus. So I was glad to see Ioan come on board here at UTMC.”

A New Mission

The project in Toledo really dates back more than a year and a half, when senior executives of UTMC looked at the organization’s dismal patient satisfaction scores and decided to do something about them. They traveled to The Dalles, Ore., to meet with officials at Mid-Columbia Medical Center, the first hospital to fully embrace the patient-centered Planetree philosophy. They had Mid-Columbia’s former CEO, Mark Scott, the author of the book, The Courage to Be First, come to UTMC.

“We were told this is a three-year journey to turn this thing around,” said Scott Scarborough, PhD, the medical center’s senior vice president and executive director. “Things really got moving only a year ago when we brought in the best patient experience director we could find in Ioan Duca.”

In Duca’s first week on the job in November 2010, he joined into a special event called “A New Day,” where the new mission of patient-centered care was announced by Scarborough. Part of the event was to unveil a common uniform – scrubs with the university’s colors. “We wanted to look more professional and more like a team, not people with SpongeBob Square Pants scrubs,” Duca said.

The UTMC project dates back more than a year and a half, when senior executives looked at the organization’s dismal patient satisfaction scores and decided to do something about them.

Scarborough said the challenge for UTMC is to match its stellar reputation for clinical quality with an equal reputation for customer service. “We have always had great clinical outcomes, and recently we received an honor from U.S. News and World Report, which ranked us No. 1 in the Toledo area, but our patients sure weren’t seeing us that way. We looked at where we stood in the state of Ohio, and we were 140th out of 147 hospitals on HCAHPS. We were saving people’s lives, yet they were walking away angry. We had to learn how to save lives and still treat people like human beings.”

To further signal its change of approach, UTMC rewrote its mission statement from a full paragraph to just one sentence: “Our mission at the University of Toledo Medical Center is to improve the human condition by providing patient-centered, university-quality care.”

Inside the ‘University’

iCARE University is housed in a new training facility that includes a small classroom, a medical exam room and a simulated business office. In the exam room, clinicians are evaluated on their active listening, the effectiveness of their efforts to reduce anxiety, their clarity of communication, and their ability


to focus on the patient, not their own stress. In the office, registration staff and others who greet patients on arrival at the hospital or ambulatory care clinics are evaluated on some of the same skills.

Joseph Schiavone, a service excellence specialist and one of three people responsible for hands-on training, said his department kicked things off with the basics, teaching about HCAHPS, Press Ganey scores and value-based purchasing. “We set the table, so when staff members go to the weekly lineups, they know what is going on,” he said.

Training modules are customized based on the needs of each department. “We looked at what is appropriate communication with a patient and what isn’t, what constructive criticism of each other looks like,” Schiavone said.

Currently, the AIDET (acknowledge, introduce, duration, explanation and thanks) process, a form of scripting that guides each patient interaction, is being rolled out across the hospital. The service excellence team is layering on additional scripting.

“We have always had great clinical outcomes … but our patients sure weren’t seeing us that way. We were saving people’s lives, yet they were walking away angry. We had to learn how to save lives and still treat people like human beings.”

Scott Scarborough, PhD

Senior Vice President and Executive Director, UTMC


THE UNIVERSITY OF PATIENT SATISFACTIONCOVER STORY

Action Plans Unfold

On the floors, the nursing staffs are buying into the iCARE process, says Kelli Chovanec, RN, MSN, assistant nursing director on the orthopedics and rehab unit. Her team has fostered the mentality that everyone is responsible for every patient. “We take frontline staff at least once to the weekly lineup. We have really interactive, good discussions about what patient-centered care really looks like.”

The unit has a specific action plan around two HCAHPS questions – communications about medications and response of hospital staff. Nurses use scripted language when speaking about medications during administration, provide clear and concise descriptions of the drugs, discuss potential side-effects, avoid use of confusing medical terminology, and always end with, “Do you have any questions about your medication?”

There is hourly rounding, with nurses taking even hours, aides doing odd hours. All have scripting cue cards in their pockets.

“Accountability is a huge part of changing our culture,” Chovanec said. “We personally investigate every single patient issue that arises, and we do pull nurses in. We also evaluate every staff member and rate them high, medium or low on customer satisfaction. We did one-on-ones with lower performers and told them, ‘Hey, you have to raise the bar.’ ”

Changes Everywhere

The changes under way at the campus – which has three hospitals with a total of 320 licensed beds; a Level One trauma center; centers devoted to orthopedics, cancer and rehab care; and numerous clinics – are also physical. About $50 million is being spent over the next few

years to renovate the main hospital entry area and create all private rooms. A new food service vendor was brought in, and the medical center is hiring its first executive chef. At the front door, a new, more customer-centric valet service is provided.

“We even worked with our volunteers to make sure the friendliest people greet you inside the door,” Duca says. “More than anything, you just see a difference in how employees look. They used to look down when they walked, now they are looking up.”

Ioan Duca wants to create a church-like reverence for customer satisfaction at UTMC.

Scarborough stresses that the changes have to emanate from the top. “Part of my role and responsibility is to ensure that people know my emphasis on these issues. In every talk I give, I lend my voice to what Ioan is doing, giving him the verbal support he needs to move the mountain that he is being asked to move, creating the environment in which he can be successful.”

Bringing in the Docs

Duca is now zeroing in on physicians. He has done one-on-one sessions with almost all of them about the basics, including the validity of Press Ganey data and the fact that HCAHPS is now tied to Medicare reimbursement under the Hospital Inpatient Value-based Purchasing Program.

He is now moving on to the next phase, where each physician is receiving his or her individual scores. “A lot of them are in shock, saying, ‘Are you kidding me? This is me?’ My answer is, ‘Yes, that is you, now let’s work on how to fix that,’ ” he said. The next phase of iCARE is targeted education aimed at physicians, with modules being developed.

Scarborough has been pleasantly surprised that it has been a fairly easy sell thus far to get physicians to buy into the patient experience. “We could see a little more resistance once we push them on the training in iCARE University, but so far, they are more resistant to the electronic medical record than they are to improving the patient experience.”

UTMC’s most recent union contract builds in incentive compensation tied to improvements in HCAHPS scores. “Ultimately we are going to judge everybody on how they meet the two parts of our mission statement – quality care and patient satisfaction,” he says.


buy into the ideology, who see this place as sacred, a part of their lives and not just a job, is key. Look, this is not some Hallmark concept, not about teaching people how to smile and say hello. It is not even about giving someone the right drug or how well they recover from surgery. It is about treating the entire person; it is about the environment in which we treat them. When you walk in and show some compassion, every single human being, even the meanest person, will react well to that. That is medicine at its best.”

With a wry smile, Duca referred to another key initiative: strategically beginning to incorporate patient satisfaction into the University’s medical school curriculum. “As part of a week-long course as a bridge course from second year of med school to the third year, we also taught on key patient satisfaction concepts as well as the overall patient experience. The vision is to develop a unique patient satisfaction curriculum, with a course every year of medical school. And I will love to teach those classes.”

Not all of the selling of patient satisfaction has gone smoothly. Duca says that some staff have chosen a different career path because they “simply couldn’t hack it” on patient satisfaction. “Investing into and hiring the right people, who

At a recent weekly patient satisfaction meeting, Duca (with mic) honors food service workers for their efforts to improve the quality of customer service.

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The University of Patient Satisfaction

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