Magical facts about patients satisfaction and pearls of medical practise::Doctor-Patient Relationship & Medical Professionalism dr.sandeep c agrawal agrasen hospital gondia india

Dr.Sandeep C Agrawal Agrasen Hospital Gondia India www.agrasenortho.com!

Patient Satisfaction and Pearls of Practise

Doctor-Patient Relationship & Medical Professionalism

Magical Facts

About Patients Satisfaction That you would die to know

Dr.Sandeep Agrawal

Consultant Orthopedic Surgeon

MS,DNB

Agrasen Hospital

Gondia

Maharashtra

India

[email protected]

!www.agrasenortho.com

!09960122234

http://www.agrasenortho.com

mailto:[email protected]







Behave Professionally



Practise management skills

Every doctor is an entrepreneur !

Needs to run a business !

These skills are never taught in medical college !

Some doctors never learn them and struggle to manage their practise



Patients satisfaction

Satisfied patient 3 other people !

!

Dissatisfied patient 20 others !

Satisfying unhappy patients 50 others



Medical Professionalism : Deprofessionalism Causes

● Technology – Depersonarlise medicine & deprofessionalise a physician !

● Corporatization of Medicine !

● Specialization – Most patients identified by disease rather than human beings who happens to have disease !

● Patients knowing limitation of modern medicine !

● Greed



Being a doctor today is not easy

!

too much work too much hassle too much competition too much despair; and too little reimbursement ?



Physician motivatorsIntrinsic

Serving people Work interest Career growth

Ability to support oneself & family Autonomy

Empowerment Socio-cultural

Respect Social rewards



Physician : lets take lead

● Leadership – genes, charisma, education, wealth, luck, training, experience

Ethics do right

!

Reality Greatness vision Have no think big & new Illusion

Courage act with sustained initiation



Patient Autonomy

Autonomy = freedom to decide !Doctors need to : 1. present the options to the patients and 2. allow patients to choose for themselves !Informed choice means patients need

information



Educating patients

Most doctors do not spend much time educating their patients

!Primary role of a doctor should not be

merely treating an illness, but helping people remain healthy

Patients are the practise !

Everything else is just paper work !



Benefits of patient education :

Happier patients

practice promoter

Increase patient compliance

Improve public health

Overall :Helps to improve empathy

Reduce risk of complications



Communication skills

“ Patients don’t care how much you know them, until they know how much you care”



Communication skills in clinical practice :

“Its an art to talk medicine in the language of a non medical men” !

✓ separates successful doctors from unsuccessful ones !

✓ include ability to engage with patients

at emotional level, to listen, to convey

information with clarity & sympathy



Patient education – key component of informed consent

Don’t tell the patient what to do Present the information and the

treatment options – and allow them to make up their own mind ! Empower patients with information –

they will respect you for this !

Information therapy - “ Prescribing the Right Information to the Right Person at the Right Time” is

the best way of bridging the doctor-patient communication gap today !



Start your own website !

Patients are hungry for reliable information Internet :Excellent source of

information, but this can be wrong and dangerous !Provide reliable information to your

patients through your own website Very cost effective !

Think global – act local !



Improving Doctor-patient relationship

Based on TRUST Trust needs to be earned ! !Patients feel exploited and believe

medical profession has become crass and commercialized Doctors feel unappreciated,

overworked, victimised and threatened.

Foundation of the relationship



Become a Professional – Trust Equation

T = C + R + I/ S, where T = Trustworthiness C= Credibility R= Reliability I = Intimacy S= Self-orientation



Become a Professional – Trust Equation

Credibility =patient trust what you say ? Reliability = he trust your actions,

confident that you will act honorably ? Intimacy = is he comfortable discussing

his feelings and emotions with you ? Self-orientation = can he trust your

motives, knowing that you care about him, and will act in his best interests ?



What do patients want

- Patient dissatisfaction relate to problems of communication rather than clinical competence !

- They want ● - quality information about their problems ● - risks & benefits of treatment ● - relief of emotional distress ● - to be active participate in medical

decision making



Educate All Informations to Patient



Benefits of doctor patient communication

- communication with personal touch provides treatment beyond drugs !

- Patients more likely to comply !

- Overall quality of care & patient satisfaction improved



Answering skills

▪ weakest communication skills among Indian Medical Professionals !

▪ In Indian context patient satisfaction is largely decided by the quality of answers & explanation given by doctors !

▪ Understand the question clearly, answer fully, & clearly but briefly !

▪ Avoid major technical terms



Barriers to communication

● Work over load on doctors !● Shortage of man power- less time for

individual patient !

● Lack of training in communication skills during medical education !

● Individual attitude & personality traits !

● Under utilization of paramedical staff



Communication

● 7% - Spoken words !● 38% - Voice quality like Tone, Tempo,

intonation !● 55% - Body language





How do we fix the problem ?

Two players: Doctors Patients !

It’s hard to change anyone else – you can only change yourself !



Today’s Health Care System

Patient

Health Insurance

Government

!!

Information Overload

Media

Doctor








Patient Experience is all about bottom line

LEAST PROFITABLEQUARTILE

MOST PROFITABLE

QUARTILE

PATI

ENT

SATI

SFAC

TIO

N

1 2 3 4

82.2

83.583.7

84.3

!In research conducted by Press Ganey, hospitals were divided into four groups (quartile) based on their profitability. !The least profitable hospitals had the lowest patient satisfaction scores (out of 100 points). The most profitable had the highest patient satisfaction !!

Source: HFM Magazine, 2008 : Looking to improve financial results ? Start by listening to patients : By: Melvin F Hall PhD

As patient satisfaction increased, the average hospital profitability increased

Without a quantifiable link to profits, the push for patient satisfaction is based on nothing more than the moralistic view that “it’s nice to be nice”











Patient Experience is a lot more than clinical outcomes

How well staff worked together to care for me

Overall Cheerfulness of the Hospital

Response to concerns/complaints made during my stay

Amount of attention paid to my personal and specific needs

Staff sensitivity to the inconvenience of hospitalization

How well nurses kept me informed

Staff’s effort to include me in decisions about my treatment

Nurses attitude towards my requestsSkill of the nursesFriendliness of the nurses

Press Ganey Satisfaction Report , August , 2003

0.79

0.74

0.68

0.650.65

0.64

0.64

0.640.630.62

When hospitals spend most of their efforts in clinical results & process improvement, their data are defined by outcomes and thus can be measurable objectively.

!! Patient however,

judge quality by his/ her perceptions, something that is subjective and cannot be verified in the same way as outcome.

!


Patients expectations from their doctors ?

Expertise ( be well-informed and uptodate) !Professionalism – look out for the patient’s best interests !Accountability – be answerable; say Sorry ( if there is a mistake) !Transparency – no unnecessary tests and referrals !Respect their desires and their time !Treat them as intelligent human beings



Types of Patients


If you can’t measure, you can’t manage

2 3 4 5 6 7 81 90 10

Never Absolutely

Detractor Passive Promoter

Detractors are customers with the lowest rates of repurchase and referrals. Detractors spread negative word-of-mouth comments about the company

Passively Satisfied customers stay with a company more due to inertia than true loyalty

Promoters have the highest rates of repurchase and referral.

THE NET PROMOTER SCORE

It’s all about word of mouth

!!

0

100

200

300

-100

-200

AVERAGE CUSTOMER BASE

AVERAGE CUSTOMER BASE

RETENTION

MARGINS

ANNUAL SPEND

COST TO SERVE

Economic benefits

NEGATIVE WORD OF MOUTH

! COST TO SERVE

ANNUAL SPEND

!MARGINS

! RETENTION

Economic penalties

Patients who spoke bad

Patients who spoke good

POSITIVE WORD OF MOUTH

Each one point decrease in satisfaction is associated with a 6% increase in complaints Stelfox, et. al. (2005) AJM 118

What’s bad about good service quality

A satisfied person has no story to tell. Everything went just as expected. It is the unexpected event that makes a stay memorable. !For every loyal customer, there is usually a special story

!Fred Lee , Author of award winning book If Disney Ran Your Hospital

Touch Point 1

Touch point 2

Touch point 3

Touch point 4

Touch Point 5

Touch Point 6

Touch Point 7

TO

UC

H

PO

INTS

What made them feel bad and at

which touch point?

What created tears of joy and at which touch point did that happen ?A good story to tell

A bad story to tell

Satisfied Person

Hyper Satisfied Person

Dissatisfied Person


5 Things that Matter Most to Patients

1. Doctors treat patients with courtesy and respect.

2. Doctors explain the facts in a way that patients can

understand.

3. Doctors, nurses, and other hospital staff do everything

they can to help patients with their pain.

4. The hospital room and bathroom are kept clean.

5. Patients get information in writing about symptoms or

health problems to look for after they leave the

hospital.



Patients’ Expectations

• Experience + Needs + Communication = Expectation

!

– If Perception exceeds expectations: Satisfaction !

– If Expectations are less than perception: Dissatisfaction



Patient Satisfaction: GREET Tool

GREET – 10/5 Rule: At 10 feet acknowledge; at 5 feet greet/speak – Call patient by name (If known) – Make eye contact , Smile – Let the patient(s) know they are important

RECOGNIZE – Welcome them to Hospital – State your name, department, & role in the patient’s care

EXPECTATIONS/EXPLAIN – How long a procedure or test will take & why… – How long a patient should be expected to wait before getting results & why…

EDUCATE – Explain the role of medical staff involved in providing care – Explain if the test or procedure will cause pain or discomfort, or if any post procedure instructions

are necessary – Offer to answer any other questions, concerns, or resolve any complaints… you do have the time

THANK YOU – Let your patient & family members know “Thank you for choosing me for you healthcare needs!” – Exercise courtesy by using words “Please” and “Thank You” in conversions



○ Mayo Clinic conducted a research involving 192 patients and conclude that a model doctor should be:>>

EXPECTATION OF PATIENT FROM DOCTORS

○ CONFIDENT ○ EMPATHETIC ○ HUMANE ○ PERSONAL ○ FORTRIGHT ○ RESPECTFUL ○ THOROUGH









Factors Influencing Patient Satisfaction



BalancePatient experience = service quality + clinical quality

Service Quality

Clinical Quality

Interpersonal skills/ Communication

• Engagement • Empathize • Educate • Enlist

Clinical Knowledge/

skills • Find It • Fix It

Adapted from Institute for Healthcare Communication

Process Skills • Technology • Process Improvement • Care Coordination

Patient Experience





Be a Committed Professional

• Staying Work-Focused. Not letting your private life needlessly have an impact on your job, and not spending time at work attending to personal matters.



Good Doctor Skills



Be you are remembered for Principles and Integrity







What do doctors expect from their patients ?

Patients will: !• Treat Doctor with respect • Will say “Thank You” when things go well • Will have realistic expectations of treatment • Will not unfairly blame doctor anytime

there is a problem • Will pay their professional fees promptly

and gracefully



Respect others and other Respect you

• Respect For Others. Treating all people as if they mattered is part of your approach.



Having Positive Attitude - Benefits

!• Pleasing personality !• Energizing !

• Inspiring !

• Problem Solving !• Increase work output ! ! - 85% Attitude - 15 % Intelligence & knowledge of specific facts $ figures



Elements of success Attitude

SkillKnowledge



Be Confident

• Be confident. Others will sense your confidence when they see or meet you, and they will think better of you. Also, if you always wear a sly smile, like there is a joke you get but no one else does, people will think you are above them in your knowledge



Non-verbal communication - SOFTEN

S- Smile O - Open posture F- Forward lean T – Touch. This is a privilege – use

it ! E – Eye contact N - Nod

Polish your bedside manner

How to perfect non verbal signal



How to talk to your doctor –SAFEly !

Story: Symptoms

Assessment: Problem

Fears: Overcome Patients fears by Discussion

Expectations: What patient want from doctor ?

Patients don’t care how much you know – until they know how much you care !



BATHE technique

B = Background. What’s going on ? A = Affect. Feelings. What do you feel about it ? T = Troubles. What troubles you about this ? H = Handle. How are you handling this ? E = Empathy. It must be hard.



Joy of practising medicine – how to be a happy doctor

When it comes to getting positive feedback, no profession in the world comes close to medicine !



Employees !

Can be your biggest asset – as well as your biggest problem ! Keep your employees happy, and they will

keep your patients happy Don’t skimp on their salaries Train them well Key test – how well does your clinic run

when you are not there ?





OPD SUBUNITS:





Many other issues

Time management Learning to keep upto date How to buy medical equipment How to keep medical records How to grow and expand Balancing family and career Retiring Ethics



Communicating prognosis, hope & risk

➢ Misunderstandings in these areas can lead to patient dissatisfaction & litigation !

➢ Prognostication is like weather forecasting uncertain but based on sound scientific principles

Stage of illness at presentation of patient! Curability of disease!

!➢ In face of uncertainty there is nothing wrong with providing hope

!➢ Provide evidence based risks

!➢ Never create guilt for negligence on part of patient



● If too many anxious attendants, send them one or another job. eg. Bringing medicines, arranging blood- Energy utilization

!● Never argue with attendants !● Argument will trigger them, at the same time your calmness and

promptness will even calm down a triggered person. !● If patient is sick, attend patient periodically and talk to

attendants. !● Check emergency tray for drugs. !● Try to solve/resolve crisis immediately

Do’s



Do’s

● Patients should be attended promptly: - Error in Decision making is Excusable but not attending

patients timely is not. !● Identify a Prominent Person: - Important person/relative and explain initial assessment of

patient immediately. - Explain them management has started. !● Ask if they have any questions !● Call senior consultant as per requirement, talk to them

telephonically if possible delay in arrival.



Physicians should Behave Professionally

Physicians are capable of acting unprofessionally, but cannot act unethically, as ethical standards are part of their profession. Therefore, it behoves all patients to educate themselves on what constitutes “professional” and “unprofessional” behaviour for those involved in health care. -



Don’ts

● Never argue with attendants. this situation teaches you how to remain calm in provocative circumstances. No book in the world can teach this.

!

● Never overlook a call, especially if call is by a attendant.



Dealing with mistake

● Accept responsibility for the mistake ● Discuss with trusted friend, colleague

or spouse ● Disclose & Apologize to the patients ● Error analysis ● Measures to reduce similar mistake in

future



!! Identify & avoid negative people

Positive !• Part of the answer !• Has Program !• Let me do it for you !• Difficult but possible !• I must do something !• See the gain !• See possibilities. !• Hard arguments, Soft words

Negative !• Part of the problem !• Has excuse !• Its not my job !• Possible but to difficult !• Something must be done • See the pain !• See problem. !• Soft arguments, Hard words



Be A Optimist• No one likes a

constant pessimist. Having an upbeat attitude and trying to be a problem-solver makes a big difference.



Use common sense with knowledge

Knowledge Vs Wisdom

• Knowledge - Piling up facts Wisdom - Simplifying it !•Knowledge - Potential power Wisdom - Real power !• To attain knowledge - Add things everyday To attain Wisdom - delete things everyday !! !



“ The education of the doctor which goes on after he has his degree is the most important part of his education”

John Shaw Billings

Keeping updated : Managing knowledge



Upgrade the Knowledge or you are Lost

Self-Upgrading. Rather than letting your skills or knowledge become outdated, you seek out ways of staying current.



TRADITIONAL CME Vs CPD



Practice building/Marketing

● Satisfied patients ● Volunteering at community medical service. ● Organizing an event – like conference ● Attracting Media attention ● Contributing article on health to magazine ● Public lecture ● News letter ● Website ● Marketing to referral base



Physicians: problematic spouse?

● Stage 1 -- Romance – you are perfect ● Stage 2 -- Fault finding ● Stage 3 -- Blaming ● Stage 4 -- Acceptance ● Transformation – Growing together



Marriages

● Spend time together ● Respect each other ● Have fun together ● Treat your spouse as your most important

VIP patient -- A loved spouse is also loving spouse



Children

● A meal together everyday ● Fun together once a week ● One holiday every year together ● Make sure children meet grand

parents, relatives periodically ● Help children honour family

traditions



Litigation

● Be a nice person ● Be honest ● Be open ● Be accessible ● Keep up to date professionally ● Insurance

How to reduce chances of litigation



Make connections.

• Make connections. You never know when you'll need to call in a favour from someone to get the job done help in your crisis moments, so it pays to know the right people.



Retirement

● Don’t retire unless you have enough financial security

● Studies-Retirement has Predominantly positive impact on emotional state

● Explore you hobbies ● Explore your spirituality ● Serve other selflessly-do charity work/volunteer

work ● Physical activity/light exercise



Take home

● Let us enjoy being a doctor/physician, let us work for joy of working, nor for a home, car or vacation !

● Don’t find faults in medicine, Identify happy doctor & follow their secrets

!● Lets love what we do, and do what we love !● Watching dying patients should remind us about our

own mortality enabling us to live each day well.



Take Home

● Social capital is more important than financial capital at end of the day.

!● Work & practice with Medical professionalism !● Use common sense. Identify local socio-cultural

practices & integrate in your working style !● People prefer those doctors with average clinical

skills but good communication skills rather than those with excellent clinical but poor communication skills









Never forget Professionalism is an important component of MedicineProfessionalism is an important component of medicine's contract with society. Not only do we need to make good decisions for our patients based on the evidence in the literature, but we need to apply those decisions in a way that is professional and ultimately helps our patient





SUMMARY: Increase Patient Satisfaction

1.Give patient your full attention

2. Build partnership with the patient

3. Maintain positive Attitude!

4. Respect patients privacy!5. Handle complaints effectively

7. Practice good bedside manners

6. Listen to your patients



This presentation is for doctors and students in general. . Graphics,Images and jpeg files are taken from Google and yahoo Image to heighten the specific points in this

presentation. • If there is any objection/or copyright violation, please inform [email protected] for prompt deletion.

• It is intended for use only by the doctors of orthopaedic surgery.

. Views expressed in this presentation are personal. • .For any confusion please contact the sole author for

clarification. • Every body is allowed to copy or download and use the

material best suited to him. There is no financial involvement.

• For any correction or suggestion please contact [email protected] or www.agrasenortho.com


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Magical facts about patients satisfaction and pearls of medical practise::Doctor-Patient Relationship & Medical Professionalism dr.sandeep c agrawal agrasen hospital gondia india