Okay, here we are. Ah, let me move my slides. Okay, this is my disclosure slide. And here we go, session objectives. So this is a brief overview of what we're going to cover in the next, hopefully 15 minutes I've got five key objectives to this talk. We're going to define the patient experience, talk a little bit about why it's important, what are some of the ways in which we can measure the patient experience, what are the factors that influence the patient experience, and finally I'll finish by highlighting some of the interventions we can use to improve. We've entered an era now where surviving your patient experience just isn't quite enough anymore, not dying, although wonderful is no longer the benchmark for a successful patient experience. We really have to raise the bar and truly try and understand what drives patient satisfaction. So the first objective is to define what is the patient experience and at its core, the patient experience encompasses the range of interactions that patients have with the healthcare system so from the very first contact with the physician's office to the valet attendant on procedure day to how we communicate with patients post procedure to share results, and every interaction in between contributes to the patient experience. The patient experience includes all aspects of care, everything from patient safety, clinical quality and service quality. And interestingly, the patient experience isn't always correlated with clinical outcomes. You can have a fantastic clinical outcome and a terrible experience. Understanding the patient experience is a key step in moving toward a model where we really deliver patient centered care. So what are the benefits and why is it important to improve the experience. There are a number of reasons, some intangible others a bit more concrete, some of the concrete reasons include. First, patients with a better experience are more likely to come back to your institution. We know that patients keep or change their providers based on their experiences. Unfortunately, patients are much more likely to share a bad experience and they are to share a good one to the tune of nearly two to one. Second, those organizations with higher patient experience scores report better job satisfaction amongst their employees, leading to less turnover and absenteeism. Third, the data illustrate that lower patient experience scores are associated with a greater likelihood of being named in a malpractice suit. For every drop along a five point scale from very good to poor, translated into a nearly 22% increased likelihood of being named in a malpractice suit. So in a way, the most important factor in predicting who will be named in a suit is the quality of the relationship between the physician and the patient. So, so far you've heard a number of important benefits to improving the patient experience as it relates to the providers and to the organization, but what about for the patient. Overall, an improved patient experience leads to improved patient behavior such as medication adherence and follow up with preventative care, improved clinical outcomes, improved efficiency across the healthcare system, which is defined as fewer ER and urgent care visits, and improved safety. Turns out that institutions who rank in the top quartile of patient experience scores actually report a lower prevalence of inpatient adverse events and documented surgical errors. So what tools do we have to measure patient satisfaction and how are we going to be measuring it. We have formal ways and we have informal ways. In the past, patients relied largely on informal ways, such as word of mouth, but now with technology at our fingertips, we really have a number of ways for patients to report their experience. These tools are all growing in popularity akin to what you're seeing with hotels and restaurants. There are currently more than 50 physician ranking websites, and more than a quarter of patients say they look at them before seeing a patient or even scheduling a visit. Many of us may disagree on the value of these tools but it's critical to note that patients access this information and they do in fact use it to make decisions. One of the most widely used tools in our field is the OAS CAHPS survey. CMS utilizes these surveys to attempt to standardize patient experiences across hospital based and ambulatory endoscopy units. These surveys have been used widely since 2016 and at the moment, and the moment is the key word here, are voluntary. CMS is going to continue to make this survey voluntary through calendar year 2023, but beginning in 2024 participation will be linked to reimbursement, starting with hospital based units and in 2025 expanded out to ASCs. Any hospital based unit or ASC that doesn't conduct and submit OAS CAHPS as part of their quality reporting requirement will see a reduction of two percentage points in its annual fee schedule, which is certainly not insignificant. The survey has three main stated functions. It's designed to produce data from the patient perspective to allow for meaningful comparisons between facilities. It's designed to allow consumers to use that data to make more informed choices when choosing a facility. And finally, you can't improve what you don't measure. So the third function is really to identify a unit's shortcomings and highlight opportunities for improvement. So let's cover it in the survey. The survey is 37 questions long, and it measures the patient experience on topics such as communication and care provided by healthcare providers and office staff, preparation for the surgery or procedure, post-surgical care coordination, and patient reported outcomes. I'm not going to bore you by reviewing all 37 questions in the survey, but for those of you who haven't seen these questions, I think it's important to understand how your facility is being graded. So I'm going to share with you some of the questions that jumped out at me as I reviewed the survey. This is in the domain of communication. You can see that patients are asked whether the doctors and nurses treated them with courtesy and respect, and even whether the clerks and receptionists at the facility were as helpful as the patient thought they could be. And this gets me back to one of my earlier slides highlighting all of the different variables and interactions which impact the patient experience. Preparation for the procedure is another area captured by the survey. Patients are asked whether they received all of the information they needed for their procedure. This is really an opportunity for patients to measure the experience based on whether they got their PrEP instructions. Did they have clear instructions on what to do regarding managing their anticoagulation? Were all their questions related to insurance and cost addressed? You can imagine, obviously, that there is a lot of opportunity for things to go wrong here. Moving into the post-procedure period, patients are going to be asked whether they received written discharge instructions covering symptoms to look out for. Do they know what to do with restarting certain medications? And are they aware of any restrictions when they return back home? The last stated domain of the survey is designed to address patient-related outcomes, which includes an assessment of post-procedure pain and potential complications. And finally, patients have the opportunity to grade their overall experience with very pointed and very direct questions. On a scale of 1 to 10, how would you rate this facility? And would you recommend this facility to your friends and family? Keep in mind that reporting of this data will be mandatory in the very near future and patients will have access to it at their fingertips. So I've shared with you the tools that patients have to measure the patient experience, but what factors do patients report as being the most important to them? Consistently, the most important factors are the interpersonal skills of the endoscopist and the nurses and the perception of the endoscopist's technical skill. So not necessarily how good the endoscopist actually is, but how good they perceive the endoscopist's skill to be. The other factors include, was the patient comfortable throughout the procedure? Did they receive adequate explanation of the entire experience? How did the endoscopy unit itself stack up? And did patients receive timely appointments for their procedure? And on the day of the procedure, did they have lengthy wait times? How do we start? If your unit's not currently participating in the CAHPS survey, how do you get started? The answer is really largely a shift in the philosophical approach to these surveys. We have to move away from seeing these surveys as punitive and embrace them as an opportunity to really improve the care we deliver. This entails making the patient experience a priority for every member of the staff and empowering the staff to positively impact the experience. The greatest opportunity for a successful patient experience places the patient in the center of the care team. And as you've already heard, the role of each and every member of the team is going to impact the care experience. Everything from the upkeep of the facility to the customer service provided by the registration staff matters. So how do you implement and measure success when you're trying to improve the patient experience? In any quality improvement project, it's important to follow some sort of systematic approach. For example, the PDSA or Plan, Do, Study, Act cycle. So plan to develop interventions to improve your most pressing concerns using the data from the surveys you routinely administer and find one area for improvement. So don't bite off more than you can chew. Start by tackling small opportunities for change and incorporate this initiative into your leadership team meetings to get everyone involved and committed to the process. After you have your plan, go ahead, execute it, set it in motion, and implement the change. Then monitor or study it by using smaller surveys to assess the impact of your change. Identify variations within your practice and compare yourself with national benchmarks. Finally, you want to act. What did you conclude from this cycle? This is where you're going to assess what you came away with for this implementation. Did it work? And if it didn't work, what can you do differently in your next cycle to address that? If it did work, are you ready to spread it across your entire practice? It's going to be critical to communicate this progress to patients and staff. So we've talked a lot about how to improve the patient experience on a global scale, but what can be done at the level of the physician and the endoscopy units? For one, focus on the interpersonal skills of the endoscopist and the entire staff. And this is really a skill set that can be taught and needs to be practiced in your units. Make sure that there are adequate educational resources available to all staff. And to that end, scripting can really help the staff better navigate some challenging patient encounters and offer training and coaching and communication to your entire team. Work with your anesthesia teams to minimize procedural discomfort. As you recall from one of my previous slides, this can be a significant dissatisfier for patients, understandably. And update your patients promptly after their procedures to alleviate the anxiety they have while waiting for their results. You should strive to improve access to endoscopy as well. For some healthy patients coming in for screening procedures, that may mean bypassing an office visit and proceeding directly to endoscopy. I can tell you at our institution, this is a huge patient satisfier, and I know it is for units across the country. Offer endoscopy appointments not too far off in the future. So your patients are the most motivated to get their procedures done at the time of scheduling. The longer a gap you have between scheduling and the procedure date, the higher the risk a patient's going to cancel their procedure. And this also applies to the day of the procedure. Try and minimize wait times. Give some thought as to how far in advance of the procedure you're asking your patients to arrive at the facility. If you only need an hour, let's say, to get the patient registered and ready for their procedure, don't ask them to come in two hours before their appointment time. Adhere to good communication techniques to manage patient expectations, reduce their fears, and build trust. Be honest with your patients. If there's a delay, let them know and apologize for the inconvenience the delay poses to them. And finally, when things don't go right, despite our best efforts, utilize service recovery programs. Depending on the situation, that may mean offering lunch vouchers, covering parking, or in more challenging cases, involving your service coordination teams to assist. So in conclusion, the patient experience encompasses the range of interactions that patients have with the health care system. Improving the experience has a number of important benefits in several areas. Multiple factors influence the patient experience within an endoscopy unit. Both informal and formal tools are available to assess the patient experience. We need a greater transparency of and accountability for patients' experience scores, and soon enough, incentives will be tied to them. And it's crucial to have a systematic approach with ongoing evaluation when trying to improve the patient experience. With that, thank you.

patient experience

healthcare

communication

patient satisfaction

clinical outcomes