Now, let's dive into the patient perspective. Again, I have no financial relationships to disclose. So what is an expectation? So this relates to our patients. One definition, the anticipation or the belief about what is being countered and achieved in a consultation or in the healthcare system. Patients have expectations, of course, of their healthcare experience and it'll be multifactorial. They also have expectations of themselves, you know, we all do. Just because I expect something to happen, of course, doesn't mean it will happen, but my happiness or my satisfaction might be tied to the fulfillment of my expectations. Policy theory suggests that satisfaction is primarily determined by the difference between which is expected and what is received. So patient satisfaction on one level is primarily determined on healthcare expectations that are met. So a crucial step in improving or crucial steps in improving patient satisfaction would be understanding what these expectations are and then closing the gap between what's expected and what's delivered. And as we'll discuss, what they expect is malleable. We can modify that. So why does it matter? Of course it does. If we meet or exceed patient expectations, they're more likely to be satisfied or highly satisfied. They actually may be more compliant in their medical regimen and better outcomes. They're more likely to be loyal to your practice. They might enhance our reputation. We're more likely to get positive reviews online, better ratings, and all of this supports revenue and growth. What if we fail to meet expectations? Well, of course, patients are more likely to be less or unsatisfied and they may be less compliant actually with their medical regimen, which can affect their care. They may not tell us about these things and they may just go ahead and seek another practice. We might lose patients. They are more likely to litigate. So there's that risk. And they might blast us online either with negative ratings, whether it's Google health trade or social media, as Kim just mentioned. And this does not support the success of our practice. For us to incorporate patient expectations, which are logical and we're attuned to these, we need to make sure we are, all of our providers and our staff. Patients basically want to be listened to. They want to have good explanations and instructions about their conditions. They want to be treated with concern, compassion, respect by staff that acts professionally and providers that are transparent, good listeners. They need to have trust in their care team. They want time. They want time in their visits and they want access to care. Chief quality and healthcare has two main dimensions. One is the objective and technical dimension. So that's the medical care and treatment or the quality, the outcomes, right? The more kind of medical care aspects and, you know, treatments, diagnoses. It's important those are aligned with patients. This may or may not differentiate us or our practices because there is a certain expectation that we'll deliver this care, though it certainly can also differentiate us. But the experience is different, the subjective and qualitative dimension. So we need to remember we're delivering medicine, but we are a service industry, right? And so we are, our patients are consumers in many different ways, and this can shape their experience pretty significantly. Do they have an emotional connection, good communication? Are they satisfied? And again, do they have time, convenience, access? Things we've talked about some today, you know, online scheduling, how do you optimize your website? How are we communicating with patients? These are things that are important and may be a reason that they're with your practice or not. First polling question. The pandemic has altered what our patients expect in their health, in their care and health care experience. Well, pretty overwhelming, and that makes sense. I think we all agree with that. Pandemic stress. And so I think we're all familiar with this. I mean, we're in this ongoing phased pandemic, but it doesn't seem to end, right? So continual uncertainties and other disruptive forces in our lives affects our stress and our anxiety. It absolutely affects how our patients view their health care experiences, and our providers or staff that provide care to them and service affects them, but they also have to deal with these issues, right? It's just not that easy. It creates more stress. About one out of three people report feeling fragile in some way or another. There's more angry outbursts and there's compassion fatigue for some people. And numbness is setting in. So this is definitely a factor when it comes to patient satisfaction. Relative to the pandemic, and there's various surveys out there, it really depends on when the surveys were taken. Certainly last year, there was some really striking findings, but some of those still persist. Most consumers report believing the pandemic has changed the way they receive their health care. Common complaints are poor communication, safety risks, shifting opinions, and actually higher expectations of physicians. They're more likely to be willing to switch practices, and they are definitely looking for more convenience. So these are all important when we consider how we can meet patient expectations. Endemic blues, it exists, right? We're a mastery-oriented society, and we don't tolerate ambiguity very well, right? And there's so many different levels that our patients, of course, it's everyone, but our patients might be suffering, whether it's financial, children falling behind in school, so many other things that may be happening in addition to directly COVID-related. So we need to keep those in mind. These are actually some questions our employees are fielding. I guess one question is, are your staff members prepared for questions like these? And they kind of run the gamut, right? Are all the providers and staff vaccinated? Are your exam rooms ventilated? Tell me, why do I have to come in person? What are you doing to make me safe? Why are you all still masking? What's wrong with my face covering? Why do you care if I'm vaccinated or not? I'm tired of all this BS, right? I mean, this is common. So I think it's important that, you know, you have COVID policies, keep them updated. Make sure you communicate these on a regular basis. And my advice is you can't over communicate these things, especially when they're changing. So staff understand, you know, what the policies are, and you need to educate the frontline employees. Otherwise, there's going to be mixed messaging and upset patients. And that's not a good scenario. Another polling question. Does your practice utilize a texting platform to communicate with patients, for example, pre-visit? Okay, so about two out of three, two out of three. So we'll talk about that and, you know, the benefits of texting and digital communication. So things are evolving. And it's even changed in the past year since this lecture was given before. What does surveys show? Well, you know, before the pandemic, telephone conversations with a live person were most desirable in all generations. But desirability for phone calls has dropped during the pandemic. And you know, our patients expect more communication. There's a digital craving, and there's definitely a shift in preference for interacting via text. That's important for everyone to know. Some patients are willing to change practices to receive more modern communication. And there are advantages, you know, to texting, obviously, for patients, it's convenient, you know, they can access it almost anywhere. It lessens the burden on our staff resources, right? Anything you can digitize may be more convenient for patients and also saves on staff time and labor costs related to that. So consider getting a texting platform. They're out there, you know, finding an option for that. It should make you more competitive. Another polling question. Our practice will deliver more telehealth visits in 2022 than before the pandemic. Okay, two out of three. It will vary on the practice. And we're going to talk about telemedicine a little bit next. This is a poll from pretty recent from the MGMA stat poll, October 19, 30% of medical practice felt patient demand for telehealth will increase in 2022, but 40% thought it would stay the same. So about 70% thought it would stay the same, or actually increase and this is patient demand. telehealth, we know will remain higher than pre pandemic levels, but it's definitely practice dependent. Right? You know, many patients, I would argue, have experienced it at this point, and they like the convenience. And so some may not want to come into the office necessarily, or at least have some of their care done via videoconference or telehealth. There are applications, I think, to certain types of patients, you know, routine care, you don't need to examine the patient like a GERD follow up would be classic, touching base with a hospital follow up to make sure they know what medicines they should be taking. For example, I've used it a lot for the management of chronic active conditions like IBD, where people need a lot of touch points, frequent touch points, and you can do it much more conveniently that way. Your technology is evolving, as you know, that's one thing that happened with the pandemic, there's lots of options. And you can pay for it, or you can do it for free on Doximity, or you can have a paid path form, they're usually per member per month, or per provider per month is the way that these are priced. Consider patient expectations, but access and remember pre pandemic. As one significant example, we couldn't do telehealth for Medicare patients. And now we can, it's a huge shift in the ability to provide telehealth. And this was mentioned by Sufjan, I mean, you need to make it seamless, it's not an in person in person visit. So from scheduling intake, the visit outtake scheduling after the procedure, it can't be too disjointed, it has to work for the patient. And you have to have a good workflow around that. You know, SDG, our practice, we actually implemented telehealth in 2018, before the pandemic, and we did it because we think there is a value proposition to telehealth, we do think it creates differentiated customer value, if it's done well in your practice. There's some caveats, I mean, you can't force them on patients, I mean, we're currently giving patients actually the option, whether or not they'd like to come in, or not. But some patients need to be seen in person, that they need to be examined primarily, right? Some of our providers and our patients prefer the first visit to be in person. So you can make that personal connection that you can't make via video conference, which is fine. I mean, that's fine. Sometimes it needs to be virtual, just to get someone in quickly. Obviously, you need to have good technology, really want to avoid defaulting to telephone billing. You know, if you start a telehealth visit, doesn't work out, or at some point, you lose the video connection, and you just can't do it, you need to have the video component as well as the audio component, you can't bill for telehealth. And telephone billing really is pretty minuscule compared to that. So, you know, we flag patients either if they can't do telehealth, or they prefer telephone billing or couldn't do it in the past, we flag them to make sure they try and get them to come in the office. The good news is, is that CMS has, will provide, I'm sorry, the expanded coverage will be in place 2023 for telehealth, that includes Medicare, a lot of physician groups are advocating for that to be permanent, but at least through 2023, that's available. We do monitor payer reimbursement on a regular basis. So pre-pandemic, payer reimbursement for telehealth was less than in-person visits. Right now, it's still a parity for us, but you should follow that. Even if it's less, we still think there's a value proposition for it, right? Just to give you SDG's experience, obviously, at one point last year, we were 100% telehealth, year to date, and at the end of May, 51% telehealth, year to date, end of October, 41%, but right now we're about one out of four. And so many predict that that's where many practices will fall into, somewhere around 20% or so, give or take, telehealth, but certainly it depends on the practice. Obviously, we can't meet all expectations nor expect to, but there's some strategies around how we can do our best in that regard. I'm not sure if you're doing satisfaction surveys, and we are, and there's various ways to do that. We're actually using SurveyMonkey right now, and so we know which patients are responding, so we can find them in the chart. We have, pre-pandemic, we had a patient experience manager. Now we have one of our managers that serves those functions, so in addition to some other things that she does, she serves as what we call our patient experience manager. So she sends out the surveys, gets the results. She also helps manage social media with our marketing consultant, and you can do it through Prescani, if you're affiliated with a hospital or a system, you may have other resources, of course, for these to be done. We do it on our own. But how are you doing? How can you do better? What do patients expect, and can we meet, exceed those expectations? Can we manage unrealistic expectations? We give provider staff the good and the bad, right? We get all the feedback, and we do something called an autopsy without blame when necessary. Something didn't go well, it's like a root cause analysis. What can we do better? What can we do differently? Are there pain points that are common? And sometimes we'll engage patients if they gave us a positive review and ask them to rate us online, either the practice or the physician, such as Google or Healthgrades, or if it's negative, we may engage them and see if we can perform service recovery. How do we manage expectations? I think it's important, first, to remember that patient expectations, they may be expressed or not expressed, and you may need to elicit what they are, so you may need to have that conversation. It's important that you have a trusting relationship so you can understand what do they expect in this particular visit or in the care of their disease. Their patient's expectations for how you're going to manage their Crohn's disease can be very different than what you plan on doing, right? And we've all experienced that, you know, kind of more holistic treatments versus more science-based treatments. You need to communicate well with the patients in a way they can understand, you know, understand the whys that you're doing, make sure it's clear why are we doing this particular treatment, why this particular medication. Try to educate them as best as possible, and you need to understand, you know, what their interests and expectations are. It's key to be a good listener, and sometimes I think one of the big mistakes we make, especially when we're rushed or if a patient comes late, is, you know, leading questions and trying to get through the interview, but not just physicians and APPs, but staff. Be willing to listen to patients, and so if you haven't, it's good to kind of understand what active listening is, what motivational interviewing is. These are techniques that are really designed to help people talk about themselves and understand what their needs and expectations are. There's a really good book, if you haven't read it, called Think Again by Adam Grant. It's fantastic in general for relationships, and it addresses kind of motivational interviewing techniques. You need to close the loop, right? Ask questions like, what do you think of the plan we've discussed today? Or is this what you thought would happen today? Make sure they understand and have clarity, and give them as much information as possible. So these are some techniques that can be helpful, and when necessary, you can reset things for them and explain to them why their particular expectation is not something that is in line with what you plan to do in taking care of them. A patient-centered approach, this is an old concept. I think it's always good to think about this or sit back every once in a while and think about, you know, how does the patient navigate the healthcare system or look at it through the patient's eyes? It's the patient-first culture shift. And sometimes when you're tackling problems or challenges, just think about, put yourself in the patient's shoes, right, that walks through the healthcare experience or the experience with your practice or your ASC. Cost is a big one, and we all know that. We've talked about it. And you know, we need to be as transparent as possible, and this is a potential big, big dissatisfier. Obviously, it also may lead to cancellations. People may leave your practice. So communicating clearly, communicating in a timely fashion, mitigating issues if necessary, talking to patients. You may be able to offer payment plans, potentially, depending upon the scenario, but you need to do this, tackle this at more than one angle. And remember, especially now, patients are more vulnerable financially, and deductibles are about to reset again in January, and patient responsibilities go up, down, generally speaking. Kimberly gave a great talk on this in the last lecture, and I don't have much to add, but I completely agree. I mean, you need to monitor it and actively manage it. You can't ignore it. It matters to consumers. It affects our business. So our manager that serves as the patient experience manager with our marketing consultant monitor this, flag them. If there's good reviews, we communicate those to the right staff or providers. If they're bad, you don't obviously generally know who it is. You may not be able to figure it out, but you need to decide, number one, do you want to post a response? And there's strategies around that, how you should do that or not do it. You may want to post a response to help kind of lessen the blow. And relative to ratings, again, I mean, you can reach out to patients. The providers might report, I think this is a good patient that might give me a good review. Or if somebody submitted a positive satisfaction survey or some positive results in the satisfaction survey, you can reach out to them. And one goal with ratings online like Google or whatever is to dilute the pollution, right? And to get better ratings. Service recovery is something, it's essential. Again, we're a service business. So providers and staff, especially frontline staff, need to understand what service recovery is, especially now when we have more angry, irate, frustrated patients. And we need to understand how to perform service recovery well. And you can turn an unhappy patient to a patient that actually is less unhappy or happy. Or you might salvage that patient, potentially. And new patients are gold, which we've mentioned during these talks. But you definitely don't want to lose a new patient, right? That's a huge amount of downstream revenue and referrals, et cetera. But this is really important. And if something doesn't go well, it's a teaching moment or a coaching moment, potentially for one of your employees. So what are the practice pearls? We need understanding and managing patient expectations. It can improve patient satisfaction, but also can improve health care outcomes. And it affects the bottom line, right? It affects our business, absolutely. Economic shifts are with us. They won't completely abate. So like many of these talks, we need to adapt for success. What can we do differently going forward? I would suggest that you try and harness technology as much as possible to satisfy evolving consumer desires. If they like it, it improves communication, might reduce cancellations, no-shows, improve their experience, and it takes less staff time. And ultimately speaking, make improvement a priority, right, and have a structured approach to that. And consider this as an opportunity. There are opportunities here that we're seeing because of the pandemic. Thank you.

patient expectations

healthcare

patient satisfaction

communication

digital communication

treatment plans