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Transparency Gets Results
with CEO Donna Mills, Sharp Rees-Stealy Medical Centers, San Diego CA |
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n the last five years, Sharp Rees-Stealy Medical Group, a large multi-specialty
group practice, has driven patient satisfaction from the 25th to 72nd percentile |
through a transition to a performance culture of full transparency with physicians. As a result, the medical practice was the number one ranked medical group in California at the end of 2007 in quality and service by the Blue Cross Quality Report Card. Sharp Rees-Stealy is also a 2006 Studer Group Fire Starter award winner. |
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CEO Donna Mills credits the gains to performance transparency with physicians. The foundation is the effective communication of valid patient satisfaction data to physicians for driving and sustaining change. “If I had to do it over again, I think we would have created a system architecture that engaged physicians from the beginning and then moved more quickly towards full transparency,” she says. “But we were new to this five years ago, so we started on the management side first.”
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Getting Physicians On Board
Back in 2003, Sharp Rees-Stealy Medical Group, which is affiliated with 2007 Malcolm Baldrige Award winner Sharp HealthCare, measured patient satisfaction internally within the system. As part of Sharp’s commitment to The Sharp Experience, a journey to excellence which began that year, Sharp transitioned to compare against a large national database, an uncomfortable, but pivotal cultural shift. The plan: Sharp would implement tools and tactics to improve patient satisfaction on the management side at its hospitals first, and then get physicians on board.
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It was a bit of a shock, frankly, to physicians who had always rated highly with patients when they suddenly came in at the 25th percentile in the large national database. They questioned the data. Wouldn’t neurologists, they wondered (who frequently saw grumpy patients in pain) be more likely to rate lower with patients than ObGyns delivering babies to happy new moms?
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Sharp Rees-Stealy realized that for data to impact physician behavior it had to be seen as valid and reflective of physician care. To do this, they began to report patient satisfaction by specialty: Neurologists to neurologists, pediatricians to pediatricians. Once valid measures illuminated real differences in performance, physicians began to pay close attention to their own measures and how they could get better.
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A Partnership for Momentum
Over time, Mills began to partner more closely with Sharp Rees-Stealy Medical Director Donald Balfour for a more calibrated approach to moving results on both the management and physician side of the practice.
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“I realized that I could teach my staff all day long—and get them 80 percent of the way there—but service is about the whole patient experience and physicians drive that,” adds Mills. A key organizational shift was coaching physicians to lead their clinical work unit. “The physician sets the tone that service and care are important in the office where they work. That has a profound impact on how staff approach care and efficiency.”
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As physicians became more comfortable with their data, they were also more receptive to coaching from physician fire starters. “The transition to measurement transparency must be coupled with training for improvement,” emphasizes Physician Fire Starter and 2008 What’s Right in Health Care conference presenter Stephen Beeson, MD. “Measurement without training is not only ineffective, but cruel. Most physicians have received little or no training on how to drive patient satisfaction and loyalty.”
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A tactical, physician-led training effort, undertaken at all 14 sites, was also communicated as “how we provide better care to our patients” rather than “how we improve patient satisfaction scores” for better buy-in. Training took a prescriptive approach: how to create a first impression, how to foster trust, and how to improve compliance to drive loyalty and improve outcomes.
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Accountability for performance was also embedded at all levels of the organization, including the alignment of a portion of employed physicians’ salary to clinical measurement performance and patient satisfaction. High performers were recognized and low performers were coached, while contracts of non-responsive physicians were not renewed.
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“In the early days—when physicians were still resistant—I’d sometimes get frustrated and ask them: ‘Should we stop? Do you want to go back?” says Mills. “But even then they could feel the difference.”
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As CEO/administrator of two medical groups, Donna Mills leads a staff of 2,000 employees dedicated to business systems for more than 500 primary care and specialty physicians serving more than 400,000 patients in 20 medical offices in San Diego County. She is also an American College of Medical Practice executive and MGMA fellowship candidate. |
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