In an era of big data, high performance expectations, and growing trends in pay-for-value, some organizations may struggle with what to do with this surplus of information. What’s more, they must identify how best to present the data in a meaningful, transparent and receptive way such that the feedback drives performance and creates behavioral and practice alignment. Research and our experience in coaching hundreds of healthcare organizations reveals that organizations and individuals who are aligned on goals and receive regular performance feedback tend to outperform those that lack feedback. For those that lead physicians, a quandary exists regarding how best to undertake this process as it applies to physicians and advanced practice providers (APPs). Could data and feedback be construed as threat, insult and actually create a defensive posture in physicians? It can indeed if we do not proceed with thoughtful consideration of the method by which we provide feedback.
Less effective strategies:
- Data sets are irrelevant to a provider/group or misunderstood
- No explanation of “why” we are providing feedback and a conversation
- Provider is “pushed” performance metrics or asked to log in to a data repository
- Interval of feedback is either too frequent (timetable disallows changes in “n” or effect of process/behavioral change) or prolonged (year-end illumination becomes retrospective and providers clamor “If I would have known this earlier I would have made changes to improve this…”
- Data lacks peer or group-comparison
- No conversation, coaching or mentorship
More effective strategies:
- “Why” and “what’s in it for you” clearly explained prior to data reporting and feedback sessions
- Performance and outcomes data is relevant and representative of a physician’s prowess
- Right interval for feedback is agreed upon by physician leaders and key stakeholders
- Performance can be trended and compared to that of local and national peers
- Measures can be automatically uploaded into the feedback tool with minimum manual extraction
- Performance data sharing is coupled with a conversation with a physician leader
- Physicians feel the performance review process and coaching is an investment in them and the patients they serve…and they feel motivated and inspired to improve the opportunities
- Physician leaders or those that will host the sessions are trained and comfortable with the “why and how” of the evaluative feedback process
Once equipped with meaningful performance data and a tool to store and review the information, it’s important that we have focused, structured conversations with physicians to promote collegial relationships, clarify the intent of the review, share data and mentor/coach. The INVESTSM framework is a helpful process to format those conversations. Much like Studer Group’s AIDET® communication framework, INVEST offers an easy-to-remember acronym to ensure a consistent and meaningful review is delivered. INVEST is an acronym that stands for Introduce, Narrate, Validate, Explain, Support, and Thank You. Each piece plays an integral role to ensure that the physician leader is focused on creating a dialogue with a colleague physician. It also offers the opportunity to gather input, align on the performance goals of the practice/department and allow the performance coach to maximize a physician’s impact and potential.
The keys to providing effective feedback using INVEST includes:
- Introduce – Create a personal connection, outline the purpose of the conversation and ask for insight.
- Narrate – Provide a framework for the conversation, including a verbal agenda and how long it will last.
- Validate – as we review the performance data of an individual provider, verify that they understand the data and clarify any questions that they may have regarding comparative information and data details
- Explain – Connect the dots between an individual’s performance, the group and individual goals and trends.
- Support – Share leading practices, resources, and support available. Garner commitment and promote an agreed upon plan that will promote effectiveness and improvement of performance.
- Thank You – Reiterate the “wins” and end the conversation with your gratitude for their contribution and achieving the greater mission.
Here’s an example of what a conversation might sound like:
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I
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Introduce
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(Personal connection). “Good morning, Tony. How are you today? Last time we talked you were about to go on vacation with your family – how was it?”
(Outline the purpose of the meeting) “When we met as a team six months ago and decided how we wanted to differentiate ourselves as a practice, we talked about getting strong measurement, data and feedback and organizing a process for sharing the data. Through our partnership with Studer Group, we have a new software tool called the Provider Feedback System℠ that we will be using going forward.”
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Narrate
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(Offer a verbal agenda and length of meeting). “Today I’d like to discuss how the practice is doing, identify areas where we can improve as a group, and look at your individual data. This should take about 30 minutes.”
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V
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Validate
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(Review individual data and validate use on the scorecard). “Tony your quality metrics in the diabetes composite shows that you’re in the top 10 percent in our group and in the nation. That’s outstanding! Can you share any best practices that are working for you?”
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E
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Explain
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(Explain individual & practice data and offer suggestions.) “There are six individual areas within the Doctor Communication domain that seem to be an area of improvement for our practice and for you personally. I’ve noticed an improvement in my individual scores when I take the time to sit during patient visits and stick to AIDET. I also position the electronic health record (EHR) so that it’s not a barrier between me and the patient. That may be something you want to try as well.”
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S
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Support
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(Share leading practices and available support). “Through our partnership with Studer Group, we have access to their National Learning Lab. There is a short video clip that shows ‘what right looks like’ during provider-patient encounters that I think you would find particularly helpful.”
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T
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Thank You
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(Thank the provider for their time and reiterate specific action). “Tony, I really appreciate your interest and engagement around performance improvement. You continue to demonstrate leadership through your willingness to implement new ideas and practices. We identified an action item that you are going to work on between now and our next meeting. I’m encouraged by the improvements in our practice and you are a key part of the team that will move us forward. Thank you again for all you are doing.”
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Try practicing the conversation using the INVEST framework before the actual meeting. The conversation should not feel forced or scripted, but rather a natural and genuine interaction. Just as we coach with the use of AIDET, make the framework work best for you. Remember that not every piece of INVEST is required during each encounter. With practice and time it will become second nature and you won’t even realize that you’re following the INVEST framework.
Clinicians want to be our partners in improvement. Sharing timely and relevant data through the INVEST model and seeking their feedback along the way is key. With the immense amount of change impacting providers, it’s important that we create an environment of understanding and support to drive the shared desire for exceptional patient care and best outcomes.
Additional Resources:
- The Provider Feedback SystemSM combines Studer Group’s results driven coaching with metric alignment software to improve clinical and operational performance.
- Studer Group’s National Learning Lab is a resource exclusively available for organizations engaged in partner agreements with Studer Group. Access a 13-minute video of Dr. Dan Smith holding a provider feedback conversation.
- Led by practicing physicians, Studer Conferences Physician Partnership Track offers a roadmap to achieve measureable results in patient experience, physician satisfaction and clinical outcomes. View the locations and agendas at studerconferences.com.
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