The hardest part of change is being convinced of its need. Patient satisfaction (experience of care) is a topic that rarely elicits positive emotions from providers. When tasked with improving my own scores, I began the journey with a great deal of skepticism. Before exploring how to improve, I had to first convince myself why this was necessary and worthwhile.
I felt I was doing a good job as a doctor. My patient satisfaction scores were low, but in my mind, they were unimportant and outside of my control. Surveys had poor statistical power. Patients had unrealistic expectations and were often drug seeking, and the nature of the emergency department prevented my success.
These, among numerous other fallacies, were preventing me from becoming a better physician. To quote Mark Twain, “It’s not what you don’t know that kills you, it’s what you know for sure that ain’t true.”
As I challenged myself, many things surfaced that I had not considered.
Patient experience has direct financial implications for physicians. A tenet of good business is that consumers vote with dollars. One bad experience may influence friends, family, and, if documented on social media, even thousands of future patients.
Time spent at bedside does not equal better care. High-quality communication takes no additional time when interactions are focused and address patient expectations.
Physicians drive patient satisfaction. Skilled, empathetic communication influences experience greater than any single variable. Improved clinical outcomes and lower ED recidivism rates are valued dividends.
First Steps of Change
After several nights of fractured sleep, I scheduled a meeting with our service excellence manager to review my data. I learned that I was below the 30th percentile for the majority of metrics (see Table 1).
As a medical director, I could not effectively lead my department without improving my own practice, so I began to study the many variables that drive patient perception.
It became apparent that I was not communicating effectively. My unintentional lack of collaboration with patients made it impossible to deliver reassurance and emotional comfort and alleviate fear. Any effective approach must set reasonable expectations. We serve as clinicians and guides, helping patients navigate the terrifying and often foreign ED journey. Without providing context or framework for their stay, we inadvertently foster unrealistic patient expectations. This is the reason approaches such as AIDET work.
Acknowledge and Introduce: This sets the stage for patient experience. Knock, and wait for permission to enter. Greet everyone in the room, and reciprocate with your name and title. Make routine eye contact, and use receptive body language. If they have waited, let them know their time is important by apologizing. I may be having an incredibly stressful shift, but my goal is for patients to feel that I am 100 percent focused on them at that point in time.