The key for patient satisfaction is physician satisfaction

In these early days of pay for performance (P4P) reimbursement, as the size of your paycheck begins to reflect your patient satisfaction scores, let’s have a frank discussion about three important topics all healthcare providers and organizations must understand going forward.

  1. How your performance will be measured
  2. How to get the highest patient satisfaction scores and be a happier doctor at the same time
  3. The first step to improving performance (in a healthy way) for you and your organization

How your performance will be measured

A large component of your performance ratings will be based on patient satisfaction surveys very much like the HCAHPS inpatient or Press Ganey out patient satisfaction surveys currently in use. Here is a link to the HCAHPS patient satisfaction questions where you can see the three doctor specific patient satisfaction measures that are already publicly reported on the Medicare Hospital Compare website.

It is important that we get granular here so that you understand exactly how your own personal patient satisfaction is both scored and reported.

The satisfaction surveys ask several questions the patient answers on a 4 or 5 point Lickert scale where the top score represents the word/phrase “always”, “strongly agree” or “outstanding”.

You may naturally assume that your personal physician rating is an average of the scores from individual patients. You would be completely wrong in that assumption.

Here’s how your satisfaction ratings are actually scored — it is not an average.

Your scores are reported as a “percentage of top”. This means the percentage of patients who gave you the top score. In other words, only the top scores count. Anything less than 5 out of 5 is thrown out. “Good” or “Above Average” is meaningless to these scoring systems.

Now that you understand how your performance will be rated and reported in the near future, I invite you to take just a moment to recall your last personal experience with a customer satisfaction survey of any kind.

  • Are you a person who gives a 5 out of 5 under any circumstances? (most doctors are not!)
  • When did you last give a retail transaction or online customer service top marks?
  • What did they have to do to earn that rating from you?

Imagine the experience your patients will expect and you will have to consistently provide to receive the all important “5”. This is exactly how you will be rated by your patients more and more frequently in the years ahead. Soon these patient ratings will determine a portion of your pay as well.

How to get the highest patient satisfaction score and be a happier, healthier doctor at the same time

First you must understand what most healthcare administrators do not. Physician satisfaction is the only lasting foundation for patient satisfaction. It takes happy doctors and staff to have happy patients — in that order.

To understand this fundamental fact, let me ask you the following question ..

How can we reasonably expect a patient to give a doctor a 5 out of 5 score on satisfaction when if we asked that doctor to rank their personal satisfaction with their workplace on that same day, they would score it a 3 out of 5?

Your administration might be able to goose patient satisfaction numbers temporarily by cracking the whip and teaching some communication tricks to you and your staff. It won’t last.

As P4P and the closely related “value based purchasing” become more common in your marketplace, organizations that create a healthier, happier, less stressful workplace environment for their staff and doctors will establish a strong competitive advantage.

  • Patients will want to be seen there.
  • Quality doctors will want to work there.
  • Your patient satisfaction scores will reflect the efforts to keep physicians and staff healthy and get systems out of the way of patient interactions.

Your first step to higher physician and patient satisfaction

Here is a question to get you and your leadership team going.

Start by looking back on the last 3 months in your own practice. What average score would you give your personal satisfaction level with your day-to-day practice experience on that same 5 point scale? Take a moment to actually give it a number.

1=very low | 2=low | 3=OK | 4=Good | 5=Excellent

What is your physician satisfaction number? Keeping your score in mind:

  • What is the first thing you would change at work to improve your personal satisfaction score? Even if you have given up on this change being possible, what is the one thing that would make all the difference for you?
  • What is the first step in making that change – the smallest step to making progress in the direction of a better work day?

Now grab your medical director (or your team if you are the medical director) and get on it.

This simple process identifies a piece of low hanging fruit for you and your organization to improve three things all at once:

  • Your personal satisfaction
  • Your patient satisfaction scores
  • Ultimately, the size of your paycheck down the road

Dike Drummond is a family physician and provides burnout prevention and treatment services for healthcare professionals at his site, The Happy MD.

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  • buzzkillerjsmith

    Dike, I expect better from you than this. Stop jumping through the hoops that others put in front of you unless those who have placed the hoops are better physicians that you are. You know this, Dike.
    If we focus on this foolishness, then we are lost. If we focus on what Corpmed thinks, then we are lost. If we focus on the size of our paychecks, then we are lost.
    My advice for the young docs is to pay off the loans. Live on rice and beans, live in an apartment where you have to hear your neighbors having sex, deal with the vomit on the carpet outside your door, but pay off those loans. Then you are free from Corpmed if you so desire.
    Then you can do the right thing, take care of your patients and practice good medicine, and let the chips fall where they may.

    • Suzi Q 38

      “My advice for the young docs is to pay off the loans. Live on rice and beans……but pay off those loans. Then you are free from Corpmed if you so desire.”
      Good, solid advice for any young professional, especially doctors.
      If you graduate, land that first big job with the huge paycheck and run out and buy a house for a couple of million dollars, you have few options.
      Wait at least until the loans are paid off.

      • Dike Drummond MD

        Financial responsibility is important for everyone all the time, nowhere more so than a doctor who has taken on loans to pay for your education.

        And it is important to know this
        - the PRACTICE of medicine is a calling, an art and a science.
        - the JOB of being a doctor is a game especially in a volume driven “big medicine” organization. This post is to show you some of the invisible rules of the game so you can play it with skill if you choose to try to “win” under those conditions,


        Dike Drummond MD

    • Dike Drummond MD

      You are SUCH a buzkiller. Take care of your patients and practice the best medicine possible and take a full frontal look at whether your administration cares about your experience with and satisfaction with your working conditions.

      If you raise an issue and they help you work on it … you just may be in a physician friendly workplace. If they ignore or label you “disruptive” for wanting things to change .. it is probably time to move on.

      And if you are tired of “corpmed” and are a primary care doc there are always the direct care/concierge models which are ramping up across the country at the moment.

      Having said all that … you have to know how you will be graded (percentage of top) to understand how important all this is.

      Dike Drummond MD
      117 tools to prevent burnout in the MATRIX report

      • buzzkillerjsmith

        If admin doesn’t care and you can’t take it, quit your job. That’s what I did–3 times over the past 15 years. Never regretted leaving those jobs for a second. Now I’m in a practice run by the docs, and it’s working OK. But if they even so much as look at me the wrong way, well, I might just walk. The loans are paid off, you see.

        I know you know this. This is for the young docs. Pay off your loans, keep you materialism in check, and your life will be better. Enserfment by Corpmed is no way to live life, especially when you’re really fashioning your own chains by your own decisions. That’s insanity–or at least it’s never worked for me.

        • Dike Drummond MD

          I agree BKS … sometimes you just have to move on when the administration proves they don’t comprehend the working conditions in the front line and that they don’t care either.

          Just make sure in your running away from the bad situation that you don’t jump out of the frying pan and into the fire. The key to a quality job move is to take the time to create an ideal job description and use this living document to guide your job search. Rather than simply looking for a position that does not have what you hated about the last one

          Dike Drummond MD

  • Suzi Q 38

    How are the doctors supposed to get all 5′s?
    Who is perfect?

    • buzzkillerjsmith

      Why are doctors supposed to get all 5′s? And believe me, getting all 5′s has absolutely nothing to do with perfection.

      I’ve thought about this a lot, and I think a big problem with a lot of docs is the “good student syndrome.” Most docs did well in school and have gotten a lot of bennies from that, particularly a high-paying job. But a lot of us never get past that. Others, psychological substitutes for our parents or teachers, set the goals for us–they put up the hoops and we jump through them. P4P is a classic example. How many docs are in a huff about that because they can’t stand the thought of making a little less money than the guy down the hall? It’s stimulus-response. Comical really.

      I know I’m wasting my breath here. You can’t get a leopard (or most leopards) to change his spots. But I do find it interesting that such intelligent people can have such limited vision.

      • Dike Drummond MD

        I agree with you BKS – what is the relationship between patient satisfaction and quality of care?

        The statisticians treat them as independent data point and they are related in some way. I am suspicious that it is an inverse correlation. As in … the higher your patient satisfaction, the lower the quality of care you may be offering … because you are giving into the desires of someone far less qualified than you as to what is medically appropriate.

        Again … we live in interesting times. P4P is upon us … how will you play this game. Here is one way to start your approach.

        Dike Drummond MD

    • Dike Drummond MD

      That is a great question Suzi. Just think about the way you rank customer service with … say … your salesperson at Target. When would you give them a “5″. Hang on a second … do you ever give anyone a “5″ under any circumstances or are you not that kind of a person ( most of us are not unless the service is completely over the top).

      AND what does what the patient thinks about the “quality” of the service have to do with “quality care”.

      We live in interesting times. This article is just to bring everyone up to speed on how you will be measured – NOT average, but percentage of top – and to fire the first shot in the conversation about “Where does patient satisfaction come from?”.

      It comes from physician satisfaction and this is no chicken and egg conundrum here. Physician satisfaction is the foundation for quality care and patient satisfaction … it MUST come first. That is the place to focus attention now, before the last straw falls on this camel’s back.

      Dike Drummond MD
      117 burnout prevention tools in the MATRIX report

      • Suzi Q 38

        I have given 5′s if the service is exceptional.
        One doctor told his nurse to tell me that I asked too many questions. If I wanted to switch doctors and get a different one with the same specialty, that was O.K. with him, LOL.

        I told the nurse that while I was offended at the suggestion, I don’t mind switching.

        When I was talking to the patient advocacy director, I mentioned the doctor’s suggestion. I told her that I had never been asked to do that before, so could she please help me out and get me another appointment with a different doctor?

        She said she tried, but his boss would not allow us to do so until we worked it out at least during one more visit.
        I brought my husband with me the next time, because sometimes I don’t remember all the details.

        At our next appointment, he was actually nicer. He explained more, and and answered my questions.

        I know that since he is a urologist, he gets paid $250.00 a visit from my insurance company, so he has more time to see me.

        I think that if you are a doctor, you have to be open to a few concerns, complaints, and questions.

        If you are not skilled at handling concerns and objections, then there may be problems keeping patients.

  • lemaman

    another government ploy to not pay us. Try being ER and make people happy. We whore ourselves for ratings? WTF is this, pole dancing? It’s a joke that’s not funny when patients die in the name of “satisfaction”.

    • Dike Drummond MD

      It is almost impossible to not feel like you are “whoring” yourself if you know your administration does not have your back. The key is to see if you work in an organization that even considers physician satisfaction as a worthy goal. I think it is the foundation for all patient satisfaction.

      And it is a mystery to me how patient satisfaction (from a patient’s perspective) and quality of care (usually judged by physician generated care protocols) are related.

      You are “damned if you do and “disruptive” if you don’t.

      Dike Drummond MD

      • Haroon Saleemi

        You’re exactly right. Physician satisfaction must be a goal for an administration. It would be no different than employees hating the place they work at – and the customers obviously feeling the negative effects of it.

        The admin must listen to physician concerns and address them if they ultimately wants highly satisfied patients.

        • Dike Drummond MD

          Thanks for the comment Haroon. I believe that in the next few years organizations that understand the pivotal importance of having a healthy, balanced, happy group of doctors -will develop a striking strategic advantage over the usual high volume patient mill group.

          This enlightened organization can be expected to have higher patient satisfaction, higher quality of care, lower malpractice risk and turnover AND all the docs in town will want to work there.

          Unfortunately I believe such groups will be only about 2-4% of the universe of healthcare organizations in the US.

          Dike Drummond MD
          Over 117 burnout prevention tools in the MATRIX report

    • Suzi Q 38

      No you just be polite. You don’t even have to be nice and kiss our rear end. You also have to appear to be concerned, and listen to us…then medically treat accordingly.
      I have told a doctor about a problem, then relay a message from a PT, only to have the doctor ignore both of our concerns and requests for further testing.
      He didn’t want to order the upper cervical MRI.
      A year and a half later, with persistent symptoms escalating the latter 3 months, he finally orders the MRI when a colleague (who was the chief of staff) told me to tell him that “he said so.”
      By then I had signal changes for over a year. Paralysis was starting to set in and become irreversible.
      Yet, it wasn’t enough for myself and the physical therapist to be concerned and ask.
      I still have the evaluation form on my desk. I think it was sent to me in October or November 2012.
      I usually only fill these out when I have something good to say, because I just don’t like them. AS if the doctor has to act differently because of how I will evaluate him or her.
      I am not sure when I am going to turn this one in. The doctor will probably get 2′sand 3′s.
      I keep waiting to see if my anterior discection improves my walking ability. The patient advocacy department wants me to write up a grievance. That will take me a lot of time, because I have to get my facts right. Plus, if I complain, I have to be resourceful and think about what can be done for someone like me in the future. I hate to complain if I can’t think of solutions.
      There were definite hospital and physician errors that resulted in me not getting the proper care that I needed, even though I asked.

  • Dorothy Pugh

    My one concern about this: will doctors feel pressure to eliminate from their organization patients whom they think will give them bad evaluations, either because of the patient’s getting poor care or just because his/her attitude? When a big medical center dominates medical care in a region, this could deprive a patient of local care.

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