10 Tips To Improve Your Press Ganey Satisfaction Scores


This post explains The Average Doctor’s experience going from the lowest percentile of patient satisfaction scores to the highest. And learning how is not as bad as it seems. 

Patient satisfaction scores are the bane of many physician practices, but they don’t have to be. It is possible for a doctor in the lowest percentile of scores to jump to the highest percentile by implementing only a few changes to their practice. 

I understand if you recoil at the thought of hearing about press ganey or patient satisfaction or HCAHPS or whatever your hospital employer calls them. You were trained to be a doctor, to treat patients medical problems, and to make the right decisions. And you’ve never been rude to a patient even though it’s likely more than one patient has been rude to you. 

Yet your satisfaction scores are still low. And now you’re getting E-Mails telling you to improve them. It seems completely out of your control. But it isn’t. I improved my scores immensely, and I believe you can do the same. 

Here are 9 tips to improve your press ganey patient satisfaction scores:

1: Believe you can change your satisfaction scores

When I was first told that my patient satisfaction scores were low, I was shocked. I was treating patients as I always did. Kindly, respectfully, and professionally. As far as I knew, I wasn’t a mean, terrible doctor. But here my scores were telling me I was.

So being a newer doc, I reached out to those with more experience. I asked an old residency colleague what tricks they had because we all learned to practice medicine a similar way, but his scores were good.

This is what he told me:

“Patient satisfaction scores? You have absolutely no control over them. One year my scores are down, the next year my scores are up. And I never change anything. It’s completely bonkers.”

So for the next few months, I followed that mentality. Continue treating patients the way I’ve been treating them. With respect. With patience. But primarily as their physician advising them on the best medical treatment plan. I made sure not to be mean, rude, or disrespectful.

I figured maybe my friend was right and my scores were just randomly low. They’d have to go up, right?

But they didn’t. The next quarter, my scores were even lower, and I realized I couldn’t keep treating them as random. I had to find a different answer.

I ended up taking a CME course, searching the literature, and reading a book on patient satisfaction. And I’ll tell you one of the biggest takeaways was this graph, taken from the Journal of Patient Experience in January 2018

What the graph shows is the difference between doctors who followed a system to improve patient satisfaction vs those who did not. On the left, the low performers followed the system half the time, while on the right they followed it 90% of the time or more.

That was the only difference. Nothing to do with being nice to patients or mean to patients. I wasn’t just a terrible, mean doctor like my scores made me believe. I just didn’t know the system. That meant this was a learnable skill.

Once I knew that certain behaviors led to increased scores, I implemented them. And my scores went up. All the way from the lowest 1st percentile to the 90th percentile.

So no, scores don’t just fluctuate with the seasons. They’re not completely out of your control. Once you believe you can change them, the next step is to learn how.

2: Understand why hospitals and doctors care about patient satisfaction

Like most things in the world of corporate medicine, patient satisfaction scores are simply part of the system. Not only do they affect patients, but they affect hospitals and providers, too. Here’s how.

Patient Satisfaction Scores Impact Hospital Reimbursement

CMS is the Center for Medicare and Medicaid Services, and they created the HCAHPS system, which stands for Hospital Consumer Assessment of Healthcare Providers and Systems. In essence, it’s a standardized data collection system for medicare to evaluate which hospitals provide better patient experiences and which ones are worse. But they took it one step further.

HCAHPS data is also used by medicare to determine levels of hospital reimbursement. Here’s how it works. When your patients fill out surveys, the HCAHPS system looks at the top box score, or the percentage of total surveys that gave you the top possible score. A 5 on a scale of 5. A 10 on a scale of 10. etc.. Your facility’s top box score is then compared to other hospitals that provides services to medicare patients and gets ranked on a star system. One star is bad, five stars is excellent.

You can look up your hospital’s score here on Hospital Compare.

Medicare then determines their reimbursement to different hospitals based in part on their star level. And because higher scores means more stars means higher reimbursement, your C-suite will care about your patient satisfaction scores.

Patient Satisfaction Scores Reflect Customer Loyalty

The next question you might have about patient satisfaction is why they use Top Box scores instead of, say, average scores or any other statistical data point. Top box doesn’t seem fair. I mean, how often are you rating a service 5 stars if you even bother rating them at all? Clearly only angry patients fill out these surveys, right?

Or so I thought.

It turns out that top box scores aren’t really a measure of patient satisfaction at all. Instead, they’re a measure of customer loyalty.

I learned this from the book If Disney Ran Your Hospital, 9 1/2 Things You Would Do Differently. In the book, the author talks about his experience going from hospital manager to Disney employee. Why, he wondered, was his hospital’s satisfaction scores better than the scores at Disney? It turns out that his hospital included 3’s, 4’s and 5’s on survey responses in the pool of satisfied patients. In contrast, Disney only counted the 5’s.

Here’s why.

If you have a really terrible experience, you’re pretty likely to rate it a 1. If it was everything you expected and nothing more, you probably had a pretty good time and your score will reflect that. A 3. But what if something happened that made your experience incredible. Maybe a nurse held the hand of a dying patient. Or a restaurant manager remembers you by name and adds your favorite childhood meal to the menu. Or maybe someone just simply walked you to the bathroom when you asked where it was.

If some part of your experience really sticks out as different from what you expected, but better, you’re probably gonna rate that a 5. And you’re probably going back to that place the next time you need that service. A 5 means you’re a loyal customer.

If a hospital wants to grow by treating more patients, it can do one of two things. It can spend money on advertising and buy it’s patient population. Or it can provide amazing services and build that through customer loyalty.

Patient Satisfaction Scores Affect Provider Satisfaction AND Malpractice

Hospitals aren’t the only ones who benefit from higher patient satisfaction scores. Believe it or not, higher scores actually do reflect higher provider satisfaction. That means you…and me. And I hate to say it, but it’s true. Ever since worrying about patient satisfaction, I started enjoying conversations with my patients a lot more. I think it’s a result of the simple fact that as humans, we’re very social. And creating that social connection with your patients improves your job satisfaction.

The other great benefit for providers is that higher scores actually reflect a decrease in malpractice cases. Apparently if patients like you, they’re much less likely to sue you.

3: Take a course

I mentioned before that I really learned the patient satisfaction game by taking a course and reading the Disney book. I don’t think you have to go all in like I did just to get your scores up, but I do highly recommend taking a course.

The one I went with is the PatientSET course by the Sullivan Group. It was under $200. It gave me CME for the year. And It only took about an hour. Not bad for something that can keep you out of meetings with your boss.

I won’t go into too much detail because I think taking the course itself is incredibly valuable (and no, I’m not sponsored and don’t get paid to recommend it). But the course did a few things for me. First, it outlined the whole patient satisfaction game. And secondly it showed me exactly what I was doing wrong with A/B video scenarios.

“Oh hey, that doctor didn’t introduce themselves to the family, asked the patient about the chief complaint, stood in a relaxed position, and left when the nurse said a consultant was on the phone…I do pretty much all those things. And oh ok those are bad things.”

Actually seeing good and bad situations acted out gave me a much better sense of how to improve. And I think watching those videos will help you as well.

4: Know which patients get surveys

You might think that every patient you see gets a patient satisfaction survey, but that’s not the case. Survey results only represent a fairly small portion of your patient encounters, especially for doctors practicing emergency medicine. Here are a few of the criteria:

  • The patient must be at least 18 years old at the time of admission
  • The patient must have a non psychiatric principle diagnosis at the time of discharge
  • The patient must have stayed one full night in the hospital
  • The patient must be alive at the time of discharge
  • The patient is ineligible for a survey if
    • They have a home address outside the United States
    • They have been discharged to hospice
    • They have been discharged to a specialized care facility (i.e. nursing homes)
    • They are a prisoner
  • Patient may only receive one survey every 90 days

And for emergency medicine physicians

  • Patients admitted to the hospital will not receive emergency department surveys.

If you’re an ER doctor, I completely understand why that last point is a major issue. If your job security is based on high scores, and if the least sick patients you see fill out surveys while the most critically ill patients you take care of don’t, a clear bias arises. If you want to read more about this dilemma, I recommend this article from EP Monthly.

Regardless of whether we like this system or not, it is the system we live in. And there is a way to get better scores without sacrificing patient care. Teaching you how is why I wrote this article.

5: Know what the surveys ask

There are five categories that patients rate doctors on in press ganey patient satisfaction surveys.

  • Courtesy of the doctor
  • Doctor took time to listen
  • Doctors were informative regarding treatment
  • Doctors were concerned for your comfort
  • Doctors included you in the treatment decision

Each of these are scored on a scale of 1-5, then aggregated into your overall score. Mastering these 5 things will get you higher scores. Now let’s discuss what steps you can take to do exactly that.

6: Stop crossing your arms

In a typical patient encounter, the following situation arises. The patient gets to the room and I try to be in there as soon as possible. Nurses enter with me and sit down to start placing IVs and begin talking to the patient. There also might be a student in the room as well. With nowhere to sit, I’ll lean against the counter with arms crossed in a comfortable position, and take the history from the patient.

When I explained this to Mrs. Average Doctor… “OMG that’s the worst thing you can do!!!”

Confused, I acted out the scenario. Standing on the far side of the room, arms crossed in a comfortable position, I introduced myself as the doctor to her as the patient. Then, I sat next to her only a foot apart and did the same thing. “Is this seriously any better?”

It was.

As it turns out, Mrs. Average doctor has a much better understanding of body language than I do. Crossed arms close you off. Sitting, even for the same amount of time as if you were standing, makes people feel like you’re listening. These two simple tricks make such a massive difference in patient satisfaction, I couldn’t believe it.

So stop crossing your arms. And stop standing. Sit down when you talk to your patients. It will make them feel like you’re listening to them. And get you better scores.

You may need to work with your nurses to make sure you can use the chair during the h/p. But if there isn’t a chair in the room, go find one. You’ll be surprised how your interactions change.

7: Introduce yourself properly

Do you normally walk straight into the room and introduce yourself to the patient? “Hi, I’m The Average Doctor”. That’s fine, but if you want better scores, do this.

First, pause before you enter the room, and knock. “Is it ok to come in?”

Then, scan the room and introduce yourself to everyone. “Hi, are you Mr Smith?” “I’m The Average Doctor. Nice to meet you. Who did you bring with you today?” “It’s nice to meet you, too”.

It doesn’t take very long, but these simple steps slow down the encounter and put both the patient and their family member at ease. Remember, the exam room is normal for you, but probably causes some level of anxiety for your patients. By properly introducing yourself to them and their loved ones, you’re showing them you’re not a scary doctor.

8: Start practicing evidence based behaviors that are proven to help

In that same study of 191 bedside encounters that showed the difference between trained and untrained providers’ patient satisfaction scores, they also isolated a number of behaviors with statistically significant impacts on patient satisfaction.

  1. Smile and make eye contact: Together, these indicate to your patients first that you’re not threatening, and secondly that you’re listening.
  2. Appropriate touch: A simple handshake or touch on the shoulder that establishes human contact with your patients. Of course, you’ll need to read your patients a bit on this one. If they don’t want to be touched, don’t touch them.
  3. Acknowledge the wait and apologize: Whether you walked into the room immediately or took 30 minutes before you could see the patient doesn’t matter. For your patients, they started their medical experience well before they even got to your facility. Apologizing for the wait shows empathy, and lets them know that you care.
  4. Begin with “How can I help you”: Instead of reading a chief complaint and telling you patient “So I saw you came in for chest pain that’s been going on for a while,” start with “How can I help you” instead. This open ended question is much less aggressive and allows you to gather better detail on the patients history of present illness.
  5. Do at least one non-medical gesture: Take a moment before you leave the room to do one non-medical thing. That could be acknowledging the temperature in the room and getting the patient a blanket, showing them how to raise and lower the bed, handing them their call button, or getting them or their family member a glass of water. I was not a fan of this one, but by goodness it works. And it doesn’t take very long.
  6. Overestimate time: How long does a typical encounter take? 2 hours for labs and a CT? 4 hours for a 2-set troponin? You probably have some idea of the typical visit for the patient’s specific complaint. Take that time, add 25% to it, and tell the patient that’s how long it’ll take. This is a customer service trick taken straight from the customer service manual.

Outside of getting the occasional glass of water or blanket, performing all of these actions shouldn’t take any more than 60 seconds in total. But they’re proven by evidence to increase your patient satisfaction scores.

9: Empathize with your patients and show concern for their comfort

When I was a patient before my appendectomy, I remember two things. First, my stomach hurt for over 6 hours and my surgery attending in med school told us you should go to the ER for any abdominal pain lasting more than 4. Second, I remember waiting.

Waiting in a small room, on an uncomfortable bed, with the world’s smallest TV alongside the worst speaker. And I think my phone was dying too.

What I don’t remember is how often I saw my doctor. I think it was twice? Once when I came in and again when he told me I’d need surgery.

Think about the last time you went to a restaurant. How many times did the waiter come to your table? The good ones probably came by more than a few times, right? What about the manager? They only come by once, in the middle of your meal to ask how you’re doing. You’d definitely tip a good waiter well, but how would you rate the manager? Would you feel comfortable giving them a 5?

That’s the situation with patients, too. They spend plenty of time with their nurses who check on them frequently. But docs tend to wait for all the results to come back so we can tell the patients what’s going on. The thing is, when we do that they only see us two times.

Do better than that. If the patient’s gonna be there for more than an hour, check up on them. Acknowledge how awful it is to wait in the ER. Tell them you just want to make sure they’re doing ok. Heck, ask if their family members want a glass of water. It won’t take long and it will make them remember you. For a good reason.

10: Become a good listener 

Raise your hand if you think you’re a good listener. If you did, go ask a family member for their honest opinion and see if that’s true. I asked Mrs. Average Doctor and it turns out I was pretty bad at listening, myself.

Listening is an essential life skill, but it’s not one that we practice very often. Think back to conversations you have with patients, family, or friends. Chances are you’re listening for your chance to reply. Or tuning out some part of the conversation. Most of us do this. Most of us are bad listeners.

Now try something different. Show your patients that you’re paying attention. Make eye contact. Say “uh huh” at appropriate times to encourage them to keep talking. Mirror what they said by paraphrasing it back to them. These strategies worked for Chris Voss, ex-FBI negotiator and author of Never Split the Difference. And it will work for you, too.

Conclusion

Hopefully, reading through this article has helped you understand what patient satisfaction scores are, why they’re important, and how to master them. I can’t say whether or not these surveys are overall a good or bad thing for healthcare in America. But I can tell you that residency never taught me how to conquer them. I had to learn that the hard way. Hopefully, now you won’t have to.

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