Free the data: Giving patients a voice
Let patients grade us and post the scores online, the good, bad and ugly? Are you crazy? This wasn’t the verbatim response of doctors to University of Utah Health Care’s push to publish patient satisfaction data on its Find-A-Doctor website. But it’s pretty close.
“A basic principle of health care is that everyone strongly favors transparency – for everyone but themselves,” wrote Thomas H. Lee in the Harvard Business Review, extolling the virtues of the U.’s pioneering move. Doctors worry colleagues might game the system by cherry-picking patients, that data aren’t risk-adjusted or that they’ll lose patients if they look less than perfect, wrote Lee, M.D., Chief Medical Officer at Press Ganey Associates, the nation’s leading provider of patient surveys. But he said, the U., the first academic medical center in the U.S. to publish its Press Ganey scores, complete with patient comments and an accessible five-star ranking system, was “richly rewarded for its creativity and courage.”
In 2008 the university ranked in the 18th percentile in outpatient satisfaction nationally. Last quarter we ranked in the 85th percentile. Nearly half of our 1,300 plus providers had 30 or more surveys returned. Of those, one of every two ranked in the top 10 percent nationally when compared with their Press Ganey peers. One of four placed in the top 1 percent.
The U. started by privately sharing patient reviews with individual physicians, opening the door to ticklish conversations about how to improve. Then the data were shared internally, allowing doctors to compare themselves to their colleagues. High performers were recognized and lower performers were offered support and personal coaching. In December 2012, the reviews went live at: http://healthcare.utah.edu. “Virtually all, about 99 percent, of comments are unedited, and are only removed in the event that a comment might compromise patient privacy or could be considered legally libelous,” says Brian Gresh, senior director of interactive marketing and web. Initially, Gresh says, the goal was to give consumers a trustworthy alternative to popular consumer portals like Healthgrades.com where it’s impossible to verify if those submitting scathing or glowing comments are actual patients. Instead of allowing a few squeaky wheels to drive the discussion, the U. electronically surveys all patients.
It worked. “Analytics show our web traffic nearly doubled. When you search for a University of Utah doctor, it’s our portal you now see. We own the first position on Google,” says Gresh. Patients are more engaged. About 50,000 patient surveys were returned that first year in 2012. Today the number exceeds 75,000, about 15 percent of our outpatient visits. And though patient volumes have increased––likely due to a mix of factors, including expanded services, an improving economy and Utah’s growing population––we’re keeping costs in check. From 2010 to 2014 health costs nationally grew in pace with inflation, at an annual average rate of 3.5 percent. Our costs grew at just 1.4 percent on average.
Other systems, including, Piedmont Health in Georgia and Wake Health in North Carolina, have since followed the U.’s lead. “University of Utah leaders realized that putting their patient information on the Web wasn’t mere marketing – it was creating a powerful motivation for physicians to give every patient the best, most empathic care. Financial incentives to improve patient experience could never have produced this kind of change,” wrote Lee. “What mattered was physicians’ awareness that every patient visit is a high stakes encounter – the biggest event of the patient’s day or even month. As one orthopedist put it, ‘It forces me to be on top of my game for every single patient.’”
