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The Community Hospital of Monterey Peninsula developed a system to receive real-time feedback from patients, allowing staff to address patient needs immediately.
Following the success of the real-time feedback program, the radiology department developed an appointment reminder email that gives patients pre-exam information and allows them to ask specific questions before they arrive for their appointments.
By anticipating and addressing issues early and recognizing employees for positive responses, the radiology department has received “excellent” ratings from 90% of patients and no-show rates have virtually evaporated in the radiology department.
It's widely known that early detection and treatment of diseases can improve patient outcomes. Now, radiologists at the Community Hospital of the Monterrey Peninsula (CHOMP) in coastal California are applying similar logic to patient experience issues—and are seeing higher patient satisfaction scores, fewer patient no-shows, and departmental cultural improvements as a result.
Quiz Ref IDWhile most radiology groups and other medical practices often wait weeks to send patients surveys about their care experiences, CHOMP's radiology team has implemented a system to collect and respond to feedback while patients are in the department. The electronic Excellence 24/7 (E24/7) system allows patients to submit real-time feedback using QR codes to radiology team members who can promptly address situations as they arise.
“If you wait for satisfaction surveys to come back, you're calling patients 4-6 weeks later to apologize for issues they experienced during their appointments,” says Eric B. LoMonaco, director of diagnostic and interventional radiology at CHOMP. “By that time, it's often too late to make it right. This system allows us to address patients' concerns when they matter most—right on the spot.”
Eric B. LoMonaco, director of diagnostic and interventional radiology at CHOMP, has led implementation of a system to immediately college feedback from patients.
E24/7 also includes a robust appointment reminder feature that includes links to patient educational resources, including videos from RadiologyInfo.org, a website that the ACR and Radiological Society of North America co-manage to educate patients about appropriate imaging, and an instant messaging form that allows patients to ask questions and make requests prior to their appointments.
Anthony Filly, MD, chairman of the department of medicine and chief of radiology at CHOMP, says the system engages patients in their care: “What I love about it is that we are allowing patients to reach out to us when it's convenient for them. They get their questions answered the first time by appropriate staff who are qualified to provide the information.”
Anthony Filly, MD, chairman of the department of medicine and chief of radiology at CHOMP, says the patient feedback system allows patients to take charge of their care experience.
Quiz Ref IDAnd patients seem to like it, too. Since implementing E24/7, CHOMP's radiology department has seen a 60 percentage point increase in the number of patients who have given it a favorable rating on patient satisfaction surveys, and its patient no-show rate dropped below 1%.
Before E24/7, CHOMP, like most hospitals, used a survey company to monitor its patient satisfaction. But relying on post-discharge surveys to improve patient experience and boost satisfaction scores is a losing proposition, LoMonaco says. “The patient has left the building,” he says, adding that addressing an issue after it has already happened is unlikely to be effective.
Patient satisfaction—which hospitals typically evaluate with the Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) survey—has long been an important measure of quality for hospitals and health systems and has gained increasing prominence in recent years. Under the Affordable Care Act, HCAHPS scores affect reimbursement rates, penalizing hospitals with low scores and rewarding those with high scores, resulting in up to a 30% variance in reimbursement rates between high-scoring and low-scoring institutions.1
With this in mind, LoMonaco began thinking critically about CHOMP's approach to patient satisfaction. He knew that to improve its scores, CHOMP needed to be more proactive, allowing patients to provide feedback while they were in the facility and, when possible, heading off issues as they arose. This type of approach, he thought, would enable staff to address patient complaints, learn from the experience, and apply what they learned to new situations—creating a cycle that would lead to a better experience for patients and providers alike. “My vision was to empower the patient, from their first phone contact to schedule the appointment, through the procedure, and even the billing process,” LoMonaco says.
Quiz Ref IDWhile brainstorming with a software consultant with hospitality experience, LoMonaco came up with the idea of using QR codes—black and white squares that smartphones can scan—to allow patients to immediately report situations to staff. He envisioned strategically placing the codes around the hospital, so patients could conveniently scan them and send a comment, question, or complaint to departmental staff who could then address the issue.
LoMonaco presented the idea in an email to hospital administrators, who saw little downside to the proposal. Implementing the QR codes was inexpensive, involving little more than printing signs and setting up a simple website. An outside software vendor developed the QR codes, which take users to a web-based form and sends an email to the appropriate staff—with no intervention from the hospital IT department.
Filly eagerly agreed to test the system in the radiology department. The system, he says, lets patients take charge of their experience and allows staff to focus on making the experience as good as it can be. The system provides a way to “take those potentially negative experiences and turn them into good or even great experiences,” he says.
The radiology department began piloting the program in 2013. The team posted signs with the QR codes around the department and set up the email messages to go to the radiology management team.
Patients quickly started using the codes, with the radiology team receiving five to 10 comments a day, most of which were negative. Many comments involved requests for cleaning services or complaints about long waits. Occasionally, patients criticized staff behavior during scheduling, registration, or parking.
Whatever the situation, LoMonaco addressed it as soon as possible. He tracked the comments and resolutions and reported back to staff at regular morning meetings, which they call huddles. Hearing the patient perspective and how much they appreciate staff efforts to address problems helps remind staff of their impact on patients—both negative and positive, LoMonaco says. It helps motivate staff to take that extra step to improve the patient experience. “Staff tell me, ‘Thank you for reminding me why we do what we do,'” he says.
Before implementing the codes, about 30% of patients scored CHOMP's radiology service as “excellent” on patient satisfaction surveys. Within a few months of implementing the QR codes, 90% of patients gave the radiology department an excellent rating.
Following the success of the QR code initiative in radiology, LoMonaco began exploring how the team could take E24/7 further to create a better experience before patients even arrive at the hospital for their imaging exams. He wanted to give patients a way to get answers to their questions about logistics, costs, and exams prior to their appointments and envisioned robust appointment reminders that would allow patients to send their questions to the radiology department. Doing so would head off issues and potentially reduce no-shows, he thought.
Quiz Ref IDThe same consultant that developed the QR code also created the appointment reminder software, which the department launched in September of 2017 for CT, MRI, and ultrasound appointments (the procedures most prone to no-shows at CHOMP). The software downloads a list of patients with upcoming radiology appointments from the hospital's electronic health records and uses that information to personalize each reminder email with the patient's name, appointment time, and procedure.
The emails also contain directions to the hospital, background information on the imaging exam the patient will be undergoing, and a link to the library of patient education videos at RadiologyInfo.org.
Patients can ask questions about their exams or make special requests via an instant response form embedded within the emails. Like the messages sent from the QR codes, these patient requests go directly to the radiology management team, including Filly. For example, one patient wrote to say that she previously had an allergic reaction to a contrast agent, and she was worried it would happen again. Filly responded right away, reassuring the patient and avoiding a last-minute delay in the procedure.
In another instance, a patient who frequently missed her appointments used the form to request a wheelchair at the entrance to the facility. She explained that if one wasn't available when she arrived, she would drive away without getting the needed test. Armed with this information, LoMonaco arranged to meet her at the door with a wheelchair and (at her request) a caramel macchiato. The patient told LoMonaco that the service made her feel “like the CEO.” “Stories like that happen every day now,” LoMonaco says.
The emails also include a link that patients can use to reschedule or cancel their appointments, as necessary. Once a patient clicks the link, the system immediately releases the appointment time and alerts scheduling staff to call the patient and set up a new appointment—sometimes within seconds.
With the system, the department's no-show rate for CT, MRI, and ultrasound has dropped to virtually zero: .01%—compared to a national average of 2-5% in radiology.2 This reduction in no-shows is significant, and more than justifies the cost of the E24/7 program, which costs approximately $3,000 per month (or about the same amount of one missed CT exam).
Based on the E24/7's positive impact in radiology, it quickly spread throughout the hospital. QR codes are posted throughout the facility, and plans are underway to implement the appointment reminders for mammography appointments and for all scheduled inpatient admissions throughout the hospital.
As in radiology, the system has had a positive impact on the hospital's satisfaction scores. In the spring 2019 HCAHPS, CHOMP was among the fewer than 300 hospitals nationwide to receive a five-star rating3—the second year that CHOMP has earned this distinction.
Additionally, CHOMP now uses the Net Promoter Score, a metric that retail businesses use to measure customer experience based on responses to a key question: “How likely is it that you would recommend [brand] to a friend or colleague?” CHOMP's current score is in the 90s—by comparison, Costco and the Ritz Carlton Hotels (both considered customer service giants) generally score in the 70s.
The effects of the E24/7 program have gone beyond patient satisfaction scores and cost savings. “It's the culture change that's the real value,” LoMonaco says.
In the past, CHOMP has tried to boost patient satisfaction scores with customer service seminars, which can cost upwards of $250,000. But real-time feedback and individual mentoring appear to have a bigger impact than broad training programs—and are more cost effective, too. “The improvement happened organically with the process, resulting from both negative and positive feedback,” Filly explains. “The program not only helps identify staff for individual patient experience coaching, but also motivates staff members to create the positive experiences that patients rave about and that get mentioned in morning meetings.”
Quiz Ref IDTo engage employees further, Filly hopes to add a QR code that employees can use to report problems and suggest potential solutions to administrators, an approach he believes could help address burnout among staff and clinicians. “My experience is that burnout often comes not just from being too busy but also from dealing with systemic problems,” says Filly, who has pitched the idea of putting the staff communication QR code on employee badges. “This approach would empower employees to engage further to improve the department's culture.”
Along with the employee codes, LoMonaco, who now leads CHOMP's Customer Experience Workgroup, plans to issue a “Very Special Person” card to every patient who comes to the hospital. Printed on the card will be a QR code for feedback and these words: “Your care is our number one priority. If we are exceeding your expectations or falling short, please tell us how.”
Customer service initiatives like this are critical to maintaining a quality facility—particularly as more patients shop around for health care. Filly recommends the system to other radiology departments as a great way for radiologists to increase interaction with patients while maintaining and even improving workflow. “This software product lets us create meaningful dialogue with patients when it is convenient for both parties and helps create a relationship before the patient even enters the department,” Filly says.
Approach administrators or patient experience officers at your organization or in your department about how an instant feedback system can identify and address issues early and boost patient satisfaction scores.
Work with departmental leaders to develop a system for receiving inquiries and comments from patients and a method for tracking and reporting on outcomes.
Identify resources and information that patients need before radiology appointments and incorporate them into appointment reminder emails, along with a form for patients to ask questions and make special requests to ensure all goes smoothly when they arrive at the facility.
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ACR's Imaging 3.0 case studies series spotlights radiologists who are partnering with clinicians, other medical professionals, and patients to make the transition from a focus on the volume of scans read to the value of care provided. Each case study includes actionable steps that providers can follow to implement similar initiatives at their own institutions. Learn more
This case study by American College of Radiology is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License. Based on a work at https://www.acr.org/Practice-Management-Quality-Informatics/Imaging-3. Permissions beyond the scope of this license may be available at www.acr.org/Legal.
Disclosure Statement: Unless noted, all individuals in control of content reported no relevant financial relationships.
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