The University of Patient Satisfaction. Partners. 22-27

COVER STORY
THE UNIVERSITY OF PATIENT SATISFACTION
A Total Immersion
Approach to Raising
the Bar in the Era of
Value-based Purchasing
The University
of Patient Satisfaction
O
By Todd Sloane, Editorial Manager,
Press Ganey Associates
ne recent Tuesday morning,
managers, directors, frontline staff
and some physicians gathered in
a garden-level room at the University of Toledo
Health Science Campus. Though they were
there to hear about statistics and watch a
PowerPoint presentation, the meeting had the
air of a religious revival meeting.
“Extraordinary times take extraordinary people,
and you are those folks!” Ioan Duca, the service
excellence officer for the University and its
Medical Center, exhorted the crowd. “In the last
six months, our HCAHPS global dimensions
have moved from the 50th to the 62nd percent.
We are so close to our goal! So take charge
of your area, take a look at your Press Ganey
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questions, at your HCAHPS questions. Have
a very simple plan of action. Communicate
the plan day in and day out. Devote 10 hours
every month to patient satisfaction. Work with
every single patient. Be nice to patients, to one
another, to yourself. Can we do this, folks?”
Some murmurs of “yes” came from the crowd.
“I didn’t hear that. Can we do this?” Duca
asked again.
“Yes!” came the reply, much louder this time.
There is method to Duca’s madness. He
has been attending some unusual events to
enhance his already well-developed ability
to proselytize, including a local church and
Texas A&M University’s freshman orientation, a
HCAHPS “RATE HOSPITAL 0-10” 2011 DATA BY MONTH
total cultural immersion that Duca says leaves
students “Aggies for life.”
“I am really focused on creating a church-like
environment here,” he said in an interview
later that day in his office at the University of
Toledo Medical Center (UTMC). “We want a total
cultural transformation. I want that Disney-like
experience, the Ritz Carlton experience, the
Texas A&M experience. I want that kind of true
belief. When people really believe in something,
they will risk everything to get it done.”
Duca’s role has expanded to encompass a
patient satisfaction and student experience
improvement initiative involving 9,000
employees and 27,000 medical, nursing and
other students.
The centerpiece of the project is iCARE
university, which stands for communication,
access, respect and excellence. iCARE has
coursework and hands-on training in patient
satisfaction for everyone at the University.
The larger initiative includes a weekly patient
satisfaction lineup meeting attended by leaders
and representatives of all departments.
“What we are doing here is a first of its kind
across the nation, where you have a hospital
within a university and the university, itself,
targeting cultural transformation,” Duca said.
“We are shaking this place up, top to bottom.”
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COVER STORY
THE UNIVERSITY OF PATIENT SATISFACTION
He came to Toledo after leading a similar
transformation at Oakwood Healthcare System
in southeastern Michigan. Bryan Hinch, MD,
an assistant professor of internal medicine and
pediatrics at the UT medical school, worked
at Oakwood right after his residency, and was
impressed by Duca’s efforts there. “I came in
after everything was better. You got a sense
of mission starting right away at orientation.
Everything was very patient-satisfactionoriented. When I left to go work at other
organizations, I started to see what the real
world was like without that focus. So I was glad
to see Ioan come on board here at UTMC.”
A New Mission
Scarborough said the challenge for UTMC is to
match its stellar reputation for clinical quality
with an equal reputation for customer service.
“We have always had great clinical outcomes,
and recently we received an honor from U.S.
News and World Report, which ranked us No. 1
in the Toledo area, but our patients sure weren’t
seeing us that way. We looked at where we
stood in the state of Ohio, and we were 140th
out of 147 hospitals on HCAHPS. We were
saving people’s lives, yet they were walking
away angry. We had to learn how to save lives
and still treat people like human beings.”
To further signal its change of approach, UTMC
rewrote its mission statement from a full
paragraph to just one sentence: “Our mission
at the University of Toledo Medical Center is
to improve the human condition by providing
patient-centered, university-quality care.”
Inside the ‘University’
iCARE University is housed in a new training
facility that includes a small classroom,
a medical exam room and a simulated
business office. In the exam room, clinicians
are evaluated on their active listening, the
effectiveness of their efforts to reduce anxiety,
their clarity of communication, and their ability
The project in Toledo really dates back more
than a year and a half, when senior executives
of UTMC looked at the organization’s dismal
patient satisfaction scores and decided to do
something about them. They traveled to The
Dalles, Ore., to meet with officials at MidColumbia Medical Center, the first hospital to
fully embrace the patient-centered Planetree
philosophy. They had Mid-Columbia’s former
CEO, Mark Scott, the author of the book, The
Courage to Be First, come to UTMC.
“We were told this is a three-year journey to
turn this thing around,” said Scott Scarborough,
PhD, the medical center’s senior vice president
and executive director. “Things really got moving
only a year ago when we brought in the best
patient experience director we could find in
Ioan Duca.”
In Duca’s first week on the job in November
2010, he joined into a special event called “A
New Day,” where the new mission of patientcentered care was announced by Scarborough.
Part of the event was to unveil a common
uniform – scrubs with the university’s colors.
“We wanted to look more professional and more
like a team, not people with SpongeBob Square
Pants scrubs,” Duca said.
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The UTMC project dates back more than a year and a half, when senior executives looked at the organization’s dismal
patient satisfaction scores and decided to do something about them.
“We have always had great clinical
outcomes … but our patients sure weren’t
seeing us that way. We were saving
people’s lives, yet they were walking away
angry. We had to learn how to save lives
and still treat people like human beings.”
Scott Scarborough, PhD
Senior Vice President and Executive Director, UTMC
to focus on the patient, not their own stress.
In the office, registration staff and others who
greet patients on arrival at the hospital or
ambulatory care clinics are evaluated on some
of the same skills.
Training modules are customized based on the
needs of each department. “We looked at what
is appropriate communication with a patient and
what isn’t, what constructive criticism of each
other looks like,” Schiavone said.
Joseph Schiavone, a service excellence
specialist and one of three people responsible
for hands-on training, said his department
kicked things off with the basics, teaching about
HCAHPS, Press Ganey scores and value-based
purchasing. “We set the table, so when staff
members go to the weekly lineups, they know
what is going on,” he said.
Currently, the AIDET (acknowledge, introduce,
duration, explanation and thanks) process,
a form of scripting that guides each patient
interaction, is being rolled out across the
hospital. The service excellence team is layering
on additional scripting.
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COVER STORY
THE UNIVERSITY OF PATIENT SATISFACTION
Action Plans Unfold
Scarborough stresses that the changes have
to emanate from the top. “Part of my role and
responsibility is to ensure that people know my
emphasis on these issues. In every talk I give,
I lend my voice to what Ioan is doing, giving
him the verbal support he needs to move the
mountain that he is being asked to move,
creating the environment in which he can
be successful.”
On the floors, the nursing staffs are buying
into the iCARE process, says Kelli Chovanec,
RN, MSN, assistant nursing director on
the orthopedics and rehab unit. Her team
has fostered the mentality that everyone is
responsible for every patient. “We take frontline
staff at least once to the weekly lineup. We have
really interactive, good discussions about what
patient-centered care really looks like.”
Bringing in the Docs
The unit has a specific action plan around two
HCAHPS questions – communications about
medications and response of hospital staff.
Nurses use scripted language when speaking
about medications during administration,
provide clear and concise descriptions of the
drugs, discuss potential side-effects, avoid use
of confusing medical terminology, and always
end with, “Do you have any questions about
your medication?”
Ioan Duca wants to create a church-like reverence for
customer satisfaction at UTMC.
He is now moving on to the next phase, where
each physician is receiving his or her individual
scores. “A lot of them are in shock, saying,
‘Are you kidding me? This is me?’ My answer
is, ‘Yes, that is you, now let’s work on how to
fix that,’ ” he said. The next phase of iCARE is
targeted education aimed at physicians, with
modules being developed.
Changes Everywhere
years to renovate the main hospital entry area
and create all private rooms. A new food service
vendor was brought in, and the medical center
is hiring its first executive chef. At the front
door, a new, more customer-centric valet
service is provided.
The changes under way at the campus – which
has three hospitals with a total of 320 licensed
beds; a Level One trauma center; centers
devoted to orthopedics, cancer and rehab care;
and numerous clinics – are also physical. About
$50 million is being spent over the next few
“We even worked with our volunteers to make
sure the friendliest people greet you inside the
door,” Duca says. “More than anything, you just
see a difference in how employees look. They
used to look down when they walked, now they
are looking up.”
Scarborough has been pleasantly surprised
that it has been a fairly easy sell thus far to get
physicians to buy into the patient experience.
“We could see a little more resistance once we
push them on the training in iCARE University,
but so far, they are more resistant to the
electronic medical record than they are to
improving the patient experience.”
There is hourly rounding, with nurses taking
even hours, aides doing odd hours. All have
scripting cue cards in their pockets.
“Accountability is a huge part of changing
our culture,” Chovanec said. “We personally
investigate every single patient issue that
arises, and we do pull nurses in. We also
evaluate every staff member and rate them
high, medium or low on customer satisfaction.
We did one-on-ones with lower performers and
told them, ‘Hey, you have to raise the bar.’ ”
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Duca is now zeroing in on physicians. He has
done one-on-one sessions with almost all of
them about the basics, including the validity
of Press Ganey data and the fact that HCAHPS
is now tied to Medicare reimbursement under
the Hospital Inpatient Value-based
Purchasing Program.
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| January/February 2012
UTMC’s most recent union contract builds in
incentive compensation tied to improvements
in HCAHPS scores. “Ultimately we are going
to judge everybody on how they meet the two
parts of our mission statement – quality care
and patient satisfaction,” he says.
At a recent weekly patient satisfaction meeting, Duca (with mic) honors food service workers for their efforts to
improve the quality of customer service.
With a wry smile, Duca referred to another key
initiative: strategically beginning to incorporate
patient satisfaction into the University’s medical
school curriculum. “As part of a week-long
course as a bridge course from second year
of med school to the third year, we also taught
on key patient satisfaction concepts as well
as the overall patient experience. The vision
is to develop a unique patient satisfaction
curriculum, with a course every year of medical
school. And I will love to teach those classes.”
Not all of the selling of patient satisfaction has
gone smoothly. Duca says that some staff have
chosen a different career path because they
“simply couldn’t hack it” on patient satisfaction.
“Investing into and hiring the right people, who
buy into the ideology, who see this place as
sacred, a part of their lives and not just a job,
is key. Look, this is not some Hallmark concept,
not about teaching people how to smile and
say hello. It is not even about giving someone
the right drug or how well they recover from
surgery. It is about treating the entire person;
it is about the environment in which we treat
them. When you walk in and show some
compassion, every single human being, even
the meanest person, will react well to that. That
is medicine at its best.”
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