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The
best physician-leaders always behave as if they have a patient
at their elbow, and they bring the patient's perspective into
every conversation.
James Reinertsen, MD,
"Physicians as leaders in the improvement of health care
systems"2
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The following
is adapted from a resource guide titled Creating the Best Place to
Practice: What Physicians Can Do to Improve Patient Care and to Enhance
Their Everyday Work Experience. This guide was developed in May 2003
by the Organizational Research Department at the request of Kaiser
Permanente's Care Experience Council. This chapter--Focus on the Patient--is
especially appropriate as physicians lead efforts in providing patient-centered
care. --Editor
Introduction
What's
in it for me? Every physician is a leader, and all physicians have
direct influence on their work environment. Whether in a formal leadership
role or not, physicians greatly influence the work environment. Physicians
are leaders in their health care teams because of training as well
as from a legal perspective. The way you conduct yourself and your
relationships with others can either lead to, or detract from, a work
culture that supports patient care and service. Research suggests
a relation between physician behaviors that create a work environment
of teamwork, collaboration and support, and the ability of all health
care team members to provide patients with a high-quality care experience.1-3
Your Role as Patient
Advocate
This
section focuses on behaviors you can adopt to influence patient satisfaction
and promote service and health care quality. These behaviors help
you promote a service culture through words, actions, systems, and
processes.
As you
know, your primary responsibility as a physician is the well-being
of your patient. Because of your deep understanding of your patients'
needs, you are the perfect advocate to lead changes to health care
systems and processes. To successfully lead change as a patient advocate
and as leader of the health care team, you are in a perfect position
to determine what is important to your patients. By spending time
inquiring about their needs and their experiences with the health
care system, you can assess how well your care processes perform against
those stated patient needs. You will then be in a position to advocate
for changes that really matter to your patients--changes that will
improve their care experience.
Patient Needs-- Obtaining
Important Feedback
First,
you can use opportunities to obtain patient feedback. Here are some
specific questions you can use to obtain a better understanding of
your patients' needs, as well as questions to assess how these expressed
needs are being addressed by you and your team.
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Ask questions about their needs:
How
would you define high-quality service? High-quality care?
What is most important to you when you visit your doctor?
- Talk
to your patients about the service they receive:
How are we serving your needs?
What
do you like and dislike about our service and care?4
How
can we improve our service?4
What are we not providing that you feel we should provide?5
- Observe
interactions between staff and patients.
What
processes (for example, scheduling appointments or check-in) work
smoothly from the perspective of both patient and staff?
What processes require unnecessary multiple steps or potential
rework?
What barriers do staff encounter as they try to serve the
patient?
- Encourage
staff to be "listening outposts" to obtain information
about members.
What
has staff learned from patients about what helps or hinders meeting
patient needs?
What complaints are heard from patients about services or
processes?
Tell
your patients that their feedback to you about the care and service
they receive is highly valued and will be used to make service improvements.
How To Use The Information
Personal
Application
Use this knowledge to better serve your patients. Commit to quality
through your actions and words.
- Set
the tone for your team by modeling excellent service to patients
and letting your staff know that the same sort of behavior is expected
from them.
- Understand
the unique needs of your patients based on differences in background
and culture.
- Participate
in improvement efforts when asked.
- Talk
about issues of quality honestly and openly. Work with your team
to create a "blame-free" environment so issues of quality
can be discussed.
Share
Information
It
will be important to then share what you know about member and patient
needs. Communicate to your team the importance of good patient service
and its place in the delivery of quality care. Ask team members to
contribute their knowledge of members' needs. Encourage discussions
of patient feedback at team or department meetings.
- Repeatedly
communicate to all team members the importance of service quality
in your team.
- Discuss
how your team is an important link in the chain of meeting patient
needs.
- Communicate
that the contributions of all team members are valued and important
to fulfilling the team's patient satisfaction goals.
- Before
your team makes a decision that may affect your patients, ask
"Does this solution contribute to meeting our patients' needs?"
"Is this really patient- centered care?"
- If
patient satisfaction data are available for your department or team,
use these results to improve service.
- Support,
encourage, and empower team members to solve member problems on
the spot.
- Examine
from the patient's perspective the systems and processes of your
department to identify barriers to service.
- Ask
staff for their ideas on ways to improve. Work as a group to implement
solutions.
- Make
a point of drawing together diverse groups when discussing issues
or solving problems to fully consider different points of view.
- Always
ask your team as well as your patients the question,
"How can we improve?"
Checklist for Focus
on the Patient
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I talk to patients about how well their health care needs are being
met.
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I participate in discussions regarding patient feedback and performance
data with my team.
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I identify barriers to service and quality and encourage others
to do so.
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I get involved in fixing problems and encourage others to do so.
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I model high-quality service behavior for my team members.
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I demonstrate my commitment to quality through my actions and words.
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The
ability to understand
the customer's needs and wants can be summed up
in a simple phrase:
"Always be Learning."
-- Karl Albrecht and Ron Zemke, Service America!: doing
business in the new economy5
"Quality
service is a top
down affair. It starts at the top or it doesn't start."
-- Karl Albrecht and Ron Zemke, Service America!: doing
business in the new economy5
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Summary
As physicians
take the lead in creating patient-centered care, the ability to understand
patient needs and translate those needs into meaningful improvement
in the health care environment will require a new set of skills. Understanding
patients' experiences outside your exam room, leveraging staff to
work as a team, serving as a role model for service behavior, and
sharing your knowledge are different from what makes the solo practitioner
successful. These are the behaviors that make leaders successful.
You can begin the process by slowly adopting the behavior mentioned
in this article in a manner that fits your style. Small changes in
behavior can reap big rewards. It is important to take the first step.
References
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Tallman K, Steinbruegge J, Hatzis M. Successful practices in the
physician work environment: We work together. Perm J 2002 Fall;6(4):39-42.
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Reinertsen JL. Physicians as leaders in the improvement of health
care systems. Ann Intern Med 1998 May 15;128(10):833-8.
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Kam S, Brooks S. Touching the customer by understanding the employee:
Preliminary linkage research findings from four regions of Kaiser
Permanente. Perm J 1998,2(2):47-54.
-
Gebelein SH, Stevens LA, Skube CF, Lee DG, Davis BL, Hellervik LW,
editors. Successful manager's handbook: development suggestions
for today's managers. 6th ed. Minneapolis (MN): Personnel Decisions
International; 2000.
-
Albrecht K, Zemke R. Service America!: doing business in the new
economy. Homewood (IL): Dow Jones-Irwin; 1985.
