Who Is Press Ganey and why are they measuring patient satisfaction?
In 1979, Irwin Press, PhD focused his interest on the modern patient experience, the study of which would lead him to become known as a patient satisfaction expert. In 1984, Dr. Press introduced the importance of survey methodology when establishing a patient satisfaction program and by early 1985, he had developed a survey that would measure patient satisfaction as a means to improve performance. To address the need for statistical analysis and survey methodology, he collaborated with Rod Ganey, PhD and together, the two formed Press Ganey Associates in 1985.
According to their website, today Press Ganey “partners with more than 10,000 health care organizations worldwide to create and sustain high performing organizations, and, ultimately, improve the overall health care experience. Press Ganey works with clients from across the continuum of care hospitals, medical practices, home care agencies and other providers including 50% of all U.S. hospitals.”
The Press Ganey Pulse Report is an annual report which collates research and analysis of public and proprietary data and the perspectives of patients, employees and physicians to uncover trends in healthcare. The 2011 report reveals:
“The top priority item for medical practices is sensitivity to patient needs, indicating a need for medical practices to personalize their interactions with every patient.”
The remaining top-priority items for medical practices all reference patient satisfaction with the care provider, and include:
- Physicians and medical practices need to serve the whole patient.
- Physicians and medical practices need to understand a patients culture, the relationship with a patients family or caregivers, and the unique communication needs of individual patients.
- Physicians and medical practices need to validate patient concerns and confirm comprehension, which are critical to ensuring compliance with treatment protocols, and also increases the likelihood for better outcomes and greater patient satisfaction.
The report also has some pretty fascinating information on the Overall Satisfaction in Top 25 Medical Practice Specialties (!) and Medical Practice Satisfaction by Waiting Times. Press Ganey outpatient questions are answered by over 3 million people annually over the course of 12 months. You can download the 2011 Press Ganey Pulse Report here.
Press Ganey also has other free resources available on their site:
For Medical Practices and Outpatient Facilities – case studies, recorded webinars, ROI resources and White Papers here
For Hospitals – case studies, Pulse Reports, Emergency Department resources, recorded webinars, ROI resources and White Papers here
For Home Care -case studies, recorded webinars, ROI resources and White Papers here
Government Initiatives for Public Reporting – includingthe Clinician and Group Consumer Assessment of Healthcare Providers and Systems (CGCAHPS) survey, the Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) survey, the Home Health Consumer Assessment of Healthcare Providers and Systems (HHCAHPS) survey, and Meaningful Use and Value-based Purchasing here
Like other medical conditions, behavioral health issues span the spectrum from mild to significant mental illness (SMI). There are many national studies, such as the Impact Model, showing the benefits of identification and treatment of depression in the primary care setting. Many practices have added a mental health clinician or social worker to their staff to expand on-site care for those needing lower level behavioral health services and to reduce the stigma for patients accessing mental health services. It is care for those with more significant mental illness that becomes challenging to the primary care practice.
What is the relationship of SMI to physical health?
The National Council for Community Behavioral Healthcare reports that 3 out of 5 individuals with a SMI die from a preventable health condition. In general, the life expectancy of a person with SMI is 25 years less than the average population. They have a higher incidence of chronic medical conditions for individuals exacerbated by smoking, obesity, homelessness, and sometimes by the very drugs used to treat their psychiatric condition. There are many reasons for the lack of medical care for these individuals including social isolation, cost, transportation, and inability to fit in to a primary care practice culture of focused discussions. Many use the emergency department for routine care rather than establishing and maintaining a relationship with a primary care practice.
Barriers to behavioral health services and to primary care for behavioral health patients
For the organized and busy professional on the go, the smartphone has quickly become a necessity on par with a persons house keys, wallet, or purse. The past five years have vaulted the smartphone from status symbol to must-have business tool by bringing data and communication capabilities from your office to the palm of your hand. With decision making and communication tools always at the ready, you can be productive from anywhere you are, and you are freed up to bring information to clients, meetings, and conferences without the hindrance of a laptop.
Physicians, practitioners and forward thinking healthcare organizations are leading the charge to embrace mobile health, often called mHealth, or the practice of patient care supported by mobile devices. A survey conducted at the physician online and mobile community QuantiaMD in May of 2011 found 83% of physicians reported using at least one mobile device and 25% used both a phone and a tablet. Of the 17% surveyed who did not use a mobile device, 44% planned on purchasing a mobile device sometime in 2011. Physicians surveyed reported their top uses for mobile devices as :
A Continuing Care Retirement Community (CCRC) offers a span of care in a single setting beginning with independent living and as needed, assistance-in-living and skilled nursing care.
The goal of these communities is to allow residents to age in place.
Support for independent living and quality of life for every stage of life is evident in the flexibility and choices residents in these communities have. Residents do not have to move elsewhere to obtain the care they need regardless of how long they live in the community.
CCRCs require a sizeable entry fee plus monthly maintenance fees in exchange for a home or apartment, food and care. This model requires a long-term, upfront financial commitment that, in turn, guarantees housing, services and nursing care all in one location through the end of life.
A special type of CCRC is a LifeCare community.
LifeCare communities must provide:
- Health care coverage for life in a skilled nursing center at little to no increase in the housing monthly service fee.
- A guarantee that if the residents resources are exhausted they do not lose their residence or their benefits.
- The retirement community has to have a skilled nursing facility within the community itself.
I had the opportunity to visit a LifeCare CCRC this week.
I was visiting my dad and stepmom, who live at Abbey Delray South (ADS) in Delray Beach, Florida owned by not-for-profit Lifespace Communities, Inc. headquartered in Des Moines, Iowa. Every time I visit I am more impressed with the community and the life my parents are leading.
My parents have a garden home at the LifeCare CCRC where they’ve lived for 8 years. They know almost everyone in the 400-resident, 222-staff, 35-acre ADS community. They take advantage of most of the community amenities including:
- Heated pool and jacuzzi, horseshoes, driving net and putting course, croquet, shuffleboard
- Weekly group exercise classes as well as personalized exercise groups for specific needs
- Dakim BrainFitness computer exercises designed to improve functional independence
- On-campus worship and transportation to local churches and synagogues
- Poker, billiards, Wii bowling, chorus, bridge, computer classes, lectures, movies
- Discussion groups, book clubs, entertainment nights, wine and cheese events and monthly parties
- Transportation to stores and medical appointments, on-site rehab and physical therapy services
At this community, one meal a day is included.
Residents sit on an advisory committee to give the dining room managers and chef feedback on their likes and dislikes. Dinner in the dining room requires a jacket (my dad has quite a selection), but not a tie for the men. After the meal, residents pick up soup, cookies and fruit to have in their own kitchens for their other meals. A cleaner comes once a week, laundry service is available for sheets and towels, and household repairs and maintenance are included in the monthly fee.
The week we visited ADS was in the midst of their annual promotion of the FITSIXTM wellness program. Each resident receives a lanyard (see top picture) with a pie chart showing the six dimensions of wellness physical, social, intellectual, emotional, spiritual and vocational – and spends the week earning “jewels” for participation in many special events and programs. At the end of the week, the residents meet to hear how they’ve done and prizes are awarded.
Here’s a fascinating video on how the Internet is transforming healthcare. Susannah Fox from the Pew Internet and American Life Project spoke in September 2010 at Mayo Transform 2010 : Thinking Differently About Health Care. The transcript of her talk is here. If you have an interest in where healthcare is going and where your medical group needs to be, take 15 minutes and listen to Susannah Fox.
I could write thousands of words about Adrian Segar and “Conferences That Work” because my conversation with him went that far and that long and he was that interesting to speak with.
Adrian told me “I am on my fifth career” and that “the arch of my life makes sense.” What a wonderful thing – to have one’s life make sense.
He has been an academic, a physicist, an IT consultant, a conference developer, and now, a consultant to others searching for ways to make conferences work. His book “Conferences That Work” was published last year and is now gaining the recognition it deserves. Among others, he has been consulting with MGMA on the new “EDGE” program they are unveiling for 800 people in March 2011.
Adrian and I covered a range of topics and we discussed my dwindling interest in attending conferences for the past several years. He, too, had been disappointed in conferences – even those he organized – and was determined to find why traditional conference aren’t making the grade any more.
His book outlines four assumptions that traditional conference planners make:
Assumption #1. Conference session topics must be chosen and
scheduled in advance.
Assumption #2. Conference sessions are primarily for
transmitting pre-planned content.
Assumption #3. Supporting meaningful connections with other
attendees is not the conference organizers job; its something
that happens in the breaks between sessions.
Assumption #4. Conferences are best ended with some event that will hopefully convince attendees to stay to the end.
Adrian’s starting point was the current conference model of passive learning – letting others choose the topics and speakers and offering attendees limited opportunities for anything besides pre-determined content. He moved from the model of passive learning to peer learning – leveraging the power and knowledge of the attendees to harness the hot topics of THAT MOMENT, not the moment that the conference committee met to determine the educational content 12 months or even 6 months ago. He noted that the best conference committees are able to guess less than 50% of what attendees really want from a conference.
Adrian uses the example of social media to illustrate the difference between broadcasting information (old) and partnering to share information (new), and notes that the goal of Conferences That Work is to “bring the resources of all attendees to each attendee.” I’ve been to a one-day meeting that accomplished that goal and I left the “camp” feeling energized, overrun with ideas and already connected through Twitter with almost everyone at the well-attended program. It was amazing.
If you are developing meetings or conferences for your church, your charity, your local or state managers group or for any other type of group, or if you want to see the future of conferences, you owe it to yourself to read “Conferences That Work” by Adrian Segar. He’s on a mission and he’s going to design and rock a conference that you, if you’re lucky, will attend some day soon.
Excerpts from his book are available here.
Free downloads to assist in making conferences that work are here.
His blog is excellent and can be found here.
Health and Human Services Secretary Kathleen Sebelius today announced the launch of HealthCare.gov on Facebook: http://www.facebook.com/Healthcare.gov.
HealthCare.gov on Facebook offers Facebook users a new tool to understand and stay informed about the Affordable Care Act, said Secretary Kathleen Sebelius. This new page is another resource that people can use to learn about and discuss health care issues that are important to them, their family, or their small business.
HealthCare.gov on Facebook provides additional resources that allow consumers to take health care into their own hands.
HealthCare.gov on Facebook allows people to:
- Search for insurance coverage using our Insurance Finder tool. The tool asks users to fill out two fields with basic information about themselves and the state they live in. Users are then redirected to a page on HealthCare.gov that continues with the insurance finder process based on the information provided.
- Share thoughts and ideas with other members of the HealthCare.gov network.
- Learn more about what the Affordable Care Act means for individuals, families, or small businesses.
- Stay informed with new blog posts and webchats.
To join HealthCare.gov on Facebook visit http://www.facebook.com/Healthcare.gov, and click the Like button at the top of the page.
*Text from today’s press release
When Matthew Browning first described YNIO (Your Nurse Is On), I was really surprised to learn what his product was. I don’t know what I expected, but it wasn’t the elegant solution to staffing he described.
Here’s the description from the YNIO website:
Your Nurse Is OnTM was developed in 2000 by a trained Family Nurse Practitioner in response to the inefficient relief staffing procedures found in healthcare today. With today’s challenging environment of cost savings and instant communications it became apparent that calling replacement staff one at a time was no longer an adequate solution.
With the improvements in internet telephony that occurred around 2005, we created a system that allows you to call any available nurse to fill your vacant shift. You now have the power to contact many nurses, in any order you choose, on whatever device they prefer. Since the nurses on our system make their availability known in advance, you will never disturb another unavailable nurse or waste your time calling them.
I could really relate to this solution! Who among us hasn’t spent hours on the phone filling staff slots, getting coverage for unexpected medical leaves, and trying to piece together coverage for routine vacations?
YNIO distills the product down to four easy steps:
- Scheduler creates a request for staff.
- YNIO contacts all available staff – instantly.
- Staff receives the request and accepts or rejects the shift.
- Scheduler is immediately notified.
And what are the proposed benefits to a facility using YNIO?
- Save time – system can call dozens of nurses simultaneously
- Save money – no more dollars wasted calling nurses who are unavailable
- Fill shift vacancies – expanded pool of available nurses
- Increased employee morale – decreased shift vacancies can decrease shift call outs, injuries and burnout
- Increased efficiency – leverage technology to save money, save time, quickly fill shift vacancies and save paperwork with our paperless billing and performance tracking systems.
This sounds like a needed solution for practices, nursing homes, hospitals, and home health agencies. I am also fascinated by the creative process of innovation and delivery to the market and asked Matt a few questions about the development of his product.
MARY PAT: Matt, what does it take (emotionally, financially and otherwise) to conceive an idea and bring it to the market?
MATT: I believe it begins with a personality that is inclined to analyze situations and procedures with an eye toward improvement. How can we make this, or do this, better than we are today? As this behavior becomes internalized and part of our daily routine, we begin to generate ideas, maybe this could work type of thoughts that can result in some solid ideas, proposals and hypotheses. This stage of innovative thought is rather common and many people have an idea that could change the world, however an idea at this stage is often lacking a vision of how it can interact with our current realities, change existing processes, improve outcomes, save time and reduce expenses. The basic business infrastructure, legal processes, finances and team that are very important considerations to bring an idea from conception to market are often not understood, at this point of the innovation cycle, by the inventor and are definite challenges. These challenges may be the reason that many potential innovations are never brought to market.
So, besides an idea, and a vision of how it fits into the world, flexibility, determination and persistence may be the most required traits for the innovator. The key to this game is teamwork, assemble the highest quality team you can, rely on experts for knowledge outside of your personal domain and remember that the objective is bringing the product or process to the world to make it a better, safer, more enjoyable place for as many people as possible. Success is often a direct result of service to others and bringing your innovation to the world can be a great service.
On the emotional and financial fronts, expect the endeavor to take twice as long as you expect and to cost twice as much as you expect. Having an awesome team and a supportive social network are invaluable to the eventual success. I am fortunate to have a very supportive family that believes in me and our innovation and they have been very tolerant of the extraordinary amount of hours and obligations that are part and parcel of this innovators life. To summarize, I believe a good idea can become a vision that with a very dedicated individual can become a team working toward the release of an innovation commercially. Hard work, perseverance, flexibility, ability to learn and the ability to delegate are all requisite as well.
MARY PAT: What’s been your lowest moment to date in bringing your product to market and what has been your highest?
MATT: My personal and corporate nadir occurred, ironically, during one of the best events of my life, the birth of my son, Arthur. Our product, YourNurseIsOn.com, was struggling through the proof of concept phase, after nearly a year in development and design, when my wife had an unexpected, emergent delivery of our son. We were traveling in Florida on a doctor-approved combination business and family trip, when our son decided he was coming into the world, nine weeks early. Aside from a very difficult and dangerous birth experience, we were over 1500 miles from our home in New Haven, CT. Our company was being run from my laptop and mobile phone and I was juggling a fully packed calendar of business obligations all while running from ICU to NICU, for 5 weeks. It was two months before I was able to safely return my family to our home in New Haven. In addition the amazing amounts of time needed for both my wife, Phoebe, and my son, I still needed to meet with potential customers, conduct regular tech meetings, solicit further investment and continue to work on intellectual property issues, technological challenges and personnel needs.
We had invested our lifes savings to get to this point and now, with this amazing, yet traumatic family event, we began to question many of the decisions that had brought us to this place and time. Out of time, out of money and out of my home, it was easy to think how much better it would be if I just worked as a Family Nurse Practitioner as I was trained to do and could bring home a regular ol paycheck for only 40 hours. Those questions never last for long, the vision, never sleeps, it never relents and it can become all-encompassing and turn us into 4am to 11 pm machines but, occasionally, even entrepreneurs are human 
Conversely, our highest point to date has been our attendence at HIMSS 2010 this March. We were selected to present at the Healthcare IT Venture Fair and after an exciting presentation we were no longer unknowns to the major players in the healthcare arena. When big names like Intel, Blue Cross, GE, McKesson, Blank Rome and the United States of America take note of your product and want to engage in investment, customer and business development discussions, you begin to realize that the power of the innovation is becoming recognized. The time since HIMSS10 has been a constant blur of inquiries, customer demos, partner requests, commercialization deals, amazing pilot discussions, customer implementations and, of course, investors.
MARY PAT: Is this a product that can be affordably scaled for any customer, or do you anticipate the ROI being on target for a specific type/size of customer?
MATT: Our product, YourNurseIsOn.com, is a Software as a Service (SaaS) product that helps allocate the right healthcare staff, where they are needed, when they are needed there, by instant, 2-way text, phone and/or email communications. We are a Software as a Service (SaaS) platform that allows for quick and easy adoption, keeps customer costs low and removes their maintenance responsibilities.
We offer a number of value propositions for the customers including faster speed of fulfillment, decreased nurse vacancy, reduced overtime spending, increased patient-provider contact hours, improved patient outcomes, license management, call order adherence, expanded communications capabilities and amazing compliance reporting performance. Flexible scheduling, with all the extra communications needed, has become a best practice for healthcare workforce recruitment and retention. YourNurseIsOn.com makes these communications effortless. For organizations that rely on communicating with a distributed workforce, to operate around the clock, our solution is quickly becoming indispensable.
The ROI metrics are being compiled presently and should prove to be favorable for any size organization. We expect the return on investment period to be very brief as we can provide over 8 hours of phone calling in under 30 minutes and provide the 2-way text and email channels for improved efficiencies. Our soon to be announced pilot with a nationally recognized health provider network will soundly demonstrate our scalability for any sized facility, organization or governmental body.
MARY PAT: Where do you want YNIO to be in 5 years?
MATT: YourNurseIsOn.com is focused on excellent customer experience, and service, for every single client that engages our services, and we will continue with that focus relentlessly as we continue to grow and scale our platform. YourNurseIsOn.com is well poised to become the de-facto communications method for healthcare organizations that need to contact and confirm their specialized, distributed workforces on demand. The ability to easily reach specific individuals, that are qualified and available for a specific function, in a quick and easy manner on any device of their choosing will only become more important given the coming increases in healthcare demand and simultaneous scarcity of all healthcare providers. YourNurseIson.com has the ability to efficiently deliver caregivers where they are needed, not only in institutional settings, but in the communities where the majority of care is being delivered. YNIO, with its international patent -pending status will be the communications glue that holds it all together.
MARY PAT: Many people are predicting that NPs and other mid-level providers will be the future of primary care if physician shortages play out as expected. What do you think?
MATT: Personally, as a nurse practitioner, I feel that this is all too often the focus of discussions about the future of healthcare and is, just as often the beginning of contentious debate that ends in a turf war between doctors and other providers. I do not believe that either of us are the future of healthcare. I believe that we cannot possibly train sufficient numbers of providers to care for the onslaught of demand that is quickly approaching. The future of primary care will lie in the hands of the individual, their families and their communities. This will be supported by tele-medicine, bio-sensors and smart homes to begin and eventually lead to caregiver robots and software algorithms diagnosing and treating your ailments:
- A wristwatch, scale and shoes that track your fitness regimen, downloaded nightly into your Personal Health Record and gently recommending tomorrows diet or workout schedule.
- Personal reminder software to gently prod you to take your medicine, engage in physical activity or to remember a wellness event or medical appointment.
- Accentuated reality software to help make informed dietary, activity or purchase selections based on wellness scales, provider recommendations or personal preferences.
- The ability to export this information to your Electronic Health Record to share with your providers, specialists or family
- A smart home with a bed that signals that Grandma woke up later than usual after a restless night, a chemical sensor toilet that signals she may be a bit dehydrated, a pill bottle that alerts when she hasnt opened it- these types of events triggering personal reminders, check-in requests to a neighbor, visit requests to family, or send an alert to her community caregivers, etc. If no one is able to check on her status, emergency services could be automatically notified.
Couple these technologies with instant, 2-way, verifiable communications systems, and these networks will provide the bulk of care in the near future. There simply are not enough resources to provide care any other way. I hope to see NPs continue to expand their roles, earn autonomy and continue to provide excellent care to millions of people. NPs, MDs, therapists, etc. are all going to be in short supply and high demand. All of these professionals are important to the healthcare delivery team and will have to be allocated with, supported by and communicated to with advanced technologies to expand their practice reach, improve their collective effectiveness, begin to decrease costs, and continually improve outcomes.
******
It was a real pleasure talking with Matt and getting to know more about YNIO and more about him (the geek in me enjoyed the geek in him!) I truly appreciate how open he was in the interview. Thanks, Matt!
The YNIO (Your Nurse Is On) website is here. Matt recently guest posted on HealthcareIT Today which can be found here. You can connect with Matt here:
In 2001, the Institute of Medicine (IOM) published Crossing the Quality Chasm: A New Health System for the 21st Century, which outlined fundamental changes that must be made in order to improve healthcare in the United States. Here is a quote from the book:
“The U.S. health care delivery system does not provide consistent, high-quality medical care to all people. Americans should be able to count on receiving care that meets their needs and is based on the best scientific knowledge–yet there is strong evidence that this frequently is not the case. Health care harms patients too frequently and routinely fails to deliver its potential benefits. Indeed, between the health care that we now have and the health care that we could have lies not just a gap, but a chasm.”
Although the concepts in the books have been widely implemented in the inpatient setting (100,000 Lives Campaign and now 5 Million Lives Campaign), not as much has been done in the outpatient setting, predominantly because inpatient safety has been (rightfully) highlighted by needless deaths and injury (The Josie King Story, The Dennis Quaid Story.) These same concepts must be applied in the outpatient setting to achieve improved patient care and patient satisfaction. Ultimately, patients will demand to know what medical practices are doing to provide safe, effective, patient-centered, timely, efficient and equitable care. This is a great book to read (you can read it online) and think about in preparation for the changes coming with healthcare reform, “Payment for Performance” (P4P) and electronic medical records promulgation.
Aim #1: Care should be SAFE: Patients should not be harmed by the care that is intended to help them. Current estimates from the Agency for Healthcare Research and Quality place medical errors as the eighth leading cause of death in this country. About 7,000 people per year are estimated to die from medication errors alone about 16 percent more deaths than the number attributable to work-related injuries.
Aim #2: Care should be EFFECTIVE: providing services based on scientific knowledge to all who could benefit and refraining from providing services to those not likely to benefit. Estimates are that about half of all physicians rely on clinical experience rather than evidence to make decisions. But should they? Experts say that physicians in most practices do not see enough patients with the same conditions over long enough time to draw scientifically valid conclusions about their treatment.
Aim #3: Care should be PATIENT-CENTERED, respectful of and responsive to individual patient preferences, needs, and values and ensuring that patient values guide all clinical decisions. One study of physician-patient interactions showed that physicians listen to patients’ concerns for an average of 18 seconds before interrupting. Medical schools are beginning to place greater emphasis on the development of good patient-interaction skills.
Aim #4: Care should be TIMELY: reducing waits and sometimes harmful delays for both those who receive care and those who give care. Many hospital Emergency Departments (EDs) are symptomatic of a system that cannot reliably give timely care. One recent survey revealed the average wait at “crowded” EDs was one hour. One third of U.S. EDs report they must periodically divert ambulances to other facilities.
Aim #5: Care should be EFFICIENT: avoiding waste, including waste of equipment, supplies, ideas and energy. Some experts estimate that most physicians are productive only 50% of their time, in part because the system works against them. Working smarter, not harder, can reduce non-clinical work and increase “face time” with patients.
Aim #6: Care should be EQUITABLE: care that does not vary in quality because of personal characteristics such as gender, ethnicity, geographic location, and socioeconomic status. There is a growing number of studies showing disparities in care and treatment for some population groups. The implications can be dramatic: for example, the life expectancy of a black child is seven years shorter than that of a white child in Baltimore, Maryland, USA.
You can download a PowerPoint program from the Institute for Healthcare Improvement (IHI) that cover the concepts in the book for free here. Registration is required, but it is free and gives you access to lots of tools and resources.
You can also read the book for free online by clicking on the “READ” icon below. No registration is required.
What books, websites, blogs, organizations or people would you add to the list of resources to prepare us for the changes of the future?
Not on facebook yet?
