"We talk about patient-centered care, but if we don't listen to the patient, how can we possibly build a system that is patient centered?" asks Barbra Rabson, executive director of the Massachusetts Health Quality Partners.
Transparency in health care took a giant leap forward recently when Consumer Reports, for the first time in its history, published Patient Experience Ratings of primary care physician groups. The ratings cover nearly 500 practices in Massachusetts and were compiled in collaboration with Massachusetts Health Quality Partners, a coalition of consumers, government agencies, hospitals, insurers, physicians and researchers.
“We talk about patient-centered care, but if we don’t listen to the patient, how can we possibly build a system that is patient centered?” asks Barbra Rabson, executive director of MHQP. “We believe very strongly that listening to the patient’s voice and using that information to improve the care experience is key to getting to the type of care system we say we want.”
The transparency effect
The Robert Wood Johnson Foundation funded the special doctor ratings report through Aligning Forces for Quality, the Foundation’s signature effort to improve the quality of 16 targeted communities across the country. Anne Weiss, MPP, quality/equality team director and senior program officer for the Foundation, says making the information public is essential to improving the patient experience.
“Hospitals and doctors are just like the rest of us,” Weiss explains. “When we see how we’re doing compared to other people, it can be a very important motivator. And when it’s unmasked and transparent and the public can see it, that tends to be an even bigger inspiration for the providers.”
Those sentiments were echoed by Susie Dade, deputy director of the Puget Sound Health Alliance in Seattle, Washington, where results of a similar patient experience survey, titled “Your Voice Matters,” were released to the public via the Alliance’s website. Dade noted that transparency is an important stimulant for improvement.
“You can’t really improve what you don’t measure,” Dade says. “By having comparable results, it gives provider groups some actionable information they can use to improve their practice.”
The surveys conducted in both Massachusetts and Washington were developed with considerable stakeholder input. Rabson explains that the MHQP has a physician council made up of leaders from the 15 largest physician organizations across the state. As a regional health collaborative, she says the organization earns its trust by gaining everyone’s input — not just soliciting it, but also using it.
“Our docs and others know that they have a voice at the table, and to them that’s huge,” Rabson says. “As opposed to things happening to them, this way, things happen with them.”
Similarly, Dade says that when the Alliance embarks on a project such as the recent patient experience survey, a planning committee is assembled that includes both small and large medical group representatives, as well as employer, consumers, and health plan representatives. And the medical group representatives are not just involved on the front end.
“When we completed compiling the results, we sent those results out about five or six weeks prior to publicly reporting them, so that the medical group had a chance to see the results, understand them, ask questions about them, prior to any kind of public release,” Dade says. “We hosted several webinars for all of the medical groups; free of charge, hour-long webinars where these medical groups could dial in. We did a lot of work to communicate with the medical groups about what we were doing and what the results looked like.”
Positive physician reaction
Lester Hartman, MD, is the medical home director for Westwood-Mansfield Pediatric Associates in Massachusetts. In 2007, when MHQP conducted an early version of the patient experience survey, Hartman didn’t believe the results.
“I didn’t believe that we had scored that low,” Hartman recalls. Having access to email addresses for all of the patients in the practice, Hartman re-surveyed using the same questions. “We got back the same answers. In fact, maybe even a little worse. I was very humbled.”
But he didn’t sit pat. He began working closely with MHQP, and also brought representatives to the practice so that his staff would hear the message straight from the experts. Ideas on how to improve care were developed, and the practice has since seen a significant jump in patient willingness to recommend.
“I feel these surveys are absolutely important to motivate physicians to improve care,” Hartman says. “Too often I think physicians sit back and think these kinds of experience surveys are working against them, and that’s not the intent.”
The intent was clearly recognized in Washington. After the survey results were released, Dade surveyed all 40 of the Alliance’s medical groups, and received great feedback. For example, 83% agreed that they now know more about their patients’ experiences with their medical group than they did prior to the survey; 88% said they would use the results to improve the patient experience; and 91% agreed it was important that comparable information about patient experience be available to consumers.
“I think the responses reflect physicians’ growing understanding of the importance of this information,” Dade says. “They value the information, and, for the most part, don’t object to public reporting. And I think that’s really important.”
One More Dance, a book about one family's courageous battle against time and glioblastoma brain cancer. Read more about the book here.
Ed Rabinowitz recently wrote