Strategies to Improve Press Ganey Scores (serious)

[Fox800]

Most of this is very good, but I tell patients all the time "I don't know." Because they ask me questions all the time I don't know the answer to. "Should I get a CABG?" "Should I get my knee replaced?" "Can my seasonal rhinitis be caused by black mold?" Honestly if I looked into everything they always asked me, I would be seeing 5 patients / shift.

But maybe I get bonus points because I tell them I'm just a board-certified, Ivy league trained ER doctor that knows how to safe your life! Ask me a question about that and I'll know the answer!

I don't think patients hate me as much as the regular ER doc, usually because I sit down and talk to them. If there is a chair in the room I sit down. Then I get up 3 minutes later, examine them, and leave. But for those three minutes, I'm sitting down!

Would you say you went to a p o w e r h o u s e residency program?

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[thegenius]

Pt's eyes always light up when I say Ivy-League trained. Whether it gets me good scores is a different matter. but I stopped looking at mine. I don't care at all. I figure if I'm a problem admin will talk to me, and they haven't yet.

 

[d2305]

If they were going to fire my arse for PG scores, I would read The Power of Persuasion, Rodgers.

 

[Arcan57]

Thanks to everyone for the help. I am a doc facing unemployment if my scores don’t improve. But I think your help will be valuable and hopefully keep me from having to explain an extended gap (thanks covid)

3 things immediately come to mind:

1) Scripting/managing expectations. Start off every non crashing encounter the same way. My script is something along the lines of
"Hi I'm Arcan57. I'm the emergency doctor. <eye contact> I'm going to take very good care of you. The nurse was telling me that you're having (insert chief complaint)." I then ask one close ended question that I know nobody has asked them during the triage process, then I ask an opened ended question.

After my H&P, I tell them what the next steps are including my pre-test assessment of admission or discharge. If they're going home unless they have some jacked up result, I talk to them about how we look for the dangerous stuff that you have to be in the hospital to get treated. I also sketch out the next steps in diagnosis and treatment (PPI then f/u if suspected GERD, etc.)

When I go back in to discharge them, I talk about the tests we did, I tell them a list of big bad scary (common) diseases I'm sure they don't have, and I talk about how there's a lot of conditions that make your life miserable that we don't have tests for in the ED and refer them back to their primary. I'll then give them return precautions for serious badness and end by saying that there's no way I'd send them home if I thought they had (big bad diseases) but those are the things to watch out for.

2) Manage your non-verbal communication. Sitting down, as mentioned above, helps. Make eye contact occasionally. If you're annoyed or frustrated, you may need to mentally redirect so you don't express it in abrupt movements. Nod , lean forward slightly to show interest. Be courteous to any visitors in the room but direct your attention to the patient.

3) Use empathetic language. Validating that the patient feels like they're suffering is powerful, even if it's not something you can change or it's something the patient is doing to themselves. Acknowledge powerful but unspoken emotions. Often our discomfort with other's distress creates a wall that comes off as "They didn't care about me". If the patient looks like they're about to burst out crying or is twitching in frustration, acting like that's not happening isn't going to help. Learn the blameless apology, "I'm sorry you're going through this". Apologizing doesn't mean you have to take full responsibility for the situation, just that you're human and the patient is human and you'd both like the patient's life to be going a bit better than it is at the moment.

 

[bravotwozero]

For frequent flyers/difficult patients that don't need to be admitted, make them own their medical decision making. "Mr X, based on your exam, vitals, test results, etc, I don't think you need to be admitted for your herniated disc in your l-spine, but I am going to leave that decision up to you. Or be more direct "Do you WANT to be admitted?" That way, if they are made to feel they were in the driver's seat of their medical decision making, it's going to be hard for them to blame anyone else if things weren't up to par for them for whatever reason. I've lost big time in the patient satisfaction game, so you can take it with a grain of salt YMMV etc. Experience is a brutal teacher.

 

[GeneralVeers]

For frequent flyers/difficult patients that don't need to be admitted, make them own their medical decision making. "Mr X, based on your exam, vitals, test results, etc, I don't think you need to be admitted for your herniated disc in your l-spine, but I am going to leave that decision up to you. Or be more direct "Do you WANT to be admitted?" That way, if they are made to feel they were in the driver's seat of their medical decision making, it's going to be hard for them to blame anyone else if things weren't up to par for them for whatever reason. I've lost big time in the patient satisfaction game, so you can take it with a grain of salt YMMV etc. Experience is a brutal teacher.

Most of these people will opt for admission so it's not always a great tactic. Sure I can admit them, but the hospitalists will hate me. One reason I don't get pushback on admissions is that the admitting docs know me, and know I don't give them nonsense.

 

[bravotwozero]

I hear you, but the places I work I can admit anyone for anything without much pushback. The hospitalists may or may not like me, but they don't fill out surveys or complain to the patient care advocate. I get there's a limited amount of beds in the hospital, but we are not really empowered as EPs to be a steward of resources. Now, I'm in the process of getting a PRN gig at a county hospital, where I will not have to worry about this as much, so my approach will change. The community is different.

 

[Backpack234]

Turns out there’s some data on this. And the most impactful things you can do are to apologize for the wait (even when there isn’t one), overestimate how long I’ll take (say 3 hours for your 2 hour troponin), and do one non medical thing (offer and get them water or a blanket or show them how to use the tv remote or whatever).

I’m starting to think I’ve actually just never received training in customer service. But now that it’s so important hopefully these things work out.

 

[RustedFox]

Turns out there’s some data on this. And the most impactful things you can do are to apologize for the wait (even when there isn’t one), overestimate how long I’ll take (say 3 hours for your 2 hour troponin), and do one non medical thing (offer and get them water or a blanket or show them how to use the tv remote or whatever).

I’m starting to think I’ve actually just never received training in customer service. But now that it’s so important hopefully these things work out.

Don't drink the kool-aid, amigo.
These things shouldn't define our job performance at all in the first place.
You have a degree in medicine, not in hospitality or food/bev.
If the C-suiters wanted, they could cheaply and easily hire a hospitality or food/bev "manager" to ensure "customer satisfaction" in the ER; but that would cut into their quarterly bonuses, which are often far more than we could possibly make in [similar timeframe].

Let the hate flow through you.

 

[RustedFox]

Turns out there’s some data on this. And the most impactful things you can do are to apologize for the wait (even when there isn’t one), overestimate how long I’ll take (say 3 hours for your 2 hour troponin), and do one non medical thing (offer and get them water or a blanket or show them how to use the tv remote or whatever).

I’m starting to think I’ve actually just never received training in customer service. But now that it’s so important hopefully these things work out.

For emphasis:

"Apologizing for the wait (even when there isn't one)."
"Overestimate how long I'll take (say 3 hours for your 2 hour troponin)."


Any second-grader can tell you that this is called lying.

 

[miacomet]

I don't worry about Press Ganey at all. The amount our site incentivizes for getting good Press-Ganey simply isn't worth the effort. Even being a "non-empathetic" doctor, I still get the bonus 50% of the time without actively trying.

Back when I first started EM and actually looked at my scores (I don't bother now) it seemed random. Some months I'd be near the top of the list, and some months at the bottom. The statistical sampling is such that one bad score destroys you.

Unless you are being threatened with your job if you don't improve, it's simply not worth worrying about.

I would also say that, if you are being threatened with your job over this, quit, if there are any other jobs.

 

[turkeyjerky]

I would also say that, if you are being threatened with your job over this, quit, if there are any other jobs.

Obviously the second part is key

 

[thegenius]

For frequent flyers/difficult patients that don't need to be admitted, make them own their medical decision making. "Mr X, based on your exam, vitals, test results, etc, I don't think you need to be admitted for your herniated disc in your l-spine, but I am going to leave that decision up to you. Or be more direct "Do you WANT to be admitted?" That way, if they are made to feel they were in the driver's seat of their medical decision making, it's going to be hard for them to blame anyone else if things weren't up to par for them for whatever reason. I've lost big time in the patient satisfaction game, so you can take it with a grain of salt YMMV etc. Experience is a brutal teacher.

I'm not sure how effective this tactic would be. First, most people (especially those that come into my place) would opt for admission because 1) they don't have to pay for it, 2) being in a hospital with people giving you things all the time is probably a better place to be than their own home where they have to do all the work, and 3) there probably isn't a need for acute care so trying to convince the hospitalist to admit the patient will be very tough. Even for a painful herniated nucleus pulposus (HNP) surgery that is rarely a medical or surgical emergency, where I work the hospitalist would say "I will only admit if the neurosurgeon will consult or indicate if the patient needs admission", and then you have to convince the neurosurgeon who won't care about HNP because it's a no big deal to them.

 

[thegenius]

Let the hate flow through you.

Some of the things you write are so damn funny.

 

[RustedFox]

Some of the things you write are so damn funny.

At the core of every good joke is a kernel of truth.

 

[thegenius]

At the core of every good joke is a kernel of truth.

The hate sometimes FEELS SO DAMN GOOD. That is the truth brotha!

 

[VA Hopeful Dr]

For emphasis:

"Apologizing for the wait (even when there isn't one)."
"Overestimate how long I'll take (say 3 hours for your 2 hour troponin)."


Any second-grader can tell you that this is called lying.

Its a good enough tactic for Scotty

 

[GeneralVeers]

The hate sometimes FEELS SO DAMN GOOD. That is the truth brotha!

The dark side is quicker, easier, more seductive.

 

[Backpack234]

The dark side would be nice. But I’m afraid this is the way our field is headed. If this was a golden age where er docs could choose any job they liked (like 5 years ago), I might join the sith. But for now, im willing to do what it takes to stay employed.

 

[Backpack234]

Adding onto this a little tangent....has anyone on here been fired? How does that affect your ability to get jobs/licenses in the future?

 

[dadaddadaBATMAN]

Adding onto this a little tangent....has anyone on here been fired? How does that affect your ability to get jobs/licenses in the future?

No I haven’t. But most of the people I know of that got fired had been hired by one of the local competitors in search of warm bodies.

I think a lot of it depends on why you got fired.

Finances like how people are getting let go now is different from the doc who started screaming about her patients were going to die in the middle of a single coverage night shift.

She now works for the morgue in a scrubs-like twist

 

[docB]

Adding onto this a little tangent....has anyone on here been fired? How does that affect your ability to get jobs/licenses in the future?

Good question. I haven't been fired (yet) or pushed out but I have observed that most groups prefer to urge docs to leave on their own. Exceptions are cases or serious clinical incompetence or ethical problems (e.g. sleeping with patients). The advantage to the group is that there is no labor law blow back and the advantage to the doc is that there aren't any complicating issues getting a new job. The disadvantage is that they can shove you out for basically anything.

Now if a hospital takes action against your privileges that's a whole different issue. If you have your privileges yanked you have to report it and note it on any new credentials packs you do. That does create a huge barrier to getting a new job.

Everyone should take a look at the list of "Have you ever..." on their next credentials renewal. Try to avoid doing anything that means you have to check yes.

Oh, and agree with Birdstrike, statute of limitations in my area is 1 year from the time the alleged negligence was noticed, not happened.