"The two words ‘information’ and ‘communication’ are often used interchangeably, but they signify quite different things. Information is giving out; communication is getting through." -- Sydney J. Harris

How Clinics are improving the Experience of Care for their Patients

The recent release of the 2015 Patient Experience of Care results made it clear Minnesotans are quite happy with their providers and clinic office staff, but want more access to care when they need it.

According to the survey responses of more than 200,000 patients, 79 percent are pleased with their providers overall; 83 percent felt they received top-level communication from their providers; and 81 percent said clinic office staff was respectful and helpful; however, just 60 percent said they had satisfactory access to their clinic and providers. Individual clinic results are available for 765 clinics across Minnesota and neighboring communities. Search for yours.

Since MN Community Measurement unveiled the state’s first patient experience ratings in 2013, many clinics have increased their focus on patient experience. We recently spoke with several that shared some of the ways they’ve improved care experiences in their practices.

Improved Provider Ratings

Between 2013 and 2015, Albany Medical Center had the largest increase of any clinic in the Providers with a “Most Positive” Rating survey domain. The clinic jumped 18 percentage points, from 68 to 86 percent of their patients giving providers a 9 or 10 on a 10-point scale.

Tressa Schmidt, Clinic Nurse and Business Office Manager, credited the increase to the consistency of their staff and providers, as well as exposing providers to the feedback from their patients more regularly.

“We’ve had the same providers for a while – that consistency has been great for our patients,” she explained. All five family practice doctors who were seeing patients at the time the survey was taken have worked at the clinic for at least three to four years, she said.

Additionally, sometimes it’s as simple as exposing the providers to how their patients are rating them, Schmidt said. The clinic creates quarterly, detailed patient experience reports for each provider so they know where to focus as they look to continually improve. Another impactful feedback loop has been the clinic’s Patient / Family Advisory Council, which meetings every other month and advises clinic staff on how to improve patient experience. For example, the group recently worked with clinic staff to create new pre-surgery patient education materials.

High Marks Across the Board

Tawny Zbanski, Clinic Manager of Park Nicollet – Maple Grove Women’s’ Services Clinic, credits the clinic staff’s team mentality for their ability to earn high marks on all four domains of the 2015 Patient Experience of Care survey. The clinic received Top ratings for Provider Communications and Overall Provider Rating and Above Average ratings for Access and Office Staff.

“Everyone on the team recognizes that they play an important role for that patient and in that patient’s experience,” Zabsnki explained. “The better that patient’s experience, the better our experience is too. Every touch point has to be a positive experience even if it’s not a positive reason that [the patient is] here.”

Ensuring patients receive consistent messages and have easy ways to reach their providers is critical to that good experience. The clinic offers multiple avenues to reach out to providers, including an online patient portal.

“Our providers have a really strong desire to practice evidence-based medicine and practice similarly,” explained Dr. Christine Goudge, who practices at the clinic. “Patients get consistent answers when they talk to a nurse or the provider or if they call back later.”

The clinic has also adjusted the way it schedules appointment to improve care and experience. They carved out 15 minutes at the beginning of every appointment for nurse to have time with the patient. This helps the nurses build report with their patients, as well as allows they time to gather important information so providers can focus solely on the patient and any problems they’re experiencing.

“I value the nurse’s time and her doing what she needs, and then I have more information when I go in to see the patient,” said Dr. Goudge.

And, finally, you can never underestimate the value of a friendly face. “In OB/GYN, we see patients frequently,” said Dr. Goudge. “The friendliness of front line staff is important. They know [the patients] and the patients feel welcomed and at home.”

Increased Access

Scenic Rivers Health Services in Cook, Minn. is the only federally-qualified health clinic north of Duluth. Located in a sparsely-populated area where patients have few alternatives for care, the clinic focused on new ways to expand access over the past two years.

“We’ve increased the number of providers from five to eight,” said Nancy Mault, EMR and Clinic Services Director. “We also implemented an online patient portal at the end of 2013. For those who want to and can use it, it’s been a big thing.”

Patients clearly agree. Scenic Rivers had the largest increase in its Access domain rating between 2013 and 2015, jumping 28 percentage points from 38 to 66 percent.

Mault said the clinic works hard to ensure each visit is as meaningful and comprehensive for the patient as possible. They’ve increased their case management resources and reach out to patients before visits to ensure all records are up to date. This allows the time in the exam room to be very focused on the provider and patient interaction.

“We try to involve the patient in decision making,” Mault explained, “and they’re very involved in the outcomes of their care.”

Keys to Patient Communication

Four of the five highest rated clinics in the Provider Communication domain were also among the highest rated in the “Most Positive” Provider Rating domain, indicating a strong correlation between provider communication and overall patient experience.

One of the clinics that saw increases in both of those domains between 2013 and 2015 was Park Nicollet’s Maple Grove Clinic. And while these survey areas focus on patients’ experiences with individual clinicians, Clinic Practice Director Dr. Bernt Helgaas explained that, to be successful, it is truly a team effort.

“Medicine is a team project and the more people we can get on the team to help the patient, the quicker we can get what the patient needs,” Dr. Helgaas explained. “Every patient sees a primary provider; but if that provider is out, they don’t wait until the next week to get an answer. Someone else on the team will step up and get an answer, a refill or whatever the patient needs at that point. We’ve incorporated that mentality into our front line, lab, social work, care coordinators – on every level; there is someone to help the patient.”

Particularly when focusing on patient communication, it’s important to include what happens before and after the visit, not just during. “The time in the clinic exam room is 15 to 20 minutes for a lot of visits,” Dr. Helgaas said, “so the communication involved in setting up the visit and even more so after the visit is critical … All of the surrounding communication is equally, and perhaps more, important.”

Clinic Manager Terri Harrer said the clinic kicked off its “patient partners” group about two years ago. The group meets monthly and provides feedback on a wide range of clinic operations and activities. For example, when a new clinic building was recently being planned, the group provided feedback that the building’s planned orientation on the property would make walking into it difficult for some patients. As a result of the feedback, the orientation was shifted to a more patient-friendly option.

Dr. Helgaas also credited the clinic’s evolution into a Health Care Home as enhancing the communication and follow up they’re able to offer patients. As part of the process to become a Health Care Home, he said the clinic added several additional nurse practitioners and physician assistants, as well as created more formal coordination processes with social workers, pharmacists and care coordinators.

He said “the freedom that allows a clinician to dive into areas that perhaps we didn’t go into before, such as complicated social situations, because I know that now we have someone who can follow up with [the patient]” has been a phenomenal change.

And it’s not only the patients who indicate they like the changes; “our employees are having a great experience at work too,” Harrer said.