The Patient's Primary Care Experience: A Road Map to Powerful Partnerships

PRAISE FOR

THE PATIENT’S PRIMARY CARE EXPERIENCE

Piche and Luna’s The Patient’s Primary Care Experience: A Roadmap to Powerful Partnerships is an informative guide for the advanced practice nurse and primary care clinician, offering strategies to enhance patient experience and satisfaction and to optimize outcomes. It is a must-read primer for any healthcare provider working in the primary care arena.

Donna M. Emanuele, DNP, RN, FNP-BC, ENP-C, CNS, FAANP

Director, Doctor of Nursing Practice Program

College of Graduate Nursing, Western University of Health Sciences

The Patient’s Primary Care Experience: A Roadmap to Powerful Partnerships gets it right. It moves beyond patient satisfaction to the experience and, more importantly, patient engagement. This handbook contains just enough theory to lay the foundation for the strategies. The book outlines practical, actionable tools and tips for improving the experience in the ambulatory care setting. The content will help organizations progress from the abstract to the observable.

Nancy DeZellar Walsh, DNP, RN President and Founder, DeZellar Walsh Consulting, LLC

Primary care is the backbone of the American healthcare system. Piche and Luna provide solid content for maximizing the primary care experience. This book gives providers the strategies, tips, and tools to strengthen the patient-centered medical home through provider and employee engagement. It’s a great balance between pragmatic, how-to advice and evidence-based practices. Providers and practice managers will want this as their go-to tool kit, but the ultimate winner is the patient.

Kristin Baird, MHA, BSN, RN President/CEO, Baird Group Author, Raising the Bar in Service Excellence

Each of us has had a memorably negative healthcare experience. In this exceptionally valuable volume, the authors present a complete synthesis for a reconstructed, enhanced, ultra-safe, highly satisfying, comprehensive primary care clinic. As you implement these ideas, your clinic will become more rewarding for you and for your patients, and their health will improve. No more bad memories!

G. W. McCarthy, MD, MBA, DAvMed Hospital CEO, US Air Force, and Veterans Administration

ACHE Management Series Editorial Board

Douglas E. Anderson, DHA, LFACHE, Chairman

SHELDR Consulting Group

Tyler A. Bauer

NorthShore University HealthSystem

CDR Janiese A. Cleckley, FACHE

Defense Health Agency

Kris M. Drake, FACHE

Ingham Community Health Centers

Guy J. Guarino Jr., FACHE

Catawba Valley Medical Center

Shanna Johnson, FACHE

Ascension St. John Hospital

Sylvia E. Lozano, FACHE

Alameda Health System

Faith Needleman

Samaritan Life Enhancing Care

Mitali Paul, FACHE

Houston Methodist Specialty Physicians Group

Jayson P. Pullman

Hawarden Regional Healthcare

CDR Lisa A. White, FACHE

Navy Medicine Professional Development Center

Nichole C. Wilson, FACHE

Community Health Network

Your board, staff, or clients may also benefit from this book’s insight. For information on quantity discounts, contact the Health Administration Press Marketing Manager at (312) 424-9450.

This publication is intended to provide accurate and authoritative information in regard to the subject matter covered. It is sold, or otherwise provided, with the understanding that the publisher is not engaged in rendering professional services. If professional advice or other expert assistance is required, the services of a competent professional should be sought.

The statements and opinions contained in this book are strictly those of the authors and do not represent the official positions of the American College of Healthcare Executives or the Foundation of the American College of Healthcare Executives.

Copyright © 2022 by the Foundation of the American College of Healthcare Executives. Printed in the United States of America. All rights reserved. This book or parts thereof may not be reproduced in any form without written permission of the publisher.

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Library of Congress Cataloging-in-Publication Data

Names: Piche, Mary-Ellen, author. | Luna, Gina, author.

Title: The patient’s primary care experience : a road map to powerful partnerships /

Mary-Ellen Piche, Gina Luna.

Other titles: Management series (Ann Arbor, Mich.)

Description: Chicago, IL : Health Administration Press, [2022] | Series: ACHE management series | Includes bibliographical references and index. | Summary: This book makes a business case for improving the patient experience in the primary care setting and presents proven strategies, tools, and templates for enhancing both the patient and staff experience—Provided by publisher.

Identifiers: LCCN 2021047196 (print) | LCCN 2021047197 (ebook) |

ISBN 9781640553323 (paperback : alk. paper) | ISBN 9781640553293 (epub)

Subjects: MESH: Patient-Centered Care | Professional-Patient Relations

Classification: LCC R727.3 (print) | LCC R727.3 (ebook) | NLM W 84.7 |

DDC 610.69/6—dc23

LC record available at https://lccn.loc.gov/2021047196

LC ebook record available at https://lccn.loc.gov/2021047197

The paper used in this publication meets the minimum requirements of American National Standard for Information Sciences—Permanence of Paper for Printed Library Materials, ANSI Z39.48-1984. ∞ ™

Acquisitions editor: Jennette McClain; Manuscript editor: James Fraleigh; Project manager: Andrew Baumann; Layout: Integra

Found an error or a typo? We want to know! Please e-mail it to [email protected], mentioning the book’s title and putting Book Error in the subject line.

For photocopying and copyright information, please contact Copyright Clearance Center at www.copyright.com or at (978) 750-8400.

Contents

Foreword

Preface

1 The Evolving Landscape of Primary Care

2 The Patient-Centered Medical Home

3 How to Implement the Patient-Centered Medical Home

4 Staff Engagement

5 Provider Engagement, from a Provider’s Point of View

6 Patient and Family Engagement

7 Designing an Evidence-Based Healing Environment

8 Key Performance Indicators

9 How to Select and Manage the Best Key Performance Indicators for Your Organization

10 The Last Word: Lessons from the Pandemic

Appendices

A SMART Goals Worksheet for Diabetes

B Appointment Prep Checklist

C Shared Medical Appointment: Diabetes

D Shared Medical Appointment Preparation Checklist

E Process Improvement Poster Template

F Leader Rounding Tool

G Personal Development Plan Template

H Patient/Family Advisory Council Sample Charter

I Onstage–Offstage Design

J Mystery Shopping List

K SMART KPI Worksheet

Index

About the Authors

Foreword

FOR THE PAST four decades, healthcare has struggled to create a system of care delivery that balances quality, safety, and patient-centeredness. Although significant progress has been made on the quality and safety fronts, person- and patient-centered approaches to care have remained aspirational in many settings. The challenge of partnering with patients and families and the fragility of the progress made became frighteningly evident during the COVID-19 pandemic. As safety practices ratcheted up, we saw erosion in most person-centered practices across all settings of care. Out of an abundance of caution, patients and families were once again marginalized as clinical care teams prioritized risk reduction over the patient experience of care. The consequences of policies enacted with little to no input from the patients and families they were intended to keep safe created unintended and avoidable harm. Once again, the challenge of balancing essential elements of optimal care went unmet.

If we can take one thing away from this recent crisis, it is the importance of creating a more robust, standardized, and enduring patient-centered medical home to achieve that needed balance. As the backbone of our care delivery system, primary care sets the tone and the expectation around the partnership between patients, their families, and members of the care team. Designing a welcoming healing environment that supports the active engagement of all stakeholders can be accomplished with the right roadmap. Mary-Ellen provides that roadmap, focusing on practical tools, tips, and strategies for creating and sustaining an optimal patient experience in primary care settings. In my years of working with Mary-Ellen on implementing the Planetree Patient-Centered Care Model in scores of hospitals and clinics, I was repeatedly impressed by her ability to find concrete methods for achieving aspirational results. The handbook she and Gina Luna have developed shares that knowledge and should be required reading for every primary care practice with a commitment not only to their patients, families, and caregivers, but also to the practice of safe, high-quality, compassionate care.

Susan Frampton

President, Planetree International

Author, Putting Patients First: Best Practices in Patient-Centered Care

Preface

HAVE YOU EVER had a wow! experience at your primary care visit? An encounter in which you felt fully engaged, heard, and an equal partner in your healthcare? Probably not. Too often we experience delays in getting an appointment, long waiting times after we arrive at the scheduled time, harried staff, and providers who interrupt seconds into our explanation of our reason for the visit.

How do we ensure a consistently positive experience for our patients, every encounter, every time? This book will provide tips and tools to help you on that journey. Make no mistake, this is not a silver bullet. It takes commitment, hard work, and every staff member’s connection to purpose.

We have designed, tested, and refined these strategies since 2002 in the primary care setting: specifically, a group of clinics across the country located in both urban and rural areas. As healthcare evolves to meet rapidly changing expectations and a new normal as a result of the COVID-19 pandemic, so must our approaches to providing a fulfilling primary care experience.

CHAPTER CONTENTS AND FEATURES

Chapter 1 lays out the drivers for improving the patient experience in the primary care space. Chapters 2 and 3 explore the key elements of the patient-centered medical home model, including shared medical appointments and telehealth.

Chapters 4 and 5 describe tactics to promote staff and provider engagement by focusing on behavioral standards, reward and recognition, and creating joy in the workplace. Chapter 6 shifts to patient and family engagement, featuring the importance of the social determinants of health and patient activation in creating an effective provider–patient partnership.

Chapter 7 highlights the key aspects of environmental design, including the onstage–offstage model for team-based care. Chapters 8 and 9 focus on measurement—the key performance indicators to evaluate the performance of your primary care practice.

Chapter 10 discusses lessons learned from the COVID-19 pandemic as they apply to the primary care space.

APPENDIX AND RESOURCE LIST

Last, we share several of the tools and templates we have developed and tested such as a shared medical appointment guide, the SMART goal patient worksheet, and a template for showcasing process improvements.

We hope that this material helps all who provide primary care—medical and behavioral health clinicians, nurses, administrators, technologists, social workers, and nutritionists—to deliver the best and safest experience possible for the primary care patient.

CHAPTER  1

The Evolving Landscape of Primary Care

THE UNITED STATES’ life expectancy ranking continues to decline, despite its spending far more on healthcare than any other country. The United Nations Population Division (2021) reports the United States has dropped to 46th place, with 79.11 years as the estimate for both sexes combined. At the same time, competition for healthcare services abounds while customers and stakeholders expectations escalate, causing these services to move out of the traditional bricks and mortar and into homes (via phones, computers, health monitors, etc.) and the retail space. New delivery models are also emerging that center the patient in the healthcare practice.

This chapter will explore the factors driving improvement of the patient experience in the primary care space, in light of growing consumer expectations and accreditation requirements and a changing regulatory environment. First let’s examine the critical forces shaping the future of primary care delivery.

CONSUMER EXPECTATIONS

The Beryl Institute (2010) defines the patient experience as the sum of all interactions shaped by an organization’s culture that influence patient perceptions across the continuum of care. The first step in this experience is deciding upon a healthcare provider—and today our patients have many choices. They get their information from family, friends and neighbors, social media, news outlets, Medicare’s Hospital Compare website, and advertising.

What characteristics set one healthcare organization apart from others? The following domains speak directly to Beryl’s patient perceptions across the continuum.

Access

Access covers the ease of getting an appointment and navigating the healthcare facility, and how long one waits to be seen. High-performing organizations develop smooth, efficient processes to provide a seamless experience. They routinely seek feedback from their patients to continually improve their processes and meet ever-evolving expectations.

Relationships

Patient feedback tells us that relationships are important to their experience. Are patients treated with dignity and respect by the scheduler, the receptionist, and all members of the primary care team (nurse, provider, social worker, pharmacist, nutritionist, etc.)? Are they considered partners in receiving care, setting health goals, and making decisions? We need to listen more and talk less.

The foundation of these relationships is trust, which must be nurtured and built over all touchpoints across the continuum. One negative encounter can erode trust very quickly—it can take as many as three positive encounters to restore the patient–provider relationship. For our patients, trusting relationships are about the emotions generated, their perceptions, and what they remember. How do we make them feel? Are we honest and transparent?

Exhibit 1.1 is a consumer survey by the Beryl Institute that reinforces the relational nature of healthcare. Beryl asked patients the importance of specific aspects of their healthcare experience: communication, competence, the environment and access. As you can see, respondents rated all of these aspects as high.

Exhibit 1.1: Beryl Institute Consumer Survey

Source: Adapted from Beryl Institute (2018).

Safety

Although the exact phrase First, do no harm does not appear in the original version (AD 245) of the Hippocratic Oath, keeping patients safe was clearly intended. Fast-forward to the present day with this updated maxim: zero preventable harm, a call to action for the movement toward high reliability in healthcare. Getting to zero is a journey, and many organizations are transforming the way they work to reach this goal. We will further detail what this means to staff and patients in chapters 4 and 6.

Quality

This domain is characterized by care that is safe, effective, patient centered, timely, efficient, and equitable. In the past our patients might have taken for granted that care would be technically sound. They trusted that their providers were qualified, competent, and proficient. Today, Healthcare Effectiveness Data and Information Set measures, satisfaction surveys, Hospital Compare ratings, and accreditation status reports give them the information they need to make informed choices. Providing best-in-class care gives a healthcare organization a competitive edge.

Value

Consumers want to know they are getting the most for their healthcare dollar. The patient investment continues to increase through insurance premiums, copays and, all too often, surprise billing.

But healthcare value goes beyond controlling costs, to medical necessity. Do our patients receive the right treatment, at the right time, in the right