Hello, welcome to Module 7 on Patient Engagement, Satisfaction, and Experience. My name is Nikki Smith, Director of Member Services for MedAxiom. Here are my disclosures. And here are our learning objectives for this module. We're going to demonstrate the difference between patient engagement, patient satisfaction, and patient experience. We're going to understand how to measure these metrics with the concept of top box and percentile. We're going to learn our patient's demographics, as well as what's important to them. And we're going to understand how the entire team can have an impact on these measures. Patient engagement is a term that's used very frequently, and it's often confused with patient satisfaction. And although these terms are related, they're not the same. We also hear the term patient experience used interchangeably with both of these. But this isn't exactly like the others either. We're going to help define these for you and help unpack them a bit. We'll help you understand why each of these are important and how you can improve them all. Patient engagement is defined as the process of actively involving patients in their own health care. This means health care providers and settings partnering with patients to make decisions and manage their health. Patient engagement is an important element to value-based health care, which is meant to improve quality of care while reducing costs. The benefits of patient engagement are improved outcomes of treatments, decrease in patient no-show rates, fewer health care visits, which often means lower health care costs, improved practice operational metrics, and increased patient satisfaction. You'll hear more about a couple of these metrics in just a few minutes. Some of you may use a tool called PAM, the Patient Activation Measure tool, which was developed by the University of Oregon. It's a questionnaire that assesses a patient's knowledge, skills, and confidence in managing their health. The utilization of this tool can help an organization create interventions that meet each patient where they are in regards to their engagement and abilities. This tool has been studied by the National Institution of Health and endorsed by the National Quality Forum. However, not all organizations have access to use this tool due to costs or technology requirements. So how can you measure patient engagement for your practice or program? Here are a few operational and quality metrics that will give you some insight as to how engaged your patients are. Many of you, if not all of you, have access to some of these metrics. So by putting all of this together, you should have a pretty good overview of what your patient engagement is. Appointment utilization rates, which is the percentage of appointments that are filled. No-show rates, which is the percentage of appointments that patients don't show up for. Re-admission rates, which is the cancellation percentage. The patient portal utilization. If you have a patient portal utilization, then you can find out how many of your patients use it and exactly how they use it. So do they use it to make appointments, do they use it to communicate, or do they just look up test results? Re-admission rates. How many patients are readmitted to the hospital? Are these the same patients that don't show up for appointments, or are these patients who are compliant with their treatment plans but still being readmitted? And then patient satisfaction rates. So those are usually surveys, and these tell us what our patients are saying about our program and our providers. So the gift is to figure out how to use that information. Patient satisfaction is a measure of how content a patient is with the care they receive from a healthcare provider or organization. This is the most common term that's used. I'm sure most of you have received one of those surveys asking about your recent visit or procedure, and these surveys measure patient satisfaction. These self-reported surveys that are sent electronically through the mail or even through a follow-up phone call or a text are survey questions that are geared towards metrics such as communication, access to care, easy access to information, courtesy and respect, and then overall experience. The term patient experience is sometimes used interchangeably with patient satisfaction. However, patient experience speaks to what should happen during an appointment and whether it actually occurred. So let me repeat that. Patient experience speaks to what should happen during an appointment and whether it actually occurred, meaning the patient felt heard, questions were answered, and information was easy to understand. Patient satisfaction is measuring if the patient's expectations of what should happen are met. Therefore, the goal for every visit should be a medically sound experience that addresses their expectations early so we understand what they are and how they can be met. So these two are often measured using the same survey methodology and tool. Patient satisfaction and experience are measured separately and differently for hospitals and practices. Hospitals use HCAHPS, which stands for Hospital Consumer Assessment of Healthcare Providers. This survey is administered within two days of discharge and centers on topics such as communication, hospital environment, pain management, and care transitions. Physician practice satisfaction is measured through CGCAHPS, which is Clinician and Group Consumer Assessment of Healthcare Providers and Systems. That's a mouthful. There are three versions of this survey that ask about experiences within three different time periods, ranging from most recent to six months. All versions cover similar domains of the patient experience, which are access to care, communication with providers, care coordination, and interactions with staff. We have provided a link to the AHRQ, which is the Agency for Healthcare Research and Quality, in the slide deck and in the resource section of the syllabus. There you'll find a link to the survey for your review, as well as a link to a document that walks you through the process of developing a clinician and group survey for your organization and instructions on how to analyze the data that you receive back from respondents. Both assessments use measurements of the survey data set, which shows top box scores and bottom box scores for each measure or question. The top box score is the percentage of survey respondents who gave the most favorable responses to a question. For top box measures, percentile rankings from 95th down to 5th percentile are calculated. The bottom box is calculated also for the 5th to the 95th. This ranking allows the comparison for both top and bottom box with other hospitals on each measure. Let's take a look at this example HCAHPS report. The top box is the most positive responses to HCAHPS survey items. Percentiles indicate how often patients gave positive assessments of their hospital experience. With top box scores, the higher the better. For example, communication with nurses, 5% of hospitals scored 90 or higher, the 95th percentile. And the top box, while 5% scored 72 or lower, the 5th percentile. The median score, the 50th percentile, on this measure was 80. The bottom box summaries for the least positive responses to HCAHPS survey items. Percentiles indicate how often patients gave negative assessments of their hospital experience. With bottom box scores, the lower the better. For example, on communication with nurses, 5% of hospitals scored 1 or lower, the 5th percentile in the bottom box. While 5% scored 9 or higher, the 95th percentile. And the median score, the 50th percentile, on this measure was 4. This can be a lot to digest. So this information, again, we've provided a link to the AHRQ. You can get in and take a look at this. Read it as many times or listen to this as many times as you need to so that this makes sense to you. Once you have this down, it's very helpful to understand the top box and bottom box. And many healthcare organizations center on top box, bottom box, and percentiles. So it's relatively important for you to have an understanding of this. So why does all of this matter? As with patient engagement, patients who are satisfied with their healthcare are more compliant and have better outcomes. They're loyal and have fewer complaints. Complaints lead to lawsuits. So over the last decade, patient satisfaction has become a very important measure of the effectiveness of healthcare delivery. Healthcare organizations have been forced to focus on this as a way to stay competitive and stay ahead in the market. Patients are choosing their healthcare providers in many instances, and those not chosen run the risk of not remaining viable. Who are our patients? By knowing our patients, we can better meet their needs and expectations. Our cardiac and vascular patients want what all patients want. However, their level of anxiety and sense of urgency may be more pronounced than others. They want confidence in their providers. They want confidence in their ability to achieve their healthcare goals. They want autonomy to choose and be part of their own treatment plan. They want easy access to information on what they can do to achieve their goals. And this includes education, referrals to service, such as smoking cessation and cardiac rehab, and support from their caregivers and possibly support groups. What can you and your team do to instill confidence and provide patients with what they're looking for and need? The same things that will boost patient engagement, patient experience, and patient satisfaction. It's also very important that your staff and providers know that every single interaction in a doctor's office or hospital can affect your patient's experience, satisfaction, and engagement. It may begin before the patient even comes through the door. How are your staff answering the phone? Are they friendly and helpful? Then on the day of the appointment, the experience begins when the patient is greeted. The experience and satisfaction includes all interactions. It even includes the environment and how it feels. But the most important element is communication. Here are some strategies that can assist your staff improve satisfaction and engagement. Use active listening skills. Maintain eye contact. Face the patient and smile when appropriate. Create a welcoming environment. Keep things clean and orderly. Build a rapport and personalized care by asking questions. Show curiosity and compassion. Again, patients are more transparent about their health and their needs, which leads to better health care when they trust those that are caring for them. Let expectations from the start clearly communicate what will be happening during the appointment or procedure. Encourage questions. Ask open-ended questions and let them explain their concerns and what they hope to accomplish at their visit. Ask their preference and involve them in developing the plan to move forward. Do your best beyond time, and if not, be proactive in sharing that there's been a delay. And encourage self-service and tech tools when able and show them how they work. Start the engagement before the appointment using technology to assist. Use comprehensive and accessible patient education materials. Provide continuous care and support. Practice empathy and lead each interaction with a smile. This concludes our module on patient engagement, experience, and satisfaction. I hope that this helped you understand the difference between each and how you can help your team to make some improvements. If you have any questions at all, please email us at academy at medaxiom.com.

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