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Improving Patient and Physician Satisfactionwith a Patient PortalAbout Women OB/GYN, Woodbridge, Va.

Patient Satisfaction

SUCCESSSTORY

Yolanda Raffert, practice admin-istrator for About Women OB/GYN, is a rm believer in the

concept of working smarter, notharder. She has to be About Womenis the largest OB/GYN group on theeast side of the county in Woodbridge,Va., a suburb of Washington, D.C.They deliver 80 percent of the babies

in this region and they do it with onlysix full-time OB/GYN physicians,one nurse practitioner, and 32 staffmembers. It isnt uncommon for thepractice to deliver 100 to 110 babiesper month. The practice offers a widerange of OB/GYN services in additionto a laser skin care center. Were allabout women and we want to be ableto take care of every womans needsfrom puberty to menopause and afterand everything in between, saysRaffert. While the practice works hardto serve its patients needs, AboutWomen aims to maintain an appro-priate work/life balance for its staff andphysicians.

Surveying AllRafferts method for meeting thesetwo seemingly disparate goals begins

with accurately gathering satisfaction

data from the entire staff and frompatients. Practice satisfaction surveysare administered to physicians andstaff yearly during the employeesannual review. Annual reviews are notjust an assessment of employees jobperformance but also a conversationalexchange of information that leadsto improved job descriptions, renedroles and responsibilities, and neces-sary organizational changes. Duringthe process, employees also completea survey evaluating their satisfaction

with the organization and their super-visor. This review process aspires toimprove employee satisfaction and theorganization as a whole its an hourdedicated to enhancing job satisfac-tion and bolstering overall practiceperformance.

Patient satisfaction data comesfrom several sources: paper surveys are

available at check-in and check-out

and electronic surveys are sent to allnew patients. Though the practiceconsiders this information valuable,more often than not survey responsesreect singular experiences of negativeevents. As such, surveys alone were notgiving Raffert a comprehensive pictureof the practice.

In addition to gathering patientsatisfaction data through these tradi-tional sources, Raffert implementeda secret shopper program to get abroader view of patient experience.

Every year she chooses ve to tenOB patients to participate. Raffertsrationale is that OB patients visit thepractice frequently over a longer timeframe (about 14 visits over the courseof ten months). Raffert believes thisgroup can provide the best criticalevaluation of her practice. Theyliterally cross every department and

Aneight-hourdaycanbeastressfuleighthoursoritcan

beanenjoyableeighthours.Sothestresslevelandthe

lifestyleenjoymenthaveobviouslyimprovedwiththe

portalitself.

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provider in the practice, she says.They see all of our physicians andgo to our two ofces. They go to laband imaging and have many dealingswith the business ofce and surgicalcoordinator. To me this is my bestpatient survey because we get to see thecontinuum of care. Raffert provideseach secret shopper with a packet ofinformation about how to submitfeedback. In return for their efforts,she offers them free laser hair-removal

services.

Finding Themes in the DataThe data from these sources arecompiled and examined by the practicemanagement group, which consistsof all practice physicians, the billingand clinical supervisors, and Raffert.The group meets monthly and looksat quality assurance, patient concerns,and operational issues and discussesplans for the practice as a whole. Thetop concerns from the internal andexternal surveys are examined. Everyquarter the group creates a hit listthat they will focus on for the nextsix months. The group creates a pointsystem to identify which issues toaddress and determine their priority.Issues that appear on both the patientand the staff lists become high priorityitems.

In prior years, a commoncomplaint from the clinician sidefocused on the complexity in commu-

nicating results to patients. Specically,physicians experienced difcultyclosing the compliance and qualityassurance loop. The practice triedsending letters to patients, but onlyFedEx or certied mail could verifyacceptance of patient letters. As such,the clinical staff became overwhelmed

with phone calls and endless roundsof phone tag between the practiceand patients. Patients also reporteddissatisfaction regarding the receipt oftest results. This desire for improvedcorrespondence between physiciansand patients motivated the groupto research the implementation of apatient portal.

Patient Portal SolutionSince the practice already used an

electronic health record (EHR), a Webportal seemed like a good option toexplore. In making the decision, thepractice analyzed the cost of installingand running a portal and the antici-pated savings. We put a dollar valueon savings on the physician time, butwhat we soon discovered is the postagewe save in one week literally pays forthe portal for one month, says Raffert.That doesnt include savings for stafftime, paper, or physician time. It was avery, very affordable solution.

Affordability wasnt the onlyselling point. The portal could validatethe receipt of patient results whenthe patient picked up the message,a date-time stamp owed into themedical record, allowing the physi-cian to conrm that the patient hadread the results. The portal is secureand password protected, operatingmuch like an online banking system.Convenient for both physiciansand patients, the portal can answer

common questions, monitor patientvitals like weight gain, and trackmedications. The portal also expeditesprescription rells and renewals andallows patients to validate patientinformation prior to visits, saving thestaff valuable time.

Buy-In from the BeginningTo make this project happen, Raffertenlisted one person from eachdepartment (scheduling, registration,nursing, billing, and one physician) tosit on the team. I dont do anything

without a team, says Raffert. Teammembers are selected based on theirinterests or a strategic objective. Oncethe team was selected, the portal teamchose a portal based on the featuresthey thought would most benet thepractice. It took the team 90 days toselect a vendor. Building the systemand personalizing it took another 90days. All in all, installing and imple-menting the system took seven monthsto a year to roll out.

Team members were tasked withreporting back to their departmentsand collecting feedback. In this way,the entire staff had some input inthe process. Furthermore, Raffertincreased staff members buy-in byallowing them to use the system priorto rollout so all could become familiarwith the portal and feel comfortableanswering patient questions. She alsogave different staff members ownershipof different parts of the system. Finally,during training, Raffert emphasized

how the portal could save the staff timeand effort if executed properly.

Marketing the Portal to PatientsThe practice decided to maximizethe impact of the patient portalby refusing to settle for the 20- to30-percent patient participationrates experienced by other groups.When the system went live it washard for anyone to ignore what washappening, says Raffert. The staff

hung banners throughout the practice.An e-mail blast went out to all patientsannouncing Our portal is live. Theyput signs in all of the restrooms. Theycreated the slogan, Why call whenyou can click? The staff and physi-cians even wore buttons. In addition,Raffert and her team reinforced to staff

Convenientforbothphysiciansandpatients,theportalcan

answercommonquestions,monitorpatientvitalslikeweight

gain,andtrackmedications.

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members that getting patients to usethe portal represented a home run foreveryone.

The strategy implemented forpatients was to inform them threetimes over the course of one visit about

the portal. The rst conversationoccurred with the front-desk staff, whoeducated patients about the portaland asked patients which form ofcommunication they preferred. Theyalso noted that the practice preferredto communicate via the portal. Thenthey directly asked patients if theywere willing to use the portal. Thesecond conversation occurred with thephysician. Check-out provided thethird and nal opportunity to informpatients about the portal. If patients

agreed to use the portal, the check-outstaff conrmed this and provided thema business card that listed directions onhow to activate their account and howto contact the IT department (anotherof Rafferts duties) if they experiencedproblems. A patient wasnt considereda portal patient until they loggedin and activated their account. Thepractice continues to use this processwith new patients. At the end of eachmonth, Raffert runs a report to seewho hasnt activated their account and

sends those patients another welcomee-mail inviting them to sign up for theportal.

The portal doesnt work foreveryone. Some people simply dontfeel that e-mail is secure and thereforeresist the system. Also, a portion

of the practices patient populationdoesnt have computers or use theInternet. The practice does not activateWeb accounts for these patients andcontinues with a paper process. Thatsaid, About Women has achieved a

75-percent usage rate with their portalsystem after only six months of thesystem being live.

Portal SuccessRaffert reports that the portal hasdenitely improved job satisfaction forthe physicians. An eight-hour day canbe a stressful eight hours or it can bean enjoyable eight hours. If [the physi-cians] are trying to make 50 phonecalls in between every single patient

because they cant reach them theresno downtime in their day. So the stresslevel and the lifestyle enjoyment oftheir job have obviously improved withthe portal itself. Physicians also havethe opportunity to log on at night,which allows them more exibilitywith their schedule. Probably the mostsignicant difference is the physicianscan now get closure on a key partof their job. They can leave a recordknowing theyve notied the patient,reviewed their lab work, and given

the patient direction on what to donext. One physician in the practicecommented to Raffert, For the rsttime, I feel like the practice is goinggreat. I dont miss printing and signinga hundred letters a day.

Raffert is thrilled that she willbe able to use the portal to meet

meaningful use criteria. Her goal is todevise a template based on the require-ments and have it automatically postto the portal. Currently, the systemprovides patients with vitals, labs, andthe reason for their last visit, but now

patients will get a visit summary basedon the meaningful use criteria. Otherpractices planning to prepare end-of-visit patient summaries will still haveto nd a way to incorporate lab results.The portal will do all of this for AboutWomen OB/GYN.

Whats Ahead?Raffert is determined to meet mean-ingful use and ICD-10 requirementswithout creating more workload or

increasing the staff. She also plans toboost their current efciencies whilecontinuing to meet patient needs.Raffert makes it a habit to look outsidethe medical eld for tactics workingwith other industries and she chal-lenges her staff to do the same. Shewants everyone to think outside thebox. I keep the staff involved. Findthe things that they love and involvethem in the practice with those things not just doing their day-to-dayresponsibilities. Let them have the

valuable input in their department.Rafferts attitude exudes appreciation.It is no wonder the average tenure forher staff members is nine years. Peoplestay where they have ownership, shesays. People who rent, move. Peoplewho own, stay.