TUHS Tailors Transparency, Consumer Analytics to Its Medical Practice Cultures

Added on Jul 18, 2019

Thinkstock_465514531_Hires_RFTemple University Health System Tailors Transparency, Consumer Analytics Approaches to the Cultures of Its Medical Practices

By Audrey Doyle

In early 2017, Temple University Health System launched a systemwide transparency initiative and began publicly reporting physician star ratings and unedited patient comments monthly from its CAHPS Clinician & Group Survey (CG-CAHPS).

But instead of taking a one-size-fits-all approach, TUHS leaders tailored the process for the organization’s three medical group affiliates to fit their existing cultures. This ensured that the groups’ physicians would embrace the initiative, and, in turn, has increased physicians’ engagement in both CG-CAHPS and their work, raised the groups’ CG-CAHPS top box scores, optimized utilization of the system’s performance improvement training resources, and strengthened the system’s consumer analytics strategy.

Based in Philadelphia, TUHS offers medical education services through the Lewis Katz School of Medicine at Temple University, and health care services through its three medical group affiliates—Fox Chase Medical Group–Oncology, Temple Faculty Practice Plan (TFPP), and Temple Physicians, Inc. (TPI)—as well as four hospitals, a ground and air ambulance company, and several urgent care centers.

According to Dwight McBee, TUHS chief experience officer, customizing the medical groups’ implementation of the transparency initiative was necessary because the groups’ physicians had varying levels of engagement in CG-CAHPS and, by extension, varying degrees of comfort with the idea of publicly reporting physician star ratings and patient comments. 

“We began using CG-CAHPS in 2014, but it wasn’t until we announced plans for systemwide transparency in early 2016 that we realized most of the groups’ physicians viewed the survey as either an unnecessary rite of passage or a form of punishment,” said McBee. “We could tell they weren’t reviewing their feedback regularly because so many of them asked if their patients had anything positive to say about them.” The physicians also expressed concern that their profile pages would include unfavorable comments based on things that had nothing to do with their interactions with patients.

TUHS executive leadership had set a target of Q1 2017 to launch the initiative systemwide, and they were worried there might be lack of buy-in among the medical group physicians. “We felt that customizing their implementation processes would address gaps in their understanding of CG-CAHPS and alleviate their concerns about both the survey and transparency,” McBee said. “We wanted them to view patient feedback as constructive and valuable instead of punitive and unimportant.”

To do that, said Chelsea Murtin, quality assurance specialist at Temple University Hospital, system leaders had to assure the physicians that none of the comments appearing in their profiles would pertain to experiences patients had that were beyond the physicians’ control.

“This was important, because many of the CG-CAHPS questions concern things like timeliness of appointments and behavior of office staff,” Murtin said. “We had to make sure everything that is included is related to physician–patient interactions and nothing else.”

After reviewing the survey, the leaders determined that patient feedback pertaining to all three groups would be included on the following six questions:

  • Provider gave instructions that were easy to understand
  • Provider explained things in a way that was easy to understand]
  • Provider listened carefully to patient
  • Provider showed respect for what patient had to say
  • Provider spent enough time with patient
  • Overall rating of provider​​
To rate patients’ comments as positive, negative, or neutral, the leaders developed a process based on Binary Fountain’s Binary Health Analytics (BHA) reputation management solution. Using this tool, an internal committee reviews each comment and gives it a Patient Feedback Score (PFS); comments with a PFS of 3.5 to 5.0 are considered positive, those with a PFS of 2.0 to 3.4 are viewed as neutral, and those with a PFS of 1.9 or below are considered negative. 

Three Groups, Three Approaches

Tailoring the implementation of the initiative required careful consideration of each group’s culture and the concerns expressed by their physicians. According to McBee, Fox Chase Medical Group required the least amount of customization. “The 100 or so physicians in this group had spent a fair amount of time maturing their online presence through Facebook and Twitter, and felt they had a good handle on patient feedback through the internal dissemination of their CG-CAHPS comments,” McBee said. Therefore, the only customization this group required was the hand-picked physician-specific survey questions. All star ratings and comments—positive, negative, and neutral—are published immediately. 

The approximately 120 physicians with TPI, TUHS’s network of community-based specialty and primary care physician practices, were “middle of the road,” according to McBee. Because this group was more familiar with the quantitative data than the qualitative data from their surveys, they were onboard with the initiative but asked for time to review negative comments before they’d be published. “For this group, we publish the positive and neutral comments right away, and delay publishing the negative comments for two months,” McBee said.

The 300 or so physicians in TFPP, TUHS’s clinical faculty practice plan, had the least amount of familiarity with their CGCAHPS data and the most trepidation about transparency among the three medical groups. Therefore, their implementation process required the greatest amount of customization. “They knew patient experience data were being collected, but they needed to better understand why the data were important,” McBee said. So, during the 12 months leading up to the launch, the leaders spent time discussing the group’s past survey results, rearticulating the importance of the survey, and underscoring the fact that the system as a whole was headed toward full provider transparency.

According to McBee, the TFPP physicians also wanted a “gentle approach to easing in to transparency.” Therefore, physicians who receive negative comments initially receive an email each month containing just those comments that relate directly to them. The physicians have 15 days in which to review the comments and appeal the posting of those that concern them. An appeals committee then has the following 15 days to consider the appeal and decide whether to accept or deny it. Appeals that are denied are then included in the physicians’ profile.

According to McBee, the appeals committee reviews each appeal carefully, taking into account the context of the concerning comment. “For example, if a patient complains that their physician always yells and curses at them or never listens to them, and the physician’s appeal reveals that the patient has documented schizophrenia or delusions, the committee will accept the appeal and the comment won’t be published,” he said. Ultimately, he noted, the committee’s goal is full transparency, so it only accepts appeals on comments that should be screened out due to documented clinical or behavioral concerns.

Regardless of whether a comment goes through the appeals process, patient grievances concerning a physician are addressed through targeted training—which, said McBee, has been an important benefit of the transparency initiative. “Like all health systems, we have a finite amount of resources for performance improvement and training. Patient feedback tells us what skills need improvement and who needs that extra training, and this allows us to dedicate our resources appropriately,” McBee said.

Improvement of the lower-performing physicians has been “the tide that has lifted all the boats” and resulted in performance improvement for all three groups, McBee added. The groups’ CG-CAHPS top box scores for 2018 bear this out, according to Murtin, with Fox Chase Medical Group scoring 92.2 (up from 91.4 in 2016), TPI scoring 88.5 (up from 87.2 in 2016), and TFPP scoring 86.4 (up from 84.9 in 2016).

Managing Physicians’ Online Reputation

According to Murtin and McBee, the transparency initiative succeeds in keeping TUHS leaders and group physicians wellinformed about patients’ perceptions of their care experiences as reported through CG-CAHPS. But it’s also important for leaders to keep a finger on the pulse of what patients are saying about the medical groups on social media outlets.

To that end, leaders log in to dashboards they developed with assistance from Press Ganey and Binary Fountain that automatically collect, curate, and display comments patients make through social media sites such as Twitter, Yelp, Facebook, and Google. Automated email notifications keep the leaders informed about the comments so that they can address them as needed.

Because the tool automatically identifies, aggregates, and displays the comments, leaders don’t have to search social media sites manually. “Everything lives in the tool, which makes reviewing and responding to every comment a clean and efficient process,” Murtin said.

Furthermore, through the tool, leaders know that patients tend to leave more negative comments on Yelp and more positive comments on Google and Facebook. “We use this knowledge to allocate our marketing efforts and resources to best address and create some dialogue around problematic reviews,” McBee said.

Establishing the groups’ online presence and leveraging the intelligence of online reviews to drive success has given the leaders a powerful quantitative metric around physician reputation and performance, according to McBee. “In this way, our consumer analytics strategy is an important supplement to our transparency work, because at the end of the day, we’re transparent to improve the individual and collective performance of our physicians, enhance our reputation, and drive health care consumers to Temple, but consumers won’t choose us for their care if our reputation is poor,” he said.

Thanks to their reputation management efforts, the groups have experienced an increase both in the number of positive reviews and in their patient feedback scores, Murtin added, noting that the number of positive reviews left on social media sites overall increased 51.85% from 2017 to 2019. During the same period, on Google alone the number of reviews increased 152.97% (from 404 to 1,022) and the groups’ patient feedback score rose 6.60% (from 3.3 to 3.5).

According to McBee, leaders are currently taking steps to more tightly focus their consumer analytics listening efforts on feedback that is directly associated with initiatives set forth in the system’s strategic plan. “We’re starting with our lung transplant program. Our next step will be to leverage consumer analytics across some of our other focus areas, such as our heart transplant program and our obstetrics service line,” he said.

Improving Physician Engagement through Positive Reinforcement

As noted earlier, one of the hurdles the leaders had to contend with concerned physicians’ feelings that patient feedback would only hurt their reputations. However, the more familiar the physicians have become with what their patients are saying about them, the more they realize how many positive comments they receive through both CG-CAHPS and social media, and the better they consistently perform.

This has given the system a platform from which to meaningfully acknowledge top-performing physicians through a rewards and recognition program. According to McBee, all physicians who earn a 5-star rating receive recognition in the system newsletter, and TPI physicians also receive a plaque to hang on the wall in their practice. “Not only does this boost the reputations of the physicians who are recognized for their achievements,” McBee said. “It also drives conversation around what makes for a positive care experience by getting other physicians to think about what these doctors are doing that they’re not doing and what they can do to augment their practice habits so they can be on that list or get that plaque.”

Through these efforts, physician engagement has improved substantially. While quantitative data were unavailable at press time, McBee said that the physicians express more interest in their ratings and comments and more excitement and engagement around improving the patient experience. “They’re also more engaged in their day-to-day work, more resilient, and less burned out,” he said.

“In the past, our physicians thought of patient feedback as being punitive, which contributed to burnout, compassion fatigue, and all the other things that make physicians become disengaged,” he concluded. “Now they think of it as being constructive and valuable. It’s something that can improve their reputations and boost their referrals, not hurt or take away from them.”