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Patient Experience Case Study - California Health Care SNI
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Enhancing Staff and Provider Communication Skills to Improve the Patient Experience

What was the challenge, opportunity or issue faced?

As part of California’s current Medicaid Waiver pay-for-performance incentive program, all of the state’s primary care clinics owned and operated by California’s public healthcare systems recently rolled out a standardized patient experience survey (the Clinician and Group CAHPS survey, or CG-CAHPS.) This common rollout was recognized as an ideal foundation for orchestrating joint improvement activities centered on patient experience in primary care.

Seizing the moment, 15 primary care clinics from four public health care systems partnered with their joint quality improvement facilitator, California Health Care Safety Net Institute (SNI), to measurably improve the patient and staff experience. After reviewing the baseline results from the CG-CAHPS survey, a decision was made that the improvement activities will center on the quality of staff’s and providers’ communication with their patients.

What did you do to address it?

Each clinic was asked to assign a local program management team consisting of at least one person in each of the following roles: Management Sponsor, Language of Caring Facilitator and Data & Quality Improvement Contact. In addition to gathering baseline CG-CAHPS data for the group, we also administered a brief Staff Pulse Survey, which allowed clinic staff and providers to provide feedback on their experience of working in the clinic.

The program had two key components:

  • The rollout of Language of Caring, a comprehensive training program designed to expand and strengthen staff’s empathy communication skills in interactions with patients and colleagues. All the clinics were gathered in an initial 2-day Leadership Kickoff and Train-the-Trainer program, aimed at developing the leadership and facilitation skills necessary to implement the program and sustain the practice of empathetic communication in each clinic. Over the course of 9 months, 9 skills training modules were rolled out on a unified schedule in all 15 clinics.
  • Complementing the rollout of empathy communication skills, the clinics received a package of support around Measuring, Understanding and Acting Upon patient experience data, boosting their know-how in quality improvement focused on experience. In addition, the clinics received web-based training on Patient Shadowing and the Poker Chip Method, a point-of-care means of gathering patient’s input about the quality of health care services. The method involves asking a patient to "vote” on the kind of experience he/she had during the visit by depositing a "poker chip” into a box that most closely describes their experience.

The program concluded after 9 months with an all-day Capstone Event where clinic teams and patients showcased their implementation and improvement efforts, reviewed results, and outlined plans for sustainability.

What were the outcomes?

The ensuing CG-CAHPS Improvement Network was a year-long collaboration aimed at enhancing the skills of staff and providers to effectively and reliably communicate empathy and caring, as well as increase their capacity for conducting evidence-based quality improvement in the area of human experience.

At the post-measure, the aggregate CG-CAHPS scores revealed an overall pre-to-post increase on the Staff Communication items. Aggregate Provider Communication results were varied, with some scores remaining the same or decreasing. The aggregate results on the Staff Pulse Survey revealed an increase in scores on all questions. The data suggest that the program was effective in improving communication and empathy conveyance among clinic staff: clerks, receptionists, and clinical/medical assistants.

Although it is always difficult to be certain about the impact of a single program given the complexity of health care environments in the public health care systems’ clinics, our pre and post CG-CAHPS and Pulse Survey data were supported by ample anecdotal evidence gathered from the clinics throughout the implementation activities. The four systems that participated in our Network were eager to work on accelerating improvement using CG-CAHPS as the common metrics platform. They recognized the focus on empathy conveyance skills as an appropriate vehicle for improvement in their safety net environments and saw improvements in staff communication and the overall clinic climate.

The seed has been planted and the majority of the clinics plan to continue affirmatively focusing on the communication with their patients and among staff in order to sustain and deepen the gains achieved through this program.

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About California Health Care SNI

Established in 1999, the California Health Care Safety Net Institute (SNI) is committed to advancing community health for California’s low-income and uninsured populations. Their work builds on the belief that California’s public healthcare systems are uniquely well-qualified and dedicated to addressing the health needs of vulnerable individuals and at-risk communities, within the context of California’s rich racial and ethnic diversity.

About Language of Caring

Language of Caring is a partnership of Wendy Leebov, Jill Golde and Dorothy Sisneros—a powerhouse trio who share a passion for reshaping healthcare organizations to become communities of caring. Their track record as healthcare leaders, organization development professionals, instructional designers, strategists and coaches is without equal. They’ve enlisted and certified a talented team of physician leaders, nurse leaders, trainers, team-builder, and culture change professionals who share their passion for this work and serve as coaches, strategy partners and facilitators with clients engaged in implementing Language of Caring programs.

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