Does Provider Self-reporting Of Etiquette Behaviors Improve Patient Satisfaction?

Does Provider Self-Reporting of Etiquette Behaviors Improve Patient Satisfaction?

Zishan Khalid Siddiqui, MD^*¹; Dr. Rehan Qayyum, MD, MHS, FAHA²; Dr. Ibironke Oduyebo, MD³; Dr. Sosena Kebede, MD, MPH¹; I Lucia Ponor, MD MBA⁴; Lisa Allen, PhD⁵ and Dr. Daniel J. Brotman, MD⁶, (1)Johns Hopkins School of Medicine, Baltimore, MD, (2)University of Tennessee, Chattanooga, TN, (3)Mayo Clinic, Baltimore, MD, (4)JOHNS HOPKINS SCHOOL OF MEDICINE, Baltimore, MD, (5)Johns Hopkins Medicine, Baltimore, MD, (6)Johns Hopkins University, Baltimore, MD

Meeting: Hospital Medicine 2016, March 6-9, San Diego, Calif.

Abstract Number: 273

Category: Research

Sub-Category: Quality Improvement

Keywords:

Background: There is a glaring lack of published evidence based strategies to improve HCAHPS patient satisfaction scores on the physician domain. Anecdotally, various hospitals have improved their physician domain scores through training programs to improve physician communication and etiquette. Role of physician self-reported etiquette based bedside behavior has not been reported.

Methods: After collecting 1 year of baseline satisfaction data, we randomized hospitalists from 4 hospitals to the study or the control arm. Study arm participants reported how frequently they engaged in the six best-practice bedside etiquette behaviors, over the previous two-week period. Control arm received similarly worded questions on quality improvement (QI) behaviors. Surveys were sent biweekly for a period of 1 year. Provider satisfaction scores were calculated from the physician HCHAPS (scored 0 or 1) and Press Ganey survey items (scored 1-5). Provider scores were weighted based on the proportion of days each hospitalist billed for the admission such that satisfaction scores of patients who were cared for by multiple providers were proportionately assigned. Composite physician scores were generated from the Press Ganey physician items, each with equal weighting (scored 5-25). We hypothesized that biweekly surveys to the intervention arm would improve the frequency of the etiquette behavior and improve satisfaction scores during the study period.

Results: 80 hospitalists were enrolled in the study and 67 elected to participate. Physicians reported high rates of etiquette based behavior at baseline and this did not correlate with baseline satisfaction scores. There was small but statistically significant improvement in reported etiquette behavior during the study period (intervention arm = 1.2% per 100 days). The self-reported behaviors were not associated with improved satisfaction scores. The difference in difference analysis of the baseline and post intervention composite physician Press Ganey satisfaction scores between the intervention arm and the control arm was not statistically significant (-0.163 vs -0.322, p=0.71).

Conclusions: In this 12-month study, bi-weekly reflection and reporting of best-practice bedside etiquette behaviors did not result in significant improvement on these behaviors or physician domain satisfaction scores. It is likely that hospitalists’ self-assessment of their bedside etiquette may not reflect patient perception of these behaviors. Furthermore, hospitalists may be resistant to improvement in this area since they already rate themselves very highly. Interventions that rely on physician self-assessment may fail because of these reasons.