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What Impact does Telehealth have on Patient Satisfaction?

Posted by Michael Greiwe, MD | April 3, 2018 |
Michael Greiwe, MD

Patient satisfaction. Even as I wrote those words I groaned out loud a little bit. We hear about patient satisfaction scores all the time and it feels like many times it isn’t a positive conversation. We’re bombarded with metrics showing us how happy or disappointed people are with our care. Not only that, but online marketing studies have shown over and over that the “customers” (patients) most likely to leave an online review are the ones who are most unhappy. You have to work 10x as hard to get reviews that even closely represent the number of patients that are pleased with your service.

When compensation starts to be based on these scores, it’s easy to want to push back. “Patients don’t have any formal medical training! The surveys only measure how happy the person is not their care. They are basing their answers on their overall health status not the quality of care they received.” These concerns resonate with me.

I don’t want to do something like prescribe a medication or perform a procedure, against what I see as best practice, just to make a patient happy. I also don’t want to be held responsible for some other care provider’s poor bedside manner.

It’s easy to be a skeptic of patient satisfaction scores, and there are some studies to validate your feelings if you want. However, according to a recent article from the New England Journal of Medicine there is a glaring hole in these studies: There is no set definition of what “satisfaction” is.

When surveys consider specific provider-patient interaction encounters, there is a facet of quality of care that can be measured by patient satisfaction, and that’s service. I think it’s important to realize that while we aren’t in the service industry like Uber drivers, we do provide a service to our patients.

The studies recognize that no amount of patient satisfaction is going to change the outcome of an aggressive cancer, but that should not be taken to mean that our service has no impact on the patient’s outcome. So what parts of our service can we focus on to give our patients better outcomes? The parts that have been shown to improve patient adherence to treatment plans: provider-patient communication, physician empathy, and care coordination.

Patient-Provider Communication

It’s hard to engage with a patient when we aren’t communicating well. If we can’t engage, it’s really hard to have a therapeutic relationship. Telehealth increases the ways in which a patient can reach out to a provider and vice versa.

The key benefit of multiple avenues of communication is reduction of friction. Friction is any reason or difficulty a patient may have that increases the amount of effort needed to follow up with their physician, be that for a scheduled follow-up or to check in due to a concerning development.

It could be that the in-person cost is too much, so they forgo an appointment. Maybe due to the length of visits, and the reduced number of appointments in a day, the patient won’t be able to see the physician for a weeks. Or, the only available appointment will not allow them to get across town and be at work in time. Patients might also rely on others, either for transportation or watching children, to be able to make in-office appointments. All of these normal issues create friction that prevent the open communication between the physician and his or her patient.

Our virtual office visits allow for quick check-ins to see how wounds are healing, questions about care can be answered quickly, when if unanswered, the patient may stop following the treatment plan. It is much less of a time commitment for both the provider and the patient to engage in and so can be utilized more frequently. They don’t have to remember all their questions for an office visit 3 weeks away they just have to access a patient care portal. When patients feel there is good communication occurring with their doctor, they follow their treatment plans, thus improving their outcomes.

Physician empathy

As healthcare has grown, the personal touch has been one of the hardest things to maintain. Most of the time it seems the technology advances increase the distance from our patients, but telehealth can buck this trend and work to close the gap. The more avenues we give patients to engage with us the more we show them we truly care about taking care of them. Feeling like your provider and you are on the same team has shown to help people stick to treatment plans making your job easier and your patient healthier than they might have been.

The ability for the physician and patient to connect grows when telehealth includes live video instead of relying on asynchronous communication. We can respond to their facial expressions and delve deeper to possibly understand unspoken expectations or needs.

Care Coordination

Proper care coordination has proven benefits for all involved. Not only do the patients get the proper providers involved at the right time, but having the right team together at the right time reduces expenses and decreases the opportunities for error.

Healthcare costs continue to rise, and poor communication between physicians has been cited as one of reasons. Electronic Health Records have been used to ensure each physician has access to the patient’s most recent lab results, medications, and examination notes. While this is drastically superior to the paper system of only 10 years ago, telehealth can improve coordination even further. With the ability to quickly remote in to the patient’s room, the present physician can work with the specialist at the same time, thus allowing for a truly collaborative experience.

One of the key benefits OrthoLive has provided to ED departments is the speed at which an injury can be assessed by an orthopedic surgeon. The patient and ED providers are not waiting for the specialist to travel in (or the patient doesn’t have to wait for the next available appointment), thereby potentially delaying proper treatment. And in other contexts, a quick visit with the right specialist can keep the patient from later seeking emergency care.

Towards a better way of viewing our service

I think the studies are clear that better service is better for the patient. And while the measures used for patient satisfaction are nebulous, we shouldn’t let that dissuade us from attempting to improve how our patients perceive our service.

Telehealth improves our availability to our patients. We can see more patients in a day, which means less delay between appointments. It improves our ability to communicate, which increases the odds the patients will follow the treatment plan. And it allows us to be remotely present at the exact time we are needed to care for emergency situations--without having to leave the comfort of our home.

Additionally the cost of losing patients is high. When a patient is dissatisfied with their care it’s not only them that doesn’t come back, but their family. Lifetime loss of a household is estimated at $1 million.. Patients are going to tell the story of the care you gave them. If the experience is good they will tell 5 people, but if it’s negative they will tell 9. Using OrthoLive can not only help keep you from losing patients, it can keep you from losing potential ones.

The nature of illness and injury will never allow us to fully control patient outcomes, but we can have a lot of control over the quality of service we provide to them. So instead of feeling frustrated at patient satisfaction ratings, maybe we can see it as an opportunity to improve one of the few things we really can control.

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