Quality Improvement Toolkit

Background

The Maine Quality Forum (MQF) is committed to improving the experience of patients with their primary and specialty healthcare providers. A major goal of the MQF’s Patient Experience Matters initiative is to collect standardized information on how patients rank their experience with providers on dimensions that patients consider important, such as timely appointments, provider communication, helpful and courteous staff and attention of your healthcare and emotional needs. By making this information publicly available, consumers and providers are able to compare practices in a consistent and reliably valid manner.

But knowing how practices perform on patient experience is only the first step. A key purpose of Maine Patient Experience Matters is to help practices better understand their areas of weakness and strength and to improve the patient experience. This Tool Kit compiles available research and practical strategies that health care executives, managers, staff and providers can use to improve performance. Primary sources used in the toolkit rely heavily on abstracts from the Agency for Healthcare Research and Quality (AHRQ) website, Maine Quality Counts, and other national quality initiatives. The MQF is especially grateful to Avatar, a survey vendor under this initiative, for sharing proprietary case studies and resources that normally would be available to only their clients. In permitting its work to be incorporated into this Tool Kit, Avatar demonstrated commitment to our common goal of improving patient experience across all practices.

What does this Tool Kit address?

The Tool Kit is organized into the same nine composites addressed in the Consumer Assessment of Healthcare Providers and Systems (CAHPS) Clinician & Group Survey 2.0 (CG-CAHPS) and supplemental patient-centered medical home (PCMH) items for children and adults.

Under each composite, individual survey items are listed as well as a general summary of the factors that may impact a practice’s performance. Improvement resources are provided by composite given the extent of interaction across survey items. Links are provided for practices wishing to get a more in-depth understanding of available research supporting specific improvement strategies.


      1. Getting Timely Appointments, Care and Information
      2. How Well Providers Communicate with Patients
      3. Helpful, Courteous, and Respectful Office Staff
      4. Attention to Your Mental or Emotional Health (Adult only)
      5. Talking with You about Taking Care of Your Own (or Your Child’s) Health
      6. Talking about Medication Decisions
      7. Provider's (or Doctor's) Attention to Your Child's Growth and Development (Child only)
      8. Provider's (or Doctor's) Advice on Keeping Your Child Safe and Healthy (Child only)
      9. Patients’ Rating of the Provider (or Doctor)
      10. General Patient Experience Improvement
      11. Provider Engagement

 

1. Getting Timely Appointments, Care and Information

The survey asked patients how often they got appointments for care as soon as needed and timely answers to questions when they called the office. The survey also asked patients how often they saw the provider within 15 minutes of their appointment time and whether they received reminders between visits.

Survey Question

Possible Reasons for Low Scores

Potential Quality Improvement Strategies

  • Patient got appointment for urgent care as soon as needed
  • Patient got appointment for non-urgent care as soon as needed
  • Patient got information about what to do if he/she needs care on evenings, weekends or holidays
  • Patient got needed care during evenings, weekends, or holidays*
  • Patient got answer to medical question the same day he/she phoned provider’s office
  • Patient got answer to medical question as soon as he/she needed when phoned provider’s office after hours
  • Patient received reminders about tests, treatments or appointments between visits*
  • Patient saw provider within 15 minutes of appointment time
  • Patient panel size to provider ratio is too large resulting in longer wait periods.
  • There is a backlog (wait times for appointments) which prevents patients from getting day of choice appointments.
  • Not having open scheduling; limited hours
  • No systemized approach for patient follow-up
  • Appointment slots too close together or double-booked
  • Patient not informed about delays
  • Nothing to occupy patient while waiting
  • Provider/staff not acknowledging length of delay or expressing empathy for the delay
NOTE: * indicates PCMH supplemental items

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2. How Well Providers Communicate with Patients

The survey asked patients how often their providers explained things clearly, listened carefully, showed respect, provided easy to understand instructions, knew their medical history, and spent enough time with the patient.

Survey Question

Possible Reasons for Low Scores

Potential Quality Improvement Strategies

  • Provider explained things in a way that was easy to understand
  • Provider listened carefully to patient
  • Provider gave easy to understand information about health questions or concerns
  • Provider knew important information about patient’s medical history
  • Provider showed respect for what patient had to say
  • Provider spent enough time with patient
  • Someone from provider’s office followed up with patient to give results of blood test, x- ray, or other test*
  • Provider seemed informed and up to date about care patient received from specialists*
  • Patient not treated as a partner in care decisions
  • Breakdown in communication between providers and patient
  • Provider behavior or attitude (hurried, impatient, etc.)
  • Not enough time scheduled for the visit
  • Reason for visit not clear; main reason not addressed until the end and not enough time for review
  • Provider did not make time for questions or to check understanding
  • Provider explained things at a level the patient could not understand
  • While the provider may have been informed about patient’s medical history, this was not communicated to the patient
NOTE: * indicates PCMH supplemental items

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3. Helpful, Courteous, and Respectful Office Staff

The survey asked patients how often the office staff were helpful and treated them with courtesy and respect.

Survey Question

Possible Reasons for Low Scores

Potential Quality Improvement Strategies

  • Clerks and receptionists helpful
  • Clerks and receptionists courteous and respectful
  • Patient felt they or their family members were not respected
  • Under staffed front desk
  • Front desk not trained in customer service
 

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4. Attention to Your Mental or Emotional Health (Adult only)

The survey asked patients whether the provider talked to them about worry or stress in their life, feeling sad or depressed, or other personal or family problems.

Survey Question

Possible Reasons for Low Scores

Potential Quality Improvement Strategies

  • Anyone in provider’s office asked if patient had felt sad, empty, or depressed
  • Anyone in provider’s office talked about worry/stressful aspects of patient’s life
  • Anyone in provider’s office talked with patient about personal problem, family problem, alcohol use, drug use, or a mental or emotional illness
  • Provider uncomfortable addressing mental health issues
 

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5. Talking to You about Taking Care of Your Own (or Your Child’s) Health

The survey asked patients (or parents of children) about whether the provider worked with them to set specific goals for their/their child’s health and asked about things that make it hard for them to take care of their/their child’s health.

Survey Question

Possible Reasons for Low Scores

Potential Quality Improvement Strategies

  • Anyone in provider’s office talked with patient (or parent) about specific health goals
  • Anyone in provider’s office asked if there were things that made it hard for patient (or parent) to take care of health
  • Patient not supported to manage their own health and health conditions

Pediatric Care resources developed under Learning Collaboratives established as part of First STEPS - a Maine-based quality improvement initiative to improve children's health care and preventive health screenings:

 

 

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6. Talking about Medication Decisions

The survey asked patients whether the provider talked about reasons to take or not take a medicine and asked the patient what they thought was best for them regarding the medication.

Survey Question

Possible Reasons for Low Scores

Potential Quality Improvement Strategies

  • Provider talked to patient about reasons patient might want to take medicine
  • Provider talked to patient about reasons patient might not want to take medicine
  • Provider asked what patient thought was best for patient
  • Anyone in provider’s office talked to patient about all the prescription medicines patient is taking*
  • Provider not engaging patients in conversation of medication concerns and compliance
NOTE: * indicates PCMH supplemental items

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7. Provider's (or Doctor's) Attention to Your Child's Growth and Development (Child only)

The survey asked parents if the provider talked about their child’s growth, behaviors, moods, and emotions, and ability to learn and get along with others.

Survey Question

Possible Reasons for Low Scores

Potential Quality Improvement Strategies

  • Respondent and provider talked about child’s learning ability
  • Respondent and provider talked about age- appropriate behaviors
  • Respondent and provider talked about child’s physical development
  • Respondent and provider talked about child’s moods and emotions
  • Respondent and provider talked about how much time child spends on a computer and in front of a TV
  • Respondent and provider talked about how child gets along with others
  • Provider not trained in Bright Futures
  • Provider has insufficient time; length of visit too short

Guides to help parents understand child health and developmental screening:

Practice tools on child health development

 

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8. Provider's (or Doctor's) Advice on Keeping Your Child Safe and Healthy (Child only)

The survey asked parents if the provider talked about keeping their child from getting injured, the food the child eats, physical activity, and household problems.

The survey also asked parents if the provider gave printed handouts or booklets on keeping their child from getting injured.

Survey Question

Possible Reasons for Low Scores

Potential Quality Improvement Strategies

  • Respondent and provider talked about injury prevention
  • Provider gave information on injury prevention
  • Respondent and provider talked about child’s eating habits
  • Respondent and provider talked about child’s physical activity
  • Respondent and provider talked about any problems in the household that might affect child
  • Provider not trained in Bright Futures
  • Provider has insufficient time; length of visit too short

Practice tools on child health development

 

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9. Patients’ Rating of the Provider (or Doctor)

The survey asked patients to rate their provider on a scale of 0 to 10, with 0 being the worst and 10 being the best.

Survey Question

Possible Reasons for Low Scores

Potential Quality Improvement Strategies

  • Rating of provider
  • Patient did not feel that concerns were addressed; length of visit too short
  • Patient waited longer than 15 minutes for scheduled appointment
  • Breakdown in communication between patient and provider
  • Clinic unpleasant because of uncleanliness, inconvenience, staff/provider behavior or attitudes
  • Factor not related to something specifically asked about on the survey. Further exploration may be necessary.
 

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10. General Patient Experience Improvement

Potential Quality Improvement Strategies

The following resources provide general information on patient experience improvement strategies:

 

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11. Provider Engagement

Potential Quality Improvement Strategies

Dissatisfaction among staff has been associated with lower patient satisfaction. Here are some resources addressing the engagement of healthcare providers. 

AMA Steps Forward resources:

Additional resources: 

 

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