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A Patient's Voice

Doctor showing patient digital survey

Closing the Gap Between Doctor and Patient

The digitization of health care is enabling providers to gain insights into patients and help them in ways that hadn’t been possible before. One shining example of that is a patient-satisfaction survey developed by Neil R. Malhotra, MD, Vice Chairman for Operations and Associate Program Director of the Department of Neurosurgery at Penn Medicine.

Soon after Penn Medicine implemented its electronic health record system, more than 10 years ago, Dr. Malhotra began organizing weekly, department-wide meetings that were aimed at pinpointing inefficiencies with it and dreaming up ways to improve them. Before long, they developed a more intuitive interface, the EpiLog tool, designed specifically for neurosurgery office visits, that would capture more granular information that they believed was vital to their patients’ care.

“A Patient’s Voice,” as the digital patient-satisfaction survey has come to be called, started as an outgrowth of that project.

Giving Patients a Voice

Improved health system responses to patients’ concerns is one of Dr. Malhotra’s many goals. “Gradually, I started to get this sense from some patients that they didn’t really have a voice unless they made a pretty significant effort, like writing a letter to the chair of the department or the CEO of the hospital,” he says.

With that as its impetus, Dr. Malhotra intended for A Patient’s Voice to become a much more accessible way for patients to provide feedback on the quality of their care. At the conclusion of their treatment—typically, following surgery—neurosurgery patients are asked to answer 11 yes-or-no questions about their experience at the hospital and with their surgeon.

Over the course of the last decade or so, the system Dr. Malhotra built has, as he describes it, “ ‘heard’ nearly 30,000 voices.” Put another way, nearly 30,000 surveys have been completed by neurosurgery patients. (The average response rate ranges between 90 and 95 percent, according to Dr. Malhotra, which he attributes to the survey’s brevity and simplicity.) For the first few years, the department largely compiled the resulting data and established baselines for each response.

But the survey’s taken on a new dynamic over the last few years. Now, as soon as a patient completes a survey, the results become immediately available to every physician in the department.

Responding to Deviations

Dr. Malhotra says he usually scans the survey data for the whole department at least weekly. “And then once a month, I’ll take a deeper dive, just to make sure there are no unexpected divots,” he says.

Since the survey’s inception, the results have been used entirely to track the department’s performance, according to Dr. Malhotra. And the greater the sample size, of course, the greater the weight each average starts to hold. So, when he says, “Around 98 percent of our patients would recommend their neurosurgeon to a family member,” that’s a significant statement, considering it’s based on 10 years’ worth of opinions.

But it also means that the responses that veer from those averages become a little more glaring. “When the data dips, it creates an opportunity for me to have a conversation with that faculty member, nurse manager, or leader overseeing the area that has veered off course from our established high standard,” Dr. Malhotra says.

The absolute nature of the data diffuses any tension that would likely arise without it. Defenses now lowered, the discussions quickly become constructive.

Where the patients are concerned, Dr. Malhotra has developed an algorithm that triggers an alert any time negative responses are given to any two of the following questions:

  • Surgery went as I was told it would go?
  • Surgery met my expectations?
  • Am I worse than before surgery?
  • Would you recommend your neurosurgeon to a family member?

In the instance of an alert, a designated clinician will follow-up directly with the individual patient. The clinician seeks to understand what drove the patients’ disappointment and, when possible, remedies the situation.

It’s an approach Dr. Malhotra likely would have taken himself with a concerned patient before A Patient’s Voice existed. Now, with a clearer channel between patient and physician, the response time has not only been minimized, the response itself has also become systematic.

Proud as he is to be realizing one of his goals, Dr. Malhotra’s most excited about a new use for the survey that’s only now coming into focus. “We’re nearing a time when we’ll be able to provide patients with a clear picture of how past patients felt after any individual procedure,” he says. “It’s the type of guidance and care I’d want for myself and my family.”

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