Thomas Rehring, MD On Supporting Physician Engagement

As physicians grow increasingly overwhelmed by the focus on their patient experience scores and online reputation, the need for shifting the conversation with toward progressive learning and supporting reward and recognition is more urgent than ever.

To gain perspective on how patient experience measurement initiatives are evolving for our healthcare partners, Gidon Margolin, President of Practicing Excellence, spoke with Thomas Rehring, MD, Vice President and Chief Experience Officer for the Colorado Permanente Medical Group in Denver, Colorado.

Dr. Thomas Rehring
Vice President & Chief Experience Officer, Colorado Permanente Medical Group
Denver, Colo.

Gidon: At CPMG, you’ve got over 1000 clinicians you’re trying to engage. How have you kept patient experience relevant for those clinicians?

Dr. Rehring: Maintaining the relevance of patient experience should be easy in healthcare. The nobility of purpose is no secret to clinicians. It is that longitudinal, intimate connection to humanity that brought us here and keeps us coming back. Like anything, we see variation in skill and self-awareness. We leverage actionable, detailed data from surveys of over 225,000 patients annually to reduce that “unconscious incompetence” tied to skill-building opportunities to improve. Administratively, relevance can be harder to champion. The ROI is less clear and it requires constant attention to remind each other that patient experience correlates with overall satisfaction, retention, renewal, value, likelihood to recommend, and more. Further, that physician communication skills are the overwhelming driver for patient experience.

Gidon: When you think about the size of the medical group, what is the greatest challenge you face in helping all of your clinicians improve?

Dr. Rehring: Programmatically, we are challenged with prioritizing non-patient facing time and resources into physician growth and development when access is prime. Even when resourced and prioritized, it can be difficult to scale a developmental program to 1,200 clinicians. Individually, we are competing for time and a recognition that self-investment has exponential synergy on effectiveness, efficiency and wellness. Provider-level data gets you in the door, reveals opportunity, then you must capitalize on growth mindset and willingness to improve.

Gidon: Tell us more about that. How have you thought about allocating resources towards improvement and then the impact or benefit you’ve observed in your clinician participation when leveraging those resources?

Dr. Rehring: We believe that patient experience correlates with overall satisfaction, retention, renewal, value, likelihood to recommend, etc. and that physician communication is the driver for all of those. If so, it should be resourced. For a more scientific approach, plot your CAHPS Rating of Health Care or Plan drivers against performance in a priority matrix. For many, physician communication rises as an area of opportunity. Now you have a burning platform. Next, you need individual, detailed data with peer comparisons to guide an intervention. Finally, you need a scalable skill-building platform that is both foundational and can be tailored to individual performance. When resources are tight, you should invest carefully in interventions that demonstrate proven efficacy.

Our first year, we evaluated the effect of the Clinician Experience Project in 400 adult primary care physicians in a mixed-model ANOVA analysis. We did a minimal amount of prescribed content or outreach. In the subset of physicians that engaged heavily with the Project—heavily was about twenty, three-minute videos over the course of a year—we saw a statistical improvement in their Art Of Medicine (communication skills) survey results.

Gidon: Share your thoughts around the idea of a “certification program,” not in the sense of a top-down, certified approach, but as an opportunity to align the imperative around outcomes with individual clinicians. How do you view this cohesive strategy working today or evolving over time?

Dr. Rehring: Recognition has never been my strong suit and clearly most organizations underutilize reward and recognition as a strategy for retention and cultural development. This is one opportunity for us to recognize those that have self-invested and maybe create some competition in others. This is also a convenient way to track progress on a suggested curriculum for our younger, pre-shareholder physicians.

Gidon: You have tested several different strategies, both with the in-person immersive learning but also have looked at the Clinician Experience Project as a mechanism to drive that scale. How do you get clinicians excited about that in a world where they’re busy, tired, and overwhelmed?

Dr. Rehring: I would say I have the humility first of all to say that I don’t think that we’ve necessarily succeeded yet. We’re on the first baby steps of a long journey and still toddling, hanging onto the couch. This is a classic change management challenge and should be addressed in that structured fashion—communicate the burning platform, get executive sponsorship, vision the future, tell stories, and engage others. Executive leadership support and sponsorship is core to your success. This change effort is best led by an actively practicing, respected clinician who can authentically, passionately carry the message while listening and responding to feedback.

I think building engagement is our next big challenge. It starts with a conversation about whether or not we feel that the skill is important. If so, how are we doing? The idea of “unconscious incompetence,” is powerful and not meant to be derogatory. We all think we communicate well. Transparent data can reveal opportunities to improve and is a solid first step. There are frequently challenges in how people respond to the data. On an individual level, a physician should ask, “Am I really willing to take the time to invest in myself?”

Gidon: What impact do you think reward and recognition could have on driving engagement? If clinicians are looking for that kind of acknowledgment, could it potentially spur increased activity if it became the new norm?

Dr. Rehring: I think there’s very clear evidence that many organizations don’t reward and recognize with sufficient frequency. For me, it is both an effort and a great pleasure of my job. We receive patient comments from our various surveys daily. I receive all of them. When a particularly beautiful comment comes across, I send it back to the individual physician with a personal note and copy to their supervisor and local leader. It’s as simple as, “Hey, I noticed, and thank you. What an amazing impact you have had.” So frequently we focus on the negative. The bad stuff. The angry patient. It’s just a quick reminder of the amazing, intimate, rewarding, rich lives we lead in health care.

That is just one piece of it. We are modeling behavior, paying attention, and shifting the focus back to patient connectedness. This year, we will adopt a process of recognition of completed curricula in the Project. Everyone likes to have their work recognized and it may just drive a little competition. Ultimately, and perhaps obviously, it is less about completion, more about a personal and cultural shift. Maybe less conversation about the challenges and frustrations in our days, more about the joys.

While we are at it, I’d like to share some appreciation for you and Dr. Beeson in delivering a unique resource that is helping us towards that cultural shift. We are early in our journey, but moving forward!

Learn more about our Patient Experience Certification Program designed to advance clinician knowledge in connecting with patients and support development through reward and recognition.