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Connecting the Dots Between Clinics and Hospitals Improves the Patient Experience

For the past two years, professional staff members at the Memorial Hermann Mischer Neuroscience Institute at the Texas Medical Center and Mischer Neuroscience Associates (MNA), its clinical extension in the community, have worked together to provide a consistent experience for patients from the clinic to the hospital and back to the clinic. The result: a dramatic improvement in Press Ganey patient satisfaction scores at MNA’s citywide clinics and in HCAHPS scores at the Institute.

“We’ve created a holistic culture at our clinics in which everyone is held accountable for patient satisfaction, from the front desk staff to the medical assistants and even to the back-office staff, who generally don’t see patients,” says Amanda Spielman, senior vice president for neuroscience at Memorial Hermann Health System. “We’re very aware that our patients would rather not be in a neuroscience office, so we’ve worked to make their experience as pleasant as possible. If there’s even a small decline in our patient satisfaction scores, we respond immediately. We stay focused on this every single day.”

With their sights set on attaining a distinguished ranking within the Memorial Hermann Health System, Spielman and her team developed a program of education, information and training to ensure that staff members understand each component of Press Ganey and HCAHPS surveys and what patients expect of their healthcare experience. New employees receive training on how to dress for a professional appearance, how to welcome patients and how to keep them informed during their office visit. To help set expectations, they distribute information to patients both in print and in emails, explaining how the clinic visit will work and how long the appointment should take. In the rare event that patients have to wait, a staff member explains why, offers a snack and asks if anything will make them more comfortable during their visit.

Developing a Bonus Plan

As an added incentive, Spielman also developed a bonus plan. “Clinic employees who excel have the opportunity to receive up to 7 percent of their annual salary increase as a year-end bonus, with 3.5 percent tied to overall patient satisfaction scores and 3.5 percent based on various operations and quality metrics in their specific work area,” she says. “Memorial Hermann Health System’s goal is the 65th percentile in Press Ganey scores. To earn a bonus, staff members in a particular area must achieve the 75th percentile or higher.”

Emily Paisley manages the front office at Mischer Neuroscience Associates-Texas Medical Center and also oversees the patient experience at MNA clinics across the city. “Because the Texas Medical Center is our largest clinic and the one we first focused on improving, it sets the standard for the other 14 clinics across the city,” Paisley says. “Staff members open doors for patients, look them in the eye and smile when they greet them. When patients arrive, they find a clean, professional environment with flowers at the front desk.”

Staff hired to work at other sites spend time in training at the Texas Medical Center clinic. Paisley meets with physicians and new clinic managers to ensure that they understand the Mischer Neuroscience vision for the patient experience. If a particular clinic’s patient satisfaction scores reflect even a slight decline, she spends time reeducating staff members.

A Dramatic Improvement

The focus on the patient experience at the MNA clinics has paid off. Since December 2013, the clinics have reported Press Ganey scores above the 75th percentile. For the Memorial Hermann Health System, the 67th to 89th percentile is target, and attainment of the 90th to 99th percentile is considered distinguished. For the first three months of 2015, MNA clinic scores were in the 91st percentile for a distinguished ranking. The team closed the fiscal year in the 83rd percentile across all MNA clinics, a dramatic increase over past scores.

To ensure coordination and sharing of information as patients move from the clinics to the hospital, Spielman and Nicole Harrison, RN, administrative director of nursing for the Mischer Neuroscience Institute, formed a hospital/clinic coordinating committee. “We discuss anything we see or hear that could make the patient experience less than ideal and find ways to address the issues,” Harrison says. “Those of us on the hospital side don’t know what patients experience in the clinic, so we created a rotating schedule that allows nurses to spend a couple of hours in the clinic. We want our staff to understand the entire patient experience and the impact they have on patients’ lives.”

Focusing on the Patient Experience

To help ensure a seamless experience, neuroscience navigators see patients and families in the clinic and also visit during their hospitalization. “We’re continually asking ourselves how we can streamline the experience with the patient in mind,” Spielman says. “I want patients to know that we’re all part of one neuroscience team, working together. If they see a familiar face from the clinic while they’re in the hospital, it helps make the experience less frightening. Information about patients flows back and forth between the hospital and clinic. If a patient and family are particularly anxious about surgery, that information goes to the hospital staff. If a patient has pain after surgery, that knowledge goes back to the clinic staff.”

In the 2015 fiscal year rollup of HCAHPS patient satisfaction scores at Memorial Hermann-Texas Medical Center, the neuroscience service line led the hospital at the 76th percentile, more than 25 points higher than the previous year. In the first quarter of the 2016 fiscal year, neuroscience moved up to lead the hospital at the 86th percentile.

“All this has occurred because we’ve kept our eye on the little things that are important to a good patient experience,” Spielman says. “We’re very clear about our service standards and expectations when we interview and very careful when we hire. We’ve made everyone aware of the components of Press Ganey and HCAHPS and have held people accountable. It took us nearly two years to change the culture, and we’ve done it. The attitude toward patients used to be ‘You’re lucky to be here.’ Now it’s ‘We’re lucky we have you.’”