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Building Referring Physician Loyalty: OSUMC Gelb-PAN
The James Cancer Hospital is conducting research to better understand the experience of referring physicians and identify opportunities to increase physician loyalty and referrals. They utilized experience mapping to evaluate the entire physician and patient journey. Interviews with 44 referring physicians revealed that The James is known for its reputation but physicians have little knowledge of individual oncologists. They seek more information on specialists to refer specific cancer types and better understand diagnostic options. While coordination of referrals works smoothly, physicians want improved communication and relationships with oncologists to facilitate referrals.
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Building Referring Physician Loyalty: OSUMC Gelb-PAN
- 1. Building Referring PhysicianLoyalty NACCDO-PAN April 2013
- 2. PAGE 2 Agenda 1. Background 2.Approach 3. Insights 4. Insights to Action 5. A Sustainable Process
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- 4. PAGE 4 OSUCCC-James Background •NCI-designated Comprehensive Cancer Center • The James Cancer Hospital and Solove Research Institute was the Midwest’s first freestanding cancer hospital • New hospital currently under construction – 1M sf with 276 inpatient beds, 14 OR's, 7 Rad Onc vaults, 40 chemo bays
- 5. PAGE 5 Situation Overview ManagingReferrer Relationships • The James began an initiative to seek insight on the experience provided to referring physicians as well as glean key drivers for referrals and satisfaction • Goals included an action-based physician relations management program and ultimately increasing referrer loyalty
- 6. PAGE 6 Experience Mapping WhyWe Chose This Approach • Evaluates the entire experience – from the moment a decision is made to refer to the state of transitioning care back to the provider • Creates a framework for an action plan and accountability • Gives insight into marketing and communications strategies for referring physicians • This framework can then be used to assess and monitor the experience over time through a PRM system
- 7. PAGE 7 Gelb: TheBasis of Their Insights Works with Nationally-recognized Institutions: • 5 “Honor Roll” institutions • 3 out of the top 5 cancer programs • 2 out of the top 4 pediatric hospitals • 2 out of the top 4 cardiovascular programs Conducts National Benchmarking Studies: • Patient experience • Marketing • Physician relations • International programs
- 8. PAGE 8 IMPACT DESIGN ANALYZE DISCOVER ALIGN Overview • Kickoff Meeting • Document key insights • Qualitative Research – Referring Physicians • Day in the Life • Touchpoint assessment • Define the ideal experience • Create action plans with leaders and staff • Touchpoint prioritization • Develop implementation plans • Dashboards to monitor progress
- 9. PAGE 9 Selecting Interviewees •When selecting physicians we want to capture as many “unique” experiences as possible • Identified physicians who have / have not referred to The James • Determined which physicians made referrals to multiple areas of interest in this study (GI, Hematology, Breast Cancer and Head and Neck Cancer) • Developed a sample pool representing those who refer to at least two areas of interest • Completed 44 interviews
- 10. PAGE 10 Discussion Areas Acustomized experience map was used to focus their input on the steps during which they have the most involvement • Perception of and knowledge about The OSU and The James • Referral decision-making process and assessment of the referral experience • Methods of receiving progress reports (electronic, phone calls, etc.) and analysis of touchpoints • Coordination of patients’ on-going care • Prescriptions for growth and increasing referrals
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- 12. PAGE 12 Philosophy Culture andyour brand promise are linked through the experience delivered. Leaders translate customer expectations to the organization and reinforce desired employee behaviors. This alignment creates an exceptional experience and a sustainable competitive advantage. We call this desired state enchantment. EXPERIENCE EXPECTED BEHAVIORS Cultural Alignment Transformational Leadership Brand Promise
- 13. PAGE 13 Difference inDrivers What We Do • Services offered • Clinical outcomes • Transfer efficiency • Scheduling delays Functional Needs How We Do It • Inclusion in treatment • “Feel” of the interactions • Subjective quality judgments • Feeling valued Emotional Needs NUMBERS STORIES
- 14. Enchantment Cycle Listen Define Promise Deliver Reinforce Physician Listen tocustomers, their influencers and other stakeholders Define how your organization will meet or exceed needs Communicate a resonant Promise Deliver flawlessly on the Promise Reinforce the promise in all communications & interactions
- 15. PAGE 15 Referring PhysicianExperience Map Awareness • Perceptions of The James • Knowledge about The James • Marketing or educational resources • Ideal relationship with The James Need • Evaluation and selection of treatment providers • Discussion with patients (diagnosis, referral options) • Preparing patients for what to expect Scheduling • Initial contact with The James • Timing and ease of process • Resources for patients and their families Treatment • Coordination of care with oncologist • Progress notes and methods of communication • Patient feedback about clinical experience Transition of Care • Discharge summary • Coordination of on-going care • Ongoing patient care/support • Call-backs for assistance Primary Experience Stewards • Faculty/Staff • Patients and their Families • Front Desk Staff • Faculty/Medical Staff • Faculty/Medical Staff • Support Staff • Faculty/Medical Staff • Support Staff • Faculty/Medical Staff • Support Staff Key Touchpoints
- 16. PAGE 16 Experience Mappingis an in-depth qualitative research technique that utilizes a visual cue (the experience map) to help physicians, patients, staff, and other influencers recall specific episodes in their journey. It provides: Assessment of the total experience • Expectations- before first encounter • Activities and Touchpoints • Changes in attitudes, if any Framework for action • Experience stewards who are responsible for delivery • Steward can appreciate the relationship of their actions to the rest of the journey • Interactions or “touchpoints” are categorized at each step Experience Mapping: Fitting it All Together
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- 18. PAGE 18 Video /Audio Recordings Physical Environment Communications From Data… Physician Interview Transcripts 1. 2.
- 19. PAGE 19 …to Insights DetailedFindings: • Key themes • Verbatim comments • Strengths and barriers Day in the Life Touchpoint Assessment: • Key Recommendations • Illustrate with pictures • Enrich with clips 3. 4.
- 20. PAGE 20 Imparting theInsights The James provides the best care and communication They are experts, but I need more communication about my patient I prefer other referral options because my patients are unhappy and I am left out of the loop High performance Moderate performance Low performance “The James is the best option for my patient” Ideal Outcome: Day in the Life: Touchpoint Performance: Icons for each stage: Electronic communications, telephone communications, facility, written communications, interpersonal communications
- 21. PAGE 21 Persona: PrimaryCare Providers Primary Care Provider GOALS • Grow their patient base • Strengthen reputation through excellent care for their patients • Build lasting relationships with their patients BEHAVIORS • Employed or affiliated PCPs refer to their institution • Refer locally for less complicated cases, believing their patients want convenience • Refer to The James for many types of cancer and to other areas of The OSU “My patient’s satisfaction with care directly impacts the success of my practice. When my patients are happy, they stay with me and refer me to their friends and family. When I refer a patient, my reputation is at stake.” NEEDS • Know what their patients can expect at The James so they can prepare them in advance • Secure timely appointments • Referral process that does not tax their resources and staff • Stay informed about their patient’s treatment and care • Have their patients perceive them as being engaged and involved in their care
- 22. PAGE 22 Persona: Specialists GOALS •Grow their patient base • Strengthen reputation through excellent care for their patients • Building lasting relationships with Primary Care Physicians BEHAVIORS • Refers to sub-specialist at The James for complex cases • Manages more common cancer- related issues and screenings “I am an expert in my specialty. Almost every case I refer is complex. For rare cases or those that require special technology, I need a physician at the top of their field with very specific expertise- distance to travel is less important.” NEEDS • Ability to identify oncologists at The James based on expertise • Knowledge of technique/technology available • Have the patient referred back for specialist-level care when possible (such as common surgeries) Specialist
- 23. PAGE 23 NEED Ideal Outcome Activities Evaluationand selection of treatment providers Discussion with patients (diagnosis, referral options) Preparing patients for what to expect Key Touchpoints “I trust The James to handle the most complex cases and provide a smooth experience.” Need
- 24. PAGE 24 Most splitreferrals, selecting The James for the most complex cases The James is a tertiary center that offers top notch physicians and cutting edge technology; I can send them my most complex cases (such as head and neck cancer) I know The James is a NCI designated center, but their reputation and patients’ experiences are most important for referral decision-making Although I prefer The James to other tertiary centers like Cleveland Clinic, local options like Riverside do a great job for common cancer cases (such as breast cancer) and provide a more personalized experience for patients As a primary care doctor, it is common for me to refer first to a local oncologist, who then might refer the patient to The James if their case is complex Sometimes The James wants a confirmed diagnosis before they will accept a patient, which can be difficult if we are unable to perform a biopsy – I wish there was an advanced diagnostic center at The James to which I could refer Commonly-mentioned local competitors: 1. Ohio Health - Riverside 2. Mount Carmel St. Ann’s 3. Genesis Health- Zanesville 4. Ohio Health –Grant Medical Center 5. Ohio Cancer Center The Zangmeister Center
- 25. PAGE 25 Patient requestsand referrers’ relationships with The James oncologists increase referrals My biggest barrier to referring to The James is lack of knowledge about their individual oncologists and what they do better than local providers; especially for common types of cancer, I need to know why patients should drive a longer distance and navigate a larger center than what is available locally If I have a personal relationship with an oncologist at The James, I am more likely to refer there regardless of the complexity or cancer type Most patients follow my referral advice, but if they do make a request, it is almost always for The James I don’t routinely recommend second opinions, but if patients ask for it, I almost always direct them to The James I anticipate that a freestanding cancer hospital would improve parking and staff’s sensitivity to cancer-related needs but would want assurance that patients would have easy access to the main hospital if needed “When referring I take into account if I know a physician there (which makes me more likely to send a patient), how far the patient is willing to travel, if they have a doctor at another system, and their overall preference.” (022 A)
- 26. PAGE 26 The Jamesis on a large campus and intimidating to many patients. Navigating travel, parking and the large facility are often reported as reasons that referring physicians and patients may choose a local provider if the patient’s case is not complex (for example, if they will be receiving standard breast cancer treatment protocol). However, a stellar reputation promotes referrals for the most complex cases and also promotes patient-requested referrals, especially for second opinions. Relationships, prior experience and word of mouth recommendations are often a means for selecting a physician to refer. However, The James is so large that it is challenging for referring physicians to develop relationships with faculty and staff. Physicians find it difficult to identify who would be the best physician for their patient’s specific condition. This is amplified by many referrers having relationships with local oncologists to whom they send the majority of their cases. High performance Moderate performance Low performance Preferred for complex cases, but smaller, local providers are competition for common cases
- 27. PAGE 27 Translating Insightsinto Action Communication Coordination Care Awareness Need Scheduling Treatment Transition of Care
- 28. PAGE 28 Communication I amaware of OSU and The James, as they have a reputation for top notch clinical treatment - but I have never visited the facility and would like to know more about what my patients experience when they arrive for care Communication CoordinationCare Communication
- 29. PAGE 29 Communication I amaware of OSU and The James, as they have a reputation for top notch clinical treatment - but I have never visited the facility and would like to know more about what my patients experience when they arrive for care My biggest barrier to referring to The James is lack of knowledge about their individual oncologists and what they do better than local providers; especially for common types of cancer, I need to know why patients should drive a longer distance and navigate a larger center than what is available locally “The biggest issue that I have is not knowing the physicians specifically...I often don’t know if there are particular cases where one doctor is truly the regional expert...In comparison to the community hospitals, I have relationships with surgeons.” Communication
- 30. PAGE 30 Communication I amaware of OSU and The James, as they have a reputation for top notch clinical treatment - but I have never visited the facility and would like to know more about what my patients experience when they get there My biggest barrier to referring to The James is lack of knowledge about their individual oncologists and what they do better than local providers; especially for common types of cancer, I need to know why patients should drive a longer distance and navigate a larger center than what is available locally I receive mailed resources from OSUMC, but am in need of printed directories with information about specialists for each type of cancer (including their pictures and direct contact numbers) so I can refer my patients to an oncologist by name Communication
- 31. PAGE 31 Communication The OSUand The James are well known throughout the region and farther. Advertising adds to positive perceptions. However, few have recently visited The James and are unsure what their patients experience. They suggest on-site CME offerings with the opportunity for a “backstage” tour and meeting the faculty. Communication
- 32. PAGE 32 Communication The OSUand The James are well known throughout the region and further. Advertising adds to positive perceptions. However, few have recently visited The James and are unsure what their patients experience. They suggest on-site CME offerings with the opportunity for a “backstage” tour and meeting the faculty. The website is reported as a valuable resource, but should not replace mailed materials. Printed referral directories to The James are sought. Many are unaware that The James offers advanced diagnostic options, so refer undiagnosed patients elsewhere although they would prefer The James. They need information about how and where to refer undiagnosed patients. Communication
- 33. PAGE 33 Communication The OSUand The James are well known throughout the region and further. Advertising adds to positive perceptions. However, few have recently visited The James and are unsure what their patients experience. They suggest on-site CME offerings with the opportunity for a “backstage” tour and meeting the faculty. The website is reported as a valuable resource, but should not replace mailed materials. Printed referral directories to The James are sought. Many are unaware that The James offers advanced diagnostic options, so refer undiagnosed patients elsewhere although they would prefer The James. They need information about how and where to refer undiagnosed patients. Providers at The James stand out as exceptional for their expertise and compassionate care. However, most referring physicians do not have personal relationships with oncologists at The James, providing a competitive advantage to local providers. Communication
- 34. PAGE 34 Coordination I havemy staff contact The James via the main line to make an appointment; I hear few complaints and they are able to direct my staff to where my patient needs to be seen Coordination
- 35. PAGE 35 Coordination I havemy staff contact The James via the main line to make an appointment; I hear few complaints and they are able to direct my staff to where my patient needs to be seen If the normal referral resources are inadequate, I need to get in touch with a person – usually an oncologist – but am unsure how to do this unless I already have an individual’s phone number “It is almost impossible to speak to someone if you don’t know them personally...we will leave a message...Usually we don’t get call-backs when we leave messages.” Coordination
- 36. PAGE 36 Coordination I havemy staff contact The James via the main line to make an appointment; I hear few complaints and they are able to direct my staff to where my patient needs to be seen If the normal referral resources are inadequate, I need to get in touch with a person – usually an oncologist – but am unsure how to do this unless I already have an individual’s phone number Throughout the continuum of care, I consistently receive a fax almost immediately after patients are seen or treatments are completed; faxes are ideal because they are easy to scan into my EMR system “We primary care physicians are the quarterback and we have to know what is going on.” Coordination
- 37. PAGE 37 Coordination I havemy staff contact The James via the main line to make an appointment; I hear few complaints and they are able to direct my staff to where my patient needs to be seen If the normal referral resources are inadequate, I need to get in touch with a person – usually an oncologist – but am unsure how to do this unless I already have an individual’s phone number Throughout the continuum of care, I consistently receive a fax almost immediately after patients are seen or treatments are completed; faxes are ideal because they are easy to scan into my EMR system The James returns patients to my care and is willing to coordinate with me to provide on-going care to minimize patient travel, which becomes more important if my patients travel over an hour to The James Coordination
- 38. PAGE 38 Coordination Most reportsatisfaction with the main referral line, although at times the process takes longer than they would like. However, they are directed to the right department and can make appointments quickly while patients are still in the office. Those who have direct numbers to oncologists at The James highly value this as a resource. Coordination
- 39. PAGE 39 Coordination Most reportsatisfaction with the main referral line, although at times the process takes longer than they would like. However, they are directed to the right department and can make appointments quickly while patients are still in the office. Those who have direct numbers to oncologists at The James highly value this as a resource. Those who do not have contact information for an oncologist at The James find it difficult to speak with the right provider when they have scheduling- related problems or questions about unusual cases. Despite the faxed updates, phone calls initiated from oncologists at The James would be appreciated – especially if the situation is unexpectedly taking a turn for the worse. Community providers regularly call referring physicians, which they appreciate. Coordination
- 40. PAGE 40 Care I amhappy with the clinical outcomes; The James gives options and hope to patients when other providers have nothing to offer Care
- 41. PAGE 41 Care I amhappy with the clinical outcomes; The James gives options and hope to patients when other providers have nothing to offer Patients are often overwhelmed about the large size of the campus and long wait times – but report positive feedback about their treatment experience; they understand their treatment plan, feel the nurses are caring and recall their doctor takes the time to listen Care
- 42. PAGE 42 Care I amhappy with the clinical outcomes; The James gives options and hope to patients when other providers have nothing to offer Patients are often overwhelmed about the large size of the campus and long wait times – but report positive feedback about their treatment experience; they understand their treatment plan, feel the nurses are caring and recall their doctor takes the time to listen Since I trust The James’ expertise, I would like cancer treatment protocols so I know best practices for cancer screening, at what point to refer my patients and how to conduct tests so The James does not need to repeat them after my patient arrives Care
- 43. PAGE 43 Care I amhappy with the clinical outcomes; The James gives options and hope to patients when other providers have nothing to offer Patients are often overwhelmed about the large size of the campus and long wait times – but report positive feedback about their treatment experience; they understand their treatment plan, feel the nurses are caring and recall their doctor takes the time to listen Since I trust The James’ expertise, I would like cancer treatment protocols so I know best practices for cancer screening, at what point to refer my patients and how to conduct tests so The James does not need to repeat them after my patient arrives I have a physician liaison from other hospitals, but not The James; I would like a relationship with someone who can give me information and access to The James Care
- 44. PAGE 44 Care Patient satisfactionwith their experience is the most motivating factor for continued referrals to The James. Although there is room for improvement in personalizing the experience, patients and referrers alike feel they received the best outcome possible and understand their treatment plan. Care
- 45. PAGE 45 Care Patient satisfactionwith their experience is the most motivating factor for continued referrals to The James. Although there is room for improvement in personalizing the experience, patients and referrers alike feel they received the best outcome possible and understand their treatment plan. In general, referring physicians describe the transition of care back to referring physician as rather smooth. The transition is facilitated by faxes with instructions for on-going care and patients being well-informed of their care plan. Despite satisfaction with faxes, some would like more detailed instructions for on-going care. Care
- 46. PAGE 46 Building Referrals •Help them feel valued as medical professionals • Enhance their reputation with patients • Emphasize why and when you are the best option, including advanced diagnostic options • Simplify the patient’s experience • Create meaningful relationships • Pick up the phone “A way The James could build referrals would be (for The James doctor) to just call my office and just talk for five minutes about the patient.” “It is my lack of knowledge of what they have at The James that makes me not want to refer there for the non-complicated cancers. The basic breast cancer protocol is the same everywhere.” “Whatever The James can do to be more customer-oriented would be helpful.”
- 47. PAGE 47 Today’s Business Model Future Business Model The RedZone Red Zones Require Concurrent Action Run Employees Transformational Leaders Managers “We must continue doing business today while simultaneously changing the way we do business.”
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- 50. PAGE 50 Strategic Questions •Will we promote usage as a tertiary center for complex cases (most current usage) or a preferred provider for all cases? If we want to change perceptions, how will we do this? • What is the emphasis on clinical care v. research? How can we continue stellar research while enhancing patient-focused clinical care? • How can we coordinate care for more geographically distant patients? • What are consistent ways we can build emotional connections with referrers to which our oncologists and staff will agree to adopt? • How can we motivate oncologists to call referrers more often despite the time investment?
- 51. PAGE 51 Results toDate • Results communicated with organization-wide physician leadership to develop awareness • Hired a Cancer Specific Referring Relations Coordinator • Goals to increase communication between the James and the referring community • Liaison for operational concerns between referring MDs and James. Takes action plans back to the referring docs • Host one CME per quarter to bring referring MDs to the James • Coordinates and hosts referring physician meets for our physicians to go to the community
- 52. PAGE 52 Results toDate (cont.) • Referring MD communication strategy and operational access plan has been drafted • Cancer MD cell phone numbers are being collected and organized for communication to referring MD's • Developed a paper referring physician directory that is organized by disease service line • Information from the findings is being used in the James Ambulatory Strategic Planning process
- 53. PAGE 53 Marketing CommunicationsPlan • FY2014 goals include • Increase awareness among targeted referring & non- referring physicians • Grow relationships between James physicians and referrers/non-referrers • Increase awareness among office managers and referral coordinators • Position The James as a resource for information and consultation for referrers/non-referrers
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- 55. PAGE 55 Data Information Knowledge Action --Profitable -- Useful -- Educational -- Interesting Translating data into action through CRM
- 56. PAGE 56 Sources ofInformation & Feedback Referring Physician Survey • Deployment • Response • Escalation • Reporting Physician Relations • Physician Call Center • Liaison Specialists • Local • National • International Other Sources • Physicians/Staff at Local Offices • Regional Care Centers • Faculty Referring Physician Referring Physician Survey Physician Relations Other Sources
- 57. PAGE 57 Input Data Source Frequency Objective/Data Collected DataTransfer Method to SalesForce CMS Monthly • Contact info • Flag new Providers One-way, Upload via NPI Daily • Contact info • Specialty, privileged One-way, Upload via EPIC Weekly • Referral tracking • Financial Data One-way, Upload via SalesForce As needed • Campaign Management • Physician Visit Reports • Call Center Data User entered and maintained Satisfaction surveys Trigger based, as deployed • Physician satisfaction surveys • Post referral follow-up • Other surveys Collected via SalesForce integrated surveys HCAHPS Monthly • Track scores and compare top competitors One-way, Upload via Integrating Data Sources Processed through customized SalesForce program Custom, user specific reports and dashboard
- 58. PAGE 58 Internal Processes KeyActivities Scheduling First Visit Treatment Follow-upNeed Physician contracts call center for additional information Pain Points • Calls not returned • Provided incorrect information • Need to repeat their “story” How can CRM support/improve process? Are we improving? Information Needs • What is currently collected, needs migrated • What needs to be collected • How should that information be organized Assessing, Monitoring and Tracking • Surveys • Key Metrics • Reports and Trends LIaisonPain Points • Incomplete records • Information needs • High volume of calls
- 59. PAGE 59 Next Steps •Implement communications plan • Implement a CRM solution • Development and implementation of a complete line of materials for service lines • Continue migration to single phone number for each service line • Continue development of JamesLine product – nursing information and triage line to help with access • Evaluating referring physician access line and "ask a doc" solution for our cancer experts
- 60. PAGE 60 Lessons Learned •Perceptions were actually better than we thought • Reinforced focus on areas we already knew were a problem • Enabled us to put emphasis on relationship development • Allowed our physicians insight into perceptions and give us an actionable approach
- 61. PAGE 61 Contact Us TheresaDiNardo-Brown Chief Communications Officer (614) 293-5079 Melissa Childress Associate Executive Director (614) 293-5079 John McKeever Executive Vice President 800-846-4051 [email protected]
- 62. PAGE 62 Endeavor Managementis a strategic transformation and management consulting firm that leads clients to achieve real value from their initiatives. Endeavor serves as a catalyst by providing the energy to maintain the dual perspective of running the business while changing the business through the application of key leadership principles and business strategy. The firm’s 40 year heritage has produced a substantial portfolio of proven methodologies, enabling Endeavor consultants to deliver top-tier transformational strategies, operational excellence, organizational change management, leadership development and decision support. Endeavor’s deep operational insight and broad industry experience enables our team to quickly understand the dynamics of client companies and markets. In 2012, Gelb Consulting became an Endeavor Management Company. With our Gelb experience (founded in 1965) ,we offer clients in-depth insights in the healthcare industry and unique capabilities that focus their marketing initiatives by fully understanding and shaping the customer experience through proven strategic frameworks to guide marketing strategies, build trusted brands, deliver exceptional customer experiences and launch new products. Endeavor strives to collaborate effectively at all levels of the client organization to deliver targeted outcomes and achieve real results. Our collaborative approach also enables clients to build capabilities within their own organizations to sustain enduring relationships. For more information, visit www.endeavormgmt.com and www.gelbconsulting.com 2700 Post Oak Blvd., Suite 1400 Houston, TX 77056 +1 713.877.8130 www.endeavormgmt.com/healthcare