[Podcast] Transparent Physician Ratings – Because it is the Right Thing to Do

I have had the pleasure of interviewing Dennis Jolley, formerly the Senior Director of Marketing for the University of Utah Health Care System, many times. In this podcast, we hone in on the effects of the patient experience on doctor ratings.

“Doctor ratings, patient satisfaction and patient experience”

At the beginning of their journey, Mr. Jolley admits the University of Utah Health Care was in the bottom 10^th percentile of patient satisfaction when they started surveying patients. “We were shocked that people perceived us that way,” says Mr. Jolley, “We began working on [patient experience] and had some good traction at first, then we saw another improvement when our former senior leader, Dr. Lorris Betz, engaged at a very senior level.”

Mr. Jolley continues, “[Dr. Betz] stood up in front of all of our leadership and said, ‘It's not right that people feel this way. We have to fix this.’ Transparency is something that we value as an organization. We were already sharing patient satisfaction scores for clinics and there were several people in the system who were thinking, ‘If we could tell people how our physicians rated, that could be beneficial.’” This helped drive motivation at first, however, Mr. Jolley said they continued to struggle with physician ratings and physician engagement.

He next gives credit to their Chief Medical Officer, Dr. Tom Miller, who took the reigns on this initiative and drastically improved physician engagement using this idea of transparency -- and making physician ratings accessible to patients. “When Dr. Betz and Dr. Miller engaged, [patient satisfaction] became such a priority. There was an intrinsic motivation because our physicians wanted to get and retain high scores.”

One of the things we’ve found as we explore the patient experience journey with a variety of institutions is, how important it is for the messaging to come from the top. It doesn't seem to take hold until top leadership pushes it forward. Though some physicians initially push back, they get on board once they begin to see positive results.

“There was an outstanding surgeon who used to roll his eyes and say, ‘Oh, patient surveys, who cares?’ But when the scores came online, he began to engage in it personally. He said, ‘Why don't my patients like me?’ And I said, ‘It's not that they don't like you, they don't feel connected to you.’ Mr. Jolley believes that was an a-ha moment for this particular surgeon and witnessed him go one to make small adjustments that improved his patient satisfaction ratings.

“Today, our physicians are incredibly proud of the fact that we've gotten to a place where our patients say good things about us,” says Mr. Jolley, “I think we've always done a really good job with quality, and I think we’re a quality leader. And, I think our patient perception of quality has improved too”

As Mr. Jolley and his team continue to be transparent with doctor ratings, he has seen physicians take real pride in them. “We ran a print ad recently that listed all our physicians that are in the top 10% nationwide, and it highlighted those in particular who were in the top 1% nationwide. It took a full-page spread to list all of them. It was an impressive thing and people noticed it in our communities. What’s even better is our physicians noticed it. I had physicians asking me for copies to give to their mom or hang in their clinic."

Mr. Jolley leaves us with this final thought, “Patient satisfaction requires high-level engagement. But once you get that initial engagement, I think that marketing, internal communications and others can help keep the ball rolling and keep that intrinsic motivation high.”

I highly recommend listening to the entire podcast or reading the full transcript below.

Complete transcriptStewart Gandolf:
Going to be interviewing Dennis Jolley. He is the senior director of marketing for the University of Utah Health Care system. Dennis, welcome and thanks for joining us.

Dennis Jolley:
Thank you, Stewart.

Stewart Gandolf:
I'm really excited to talk to you again. We've actually had a couple of podcasts [e.g., The Patient Voice; Satisfaction Scores] with you, previously, and one of the topics we talked about in the past was some of the innovative things that the University of Utah Health Care is doing with doctor ratings and a broader area of patient experience. And so I'm going to presume that a fair number of our listeners have not heard one of those podcasts in the past. And so we're going to start from the beginning, and I think also maybe dive a little deeper into this specific area, whereas in the past we talked about many different topics. I think patient satisfaction, patient experience, and then certainly the ratings are very important to discuss.

Stewart Gandolf:
So, can we start off by helping our... We talked a little bit before I started the recording here, about your experience and the evolution of patient experience and patient satisfaction. Can you give us a sense of that?

Dennis Jolley:
Yeah. We're many years into our patient experience journey, and we were working on it for a few years trying to improve, because honestly, we were right at the bottom of the barrel. We were in the bottom 10th percentile when we first started surveying our patients. And it was really actually appalling for us. We were shocked that people perceived us that way, so we began working on it and had some good traction. Started moving up a little bit into the upper end of that bottom core tile, and about then, our former senior leader, Dr. Lorris Betz, he really engaged at a very senior level.

Dennis Jolley:
He stood up in front of all of our leadership physician and hospital at a meeting and said, "You know what? It's not right that people feel this way. We have to fix this. It's just the right thing to do." And him standing up and taking a really strong, I almost want to say moral approach to it, he didn't say it was about money. He didn't say it was about anything other than it was the right thing to do. He said, "These people come to us for care. We provide great health care, but if they don't feel well cared for, we're not doing it right." So that really caused us to make one big bump. And then we kind of plateaued, and one of the areas where we were struggling was that the individual physician scores weren't necessarily where we wanted them to be, and physician engagement was spotty.

Dennis Jolley:
But there were a number of people in the system who were thinking, if we could tell people how our physicians rated, that could really be beneficial. And I have to give credit to our chief medical officer, Dr. Tom Miller, who really took the leadership with this. It had to be a physician who said, again, this is the right thing to do. Transparency is the right thing. Transparency is something that we value as an organization. We were already sharing patient satisfaction scores completely transparent across the system, so everybody knew which clinic was doing well and which clinic wasn't. He said we need to start doing that with the physicians internally first, and then we should do it for our patients to have access. And when we went live with the scores, we gave them notice. It's not like we flipped the switch and was like, "Hey, surprise." We did see another big bump in our overall scores, because the physician scores jumped dramatically after we went live with the physician scores.

Stewart Gandolf:
That's terrific. One of the things that we've seem to find as we explore this patient experience journey with a variety of institutions, how important it is to come from the top. It's not something that, even if people from the administrative side of the organization, or people further down the totem pole, are interested in that. So it doesn't seem to really take hold until top leadership pushes it forward. In this case, you said you had two bumps. Once was from the very top, and then from the chief medical officer, must have given a lot of credibility to your efforts moving forward. Is that correct?

Dennis Jolley:
It really did. Our people, we've always had great people, and they wanted to do the right thing, but it's easy to let the fact that you have a policy or procedure get in the way of... It's amazing how easy it is for something like that to get in the way of being nice.

Dennis Jolley:
But we really had some good engagement with frontline staff early on, and then when Dr. Betz and Dr. Miller engaged, it really got higher level engagement and made it just such a priority. And then people really began to take pride in our improving scores, and it took that senior level engagement thing. This is the right thing to do. We're not doing it for reimbursement, we're not doing it for money, we're doing it because it's the right thing. That got people going. And then there was an intrinsic motivation, because people wanted to keep their scores high once they got them high. They began to take pride in that.

Stewart Gandolf:
Okay. We're going to talk about that in a moment. I'm curious though, before we get to that, we had talked also about not everybody was excited, not all of the doctors were excited about showing scores. And when you first got started with this, tell us more about that.

Dennis Jolley:
When we first announced that we were going to do it, it was definitely not everybody was on board, and not everybody was happy. We had physicians who said, "You can't do that. I will sue you. I will quit. I will not allow you to use my scores." We had people go through the entire denial, anger, bargaining, acceptance pattern. But again, credit to Tom Miller. He was the one who was willing to put himself out there and say, "Nope, we're going to do this. It's the right thing to do." And then he had strong support from the hospital side, from our CEO, David Entwistle, as well. So it was a unified front, definitely. But not necessarily easy. There was definitely people who were not engaged right out of the gate.

Stewart Gandolf:
Yeah. I think sometimes it takes courage, you know what I mean? Just, at the end of the day, that's really what it boils down to. Someone's got to take the lead. Someone has to have courage. Someone has to recognize that there's going to be some fighting involved, but if you want to do anything great, you've got to have courage and the will to do it.

Dennis Jolley:
I think it's both courage, and it's courage from the right sector. I think it was critically important that it was our chief medical officer, a physician, and our senior leader who is also a physician, who did that. Right or wrong, I think one of the realities in healthcare is, that if an operational leader, or heaven forbid somebody like me in marketing says, "Hey, this is a good idea," there's going to be some skepticism about it until a physician says, "You know what? This is a good idea. This is the right thing to do."

Stewart Gandolf:
I totally agree and that makes sense. That's just the nature of the world of healthcare. And you either understand that and work within it, or just get killed. It's what I think happens in the real world. Do you have any anecdotes you can think of, of a specific doctor, without naming a name, but somebody who was really getting killed before, in terms of his satisfaction scores, who has really made dramatic improvements. I think that'd be an interesting story for our listeners.

Dennis Jolley:
Well, I think one of the stories that comes to my mind is, there was a physician who, he's a surgeon, he's an outstanding surgeon. Really, really outstanding. He's not the warmest individual. I will fully admit, he's just not. He really used to just roll his eyes and be like, "Oh, patient surveys, who cares?"

Dennis Jolley:
But then when the scores came online, he really began to engage on it personally. And I remember the day he came to me, and I almost felt bad for him. He said, "Why don't my patients like me?" And I said, "It's not that they don't like you, they don't feel connected to you." So he and I talked about ways that he could, authentically, could still be himself, but find small ways to connect with patients. And I think that, for a lot of our physicians, it was a little hard to see their scores. And I think that's one of the reasons they didn't want them out there publicly. Physicians are used to doing really well at what they do. Not everybody gets into medical school, and not everybody succeeds through medical school. So they're not used to getting bad grades, so to speak.

Dennis Jolley:
And it's hard for them. But in that case, like I said, we just sat down and talked about, "What are some ways that you can connect to your patients? Talk to the people who really do like you, and ask them why they like you." And he didn't have to change his major workflow. He didn't have to start pretending to be Patch Adams or something. He's still a really focused, really cut-to-the-chase surgeon, but his scores are probably twice as good as they were. And he's right up there in the top core tile. And I think in the long run, I haven't had the conversation with him about it since, but I think he would actually look back on it and say, in the long run, it's been better for him as a physician to have gone through that.

Stewart Gandolf:
That totally makes sense to me. And you mentioned a moment ago that your physicians are proud of that, and even like to promote it. Can you expand on that a little bit?

Dennis Jolley:
Yeah. Our physicians are proud of the fact that we were one of the first major health systems to put our scores online, and I think our physicians are proud. I know our physicians are proud of the fact that so many of our physicians do well. Our survey partner is Press Ganey, which is really one of the largest survey groups for these surveys. And 50% of our physicians are in the top percent nation, or excuse me, 25% of our physicians are in the top 10% nationwide. And of that group, half are in the top 1% nationwide for patient satisfaction scores. Our physicians are incredibly proud of the fact that we've gotten to a place where our patients say good things about us.

Dennis Jolley: And they've also gotten to a place where, when someone doesn't, they recognize that it's an opportunity to learn something, I think.

Stewart Gandolf:
That's amazing. Do you think they feel like quality of care has actually improved as a result of this?

Dennis Jolley:
You know, I think we've always done a really good job with quality, and I think that we are a quality leader. What I think has happened is, patient perception of quality has improved, because we use the patient experience as a way to talk to patients about quality and help them understand. Because you can just interrupt patients seven times in the middle of the night to take their blood pressure, and just be grumpy about it, and act like it's not your fault that you're going in to take their blood pressure at 2:00 AM or whatever. Or you can talk about why you're doing it, and say, when a patient checks in, "I'm sorry that we're going to wake you up in the middle of the night. We're doing it because of X."

Dennis Jolley:
That is part of the patient satisfaction conversation. But it's also educating patients about quality. So, while I think our quality has always been good, I think it's different how we talk with patients about quality, and the patient experience improves, both perception of quality and potentially, I haven't done a study on this so that's why I'm saying potentially, potentially actual quality, because I think you get patient engagement in their care differently.

Stewart Gandolf:
Well, you mentioned this the last time we interviewed you on this topic, that the physicians are proud of the scores, and have you promoted the scores? In your marketing, how do you capitalize on this from a patient acquisition or branding standpoint?

Dennis Jolley:
We've done quite a bit of it, in terms of patient acquisition and branding. We've ran print ads locally that say, "How does your doctor rate?" Because we're very proud of how our doctors rate. We did an ad here recently that listed all of our physicians that are in the top 10% nationwide, and highlighted those in particular who were in the top 1% nationwide, and it was a full page spread in the major daily papers to even list all of them.

Dennis Jolley:
And that was really an impressive thing. And people noticed it in our communities. And what's even better is our physicians noticed it. I had physicians calling me and saying, "Hey, I'd love to get a copy of that ad. I want to send it to my mom." Or, "I want a copy of that ad to have up in my office or in my clinic." And, so the fact that the physicians were engaging on that level meant a lot. But then we had a lot of patients who commented on it, too. And so we have outdoor print and radio that talk about the fact that we're very proud of how our patients rate, and that it's really because we want to be a lifelong health partner and meet our patients' expectations for excellence and quality.

Stewart Gandolf:
Any parting thoughts, or any additional insights about this?

Dennis Jolley:
I think that my big insights, having been involved and watched it all this time, are, you said it, patient satisfaction requires high level engagement. But once you get that initial engagement, I think that marketing people, and I'll say this because that's primarily your audience, marketing and internal communications and others can really help keep the ball rolling and keep that intrinsic motivation high.

Dennis Jolley:
But I also think that transparency is key. It's easy to be a bad outlier, and hard to be a high outlier, if there's not transparency. So I think the lack of transparency pulls people down.

Stewart Gandolf:
It's funny, one of the things that I had when I was at the Cleveland clinic, that I actually tweeted about on the spur of the moment was, that I think most people in health care want to do the right thing.

Dennis Jolley:
Absolutely.

Stewart Gandolf:
And at some level cared about it, but it wasn't really the culture. The culture, in fact, was the opposite of that. And so I think most people follow the herd. If it's almost popular to dismiss the patient, it's like, "Well, I don't care if they like me. I just want them to get better." If that's the attitude, then we all lose.