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Up and running in six months: UAMS’s remarkable transparency success

On its surface, publishing patient ratings on a hospital website—what NRC Health calls ‘Transparency—might appear straightforward enough. But when it comes time to implement a transparency program, a successful rollout actually takes tremendous institutional momentum.

It requires full investment from leadership, the dedication of frontline staff, and coordination between departments. All this is to say, transparency is a serious commitment. And the larger your organization, the more challenging that commitment will be.

Imagine, then, the effort it takes to deploy a transparency program at an enormous academic hospital, with 373 beds (and 63 bassinets), 10,000 employees, and some 1.7 million visitors every year.

That’s exactly what Donna Hill, Marketing Strategist, and Barbara Brunner, MEd, CHES, Director of Patient and Family-Centered Care, undertook at the University of Arkansas for Medical Sciences Hospital (UAMS).

Working together with NRC Health, the hospital’s leadership, and clinical staff, Donna and Barbara spearheaded the development of UAMS’s transparency program. Their work was remarkable.

They won over the skeptics and drummed up enthusiasm for a transparency program across the entire institution. They designed robust new protocols to integrate transparency into staff workflows. And in the end, they brought the UAMS transparency program from conception to fruition—in just six months.

In a recent presentation at the NRC Health Symposium in Boston, Donna and Barbara shared what they learned from the process. Here are some critical insights for any institution seeking to follow in UAMS’s footsteps.

 Enlist leadership—teach them the value of transparency

Donna extolled the importance of getting leadership involved from the outset. But she also warned that it may take some time for them to embrace a transparency program.

“It took me two years to get the process started,” she said. “It definitely took some convincing.”

Making her case to the C-suite, she emphasized how transparency represents the future of care. “Across the Internet, patients are either going to talk about us, or they’re going to be in a conversation with us,” she said. “That’s what this transparency program is all about.”

NRC Health’s research data supports Donna’s point. Market Insights surveys show that 77% of consumers start their search for healthcare online, and 43% of them look at online reviews before scheduling an appointment.

Donna also took care to explain why it’s critical for healthcare organizations to control how consumers discover these reviews. That’s because third-party review sites like Facebook and Yelp have some serious shortcomings:

  1. Low volumes of reviews. At best, third-party sites publish an average of eight reviews per physician—too few to fully inform patients or give a fair sense of a provider’s level of service.
  2. No patient validation. Third-party review sites cannot verify care experiences. This creates opportunities for fraud or abuse, and makes these reviews unreliable. Patients can’t count on them, and physicians can’t learn from them.
  3. No control over negative reviews. If libelous or abusive reviews surface on a third-party site, physicians have little recourse, since the healthcare organization has no ownership of the content.

Eventually, UAMS’s leadership found Donna’s arguments persuasive. In fact, those same leaders became some of the strongest program advocates within the organization.

With votes of confidence from the UAMS leaders, Donna and Barbara now faced an even bigger challenge.

Build strong systems by overcoming staff skepticism

Donna and Barbara knew that a transparency program wouldn’t work as a top-down mandate—clinical staff had to rally around it as well.

But physicians and other providers had understandable concerns about it.

“It’s a common myth for physicians to say, ‘People only leave reviews if they had a negative experience,’” Barbara said. “And who wants to be exposed to that?”

Physicians also reported fears about false reviews, HIPAA problems, and other liability issues. In light of these fears, Barbara underscores the importance of making providers feel protected.

“We did a few things to make sure our doctors knew that we had their backs if something went wrong,” she said. First, she made very clear that incoming comments would be subject to rigorous screening standards. The hospital would not be publishing any abusive or fraudulent reviews. Nor would they accept reviews that disclosed personal health information, nor even any reviews with profanity.

“The exclusion criteria were critical,” Barbara said, “because you’re in the same boat as the physicians. You only want verified, honest reviews.”

To ensure that level of verification, UAMS had help from NRC Health. Andy Ibbotson, NRC Health’s Transparency Director, explains: “As patient comments come in, they’re immediately visible—internally. But before they’re published, we have trained auditors examine them to make sure they don’t contain any PHI, profanity, or libelous or defamatory content.” That filtering mechanism helped give UAMS’s physicians peace of mind.

But the hospital went one step further. They established a Transparency Review Board that included the CEO, the COO, physician departmental leadership, and legal counsel. Now, if a physician takes issue with a patient rating or comment, they can bring it up with the Board, who will examine the review in question, then decide whether or not to publish the review.

“We give the physicians a process that they can activate when they have concerns,” Barbara said. “That way, they feel they have a sense of control.”

With these safeguards, Barbara observed that physicians felt less trepidation about patient reviews and were ready to embrace the UAMS transparency program.

“I can’t commend enough the bravery of our UAMS physicians,” she said. “It’s a bold statement from them. Once they felt secure, they all agreed: ‘We want to get there first—we want to be in control of the feedback.’”

Transparency’s rewards

Six months after recruiting physicians to the cause, UAMS deployed its transparency program. The positive results came quickly.

Donna commented on the effect that patient reviews have had on UAMS’s online presence. “This is the ultimate marriage of marketing and patient experience. For example, we didn’t spend anything on promoting our transparency initiative to the public. No ad budget—nothing. But in spite of that, almost immediately after we started publishing patient reviews on our site, we saw a 28% increase in traffic.”

Physicians also reported a positive change in their first interactions with new patients. “When you think about it, the relationship between a doctor and a patient is very, very intimate,” Donna said, “and when there are reviews of a doctor up on the site, patients feel like they know the doctor already. That gets the relationship going faster.”

It wasn’t long before the hospital’s transparency program had measurable effects on care operations, too. “The reviews really spurred our docs on!” Barbara announced proudly. “Once they saw the star ratings, they got competitive with each other, like, ‘Who here can have the shortest wait time?’ How great is that?”

Transparency also enabled some UAMS physicians to solve problems they hadn’t even noticed. “One physician told me a story about how he received a review saying he never washed his hands,” Barbara recalled. “Well, of course he was washing his hands. But now he’s started washing his hands in front of patients. That made a difference. Little things like that, we never would have known about if it wasn’t for transparency.”

Finally, the transparency program has become an integral part of UAMS’s future plans for process improvement. “The reviews we saw about physicians led us to create a Master of Communication course for doctors that might have trouble communicating well with patients,” Barbara said. “We’re excited to see how it improves things.”

Transparency isn’t the future—it’s the present

Dan Rahn, MD, UAMS’s former Chancellor, said it best: “I believe that light heals. And I believe when you shine sunlight on things, things get better. It leads to better decisions.”

New initiatives like a communication course, or physicians changing where they wash their hands, or doctors competing to shorten their wait times—these are the “better decisions” that stem from authentic feedback from patients. They’re of immeasurable benefit to institutions, and they dramatically improve quality of care.

Perhaps that’s why Christopher Westfall, MD, UAMS’s Chief of Staff, said, “I really believe that in five years, this is the way most responsible physicians and institutions will approach patient care.”

And healthcare leaders with foresight and initiative, like those at UAMS, may act even sooner.

Click here to see a recording of the presentation that Barbara Brunner and Donna Hill gave at the recent 2017 NRC Health Symposium in Boston.