Secrets of a successful transparency rollout
Oklahoma University (OU) Physicians is a transparency trailblazer. They were among the very first health systems to deploy a transparency solution with NRC Health, and they remain a textbook success story for best practices with the platform.
In a recent webinar, OU Physicians’ leaders discussed how they achieved their standout results, and how they managed a smooth rollout in an organization with 1,400 employees, 76 clinic locations, and over 660,000 ambulatory visits per year.
What makes a rollout work
Understand physician hesitations
Holly Adams, OU Physicians’ executive director, remarked that, “with the volumes we see, we were drawing in so much patient data, and we thought, ‘There must be an opportunity here.’”
But to capitalize on that opportunity, leaders had to ensure complete buy-in from clinical staff. At OU Physicians, the first step was empathy. To get clinicians to embrace transparency, leadership had to grasp why providers might be wary of it.
Ryan Biggers, MD, a doctor in the OU Physicians system with a five-star average rating, explained the problem. “As a doctor, you’re always fearful of that negative review. Things are not always in your control. There’s that patient who’s seeking narcotics, or has to wait a long time, or just catches you on a bad day. You don’t want these things affecting your reputation.”
Understanding that fear helped OU Physicians’ leadership shape their rollout process to mitigate it.
“We knew that doctors would be worried about opening themselves up to potentially negative reviews,” Holly said. “So we took steps to help them feel more comfortable with it.”
To warm clinical staff to the idea of transparency, leadership had to offer transparency in turn.
First of all, Holly said, “We were very open about the feedback mechanism. We didn’t want anyone to be surprised.”
They made sure, for example, to explain how reviews would never be published until the system had gathered at least 30 reviews per clinician. In fact, the average doctor saw 130 of them. These high volumes helped insure against the negative impact of any outlier poor comments—and soothed physician anxieties about public exposure.
Paul Sund, OU Physicians’ Marketing Director, expanded on the critical role of openness. “It meant this couldn’t be an overnight thing,” he said. “It was a slow, deliberate, six-month process. All the while we had a running FAQ list, we were constantly fielding questions, and we gave every doctor a preview of what their find-a-doc page would look like.”
OU Physicians’ Chief Medical Officer, Lynn Mitchell, MD, underscored the point when she said, “It’s impossible to over-communicate about this. We were reaching out constantly. We didn’t want to leave staff with any unknowns.”
One source of doubt, however, lingered among clinicians: what if patients left abusive or libelous comments?
To dispel this fear, Holly said, the organization emphasized the importance of clear exclusionary criteria. “We don’t publish it if it’s profane, or if a patient is fighting a treatment plan, or if it’s not related to our clinics,” she said.
These safeguards reassure doctors who worry about being broadsided by negative comments.
But what if, despite the exclusionary criteria, physicians receive comments that strike them as invalid or unfair?
For this, devising a concrete, internal comment-appeal process is critical.
“Our appeal mechanism is governed by our Transparency Advisor Group, or TAG,” Paul said. “Giving physicians this specific appeal process helped them feel safe about transparency.”
OU Physicians’ TAG group draws from a broad array of staff. Nurses, physicians, support staff, and administrators all sit in the group.
“An important ancillary benefit of that TAG is, having doctors in it gives transparency a lot of street cred,” Dr. Mitchell said. “It helps physicians feel like patient comments are being reviewed by their peers, not just their bosses.”
Nor, as Paul explained, does a TAG require an enormous time commitment from its members. “There just aren’t that many appeals that come through,” he said. “Maybe 18 of them, in two years of running it. Once the process became clear, doctors recognized the validity of these reviews, and disputes petered out.”
What success looks like
Positive reviews—powerful social proof
As it turns out, OU Physicians’ doctors needn’t have feared overly critical comments. “We found that very few people go out of their way to leave negative reviews,” Holly said.
Since the organization’s deployment of their transparency initiative, patients have left 115,651 reviews. A full 104,462 were five-star reviews. As a whole, the systems’ clinicians enjoy an average 4.81 stars out of five.
These remarkably high star ratings inspire trust in future consumers. They’re a superb marketing tool for the organization. As Andrew Ibbotson, NRC Health’s Vice President at NRC Health, pointed out, “It’s hard to argue with hundreds of thousands of independent, verified reviews. Other patients see that, and that’s a strong validation of the quality of care on offer.”
Behavior change—care improvement
Occasionally, however, critical reviews do come in. OU Physicians’ clinical staff takes a constructive attitude toward them.
“It’s called a ‘practice’ for a reason,” Dr. Biggers said. “A bad review is a teaching point. It’s an opportunity to do better.”
Transparency, then, drove continuous care improvement at OU Physicians. The high point of pride for OU Physicians came this year, when 19 of their doctors earned CGCAHPS scores in the 98th percentile, nationwide.
Dr. Mitchell knows that transparency, in part, fueled this success. She explained how. “Once these reviews are out there, facing the public, doctors become extremely motivated to improve,” she said. “For instance, we have an internal clinician coach at OU Physicians, and demand for the coach’s time spiked up almost immediately after transparency went public. Our doctors were that much more enthusiastic about improving themselves.”
Transparency is the first step
And that, Dr. Mitchell said, is the most important lesson for organizations to learn about transparency.
“Yes—that feedback data drives improvements, as long as you have those opportunities out there. Doctors have to be able to take the information and run with it,” he said.
Transparency worked so well at OU Physicians because, from rollout to deployment to follow-up, they took steps to ensure its success. A transparency platform, properly deployed, can have an enormous impact at your organization, too—it’s the first step in the longer journey of improvement.