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Transparency best practices: A conversation with Andy Ibbotson

This article was also published on Becker’s Hospital Review website.

By Andrew Ibbotson, Vice President for Reputation Management at NRC Health.


When it comes to publishing patient ratings and reviews, no two health systems will approach it the same way.

Every setting comes with unique demands, and not all of them are easily met.

Here, Andrew Ibbotson, Vice President for Reputation Management at NRC Health, talks best practices for deploying Transparency within any organization.

Question: Why should transparency be a priority for today’s organizations?

Andy Ibbotson: Across care settings, in institutions of every size, patient experience is becoming an operational priority. To improve that experience, strong visibility into provider performance is essential. The Transparency methodology—collecting patient reviews and publishing them as five-star ratings—is an optimal way to achieve that.

Transparency reliably drives improvement in care quality. Organizations that choose to publish ratings and reviews see CAHPS scores consistently improve by 10 percent or more.

Transparency is also extremely important for healthcare branding: 77% of patients begin their search for a new provider online, and almost all of them want to see verified reviews from other patients before they’ll book an appointment. By enabling organizations to publish verified patient reviews on their own websites, NRC Health’s Transparency solution gives health systems a way to proactively manage their brand, and to offer the content patients want to see.

Q: What principles should guide the deployment of Transparency?

AI: From the beginning, it’s very important for providers to understand that ratings and reviews aren’t meant to be punitive. The objective is to use Transparency to drive improvement—so focus on the positive. Put an emphasis on rewarding high-performers, and on cultivating role models within the organization.

Health systems should also offer every possible resource to help clinicians improve their scores. That includes consultations with the patient-experience team, evidence-based guidelines on specific skill-sets, and extensive coaching on best-practice exam-room behaviors.

Finally, to keep providers from feeling trepidation, it’s key to keep a Transparency rollout progressive, instead of premiering it all at once. Developing it in stages, so that physicians and staff members have time to get comfortable with the concept, helps achieve buy-in across the organization.

Q: How can hospitals structure the rollout to keep anxieties under control?

AI: The first phase of the rollout should happen before Transparency is ever installed. There must be an extensive communication campaign to help everyone get on the same page.

Explaining the mechanics of the platform—especially how patient comments are reviewed by NRC Health, how they’re flagged if NRC’s analysts identify any comments containing PHI, profanity or libel, and which comments are automatically excluded from publishing—is very important to help your teams and their patients feel protected.

To that end, leaders can’t communicate enough. Road-shows with department chairs are a technique we’ve seen successfully deployed. Patient-experience officers can spread the word to individual clinicians. It’s worth it to spend the time reviewing and explaining exclusion criteria across multiple departments. Finally, hospital communication teams can develop campaigns—including emails, articles and testimonials from doctors—to help explain the rationale behind the transparency initiative.

With all that preparation, no one should be surprised when the first Transparency reports start to appear in their inboxes. However, it’s also important that these initial reports are only made available internally at first. That way, clinicians have a chance to acclimate to how they will be represented online.

Q: How can organizations handle any hold-outs or pushback?

AI: Leaders can assuage their concerns with a few different background processes.

For one, it’s important to have a clear infrastructure for oversight of the program. A Transparency Governance Council is a good idea, as well as a documented appeals process that providers can use to challenge any reviews they think are unfair.

As Transparency rolls along, it helps to make sure that meetings about reviews start with highlighting the positives. This gives a huge boost to morale, and can strengthen acceptance and support for Transparency.

If providers have concerns about any patterns they see in the feedback, you want them to have a place to turn. To that end, making patient-experience team members available for consultation is invaluable. Being able to email them for clarifying questions, in-depth reporting or support on how to improve can really ease providers’ worries.

Q: What successes can organizations expect to see from Transparency?

AI: The numbers certainly speak for themselves. With Transparency, average provider ratings published directly on organization websites is typically between 4.5 and 4.9 out of five stars (based on an average of more than 200 verified patient ratings per provider over the past 12 months). When you compare that with a national average of 3.8 out of five stars—and an average sample size of less than 10 all-time reviews on anonymous, unverified review sites like Yelp—that’s remarkable. It creates a much more accurate and robust representation of the care experience than currently exists online, and proactively promotes the quality of care being delivered by your organization.

But more important than these quantitative factors is the opportunity for culture shift that Transparency provides. By keeping patient voices top-of-mind, Transparency elevates the role that patient experience plays in strategic discussions. It’s an efficient way to move experience from being one among many operational priorities to constituting a central core of an organization’s work. By publishing performance online, and by automatically distributing reports to relevant administrators, Transparency helps entire teams embrace a higher level of accountability. This creates a better culture of care—which is what we at NRC Health are most proud of.