Focus on Better Care

August 31, 2018

Achieving the Quadruple Aim

By Joseph Frolkis MD, PhD, FACP, FAHA

President and Chief Executive Officer, New England Quality Care Alliance


Joe Frolkis

The focus of my fourth installment in the Quadruple Aim series is “Better Care.” At NEQCA, we recognize that healthcare is not just a “service industry.” At its core, it’s a patient-centered experience industry. From the moment patients enter our offices, they are placing their lives and trust in the hands of their physicians. No one wants to be in a doctor’s office. Patients are often anxious, uncomfortable, embarrassed or in pain. They want access to their caregivers when they need it, and they want those caregivers to know them, to really “hear” them, and – increasingly – to involve them in clinical decision-making. This is why we provide our affiliated physicians with specific feedback and resources they can use to better understand, engage and communicate with their patients. So what is it that qualifies care as good, great, or “better?” And what is NEQCA doing to improve care and experience from a patient standpoint?

  • For the past 6 years, NEQCA has pushed for a focus on Better Care through our Patient Experience team, and we piloted our first Patient Experience Panel in 2010. Here, physicians were interviewed for their best practices. In 2014, NEQCA’s PtX Panel developed into a Patient Experience cross-functional workgroup, with a focus on lower performing practices. Now, our Better Care efforts include all practices and our Patient Experience team works to provide all NEQCA physicians with resources to improve their standards of care.
  • To evaluate where our physicians rank on providing quality patient experiences, we turn, in part, to Massachusetts Health Quality Partners (MHQP) survey results. This yearly assessment is informed by patient provided feedback on physicians in the areas of communication, integration of care, organizational access and self-management support. In 2017, out of eight Massachusetts physician networks, NEQCA received the highest scores in “Organizational Access” for both the Adult and Pediatric categories and second highest in the “Knowledge of Patient” category. We were thrilled to learn that both of these scores surpassed state benchmarks. We’ve also seen steady improvement since 2015 in our “Physician Communication” scores for both Adult and Pediatric care. Using these comparative results, along with each physician’s individual assessments, helps our PtX team determine which practices need the most support and in which areas.
  • While assessments do provide great insight into our practices, we know that Better Care means more than meeting or beating standardized benchmarks. It’s about getting to the core of what patients really want, and for physicians to take every opportunity to not just know their patients, but ensure that their patients feel known!
  • The 2018 Shadowing Project is a NEQCA PtX team initiative that provides direct insight into the patient experience. This involves on-site visits, during which our Quality Improvement Specialists recognize “touch points” or times in an appointment where a physician or staff member has an opportunity to exhibit helpfulness, sensitivity or friendliness to a patient. These results, along with proposed solutions, are then shared with the office staff. In some cases, the findings are presented directly to physicians during a one-on-one meeting with one of our Quality Improvement Specialists.
  • To ensure that all ears – no matter the distance – are actively listening to patient needs, we developed the “We Need to Talk – Patient Goals of Care” initiative, which trains Medical Directors throughout our network in identifying patients in need of “goals of care conversations” and in conducting them. The initiative uses tools developed by NEQCA and our colleagues at Ariadne labs and includes training in risk adjustment and coding for those services. The team anticipates having more than two-thirds of NEQCA’s LCOs trained by the end of the year.
  • In addition to our efforts within the NEQCA network, our colleagues at Tufts Medical Center, NEQCA’s parent company, are working on their own Better Care initiatives. We’re proud that Tufts MC was recently named the most consistently rated 4-star Academic Medical Center (AMC) in the Boston area for Patient Experience. This rating was determined by the “HCAHPS” survey – a national assessment that is part of Hospital Inpatient Quality Reporting (IQR). The assessment looks at wait time, clear, thorough communication between patients and physicians, timeliness, and effectiveness of visits to determine overall patient satisfaction.
  • One of Tufts Medical Center’s 2018 initiatives is to provide better experience for LGBTQ patients and employees through an LGBTQ Steering Committee. Other 2018 initiatives include training in “Elevator Etiquette,” implementing a designated “Quiet Time” for the hospital and developing the “Baby Café” –a communal space for new moms.

“Better Care” is about improving how our physicians communicate, how thorough they are in delivering explanations and how well they understand and engage their patients. It’s not about settling for good service but, instead, always aiming to improve. Better Care means striving to not only meet but fully understand a patient’s individualized needs. When we align our initiatives with the values, goals and preferences of our patients, our quadruple aim goals work in-sync, and we can offer the highest quality of care. At NEQCA, we work hard to provide the resources for our physicians to focus on what they do best – care for their patients!

Read my December 2017 article on Higher Clinician Satisfaction.

Read my March 2018 article on Better Health.

Read my June 2018 article on Lower Cost.

Click the image below to watch our video on Achieving the Quadruple Aim.