Shadow Coaching Improves Patient Experience With Care, But Gains Erode Later

Quigley, Denise D.; Elliott, Marc N.; Slaughter, Mary Ellen; Burkhart, Q.; Chen, Alex Y.; Talamantes, Efrain

doi:10.1097/mlr.0000000000001629

Cited by 10 publications

(26 citation statements)

References 87 publications

(166 reference statements)

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“…11,[31][32][33] We previously examined patient experience scores before and after coaching that incorporated many features consistent with the literature on successful behavior change (i.e., learnercentered approach, immediate feedback, written recommendations on what skills to practice/behaviors to engage in). 34 We found an immediate improvement in patient experience scores following coaching; however, the gains for coached providers eroded, disappearing after 2.5 years.…”

Section: Introductionmentioning

confidence: 58%

Follow-Up Shadow Coaching Improves Primary Care Provider-Patient Interactions and Maintains Improvements When Conducted Regularly: A Spline Model Analysis

et al. 2022

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INTRODUCTION: Shadow coaching improves providerpatient interactions, as measured by CG-CAHPS® overall provider rating (OPR) and provider communication (PC). However, these improvements erode over time. AIM: Examine whether a second coaching session (recoaching) improves and sustains patient experience. SETTING: Large, urban Federally Qualified Health Center PROGRAM: Trained providers observed patient care by colleagues and provided suggestions for improvement. Providers with OPRs<90 (0-100-point scale) were eligible. EVALUATION: We used stratified randomization based on provider type and OPR to assign half of the 40 eligible providers to re-coaching. For OPR and PC, we fit mixedeffects regression models with random-effects for provider (level of treatment assignment) and fixed-effects for time (linear spline with knots and possible "jump" at initial coaching and re-coaching), previous OPR, patient characteristics, and sites. We observed a statistically significant medium jump among re-coached providers after recoaching on OPR (3.7 points) and PC (3.5 points); differences of 1, 3, and ≥5-points for CAHPS measures are considered small, medium, and large. Improvements from re-coaching persisted for 12 months for OPR and 8 months for PC. DISCUSSION: Re-coaching improved patient experience more than initial coaching, suggesting the reactivation of knowledge from initial coaching. However, re-coaching gains also eroded. Coaching should occur every 6 to 12 months to maintain behaviors and scores.

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Section: Introductionmentioning

confidence: 58%

Follow-Up Shadow Coaching Improves Primary Care Provider-Patient Interactions and Maintains Improvements When Conducted Regularly: A Spline Model Analysis

et al. 2022

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“…The evaluation team assessed P4P incentive payments before and after the peer coaching, provider perceptions assessed by survey and in interviews, and the content of the coaching reports given to the coached providers after the coaching sessions. The results showed that coaching improved providers' overall rating and CAHPS communication scores, but these improvements faded over time [25]. The content analysis of the recommendations indicated that the coaching recommendations were split between encouragement of existing behavior and identifying new behaviors.…”

Section: Panel On Evaluating Patient Experience Improvement Strategie...mentioning

confidence: 97%

“…Edgman-Levitan also discussed research that identified several organizational characteristics associated with good patient experiences: governance, leadership, and vision; partnerships with patients and families; human resources and employee engagement; systematic feedback, data management, and goal setting; use of best practices around communication strategies and technology support; and the built environment [24][25][26].…”

Section: What Do We Know From Research About Why and How To Improve P...mentioning

confidence: 99%

“…Communication strategies and technology support. Health care leaders need to disseminate best practices around communication and technology support [25,36]. Leaders should implement training programs that focus on service excellence, service recovery, and empathy, as well as diversity and equity training for all staff.…”

Section: What Do We Know From Research About Why and How To Improve P...mentioning

confidence: 99%

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Summary of the 2020 AHRQ research meeting on ‘advancing methods of implementing and evaluating patient experience improvement using consumer assessment of healthcare providers and systems (CAHPS®) surveys’

Quigley

Qureshi

Rybowski³

et al. 2022

Expert Review of Pharmacoeconomics & Outcomes Research

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Background:The Agency for Healthcare Research and Quality held a research meeting on using Consumer Assessment of Healthcare Providers and Systems (CAHPS ® ) data for quality improvement (QI) and evaluating such efforts. Topics Covered.: Meeting addressed: 1)What has been learned about organizational factors/environment needed to improve patient experience? 2)How have organizations used data to improve patient experience? 3)What can evaluations using CAHPS data teach us about implementing successful programs to improve patient experience? Key Themes: Providers and stakeholders need to be engaged early and often, standardize QI processes, complement CAHPS data with other data, and compile dashboards of CAHPS scores to identify and track improvement. Rigorous study designs are valuable, but much can be learned and accomplished through practical organization-level studies.

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“…[35][36][37] Evidence from a recent evaluation study of a large shadow coaching program conducted in a large, urban federally qualified health center (FQHC) in California found statistically significant improvements (2-point, small-to-medium, increase) in coached providers' Clinician and Group CAHPS (CG-CAHPS) Visit Survey 2.0 overall provider rating and provider communication scores immediately after being coached. 38 Shadow coaching at this FQHC was introduced as part of quality monitoring to improve patient care experiences. Each January and July, the FQHC calculated every provider's average 6-month score on the CG-CAHPS overall provider rating (scored from low of 0 to high of 100) based on each provider's adult and/or child patient surveys.…”

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confidence: 99%

Content and Actionability of Recommendations to Providers After Shadow Coaching

Quigley

Qureshi

Palimaru

et al. 2022

Quality Management in Health Care

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Background and Objectives: Health care organizations track patient experience data, identify areas of improvement, monitor provider performance, and assist providers in improving their interactions with patients. Some practices use one-on-one provider counseling (“shadow coaching”) to identify and modify provider behaviors. A recent evaluation of a large shadow coaching program found statistically significant improvements in coached providers' patient experience scores immediately after being coached. This study aimed to examine the content of the recommendations given to those providers aimed at improving provider-patient interactions, characterize these recommendations, and examine their actionability. Methods: Providers at a large, urban federally qualified health center were selected for coaching based on Clinician and Group Consumer Assessment of Healthcare Providers and Systems (CG-CAHPS) patient experience scores (92 of 320 providers), shadowed by a trained peer coach for a half to full day and received recommendations on how to improve interactions with their patients. We coded 1082 recommendations found in the 92 coaching reports. Results: Reports contained an average of 12 recommendations. About half encouraged consistency of existing behaviors and half encouraged new behaviors. Most recommendations related to behaviors of the provider rather than support staff and targeted actions within the examination room rather than other spaces (eg, waiting room). The most common recommendations mapped to behavioral aspects of provider communication. Most recommendations targeted verbal rather than nonverbal communication behaviors. Most recommendations were actionable (ie, specific, descriptive), with recommendations that encouraged new behaviors being more actionable than those that encouraged existing actions. Conclusions: Patient experience surveys are effective at identifying where improvement is needed but are not always informative enough to instruct providers on how to modify and improve their interactions with patients. Analyzing the feedback given to coached providers as part of an effective shadow-coaching program provides details about implementation on shadow-coaching feedback. Recommendations to providers aimed at improving their interactions with patients need to not only suggest the exact behaviors defined within patient experience survey items but also include recommended behaviors indirectly associated with those measured behaviors. Attention needs to be paid to supplementing patient experience data with explicit, tangible, and descriptive (ie, actionable) recommendations associated with the targeted, measured behaviors. Research is needed to understand how recommendations are put into practice by providers and what motivates and supports them to sustain changed behaviors.

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Shadow Coaching Improves Patient Experience With Care, But Gains Erode Later

Cited by 10 publications

References 87 publications

Follow-Up Shadow Coaching Improves Primary Care Provider-Patient Interactions and Maintains Improvements When Conducted Regularly: A Spline Model Analysis

Follow-Up Shadow Coaching Improves Primary Care Provider-Patient Interactions and Maintains Improvements When Conducted Regularly: A Spline Model Analysis

Summary of the 2020 AHRQ research meeting on ‘advancing methods of implementing and evaluating patient experience improvement using consumer assessment of healthcare providers and systems (CAHPS®) surveys’

Content and Actionability of Recommendations to Providers After Shadow Coaching

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