Gapingvoid Healthcare Case Study
A case study on Physicians Group of South Florida
July 10, 2015
Justin Feldman, MBA, Jeff Shub MD, and Jessica Higgins JD, MBA, BB
Effective January 1, 2015 and in accordance with the Affordable Care Act (ACA), physicians will be paid based on value, as opposed to volume. This new provision of the ACA will tie healthcare providers’ payments to the quality of care they provide.i Providers will see their payments modified so that those who provide higher value care receive higher payments than those who provide lower value care. Institutions are now moving away from a supply-driven health and toward a patient-centered system that focuses on the patient and their needs as a consumer. ii
This system presents a problem in that the quality metrics have not been properly defined. The ACA sets out general standards and suggests that the current measuring systems will remain, albeit reviewed and possibly modified. Because of this transition, healthcare providers are increasingly looking to stay competitive in the evolving market through the use of disruptive technologies, innovation, and pivot points. Providers need to shift the focus from the volume and profitability of services provided—clinic visits, hospitalizations, procedures, and tests—to the patient outcomes achieved.iii
Gapingvoid understands that making this transition requires more than a single step – an overarching strategy. Part of that strategy is the reimagining of the healthcare environment to promote positive outcomes for patients and productive workspaces for employees. An increasing amount of evidence demonstrates a correlation between the physical environment in which patients receive their care and the quality of that care, as well as the patient’s perception of that care.iv Similarly, there is a growing understanding of the connection between the work environment and employee job satisfaction and stress.v A less stressful work environment promotes greater productivity and increases office morale. In turn, a positive work environment increases the overall perceived value the patients receive.
The Physicians Group of South Florida, PA retained Gapingvoid to assist them with their transition by increasing patient satisfaction, improving staff morale, and raising productivity.
Gapingvoid is a consulting firm that uses Six-Sigma methodology to define, measure, analyze, and implement change management in the form of corporate culture. Gapingvoid creates immersive art installations that purposefully connect people with positive outcomes both visually and emotionally. In the healthcare environment, art is often the most visible component of a space.vi
The Physicians Group of South Florida is a private practice, with two clinical offices, that specializes in Internal Medicine, Gastroenterology, and Endoscopy.
Anticipating the impending changes set forth by the ACA, the group decided to affect change at both of their locations, North Miami and Mt. Sinai.
Gapingvoid was recruited to assist with the transition for both locations. By combining culture change methodology with creative work from a world famous artist, Gapingvoid helps physicians, staff and – most importantly – patients become more aligned in their goal to achieve positive outcomes. Such outcomes are defined as quantifiable metrics based on perception.
The primary stakeholders in this project were the various members of the office staff, physicians, and patients. Having the physicians actively involved was essential in affecting change because it served as a signal to the staff that change was occurring and should be accepted.
The primary objective of the project was to increase morale and productivity by developing a positive work environment.
To achieve this objective, the Gapingvoid team defined the group’s mission and purpose. The team then began to create visual cues that align staff and keep them on message.
Gapingvoid consultants administered employee engagement surveys to establish a baseline of the office culture prior to the installations. The survey questions were intended to gauge motivation, communication, higher purpose, and mood.
The greatest challenges identified by the staff were communicating complicated issues, working towards a common goal, navigating office politics, and staying motivated. These issues were compounded by confusion with the new phone system.
Using the results from the surveys, Gapingvoid consultants identified two culture best practices that required improvement.
Mission/Vision/Core- Successful cultures need clear and honest communication about the strategy and direction of the business. Values are communicated clearly and seamlessly. All employees are “in the know”; they can tell you what the business stands for, its higher purpose, and where they fit into that purpose.
Observed symptoms: Employees felt that they received mixed messages about the company’s strategy and direction. Employees also experienced problems with message clarity, citing infrequent updates on future projects.
Higher purpose– A quality that drives the humanity of the business beyond transactions. This best practice is a belief that what the business does benefits consumers, stakeholders, etc. It is the knowledge that financial success flows from doing great work. This mindset leads to more inspired teams that are focused on long-term goals and collaboratively changing the industry.
Observed symptoms: Employees demonstrated a lack of enthusiasm for their work. This led to a lack of consumer focus. Employees were more interested in their benefits, vacation, and salary. They had a “what’s in it for me” mentality versus a “how can I contribute” mentality. When asked about what they love about their work, they respond “the people I work with” and not much else. This suggests a lack of passion for the business.
The Gapingvoid team used the compiled data to select art pieces that would resonate with the physicians, staff, and patients, and placed them strategically around the office.
The art installed in the office was specifically chosen to address the various issues the physicians and staff identified as areas for improvement. The result was an uplifting, positive, and humorous atmosphere for patients, physicians, and staff alike.
After the art was introduced, staff became more focused. Surveys reflected that staff satisfaction that resulted from helping patients increased from 22% to 33% and satisfaction for their work rose from 17% to 28%.
The office art improved positive moods as reported by the staff, from 85% to 93%. This outcome, in turn, positively impacted the staff’s sense of a higher purpose. Staff became less focused on coming to work for money (22% to 17%) and “no reason” (17% to 5%) and more attuned to improving patient outcomes. There was a significant shift in focus toward patient care from 39% to 61%.
After the art was introduced, employees reported that staying motivated was eliminated (0%) as the biggest challenge at work as compared to 31% prior to the installation. Helping patients was reported as the most fulfilling part of work, with an increase from 33% to 66%.
The art led to improvements in communication and positivity. It also enabled personnel to feel more engaged and a part of something larger, creating a more rewarding work experience.
The team then collected information from the patients to gain a better understanding of their perceived experience in the office. The surveys asked the patients about the waiting room, staff friendliness, quality of service provided, and communication.
The patients’ experience improved as a result of the art. Fifty patients were chosen and surveyed:
- 90% of the patients interviewed were satisfied with the waiting room.
- 96% were satisfied with the overall office environment.
- 94% were satisfied with the overall quality of patient care.
Patient comments about the art included:
- “They put a smile on my face. I like it!”
- “Very interesting and unique, in a positive way”
- “Nice for a physicians office!”
- “It lifted my spirits, thank you!”
Gapingvoid placed art in high communication points, such as hallways and the front desk. This placement also improved the perception of staff communication with patients.
- 95% of the patients were satisfied with the communication in the office.
- 96% of the patients were satisfied with the office staff’s friendliness.
- 98% were satisfied with their doctor.
- 95% were satisfied with the nurses.
- 96% were satisfied with the other office staff.
Patients’ perceptions of their care experience has become much more important in light of the new quality metrics promulgated by the ACA. Delivering value in a competitive environment requires a deep understanding of consumers’ needs and the ability to determine how well those needs are being met. It also requires medical practices to actively monitor employee engagement since such engagement affects patient perception of value.
“Performance and engagement measurement and advanced analytics are fueling [healthcare] value based transformation. With these tools, health systems can better understand patient needs, improve patient outcomes and drive solutions that promote population health while building market share.”vii
Positive medical experiences are highly valued by patients and have been tied to important clinical outcomes. For example, researchers have found significant positive relationships between patient experience measures and psychological/functional status and symptom recovery,viii medication compliance,ix and adherence to practice guidelines and outcomes.x
“Medical practices that can compete on value by measuring, reporting, and improving the outcomes that matter most to patients should be able to achieve success in the new health care marketplace.” xi
Gapingvoid helps medical practices understand their preexisting work environments through surveys and analysis. Using the collected data, they create immersive visual spaces that improve staff morale and boost productivity. As hypothesized, this focus proved to enhance patient experiences, which has been shown to correlate with positive medical outcomes.
i Healthcare.gov. “Key Features of the Affordable Care Act By Year.” Accessed June 22, 2015. http://www.hhs.gov/healthcare/facts/timeline/timeline-text.html
ii Porter, Micahel E, and Lee, Thomas H. “The Strategy That Will Fix Healthcare” Harvard Business Review. October 2013. < https://hbr.org/2013/10/the-strategy-that-will-fix-health-care>
iii Porter, Micahel E, and Lee, Thomas H. “The Strategy That Will Fix Healthcare” Harvard Business Review. October 2013. < https://hbr.org/2013/10/the-strategy-that-will-fix-health-care>
iv Sadler BL, Joseph A, Keller A, Rostenberg B. Using Evidence-Based Environmental Design to Enhance Safety and Quality. IHI Innovation Series white paper. Cambridge, Massachusetts: Institute for Healthcare Improvement; 2009. (Available on www.IHI.org)
v Sadler BL, Joseph A, Keller A, Rostenberg B. Using Evidence-Based Environmental Design to Enhance Safety and Quality. IHI Innovation Series white paper. Cambridge, Massachusetts: Institute for Healthcare Improvement; 2009. (Available on www.IHI.org)
vi Sadler BL, Joseph A, Keller A, Rostenberg B. Using Evidence-Based Environmental Design to Enhance Safety and Quality. IHI Innovation Series white paper. Cambridge, Massachusetts: Institute for Healthcare Improvement; 2009. (Available on www.IHI.org)
vii 2015 Strategic Insights report–Competing on Patient-Driven Value: The New Health Care Marketplace. Press Ganey Associates, Inc. 2015
viii Stewart MA. “Effective physician-patient communication and health outcomes: A review.” CMAJ 1995. 152(9):1423–1433.
ix McKee M, and Chow CK. “Improving health outcomes: Innovation, coverage, quality and adherence.” Isr J Health Policy Res 2012. 1(1):43.
x Glickman SW, Boulding W, Manary M, et al. “Patient satisfaction and its relationship with clinical quality and inpatient mortality in acute myocardial infarction.” Circ Cardiovasc Qual Outcomes 2010. 3:188–195
xi 2015 Strategic Insights report–Competing on Patient-Driven Value: The New Health Care Marketplace. Press Ganey Associates, Inc. 2015