Patient Satisfaction
SUCCESS STORY
Improving Patient and Physician Satisfaction
with a Patient Portal
About Women OB/GYN, Woodbridge, Va.
Y
olanda Raffert, practice admin-
istrator for About Women OB/
GYN, is a firm believer in the
concept of working smarter, not
harder. She has to be — About Women
is the largest OB/GYN group on the
east side of the county in Woodbridge,
Va., a suburb of Washington, D.C.
They deliver 80 percent of the babies
in this region and they do it with only
six full-time OB/GYN physicians,
one nurse practitioner, and 32 staff
members. It isn’t uncommon for the
practice to deliver 100 to 110 babies
per month. The practice offers a wide
range of OB/GYN services in addition
to a laser skin care center. “We’re all
about women and we want to be able
to take care of every woman’s needs
from puberty to menopause and after
and everything in between,” says
Raffert. While the practice works hard
to serve its patients’ needs, About
Women aims to maintain an appro-
priate work/life balance for its staff and
physicians.
Surveying All
Raffert’s method for meeting these
two seemingly disparate goals begins
© 2010 Medical Group Management Association Performance and Practices of Successful Medical Groups: 2010 Report Based on 2009 Data   55
“An eight-hour day can be a stressful eight hours or it can
be an enjoyable eight hours…. So the stress level and the
lifestyle enjoyment … have obviously improved with the
portal itself.”
with accurately gathering satisfaction available at check-in and check-out
data from the entire staff and from and electronic surveys are sent to all
patients. Practice satisfaction surveys new patients. Though the practice
are administered to physicians and considers this information valuable,
staff yearly during the employees’ more often than not survey responses
annual review. Annual reviews are not reflect singular experiences of negative
just an assessment of employees’ job events. As such, surveys alone were not
performance but also a conversational giving Raffert a comprehensive picture
exchange of information that leads of the practice.
to improved job descriptions, refined In addition to gathering patient
roles and responsibilities, and neces- satisfaction data through these tradi-
sary organizational changes. During tional sources, Raffert implemented
the process, employees also complete a secret shopper program to get a
a survey evaluating their satisfaction broader view of patient experience.
with the organization and their super- Every year she chooses five to ten
visor. This review process aspires to OB patients to participate. Raffert’s
improve employee satisfaction and the rationale is that OB patients visit the
organization as a whole — it’s an hour practice frequently over a longer time
dedicated to enhancing job satisfac- frame (about 14 visits over the course
tion and bolstering overall practice of ten months). Raffert believes this
performance. group can provide the best critical
Patient satisfaction data comes evaluation of her practice. “They
from several sources: paper surveys are literally cross every department and

Convenient for both physicians and patients, the portal can
answer common questions, monitor patient vitals like weight
gain, and track medications.
provider in the practice,” she says.
“They see all of our physicians and
go to our two offices. They go to lab
and imaging and have many dealings
with the business office and surgical
coordinator. To me this is my best
patient survey because we get to see the
continuum of care.” Raffert provides
each secret shopper with a packet of
information about how to submit
feedback. In return for their efforts,
she offers them free laser hair-removal
services.
Finding Themes in the Data
The data from these sources are
compiled and examined by the practice
management group, which consists
of all practice physicians, the billing
and clinical supervisors, and Raffert.
The group meets monthly and looks
at quality assurance, patient concerns,
and operational issues and discusses
plans for the practice as a whole. The
top concerns from the internal and
external surveys are examined. Every
quarter the group creates a “hit list”
that they will focus on for the next
six months. The group creates a point
system to identify which issues to
address and determine their priority.
Issues that appear on both the patient
and the staff lists become high priority
items.
In prior years, a common
complaint from the clinician side
focused on the complexity in commu-
nicating results to patients. Specifically,
physicians experienced difficulty
closing the compliance and quality
assurance loop. The practice tried
sending letters to patients, but only
FedEx or certified mail could verify
acceptance of patient letters. As such,
the clinical staff became overwhelmed
56  Performance and Practices of Successful Medical Groups: 2010 Report Based on 2009 Data © 2010 Medical Group Management Association
with phone calls and endless rounds
of phone tag between the practice
and patients. Patients also reported
dissatisfaction regarding the receipt of
test results. This desire for improved
correspondence between physicians
and patients motivated the group
to research the implementation of a
patient portal.
Patient Portal Solution
Since the practice already used an
electronic health record (EHR), a Web
portal seemed like a good option to
explore. In making the decision, the
practice analyzed the cost of installing
and running a portal and the antici-
pated savings. “We put a dollar value
on savings on the physician time, but
what we soon discovered is the postage
we save in one week literally pays for
the portal for one month,” says Raffert.
“That doesn’t include savings for staff
time, paper, or physician time. It was a
very, very affordable solution.”
Affordability wasn’t the only
selling point. The portal could validate
the receipt of patient results — when
the patient picked up the message,
a date-time stamp flowed into the
medical record, allowing the physi-
cian to confirm that the patient had
read the results. The portal is secure
and password protected, operating
much like an online banking system.
Convenient for both physicians
and patients, the portal can answer
common questions, monitor patient
vitals like weight gain, and track
medications. The portal also expedites
prescription refills and renewals and
allows patients to validate patient
information prior to visits, saving the
staff valuable time.
Buy-In from the Beginning
To make this project happen, Raffert
enlisted one person from each
department (scheduling, registration,
nursing, billing, and one physician) to
sit on the team. “I don’t do anything
without a team,” says Raffert. Team
members are selected based on their
interests or a strategic objective. Once
the team was selected, the portal team
chose a portal based on the features
they thought would most benefit the
practice. It took the team 90 days to
select a vendor. Building the system
and personalizing it took another 90
days. All in all, installing and imple-
menting the system took seven months
to a year to roll out.
Team members were tasked with
reporting back to their departments
and collecting feedback. In this way,
the entire staff had some input in
the process. Furthermore, Raffert
increased staff members’ buy-in by
allowing them to use the system prior
to rollout so all could become familiar
with the portal and feel comfortable
answering patient questions. She also
gave different staff members ownership
of different parts of the system. Finally,
during training, Raffert emphasized
how the portal could save the staff time
and effort if executed properly.
Marketing the Portal to Patients
The practice decided to maximize
the impact of the patient portal
by refusing to settle for the 20- to
30-percent patient participation
rates experienced by other groups.
“When the system went live it was
hard for anyone to ignore what was
happening,” says Raffert. The staff
hung banners throughout the practice.
An e-mail blast went out to all patients
announcing “Our portal is live.” They
put signs in all of the restrooms. They
created the slogan, “Why call when
you can click?” The staff and physi-
cians even wore buttons. In addition,
Raffert and her team reinforced to staff
members that getting patients to use
the portal represented a home run for
everyone.
The strategy implemented for
patients was to inform them three
times over the course of one visit about
the portal. The first conversation
occurred with the front-desk staff, who
educated patients about the portal
and asked patients which form of
communication they preferred. They
also noted that the practice preferred
to communicate via the portal. Then
they directly asked patients if they
were willing to use the portal. The
second conversation occurred with the
physician. Check-out provided the
third and final opportunity to inform
patients about the portal. If patients
agreed to use the portal, the check-out
staff confirmed this and provided them
a business card that listed directions on
how to activate their account and how
to contact the IT department (another
of Raffert’s duties) if they experienced
problems. A patient wasn’t considered
a “portal patient” until they logged
in and activated their account. The
practice continues to use this process
with new patients. At the end of each
month, Raffert runs a report to see
who hasn’t activated their account and
sends those patients another welcome
e-mail inviting them to sign up for the
portal.
The portal doesn’t work for
everyone. Some people simply don’t
feel that e-mail is secure and therefore
resist the system. Also, a portion
© 2010 Medical Group Management Association Performance and Practices of Successful Medical Groups: 2010 Report Based on 2009 Data   57
of the practice’s patient population
doesn’t have computers or use the
Internet. The practice does not activate
Web accounts for these patients and
continues with a paper process. That
said, About Women has achieved a
75‑percent usage rate with their portal
system after only six months of the
system being live.
Portal Success
Raffert reports that the portal has
definitely improved job satisfaction for
the physicians. “An eight-hour day can
be a stressful eight hours or it can be
an enjoyable eight hours. If [the physi-
cians] are trying to make 50 phone
calls in between every single patient
because they can’t reach them — there’s
no downtime in their day. So the stress
level and the lifestyle enjoyment of
their job have obviously improved with
the portal itself.” Physicians also have
the opportunity to log on at night,
which allows them more flexibility
with their schedule. Probably the most
significant difference is the physicians
can now get closure on a key part
of their job. They can leave a record
knowing they’ve notified the patient,
reviewed their lab work, and given
the patient direction on what to do
next. One physician in the practice
commented to Raffert, “For the first
time, I feel like the practice is going
great. I don’t miss printing and signing
a hundred letters a day.”
Raffert is thrilled that she will
be able to use the portal to meet
meaningful use criteria. Her goal is to
devise a template based on the require-
ments and have it automatically post
to the portal. Currently, the system
provides patients with vitals, labs, and
the reason for their last visit, but now
patients will get a visit summary based
on the meaningful use criteria. Other
practices planning to prepare end-of-
visit patient summaries will still have
to find a way to incorporate lab results.
The portal will do all of this for About
Women OB/GYN.
What’s Ahead?
Raffert is determined to meet mean-
ingful use and ICD-10 requirements
without creating more workload or
increasing the staff. She also plans to
boost their current efficiencies while
continuing to meet patient needs.
Raffert makes it a habit to look outside
the medical field for tactics working
with other industries and she chal-
lenges her staff to do the same. She
wants everyone to think outside the
box. “I keep the staff involved. Find
the things that they love and involve
them in the practice with those things
— not just doing their day-to-day
responsibilities. Let them have the
valuable input in their department.”
Raffert’s attitude exudes appreciation.
It is no wonder the average tenure for
her staff members is nine years. “People
stay where they have ownership,” she
says. “People who rent, move. People
who own, stay.”