Better patient education equals better patient care

SkyVision's 'Rule of Threes' aims to inform patients at several time points before, during and after appointments.

Issue: May 25, 2017

ByDarrell E. White, MD

In December 2003, I needed surgery on both wrists for carpal tunnel syndrome. As it turns out, this is fairly common among microsurgeons such as ophthalmologists, although probably not at age 43. At the time I happened to be in the middle of the slowest, cruelest midlife crisis in the history of maledom — yep, another confessional column — even though there was literally no earthly reason to suffer even the tiniest bit of ennui, let alone something one would call a crisis. Long story short, my “crisis” stemmed from a degree of professional dissatisfaction.

Consumer experience

I had an epiphany: Medical care is the ultimate consumer service industry. Why couldn’t we engineer a medical eye care practice that starts from the patient’s experience and moves outward? Was there any reason why you couldn’t benchmark the customer-facing processes and protocols used by world-class consumer companies and bring them into the medical field? What could we learn from businesses such as Nordstrom or Canyon Ranch resorts that we could apply in our offices and hospitals to make medical care more pleasant? Our new practice, SkyVision Centers, went all in.

Sadly, we then learned that you could not really do this in medicine. The law of “cost, convenience or quality, choose any two” is still unbroken when it comes to the business of medical care in the United States. Your massage experience at Canyon Ranch is that much better than Massage Envy because you paid more, and that is not allowed in our system of third-party payment for care. Face it: It is hard to provide a Ritz-Carlton experience for your hernia repair when your surgeon is paid the equivalent of a night at a Days Inn.

All is not lost, though. There are some lessons from the broader consumer service industry that can be applied in the arena of medical care to help us provide a better care experience. For starters, every consumer service business spends time and money learning how to get a message of some sort across to their customers. Much of what they do is based on some basic understanding about how human beings learn things. We can apply this knowledge quite readily in our practices, specifically as it applies to educating our patients about dry eye disease.

Inspired by these insights from companies such as Ritz-Carlton, I plunged into the psychology of learning during our run-up to the launch of SkyVision. From this research came SkyVision’s “Rule of Threes.” Human beings learn through a combination of three basic strategies, any one of which is more effective than the others in a particular individual. We have three opportunities to reach our patients with information. Once in our office, there are three distinct groups of staff members who will interact with a patient. Each group plays an equally important role in educating our patients about the diagnosis and treatment of their particular problem.

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Read, tell or show

We learn by listening, reading or viewing/doing. Read, tell or show. I am a reader; I remember almost everything I have read. To learn Spanish, I would be better off combing Amazon for used language textbooks rather than using the popular and effective interactive app Duolingo, for example. On the other hand, my youngest son is a see/do learner. Randy can watch a video of a new exercise and then both do and teach it exactly as it is presented after a single viewing. In a practice it is not always possible to discover the optimal learning strategy for every patient. Our strategy at SkyVision Centers is therefore to hit every patient with at least two of the three possible approaches each time we see them.

You have three opportunities to reach and teach your patient, no matter what type of malady you are treating. Once you know a patient will be in for a visit, you can interact with them before they come through your door, while they are in the office and after they have gone. It sounds too simple and obvious to mention, but you have to make a conscious attempt to be present in all three spaces. In your office, there are also three “locations” where education can occur: intake, care and outflow. Again, this may seem obvious, but if you do not make an attempt to put patient education in each spot, it is highly unlikely that it will spontaneously occur in any spot, let alone all three.

Our SkyVision processes are under continuous development. DED is a major part of our service offerings, and we are constantly working to improve our patient education. When a patient calls, our service staff tries very hard to determine a specific reason for the visit. Once (if) this is known, our staff is trained to direct the patient to our website (“show/do”) for introductory information about their problem. (Note: This is a weak point for us; it is hard to have enough time on the phone to do this. A working/workable patient portal would help.) This process is repeated in part when the patient arrives, and when the patient is “handed off” to the technical/care staff, the problem or diagnosis is acknowledged in print.

A DED evaluation includes verbal education from our technicians (“tell”) during the pre-exam. Introducing the awareness that the patient’s symptoms may be dryness through the explanation of the OSDI or SPEED survey is a part of the process. Each test (osmolarity, MMP-9, Schirmer, gland imaging) is accompanied by verbal education, and each patient sees the outcomes of every test (“show”). At the conclusion of every exam for DED, each patient is given an explanation (“tell”) and a written description of the problem and our recommendations (“read”). If available, a follow-up email is sent with a link to videos such as those from Rendia (“show”).

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The SkyVision Rule of Threes can be applied to any diagnosis or treatment. We can take some of the best practices of world-class service companies and apply them in eye care, even if we are prevented from charging more for the effort. Knowing how and where to educate our patients is one clear example.

For more information:
Darrell E. White, MD, can be reached at SkyVision Centers, 2237 Crocker Road, Suite 100, Westlake, OH 44145; email: dwhite@healio.com.

Disclosure: White reports he is a consultant for Bausch + Lomb, Allergan, Shire and Eyemaginations; is on the speakers board for Bausch + Lomb, Allergan and Shire; and has a financial interest in TearScience.