UNC startup aims to improve patient experience

Bivarus, Inc., the startup cofounded by Seth Glickman, MD, MBA, assistant professor in the UNC Department of Emergency Medicine, is improving patient satisfaction in the Emergency Department and the Department of Dermatology by obtaining real-time patient feedback via smart phone and email.

UNC startup aims to improve patient experience click to enlarge Glickman and colleague Abhi Mehrotra, MD, using Bivarus.

by Zach Read - zread@unch.unc.edu

Several years ago, motivated by increased national efforts to make care more patient-centered, Seth Glickman, MD, MBA, set out to develop a new approach to measuring the patient experience that would make on-the-ground change in the Emergency Department (ED) possible. The existing feedback permitted the ED to compare itself to peers on some general measures of the patient’s overall experience in the hospital. Glickman felt that the ED could make further improvements in health care delivery and patient satisfaction if patients were asked targeted questions.

Collaborating with Bivarus cofounders Sandy Heard, at UNC, and Kevin Schulman, at Duke, Glickman produced a change management platform that’s being used in UNC Hospitals’ ED and UNC’s Dermatology Clinic. Implemented last fall, it provides richer information about what patients like and don’t like about their care experience, and it’s more accessible to patients and less time-consuming to fill out.

“One of the key barriers preventing patients from answering the paper surveys was length,” says Glickman. “They were receiving an 80-question survey by mail, which frequently wound up in the trash.”

Bivarus aims to improve the patient experience, involve patients in their care, and create a better system of health care delivery. Achieving those goals involves asking fewer—but more relevant—questions of patients, making the survey available via smart phone or email, and sending the survey to patients within 24 hours of their visit, a critical window during which the care experience remains fresh in patients’ minds.

“The whole idea is to get information to people on the ground in the ED but to minimize the burden required for individual patients to respond to surveys,” says Glickman.

The survey only takes two minutes, on average, to fill out. It uses a patented algorithm to ask questions more efficiently and features a sophisticated analytic platform for reporting data and tracking interventions. The tool is designed to look at the stream of responses, to evaluate the information, and to not waste time asking questions that, from a statistical standpoint, the provider has already learned the answers to.

“If the walls in the ED are painted a different color, patients are asked whether they like the new color, and 28 of the first 30 responders like it a lot, then the survey tool determines that it’s not necessary to ask patients 31 through 2,000 the same question,” says Glickman.

The results so far are encouraging. Not only is patient survey return up nearly tenfold in the ED and Dermatology, Bivarus surveys have produced valuable information that has led to improvements in patient satisfaction and affected changes in how the departments work. For instance, wait times in the ED have improved, procedures for getting blankets and pillows to patients have changed, parking has become more available to patients, medications traditionally not stocked are now readily available, and patient concerns have been acknowledged almost immediately by staff in Patient Relations. According to Glickman, the result is an improved health care experience that strengthens relationships with patients and deepens their loyalty to UNC.

Bivarus has also demonstrated the ability to enhance professional development by notifying providers  about situations where a patient may not have felt they received optimal care as well as areas where they’ve been successful compared to their peers. Because UNC Hospitals is a teaching institution, Glickman thinks this feature is particularly useful.

“The tool contains questions asking patients to comment about some aspect of their provider,” says Glickman. “Patients answer questions about bedside manner, communication, professionalism, whether care is patient-centered—do they involve me in the decision-making? We can actually give physicians fairly detailed feedback on their performance in comparison with their peers. This is especially valuable at a teaching hospital.”

Glickman has received favorable feedback from his colleagues about the teaching benefits of his product and believes the feature resonates more with physicians than when they receive isolated negative comments in a vacuum, devoid of context.

“They’ve been buying in more to this approach because we get a large amount of data,” he says. “They know it’s statistically valid, whereas the common patient complaint-driven approaches toward evaluating physician performance are driven by just one or two complaints. It’s a more scientific way to provide feedback to physicians.”

Brian Goldstein, MD, MBA, executive vice president and chief operating officer at UNC Hospitals, sees the possibilities of Bivarus.

“I think the product has a tremendous amount of promise,” says Goldstein. “Finding a way to make sense of the amount of information they’ll receive will be a challenge, but it has great potential for being used widely across the system and across the industry if they can solve issues of how to sift through the information, how to organize and prioritize it, and how to turn the information into useful data.”

Glickman has spent much time researching what’s important to patients, and he believes Bivarus taps into their needs. When he looks at patient feedback data and some of the papers he’s authored and coauthored, what’s most important to patients consistently themes around quality of nursing care, level of coordination between nurses and doctors, and overall communication. While pleasing aesthetics within the health care environment are nice to have, they’re not as important to patients and they don’t lead to better health outcomes.

The use of smart phone technology and email would seem to present demographic challenges for the product, but Glickman insists that the findings demonstrate increased participation from patients of all ages, races, and ethnicities.

“It’s true that older patients are less likely to have an email address than younger patients,” Glickman says. “They’re also less likely to use a smart phone device. But we’re finding that our total volume of responses is so much higher, it actually dwarfs any concern about the issue.”

Spanish-speaking and younger patients are responding in high numbers via smart phone as well, and about half of all smart phone responders are either on Medicaid or are uninsured, which would seem to fly in the face of assumptions about identities of smart phone and email users. Glickman cites emerging literature that reveals that underserved populations are more likely to have smart phones as their primary computing device than have a home computer.

“I think the early indicators are we’re reaching populations that we didn’t reach previously, which I would spin as a benefit of the tool,” he says. “But it’s something we’ll continue to follow as we get respondents.”

Glickman believes his startup has the potential to improve health care, not only at UNC Hospitals, but throughout UNC Health Care and beyond.

“Our mission is to transform how we use patient feedback to improve health care delivery, because our health care system, from a national perspective, is far from patient-centered; the only way to move in that direction is to use the patient as the guide on how to get there.”