Core Physicians Caron Callahan

Organizations Profiled

Seacoast Family Practice, Exeter, New Hampshire Core General Surgery, Exeter, New Hampshire

Jessica Boccelli, Director of Service Excellence, Core Physicians Caron Callahan, Practice Manager, Seacoast Family Practice

Beth Fletcher, Medical Office Coordinator II, Core General Surgery Marc Fournier, CMPE, Director of Human Resources, Core Physicians

Nicholas D. Garcia, M.D., Vascular Surgeon and Chief Physician Executive, Exeter Health Resources

Jason Howe, D.O., Primary Care Family Practitioner, Core Physicians Jana Jacobs, Senior Practice Administrator, Core General Surgery

Roderick S. McKee, M.D., FACS, General Surgeon, Core Physicians Diane P. Palladino, M.D., General Surgeon, Core Physicians

Jay W. Swett, M.D., FACS, Chief of Surgery and Interim CMO, Core Physicians

Core Physicians: Meeting Patient Needs with Empathy and Excellence By Elaine Zablocki, Staff Writer, Picker Institute

october 2015

pat i e n t- c e n t e r e d c a r e c a s e s t u d y A Picker Institute Series



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For 30 years, Picker Institute has been dedicated to develop-ing and promoting a patient-centered approach to health-care. For more information about our services, please call toll free at (800) 388-4264.

Picker Institute endeavors to ensure the accuracy of the informa- tion it provides to its members. This publication contains data obtained from multiple sources, and Picker Institute cannot guarantee the accuracy of the information or its analysis in all cases. Picker Institute is not involved in representation of clini- cal, legal, accounting, or other professional services. Its publica- tions should not be construed as professional advice based on any specific set of facts or circumstances. Ideas or opinions ex- pressed remain the responsibility of the named author(s). In re- gards to matters that involve clinical practice and direct patient treatment, members are advised to consult with their medical staffs and senior management, or other appropriate profession- als, prior to implementing any changes based on this publica- tion. Picker Institute is not responsible for any claims or losses that may arise from any errors or omissions in our publications whether caused by Picker Institute or its sources.

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ii Core Physicians: Meeting Patient Needs with Empathy and Excellence Call Toll Free (800) 388-4264



Organization Profile

Seacoast Family Practice and Core General Surgery are divisions of Core Physicians, a community-based, multi-specialty group practice affiliated with Exeter Health Resources. Core Physicians includes over 160 providers in 28 locations, providing comprehensive primary, specialty, and pediatric dental care throughout New Hampshire’s Seacoast Region. Core Physicians is an affiliate of Exeter Hospital, a 100-bed, community-based hospital serving the Seacoast Region. Exeter Hospital is a Magnet-recognized healthcare organization.

Seacoast Family Practice includes two family practice physicians, a part-time physician’s assistant, a registered nurse, a licensed practical nurse, and a medical assistant. Core General Surgery includes five general surgeons, a nurse practitioner and registered nurse, and three medical assistants. Core Physicians and Exeter Hospital are both operating affiliates of Exeter Health Resources, which also in- includes the Rockingham Visiting Nurse Association.

Statement of Interest Medical groups today strive to meet patient needs on many levels. The Clinician and Group Consumer Assessment of Healthcare Providers and Systems (CG-CAHPS) survey documents medical group performance in five areas of patient-centered care: • Patients’ rating of the provider (doctor,

nurse practitioner, and physician assistant)

• Getting timely appointments, care, and information

• How well providers (doctors, nurse practitioners, and physician assistants) communicate with patients

• Helpful, courteous, and respectful office staff

• Follow-up on test results

In each of these areas, certain medical groups are excellent performers, with consistently high scores on specific CG-CAHPS measures. Picker Institute case studies ex- plore the ways medical groups achieve these outstanding results and share examples of best practices.

This case study profiles Seacoast Family Practice and Core General Surgery, which the Picker Institute has identified as high performers in delivering patient-centered care based on their exemplary performance in CG-CAHPS publicly reported data. Both organizations have top ratings for “How well providers communicate with patients.” In addition, Core General Surgery has top ratings for “Getting timely appointments, care, and information.”

Core Physicians: Meeting Patient Needs with Empathy and Excellence Core Physicians defines its mission in terms of “Triple Aim Plus One.” The Triple Aim is a framework developed by the Institute for Healthcare Improvement that describes an approach to optimizing health system per- performance by pursuing three dimensions simultaneously: • Improve the patient’s experience of care

(including quality and satisfaction) • Improve the health of populations • Reduce the per capita cost of healthcare

Core Physicians adds “Plus One,” an emphasis on sustainability, because so many organizations have found that it’s not enough to just make improvements; it is equally as im- important to develop ways to sustain those im- improvements, and to hardwire a system that sustains improvements.

Core Physicians rely on Lean methodology for process improvement and to sustain its improvements. “Lean is one of the tools we use constantly to re-examine our processes so we can be more efficient, improve workflow, and see more patients,” said Jes- Sica Boccelli, Director of Service Excellence for the organization. “On every improvement project we conduct a Lean analysis and we use Lean tools. Key stakeholders at Exeter review our processes to determine which improvement projects should be our high- est priorities.”

Based on these aims and methods, it’s not surprising that Seacoast Family Practice and Core General Surgery receive top ratings for “How well providers communicate with patients,” and that Core General Surgery has top ratings for “Getting timely

How Well Providers Communicate with Patients

The survey asks patients how often their providers explained things clearly and listened carefully to them. The specific questions are: • Provider explained things in a way that was easy to understand • Provider listened carefully to patient • Provider gave easy-to-understand information about health questions or concerns • Provider knew important information about patient’s medical history • Provider showed respect for what patient had to say • Provider spent enough time with the patient

Possible responses for these questions include “Never,” “Sometimes,” “Usually,” and “Always.”

Getting Timely Appointments, Care, and Information

The survey asks patients how often they got appointments for care as soon as needed and timely answers to questions when they called the office. The specific questions are: • Patient got an appointment for urgent care as soon as needed • Patient got an appointment for non-urgent care as soon as needed • Patient got to answer to a medical question the same day he/she phoned provider’s office

• Patient got answers to the medical question as soon as he/she needed when phoned provider’s office after hours

• Patient saw provider within 15 minutes of appointment time

Possible responses for these questions include “Never,” “Sometimes,” “Usually,” and “Always.”

1Core Physicians: Meeting Patient Needs with Empathy and Excellence Call Toll-Free (800) 388-4264



appointments, care, and information.” All of the staff at these clinics makes a special effort to listen to patients, tune in to their feelings, and treat them with care and respect. Core Physicians’ processes for hiring and evaluating physicians, nurses, and other staff emphasize qualities such as empathy, creativity, initiative, and optimism.

We asked some physicians at these organizations exactly what they do that assures their patients that they are listening carefully, showing them respect, and explaining things clearly. Not surprisingly, one of the most important things they do is take the time to listen.

Patients can face anxiety when questions arise in addition to uncertainty about what to do after a surgical procedure. Taking a per- personalized approach is standard practice for Jay W. Swett, M.D., FACS, Chief of Surgery and Interim Chief Medical Officer, who calls all of his patients. “If there are any issues that arise, I want to speak to them directly,” he said. “Patients like receiving a call from their surgeon and it saves the on-call physician from getting a call.” This best practice has created streamlined efficiencies in addition to increased patient satisfaction scores.

Jason Howe, D.O., Primary Care Family Physician at Seacoast Family Practice, be- lives that when your patients talk without interruption, it can be extremely useful. “When you let them speak without interruption, nine times out of 10 they’re going to tell you what’s wrong,” he said. “If you don’t listen, they’re not able to tell you what is really happening with them.”

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