by Dr. Trina E. Dorrah

I’ll admit it. I like reality TV. In fact, one of my favorite reality TV shows is Dallas Cowboys Cheerleaders: Making the Team. It shows what it takes to become a Dallas Cowboys Cheerleader. Why am I talking about cheerleading in a health care blog? Because the Dallas Cowboys Cheerleaders put more effort into hiring cheerleaders than most health care organizations do in hiring doctors. If you’ve read any of my previous blog posts, you know I spend a lot of my time training doctors on specific things they can do to improve the patient experience. Physician training is a common tactic in health care, but when those efforts fail, health systems spend a lot of resources trying to help their habitually low performing doctors. Lately, I’ve been thinking we should try a different approach. Why not focus more attention on hiring for the patient experience from the start?

How does this relate to the Dallas Cowboys Cheerleaders? In health care, we aspire to hire the best. The Dallas Cowboys Cheerleaders are one of the country’s best professional cheerleading teams, but they didn’t gain this distinction by solely focusing on dance skills. Instead, they have created an audition process that ensures they select cheerleaders who embody the mission and values of the organization. I think health care should follow their lead.

3 hiring tips … taken straight from the Dallas Cowboys Cheerleaders

1.    Redesign your hiring process to produce the results you want.
·      DCC: To become a Dallas Cowboys Cheerleader, you must be able to do more than just dance. The interview process puts applicants through a variety of situations, all designed to ensure candidates have what it takes to uphold the values and vision of the Dallas Cowboys Cheerleaders.

·      Health care: In health care, we are often understaffed, so we fall into the trap of hiring the first competent physician who applies for the job. The problem with this approach is we really don’t know how well they communicate with patients, if they are empathetic, or if they connect well with others. Health care needs doctors who are excellent clinicians and patient experience advocates. Unfortunately, we’re really good at assessing technical competence, but we’re lousy at assessing the more subtle qualities that make or break a patient’s experience.

2.    Focus on your core values.
·      DCC: In order to become a Dallas Cowboys Cheerleader, you have to repeatedly show the judges that you posses the values and characteristics they desire. Because the interview process spans several weeks, it’s easy to know who is genuine and who is simply faking it.

·      Health care: We all have a code of conduct we want our doctors to adhere to and we all have a set of core values we expect them to possess. However, few health care systems have a reliable way to gauge during the interview process if a doctor can or will live up to these standards. Even when we ask, we take the doctor’s word for it without ever verifying if his or her prior actions demonstrate hostility towards improving the patient experience.

3.    Assess communication skills.
·      DCC: To become a Dallas Cowboys Cheerleader, you must demonstrate that you are a good communicator by performing well in a Q&A interview session. If an applicant fails to communicate effectively, she gets cut.

·      Health care: In health care, our interview process does assess general communication skills. However, communicating to an interviewer is entirely different than the communication that is required for effective patient care. Being able to communicate things in a way patients understand is critical for providing a good patient experience, and health care currently does little to evaluate this skill when hiring.

Now that I’ve mentioned some of what’s missing from health care’s current hiring process, let me explain what I think we should do to change it. Yet again, the Dallas Cowboys Cheerleaders have already figured out the solution.

“Assess applicants’ skills before offering the job.”

What does it take to be a Dallas Cowboys Cheerleaders? Their website outlines the following steps: 1) Complete the application, 2) Preliminary Audition, 3) Semi-Final Audition, 4) Personal Interview, 5) Written Test, 6) Final Talent Auditions, and 7) Complete training camp. Notice how many steps I listed - seven! The last step alone takes several weeks. In health care, most interviews last 1-2 days max, and although applicants speak with several interviewers, they are rarely asked to demonstrate one of the most important things – their commitment to the patient experience.

3 ways to assess patient experience skills before offering the job

1.     Review prior patient experience survey results – virtually every health care organization measures the patient experience. Review your applicant’s prior results. If you’re planning to hire a physician who consistently scored at the bottom of his or her peer group, or who consistently had more patient complaints, consider hiring someone else.

2.     Focus on the patient experience throughout the hiring process – this should begin as soon as a physician submits an application. For example, put a video on your website explaining your organizations’ commitment to the patient experience, and require applicants to review it before they can submit an application. Likewise, the patient experience should be discussed throughout the interview process.

3.     Interact with patients – before you make an offer to a new doctor, observe his or her interactions with patients. You can work with your legal department to use real patients under the direct supervision of a staff physician. You can use volunteers, members from a patient advisory council, or paid secret shoppers. The point isn’t to judge the doctor’s diagnostic or technical skills, but to observe their body language, emotional intelligence, and communication skills.

In the end, not every physician will be a good fit for your organization. By learning to hire better, you can hire physicians who embrace your organization’s commitment to the patient experience. This is much easier than trying to correct behavior after the fact. What do you think?

Dr. Trina E. Dorrah (@drtrinadorrah) is an internal medicine physician/hospitalist and the author of Physician’s Guide to Surviving CGCAHPS & HCAHPS. She can be reached through


I have great news to share with you! Last week, I published my second book,CGCAHPS & HCAHPS Breakthrough: Coaching Health Care Providers for Success with the Patient Experience. As the title suggests, it's a book about provider coaching.

What is coaching, and why do I think it's beneficial for improving the patient experience? Despite the increased focus on the patient experience, this topic is often missing from medical education. As a medical student and resident, my time was spent becoming an expert in anatomy, physiology, medical diagnosis, and treatment. We spent little time discussing the patient experience - why it is important or how to improve it. 

Thankfully, that's changing as more and more health systems focus on improving the patient experience. Sit down during the visit, listen without interruption, summarize, solicit questions...these are all skills we emphasize for our doctors. However, one thing I've noticed from shadowing providers is that even when we have the best intentions, we still frequently forget to do what we know.

For example, I know not to turn my back on my patients when I'm using the computer. Yet, I frequently find myself doing this. If you asked me, I'd say I only do it occasionally. If you observed me, you'd see that I do it a lot more than I even realize. This is why a coaching program that incorporates shadowing can be so helpful. By implementing a provider coaching program, you observe your providers and offer objective feedback on what they do well, and what can be improved to positively impact the patient experience. 

If you want to learn more, I've laid out a complete program in my new book. I go into very specific detail on what it takes to create a successful coaching program, and I've included a step-by-step guide. However, I still wanted to share a few tips to get you started. 

3 tips to get you started with your provider coaching program

1. Choose an improvement coach - this is the person who will shadow and offer feedback to your providers. You want someone who is well-respected, compassionate, observant, and who truly understands the importance of the patient experience.

2. Decide what you're going to focus on - choose what skills you want your providers to focus on. These are the skills your improvement coach will look for when shadowing your providers.

3. Shadow your providers - once you select your coach and decide what you want to focus on, your coach can get busy shadowing your providers. By offering feedback based on direct observation, your coach can help your providers focus in on what truly needs improvement. 

We're all working hard to improve the patient experience. There is no one thing that will instantly change your clinic or organization's patient experience, but there are definitive drivers of success. One of those drivers is physician coaching. If you're looking to start a coaching program, I sincerely hope my book helps. 


By Dr. Trina E. Dorrah

S = Sit down

A = Avoid medical lingo

T = Teach back

S = Summarize

There are numerous patient experience improvement tips that you can share with your doctors. The problem is, no one can remember that many tips at once. If you want to help your doctors improve the patient experience, less is more. Focus on a few hi-yield tips, and emphasize them frequently.

SATS can help

Encouraging your doctors to “Check the SATS” is one easy way to help your doctors improve the patient experience. It’s practical, catchy, and doable. When done consistently, these 4 tips will go a long way towards helping your doctors focus on behaviors that truly make a difference to their patients.

SATS explained

S = Sit down; encourage your docs to sit at some point during each patient encounter.  This helps your doctor appear more relaxed and accessible. It also increases your patients’ perception of time spent with the doctor.

A = Avoid medical lingo; remind your doctors to explain using clear and simple language. Encourage them to avoid medical terminology unless followed by an explanation. As a physician, I can tell you that we are so used to speaking in medical terminology that we often do not recognize when we do it.

T = Teach back; ask your doctors to utilize the teach-back method to improve their patients’ understanding. The doctor explains the concept to the patient, and the patient explains it back in his or her own words. Your doctor then has the opportunity to clear up any confusion and re-teach as needed.

S = Summarize; your doctors can summarize at various times. After the patient tells his or her story, encourage your doctor to summarize to ensure he or she heard correctly. Your doctor can also use this technique to summarize the diagnoses and treatment plan at the end of the visit.

Next steps

Meet with your doctors now and encourage them to “Check the SATS”. We are all working to improve the patient experience. Providing your doctors with practical tools such as SATSis one way to partner with them to improve your patient experience.  In the end, patients want to be listened to, treated with courtesy and respect, receive clear explanations, and have enough time with their doctor. Having your doctors “Check the SATS” for each patient accomplishes this goal.

What's in a name?

by Dr. Trina E. Dorrah

Have you ever noticed the reaction you get when you mention the patient experience? Undoubtedly, you’re met with a few providers who demonstrate frustration, anger, and disgust. You may even hear them say that it doesn’t matter how well the doctor treats a patient as long as he or she is competent. These beliefs confuse me, especially when these same providers face their own health crises, then complain about the lack of empathy they, their partner, or child received. Do you notice the irony? When asked to focus on the patient experience, these providers dismiss it. Yet, when their doctors don’t communicate with them or show compassion, they are frustrated.

The truth is, doctors and other health care providers really do care about the patient experience. I think the frustration arises from the connotation associated with the phrase.  For some reason, many providers think of the patient experience as catering to unreasonable demands or ignoring the importance of clinical competence. That’s simply not true. When I think about what the patient experience is and is not, the following list comes to mind.

The patient experience is about…

  • ·      Listening
  • ·      Showing compassion
  • ·      Treating patients as we ourselves would want to be treated
  • ·      Explaining so our patients understand
  • ·      Spending time with our patients
  • ·      Asking for and answering questions
  • ·      Helping to facilitate care
  • ·      Working with our staff to streamline processes
  • ·      Continuing our commitment to maintain clinical competence
  • ·      Practicing according to evidence based standards
  • ·      Taking time to explore patient fears
  • ·      Engaging in collaborative goal setting
  • ·      Discussing difficult issues in a compassionate way

The patient experience is NOT about…

  • ·      Catering to every whim and desire
  • ·      Turning physicians into concierges
  • ·      Choosing treatment options that go against evidence based medicine
  • ·      Buying patients’ loyalty through rewards and perks
  • ·      Refusing to discuss difficult issues
  • ·      Only making recommendations that are pleasing to hear
  • ·      Prescribing unnecessary medications
  • ·      Subjecting ourselves to verbal abuse
  • ·      Devising treatment plans that completely exclude patients/families from the decision making process
  • ·      Creating an environment where one must work within our health care system or know someone who does to have a good patient experience

In the end, I believe if providers have a better understanding of what the patient experience truly is (and what it is not), they’ll be more willing to embrace it. If everyone in health care commits to this goal, doctors, nurses, and providers won’t feel the need to name drop/intervene/call in favors for our loved ones simply to ensure they have a good patient experience.  



    Trina E. Dorrah, MD, MPH, is a board-certified internal medicine physician who practices at Baylor Scott & White Health in Round Rock, TX. In addition to her clinical work, Dr. Dorrah is the medical director of quality and the physician champion for the patient experience. Dr. Dorrah is passionate about improving the patient experience and she loves to share her expertise with others. 

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