J Clin Aesthetic Dermatol 2021;14(9 Suppl 1):S13–S17
Leigh Ann Pansch, MSN, FNP-BC, DCNP is a Certified Dermatology Nurse Practitioner practicing in Cincinnati, Ohio. Ms. Pansch received her Bachelor of Science in Nursing at Thomas More University in Kentucky. She has worked in women’s health, pediatrics, and nursing education for the University of Cincinnati and Cincinnati Children’s Hospital Medical Center where she was the first nurse to hold joint faculty appointment. She completed her Master’s of Science in Nursing with a family medicine focus at the University of Cincinnati College of Nursing and Health. She is a national speaker on such topics as pediatric dermatology, melanoma, and psoriasis, and she enjoys educating hundreds of high school students each year on sun safety. Ms. Pansch has served as a DCNP in pediatric, private practice, and hospital settings, and enjoys getting to know her patients and being attentive to their needs. She thrives on providing patient-centric care to her clients to achieve optimal treatment outcomes. She is married with three daughters.
How did you begin your career as a nurse practitioner (NP)?
Leigh Ann: I began my career in what I call “Mamas and Babies.” I spent about 15 years working in neonatal intensive care, special care nurseries, and labor, delivery, and postpartum care. I’ll never forget how overwhelmed I felt at first learning how to be a nurse in a specialized area of practice. I asked so many questions! But I learned very quickly to align myself with other providers who pursued excellence. And then, eventually, I became one of the people that others went to for answers to their questions. This ignited a passion in me for education, and I began teaching clinicals for a local university.
I honestly see the field of nursing as a continuum. To be successful caregivers, we must constantly strive to provide optimal care. Though I couldn’t have imagined this point when I began, my continuous pursuit of providing the best possible care to my patients led me from staff nurse to educator to nurse practitioner.
What prompted you to specialize in dermatology?
Leigh Ann: When I’m asked this question, I always say, “Dermatology chose me!” I learned early on in my career that I prefer chronic care. The opportunity to have long-term relationships with my patients has always suited me.
During my last quarter of graduate school, several of my peers and I were meeting weekly for boards preparation. As the weeks went on, more and more of my peers received lucrative job offers. I recall one Thursday afternoon, I went home and had a bit of a pity party alone in my room fearing I’d never find a job as an NP. I decided to put all my energy into the things I did have control over: being the wife and mom I wanted to be, teaching well, and finishing school. My father died two weeks after I earned my Master’s of Science in Nursing. I networked with everyone I knew, I went on several interviews, received several offers, and took the best option, all while grieving the loss of my dad, but I like to think my father helped me during this time.
The field of dermatology is so vast—it’s like the foreign language of medicine—but it pulls together all the different parts and the most interesting patients. And dermatological conditions involve numerous intricacies and intertwinings. The human body is so cool!
What does being highly efficient and productive mean to you as a healthcare provider?
Leigh Ann: I believe, as healthcare professionals, we often get lost in the loud squeaky wheels (like office drama/gossip, protocols, algorithms, and productivity) rather than focus on the questions our patients took time to write down, body maps they created “to help,” and small talk. In the United States, healthcare delivery has long focused on what we as providers “do” to patients. What I’m talking about now is a complete about-face, a full reversal, a shift in focusing not on what we do TO our patients but what we accomplish FOR our patients. We are headed to a billing system where quality of care and quality measures will be keys to reimbursement. Being highly efficient and highly productive does not simply mean our visits run on time as scheduled. It also doesn’t just mean we emptied our inboxes, answered all our messages, and signed all our charts. To put it simply, I believe being both highly efficient and highly productive means we focus our entire attention on the patient in the room—each patient, each time, every day. We are wise to turn off all the other noise and give each patient the attention they so deserve and expect. I tell my patients, “You may have to wait, but when I come in the room, you’re the only patient I’m seeing. You have my entire attention.” We can’t focus on our inbox, our smart watch, our time schedule, or our dinner plans. Rather, to truly pursue excellence in who we are and what we do, we have to pause, focus, and choose to prioritize each moment with our patients over everything else. This prioritization is, after all, what we’ve been trained to do.
I call this the “Human Side” of being an NP or PA—It is the nuts and bolts of what goes on behind the closed doors of the patient exam room. If you’re looking for that “something” to improve your job satisfaction, patient quality measures, and career growth—all while overflowing in the support you can provide your entire team—read closely: Take your time. SLOW DOWN! Answer all your patients’ questions. Invest in their lives and know who they are. Walk in their shoes and try to understand their perspectives, needs, fears, and how “medicine” has failed them. Listen. Listen. Listen closely. Ask questions to understand what their goals are. Be persistent with realistic expectations, and help them reach their goals. We’ve all experienced those equally defeated moments in our careers where we failed. We over-extended ourselves, failed to deliver, and didn’t measure up (patients always know when their healthcare provider is just going through the motions). I truly hope that every healthcare provider reading this has experienced that moment in the patient exam room, that day that we were “on”—when we answered all our patients’ questions well, patiently, and wisely. These moments should be savored and cherished. So, let’s agree to make the most of every moment. Trust me when I tell you patients talk to each other. When you take time to invest in them, they tell everyone. Do you want a low no-show rate, full schedule, and impeccable reputation? Then, as my father always said, “The evidence is in the doing.”
How do you think NPs and PAs can impact/improve the quality of care provided in dermatology?
Leigh Ann: I believe this starts with a continual pursuit of learning/knowledge/understanding. We must desire to understand—to be fascinated with the human body. From there, we listen to and attempt to understand and prioritize our patients—each patient, every day. The continual pursuit of knowledge puts me in place of learning, not all-knowing. It means my ultimate goal is not being right but helping my patients be heard. When these are our priorities, we place ourselves in a position of alignment with our patients, and, no matter the outcome, they see us as their ally and appreciate it.
Let’s consider these questions: How would your visits improve if you explained why you want to see your patients back in 8 to 12 weeks? What key indicators will you be asking about and looking for to evaluate the effectiveness of the current treatment plan? You see, I’ve actually timed it. I had my team count how long, at the end of every visit usually, it takes me to explain why I want to see them back in “x” number of days/weeks/months. On average, it took 20 to 30 seconds. While this adds up in a busy patient day, I cannot stress enough how much it improves the therapeutic relationships with my patients and outcomes. It’s just that simple!
How do you define “quality care?”
Leigh Ann: I define quality care simply as giving my patients the care they deserve. None of us would make an healthcare appointment if we didn’t have a goal, need reassurance, or have a problem we needed help with. Our patients are no different. They sought us out to help, and when we invest in them, they truly appreciate it and they tell everyone.
How is quality of care measured?
Leigh Ann: Quality care comprises a number of factors, such as patient safety, effectiveness of treatments, patient communication, timeliness, efficiency, and consistency, which can be measured in a number of ways. For example, patient feedback, no-show rates, quality improvement surveys, and even workplace morale are all measures of quality care. Choose the outcome and how it will be measured, put it into place, and then evaluate the results. Bottom line—Did you help the patient? My goal was to optimize our patients’ experience when visiting our clinic. To ensure this, we started with the team as a whole. First, the receptionist always has a welcoming smile. And our staff is constantly evaluating clinic processes to make things easier and more convenient for the patient. For example, filling out paperwork may be cumbersome to some patients—some prefer paperwork to be mailed to them ahead of time, whereas others prefer scanning a bar code and completing the paperwork using their smart phone. We “walked in” the shoes of our patients to experience what a visit to our clinic is like from their perspective, from the moment they enter our building to when they check out. We then debriefed the experience with the entire team. These types of discussions occur regularly and have proven to be invaluable. One team member commented recently that she has gained a high level of personal satisfaction in identifying ways to make our patients’ day better.
How are quality metrics integrated into clinical practice?
Leigh Ann: We must begin by choosing a meaningful measure. Each of us is different and care for unique patient populations. The beauty and art of quality care are that each practice chooses the measures and outcomes, and that data is tracked, stored, evaluated, and reported. Some measures may require chart audits, patient surveys, and “counters” who collect data regarding measurable services (e.g., waiting times, time in rooms). Finally, I’d like to highlight the importance of reporting and sharing outcomes with others. We are all advocates for the high-quality, efficient care we give as NPs and PAs—If we don’t show them, who will?
The next billing update will include a quality indicator…What does this mean for NPs and PAs?
Leigh Ann: In a JAMA February 2020 “Viewpoint” article by Drs. Simon C. Mathews and Martin A. Makary,1 the authors proposed five quality metrics to improve medical billing. The first metric recommends routine provision of cost of procedures in a clear and organized way for patients. Patients must, the authors argued, be able to decipher the information in their bills. Price transparency was the focus of the second metric. The outcome is that patients should have access to prices upon demand. The third metric recommends providing patients with access to appropriate billing staff for billing concerns. The authors also insist this must be tracked. The fourth metric tracks whether healthcare organizations are suing patients for unpaid medical bills—a violation of the core mission of hospitals to be a safe place for individuals with any illness or injuries and to care for patients regardless of their situations. The final metric addresses two matters: the double standard of expecting patients who are paying out of pocket to pay more than others for the same care and assessing if patients are charged directly for complications secondary to a serious adverse event. NPs and PAs must recognize that quality measures can help improve patient experience and ultimately revenue. Drs. Mathews and Makary stated, in their conclusion, “Recognizing that billing quality is valuable information, a more holistic and patient-centered set of outcomes also could be measured for benchmarking and performance improvement.”1
Tell us more about patient-reported measures of care. What are some examples? How is this information used to improve care?
Leigh Ann: Because my passion has always been focused on chronic care, I have a dream to seamlessly incorporate patient-reported outcomes into our electronic medical records. For example, I would like a patient with psoriasis to be able to scan a bar code with their personal device at check-in to answer questions about quality of life, symptoms, progress toward goals, and so on. That information would be embedded into their chart notes for that encounter. This would provide real-time, valuable data toward enhancing quality for these patients. Additionally, it makes the office visit more efficient, allows the patient’s voice to be heard, and may even improve prior authorization approval rates.
Why is quality of care so important?
Leigh Ann: Quality healthcare means providing the care our patients need when they need it, in an affordable, safe, and effective manner. It also means we need to engage our patients to take ownership in preventative care and treatment. Given our patients have many choices—about the care they receive, where and when they receive it, and so on—we should strive to have outcomes that entice and encourage our patients to seek care from us, now and in the future. Transitioning toward quality improvement has other benefits too, such as increased job satisfaction for you and the entire team. I dare you to try it!
How do you encourage patients to become and remain engaged in their treatment plans? Why is it important to engage not just the patient, but the patient’s family in the treatment decision process?
Leigh Ann: Patient engagement begins with effective communication. We must leave room to drive the visit with calculated and purposed open-ended questions. I would argue that our ability to communicate with patients is just as important as our ability to treat them effectively. Give patients options. Allow patients to share in the decision-making and ensure this is documented. Imagine your two-year-old niece is visiting your office for a suspicious lesion on her right cheek. What changes can you make to the office, flow, procedure to make her more comfortable? Walk in her shoes and ensure her needs are met in the best way possible. Set realistic schedules and include the entire team to ensure patient flow is optimized. Lastly, don’t forget the entire team. An office focused on quality is an office moving forward in a positive direction. Lead, encourage, and listen to your team and value their feedback, ideas, and examples. In fact, give each team member a voice and encourage/incentivize care done well. Make it a personal goal to authentically give team members praise daily for a job well done. You may be surprised to hear how this sets the tone for an ideal office culture.
As a provider, what gives you the greatest sense of success in what you do?
Leigh Ann: A job well done for me is when I make a positive impact. I’ve learned to look for impact in my patients, peers, and the entire team. We “tell the stories” often when we fail and when we succeed. We routinely discuss our goals and model behavior that facilitates quality care. Our office culture promotes the understanding that we are all human and that we strive for each little success. Even making someone smile is a success worth counting here. Bring on the “dad jokes” I say.
Speaking of dads, several years ago an older gentleman I had never met before visited our clinic. In the exam room, his demeanor was harsh and heavy. He was referred to us by his GI provider to have a skin exam because he was undergoing systemic treatment with cyclosporine for anti-rejection therapy after a liver transplant. In just a few minutes, from a place way down deep, I got a glimpse of despair and quickly realized he was depressed. My assistant had already stepped out of the room and, as I was walking out the door, the patient said, “I’m not sure if I’ll see you again.” In that moment, I cannot explain the “why” but I knew I had to act. I stopped, closed the door, and with a stern voice I said, “You matter. You’re still here.” I told him about my father who had passed away at the young age of 63 and how much I desperately wish I still had him. In tears, I told this patient that I truly hoped to see him again. A month later, I received a handwritten letter from this patient thanking me for taking time that day. I have seen him regularly now for over four years. Every time I see him, he calls me his “Change Lady” because he knows I care. That was all it took for him. He’s engaged. He’s even wearing sunscreen and protective clothing— That’s success in my book.
If you could tell yourself one thing your first year practicing as a new NP, what would you say?
Leigh Ann: Focus on making a positive impact, not on being right. This simple step can set the stage for a career of lifelong learning and quality outcomes. Friends, the dividend here is full!
- Mathews SC, Makary MA. Billing quality is medical quality. JAMA. 2020;323(5):409–410.