Improving the Patient Experience

Three out of four Americans have had their health care use disrupted due to COVID-19. Caution over patient and provider safety has resulted in delayed care and canceled visits that are critical for preventive care, advanced diagnosis, and managing chronic conditions. Patients, providers, and payers all stand to lose if the population’s long-term health is sacrificed to avoid illness in the short term. Therefore, health care organizations across the country are now encouraging their patients to safely resume routine care and elective procedures as the pandemic continues.

Even in the best of times, however, creating a positive experience for patients can be challenging. In recent years, patients have been increasingly expecting their health care experience to feel more like shopping for other goods and services, and new consumer-focused competitors are entering the market to capitalize on this opportunity. Meanwhile, reimbursement models are incentivizing experience scores, and HCAHPS and Healthgrades ratings are publicly available to the community.

As onsite visits and treatment resume, prioritizing the patient experience will be more critical than ever. Risk of confusion and frustration will be high as providers implement new policies and procedures to keep everyone safe. Organizations that successfully ensure safety and deliver a seamless experience will both accelerate their financial recovery and improve outcomes for their patient population.

We find that, before any organization dives into implementing change, a critical step is defining reality. When it comes to improving patient experience, initiatives should begin with understanding the current state. These days, when the current state is constantly changing, it’s even more important for health care organizations to develop a high-resolution picture of the reality their patients face.

We’ve worked with providers to support them in improving patient experience by first identifying points of patient frustration, and then targeting areas on the patient journey that need intervention. Here’s how:

1.   Map the Current System of Care

Start by defining a specific patient population to follow. You’ll likely choose patients who need to resume regular treatment, such as oncology or cardiovascular patients. Then, identify every step in that patient’s care journey. Include every point at which they interact with your health system, not just from the ED to the Cath Lab, but from scheduling to billing and everything in between.

EXAMPLE: A hospital is a system, but sometimes we miss how one part of the process can influence a future step. In one system where we observed the continuum of care for cardiac patients, the reception desk for testing shared that when the first patients of the day showed up late, it ended up pushing their entire day back. We discovered that although testing opened at 7 a.m., valet parking didn’t open until 8 a.m. Early patients who wanted valet parking found themselves scrambling to the parking garage and then struggling to walk back in time for their appointment. Seeing this issue was a major revelation for hospital leaders, who realized they had not been thinking about all the moments that add up to patient experience and how interconnected each step is.

2.   Identify Pain Points at Each Step

Once you map the steps, describe what happens in each step. Who is the patient interacting with, and how? What will happen here to move their care forward? What does it look like when things go right? What can happen to make things go wrong? How have the patient’s and their family’s expectations changed compared to a year ago?

Talk to real patients and find out whether they’re delighted. If they are, what should we replicate? If they’re not, what should we do differently? Get specific and look for patterns.

TIP: Health care language and everyday language are two very different things, but often, when we ask patients for feedback, we use our health care terminology. While doing a study of effective patient experience rounding in a children’s hospital, we found that parents were often unclear about what and who the questions referred to (You mean environmental services is housekeeping? That doctor who comes in here occasionally is a hospitalist?). As a result, parents weren’t able to articulate their feedback in the moment. When determining what to ask when surveying or rounding, put yourself in the shoes of someone with no health care knowledge.

3.   Identify Actionable Behaviors

Now that you know the pain points, it’s time to change. How can you address the pain points to ensure things go well for your patients every time?

EXAMPLE: Sometimes this means looking at the problem from another angle and leveraging what’s working. When we studied the differences between high PX scoring admitted units and those with average scores at a major research hospital, we found that while addressing wait times for call lights, mid-performers focused on trying to reduce the wait time. High performers, on the other hand, saw things differently. They focused instead on reducing the total number of call lights by completing proactive behaviors while rounding.

4.   Implement the New Behaviors

Identify any easy wins that can be done right away and just implement them. Make a plan for anything that might require a more significant effort. Develop a clear strategy (with clear ownership and role definition) to establish the new behaviors. The strategy should include how you measure success and how you hold each other accountable.

TIP: It’s important to remember that often the behaviors that need to change are cultural and not operational. When we were working with a major health system to understand what drives great patient experience, we found that language matters. The highest performing teams spoke to each other in a positive way and found positive ways to collectively cope with the stress of caring for patients. Lower performers, however, tended to use dark or gallows humor to alleviate stress. This attempt to create separation from the patient as a coping mechanism spilled over into lower patient experience scores.

5.   Share Takeaways and Sustain the Change

Make the most of your efforts by taking what you learn to other areas. Not every fix will apply to every office or service line, but there may be a few common strategies that are worth implementing broadly. Keep a spotlight on the new behaviors, share success stories, and include measurements on report cards until the change is ingrained.

We’re all facing unique and unexpected challenges, and organizations are working hard and quickly to keep their people, their patients, and their customers healthy and satisfied. By developing a clear understanding of your current reality and the challenges you’re facing, you can ensure those efforts make an impact. And if a patient experience does go awry despite meticulous planning and due diligence, it’s essential to have a service recovery strategy for the COVID era ready to go. Look for more discussion on that topic soon.

July 22, 2020

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