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In virtually every conversation I have with healthcare executives, at some point the discussion turns to the patient experience. Health systems have always cared deeply about providing safe, high-quality care for their patients; that hasn’t changed. Now, in response to market and regulatory forces, patients are acting much more like consumers than ever before; they are increasingly shopping for healthcare like how they buy any other good or service.  And they are demanding more from their providers.

Facing this challenge, health systems are investing time, money, and executive capacity to improve the patient experience. Several large profile health systems have appointed “Chief Experience Officers,” a title that certainly did not exist more than a couple of years ago. Efforts are underway to improve service, be more accessible, and compete much more aggressively for a patient base that is willing and able to shop around.

Amidst all this effort, the question we are most often asked is “how can I get my entire organization aligned around the importance of this?” That’s an important question, and answering it starts with being clear on what you are trying to achieve. What exactly do you mean by “patient experience?”

At Root, we define “patient experience” as the totality of the interactions that a patient has with a healthcare provider. This includes everything – everything – that happens from the moment that a patient considers initiating a relationship with a provider until the moment that relationship concludes.

When we define patient experience this way, then a number of important insights become immediately apparent.

Great quality is necessary, but not sufficient, for a great patient experience. Great patient experience certainly starts with safe, high-quality care, but it doesn’t end there. You may have solved my problem, but if the experience of receiving care from you was difficult, time-consuming, unfriendly, excessively costly, or just plain annoying, then you have delivered a poor patient experience and I am less likely to seek care from you again.

Every interaction your patients have with your organization matters. And that means everything, whether you think it should be your responsibility or not.

Let me illustrate with an example from another industry. For many years I used the same car dealer to service my car. Oil changes, safety inspections, maintenance, repairs, you name it, I went to the same dealer.

About 18 months ago, a major road improvement project began near that dealer. Traffic became a nightmare, and getting to the dealership took much longer than it had before.  Was the road construction the dealer’s responsibility? No, of course not. But did the construction affect my experience as a customer? Absolutely it did. And I changed providers.

Maybe I’ll go back to the original place when the construction project is finished, but then again maybe I won’t. The new dealer seems glad to have my business, and they’re doing their best to make sure I have no incentive to leave.

It’s not that hard to translate this back to healthcare, is it? If I’m getting ongoing treatment for a chronic condition like diabetes or heart failure from your organization, and suddenly the simple act of getting to your facility becomes frustrating and challenging, then my patient experience suffers. And that gives me good reason to consider going elsewhere.

Here’s the point: whether you think something should be your responsibility or not, if it’s affecting the patient’s experience, then it matters.  And smart organizations will take that into account.

Everywhere you look, there are opportunities to improve. I often recommend that as a starting point, providers choose a few typical patients, and map out every single touchpoint that those patients have across a six-month period. For each touch point ask two questions.

  • First, how easy or difficult is this for the patient?
  • Second, consider whether any other provider of a service in the economy has a similar touch point with a customer. Compared to the very best examples you’ve seen, how well do we perform?

These are usually eye-opening questions, and tend to provoke action-oriented conversations around how we can improve scheduling, parking, signage, reception, data collection, billing.  I often wish we could equip patients with an app so that they could evaluate every interaction with us by clicking one of two buttons: easy or difficult.  How do you think your organization would score?

Because the baseline is so low, a little improvement goes a long way, and a big improvement can sustainably differentiate you. My biggest piece of advice is simple. Don’t let the best become the enemy of the good. If you can’t make something perfect right away, try just making it better. Find two things that you know annoy patients and make life unnecessarily difficult, and improve them. You’ll be two steps ahead of the competition, and by the time they have caught up, you’ll have taken two more steps, and so on.

I don’t mean to suggest that any of this is easy. Perhaps the hardest part is actually having an honest conversation. Because while most healthcare organizations like to say they are patient-centric, the reality is they are not. Most organizations are, at best, provider-centric. Facing up to that honestly, and committing to change, is not easy.

What can you do to make your patient experience great?

For more than two decades, Root has worked with some of the world’s leading provider organizations to define and deliver outstanding patient experiences. And while these organizations are different in many ways – location, size, clinical scope, populations served – they tend to have three important similarities. My colleague Gary Magenta describes these in his article, but let’s a look a little more deeply in how they apply in healthcare.

#1: They define, build, and sustain a culture that prioritizes the patient experience. This requires deep commitment from executive leadership and a willingness to stay the course through the inevitable speed bumps.

In Dr. James Merlino’s book, Service Fanatics, he describes what this journey was like while he was Chief Experience Officer at Cleveland Clinic. I find this passage particularly enlightening:

“Making patient experience a strategic priority, revamping the mission, vision, and values, and appointing a chief experience officer proved not to be enough … caregivers were not aligned and did not live the patient experience … We needed to shock the system.”

The Cleveland Clinic has become well known for its exemplary patient experience. There is a popular video on YouTube with more than 2.6 million views that very powerfully illustrates how they see this issue. But as Dr. Merlino’s book makes clear, it did not happen overnight. Creating a culture that truly prioritizes the patient experience is a necessary first step.

#2: Organizations creating great patient experiences empower people to take action. Think back to our definition of patient experience: the totality of the interactions that a patient has with a healthcare provider. Everything matters. That means the patient experience is delivered by the actions, large and small, that all of your people take every day.

Take Iora Health. They have a unique primary care model that leverages health coaches to help patients with the day-to-day difficulties of living with chronic illness. Their blog provides story after story of how Iora empowers health coaches to take actions that improve patient care and the patient experience.

#3: Exemplars in providing a great patient experience make it personal. They enable their people to be their authentic selves, because contrary to perception, great patient experience cannot come from a script.

I find it helpful to think about a framework of hard lines, guidelines, and no lines. “Hard lines” are the things we must do, whether because of regulatory compliance or because the best medical science is clear that there is a singular right answer. An example here might be a clinical protocol around when and how to remove a urinary catheter to prevent infection. We wouldn’t want someone to deviate from this practice; direct patient harm could result.

“Guidelines” would be akin to recommendations. They’re a suggested practice, but not something we require 100% compliance with. An example might be a recommendation to only do patient education when the patient’s spouse is present. Deviations here might be appropriate, and we need to give staff a framework for thinking about this issue, and the flexibility to adapt the practice as needed.

And “no lines” would be situations where you give your people freedom to use their intellect, empathy, and creativity to be their authentic selves and find a way that works best for them.   In healthcare we have these opportunities all the time. Doctors remind us often that medicine is both art and science. Let’s allow people to bring their art – their most authentic selves – to their work. Let them have flexibility on how to best greet patients, to conduct patient education, to follow up with someone after discharge. These are decisions that people can make authentically, if we trust and empower them to do the right thing, and relentlessly celebrate and reward them for it.

The case studies of Cleveland Clinic and Iora Health suggest that the patient experience really matters, and that building a differentiated experience can be transformative. Creating a great patient experience is the next frontier in medicine. It is what will ultimately differentiate those providers who succeed in a world in which consumerism has finally come to healthcare. And it will lead to better outcomes for patients, better workplaces for our employees, and a more value-based health system for all.

February 18, 2016


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