Leadership: The Multi-Faceted Challenges and Rewards of Patient Experience

Lonnie Hirsch

A curious and confounding dilemma about all that encompasses “the patient experience” is that it is not a single, straight-line continuum. Process thinking is tempting: A patient comes in the door, receives medical care and exits. A linear structure, with a beginning, middle and end would be simpler to define, quantify, manage, monitor, improve and adjust.

Unfortunately, the patient experience is far more complex.

First, healthcare usually begins from a negative. People don’t really want to be sick, injured or hospitalized. In the race to achieve “patient satisfaction,” the starting point is born of concern, need, necessity and/or discomfort. And, unlike the retail world, healthcare “customer service” comes to bat with a deficit of a strike or two to overcome.

As our nation’s healthcare system continues to recognize and embrace a patient-centered focus (with increasingly aware and empowered patients), clinical outcomes are no longer the only consideration. Hospitals, healthcare CEOs, physicians, medical practices, providers and staff, and marketing executives struggle to define the multi-faceted complexities of the patient experience, patient satisfaction and quality of care.

Clarification by definition…

Even the most thoughtful definitions illustrate this intricacy. Consider, for example, this patient experience definition:

“The sum of all interactions, shaped by an organization’s culture, that influence patient perceptions across the continuum of care.”  — The Beryl Institute

 The Beryl Institute expands on the key elements of their collaborative definition by patient experience thought leaders:

• Interactions: The orchestrated touch-points of people, processes, policies, communications, actions and environment;

• Culture: The vision, values, people (at all levels and in all parts of the organization) and community;

• Perceptions: What is recognized, understood and remembered by patients and support people. Perceptions vary based on individual experiences such as beliefs, values, cultural background, etc.;

• Continuum of Care: Before, during and after the delivery of care.

Clarification by HCAHPS survey…

The pursuit of a patient-centered experience requires measurement tools, which, until fairly recently, were not uniformly tracked or reported. Notwithstanding some lively pro-and-con discussions, the Centers for Medicare and Medicaid Services (CMS) and the Agency for Healthcare Research and Quality (AHRQ) provided a yardstick.

The goal of HCAHPS (Hospital Consumer Assessment of Healthcare Providers and Systems) is to establish a standardized instrument to measure patient perceptions of care. And further, to provide consumers with information that might be helpful to their healthcare decisions.

Subjective or perceptive surveys are always challenging, so the dozens of HCAHPS questions can be applied either as a stand-alone device or in conjunction with the facilities own patient satisfaction monitoring. It is significant to note that, in each of the following reporting areas, topics are more experiential than clinical. They also tie back to the definition components (above) of interactions, culture, perceptions and continuum of care.

Survey questions are reported in ten areas:

• Communication With Doctors
• Communication With Nurses
• Responsiveness of Hospital Staff
• Pain Control
• Communication About Medicines
• Cleanliness of Hospital Environment
• Quietness of Hospital Environment
• Discharge Information
• Overall Hospital Rating
• Likelihood to Recommend

The Beneficiaries and Benefits of Quality in Patient Experience

By whatever qualitative measure, patient experience has many rewards, and it is simply good business from several perspectives. Excellence in clinical care and achieving high levels of patient satisfaction are primary points of differentiation. Some of the benefits and beneficiaries include:

PATIENTS: The end game of medical science and our healthcare delivery system has always been to benefit the patient, generally measured by clinical outcomes. In part, the “patient experience” and “patient satisfaction” criteria add depth by also considering the process of achieving a positive patient outcome. But it’s also more than that. Patient satisfaction has been shown to materially contribute to outcomes by improved awareness and understanding, better health directive compliance, changes toward a healthier lifestyle and speedier recovery.

PROFESSIONALS & PROVIDERS: As a group—doctors, physicians, surgeons, specialists, nurses, technicians and caregivers—derive personal and professional satisfaction in both clinical achievements and, for most, by helping others. The system that reflects upon their job as “well done” is rewarding in itself. What’s more, patient satisfaction has a positive influence on the provider’s reputation with the public and peers. And it is likely to influence patients to seek their services and refer friends and family in the future.

WORKPLACE CULTURE: A healthcare facility, be it a hospital or a practice location, is no more than another brick-and-mortar structure without the people who work there. A patient-centered environment requires everyone’s commitment and participation. Ultimately, it is a reflection of a positive organizational culture. When employees are engaged and derive greater satisfaction from their work environment, retention is longer and professional growth and experience is enhanced.

THE BOTTOM LINE: On one hand, medical facilities have a financial incentive in reporting quality measures. The Inpatient Prospective Payment System (IPPS) is tied to HCAHPS reporting and the Annual Payment Update (APU) could be reduced. While this is significant, the greater reality is that a better delivery system (and greater patient satisfaction) is more productive, cost effective and simply better business.

Healthcare consumers—patients, prospective patients or family members—are better informed and more actively engaged in their own medical decisions. And, like the system itself, patients are increasingly concerned about reducing costs, finding greater value, and improving service standards and outcomes. In our perspective, the totality of “the patient experience” has become a top-tier issue for individual providers, hospitals, group medical practices and executive decision-makers.

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ADDITIONAL ARTICLES AND POSTS ABOUT THE PATIENT EXPERIENCE:

The Paradox of Disappearing Patients

How to Improve Patient Satisfaction and Win Patient Referrals

Healthcare’s Consumerist Revolution and the Quality of Caring

Healing is Not Enough: Cleveland Clinic Lessons in Patient-Centered Empathy

The Importance of “The Follow-Up” In Medical Practice Marketing

Break the 21-Minute Patient Wait Barrier to Improve Patient Satisfaction in Doctor Marketing