Going Deeper on Patient Experience

Patient Experience is a lot like the blind men and the elephant. It’s defined differently by various healthcare provider organizations. Is there one best approach and how do you get your arms around this massive initiative for your healthcare organization?

Listen to the podcast recording in this post as Lonnie Hirsch, Founder and CEO of Hirsch Healthcare Consulting interviews Janiece Gray, Founding Partner at Minnesota-based healthcare consulting firm DTA Associates as she takes us on a deeper dive into the seemingly bottomless well that is patient experience. You will find a transcript of the recording below.

Misconceptions About Patient Experience

Lonnie: The term “patient experience” covers a very broad category of services, experiences and communications and is defined differently by healthcare organizations. What is the biggest misconception you find in healthcare organizations when they try to define and implement effective patient experience programs and protocols?

Janiece: There’s no silver bullet to magically improve the patient experience. There are some essential steps but there is no easy fix.

Organizations that have succeeded in this space have devoted significant amounts of time and resources and have had to try some things (plural) in order to achieve their success. It is essential that whomever leads these efforts in the organization be able handle ambiguity and communicate the need for patience and to “go the distance” throughout the organization.

Someone recently ended a post on one of the many patient experience list servs that I frequent with this phrase: “Good luck, and if anyone discovers the silver bullet, do share!” This sentiment is not only true for those working in the field each and every day, but it is also true for the leaders of their organizations as well. Everyone is looking for the silver bullet – a quick fix, something that solves all of the problems, something to make it easier in this work.

The closest thing that I have found to said silver bullet is a combined approach of training supplemented and reinforced by personal, one-on-one shadow coaching. What makes this powerful is the individualized approach.

When we talk about improving concepts of courtesy and respect, listening carefully, explaining things in a way that patients and families understand, demonstrating empathy, addressing pain and engaging in shared decision making, these are best assessed in the moment and with actual patient encounters. For most physicians and staff, when they sit in a class and learn about these concepts or are reminded about them, often they say that they don’t really know how they do on those aspects.

I think there’s a general personal positive bias that we are better on those than other people. Let’s face it no one wants to do a bad job of communicating and deliberately disrespecting people. When I have had the opportunity to work one-on-one with care team members, I’ve seen firsthand the power that this modality can bring.

Focusing on Compulsories Alone Is Not Enough

Lonnie: What is the most frequently overlooked or misunderstood component of Patient Experience?

Janiece: That it is more than just the scores! In fact, this is why I titled my book “Beyond CAHPS – A Guide for Achieving Patient & Family Centered Care.” The publisher wanted it to be an HCAHPS Handbook and I insisted that we move beyond that.

There are not many other areas across the healthcare continuum without requirements for patient experience surveys at this time (HCAHPS, CG CAHPS, HH CAHPS, or other varietals of CAHPS surveys). Value-based purchasing is alive and well – not just in patient experience but in quality and outcomes as well.

There is no shortage of compulsories in this space. To succeed in this area, you need to be well-versed in them, keep up with them as they change, know how to navigate them, and educate others about them.

Compulsories alone are not enough to help drive significant improvement. There are few staff, leaders or physicians out there who are completely motivated to improve based on CAHPS requirements alone.

These compulsories are necessary and have helped to elevate the focus on patient experience, but they alone will not drive improvement. Thus, I see them as necessary but insufficient to completely drive the change that organizations need to succeed in this area. In addition to mastering the compulsories, you need to also master the art of building beyond them.

There’s so much more to this than just the scores. Patient Experience is so much more than a response on a survey or a number on a scorecard. And yet, so many well-meaning leaders get caught up in this!

The challenge for those leading patient experience efforts in healthcare organizations today is that the data and the scores are only part of the story.

Where To Start

Lonnie: Translating the concept and strategy for patient experience into an effective implementation of process and protocols is clearly where the heaviest lifting is required and the mission can feel overwhelming. Where do you usually recommend healthcare organizations start in this process so it seems doable?

Janiece: My team is often engaged to help an organization when they just don’t know where to begin. We’ll come in and do an assessment to help them determine where best to start. In the absence of an outside resource to help an organization do that I’d suggest the following:

1. Look at what your data and your patients are telling you.

This requires looking beyond just your CAHPS data, and including other sources of patient voices. These may be through Patient & Family Advisory Groups, patient comments, patient complaints, responses to any rounding efforts in the organization.

These data can then really help you know where to focus in terms of an area or two that collectively is coming from your patients.

2. Set up for success – create your “Village”

One of the first considerations from a sponsorship, steering team oversight, as well as frontline improvement leadership includes the scope. Are we looking across the continuum focused on hospitals, clinics, home health, long-term care, emergency departments, and ambulatory surgery? For many organizations this scope is huge. In others, they choose to deploy the resources to certain areas.

From there it is essential to determine what level of leadership you need to adequately lead this work in your organization. Do you need a CXO (Chief Experience Officer), or a Patient Experience Director? Who will govern and sponsor this work from a steering and an executive leadership perspective?

Regardless of the structure you determine and can operationalize, I believe in the “village principle” of needing more people than just the CEO, the executive sponsor and a patient experience director to care about patient experience in an organization. To truly transform a culture, and make meaningful improvements in service and patient experience, it takes a village.

One of the best ways to create this village is to form some component of a steering committee for the patient experience efforts in the organization. I always advocate for the presence of 1-3 patients (who also serve on one of the Patient and Family Advisory Councils) several frontline staff, and leaders from around the organization led by a dyad of the executive sponsor and the director/manager for patient experience or a CXO. Finding those who truly have a genuine passion for the work is important and can help to really make these efforts blossom throughout the organization.

3. Work to build an engaged group of frontline staff and physicians.

There are a multitude of reasons to care about this work. It is essential that making the case for patient and family centered care extend beyond one leader, one staff member, or one department. In order to do this you have to find a way to articulate the WIIFM (pronounced wiff ‘em — What’s In It for Me) for some key groups.

Depending on the audience and the role of the person you’re encountering, there may be different strategies about how to make the case for patient experience. There are a variety of methods that I use to appeal to executives, physicians, and staff. I’ll try to refrain from making too many stereotypes as I find that what’s compelling to one person may not be to another. However, there are some broad categories of what I find resonates with various groups.

There are several strategies that I use to try to approach people about why patient experience is important and why they should care about it. Broadly stated these fall into the categories of:

• What if it were me/my family?
• Employee engagement & physician satisfaction
• Financial
• Public image/transparency
• Patient activation/engagement

Rarely do I presume to start with the financial elements associated with the compulsories. To many caregivers, that’s almost insulting. Most entered the healthcare profession with an innate desire to help people and to make a difference in their lives. I generally try to appeal to people on a personal or even emotional level.

Set Realistic Expectations Regarding Time Required

Lonnie: How long should healthcare organizations allow to effectively integrate a strong patient experience program across the organization? Obviously, the larger the organization, the more time may be required but where is the common denominator (if there is one) regarding expectations about the timeline?

Janiece: In working with various health systems across the country, I have seen many struggle to get this going in less than 18 months. That’s not something that executives like to hear when they want the data to have improved yesterday! But, realistically, to get the right people in place, to set up a steering structure and to adequately communicate throughout the organization to ensure buy-in, takes time.

If there is some kind of training or coaching component to make this happen, that can influence this timeline as well. Our team assists organizations to help reduce this timeline by extending the internal team in getting things going. But many organizations try and get it wrong before they do find and get the right people in place.

Plus, I believe it takes time to get beyond the “this too shall pass” or “this is just the flavor of the month” attitudes among some staff and physicians. These attitudes often surface in response to a new patient experience effort.

The Future of Patient Patient Experience

Lonnie: Patient experience is never “done.” Gaze into your crystal ball and share what you see for the future of patient experience?

Janiece: More than just semantics, there is a difference between patient experience and patient engagement – and a connection too! Right now most of what you see in the marketplace with regard to patient engagement focuses a lot on technology and patient portals. I also see a TON of confusion out there between patient experience and patient engagement.

Yesterday I was confounded by a huge pile of leaves piled up in the gutter at the end of my driveway. I needed a shovel and had to go wrestle one away from the hook/tandem bike and extension ladder in our garage! This extension ladder is a great image of how I see patient experience and patient engagement relating. Picture patient experience as the bottom of the two ladders in an extension ladder, and patient engagement to be the higher or top one. I believe patient engagement starts at the top rung of patient experience.

Here’s why: for many patients, it is only when they feel like they have been treated with courtesy and respect, and have been listened to carefully, that they are able to truly hear their providers. When they do hear, it’s imperative that those providers are explaining things in a way that they can understand. It’s only when these key communication elements of patient experience are consistently achieved that we are able to actually engage patients in their own care.

The healthcare system (hospitals, clinics, etc.) is just one small piece of the puzzle for patients. The reality is that so much more (40%) is within their patients’ control and don’t intersect directly with a hospital/clinic at all.   Things like medication adherence and lifestyle choices have just as big of an impact on outcomes, if not more, as the care provided in the hospital or clinic.

So, I believe (and hope) that when we can sufficiently raise the experiences of patients, we will then be able to get to a place of better outcomes whereby patients are then more engaged and activated to take control of their health.

I also am encouraged by the work of Dale Shaller and Jason Wolf and others who have formed groups like the Patient Experience Policy Forum (PXPF) which just convened in Washington D.C. last month. This group is pushing for policy changes around six key focus points.

The PXPF believes that the interests of patients and families must drive all public policy aimed at improving the healthcare experience and will advocate for policies that:

• Advance Patient-Provider Partnerships
• Strengthen Support for Patient and Family Involvement
• Strengthen Support for Professional Involvement
• Reduce Disparities
• Improve Patient-Centered Measurement and Reporting
• Elevate the Value Case

My hope is that at minimum some improvement related to patient-centered measurement and reporting will be achieved by this group. Hopefully with some reform in that area we will be able to also help leaders realize that there is more to improving patient experience than… just the scores!