New Approaches to Patient Experience

Jacqueline Fellows, for HealthLeaders Media , August 13, 2013
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"That allows us to get a greater sense for what's taking place and actually segment that data in the place of care so we can be very specific with regard to what's happening in the different departments within the hospital, i.e., floor one versus floor two, doctor versus doctor," says Ryan.

The census-based survey aims to study 100% of a hospital's patients. They don't always get a 100% response rate, but the strategy drives home the same point Ardent Health is trying to make: More data gives you more insight into what is specifically upsetting patients.  

"What we've actually found is that organizations that take that fuller level of data and use analytic techniques to understand the effects actually perform better and are improving faster because they are capturing the patient voice, responding to it, and making changes that are improving healthcare," says Ryan.

And the need for organizations to move faster is here with the consolidation of health systems and value-based models of care.

Counting on competitive spirit

In the fifth annual HealthLeaders Media Intelligence Report on patient experience, which will be released August 15 and highlights of which appear starting on page 29, healthcare executives indicate, by far, that changing the organizational culture is their biggest stumbling block to creating an effective patient experience program.

With the emergence and acceleration of both Medicare-approved and commercial accountable care organizations, there is a new sense of urgency for some health systems to improve their patient experience, particularly because it is one of 33 benchmarks Medicare-approved ACOs have to meet in order to qualify for the incentive payment.  

Lahey Health, the Burlington, Mass.–based nonprofit integrated health system formed in 2012 when Lahey Clinic and Northeast Health System merged, relies on the competitive nature of physicians to drive up the quality of a patient's experience in physician offices. Similar to what's done at Ardent Health and other systems, comments about physicians are read aloud at staff meetings. Many organizations take this approach because it's effective, says Mary Anna Sullivan, MD, chief quality and safety officer for Lahey Health.  

"If anything makes physicians act, it's not being the best and wanting to be," she says.

Sullivan oversees performance improvement for patient experience. She says with the merger, Northeast Health brought over the discipline of surveying its outpatient providers with Clinician and Group Consumer Assessment of Healthcare Providers and Systems (CG-CAHPS), which is similar to the HCAHPS, but in an office setting.  

Greg Bazylewicz, MD, chief network development officer for Lahey Health and founding member and president of the Northeast Physician Hospital Organization, says at Northeast Health, he eased physicians into the idea of getting graded by patients. First, he says, Lahey surveyed only patients of primary care physicians before later including specialists' patients. The process involved giving individual doctors their own score but blinding everyone else's name for three months.  

Since the merger, Lahey surveys its physicians' patients 30 times per year, says Sullivan, though she wants the frequency to increase to "cut a broader swath of patients to make sure we're really hearing what our patients think."

Using CG-CAHPS in a regular outpatient setting, even though it isn't required, is giving Lahey Health a foundation for its ACO, the Lahey Clinical Performance Network, which was approved by CMS in January as a Medicare Shared Savings Program. CMS is collecting CG-CAHPS data, which will be incorporated in the ACO's overall quality score, thus influencing shared savings and loss percentages.  

Both Bazylewicz and Sullivan believe that patient experience should be better in an ACO. For Sullivan, it will lead to patients being more invested in their care.  

"An engaged patient has better outcomes, does better, takes better care of his or her diabetes, communicates better with his or her doctor. It may be hard for us to continue on this journey, but I think it's going to mean better care for patients, and happier physicians and nurses," says Sullivan.  

Bazylewicz, who leads the efforts of Lahey's ACO, believes care partners in an ACO start talking about patient experience on the front end.  

"That's really the benefit … because you have to pay attention to how it's done, how well it's done, and where you're not living up to as full a detailed and communicated care system that you could have in place," he says. "It makes you search for areas to improve in a more active way."

Using CG-CAHPs to measure doctors in their offices is catching on. HealthStream, a Nashville-based third-party provider of survey instruments to help organizations improve patient experience, reported at its first quarter call with investors in April that more than half of its 13% increase in its Patient Insights survey was from new CG-CAHPS contracts. It expects that trajectory to continue with the growth of models of care that take a longitudinal view of patient care with other partners.  

At Lahey Health, whether talking about its ACO or its integrated health system, Sullivan is quick to point out that patient experience is not patient satisfaction.  

"My belief, for a long time, is that we're relieving anxiety and meeting our patients where they are and trying to give them a good experience because that's going to help them heal," she says. "It's about our patients knowing that we care for them. It's not a business transaction but a long-term relationship."

Reprint HLR070813-2

This article appears in the July/August issue of HealthLeaders magazine.

Jacqueline Fellows is an editor for HealthLeaders Media.
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