"If our hospital leadership interacts with patients and they hear complaints, they act immediately, but for some reason, when it's on paper or it's on your computer screen, it becomes a little less real," says Gwin. "I just want our leaders, even our charge nurses and our department directors, to get used to hearing from our customers. Even the corporate CEO reads every patient comment every week and makes a few phone calls, because we just need to get into the practice of hearing from patients so we can better align our organization."
The frequency of measuring loyalty produces volumes of data on rooms that are consistently rated as noisy, dirty, clean, or quiet. The survey used is so specific that Gwin says he can tell who the nurse was and what room the patient was in, which helps identify patterns on floors among nurses and even among the cleaning crew. If he sees a room is starting to be consistently rated as noisy or dirty, he can use the data to drill down and find—and remedy—the problem. Likewise, if a room or nurse is getting praised by patients, he can find out what the nurse is doing and implement those homegrown care strategies among other nurses and at other hospitals.
Ardent Health does not dismiss HCAHPS, says Gwin, but he also adds that NPS "goes beyond HCAHPS"; the health system's third-party surveyor asks not only the HCAHPS questions but also the NPS recommendation question and another asking how the hospital can improve. It's the open-ended question where Ardent learns what went right and what went wrong, like the patient who heard others crying in their beds.
The strategy of frequently surveying patients and collecting and mining the data to find out how an Ardent Health hospital is proficient or deficient has helped its hospitals improve patient experience. At Ardent Health's Bailey Medical Center in Owasso, Okla., the 73-bed suburban hospital consistently receives a positive NPS of 95% or better, up from scores in the 50s and 60s when it opened in 2006. Its HCAHPS scores also are above both the state and national average on every single question. The increase in both scores indicates that there may be a correlation between patient satisfaction and patient experience, which means that healthcare executives may be right to rely on HCAHPS as a leading indicator of what a patient is experiencing.
"Amazing" is how Gwin describes Bailey Medical's journey. Pushing out the data regularly to pinpoint problems and quickly fix them helped the hospital's NPS climb steadily, and now its NPS score is an Ardent Health success story.
"That culture is up and running," says Gwin, who is also quick to say that implementing patient experience improvements using NPS is easier in a smaller environment. However, he is passionate that NPS data is the foundation for changing culture no matter the size.
"Sometimes, all of this is not the easiest thing to hear, but, when we act on this information, we're acting in the best interests of our patients and their families," says Gwin.
Creating sustainable cultural change
Hospitals are eager to improve a patient's experience during his or her stay, but one health system is focusing its patient experience efforts on its outpatient facilities.
"Healthcare will be delivered in a variety of settings and more and more often in outpatient locations. So ambulatory care is an important part of the future," says Chris Holt, chief experience officer and vice president of marketing and public affairs for Holy Redeemer, a Meadowbrook, Pa.–based health system with 2012 net patient service revenue of $336 million. Its system includes an acute care hospital, outpatient and diagnostic services, as well as multiple community and senior care facilities, together with a home care and hospice division.
Holy Redeemer's strategy of focusing on outpatient care is in line with what other health systems are doing or are planning on doing. According to the HealthLeaders Media Industry Survey 2013, healthcare executives said growing outpatient care is their top strategy for fueling financial growth over the next five years, so looking to patient experience beyond the inpatient setting becomes increasingly important.
Holt says Holy Redeemer's focus on improving patient experience came about two years ago from leadership wanting the brand to be associated with delivering an exceptional patient experience. The health system believes that its patient experience at outpatient facilities could be a market differentiator, potentially allowing for growth.
Holy Redeemer's C-suite turned to a consulting firm that encouraged them to abandon traditional methods of improving patient experience and instead approach it more creatively—a lot more creatively. Holt says it wasn't a hard sell because the leaders were interested in innovative techniques, but it was hard to understand how creative they would get.
"The hardest question is, 'If it's not HCAHPS scores or customer service on steroids … what are you talking about?' " says Holt.
The consultants were talking about stories, dreams, and experience guides, which are metaphors for a component of patient experience. Stories equate to why a patient is coming in to see the doctor; dreams describe the process that Holy Redeemer went through to develop how a patient interacts with staff and the environment; and experience guides are the receptionists or assistants who make sure a patient gets to the correct room.