Patient Experience: Old School Approach May Be Best

Jacqueline Fellows, for HealthLeaders Media , September 4, 2013

So far, this is the primary metric Holy Redeemer looks to for assurance that its patient experience work is having an effect because the Bensalem site is relatively new, as are the recommendations from the six working groups that presented their ideas in early 2012. However, Holt says Holy Redeemer is expecting a bump in HCAHPS scores, patient volume, and brand awareness, which Holt plans on studying over the next 18 months.

Right now, Holy Redeemer is moving ahead with another experience-derived environment at a second freestanding outpatient center as well as the entry lobby at its 242-bed acute care hospital. A dining and living room are also being dreamscaped for one its senior living communities.

To maintain the momentum for the system's ambitious patient experience trajectory, the health system has launched what it calls Holy Redeemer University, a sort of training program that will eventually educate all 4,000 employees over the next couple of years.

"Holy Redeemer University is really about aligning everyone's thinking and their work, i.e., giving them that foundation in what we expect them to do, what we want them to deliver on," says Holt.

The first group of "students" to go through the university will be managers and supervisors, approximately 250 people. Holt says they'll go through two days of classes.

First comes what Holt calls Experience U 101, which is one day and something every employee will eventually attend as well, to give a baseline of mission and expectations.

"Day one is about individual change because change starts with the individual and then it moves to the organizational level then to the community," says Holt.

Day two of class is called Experience U 201, and will be specifically for managers.

"That second day is really about addressing questions such as: How do you manage people who are delivering an experience? How do you behave as a manager in that kind of environment? We're going to try to build in accountability pieces so they'll walk out of there with a kit that provides them with guidelines on how to work with people when they return from the training and start asking questions or have ideas."

Holt says everyone who completes Experience U 101 will have an assignment to reinforce the patient experience Holy Redeemer wants its patient to have.

Holt admits that measuring its grand experiment with patient experience is going to be challenging, but she's convinced that the stories, the dreamscaping, and the behavior categories are making a difference. She says the experience has made her more adept at being a culture change champion.

"For me, the brand lived on a page or brand was a concept," she says. "To actually be able to help people act on it has been very fulfilling. It's really changed the way I approach my work, and also understanding more about who we are and connecting to that on an everyday basis."

Delving deeper into analytics

Unsure that a hefty investment in patient experience programs will net a big enough ROI, some hospitals and health systems take small steps, believing that improving food or getting the lighting and noise levels right in the room will be a short-term solution until the industry finds the right algorithm to solve the ambiguity that exists when trying to measure patient experience.

That's a mistake, says Press Ganey's Ryan.

"Patient experience is not a campaign. It's an actual, critical part of culture," he says.

From delivering patient care in an environment designed to cater to any need a patient may have, like at Holy Redeemer's Bensalem site, to the data mining at Ardent Health, organizations have a lot of choices for improving patient experience, but the common denominator must be true cultural change that involves hearing "the patient's voice and understanding what they're experiencing," Ryan says.

Ryan does not equate patient experience and HCAHPS scores, which isn't surprising. Press Ganey was built 28 years ago on the idea that a patient's voice is critical to care and outcomes, two decades before the Centers for Medicare & Medicaid Services started collecting HCAHPS data.

Ryan says HCAHPS renewed hospitals' focus on the significance of providing a positive patient experience. A 2011 white paper from Baptist Leadership Group, the consulting arm of Pensacola, Fla.–based Baptist Healthcare Group, said CMS put "a stake in the ground" with HCAHPS. But, Ryan says, healthcare organizations are focused on patient experience more than ever because of the transformation from a fee-based to a value-based healthcare system.

"The challenge that we face in the next five years is to reduce the cost of healthcare," says Ryan. "The only way in which we're going to do that and improve quality is by incorporating the patient's voice and the patient's experience into their care and understanding how we can improve their care."

Deirdre Mylod, Press Ganey's senior vice president of decision analytics and research, and executive director of the Institute for Innovation, a nonprofit organization that Press Ganey is launching and supporting, goes farther, saying that organizations need "a combination of culture and rigor" to improve patient experience.

"You need that culture where, yes, they understand why patient centeredness is important. But if they're not using the patient voice data as the operating data, if they're not incorporating that with clinical and safety data, then they are well intentioned but they are not executing on what their promise is," says Mylod. "Conversely if you have all the rigor of 'You must do this,' but you don't listen to employees and engage them, then you get people who are disenchanted with the mission, so you need that combination to really make things move."

Press Ganey has started to dive deeper into hospital data for its clients, moving toward a census-based survey of all of a hospital's patients rather than a survey based on a sample size of some patients.

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1 comments on "Patient Experience: Old School Approach May Be Best"

Steve Wilkins, MPH (9/4/2013 at 9:32 AM)
The patient experience for most hospital and integrated systems begins not with a hospital stay...but with a visit to a hospital-employed physician or a member of their medical staff. CG-CAHPS is fine but it's limited in terms of the details it provides individual clinicians...meaning that it is not very actionable. Plus it depends upon patient recall of events that may have occurred moths ago. A new "old school" that has been used for years in medical schools is something called conversation analysis where the exam room conversations between physicians and patients are recorded and then deconstructed with the goal of assessing the clinician's patient communication skills. Clinician skills can be benchmarked against best well as their peer groups. The results are highly prescriptive and actionable at the individual clinician level. The analysis is done by trained independent reviewers. Steve Wilkins, MPH




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