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Understanding the Totality of the Patient Experience through Total Quality Encounters

Posted By Paul Roemer, Monday, January 27, 2014
Updated: Saturday, January 25, 2014

Point One. New College, Oxford, was founded in 1379, hundreds of years prior to the invention of the I-Beam. As a result, the roof of the main dining hall is supported by big oak beams, two feet square and forty-five feet long.

About 100 years ago, entomologists were studying the beams and noted that they were infested with beetles, a problem which had eroded the integrity of the roof. Unfortunately for the college it was believed that all of the large trees from the old-growth forests had long since fallen.

As luck would have it, the college owned a great deal of land and actually employed its own forester. When the college asked their Forester about whether he knew of any large trees, the Forester replied, "I was wondering when you’d come asking.” It was discovered that when the college was founded, a grove of oaks had been planted to replace the beams in the dining hall when they became beetle-infested. This information had been passed down from forester to forester for more than 500 years.

Long term planning: Planning that involved the exact solution, not a series of ad-hoc fixes year-in and year-out.

Point Two. Heliocentric versus geocentric. Heliocentric—the planets revolved around the sun. Geocentric—the earth was the center of the universe and everything revolved around it. Copernicus. Early astronomer, pretty smart guy—he got it right.

Point Three. Patient experience. The hospital is the center of the universe and the patients revolve around it. Where is Copernicus when we need him? What about a patient-centric model?

Four out of five hospitals do not have a patient experience strategy. Of those 20 percent that do, most, if not all of them, do not include anything outside of HCAHPS.

There are several fatal flaws with the hospital-centric model of patient experience. Improving HCAHPS scores is not the same thing as improving patient experience. One strategy involves improving a set of numbers, the other involves improving experiences.

Here are the flaws around what most hospitals are doing:

The experiences of outpatients are ignored—surveying them doesn’t count; we already established that with HCAHPS.
The experiences of all prospective patients - the largest group of stakeholders - are ignored. Definition of Prospective Patients—everyone who has ever been to your web site, called the hospital, parked in the garage, eaten in the cafeteria and driven past the billboard advertising the hospital’s urology practice.

The hospital-centric patient experience model requires hospitals to try to apply a fix for every patient experience, patient by patient, day after day. One hospital fixing thousands of patients’ experiences. Shampoo, rinse, repeat. Since the patient is no longer classified as a patient when the fix is applied, whose experience is the hospital attempting to fix?

The patient-centric model of patient experience centers around one patient, one person. It is designed, planned and thought through. A patient, like a customer, should be able to carry the hospital around on their iPad. That person should be able to accomplish everything they need to with the hospital, with the possible exception of a hip replacement, the same way they can accomplish everything they need to with Amazon.

The following graphic shows the lifecycle of someone’s experience with a hospital. The most noteworthy aspect of the graphic is that only the green circle represents a person’s time in the hospital. The blue circles represent all of the other interactions someone has with the hospital.

Patients only spend a small fraction of their time in the hospital. Hospitals only spend a fraction of their time understanding the totality of someone’s experience.

Since most hospitals do not have a working definition of patient experience, I like to use this definition: TQE—the Total Quality of a person’s Encounter with the hospital is equal to the sum of their HCAHPS scores plus all of the nonclinical patient touch points. This definition parallels The Beryl Institute’s definition of the patient experience – the sum of all interactions, shaped by an organization’s culture, that influence patient perceptions across the continuum of care. Using these definitions as guides in their own organizations enables healthcare leaders to truly keep the patient at the center of their universe.

A remarkable experience happens for every person, every time, on every device.

Paul Roemer
Vice President
Tower Strategies
proemer@towerstrategies.com

Tags:  Customer Service  defining patient experience  HCAHPS  healthcare  Hospitals  Patient Experience  patients 

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Comments on this post...

Kathy Torpie says...
Posted Thursday, January 30, 2014
Thanks Paul. Excellent summary of the limitations of the current understanding of the patient experience
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