Posted By Katie Joyce and Katie Ziemer,
Friday, April 20, 2018
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Better patient experience has been linked with better health outcomes, improved treatment adherence, and increased provider and staff satisfaction. It creates a continuous positive upward spiral. However, initiating that upward spiral can be difficult due to the complexities of patient experience.
To continue the dialogue around understanding and addressing these complexities, we decided to bring together experts in the field, including healthcare services researchers, technology innovators, and leaders in clinical organizational improvement. We published their perspectives in the Ipsos Understanding Society, Patient Experience edition. Below, we provide the main take-aways from this initiative.
What is not measured is not improved
Before patient experience can be improved, it must first be measured, but measured in the right way. Measuring the patient experience allows us to see what needs to be improved, and points to how to improve it. When tracked over time, it lets us see whether our improvement efforts are actually making a difference. However, a number of factors need to be taken into consideration when measuring the patient experience so that we can ensure the results are actionable and accurate.
- First, it’s important to measure the aspects of the healthcare experience that actually matter to the patient. What are their expectations? What barriers impede them from getting their needs addressed? Using a journey mapping approach, where patients describe their entire experience before, during, and after the encounter, can be a useful way to get this information.
- Second, the patient experience needs to be linked to the systems and staff that impact their experience. What procedures do the staff use to check patients in? What are the rules for family visitation in hospitals? This information points to which aspects of the system or staff need to be changed to have the biggest impact on the patient.
- Third, measuring the patient experience should place as little burden on the patient as possible. Increasingly, this can be accomplished through technology, such as online surveys and incorporating alternative data streams.
- Fourth, we need to consider and account for the factors that can influence patient experience scores to gain as accurate of a picture as possible. For instance, primary care providers who have an ongoing relationship with their patients tend to receive higher scores than emergency care providers. This context needs to be taken into account when comparing scores between providers to make them equitable. Ipsos has developed fair scorecards that provide adjusted benchmarks to account for this context.
- Fifth, while patient experience is important to measure, we also need to recognize that it represents subjective perception rather than objective clinical care. For example, patients’ satisfaction with their experiences depend on their expectations. If an experience meets or exceeds expectations, the patient will be more satisfied with the experience, whereas if the experience falls below expectations, the individual will be dissatisfied.
Making the data actionable
Once patient experience information is collected, the question then becomes what do you do with it? Again, it’s important to identify the aspects of the patient journey (good and bad) that have the biggest impact on the overall experience. Patient-provider communication, care transition, and the availability of home-based medical care are all aspects of the patient experience that tend to significantly impact perceptions of the overall experience. Patients want to feel heard and respected by their doctor, a seamless transition once they leave the hospital, and the convenience of having their care team come to them (especially for elderly patients).
Once the most important aspects of the patient experience are identified, the units and staff responsible for these aspects of care need to be engaged and part of the feedback loop and continuous improvement process. Getting the right information to the right people who can take action is essential. In addition, getting staff buy-in and having a concrete action plan with tailored guidance and defined accountability are indispensable for creating successful improvements. This is often easier said than done as improving patient experience may necessitate large-scale institutional change. For instance, the Department of Veterans Affairs (VA) is rolling out patient experience improvement initiatives such as WECARE Leadership Rounding, where hospital leaders connect with patients and staff on a regular basis. Given the time, effort, and resources these initiatives require, facility leaders need to continually assess the success of these initiatives, keeping the ones that work and discarding the ones that don’t. This continuous feedback loop ensures that only the most effective initiatives are continued and promotes the upward spiral of providing patients with a better experience.
Additional details about our findings on the challenges and solutions for improving the patient experience can be found here: https://www.ipsos.com/en-us/knowledge/society/understanding-society-us-edition-patient-experience
Katie Joyce leads the US Public Affairs Government and Healthcare Service (GHS) research portfolio, with full business management responsibility. She oversees a senior team of data scientists, Ph.D. social scientists and statisticians, technologists, and project managers, as well as a behavioral science practice. In addition, Katie leads the portfolio of private health work in consumer survey research and brand tracking – key clients include Anthem, Blue Cross Blue Shield, and Kaiser Permanente.
Katie Ziemer, PhD, is an Associate Research Scientist at Ipsos Public Affairs. She conducts behavioral science research for federal and non-federal clients, including study design, data collection, data analysis, reporting, and advising. She also co-leads the development of a Behavioral Science Community of Practice which brings behavioral science service offerings to market and builds internal capabilities. Her research interests include attitude formation, behavior change, health promotion, disease prevention, brief psychosocial interventions, and positive psychology.
Katie is a licensed clinical psychologist with a doctorate in counseling psychology from the University of Maryland.
Posted By Glenn Kopelson,
Monday, April 2, 2018
Updated: Monday, April 2, 2018
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Did you know that 18%1 of the population has a mental health condition? Did you also know that 11%2 of the population has heart disease? There is less heart disease in the United States than people with mental health disorders. With mental health issues more prevalent than heart disease, why are mental health patients and families stigmatized?
Recently, the stigma associated with a mental health disorder affected me in a very profound way. I’m familiar with mental health issues because my family has a history of depression and anxiety, but in 2016 my 14 year old daughter had a suicide attempt and we were exposed to the stigma in a way which was new to us. Our journey started with my wife and I rushing my daughter to the emergency department where she had another three visits over the course of four months and was also admitted to the psych ward each of those times. After her time in the hospital, she spent the next several months attending a daily intensive outpatient program for adolescents. Next she spent one month living in a residential treatment facility. She spent the next six months at home enrolling in online schooling. With many doctors visits for medication management and one-on-one therapy in addition to group Dialectical Behavioral Therapy, she was able to integrate back into High School this year. I’m happy to say that she is doing much better as her suicidal ideations have diminished thanks to all the care we received over the past year. It’s been a long road to recovery and it would have been easier had stigma not been a part of her journey.
Unfortunately mental health disorders are viewed as embarrassing. It’s embarrassing for the patient, but also for the family because the subject is viewed as taboo by friends and family. This isn’t the case with other illnesses. Why is having heart disease less embarrassing than suffering from depression? Why is taking Lipitor more acceptable than taking Prozac? My family was faced with an ambush of gossip and innuendo. Your friends and family think, “they must be bad parents because they didn’t know what was going on with their daughter.” Moreover, what do I tell people at work? They surely won’t understand that I need time off to care for my daughter I can’t say anything at work because then it will go through the rumor mill and I don’t want to deal with all of that office craziness. Sure we received support from some of our friends, but for the most part, people were scared to talk to us because this was a mental health issue.
In addition to the stigma that my wife and I experienced, my daughter went through her own pain with shame caused by her friends. She was now labeled the crazy girl who was admitted to the psych ward. Teenagers perceive the psych ward as a place where crazy people are in straight jackets because that is how it is portrayed in the movies. A psych ward is a far cry from the depiction in movies like “Girl Interrupted” or “One Flew Over the Cukoo’s Nest.” So the stigma is perpetuated in the movies and television which does a disservice to how therapeutic a psych unit actually works and looks. In addition to fighting to heal herself, she had to navigate through misconceptions and the pressure that adolescents go through with their peers.
Let me provide a little more context to our journey with stigma that my family experienced. My next door neighbor was recently diagnosed with cancer. She told me that she has more casseroles in her freezer than she knows what to do with. Another friend of mine, whose father has terminal cancer, decided to take his dad out of the hospital so he could spend his final days at home. He too has a refrigerator filled with casseroles. My daughter suffers from depression, anxiety and PTSD and was admitted to the hospital for over a month. WHERE IS MY CASSEROLE? Of course I’m not really looking for a casserole, but for people to understand that mental health issues should be treated no differently than other medical disorders. They should be discussed with the same compassion and thoughtfulness that people provide to those suffering from all other ailments.
Let’s eradicate the stigma associated with mental health by seeking to talk openly and honestly about the issue. There are a few simple things you can do to help:
- Don’t be afraid to talk about mental health, but educate yourself and embrace that this is a common disease that affects nearly all families.
- Know that mental health is a disease, just like diabetes, heart disease and cancer.
- Most importantly show compassion. It’s amazing how far a little compassion helps a family or person with mental health issues.
- Finally, if you know someone with a family member with mental health issues, perhaps you can make them a casserole. Here’s a helpful website to get you started. https://www.delish.com/cooking/g1702/casserole-recipes/
1 Substance Abuse and Mental Health Services Administration
2 Center for Disease Control
Glenn Kopelson is Co-Chair of the UCLA Resnick Neuropsychiatric Hospital Patient Family Advisory Council where he works on issues to improve the patient and family experience.
Posted By Cally Ideus,
Tuesday, March 27, 2018
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I don’t like to think of myself as just a demographic. However, as a 43-year-old mother of five, I can’t help but identify with a famous trope in healthcare: women as the “Chief Medical Officers” of their households.
If you’re a woman, perhaps you can relate. We’re the healthcare gatekeepers for our families: 92% of us assist our loved ones with navigating care; 80% of household care decisions happen on our say-so. And research suggests that when we make these decisions for our loved ones, we rely heavily on social media to guide us.
As a professional in the industry, I understood all of this intellectually. But it took two overlapping health episodes to make me feel, on a visceral level, why we household Chief Medical Officers depend on social media to navigate our healthcare choices.
Where We Turn in a Crisis
The crisis began with a close friend’s devastating diagnosis. Just a year ago, before she got sick, we were skiing buddies. At 58, she was impossibly athletic, and she’d sailed past me on black-diamond courses without breaking a sweat. It was inconceivable that she’d ever become ill—until, of course, she did.
A week before Christmas, she learned that she had been diagnosed with inoperable, Stage IV soft-tissue carcinoma in her lungs. The prognosis was bleak. Stunned and scared for her, I wanted to lend a hand. The least I could do would be to help her find the best doctor she could.
I believed I was well equipped for this. My work puts me in contact with dozens of health systems on a regular basis, which meant I knew many knowledgeable professionals whom I could have called for a recommendation.
But I didn’t use those contacts at all. Instead, I started my search like over 80% of all healthcare consumers: online. In the heat of the moment, when I desperately wanted my friend to be in good hands, I felt compelled to turn to Google, Facebook, and star ratings on provider websites for validation.
Unfortunately, another panicked healthcare search experience would follow shortly thereafter when I got a phone call from my college-aged son. “Mom,” he told me, “I’m lying on the floor and I can’t get up.”
That frightened me. At the risk of sounding boastful, I can say that my son’s a very robust young man. A tri-sport athlete in high school, he once played through a serious bout of pneumonia, over my protests. If a health problem had literally floored him, I knew it must be serious.
My first instinct was to send him to the emergency room. After consulting with my sister, a medical professor at the nearest hospital, I learned that the ER had a serious backlog, and wouldn’t be able to see my son for four hours. My brother-in-law, a doctor, suggested urgent care.
So once again, I found myself (somewhat frantically) trawling through Google search results, trying to find a high-quality urgent-care clinic that could see him right away. My sister and brother-in-law pitched in as well—not by speaking with their colleagues, but by scanning Google results for top doctors in the area.
The reviews, provider websites and patient comments we found pointed the way to a nearby urgent-care provider, to whom I felt comfortable bringing my son. We got him an appointment, and learned that he had an extremely severe case of mono. A few weeks of bed rest later, and he was well again. Sadly, I never received a survey to compliment the amazing caring staff that took care of my son and his frantic mother. I did leave my reviews where I could, however, and raved to all who would listen on Facebook.
I wish I could say the same in conclusion to my friend’s fight with cancer. Despite our best efforts to secure her care, the insurmountable diagnosis ultimately claimed her life. Her voice lives on through her eternal comments left on social media, giving credit to the care she received throughout her journey.
The Emotional Pull of Stars
These are just two instances of how I—a relatively sophisticated and health-literate consumer—found star ratings on social media and provider websites irresistible when I needed help finding a provider. I’m certain that similar experiences happen thousands of times a day, all over the country. (In fact, there’s data to prove it: "Patient Ratings/Reviews" contain the most important information needed on a hospital website, according to the 2016 National Healthcare Consumer Study by NRC Health Market Insights.)
I believe that’s because of the unique frame of mind that a health crisis imposes on us. Such times can be frightening and extremely stressful, leaving us hungry for guidance, validation, and certainty. While no one can guarantee results in healthcare, I believe that we find comfort in the wisdom of the crowd.
Health systems looking to attract adult women, the gatekeepers of care for their families, should take note. Your online presence matters, a lot. And in cultivating it, you’ll be well served by giving your patients a voice, and by being transparent with what they have to say.
The more reviews accumulate, on your own website and elsewhere, the more information patients will have to help them with their care decisions. In moments of crisis, that information makes all the difference in the world—especially for “Chief Medical Officers” like me.
Cally Ideus is a combat veteran and international human intelligence scholar, and currently serves as a business development manager for NRC Health. In her role, Cally helps healthcare providers thrive in a consumer-driven economy by providing holistic customer intelligence essential to designing and delivering care experiences that surprise, delight, and inspire loyalty.
Her passions run deep for faith, family and justice. This is one of the reasons she speaks on multiple veteran and human intelligence subjects, but her favorite is “Battle ground on the home front” a story of survival after returning home. Cally lives in Nebraska on a ranch with her husband Jerod and sons Dalton, Quintin, Collin, Garret, and Mason. Her life wouldn’t be complete without the unconditional love of her two dogs, Daisy and Ziba.
Posted By Chris Anselmo,
Monday, March 5, 2018
Updated: Tuesday, March 6, 2018
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I will never forget the feeling of despair.
It was October 2011, and I was sitting in my neurologist’s office, staring blankly at the floor, devastated. I had urgently scheduled the appointment after recent developments in the progression of my muscle disease, Limb-Girdle Muscular Dystrophy Type 2B (also known as Miyoshi Myopathy). Two weeks prior, I had fallen for the first time in my life, at the ripe age of 25. I was walking to the store when my right knee gave out and I crumpled into a heap on the sidewalk. I thought that moment was devastating in its own right, but I had no idea the worst was yet to come.
The neurologist, whom I had seen twice before, was overall a nice guy. However, in my moment of vulnerability and fear, his words were anything but comforting. After I detailed my fall, he nodded and proceeded to tell me how my life would have to drastically change. “You are probably going to have to move out of your apartment,” he told me dryly. I was living with my best friends in a two-story walk-up, and was starting to struggle on the stairs, so although it didn’t necessarily come as a shock, it was still tough to hear. I was going to miss my friends terribly.
Unfortunately, the news got worse. “You’ll also probably need leg braces,” he said. Leg braces? All I could think of was Forrest Gump, and how, while standing in the road with his braces, unrepentant bullies hit him in the face with a rock. The news I was hearing that day felt like the rock. When I pressed my neurologist on what I was to expect in the future, he sighed and said, “You will probably be in a wheelchair by 30. It is not a guarantee, but that is the likely progression with this condition.” I looked at my parents, who were with me, and could see the color drain from their faces. “I wish I had better news,” the doctor told me when the appointment was over. “Just hang in there.”
I left that appointment despondent. It wasn’t a death sentence, but it also wasn’t a ringing endorsement of the rest of my life. I have five years left of walking, I thought. It was all too much to process, made worse by the fact that he offered no positive encouragement to soften the blow.
Already down on my luck going into the appointment, I spiraled further into depression. What can I reasonably accomplish in life if I’m going to continue to get weaker every day? Are any of my goals and dreams realistic now? Will I have the courage to deal with the difficulties to come? My life, for all intents and purposes, felt like it was over.
A few months later, while desperately searching online for any shred of hope, I came across a neurologist based out of Worcester, Massachusetts who was well-versed in my condition. I quickly scheduled an appointment for June 2012. I figured, at minimum, he could explain the science behind the disease, and keep me up to date on any progress on the drug front. If I was lucky, he might even be personable and sympathetic.
In the first ten minutes of my appointment, he told me more about my disease than all my previous doctors combined. I knew I was in good hands. Yet it wasn’t his knowledge that ended up making the difference that day.
After examining my muscle strength and telling me about the latest scientific progress, he started asking me questions I didn’t expect. What are your dreams? What do you want to do in life? I hesitated, saying that I wanted to go to business school someday, but didn’t feel I could go through with it. I told him that I had aspirations of working in the healthcare sector, helping patients, but with my declining strength and energy, I didn’t know how I’d be able to hold down a job long-term.
After listening intently, he gave me one of the most important pieces of advice I’ve ever received: “Don’t let this disease prevent you from achieving any of your goals.” He then proceeded to share an example of one of his patients who had battled ALS while attending Harvard Business School, and another man with my condition who was a businessman and who traveled frequently all over the country. “It might take some extra planning, but this disease doesn’t have to dictate what you do with your life,” he said. “It is only a part of your life.” I left that appointment feeling a sense of hope and a renewed optimism that I hadn’t felt in forever. I remembered thinking, maybe my goals aren’t so unrealistic.
Six years have passed since that appointment, and I think back on that moment often. I took my neurologist’s advice and went back to school, graduating in 2016 from the fulltime MBA program at Boston College. Today, although my goals and dreams have changed slightly since that appointment, I am well on my way towards achieving them, even though my condition has progressed significantly. I used to obsess on losing my ability to walk by age 30, but I am happy to say that I am now 31 and still on my feet. Although a wheelchair is in my near future, it is not something I fear anymore. If anything, I look forward to the freedom it will bring. Having goals and dreams to work towards has been instrumental in the acceptance of what is to come.
I share all of this because I have seen firsthand that dreams often get overlooked in the patient experience. As healthcare professionals, you are taught to diagnose, to treat, and to show empathy. And you do a great job! If I can offer one piece of advice, I would say to take the time to ask patients about their lives – what their goals are, what they dream of being someday, or what they want to do with the remaining time they have left. Really get to learn what makes their heart sing.
Dreaming is part of what makes us human. For patients diagnosed with a disease or dealing with a life-altering injury, our dreams oftentimes get dashed. Our hopes for the future evaporate into thin air. If you can help to open the doors that have shut in your patients’ faces - even just a little bit - it can make all the difference in their lives. They trust you, they believe what you have to say, and in those vulnerable first moments post-diagnosis, they are looking to you to gauge what is still possible in their lives.
If you can give your patient the permission to dream again – there is no better cure.
Chris Anselmo is a 31-year old writer and motivational speaker living with an adult-onset form of muscular dystrophy called Limb-Girdle Muscular Dystrophy Type 2B (LGMD2B). A Connecticut resident, Anselmo writes about his patient journey on his blog, Sidewalks and Stairwells, www.sidewalksandstairwells.com.
Posted By Allison Chrestensen, MPH, OTR/L,
Friday, February 16, 2018
Updated: Friday, February 16, 2018
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If you’ve listened to the patient experience conversations over the last decade, you know that much of the focus is on what happens inside hospitals (and on hospital grounds) and to a lesser extent, in outpatient clinics and doctors’ offices. And while The Beryl Institute’s definition recognizes the patient experience is shaped by a diverse group of professionals and occurs “across the continuum of care”, most of the operational focus around patient experience is on what happens within the walls of the hospital. My own patient journey, as well as my work as an occupational therapist helping patients to regain independence after illness, has taught me that it’s what happens after a patient leaves the hospital that is perhaps the most challenging part of the continuum of experience.
My first significant patient experience occurred when I suffered sudden cardiac arrest in 2013. I was unconscious during the acute phase of my illness, so my perspective is of the long recovery process, which I view in two separate phases. The first phase took place in the hospital where a team of healthcare professionals cared for me around the clock. There were people who kindly addressed my questions, even the ones I asked no less than four times; who asked how I was doing and seemed to actually want to know the answer to the question; who knew my husband by name and greeted him as they changed the bed linens and emptied the trash; who collected my meal card and patiently listened to my complaints about how a pureed dinner roll tastes nothing like real bread. There was my clinical team to whom my husband and I felt enormous gratitude for saving my life. My physicians thoroughly explained the plan to insert an implantable cardioverter defibrillator (the only treatment option for sudden cardiac arrest), a device that constantly monitors my heart rate and will deliver an electric shock if ventricular defibrillation is detected. I remember feeling very safe and secure—all of my concerns alleviated, my questions answered (or at least the ones my post-coma brain could generate at the time). I was discharged home the day after my ICD surgery.
All of that care and attention came to an abrupt end with the second phase of my recovery, which began once I arrived home from the hospital. The flurry of activity and round-the-clock care stopped, my husband went back to work where he admits he spent more time worrying about my wellbeing than he did on actual work tasks. Soon after I arrived home, I began conversations with my own employer about short-term disability, coverage for my job responsibilities, and all sorts of other details I felt unprepared to address. My friends were raising children, planning vacations, and going after promotions at work. I was fearful of going to the grocery store, afraid that I might collapse to the floor in the cereal aisle while this foreign device in my chest delivered a series of electric shocks.
In that transition time between experiencing a catastrophic illness and attempting a return to normalcy, my husband and I were left on our own to process our experience and its impact on our lives going forward. That, to me, was far more challenging than having my blood pressure taken every hour, waking from a deep sleep for a needle stick, or understanding a 10-page after visit summary.
It was only after I began to adjust to this new reality as a cardiac patient that feelings of resentment that began to overshadow my sense of gratitude for the life-saving care I received. Rather than choosing the best treatment option for myself, I began to feel that I had given consent to the treatment plan my physicians wanted for me. Note there is a significant difference in designing a treatment plan for the patient and designing that same treatment plan with the patient. Granted, in my case, the only other option would’ve been to have no intervention at all, a hard option to consider for a thirty-something-year-old woman who is at risk of experiencing another arrest in the future. As someone who likes to feel in control of her own health and wellness, however, having the opportunity to discuss this admittedly less desirable option with my team would’ve made all the difference to me as I navigated the path of recovery.
My own experience taught me that when the proverbial dust settles, the “what now?” question remains for our patients. This is an important facet of the patient experience, and it is directly impacted by what happens (or what doesn’t happen) during the patient’s time in the hospital. The extra five minutes that the physician or nurse spends asking about a patient’s values, hopes and fears can mean the difference between feeling like a number and feeling like a person. The compassionate actions of the environmental services and dietary staff, the rehabilitation and nursing teams, all create impressions and emotions that patients and families take with them into their recovery. For the patient, these actions can make the difference between feeling powerless to manage a chronic illness or cope with an unexpected health scare and moving forward with new perspective and determination.
This is the “long view” of patient experience—the awareness that our actions as healthcare professionals have far-reaching impact. We become part of the patient’s story. My patient story is about the pain of losing control of my wellness and my decision-making power in the midst of immense gratitude for receiving miraculous, life-saving care from dedicated professionals. It is also about the care and compassion that my care team showed to me and the way that fueled my desire to derive meaning from my experience and to make a contribution in this field. I am a patient. However, a patient is not who I am.
Taking the “long view” of patient experience work helps us to realize the true impact of “the little things”, and it may just help each of us to reach beyond an organizational commitment to excellence and toward an individual commitment to doing good.
Allison Chrestensen is the founder of Tandem Healthcare Solutions, a consulting firm specializing in co-designing experience improvement for patients and staff, using the Experience-Based Co-Design model. Allison brings her perspective as a clinician, patient, and quality improvement project leader to her work and has served in project leader, faculty and advisor capacities for healthcare organizations around the U.S., U.K., and Canada to facilitate building innovative and sustainable models for partnership with patients and community members.
Posted By Tom Scaletta MD CPXP,
Thursday, February 15, 2018
Updated: Thursday, February 15, 2018
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I think everyone today can agree on the importance of having communication tools to interact with patients and family members. However, in the era of value-based healthcare, doing a good job interacting with patients is not nearly enough.
At my organization, we have created a simple communication tool called G.R.E.A.T.™ that will help inspire a service-minded culture. This service standard helped us align our mission/vision/values with our culture and leads to enhanced patient satisfaction, improved care quality and a more engaged staff. Connecting on a deeper level with our patients and being mindful of their understanding of what is going on are essential components in achieving optimal outcomes.
A key component of the G.R.E.A.T. ™ is the ‘R’ that stands for ‘relate.’ To truly connect to our patients (or their family members), it is essential to have a personal conversation separate from the medical issues (of course, assuming the patient is not in any immediate distress).
An easy way to create a rapport with patients, across generations, is to ask about one’s aspirations or accomplishments.
- With younger patients, “What profession are you planning?”
- With middle-agers, “What is your profession?” and
- With older patients, “What was your profession?”
Such questions typically leads to some back-and-forth banter that creates a nice bond. You will find you like the patient more … and they will like you more. The content of the conversation is not important though it must be authentic and empathetic. This type of interchange will create trust, the foundation of the people experience, that of both patients and providers.
These conversations are beneficial not only for the patient but also the providers of care. A great patient experience requires a great provider experience and a great provider experience requires a great patient experience. The closer you get to your patients the further you get from burnout.
I would like to share a story of this in practice. I was working a typical emergency department shift with a great team and had a steady influx of patients all evening. At 8 pm paramedics rolled in with an elderly, demented lady from a nursing home with right-sided weakness that began yesterday. A CT scan uncovered a golf-ball sized tumor with swelling. She had a history of breast cancer so this likely represented a metastatic lesion. Typical care ensued -- fluids, steroids, comfort medications and a call to the hospitalist for admission.
I then phoned the patient's daughter (and power of attorney) to suggest that she and other family members begin discussing how aggressive they wanted the treatment plan to be. The daughter interrupted, "Doctor, could you just go to my mom's bedside and say 'Dr. Peters, you were right'?" After my "Huh?" she explained "My mom is smart and knows her body. She has a PhD in both psychology and religion. Last month, a doctor told us she has progressive, incurable dementia. When he left the room my mom turned to me and said 'Well, yes, I'm certainly more confused but I'm not demented. They just haven't figured out what this is.'"
So, I went to her room, sat down, described the situation, and ended with "Dr. Peters, you were right." She turned to me beaming with pride and confidence and said "I knew it!"
She certainly did.
I slipped a copy of her CV that I found online into her chart. I wanted everyone to know this amazing woman that all of us were privileged to care for.
Tom Scaletta, MD CPXP CPPS, obtained an undergraduate degree in mathematics and computer science and worked as an computer programmer before entering medical school. He completed a residency at Northwestern and is board-certified in emergency medicine and clinical informatics. Tom serves as the emergency department chairperson and medical director of patient experience for Edward Elmhurst Health.
While President of the American Academy of Emergency Medicine, Tom collaborated with the Emergency Nurses Association to create a Code of Professional Conduct. His white papers, “The Seven Pillars of Emergency Medicine Excellence” and “The Calculus of Patient Satisfaction,” were published by Medscape.
Tom designed the first patient callback system in 1996 and the first automated means of text/email contact and staff notification in 2012. His models were praised by the Robert Wood Johnson Foundation and Urgent Matters (George Washington University), an organization that evaluates emergency medicine innovations.
Posted By Mark VanderKlipp,
Friday, January 19, 2018
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With the holiday season over, your thoughts have undoubtedly turned from gift giving and New
Year’s resolutions to “getting back to daily life.” As you do so, I’d encourage you to consider a
resolution to provide a gift to your staff, patients and their families that keeps on giving: clarity.
In over 30 years as a designer, I’ve seen clients focus more on the tool (the identity,
communication, policy, wayfinding system, mobile app, architecture, etc.) than they do on the
anticipated behaviors of the people that support or interact with those tools.
To be sure, these are critical elements designed to support any patient experience initiative. My
goal in writing this post is to help you see the value of designing for human interactions
(engagement, connection, expectation, interaction, enlistment, orientation, learning) as well as
the tools themselves.
In a 2015 HBR article1, the authors assert that “with very complex tools, the design of their
‘intervention’—their introduction and integration into the status quo—is even more critical to
success than the design of the tools themselves. The more complex and less tangible the
designed tool is, the less feasible it is for the designer to ignore its potential ripple effects.”
For most healthcare employees and consumers, there is no more complex, less tangible
experience than a bewildering, impenetrable and continually changing health care system. The
tools created to help engender clarity need to be thoughtfully designed, tested and integrated
to assure they don’t add to the stress, both for caregivers and patients.2
Here’s an example: a formerly independent hospital merges with a much larger faith-based
institution. The wheels are set in motion to design tools to support this merger: internal and
external brand communications, updated facilities, wayfinding signage, EMR systems, billing
systems, relationships with insurers, ambulatory clinic networks, HR policies and procedures,
the list goes on and on.
As a clinical or clerical provider, I need clarity:
- As an ambassador for this new faith-based brand, ostensibly very different from the old one,
how is my behavior expected to change?
- Will I be able to help design the process to successfully navigate the transition?
- As new tools are designed and integrated, how will I be prepared to use them?
- How can I, in my day to day role, bring clarity to our patients and their families?
As a patient or community member, I need clarity:
- How will this impact me? How will it benefit me?
- How will expectations of me, as a patient or community member, change?
- How will the organization help make the transition easier?
- Will there be physical changes? Will I be able to park and enter in the place I always have?
- Who will help me? Will the people I’ve come to know and trust still be there?
The gift of clarity establishes the roots needed to visualize, design and deliver a a human centered
healthcare experience: to understand the potential points of confusion, then meet
individuals at each step in their journey with simple, consistent and well-supported tools.
Whether these are designed to support small initiatives or large-scale transitions, anticipating
the “ripple effects” of human interactions is critical to achieving sustainable success.
Creating an effective caregiving culture happens by design, not by default. It’s up to us as
practitioners to break down silos, see gaps in communications, then test and iterate the tools
designed to bring clarity to the questions that our staff, patients and their families bring to this
world of healthcare experience.
Truly, there is no greater gift we can give. Happy New Year!
1. Design for Action, Harvard Business Review, September 2015 by Tim Brown and Roger L. Martin
2. Creating a Culture of Health: Design that Goes Beyond the Mobile Application by Dr. Joyce Lee MD, MPH “Doctor as Designer “ @joyclee
Mark VanderKlipp is an experience and systems designer, working in human-centered graphic design for over 30 years. He helps clients visualize the systems within which they function, empowering staff to deliver an experience that’s clear, relevant and human. He previously spent 24 years with a world-class wayfinding design firm, 13 as its president, where he was the lead strategist for diverse assignments in healthcare, higher education, civic, corporate, trails and tourism throughout North America. Mark is a 1987 graduate of the University of Michigan. In 2012 he earned his evidence-based design certification (EDAC) through the Center for Health Design, and in 2017 became certified in Systems Practice through +Acumen. He is also a founding partner of the customer experience consulting firm Connect_CX.
Posted By Gen Guanci,
Thursday, January 4, 2018
Updated: Thursday, January 4, 2018
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Those in health care know all too well that the patient experience is a top pain point for executives and therefore a top organizational priority. There is also no shortage of initiatives, programs and activities that focus on improving that experience. Committees and task forces are formed with participation from leaders across the entire organization. Education and action plans are developed and rolled out. Patient experience scores are closely watched for the anticipated improvement. Then, reality often sets it: There is no—or only minimal—improvement. How can that be? And what can be done about it?
What if you were to take the traditional approach to improving the patient experience—the approach where initiatives, programs and activities are developed by those outside the point of care and rolled out to those who must operationalize them—and flip it? Shared governance is a leadership model that does exactly that. In a shared governance culture, staff members are empowered to make decisions that meet a set of articulated expectations shared by leadership. Shared governance has proven to be a highly successful partner in crafting strategies that yield sustained improvements. Shared governance is built on a set of four overarching principles:
Staff and leaders work together to improve practice and achieve the best outcomes.
Everyone contributes within the scope of her or his role as part of the team to achieve desired outcomes.
Staff and leaders share ownership for the outcomes of work and are answerable to colleagues, the institution, and the community served.
Participants accept that success is largely dependent on how well they do their jobs.
Using shared governance, groups of staff members (councils) are charged with the development of the specifics of the plan to address the opportunities for improvement. Let’s take the desire to have purposeful rounding be a standard of care. While the desired outcome is purposeful rounding, it would be up to the individual councils, groups, departments, or units to determine how this could be best operationalized in their area. Here are some examples of what could happen when the people closest to the work in each department are empowered to make decisions about how to make rounding purposeful for their specific patient populations.
The Maternal-Child department determines that rounds will be done hourly between 6:00 a.m. and 11:00 p.m., then every two hours between 11:00 p.m. and 6:00 a.m. They have made this decision to meet the needs of their patients to have a period of uninterrupted sleep.
The Surgical unit decides rounds will be a shared responsibility between the RN and the Clinical Assistants (CA). RNs round on the even hours and CAs on the odd hours. For the same reasons as the Maternal-Child department, they too decide hourly rounding hourly will be done between 6:00 a.m. and 11:00 p.m., then every two hours between 11:00 p.m. and 6:00 a.m.
The Patient Experience council, made up of a mix of staff members from across the organization (i.e., environmental services, clinical, nutritional services, etc.) work together to develop a meaningful rounding experience for patients and staff members that includes addressing the best practices in rounding conversations.
The expectation for each of the above groups was to craft a meaningful rounding experience that worked for the patient as well as the specifics of the individual units/departments. The plans, developed by staff members, are supported by colleagues as peer developed and rolled out the plans. Peers create the accountability with each other, and this in turn lessens the need for leadership to “manage” the plan. It also moves organizations from “us” and “them” to “we.”
There is an ancient Chinese proverb that states “An owner in the business will not fight against it.” Using shared governance to craft a plan for sustainable improvement creates ownership at all levels of the organization.
Gen Guanci is a consultant with Creative Health Care Management where she works with organizations as they build a culture of excellence. Her work with Magnet® and Magnet® aspiring organizations focuses on improving the patient experience, work environment, clinical practice, and patient outcomes. Her expertise in shared governance has enable her to empower staff to generate outcomes that exceed national benchmarks.
Posted By Sven Gierlinger,
Thursday, November 9, 2017
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It happened to me - first came a tingling in my fingers and toes; and within days, I was paralyzed. A husband and father of two young children at the start of a new assignment with The Ritz-Carlton Hotel Company - I was diagnosed with Guillain-Barré syndrome, a rare condition in which a rapid-onset muscle weakness caused by the immune system attacks and temporarily damages the peripheral nervous system. Suddenly, and for 90 days and nights, I was 100% dependent on my doctors, nurses and therapists.
Believe it or not, I’m actually grateful for this experience, as it showed me that as a patient, you are challenged to heal in many ways – physically, mentally, and emotionally. My experience in these moments helped me understand the power of embedding both service and empathy into the clinical processes that truly can make or break a patient or family experience. Every moment counts.
My years at The Ritz-Carlton opened my perspective to what guests really want – and it’s much more than crystal chandeliers, marble floors and fancy ocean views. The Ritz-Carlton takes culture very seriously and believes it should be fully ingrained in all its employees, even by memorization. This credo provided the gold standards of service that were the focus of my everyday work, and until this day I can recite each word.
The Ritz-Carlton Credo: The Ritz-Carlton is a place where the genuine care and comfort of our guests is our highest mission. We pledge to provide the finest personal service and facilities for our guests who will always enjoy a warm, relaxed, yet refined ambience. The Ritz-Carlton experience enlivens the senses, instills well-being, and fulfills even the unexpressed wishes and needs of our guests.
Based on my own professional and personal healthcare experiences, and as the Chief Experience Officer at Northwell Health, I knew I had to look at the experience through a very different lens. We have seen that the hospitality industry has established a precedent of best practices that can directly correlate to the healthcare industry. Let’s take the crossover themes from this credo for example: providing genuine care and comfort, personalization, a warm yet refined environment, and delivering on unexpressed wishes. I often wondered what this same credo would look like if ‘Ritz-Carlton’ was replaced with ‘Healthcare’, and if ‘guests’ were replaced with ‘patients’.
Let’s read the credo again…
The Healthcare Credo: Healthcare is a place where the genuine care and comfort of our patients is our highest mission. We pledge to provide the finest personal service and facilities for our patients who will always enjoy a warm, relaxed, yet refined ambience. The Healthcare experience enlivens the senses, instills well-being, and fulfills even the unexpressed wishes and needs of our patients.
Now, isn’t this what we all want and deserve from our own healthcare experience? It’s not only about first impressions; it’s about lasting impressions and creating that consistency in the patient experience. As experience leaders, it is imperative we understand how to enliven all the senses – what patients see, hear, touch, taste and feel. This understanding can greatly affect the patient experience, as well as the overall healing process.
At the end of the day, I think we can all agree that healthcare is about helping people through their most vulnerable time, and there is no greater honor. So, I challenge each of you to think about healthcare differently. Reflect on this healthcare credo and ask how you can translate these concepts into practice to truly make every moment matter.
Sven Gierlinger serves as the VP, Chief Experience Officer at Northwell Health. With a focus on providing exceptional customer service and delivering the highest quality care, Mr. Gierlinger is responsible for building an engaging, innovative and collaborative culture that drives organizational growth and customer loyalty through the patient/customer experience. He is also an Executive Board Member for the Beryl Institute and a member of the Institute for Innovation, Founding Executive Council. Northwell Health, headquartered in New Hyde Park, New York, is the largest healthcare provider and private employer in New York State. The system serves over 8 million patients in metro New York and the surrounding areas with its 22 hospitals and more than 550 outpatient practices.
Posted By Rhonda Ramos,
Wednesday, November 1, 2017
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Service recovery is no foreign concept to the business world. It is a fundamental practice that can turn a negative situation into a positive statement about a company. Simply put, it is the process of making things right after something has gone wrong with the consumer’s experience. You see this common occurrence in retail, restaurants, and even airlines. Yet how can we adopt service recovery in healthcare?
Let’s face it, we’re not perfect. We fail to meet our patients’ expectations in numerous ways: excessive wait times, appointment scheduling problems, room/environment issues, miscommunication, and the list goes on. In the food service world, if I go out to dinner and a steak is not prepared the way I ordered it, the restaurant would probably remove the entrée from my bill. In healthcare, can we give a free prescription because a patient had to wait, or provide a coupon for a lab draw if the patient requires multiple needle sticks? Probably not.
In order to curb bad public relations since dissatisfied customers tend to tell others about their negative experiences, we’ve had to get a bit creative in healthcare. We know that the basis of all our interactions is communication; therefore, our service recovery program is grounded in the way we communicate during a complaint. We developed the acronym GIFT:
- Gather – Listen to the individual’s concern and validate their feelings
- I’m sorry – Offer a genuine apology for not meeting their expectations
- Feedback – Explain what you plan to do and follow up
- Thank – Thank them for sharing their concerns
These four simple steps provide a mental pathway as you’re attempting to diffuse a complaint. At UPMC Pinnacle Hanover, we carefully incorporated the Heart-Head-Heart communication method, which we adopted from the Language of Caring philosophy. By offering a blameless apology, we express ownership yet not necessarily assume fault. We involved our Patient/Family Advisory Council in the creation of this program, and they advised us that a genuine apology is the most critical element. The goal is to allow the complainant to feel heard, validated, and respected.
While most concerns can be resolved simply with proper communication, there are instances when it might be beneficial to offer something “extra” such as a gift card or other small token. CMS guidelines state that a service recovery item presented to a patient cannot exceed $10 per person or $50 in an aggregate year. (This is also under Department of Health and Human Services - OIG Advisory Opinion No. 08-07.) If a department chooses to obtain a supply of gift cards to various local vendors (restaurants, gas stations, etc.), they track them using our internal reporting system. Reports can be run, by patient, on a monthly basis to ensure that we are compliant.
One of the most important elements of this entire program is empowerment. Rather than only allowing a department head to resolve concerns, which could happen after a patient has already left the facility, we wanted to educate and empower each employee to utilize service recovery. By immediately responding to concerns and complaints we can create loyalty with our “customers.” We can create a learning culture that treats complaints as gifts, or opportunities for improvement, that steers away from a negative connotation to something more positive and patient-centered.
When an issue is identified and addressed before the patient is discharged, theoretically it will also help to reduce the number of formal grievances we receive. Unfortunately, it is difficult to quantitatively prove that our service recovery program has confidently reduced our number of formal grievances. However, we do know that there has been a shift in our culture and employees feel empowered to take ownership to provide quick and decisive action when something has gone wrong. And at the end of the day, that’s a win.
Rhonda Ramos is the Patient Experience Manager for UPMC Pinnacle Hanover and has worked for the organization for ten years. She is fluent in Spanish and started her career in healthcare as an interpreter and patient advocate. Rhonda grew up in Ellicott City, MD and currently resides in Hanover, PA with her husband and two children, ages 3 years and 6 months.