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The Beryl Institute invites members and guests to submit posts on patient experience related topics. For guidelines and information on submitting a post for consideration, contact michelle.garrison@theberylinstitute.org.

 

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OpenNotes: Doctors, Patients and Caregivers on the Same Page

Posted By Liz Salmi, Wednesday, July 19, 2017
Updated: Wednesday, July 19, 2017

After dating me for only 18 months, my now husband became my health care partner. I was 29. He was 31.

In mid-2008, I suffered a massive seizure, landed in the ER, and a scan revealed I had a mass in my brain. Brett suddenly found himself in love with a 29-year-old gal with brain cancer.

After my first hospitalization, Brett jumped into caregiver mode. If I needed clothes for the hospital, Brett packed the bag. When a nurse missed one last stitch in my scalp, Brett finished the job with tweezers. When I needed help coordinating a complex regimen of medications, Brett designed a color-coded spreadsheet that matched my giant pillbox organized by days of the week and times in the day.

Meanwhile, I jumped on the Internet to research treatment options on PubMed, joined Facebook Groups and Twitter communities for people with brain tumors, and started blogging about my experience for family and friends.

There is no right way to respond to illness. My way was to respond with curiosity. I cared about understanding the how and why of my diagnosis and the what of my treatment. Brett’s way was to respond with unconditional love and support. And he cared about taking care of me.

But there is one thing we both needed and continue to need to be active and engaged participants in my care: access to the details of my ongoing care plan—information that is a part of my medical record and embedded in my doctor’s notes.

Brett and I didn’t even know notes were a thing until earlier this year when a change in health insurance forced me to uproot my care from one health system to another. While in the process of collecting my medical records I stumbled across a large PDF document that revealed an insider’s view of my last eight years of living with brain cancer—my notes.

Doctor’s notes (or visit notes, progress notes, clinical notes) are the most important information in our record. This information is readily available to doctors and other members of the health care team to remind them about a patient’s condition and plan for care.

I received great care from my previous health system, but like 96 percent of Americans, my clinical notes were not shared through the online patient portal. This made me wonder… why hide my notes?

I want this to change—for me, for my husband, and for every patient facing a health challenge or working to stay well. 

OpenNotes is a national movement encouraging doctors, nurses, and other health professionals to share the notes they write with the patients they care for using secure, patient portals, with the ultimate goal of improving the quality and safety of care. Shared notes enhance the patient experience by improving communication and trust, and reading notes helps to empower patients to make more informed decisions.

Access to notes can help caregivers like Brett, too. In a 2016 study*, patients and care partners with access to open notes stated that they had better agreement about treatment plans and more productive discussions about their care, and patients were more confident in their ability to manage their health and felt better prepared for office visits. Even better, care partners reported improved communication with patients’ providers at follow-up.

In less than five years, the OpenNotes movement has grown access to notes from 20,000 to over 15 million people. That number is impressive, but it represents just 4 percent of the U.S. population.

When I, the patient, don’t have access to notes, neither does Brett—the person most invested in my care. I spend about two hours each year with my health care team, and over 5,000 waking hours in self-care or “Brett-care.” Access to my notes could help us remember what we need to do between now and the next appointment with my doctor.

So what’s the hold up? Why don’t more people have access to their full medical record and clinical notes?

Doctors and health systems claim people will not understand their notes, or be afraid of what is written in them. This makes no sense to me. I am already looking for information about my diagnosis on the Internet—shouldn’t my first search be based on information in my own medical record?

My husband and I are the most invested people in my care, and the notes are about me. Any information about my health and health care is important to us, and we want to know about it. We can handle it.

* Wolff J, Darer JD, Berger A, et al. Inviting patients and care partners to read doctor’s notes: OpenNotes and shared access to electronic medical records. J Am Med Inform Assoc (2017) 24 (e1): e166-e172.

Liz Salmi is the Senior Multimedia Communications Manager for OpenNotes. OpenNotes is a foundation-funded national movement advocating for clinicians to share their visit notes with patients via patient portals. She is also a patient who does not have access to her notes.

 

 

To hear more from Liz and about OpenNotes, join us August 29th for the upcoming webinar, The Power of Knowing. You will learn more about the OpenNotes movement and how your health system can participate, and hear from a doctor and a patient about their personal experiences with notes and transparency. 

Tags:  caregiver  notes  Patient Experience  transparency 

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Paws and Presence: The Story of “I’m Here”

Posted By Marcus Engel, Monday, July 17, 2017
Updated: Monday, July 17, 2017

I can’t remember the impact, but I remember the headlights. Then, the pain. The all-encompassing horrors of broken jaws, crushed facial bones and desperate attempts to breathe.  I remember the metallic taste of blood mixed with gasoline. Then…the  blackness. But, how could I know that darkness was permanent? How could I know that I was now blind?

I can’t remember the medics, the crike, the ambulance speeding to Barnes Hospital, but I remember my clothing being cut off. And, I remember Jennifer. 

Throughout that wretched night in the ER, Jennifer held my hand and never left my side. Her presence and her words, “Marcus, I’m here…” were the only things she could have done to help…and they were exactly what I needed.

Throughout the hospitalization and recovery, rehab and 20 years of life, I knew nothing else of Jennifer. Her story is in my memoir and “I’m Here: Compassionate Communication in Patient Care.” But, beyond that night? I knew nothing. No last name, not her position in the ER. Nothing.

Two years after the trauma, as a 19 year old, I found myself in Morristown, New Jersey, training with my first Seeing Eye dog, a black lab named Dasher. Some people measure life in years. I measure life in dogs. Dasher was by my side for seven years. When he retired at age nine, I thought my heart would break. I’d lost my sight, so I thought I knew what loss was…but I was wrong.

Life goes on. We all know that. Dasher’s retirement ushered in another black lab, Carson, who was with me for another seven years. Then came Garrett; a yellow lab who, if you’ve heard me keynote since 2010, you’ll probably remember.

Soon after I picked up Garrett’s harness for the first time, we moved to New York City where I began my Narrative Medicine Master’s program at Columbia University. As I continued keynoting around the country, Garrett was by my side for countless flights, hotel rooms, hospitals and conference centers.    

Then, Barnes-Jewish Hospital, the facility that saved my life, invited me to speak. As always, I told the story of “I’m Here” and Jennifer. Afterward, a member of the patient experience team approached and said words I’ll never forget: “Marcus, we have a surprise for you… we found Jennifer.”

Shock. Disbelief. Confusion. I was nothing short of a blubbering mess as I, for the first time in 20 years, held her hands again. Finally, I got to say thank you.

Weeks later, Jenny and I were interviewed by the St. Louis Post-Dispatch.

The journalist asked lots of questions, including, “How long have you had Garrett? How long do Seeing Eye dogs work? Where will Garrett go when he retires?” 

Seeing Eye dogs work, on average, seven to nine years. Provided Garrett stayed healthy, we would be together around four more years.

“Will you keep Garrett when he retires?” she asked.

“No, I’ll then get another dog and need to focus all my bonding on the new pup. That’s not fair to Garrett, so I’ll find someone who wants to adopt him.”

Jenny practically jumped out of her seat declaring, “I want him!”

“For real?”

“Absolutely, I would love to have him!”

“Done,” I said. “I can’t imagine better hands.”

Last December. I laid on the floor of a hotel room, thanked Garrett over and over for being mine, for keeping me safe and for his unconditional love. Tears fell onto his velvet ears. Then, a knock at the door.

I hugged Jenny, fell to my knees and held Garrett one last time.

As Garrett and Jenny walked out, all I could think of was love. Love. Compassion. Presence. That’s what I received from Jennifer on the worst night of my life…and that’s what Garrett gave throughout his working life. It is a model of what all truly excellent patient experiences are comprised.

Marcus Engel, M.S., CSP, CPXP is a Certified Speaking Professional & author whose messages provide insight and strategies for excellent patient care. As a college freshman, Marcus Engel was blinded and nearly killed after being struck by a drunk driver. Through two years of rehab, over 350 hours of reconstructive facial surgery and adaptation through a multitude of life changes, Marcus witnessed the good, the bad and the profound in patient care. Marcus and his wife, Marvelyne, are the co-founders of the I’m Here Movement, a 501(c)3, which is changing the culture of care with two simple words.

 

To hear more from Marcus, join us August 15th for the upcoming webinar, Presence: Compassionate Communication Through Everyday Mindfulness or September 15th for our Regional Roundtable event in Ontario.

Tags:  compassion  empathy  patient experience 

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Why You Should Take Online Reviews Seriously

Posted By Tashfeen Ekram, MD, Monday, July 17, 2017
Updated: Monday, July 17, 2017

At the root of it, many physicians fear the impact and the effort it takes to manage online reviews. A Harvard study published this year showed 78 percent of physicians believed engaging with online patient reviews would increase their job stress, while a smaller group believed it would negatively affect the physician-doctor relationship. But in today’s digital world, the importance of online reviews is undeniable. After all, a staggering 77 percent of patients visit review sites before choosing a physician.

Healthcare is a Marketplace, and Patients Have High Standards

With the greater emphasis on smart decisions in today’s consumer-driven world, patients have high expectations before they walk through the door. Patients want to know what the experience is like in your practice. Did they read that the front desk staff was warm, welcoming, and thorough? Did they read how you took fifteen extra minutes to help a patient understand a drug’s side effects? Or how the bedside manner of some of your doctors was lacking? The answers are likely yes.

Patients who trust their doctors are more likely to experience satisfaction with them. Seeing a number of online reviews can help patients develop trust with a physician or practice.  Reading online reviews affirms confidence in your patient’s decision. Feeling empowered is a good start for many patients, especially when placed in a new situation, like visiting a referral specialist. Patients simply want a positive healthcare experience.

It’s Time To Be Intentional About MACRA

With the recent adoption of MACRA, the government is prioritizing quality of care. We hear again and again that the goal of value-based care is to lower healthcare costs while improving healthcare outcomes. An article from the Harvard Business Review states, “We must move away from a supply-driven health care system organized around what physicians do and toward a patient-centered system organized around what patients need.”

Unless all your patients have a very close relationship with you, you won’t always know exactly what your patients need—or where you can improve. Online reviews can show you just where your quality of care may be lacking.

What kind of information are patients looking for in your reviews? A statistic showed that 28 percent of patients searched for a practice’s care quality statistics. Star ratings, other patients’ experiences, and doctor backgrounds followed closely in importance. It seems that like the government, patients are looking for information about the quality of care you provide.

Using Reviews to Your Advantage

Online reviews can impact your practice, reputation, and even your relationship with your patients. While they can be a source of anxiety for some physicians, they can also be a tool to boost patient satisfaction and market your practice.  

According to one statistic, 90 percent of consumers read 10 or more reviews online before trusting a business. It’s simple: the more reviews you have, the more patients will perceive you to be credible and trustworthy. And the more they’ll be at ease when they visit you for the first time.

Of course, there will always come a time when the dreaded negative online review happens. The review may be pointing out an actual area of improvement for your clinic, or even something completely arbitrary and out of your control. However, responding tactfully and professionally to negative reviews is just as important as having positive reviews. After all, the internet’s eyes are watching.  

Additionally, there are a few tools out there that help minimize negative reviews. Luma Health is a patient communication platform, which sends text messages asking patients for feedback after appointments. If patients rate the visit an 8 or above, they get redirected to a review website of your choice (like Yelp, Google, Facebook, Healthgrades, RateMDS). If patients rate the visit 7 or below, they’re directed to a private feedback form that’s sent directly to your clinic. This minimizes public negative reviews, allowing you to address matters with patients directly to make it better.  

No matter what the complaint was, apologize to the patient and thank them for taking the time to leave a review. Then invite them for an offline discussion where you can get a better understanding of what they’re really concerned about. Readers—and the unhappy reviewer—will appreciate the openness, helping you build your transparency.

Tashfeen Ekram, MD, is a radiologist, self-taught coder, healthcare innovator and Co-Founder of Luma Health. Contact him on Twitter at @tashfeenekramMD.

 

Tags:  patient satisfaction  physicians  reviews  transparency 

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Embracing Patient Feedback Lays the Foundation for Better Healthcare Relationships

Posted By Brandon L. Parkhurst, MD, MBA, CPXP, Tuesday, June 13, 2017
Updated: Tuesday, June 13, 2017

In a blog, published August 28, 2012 Health IT CEO and thought leader Leonard Kish declared an engaged patient as the blockbuster drug of the century.My reaction was an immediate “Yes!”  As a physician I’ve experienced many examples of patients leading more enriched lives due to their healthy decisions.  When my organization started to discuss sharing patient feedback via online provider profiles, the potential of encouraging patient engagement seemed the most significant benefit.

At Marshfield Clinic, we decided to share patient feedback via a provider star rating and patient comments on our public website. This data is shared for our clinic practice providers who have a minimum of 30 returned surveys over a period of 12 months. We do not share data regarding our urgent care, emergency room or hospitalist providers as our patients are not able to choose providers in those settings. Our desire is that our patients, and future patients, will be able to use this data to assist in their health care decisions. Sharing patient feedback openly lays the foundation for a collaborative health partnership based upon transparency and trust. Once trust and an environment of collaboration are established, engagement is easier to achieve.

In addition to giving patients access to data which can impact their care decisions, transparently sharing patient feedback highlights the excellent care given by our providers. Personal sharing of positive care experiences, i.e. word-of-mouth advertising, is commonly identified as a significant business asset. In this age of social media, sharing a web link to a provider profile, along with a personal testimony, has the ability to impact a much wider audience than a traditional face to face conversation. This expanded conversation regarding health care providers might even empower some individuals to seek care where they otherwise might have gone without. As caregivers we all recognize the devastating consequences when care is postponed or avoided. These online conversations have tremendous power to engage individuals in their homes and communities.

Ultimately, I’m certain Mr. Kish’s words will prove wise as person-centered healthcare and the resulting effects of improving patient engagement are realized.  Sharing data transparently is one step in the evolution of person-centered healthcare.  Over the last few years many health care organizations have embraced the transparent sharing of patient feedback. Paul Sommer (Geisinger Health System) and I recently presented a webinar on this topic with many questions and comments from those attending. This webinar remains available through The Beryl Institute archives. In the end, we all benefit when health care collaboration, trust and engagement is improved and supported!

1http://healthstandards.com/blog/2012/08/28/drug-of-the-century/

Brandon Parkhurst is the Medical Director of Patient Experience for Marshfield Clinic and splits his time between the practice of Family Medicine and leading patient experience improvement. Brandon was born and raised in rural north Missouri where his parents and grandparents consistently taught him that you do right by people because it’s the right thing to do.

Tags:  data  feedback  partnership  patient engagement  physician  star rating  surveys 

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The Importance of Culture Building

Posted By Magali Tranié, Thursday, June 1, 2017
Updated: Tuesday, May 30, 2017

I graduated college with the unbridled optimism and sense of invincibility of youth, only caring about completing tasks and my salary. I never considered a company’s culture or my “engagement” level.

Until I was wrong.

Sometime after graduation, feeling underappreciated, I took an “exciting” opportunity with a great salary that was too good to be true – and it was. Thus began a very rough few months: cultures clashed, and I became highly disengaged. The overachiever that I am turned into a low performer. My friendly personality turned sullen.

Yes, culture matters. Much more than completing tasks, and certainly more than a salary.

So it was not surprising to me that recent patient experience research unveiled the growing focus of employee engagement in a comprehensive approach to patient experience improvements efforts. Not that it’s a new concept; many industries – including healthcare – have been struggling to define and embrace employee engagement initiatives for years.

No industry can benefit from employee engagement more than healthcare. In fact, a Gallup study of 200 hospitals found that nurse engagement was the number one variable correlating to mortality, beating out number of nurses per patient per day! 1

So, where do you begin?

Tackling employee engagement starts with a strong foundation: a well-defined culture. Writing down who you are, how you want to behave, and what your goals are the first steps.

Who you are starts by going deep to the core of why your organization exists. When we developed my company’s purpose, the question “Why do we go to work each day?” guided us. We knew that our associates – which is what we call our employees – were instrumental.

Our purpose reads: “To build a great company by positively impacting the lives of our associates, our communities, our customers, and their patients.” We intentionally selected words like “positively” and “impacting,” (indicating action vs. being passive). Note that associates are listed first – that was not accidental!  And we include patients – because they are ultimately the ones we impact.

Next, we wanted to provide a roadmap for the behaviors we expect from our associates; the “how we do our work”. So we developed our Values, which are “Be respectful. Be Remarkable. Be safe. Be honest.”

We then determined our goals: Associates, Customers, Growth and Profits. If you’re wondering why a business would put associates first and profits last, well, it’s deliberate! After all, how can you expect profits (a.k.a. business viability) without great people? Notice what else comes before profits? Customers, of course!

And these aren’t just words on paper, we made these public, including posting them on our website: www.imagefirst.com/Our-Values.

Once you have your culture defined and communicated, the second step is bringing it to life. And that’s not a once and done thing; this is something you do every day, week, month, quarter – methodically and intentionally. We hold daily or weekly huddles during which we discuss our purpose, values and goals – and how it ties back to our customers or their patients. Our leaders put associates first: whether it’s through one of the many established recognition programs, providing community giving opportunities for associates, celebrating birthdays every month, or the many fun team building activities.

It’s the mix of formalized ongoing programs and recognition as well as the regular fun activities that work. Providing flexibility to customize these events (we have numerous offices throughout the country) empowers associates at each office to “make it their own.”

Ultimately, great cultures and staff engagement do not happen by accident. But the good news is that with discipline and intent, any organization can drive improvements!

1. http://www.gallup.com/poll/20629/nurse-engagement-key-reducing-medical-errors.aspx

Magali Tranié is the Director of Marketing for ImageFIRST Healthcare Laundry Specialists. She has 19 years of experience working primarily in business-to-business in various marketing disciplines, leading teams and driving or contributing to employee engagement activities.

Tags:  culture  employee engagement  goals  values 

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It’s Never About The End – Taking the CPXP Exam

Posted By Diane M. Rogers, BA, ACC, CPXP, Tuesday, May 16, 2017
Updated: Thursday, May 11, 2017

Daunting – that’s the word that described how I felt each time I thought about taking the Certified Patient Experience Professional (aka CPXP) exam. It seemed like such a daunting feat, and yet I truly believed it was something I should do – professionally and personally.

Professionally, taking and (hopefully) passing the CPXP exam, there were countless reasons why I thought it was something I should pursue – most predominantly credibility.

Personally, it was overcoming that constant battle in my head that I fight – the fear of failure. You’d think that as an adult, having lived more than half a century that I would be more comfortable with accepting my best self. But alas, finding triumph in simply having the courage to try alludes me. 

Still, this was something that I couldn’t let go. I kept ‘playing the tape forward’ and could feel the disappointment in myself if I chose not to take the exam. But, ‘playing a different tape forward’ I could feel what it was like when I passed – when I called myself a CPXP. There was something empowering, bold and confident in that image that quieted the fear-filled voice in my head just a bit. Still, I wasn’t ready to apply.

I accessed all of the available information on the PXI website. I participated in the CPXP Prep Webinar. I purchased the CPXP Workbook – all in an endeavor to overcome that fear. But still, I didn’t apply.

My fear of failure is a loud, discouraging deterrent to growth and adventure, putting all of what matters on the end result. And this notion of ‘it’s all about the end’ is in such conflict of what I believe and have experienced, as one of my own mantras in life is – “It’s never about the end, it’s always about the middle”.  So, I had to find a way forward – to appreciate the middle, and to celebrate the courage I had in choosing trying.

And so, I called Peggy, my Beryl Institute Faculty colleague, in the hopes that I could find support and a study buddy to bolster my confidence. 

Hey Peggy”, I said. 
“Are you planning on taking the CPXP exam?” I asked.
“I hadn’t really thought about it”, she replied.

Seriously?!? Not thought about it?!? I haven’t stopped thinking about it!  Now what?

“Well”, I said, quietly stepping into that space of vulnerability,
“I think I want to take it, and wanted to know if you would take it with me … I’m afraid I won’t pass”. (Even as I write these words, I am hearing the ridiculousness of this fear and the stifling nature of its implications.)  
And almost immediately, I was calmed, comforted, and catapulted into the ‘middle’. 
“Sure, what the heck”, Peggy responded. 

Peggy and I set up our first prep call 3 months before the exam.  It was clear from that first meeting that we had very different study patterns.  I was very structured. I outlined a prep approach where we used the CPXP Workbook as our guide. I assigned focus areas with specified completion timeframes.  I set up weekly teleconferences for us to review content.  I made sure we had available all of the resource recommendations. And, within each structured step I took, Peggy was right there - encouraging me, supporting me, and patiently tolerating my prescriptive approach. 

We met weekly, reviewing each knowledge domain, often surprising myself by how much I knew. And over time I began to relax. I began to trust myself, my knowledge, my experience, my understanding of the material. The more comfortable I got with the process of preparing and the material, the more confident I got in taking (and passing) the exam.

Soon our study sessions grew more into developing situational exercises and less into memorizing content. I began to appreciate Peggy’s brilliance and curiosity in asking – ‘I wonder how they would write an exam question for that’?  I could feel Peggy’s confidence – it was contagious. I often thought, ‘If she can do it, so can I’!

And as you might expect, this ‘Sure, what the heck’ CPXP prep adventure grew into an remarkable friendship – one filled with respect, laughter and appreciation for each other and the strengths we share individually and collectively.

In October, 2016 I took the CPXP exam… and passed. And as I ‘play the tape backward’, reflecting on the choice I had in front of me, I am grateful for choosing to jump into the middle. The middle was filled with growth, courage, focus, support, encouragement, strengths, friendships and confidence. The middle helped remind me of my best self. And the middle helped to develop me into an even better patient experience professional. 

“It’s never about the end – it’s always about the middle”. 

P.S.  With heartfelt appreciation, thank you Peggy.

P.S.S.  For those of you considering any step forward into a new space of experience – Go for it! Trust yourself, your strengths, and those core qualities within you that make you your magnificent, best self!

Diane works with and supports The Beryl Institute as a faculty member, facilitating virtual classroom sessions, topic calls and workshops. She is also Founder and President of Contagious Change, LLC, assisting healthcare organizations to achieve new potentials. Specializing in improving the healthcare experience, she works with clients to tailor programs and improvement initiatives. She is a certified professional coach, and developer of The hArt of Medicine®, a program designed to engage the clinician in creating therapeutic relationships and improving their communication and empathy skills through a unique experiential learning approach. Diane believes that ‘everyone has the capacity to change a world’. Whether the world is the physical space that we occupy or a moment in an individual's life; we all have the ability to create a positive energy that brings about an amazing change.

To learn more about the upcoming CPXP Prep Course on June 20th in Chicago, click here.

Tags:  Certified Patient Experience Professional  CPXP  patient experience 

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Calculating and Understanding the Drivers of a Net Promoter Score in Health Care

Posted By Andrew S. Gallan, PhD, Monday, May 15, 2017
Updated: Thursday, May 11, 2017

In 2016, Advocate Health Care, the largest health system in the Chicagoland area, integrated into its performance measures a Net Promoter-like score, which they call a Patient Loyalty Score (PLS). Net Promoter Score (NPS) is a valuable metric, and it has been adopted by many companies in almost every industry. NPS is a simple, easy to use, and easily calculated metric that is intuitively associated with business health by assessing a respondent’s likelihood to recommend an organization to a friend or colleague.[1] Health care organizations are beginning to see its value, and are exploring how it is best calculated and used.

For Advocate Health Care, PLS is constructed using data from CAHPS and vendor surveys, and utilizes the likelihood to recommend question. Only a top-box score is defined as a promoter, and varying bottom scores are defined as representing a detractor. That is, for a five-point scale (ED vendor survey) the bottom three responses are categorized as detractors; for a four-point scale (HCAHPS) the bottom two are detractors; and, for a three point scale (CG-CAHPS) only the bottom score is a detractor.

Some issues with the measure include the referent (CG-CAHPS asks about likelihood to recommend the provider’s office, ED refers to the department, and HCAHPS asks about the hospital), and the limited scale width (the original NPS scale is 11 points). However, for me, having a patient-provided measure outweighs the issues, and I commend the organization for holding people accountable for patient perceptions of care. The strength of this metric is to create system-wide responsibility for a patient-provided measure, thereby ensuring that the patient’s voice is heard.

Like most organizations, Advocate Health Care is interested in earning increased rates of positive word-of-mouth recommendations. As a result, I recently engaged with Advocate as an Academic-in-Residence. In this role, championed by EVP & COO Bill Santulli, SVP & CNO Susan K. Campbell, and VP Information and Technology Innovation Tina Esposito, I performed analytics to identify drivers of PLS. The two important research questions that drove this project were:

  1. Which variables are the most important drivers of PLS?
  2. What can we learn from patient comments about potential drivers of PLS?

In order to investigate these questions, I was provided with almost two years of HCAHPS, CG-CAHPS, and ED survey data and patient comments. Top line results included the following:

Inpatient (HCAHPS): Nurses and personal issues (privacy, pain, and emotional issues) had by far the most impact on patients. Positive comments centered on comfort, communication, and care. Negative comments focused on food.

Outpatient (CG-CAHPS): The face-to-face interaction between a patient and physician is the “moment of truth,” and as such is what the patient apparently will use to evaluate the entire experience. Positive comments centered on comfort and communication. Negative comments focused on waiting and rude treatment. 

Emergency Department (Vendor Data): When patients are in the ED, taking care of personal issues will have the greatest impact on PLS. These issues include keeping patients informed about delays, caring about patients as people, pain control, and providing information about caring for yourself at home. Positive comments centered on comfort, communication, and care. Negative comments focused on feeling vulnerable and afraid in a busy and foreign environment.

As a result of this project, Advocate Health Care is now embarking on disseminating the results, integrating insights into daily practice, and evaluating additional questions that emerged from the analysis. I’d be interested in hearing more about what your organization thinks about NPS, how you use it, and what you have learned as a result!

[1] NPS was first proposed by Fredrick F. Reichheld, (2003), "The One Number You Need to Grow," Harvard Business Review, 81 (December), 46-54. For more on advantages and issues utilizing NPS in health care, see https://thepatientoutcomesblog.com/2012/11/12/net-promoter-score-in-health-care/

Andrew S. Gallan PhD is an assistant professor at DePaul University in Chicago, a member of the Editorial Review Board of Patient Experience Journal, and principal of Dignity in Action, Inc., a PX analytics and advisory company (www.dignityinactioninc.com). Andrew can be contacted via email: agallan@depaul.edu

Tags:  CAHPS  CG-CAHPS  data  drivers  HCAHPS  net promoter score  NPS  patient loyalty  patient loyalty score  survey 

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The Dichotomy of Patient Experience Messaging

Posted By Justin Bright, M.D., Friday, May 12, 2017
Updated: Monday, May 8, 2017

I have never in my life met a physician who woke up in the morning hoping that his patients hated him. I don’t know of any doctors who want their patients to have a terrible experience in their hospital, emergency department, or clinic. Yet, every time I am at a patient experience conference, the physicians there are seen as unicorns because they are actively engaged in improving patient experience. The question I hear most often from others involved in service excellence is, “how do we get more doctors to act like you?”

A question I ponder often is, if physicians care about the well-being of their patients so much, why are we having such a hard time getting physician buy-in on patient experience initiatives? If the physicians are already halfway there because they inherently deeply about the well-being of their patients, then why is this so hard!?!?!

I think it’s time that we as patient experience professionals engage in some serious introspection about how we are messaging the importance of patient experience to our physicians. What are your goals as a patient experience leader? What are the directives being handed down to you by hospital leadership? Do you want satisfied patients? Or do you want compassionate, empathetic and streamlined care? Are you leading every discussion about patient experience with stats, survey scores and percentiles? Does your health system make the physicians feel like they are terrible at providing a consistent and excellent experience to their patients without acknowledging just how incredibly complex it can be to actually do so? Are you celebrating the physicians who are doing well?

My suggestion is, you need to drop the term “satisfaction” from your vocabulary. That is not what any of us are trying to achieve. “Satisfaction” or mention of survey data makes doctors go insane. There is no partnership there. No inspiration. No buy-in. Just an adversarial relationship that makes physicians feel like leadership just doesn’t get it. Instead, focus on “experience.” Focus on communication. Inspire physicians with stories – using positive reinforcement to recognize the times when a patient’s experience was incredible. Physicians believe in a duty to their patients. The experience a patient has is the only 100% frequency event in our health systems. Care that does not involve compassion, empathy, and communication is not care at all. In my dream scenario, we are never mentioning satisfaction or scores to our doctors. Yes, the surveys need to continue, but should be monitored in the background by service excellence departments. If we engage our doctors, my hope is the rest will take care of itself. 

My fear is that as patient experience continues to evolve, and as the pendulum continues to swing more towards “Patients First,” “All For You,” and other similar mantras, that we will fail to acknowledge just how difficult this endeavor is for our physicians. Sometimes it feels as if everyone is trying to push the patient experience boulder to the top of the mountain, but everyone is pushing in a different direction. If there were a simple solution, we’d all be doing it already. The key to organizational change is for you as a leader to have a clear goal, clearly delineate a path for your physicians to follow, and then you continue to drive them down that path in order to achieve sustainability. As we continue to look at ways to improve the consistency of physician communication and compassion, I also urge patient experience professionals to look within – how consistent and compassionate is your messaging to your physicians?

Justin Bright, M.D. is the Patient Experience Champion at Henry Ford Hospital in the Department of Emergency Medicine.

Tags:  buy-in  data  patient experience  patient satisfaction  physician 

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All the Hats We Wear: A Look at the Challenges Facing the Healthcare Advocate

Posted By Rebecca Ruckno, Friday, April 21, 2017
Updated: Friday, April 14, 2017

We have all been there right? What hat should I wear at work today? The pretty hat? The thinking cap? Or maybe the hard hat? The role of the patient advocate can sometimes be confusing. We all agree that we need to support the initiatives of our hospitals while also supporting our patients and families.  How can we keep ourselves whole?

Over the past year and a half, the advocates have been working with a new initiative; Proven Experience. If the patient perceives that their experience was less than satisfactory, they can request their co-pays to be waived or refunded. Proven Experience is a promise of providing the best patient experience for every patient every time. When doing the investigation on the issue brought forth by the patient we often hear “all care was appropriate”. But what does “care” mean? To the medical team, care may mean that all medical protocol was followed and the outcome matched the protocol. To the patient, care may mean more than the “medical” care. It’s about how they were treated as a person. Did they receive all the information required to make an informed decision? Did we respect the patient and follow our C.I.CARE initiative? Often it is the compassion and the communication that our patients tell us that we are lacking. The team discusses the request with the patient and arrive at a mutual conclusion ending with the refund of the out of pocket expense. Because the perception of the outcome may differ, we may choose we wear our hard hats!

Since the roll out of the refund program we have almost doubled the issues we handle monthly resulting in adding additional staff. The relationships between the advocates and the various departments that they interact with have become stronger. Particularly, the departments of Finance, internal audits, service lines and legal. This is due mainly to our development of a more collaborative agreement with a win/win for our patients. We are looking to improve telephone wait times, appointment wait times, smooth transitions and bills that are understandable. Kindness and compassion are integral in the journey to recovery for our patients. The patients are bringing their experiences to the team hoping to make it better the next time. Perhaps we have always taken care of these issues before but now the refund has new meaning. Research in the future will show us if customer loyalty is obtained because of improving the experience. 

The frustration has been in the reliance of other areas to help us determine what the refund will look like. Information needs to be gathered from the patient, the teams and finance. Billing of insurances, waiting for information from various departments can delay the final response to the patient.

When we do have time to catch our breath we need to look at the repetitive issues, develop a strategy and truly fix the challenges. Data needs to be reviewed and solutions must be developed. We have a variety of hats to choose from every day.  Often times we may need to change our hat to meet the needs of our patients while also meeting our own needs. Thinking caps are required.

Becky Ruckno is the Director, Patient Liaisons and Interpretive Services with Geisinger Health System.

Tags:  advocate  compassionate care  finance  patient care  patient experience 

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How Much Does Culture Matter in Today’s Healthcare Environment?

Posted By Katie Owens, Monday, April 17, 2017
Updated: Wednesday, April 12, 2017

What is culture? Culture can consist of many different elements in healthcare. From the way things are done in the organization. The shared relationships among people which dictate how they behave. To a set of shared beliefs and values. Each belief (while uniquely described by many) universally acknowledges that culture is an important part of the fabric of their organization.

Despite the fact that many people have conviction that organizational culture will either enable an organization’s success or serve as a barrier to achieving outcomes, sometimes broaching the subject of Culture can cause leaders or front line team members to shy away. Culture can feel messy, hard and inconvenient. We may be proud of some aspects of our culture but disappointed in others. Our team sought to find evidence outside of anecdote and theory to help leaders understand the role culture plays in creating excellence. That query led us to conduct our recent study demonstrated that culture does impact outcomes. The two big learnings we had conducting our study published in the Journal of Healthcare Leadership is that:

First, high performing cultures are more likely to do better than low performing cultures on key balanced scorecard metrics: Employee and Physician Engagement, Patient Experience, Value-Based Purchasing and Turnover. These cultures did not outperform by a small margin but a margin of magnitude and statistical significance (see Video on Culture Imperative). In other words, our team found that culture is not “nice to have” but critical to create demonstrable outcomes.

Second, engaging your employees in your culture is the most powerful step to create positive results. Your workforce is the lifeblood of your organizational culture: their engagement, relationships with leadership and each other and commitment to your mission. We found four key levers that are more likely to support achievement of outcomes:

  • The extent to which patients are treated as valued customers.
  • You find that your values are very similar to the values of this organization.
  • You feel that being a member of this organization is very rewarding.
  • You are proud to be a part of this organization.

There is no question healthcare leaders, staff and physicians are perservering day in and day out to provide the very best care to patients despite a myriad of challenges. Our teams are craving cultures that give them a sense of purpose and joy. As we work to create a “new normal” that equips our organization to provide person-centered excellence across the continuum of care, our findings indicate that leaders should pay attention to culture and actively steer workforce engagement to create employee pride, a focus on the customer and shared values.

Katie Owens, MHA is Vice President of HealthStream Engagement Institute, a HealthStream Company. Katie is a highly regarded thought leader in the healthcare industry who is a national speaker, executive coach and facilitator of leadership. Katie is founder of Lumen, a monthly podcast dedicated to shining a light on the bright spots where excellence happens in healthcare. KatieOwens.org

Tags:  culture  employee engagement  improving patient experience  metrics  physician engagement 

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