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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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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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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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The Power of Partnerships: Unifying Patients Relations and Patient Experience

Posted By Sarah Fay, MBA, Friday, March 10, 2017
Updated: Friday, March 10, 2017

We can all agree that in order to have a well-rounded view of patient experience, we cannot look solely at the information that comes back to us in our patient experience surveys – they are just one piece of a larger puzzle that make up an organization’s culture. And culture is what drives the experience…for everyone. I believe that we must look at data from several vantage points. Some of these, include: 

  • patient experience surveys
  • employee engagement surveys
  • physician engagement surveys
  • information gathered during executive and leader rounding
  • patient stories
  • key human resource metrics
  • feedback from our patient and family advisory councils
  • quality and safety data.

If we leave one vantage point out, we risk losing the complete picture. And this picture must include patient relations data as well.

I oversee patient experience for Southwest General Health Center, a long-standing 354-bed community hospital in Middleburg Heights, Ohio. Last year, we merged our patient relations department with our patient experience department. Unifying these departments has not only helped me in my work – it has benefited our patients too.

The richness of the data collected by our patient representative is invaluable to developing and executing our patient experience strategy. By combining our patient relations data with our patient experience data, we have a well-rounded view of our patients’ perceptions. Trending our patient relations data is key to this.

  1. Trends helps us determine where we need to focus our efforts. The trends in concerns and complaints bring to light an area that we have an opportunity in, while the trends in compliments bring to light an area we can celebrate. When we combine these trends with our patient experience survey data, we are better able to prioritize our strategies, programs and celebrations.

  2. Trends help us pinpoint areas that need additional support. When we combine these trends with our patient experience survey data, I am able to hone in on areas, departments, units or individuals that may need specific training or one-on-one coaching. It also tells me where we need to focus our process improvement efforts. The trends in compliments show me areas, department, units or individuals that I can rely on to champion the cause. Those people can then help train and coach others.

  3. Trends help us conclude if the initiatives we have put in place on the front-end are working. Combining the patient experience survey data with the trends of both compliments and complaints, tells me if our programs and initiatives are having the intended outcomes. 

Our partnership extends beyond the data too. Our patient representative has a very unique skillset – one that I hope to transfer to the bedside through a robust service recovery program at Southwest General. With her distinctive skillset, she can help develop a program, train our staff and teach them how to embrace the skills necessary to handle concerns and complaints right at the bedside. This will shift her into a more proactive role and I believe that is the wave of the future.  

Sarah Fay, MBA, is the Director of Guest Experience at Southwest General Health Center in Middleburg Heights, Ohio. She may be reached at sfay@swgeneral.com

Tags:  data  engagement  partnership  patient experience  patient relations  surveys 

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