The State of Patient Experience in Practice – The Research in Action
Jason Wolf and Stacy Palmer
On the Road Again – Exploring the State of Patient Experience
When we first initiated the On the Road program in 2010, our intention was to explore the work taking place on the front lines of care – both in healthcare organizations and healthcare gatherings – around the world. Our travels have taken us behind the scenes of major system efforts and exposed us to thoughtful and personal stories of opportunity and action. These collective stories reflect the values of The Beryl Institute community, that as a community of practice we gain in strength, knowledge and collective impact in our willingness to share with and learn from others.
The month’s On the Road celebrates that very fact – and then frames it in a very powerful way. What we have found on our journeys and in the stories we have shared is that the very state of patient experience itself has been revealed. In our commitment to understand and explore the current state of patient experience efforts, we have learned many things. Our most recent study – State of Patient Experience 2015: A Global Perspective on the Patient Experience Movement – reveals some very telling trends and the positive direction the experience movement is headed. What we realized is that these findings could be seen on our very On the Road visits.
Our intention is to address some of the most significant results of this year’s research and frame these discoveries in the very practices we have seen while on the road. Specifically we will explore the continued opportunity for definition in our patient experience efforts, the recognition that leadership and culture are central to patient experience success, the growing commitment that we must shift our focus in healthcare from what we "do to”, to what we "do with” and our overall efforts to increase patient and family voice and engagement, and finally the emerging realization that experience is not a nice idea about making people happy, but rather has solid grounding in greater results and specifically seen as a driver of clinical excellence as well.
Through excerpts of our visits we will share what these ideas look like in practice. More so, as you read not only this On the Road, but also reflect on the current State of Patient Experience Research, we encourage you to think where your organization is tacking these critical issues. Then, we invite you to consider sharing your own efforts as well. We grow stronger through the sharing of our stories and we all add to the growth of this important movement. We look forward to your reflections on these lessons and your contributions as we continue on this journey.
Need For Definition
From the very start of our work at The Beryl Institute we have reinforced the importance of having a clear and shared definition for patient experience efforts. While we have developed and shared a community definition, we have encouraged organizations to adopt, adapt or create their own. The reality is that definition gives us purpose and a central rallying cry for action in patient experience efforts. As we would not operate our healthcare organizations without a clearly defined and understood purpose, we too cannot leave our experience efforts to chance.
The 2015 State of Patient Experience study revealed that still around 50% of healthcare organizations have yet to define what patient experience means to them. We believe this leaves a great deal to chance. Here are a few organizations that put definition to use for them as they lead their experience efforts forward.
An Integrated Approach to Patient Experience Performance through "One Experience”
Carolinas HealthCare – Charlotte, NC
A Foundation for Success - One Experience
Our visit was framed by time spent with the core patient experience team led by Connie Bonebrake, SVP & Chief Patient Experience Officer, and a focused team of individuals committed to tackling the various issues driving patient experience efforts at Carolinas. With a line of sight to people and culture, metrics and engagement and data and outcomes, the team has developed a strategy that encompasses a broad reach in impacting many areas in the organization. It has also done so by bringing voices from all aspects of the system to engage in the conversations driving patient experience performance.
The center of the team’s effort stems from the system’s broader brand focus on "One” and led to the statement of "One Experience” for the organization. The idea of "One Experience” is a focus on "every person, every encounter, every time,” shared Connie Bonebrake in introducing the strategy. "It is a plan grounded in our broader organizational commitment to be recognized nationally as a leader in the transformation of healthcare delivery and to ensure we are chosen for the quality and value of services we provide,” she added.
This vision is a powerful foundation on which the patient experience efforts at Carolinas are built. I also note the significance of "choice,” a word we mention often at The Beryl Institute about both the most powerful tool we have in patient experience improvement – a choice at every point of interaction – and the reality of the new healthcare marketplace – that patients are making choices as consumers of care in ways they never have before.
The core of this strategy is again a grounding in the system’s own commitment to develop enduring relationships with those they serve. This is a powerful brand statement about driving not only choice, but also loyalty. This focus also has Carolinas building its efforts firmly on its own definition of patient experience. At The Beryl Institute, we too believe that definition predicates true action. For without a focus, in what direction are you headed? The team at Carolinas put a thoughtful personalized spin (based on The Beryl Institute’s community definition) in defining what patient experience would be for the system. They define patient experience as: The sum of all interactions, shaped by the One culture of Carolinas HealthCare System, that influences patient perceptions across and at each point of the continuum of care.
The definition and aligned strategic focus has allowed Carolinas to design and act on a broader integrated experience effort. One grounded in four key areas: Foundations of Caring, Healing Environments, Teammate Engagement and V.O.I.C.E. (Values, Opinions, Information, Collaboration, and Engagement). Each of these points of focus has specific actions, practices and processes associated with them. This is a well thought out model for aligning effort and ensures a strategic focus on actions across the system in addressing patient experience overall.
What the patient experience team shared reinforced a belief central to patient experience performance excellence. That in having a clear strategic focus and a shared model on which to build actions, you can truly drive system level outcomes. The "One Experience” model does just that. In asking the team for some of its keys to success, they identified a combination of the willingness to make this a priority and provide the infrastructure of support, a clear direction and purpose framing the effort and then the commitment of people at all levels throughout the system that help to drive outcomes. It is truly a systemic approach.
Reinforcing "I am the Patient Experience"
GRHealth – Augusta, GA
Start with a Definition and Observable Commitment
Our travels have informed us and we continue to reinforce that definition is the critical starting point in experience efforts. The point being without definition you have no basis for action. Healthcare organizations would not operate their institutions without some sort of strategic plan and commitment to certain outcomes. This same idea holds true when driving experience efforts and improvement.
GRHealth not only has a definition that helps frame the importance of PFCC, they also have an infrastructure – both virtual and in people resources – committed to driving ideas to outcomes. A significant portion of action is actually taken on by patient advisors themselves, which I discuss further below.
GRHealth has put a stake in the ground around what they see Patient- and Family-Centered Care to be and they share it prominently on their facility site. They are pioneers in the concept of Patient -and Family-Centered Care having started their PFCC journey over 20 years ago. In that time they have established one of the largest patient advisor programs in the United States. They identify PFCC as an approach that removes the barriers to having collaborative partnerships between healthcare providers, patients and families and are clear to state that families are an extension of the patient.
GRHealth’s PFCC efforts are based on four principles of practice:
- Treat patients and families with dignity and respect.
- Provide clear, comprehensive information in ways that are useful and empowering.
- Create opportunities for patients and families to participate in ways that enhance their control and independence.
- Ensure that collaboration is inherent in our policies, programs, education and delivery of care.
The commitment presented in these principles guide the actions of team members across the system at all levels of the organization and across the work they tackle - from direct care, to research and to the education of future healthcare professionals. I also had the chance to see them at work as I facilitated and learned from a panel of institutional leaders and engaged with staff at 6th annual PFCC Conference. My first exposure to these ideas in practice was during a leadership panel on integrating the principles of PFCC.
Leadership and Culture Remain Central
Efforts at organizational excellence whether in healthcare or not, have one clear and well-documented common denominator – strong leaders focus and commitment and a vibrant culture that is aligned with the purpose and direction of the organization. We see great examples consistently shared of organizations such as Southwest Airlines or Zappos, but these efforts too are taking place in healthcare organizations around the world.
This too was something recognized as central in the conversation during the development of the definition of patient experience itself. At its very core is the idea that patient experience is "the sum of all interactions, shaped by an organization’s culture…”. Organization culture – the values, beliefs, expectations, behaviors, people, processes, and more – all create the foundation on both what and how actions are taken by organizations. Culture dictates behaviors and if behaviors impact interactions then culture is foundational to experience success.
Here we share a few examples of how culture plays a critical role in experience excellence. How does your own culture support (or impede) your ability to provide the best for not only the patients, families and community you serve, but also the people that comprise your organization? This is critical question we should all be asking as we strive for experience excellence.
Each Person. Every Moment. Better Never Stops.
Virginia Mason Health System, Seattle, WA
Power of Executive Sponsorship and Board Support
What Virginia Mason also exemplifies is the true importance of every person from the front lines to the executive office and beyond. In fact, they were one of the only On the Road visits that engaged a board member (and experience champion) in our discussion. This is a unique aspect of Virginia Mason’s Patient Relations and Service Team. They purposefully and actively engage champions from senior leadership that function as executive sponsors of patient experience in the organization. Pairing a physician leader, Dr. Donna Smith, Medical Director, Clinic, with an administrative leader, Katerie Chapman, Vice President, Perioperative and Support Services, in a leadership dyad, they have created a team that is able to see both sides of the equation and work together to focus on process improvements and improving the patient experience.
As Virginia Mason traveled their experience journey, a transition occurred where patient experience once seen as something "over there” became purposefully integrated into the work. In the early stages, like many organizations, Virginia Mason struggled with a focus on and commitment to these efforts, with the team working hard to show ROI and validate the needs, but now with a solid focus and strategic alignment things have started to change.
In aligning executive champions passionate about the work, they worked hard to "make the patient experience about us,” said Dr. Smith, meaning it had to include ALL voices, not just those accountable for outcomes. As champions, each individual had a role to elevate the conversation and reinforce the critical nature of the work. It took time and persistence, but the organization followed willingly. Some of the influence was also driven from the very workings of the Virginia Mason Production System (VMPS) itself, which reinforces that the customer defines value. "If that is the case, then we need to ensure we are focusing on our customers need to ensure we are providing that value,” added Dr. Smith.
Both Dr. Smith and Katerie also spoke to the value of executive champions and how they have been able to help. They have been in a position to elevate the conversation, to ensure resources, raise awareness and even weigh in on critical budget issues that could help (or limit) the experience effort. Katerie offered, "That by integrating our effort into the work of the organization, it is now part of our fundamental growth strategy.” No longer one of many potential focal points, she continued, "the benefit of having the right people at the table is that there are no more isolated patient experience conversations.”
This was reinforced further by the clear awareness and engagement of Virginia Mason’s board as the idea of having the right people at the table is carried over to the executive board meetings, and some of those right people are patients. A patient or family member attends every Board of Directors meeting and shares their story, making sure the patient voice is present. Lonnie Edelheit, Virginia Mason Health System board member, says that the sharing of patient stories is beneficial for the board members. "When patients come and share their stories, it can be electrifying.”
He recalled one such story that actually came from a Virginia Mason employee who attended a board meeting so she could share her own experience as a patient. She shared how she had been too intimidated by her physician to ask him what she saw as a critical question. She had not seen him wash his hands, but she was afraid to ask him about it because of the reaction she might receive. Through the sharing of these stories, the board members are able to maintain a connection with the patients and align with the strategic service plan area of partnering with patients and families.
In addition, Lonnie reinforced that the board can (and should) play a critical role in ensuring experience success, offering, "We have an accountability to the organization and the community to ensure the best experience.” This reinforces the powerful nature of governance and the impact it can and should have on experience excellence.
The Power of People in Patient Experience Performance
Henry Ford West Bloomfield Hospital, Detroit, MI
Rebecca’s framing of the effort at West Bloomfield provided important context to Patrick’s stories and set the stage for the perspective of senior leadership. I was able to get a great perspective from strategic leadership to clinical and medical leadership in spending time with Lynn Torossian, CEO, Karen Harris, CNO and Dr. Betty Chu, CMO. In my time with these individuals exploring the West Bloomfield experience, I was able to engage in three unique, but clearly aligned perspectives.
In speaking with Lynn, the facilities’ new CEO, she started off acknowledging the incredible physical environment built at West Bloomfield, but quickly guided me to what she saw as central to the experience. "People are the heart of this place,” she offered. She shared without question the patient-focused nature of the efforts at West Bloomfield from design, to services, to person-to-person interactions. "Every meeting we have starts with a patient story,” she added. "This keeps what we do connected to why we do what we do and reminds us that what we do is very special."
As important she stressed is that for all the audiences a healthcare executive must engage with in their roles, without question the people who come to work everyday at the hospital are one of her primary customers. She reinforced a critical expectation that everyone is and should be a leader and that the work to provide the best in care, the best in experience, never ceases. In ensuring the organization has the right talent, clarity of roles and shared expectations great things can happen. This does not diminish the intricacies of leading in healthcare today, but reflect the fundamentals that can and do drive distinction.
Lastly she offered that to be successful in healthcare today and to provide a sustainable and viable experience is to offer value. In framing value she explained, "we must continue to offer an affordable and accessible product, but that is not enough. We must also strive every day to exceed expectations. In doing that you provide the best in experience overall.”
I continued my conversation with leadership with Karen Harris, CNO. A common theme continued. "I support the people that deliver care to people,” she said reinforcing a strong sense of servant leadership that I experienced from the team. She reinforced the strong foundation of people they have built and the commitment they have to care for them as well. She also added that what has helped them in their success, is they are "not afraid to do things differently here.” This willingness to act, try new things and push the edges of care was established with the opening of the facility in thinking "beyond the boundaries.”
With that said, Karen was clear in stressing that for all these efforts there must be a foundation of clinical excellence. Consistent with what I see elsewhere and what I believe most would not question, a healthcare experience built on shaky clinical practice has no chance of taking hold. I would also add that from the patient perspective, they do not delineate aspects of experience the way those of us in healthcare might, thus reinforcing the integral nature of quality, safety and service as the full picture of experience.
From this foundation of clinical excellence, Karen reinforced the idea of people as the building blocks for success at West Bloomfield. From talent-based selection processes, to setting and reinforcing expectations, to keeping the right people and being willing to move on with those that cannot perform to expectations, again the foundation of people in driving the experience was reinforced. Karen shared the four filters on which the efforts at West Bloomfield are based – safety, memorable experience, compassionate care and efficiency (pictured here) and offered that in maintaining a clear and unwavering focus on these filters, they have been able to accomplish great things.
My leadership conversation continued with the newest member of the team, Dr. Betty Chu, CMO, who too reinforced the common theme and provided some insights into what attracted her to the facility. She stressed that West Bloomfield and the system in general is focused on its people. This is fundamental to what they do from professional development, to professional satisfaction to diversity of thought. Dr. Chu offered, "From the patient experience standpoint, this is the perfect foundation on which to build.”
Dr. Chu also raised the important perspective on the role the physician plays in the patient experience. As healthcare becomes more complex, dynamic and interconnected, the continuum of care becomes more critical to overall experience and the transitions of care fundamental synapses in the experience journey. This means that the physician team needs to keep a broader perspective in mind as they engage with patients at various points on their personal journey. They too then must realize the impact they have on the experience of those in their care.
Dr. Chu offered that most physicians are aware of this, but are also impacted by the anxiety of the new healthcare marketplace with shifts in provider delivery requirements and patients' perceptions and engagement in care. More importantly she sees an opportunity for physicians overall in care settings to continue to expand awareness of patient needs, while being provided with an outlet and mechanism to address issues and make change. This perspective reinforces the continuing efforts we see across healthcare to engage physicians in the experience conversation. Dr. Chu reinforced this was central to success at West Bloomfield and supported the notion that we must all work to continue engaging physicians as owners in the experience conversation.
Increasing Engagement Of Patient And Family Voice
The 2015 study also revealed an encouraging and enlightening trend towards including patient and family voice for input in patient experience efforts as well as a means to measure success. We were especially pleased to see this at the Institute, as one of our guiding principles for organization and systems committed to providing the best in experience is to implement a defined process for continuous patient and family input and engagement.
Below are two organizations actively leading the way in effectively incorporating patient and family voice to guide overall improvements.
Driven by the Patient Voice
Allina Health, Minneapolis, MN
Involving Patients and Families
Part of my visit included meeting Sara Arnold, Patient Experience Advisor responsible for the Patient and Family Partnership Program. Allina Health has a robust program dedicated to seeking patient and family input to drive improvement. After completing an application and going through an interview process, those selected have opportunities to tell Allina Health what matters most to them, help improve care and how it is delivered, identify areas to consider for improvement and be an advocate for health care innovation and improvement. There are several ways to participate:
Advisory council: This is an in-person, quarterly meeting of patients and family members who have experienced a variety of care settings across Allina Health.
Focus groups: These are in-person or virtual meetings held as needed. Focus groups will provide feedback on topics related to selected medical conditions or care settings.
Virtual feedback: When there is a need for timely, topic-specific feedback, patients and family members can participate via email conversations, phone interviews or online surveys.
Committee participation and panels: When patient and family participation is needed on an ongoing basis, these advisors will be invited to join committees. When the voices of patients and families are needed for meetings, conferences or programs, these advisors will be invited to present their stories either individually or as part of a panel.
The value Allina places on including the patient voice is evident in multiple ways. Dr. Tim Sielaff, Allina Health Chief Medical Officer, Senior Vice President Specialty Care & Research was very clear "patients and families can drive our agenda better or as well as our scores can. Bring patients in and they will change the conversation…we should have them present.”
Driving Experience Excellence Through Awareness, Engagement and Implementation
University of Arkansas for Medical Sciences (UAMS), Little Rock, AR
A Commitment to Voice
Inherent in my visit with the UAMS team was something we continue to see as central to patient experience excellence – a commitment to voice. That is giving voice to all engaged in the health care experience and then listening and acting on what is heard. During my visit, I had the honor to meet and spend time with some of the direct care providers and leaders and engage with a powerful group of patient and family advisors committed to supporting UAMS in their efforts.
Engaging Patients and Family
I was privileged to have lunch with a broad section of the patient and family advisors during my visit and was able to learn a great deal about the commitment and engagement of these individuals in the daily workings of UAMS. Not just a council of individuals providing occasional advice, they play a vital role in providing input and direction strategy and direction of the organization.
Guided by PFCC team member Barbie Brunner, director of Patient- and Family-Centered Care, patient and family advisors play roles across the continuum of services at UAMS and are engaged in a variety of ways from direct input to advisory councils, and active engagement with events and programs to helping frame organizational strategy. Barbie oversees eight Patient/Family Advisory Councils and works with advisors operationally to ensure their voices are embedded and heard throughout the organization. Patient advisors participate on standing committees, work groups, and in policy reviews--such as a recent effort to revise a Code Blue Policy that now captures the importance of choice if the family wishes to be present during a code and that their needs are respected during this most challenging time.
Larry Taylor, chair of the Hospital Advisory Council, shared, "As patient and family advisors, we all came here with a story and with an intention and we now come together not as tangential to the organizations efforts, but as a central part of all that is accomplished.” While I will not lay out the structure UAMS has created for its advisors, I will add that there is an incredible intentionality and purpose for ensuring the voices of patients and families are central to as much of the work of the organization as possible.
With the strong and growing effort to engage patient and family voice, Julie and Barbie shared that it remains an important work in progress. Of special note is that the advisory council is included as part of the formal organization chart, providing it formal recognition in the structure of the organization. But it seems, and rightly so, that the goals of UAMS are to go beyond words on paper to impact through action. The patient and families I spent time with during my visit seemed focused on and vigilant to that cause as well. It may have been summed up best by one of the patient advisors who shared, "I was honored to be asked for my opinion and now I am committed to giving it. And while I am not sure they knew what they were going to get in inviting me, I know they care about what I have to say.”
Designing Better Experiences with Patient and Family Involvement
Boston Children’s Hospital, Boston, MA
Seeking More Patient and Family Input
One thing clear throughout our visit was the recognition from all staff that they have as much to learn from the patients and families as they do from the scientists, physicians and care providers. It has very active Family and Teen Advisory Councils and is making efforts to more proactively include both councils in decision making throughout the hospital – from being involved in hiring processes to suggesting appropriate placement and requirements for bathrooms in new additions to selecting art for the walls.
A highlight of our visit was meeting, Linda Delahunty, a patient who co-chairs the hospital’s Teen Advisory Council. Delahunty, now 20, had heart surgery at Boston Children’s at age 16. She was so impacted by the staff and experience that she decided to make healthcare her career. She’s currently studying nursing at Simmons College in Boston, Mass., and hopes to someday return to the hospital as a staff member so she can impact children the way her caregivers impacted her. It’s an incredible reminder of the deep impact we can have on the people we care for. While in school, Linda’s actively contributing to several initiatives on the Teen Advisory Council including a project to help understand and manage the impact on patients and providers when a patient transitions from pediatric to adult care. Delahunty was excited to share other projects being worked on by the Teen Advisory Council including writing letters to state senators on such issues as the dangers of e-cigarettes and opportunities to improve handicap signage.
While Boston Children’s has made great efforts to incorporate patient and family voices, we repeatedly heard an acknowledgement from staff that even more opportunities exist. "Patient and family leadership in care design is central to all we do,” said Laura Wood, senior vice president, Patient Care Services and chief nursing officer. This focus was apparent in all the areas we had the fortune to visit from parking to administration, patient access, volunteer services and even the offsite housing made available to families.
The building renovations currently underway are one area highly influenced by patient and family feedback. The hospital is undergoing several significant changes to better serve patients and families, including a more welcoming lobby, an easier to find cafeteria with food court-inspired options and clearer navigation. The staff is enthusiastic about the changes, despite the construction challenges they face in the interim. Perhaps the most anticipated of the changes is the new Hale Family Center for Families, scheduled to open in early 2015. Every staff member we encountered lit up when they spoke about the new, facility that will support families with a much larger, easier to access location and increased amenities and offerings.
We had the pleasure of meeting Jim Smith, department manager, Parking and Commuter Services, who might be more appropriately titled Patient Experience Champion, Role Model, or Mentor Extraordinaire. It was clear as others described Smith preceding our meeting that he has significant impact at this organization well beyond parking ("Oh wait until you meet Jim”…”Oh Jim. He is wonderful…” etc.). He certainly contributes to the organization’s culture, understanding the tremendous impact parking services can have on patients and families and actively looking for ways to improve the parking experience.
With a garage that stays nearly full daily with over 1,600 cars parked in addition to the 400 cars going through valet services, managing the flow is no easy task. Smith acknowledged the importance of setting expectations, explaining that an attendant is positioned at the garage entry to let families know where spaces might be available. His department has also started a "rooftop valet” service. If families do make it all the way to the top without finding a parking spot, they’ll have the option to have their car valeted from there at no charge, saving them from having to drive back to the bottom of the garage to the regular valet area.
Inspired by feedback from patients and family members, Smith has many great visions to further improve the parking experience including better signage, more automated pay stations with live assistance nearby from greeters (who can also help with directions), a discharge lounge adjacent to the parking garage, spaces with awnings for assistance vehicles in the main drive, a bridge to connect the hospital and garage and much more. He sees his role as making things easier for families and visitors and helping the parking staff understand their impact goes well beyond collecting parking fees or valeting cars.
Patients and family members are also actively participating in the hospital’s efforts to improve overall access and navigation, a big focus at Boston Children’s. Immediately before meeting with us, Kevin Pawl, director of Patient Access, attended a meeting where a Family Advisory Council member shared her challenges managing care for her two children who combined interact with 20 different departments throughout the hospital. Pawl believes hearing stories like this are critical as his department works to create systems that "talk” and can better coordinate care. His team is working to map the various experiences of local, national and international patients, provide patients with single billing statements that incorporate multiple departments, provide convenient appointment reminders and itineraries via email, text and phone calls.
While his current position is new, Pawl has been with Boston Children’s for more than 26 years in 19 different roles, giving him good insight to impact what he believes his responsibility is: getting people to work together. "Ultimately we are here to help families navigate by building systems that have reliable, repeatable results,” said Pawl.Health Education
Recognition That Experience Drives Good (Clinical) Outcomes
Boston Children’s leaders believe education is a critical and integral part of the patient experience. Realizing that better written materials, care plans and home care policies can help keep people out of the hospital, Kristin Erekson, health education project manager and editor (and our gracious host for most of the day) is focused on building processes for standardized, easy to understand communications. She’s enlisted four families on a volunteer Family Education Steering Committee to help better understand and address patient and family education needs. The families started by creating a survey to better understand patients' and families' health education needs that will soon be administered. The results will help to shape future education plans. Erekson sees great opportunity to take communication beyond handwritten materials and brochures. She’s exploring multiple modes of delivery such as hands on instruction and videos and is also exploring ways to meet needs of patients with literacy challenges, blindness and language barriers.
There is no greater goal in healthcare than to provide the best in outcomes for those receiving care. It is why quality and safety have been so central to the healthcare conversation and why service now too graces the discussion on what people deserve in terms of outcomes overall. The idea in which experience has an ultimate impact on the broader outcomes someone faces in their healthcare situation is now unquestionably identified as the top impacted area across all the segments examined in the benchmarking study.
Some great examples of this were cited in an On the Road story from Cape Regional Medical Center.
Linking Community & Clinical Excellence for a Positive Patient Experience
Cape Regional Medical Center, Cape May Court House, NJ
Creating Experience Through Clinical Excellence: Three Cases
On my visit I was introduced to three innovative and recognized efforts that epitomize how we can link anticipating needs and addressing clinical opportunities with a true commitment to the community. These services include Diabetes Care and Education, an Anti-Thrombosis service and Wound Care Services. Through these three cases, we looked deeper than many of the typical paths to experience performance to the foundational elements of care.
Impacting Wellness and Health: Diabetes Center
I was able to spend time with Cindy Kraemer BSN, CDE, PRNC, Manager of the Diabetes Center. The team at the Center shared the story of not only building a program that addresses one of the biggest health needs of the broader community Cape Regional serves, but also of a proactive effort to address the potential health and wellness needs of patients in the facility itself.
The Diabetes Center includes direct monitoring and interventions with current patients, community education programs and now intentional linkages to post-acute care settings. All of these efforts are designed to take a systemic and active approach to address the needs of those managing and living with diabetes. As one of just a few recipients of The Joint Commission’s Disease Specific Certification Gold Seal of ApprovalTM in this area, the diabetes program exemplifies a forward thinking approach to addressing experience across the continuum and across settings.
While I will not discuss every service offering or clinical detail, what did stand out was the comprehensive nature of the program overall. As a home grown effort (and a powerful model to follow for those looking to drive excellence in diabetes care and education), it engaged a broad level of voices from caregivers to recipients of care, its takes a personal and active approach to address the needs of people in care and it exemplified generosity of spirit in providing the best in health for the community. It also has direct implications for key quality and service measures regarding communication and understanding of care needs as well as impacting the potential for readmissions as well. This is reinforced by the Diabetes Center’s team working to ensure that any patient they engage have a follow-up appointment no more than 24 hours post discharge.
This linkage of purposeful clinical effort, while addressing the unique and personal needs of each patient reinforces this example as more than an education program to an experience excellence exemplar. This may be no better represented than in the words of Cindy Kramer herself when she shared, "We are a community at Cape Regional and we just want what is best for the patients, their families and the community we serve.”
Providing Proactive and Timely Service Anti-Thrombosis Service
This same commitment was seen in an innovative idea being implemented via the facility’s pharmacy under the direction of Rich Artymowicz, PharmD, Director, Pharmacy Services. While a pharmacy managed Coumadin clinic is not a new service, it’s a rarity to find one in New Jersey. The Anti- Thrombosis Clinic provides a service that normally took place in an outpatient clinic setting, which could lead to longer wait times and other potential delays. The clinic was a concept designed to actively schedule patients, see them in a timely manner to administer medications, monitor blood levels and ensure patients were aware of what they needed to take and confirm they were prepared for their next appointment.
Again, built on clinical needs and providing the best in outcomes, the process itself was designed to ensure the best in experience. By providing quality and timely interactions with patients in the clinic, their services are in high demand. And the people delivering these clinical services are at the forefront of providing personal touch and care in the clinical encounter. As Rich shared, "It is the people up there that have really made it successful. They take the time to engage each patient as an individual, while still managing our commitments in a timely manner.” This is a service that will continue to see great demands as a proactive clinically based experience effort.
Meeting Patients at their Point of Need: Wound Care
In meeting with the wound care team, I saw another case of actively addressing community need with an innovative and interactive care service, driven by the power of personal interaction and support and grounded in the importance of engaging all members of the care team and facility community to address the issue of wound care overall.
I had the chance to meet with Jeff Andrews, Director Rehabilitation Department and wound specialists Judy Horn PT, DPT, CWS/WCC and Marc Miller PT, DPT, WCC to learn about the effort to build and grow an active wound care center for the community. The foundation of this effort, presented by Judy, reinforced much of the message I encountered during this On the Road. She shared, "In order for us to get the patient experience right, we have to ensure all the other little pieces are working to support it.”
In this case, a great example of these words in action came again not from the rigorous clinical standards exemplified by the work of the team, though clearly central to their ability to deliver the best in outcomes. Rather what I experienced and learned from Judy and the team reached beyond the nature of care they provided. For example I saw one patient coming in for her last appointment and hugging her therapist, saying how she would miss her after they were done.
More impressive was the sense of ownership this team provided for others in the facility about the critical roles they played in wound care and wound prevention. Judy created the Skin Team and Resource Staff, know at Cape Regional as STARS. These interdisciplinary caregivers provide extensive direct education, resources, and reinforce information to proactively address wound issues. Rather than prevention and wound care being an after the fact experience, the facility was turning the process inside out to focus on "enhancement of timely care at the bedside for prevention and treatment.”
This effort again exemplified Cape Regional’s focus on experience by actively engaging in innovations around clinical excellence, but by showing the willingness and innovation to stretch beyond typical boundaries of delivery to creating mechanisms to engage patients, families and the community in unique and important ways. The wound care program as with the other cases backed up plans and actions with clear outcomes. For example, a significantly reduced and sustained low level of pressure ulcers was one impact they are having through these efforts. As Judy closed our conversation she reinforced, "This has been truly an organization-wide commitment and effort. We cannot do this in silos.” As we saw in all three examples, it was about thinking forward and about engaging the broadest reach of the care team in innovative ideas and possibilities that great experiences can be created.
Conclusion – Patient Experience Matters
As we look to what we learned in our review of this range of efforts focus on experience excellence we reinforce the idea that experience matters. We would hope that the efforts you are currently undertaking or the examples we shared above are focused on more than good survey scores and instead are committed to ensuring the best in outcomes for all those you serve and hopefully all those who serve them.
When we asked consumers in the 2015 study about their perspective on patient experience overall, we were not surprised, but more so encouraged by the reinforcement of our belief in the importance of the patient experience movement. With almost 9 in 10 consumer respondents saying patient experience is important to them and 7 in 10 saying it is a factor in their healthcare decisions we can say without question that patient experience matters.
Again, we celebrate these organizations and the successes they have achieved so far in their individual patient experience efforts. We also invite you to share the journey of your facility or system through an On the Road with The Beryl Institute feature story. We wholeheartedly believe there is significant power in the sharing of each struggle or triumph you encounter along this continuous journey so others can learn through your experiences and together we can continue to inspire and impact the patient experience movement.
All voices matter. Every interaction matters. You matter. We are all the patient experience.
> Download the State of Patient Experience 2015 Research Report
> View the complete On the Road Library
> Contact us to nominate your organization for an On the Road feature story