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The Beryl Institute Patient Experience Blog
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Execution: The Key to a Greater Patient Experience

Posted By Jason A. Wolf Ph.D. CPXP, Tuesday, November 2, 2010
Updated: Tuesday, November 2, 2010
I have always been struck by an interesting paradox in healthcare, the drive of competition and the need for collaboration. I have seen the competitive drive of healthcare facilities in the same market as they strive for higher volumes, physician loyalty, expanded service lines, and growing market presence.  At the same time, with the increased focus on improving quality and service, healthcare facilities are driven to collaborate on such ideas as proven practices in combating hospital acquired infections, strategies for noise reduction on the nursing floors, or faster throughput in the Emergency Department.

My observation is that healthcare facilities seem more than willing to share ideas outside their market or at a national level rather than collaborate on ideas that may be of direct value to the communities they serve. While this broad sharing is of value, and I encourage it, it has local consequences as well. It can lead to a shrinking of the local knowledge base and require facilities to look beyond their markets for innovative ideas.

My challenge with this is that as the healthcare industry struggles overall to ensure the best patient experience for everyone, the important practices that drive a successful experience, including quality and service, should not be used as the competitive wedge between healthcare organizations. Sharing proven practices, processes and knowledge that can be used to improve the patient experience, is an obligation to the community you serve. It does not detract from your competitive edge, but rather allows you to emerge as an expert and a contributor to the overall health of your market.

Improving the patient experience is about the basic common sense fundamentals we know and believe in when choosing to take on healthcare as a profession. The "whats” of addressing the patient experience (knowledge, processes, practices) should be our universal in providing the best care for patients. The "how” you choose to get it done is where you can and should distinguish your competitive edge. It is in the execution of your plan and your organization’s commitment to engage in driving the critical components of an effective program where the patient experience is truly realized. It is not simply in WHAT you do…but HOW you choose to do it.

In the book Execution: The Discipline of Getting Things Done, Larry Bossidy & Ram Charan are explicit in defining execution as "a systematic process of rigorously discussing ‘whats’ and ‘hows’, tenaciously following through, and ensuring accountability.” Execution is your competitive edge in effectively improving the patient experience. I challenge you to use this as your measuring stick. How well do you execute on the fundamentals of an unparalleled patient experience? What are you willing to commit to to ensure your processes are most successful?

I challenge you to share your practices on improving the patient experience broadly and then compete on how well you can execute on those plans. If we are willing to focus on execution, we will find greater potential for improvement. Rather than being caught in a battle over whose process is better, our patients will be buoyed by a rising tide of execution that will ultimately ensure the best experience for the patients we all serve.

Jason A. Wolf, Ph.D.
Executive Director
The Beryl Institute

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A Simple Idea with Significant Possibility

Posted By Jason A. Wolf Ph.D. CPXP, Tuesday, October 5, 2010
Updated: Tuesday, October 5, 2010

Recently, a colleague was doing some work in a hospital system and came across the picture you see here. I was immediately intrigued by how this simple act of personal initiative represented such a significant opportunity and potential impact for this facility.

With the most recent public reporting of HCAHPS scores this September (representing data from January – December 2009), the national average "top box” score on the question "what number would you use to rate this hospital?” was only 66%. This means that less than 7 in 10 of your patients rated your facility a 9 or 10. This may not seem to be an issue until you get beneath these numbers. The 2005 National Hospital Service Performance Study by JD Powers and Associates determined that individuals giving a perfect score of 10 in satisfaction measures had an 80% chance of returning to the same facility. From there the opportunity quickly diminishes. For those rating hospitals a 6-7 in satisfaction, only 37% percent say they will return to the same facility again.

In considering these numbers in the context of this picture, I believe there are some choices hospitals and other healthcare organizations can make to begin to develop patient and family engagement and ultimately build a loyalty to their facilities. The simplest, yet potentially most important step is listening to your patients.

We must acknowledge that managing patient experience is not something we simply DO to patients. If we are to be truly successful, we must build our patient experience strategies and efforts WITH patients. By involving patients in creating unparalleled experiences, we ensure they begin to develop a sense of ownership, are more highly engaged and ultimately better connected with a facility. Patients are and should be active participants in their experience, not simply subjects to it.

The picture above is just one example of how a patient directly engaged herself to improve the facility in which she was staying. It represents a clear expectation about how the patient wanted to be cared for. I am sure the hospital had similar signage for its staff, perhaps even in this patient’s very room, but she wanted to emphasize one aspect of the care experience that was critical to her. We have all heard of or experienced similar situations regarding surgical patients marking their own limbs for surgery…”this leg,” or "not this leg.” These are just some of the many examples of patients seeking to improve communication and compliance with their wishes.

My advice to healthcare leadership and staff looking to elevate the patient experience is to start asking patients how they would like to be involved in their care process. I know many facilities today have established patient and family councils, community focus groups and other resources. Yet, while important, these processes deal with macro issues that often take time to influence or change.

If you are looking for a way to act now, it will happen at the individual level, at every point of personal interaction with your patients. Take the time to ask, "Is there something I haven’t covered that you’d like to discuss? Is there anything we can do to make you feel more comfortable about the care plan we’ve developed? What can we do to ensure you have the best experience while you are with us?” or any of many other questions that align with your organization’s experience goals. Some patients may surprise you by putting up a sign. And it is those types of signs we’d better pay attention to if we want to see our scores improve and our customers return. Perhaps it is nothing simpler than that.


Jason A. Wolf, Ph.D.
Executive Director
The Beryl Institute

Related Body of Knowledge courses: Patient & Family Centeredness.

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Defining Patient Experience

Posted By Jason A. Wolf, Ph.D., Tuesday, September 7, 2010
Updated: Tuesday, September 7, 2010

Does a definition really matter? Especially when it comes to something as dynamic and complex as the patient experience? As an organization committed to improving the patient experience we felt it was important to tackle this question head on.

 

I would assert a definition does matter for a number of reasons. It is through definition that we create a standard by which to understand, act and measure. If your organization is on the path to improve the patient experience, you should know what it is you are out to change.

 

Equally important is the recent discovery that there is a performance impact to having a clear definition of experience. A 2008 study by Aveus, a global strategy and operational change consultancy, discovered companies that have a definition for customer experience and use this definition in everyday decision-making are more likely to exceed profit and revenue goals. The study showed:

 

  • While individual definitions of customer experience vary by organization, there is a clear performance difference between those who have an organization-wide definition and those who do not;
  • 26 percent of companies with a definition for customer experience report exceeding profit targets, compared to only 14 percent of those without definitions;
  • Organizations with the greatest use of customer experience in daily decision-making report the strongest operating results with 67 percent meeting or exceeding revenue targets and 65 percent meeting or exceeding profit targets.

 

 

The bottom line, customer experience is a path to improved profitability, not a distraction from it AND it is a clear and shared definition that is a critical key to successful outcomes. I would suggest that focusing on the patient experience in healthcare has the same potential value.

 

Therefore, I believe a definition can have a significant impact on what you do within your organization as you work to improve the patient experience. To support you, The Beryl Institute decided it was important to help define this somewhat amorphous term – patient experience. Our hope is that this definition will create a shared understanding and common framework that will support your organization’s efforts in building a plan of action around the patient experience.

 

To accomplish the task of defining patient experience, a work group of your peers - patient experience champions and leaders from a number of hospitals and healthcare systems - came together over a series of virtual meetings to brain storm, research and collectively craft a definition. The definition is purposefully designed to be value neutral, suggesting that we first must acknowledge that there is some "thing” called the patient experience we need to both recognize and address. The result of the team’s efforts was powerful, broad, and yet concise.

 

The Beryl Institute defines the patient experience as:

The sum of all interactions, shaped by an organization’s culture,
that influence patient perceptions across the continuum of care
.

 

At the Institute, we will use this definition as a guide for how we build resources for our members. It will also serve as the standard for how we support and advocate for the creation of a positive patient experience across all healthcare organizations. How will you use the definition in your organization? And what value might it bring to your efforts?

So to our original question, does a definition matter? I maintain that it does. There is much more than you may believe riding on it.

Jason A. Wolf, Ph.D.
Executive Director
The Beryl Institute

Related Body of Knowledge courses: History.

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Can You Create a Formula for Improving Patient Experience?

Posted By Jason A. Wolf, Ph.D., Wednesday, August 4, 2010
Updated: Wednesday, August 4, 2010

As part of its ongoing commitment to providing an exceptional patient and family service, Community Health Network (CHN) in Indianapolis, decided to turn to its employees for input on how it can continue to improve this aspect of its mission. As part of a recent survey to staff members at one of the system’s hospitals, CHN asked about potential barriers to improving patient experience. This generated great energy among the staff with more than 300 staff members offering over 800 distinct responses regarding possible influences on the patient experience in their facility.

From those responses ten top barriers were identified, including:

  1. Poor personal communication skills
  2. Lack of time to spend with patients and families due to conflicting organizational priorities
  3. Managers and Administration not making Patient Experience a priority
  4. Lack of staffing
  5. Equipment and supply issues that both interrupt the ability to provide care and frustrate the patient
  6. Attitudes and mood of the staff that affect ability to relate to patient
  7. Ineffective systems and processes
  8. Interdepartmental communication breakdowns
  9. Excessive "all staff” emails cut into patient care time
  10. Breakdown in teamwork

    One of the significant "ah-has” from the survey is that while many of the barriers are not surprising, they are clearly items that can (and should) be addressed and improved. While some are operational issues, such as staffing or equipment that may require longer decision cycles, the others get to the core of how staff at all levels engage with patients and one another. These provide potential opportunities for more immediate impact.

    Hospitals that want to pursue improvements in patient experience can learn from CHN’s process. Take the important first step to identify organizational changes that can be made quickly. They can also learn from the list itself, in recognizing it may be some of the very fundamental aspects of organizational life that impede our ability to best meet patients needs. In CHN’s case, how can communication skills be improved, interdepartmental communications reinforced or stronger teamwork developed?

    Let me be clear, in sharing these examples I am not suggesting the solution is simply training. Rather, success is realized through an unwavering commitment to make fundamental changes in your organization. These are not cumbersome and large shifts taking great time, effort or resources. They are focused and purposeful improvements that will go a long way to change the experience for patients and their families, as well as your employees.

    This week The Beryl Institute releases the first in our expanded series of white papers on improving the patient experience. The paper provides insights from three individuals who are leading efforts to transform how their organizations address the patient experience, one of which is CHN. For all three organizations, the patient experience starts well before the patients enter the physical hospital building at their first contact with the hospital - be it online, on the phone, or in the parking lot. This reinforces the idea that first impressions are just the start of creating truly lasting impressions. Through their stories, each individual helps us see is that it is often a commitment to identifying opportunities and then taking steps to address the fundamentals that can have a significant impact.

    The healthcare marketplace is increasingly focused on what it will take to improve the patient experience. The trick is determining what steps matter, where we can make positive change quickly and what actions may require more time and resources. Right now, having a top patient experience score translates into local market bragging rights. Soon it will equate to bigger reimbursements from CMS. So can we create a formula for improving the patient experience? Remember, as the experience at CHN shows, improving the patient experience is an individual journey for each organization; one that requires clear priorities, unwavering commitment and a bias for action. Perhaps the real question is can you afford not to?

    Jason A. Wolf, Ph.D.
    Executive Director
    The Beryl Institute

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    The Highest Mission in Hotels and Healthcare

    Posted By Jason A. Wolf, Ph.D., Tuesday, July 6, 2010
    Updated: Thursday, July 29, 2010

    There is no disputing the name Ritz-Carlton is synonymous with customer service. Part of the credo of Ritz-Carlton is, "Where the genuine care and comfort of our guests is our highest mission.” And now more and more hospitals are adopting the Ritz-Carlton service excellence model. This isn’t surprising given that hospitals will soon receive a portion of their Medicare reimbursement based on patient satisfaction scores. With this imminent reality, I wasn’t surprised when Henry Ford West Bloomfield, a new suburban Detroit hospital, chose a former Ritz-Carlton executive as its CEO, nor was I shocked to learn about the Concierge Care program at New Jersey-based Riverview Medical Center. Through this service, Riverview patients can order a massage or manicure during their stay, make arrangements for pet care, take care of gift lists with gift selection, wrapping and shipping services, and order delicious meals from participating area restaurants. These services dramatically reframe the traditional expectations of a hospital experience.

    What did catch me by surprise is that some hotels are now purposefully shifting to act more like hospitals. The Ritz-Carlton in Philadelphia has rolled out a new concierge service developed exclusively for discharged patients who aren’t ready to go home and don’t want to stray too far from the medical team that provided care. The service appears ideal for patients who have lengthy but uncomplicated recovery times or lengthy treatment scenarios. For patients, the hotel offers more pampering than if they had stayed at the hospital. For the hotels, the recovering guests present the opportunity for new revenue streams. A medical concierge at the hotel tends to each guests needs. The concierge does not perform medical procedures or administer drugs, but the concierge can provide wake-up calls for medical appointments, transportation to and from doctors' offices, special sleep arrangements, custom dietary options, prescription pickups, etc. Because the hotel is close to the hospital, medical teams can more easily provide necessary follow up care. The hotel shuttle can even pick them up. All the services are a la carte, added to a guest's final bill much as an in-room movie would be. Whether specific services are covered by health insurance is up to the guest's provider.

    Philadelphia, with its abundance of internationally recognized hospitals, was a natural fit for the hotel chain's pilot program, said Michael Walsh, general manager of the city's Ritz-Carlton. Hotel analysts say the medical-concierge idea is the latest competitive strategy for luxury hotels, which boast of having the best of everything. If the medical-concierge program is successful, the Ritz-Carlton Hotel Co. says it plans to expand it nationally and abroad.

    You may be thinking to yourself, "We don’t have a Ritz-Carlton next to our facility or even the internal bandwidth to offer concierge-like services.” This shouldn’t limit you in this effort. Perhaps you can partner with other businesses in your community to provide special services for your patients while they are undergoing outpatient treatment or in the hospital. For instance, are you near a bakery that will deliver get-well cookies, or a drycleaner who is willing to pick up patient clothing? Could a local hotel shuttle pull double-duty as a hospital shuttle for outpatient visits or doctor’s appointments? If a service could be viewed as a value-add for the patient or family member, consider how to make it work. It will be sustainable if the concept benefits both the hospital and the local business, plus it will have you stand out for your commitment to service.

    As someone whose organization is committed to helping hospitals provide the optimum customer experience to patients and families, I’m struck by the genius behind the Ritz-Carlton effort. This type of commitment to the patient experience before, during and after the delivery of care should be at the core of all we do in health care. It is a chance for you to become an extended business partner in the communities you serve and more importantly have your institution be the place patients choose not only for care, but for superior service. Go ahead…surprise them!

    Jason A. Wolf, Ph.D.
    Executive Director
    The Beryl Institute

    Related Body of Knowledge courses: Patient & Family Centeredness.

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    The Hospital as Traffic Cop

    Posted By Jason A. Wolf, Ph.D., Tuesday, June 1, 2010
    Updated: Wednesday, August 4, 2010

    If you’ve spent time near urban downtown traffic intersections, you’ve likely seen these brave souls…. traffic cops. Nowadays, of course, traffic police can be spotted near malls, busy school zones and large churches. They are indispensible.

    As health care policy experts talk about health care reform, one of the central aims of reform is improving care coordination, and the overriding assumption is that hospitals will be the traffic cops. Health care’s busiest intersection is the nexus where hospitals, insurers, other health care providers and payers mix together. It’s a loud and busy place. In the future, physicians will no doubt play a role in care coordination, but hospitals will be deciding when patients need to be released, where they should go for care after discharge, and what the care continuum will look like. This is all the more likely as an increasing number of physicians become employees of hospitals as part of growth initiatives or due to the fact that they are seeking some level of economic security.

    Many health care experts are betting that Accountable Care Organizations will form across the country to manage care coordination. That’s not necessarily the case everywhere when you consider that setting up an ACO is a complex proposition.

    With or without ACOs, my instincts tell me that hospitals will be the central drivers in a new care coordination system. To operate effectively, though, hospitals will need a more sophisticated system of communications to accomplish their work, meaning integrated voice, IT and patient records systems and channels.

    We know the government has pledged to help hospitals upgrade their IT systems to advance use of electronic health records. The government hasn’t pledged financial support for upgrading phone communications systems and triage networks, leaving that to each hospital to manage. But this work isn’t merely a technological issue; it’s also an issue of customer relationship management. How will hospitals maintain connections with patients, payers and other providers so that care is better coordinated? The same way they do it now? Let’s hope not. I say this simply because we’ve seen only limited examples of successful and effective care coordination, primarily in markets that have sole providers in a tight geographical region--Geisinger Health System comes to mind. The Medicare Advantage program also deploys care coordination teams for some, but not all, of its covered lives.

    The real challenge for hospitals that will carry out the job of traffic cop will be setting up the care coordination teams, creating infrastructure to support them, and paying for this new and intense level of service. Some health systems are large enough to manage this endeavor on their own having the needed staff resources on hand, but my guess is most hospitals are not prepared for the potential scope of this effort. In terms of the financial implications for this effort, it’s anyone’s guess.

    We know care coordination holds the promise of improved health outcomes for many patients, especially patients with chronic illnesses. We believe better care coordination will ultimately generate savings through reduced hospitalizations and readmissions and eliminating duplicative services. Maybe the savings will balance the expense. More often than not, the savings don’t fall to the hospitals, but to the payers. My hope is that regulatory issues won’t prevent all the parties involved from sharing the savings with hospitals and ultimately the consumers of healthcare themselves.

    One consistent theme in the discussions around health care reform is that hospitals are being asked to invest a great deal of their limited resources up front to help fix the system, with the hope and promise that they will reap a legitimate ROI later. I sincerely hope this is the case. No sane traffic cop would enter an intersection without a whistle, orange vest and white gloves. We can’t expect hospitals to perform the vital activities that are linked with care coordination without providing them adequate resources and support.

    Jason A. Wolf, Ph.D.
    Executive Director
    The Beryl Institute


    Related Body of Knowledge courses: Metrics and Measurement.

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