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Expanding the dialogue on experience excellence to long term care

Posted By Jason A. Wolf Ph.D. CPXP, Tuesday, September 2, 2014
Updated: Monday, September 1, 2014

When we first developed the definition for patient experience with a group of contributing healthcare leaders, four themes emerged as central to our discussion and ultimately to the definition itself – the sum of all interactions, shaped by an organization’s culture, that influence patient perceptions across the continuum of care. These themes shaped the fundamentals for action in providing the best in experience and I still see them as central and imperative across healthcare settings today.

Experience efforts are shaped through the interactions of all individuals involved and grounded in the organization’s culture through which they are delivered. It is the actions of all participants in the care experience – caregivers, support teams, patients and family members alike – that ultimately influence the perceptions of experience and create the lasting impact (and I suggest ripple effect) that each experience has. Experience is a partnership with patients, residents and families, not a doing to, and these words reinforce this critical point.

It is the last element of the definition that is also perhaps the most easily accepted: across the continuum of care. As the patient experience movement has flourished, there has been growing recognition that experience stretches well beyond the four walls of any clinical encounter or the physical structures of the acute care setting. In fact, the ideas of experience, in variations of language including patient, resident or person-centeredness, have permeated the wide array of care experiences one can have in healthcare today. This idea may be no better reinforced than the focus on the experience of individuals in long-term care.

The effort to provide a strong and positive experience for individuals in long-term care is not a new concept. This idea has been addressed in the dialogues of great institutions such as the former Picker Institute and now via Planetree and through organizations such as the Pioneer Network, Leading Age and the American Health Care Association (AHCA). Partly driven by policy, such as we have seen sweep the US healthcare system in other segments of the continuum with the CAHPS efforts, and framed by what we know to be the right thing to do, long-term care has long been focused on the elements of resident quality, safety and service and the built environment to ensure the best for those in their care.

There is a growing understanding in all environments, that aside from the right thing to do for those in our care, or even a must do, there is also increasing policy focus and requirements that not only measure action, but also tie financial implications to them. Yes, we must acknowledge the financial implications of this effort as well, including the reality that individuals in the healthcare system at all points on the continuum are now consumers – people carefully select doctors, they make decisions on which hospitals to seek care and they look long and hard at the options in selecting a location for a parent or loved one to reside for long-term care needs.

If we accept choice is a factor now in healthcare, then experience matters. In focusing on the continuum of care, it matters to the patients, residents, people in our care, it matters to their families and it matters to all who deliver care as well. It is for this reason we continue to evolve our work at The Beryl institute to expand the experience conversation to all points on the continuum of care and to acknowledge the opportunities at the moments of care transition as well.

We have worked to engage broader voices in the physician practice setting by exploring how experience is being addressed by physician clinics and groups and our events are expanding to include greater dialogue and content on the important practices taking place in the ambulatory and outpatient settings. With equal focus (and the support of energized and committed members of our community), we are embarking in expanding our efforts to address experience in the long-term care setting as well. In the coming months, through Patient Experience Conference 2015 and beyond, we will work to collaborate with leading thinkers and organizations to reinforce and expand the critical conversation of experience in the long-term care environment. This will include papers, webinars, conference sessions and expanding research into this area of the continuum.

We hope through these efforts and partnerships we can support the critical dialogue of experience at all points on the care continuum. We will strive to continue our growth as a community encouraging and supporting the dialogue among individuals impacting each touch point in the care experience. If we maintain that experience as defined truly crosses the continuum of care, not only is this a critical effort to take on, it is a must do in ensuring that the experience conversation – the critical confluence of quality, safety and service and the fundamental considerations of people, process and place – engages all and includes all voices. We are excited by this next stage of the experience movement and invite and encourage your thoughts, ideas and participation.

Jason. A. Wolf, Ph.D.
President
The Beryl Institute 

Tags:  choice  community of practice  Continuum of Care  culture  defining patient experience  Field of Patient Experience  HCAHPS  healthcare  improving patient experience  Interaction  Interactions  long term care  patient  Patient Experience  Patient Experience Conference  service excellence  voice 

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Reigniting our Intention for Patient Experience Improvement

Posted By Jason A. Wolf Ph.D. CPXP, Tuesday, April 1, 2014

In just the last few days I had the privilege of spending time with the team at Cincinnati Children’s and then speaking with caregivers, staff, patients, family and community members as part of the Ontario Ministry of Health’s Central Local Health Integration Network Quality Symposium. While vastly different organizations and experiences that crossed an international border I was struck and even moved by the passion and commitment I see growing around the patient experience.

This is no better exemplified then by the growth of our community at The Beryl Institute and the efforts that have been inspired by each of you. The dialogue on patient experience improvement is growing, not just due to surveys, or even at-risk dollars (though we would be mistaken not to acknowledge its influence). It is not just driven by shifts in policy or even an emerging consumer mindset that has brought the concept of personal choice to healthcare decision-making. We may best describe it instead, by the "perfect storm” of personal awareness, professional passion, and external influence all culminating in this moment. And this is your moment as an individual committed to patient experience improvement.

This culmination guides what we have been inspired to create through our community and in the coming weeks will make available to support this powerful intention. My hope as a servant for the needs of the over 20,000 members and guests of The Beryl Institute and the countless others committed to this movement is that we provide the framework, resources, learning and connections to foster continuous motion.

We start in just a few days with Patient Experience Conference 2014, a physical gathering to engage with one another in learning, sharing, challenging and inspiring efforts. It will be soon followed by Patient Experience Week, a new annual event, inspired by members of the Institute community, to celebrate healthcare staff impacting patient experience. Taking pause during this week provides a focused time for organizations to celebrate accomplishments, reenergize efforts and honor the people who impact patient experience everyday.

In the midst of these major events, are two dynamic resources designed to support the very intention I see burgeoning. The first, the release of the initial Patient Experience Body of Knowledge learning modules, brings this community effort guided by almost 500 voices to its next stage, in providing core learning for current and aspiring patient experience professionals. From this focus on practice we will also see a push for greater research with the launch of Patient Experience Journal (PXJ) and its Inaugural Issue bringing together the voices of academic and practical research from around the world to inform and even challenge our work.

In the weeks ahead, and in the weeks and months beyond, our task together must be to refresh, renew and reignite our intention through these and other efforts. The task at hand may be no simpler, yet never more complex. Your work as champions of patient experience is a relentless effort of doing what is right in every moment. Consider this a rallying cry in a month where powerful people and strong efforts will collide in great possibility. So what can you do about it? I offer:

  1. Acknowledge that whatever role you play, what every title you hold, whatever resources may be at your call, you are a leader for patient experience improvement.
  2. Recognize that complexity may be our greatest foe in dealing with what at its core is our commitment as human beings caring for human beings – keep it simple, that is where great power can be found.
  3. Commit to engaging others in your efforts – be it the voices of patients and families, the insights from community, the experiences of peers or colleagues. While at times it may feel lonely on this journey, know there are so many more carrying this passion with you.
  4. Focus relentlessly on where you can make a difference; the operative concept being there is a place that each and every one of you has a difference to make.
  5. Don't let complacency be the enemy of your intention; yes there are now scores to earn, objectives to achieve, targets to shoot for, but don't be afraid to do what you know is right in the end.

The team at Cincinnati Children’s reinforced what I have seen on many On the Road visits and the participants in Ontario exemplified it in their efforts. We all have a vested interest in improving patient experience – be it for ourselves, our loved-ones, our friends, or our communities. This is a cause worth working towards and one in which I hope we will always remember the power of strong and true intention.

Jason. A. Wolf, Ph.D.
President
The Beryl Institute

Related Body of Knowledge courses: Organizational Effectiveness.

Tags:  body of knowledge  central LHIN  choice  Cincinatti Children's  culture  global healthcare  HCAHPS  healthcare  improving patient experience  intention  Leadership  patient  patient experience  Patient Experience Conference  patient experience journal  patient experience week  pxj 

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How Will You Inspire the Patient Experience Movement? Four Considerations for 2014

Posted By Jason A. Wolf, Ph.D., Tuesday, January 14, 2014

I am inspired. The New Year has arrived with great energy at The Beryl Institute. We start 2014 as a global community of practice of over 20,000 professionals, focused without hesitation on ensuring the best in experience for patients, families and one another in healthcare.

I am inspired by the continued commitments expressed for this work: by The Beryl Institute’s Patient Experience Scholars who met recently to share their research and reinforce their willingness to encourage and support others; by the members of the Global Patient & Family Advisory Council who want to influence how patients and family members are heard and engaged in making a profound difference in healthcare; by the many contributing to the development of the Patient Experience Body of Knowledge courses soon to be available to the community; and by many more.

I am inspired by how in the first two weeks of a new year, such commitment and intent can emerge, built on all that has come before and focused with purpose on the great opportunities ahead. As I reflect on this idea, a question emerged and perhaps a challenge for each of us to consider:

How will you inspire the patient experience movement in the year ahead?

I pose this question with the hope that actions and considerations from the smallest moments of unparalleled kindness to the largest strategic triumphs all find room to take root and grow. Inspiration comes in all shapes and sizes, but in this diversity it has strong commonalities – it causes us to feel a sense of something special and powerful. It provides a boundless energy to influence, lead, change and make a difference. This is an exciting prospect in seeing that each of us can choose to have an impact. And while no two actions will be exactly alike, I do want to offer a few thoughts on how you can continue to frame your patient experience efforts to inspire yourself and others.

As we return to the definition of patient experience, I continue to experience its relevance time-and-time again in the application of these words to central actions associated with excellence. In reviewing its words – the sum of all interactions, shaped by an organization’s culture, that influence patient perceptions, across the continuum of care – I again see clear directions on moving your own experience efforts forward. They include:

1. Reinforce strategic focus. Patient experience has proven itself to be a relevant part of the healthcare conversation. It has surpassed the challenges of being dubbed a fad; it too has shown it has stronger legs than just serving as a policy framework. Experience is a central strategic pillar to organizational performance and success. Patient Experience in its broadest sense should be a clear and transparent component of every healthcare organization’s strategy.

2. Clarify and map your critical interactions. Experience doesn’t happen on billboards or in espoused actions, it happens at the most personal moments, at those points of engagement between one individual and another. The ultimate tool in patient experience improvement is your self, your heart, your hands and arms, your minds, your compassion and your common sense. We have a huge opportunity to map the interactions that occur on the patient path to ensure we consider the most effective way to respond at every touch point.

3. Model desired behaviors. Simply put, if interactions drive experience, then the behaviors that comprise them are the conduits that direct these interactions in one way or another. Organizational culture is shaped by behaviors, they represent the people, presence and purpose of an organization overall and no slogan, policy or program will trump the power of individual behavior. We must model, observe, coach and improve constantly to impact experience outcomes.

4. Expand your listening. As we ended 2013 exploring the Voices of Measurement, we learned that the power of data is only as valid as what we choose to do with it. Collection or reporting data for the sake of data misses the opportunity for learning and relevant action. To capitalize on the value of the voices that surround us in healthcare we must expand our listening. Experience is measured first in the direct voices of healthcare consumers, who remain our most significant mirror into our own efforts, but it is also found in the voices of our peers and colleagues. We are only capable of achieving our strategy through our people. They are much more than pawns to direct, but rather living resources accountable for ensuring excellence.

Perhaps these ideas will help spark your own thoughts on how you will choose to inspire the patient experience movement. Regardless of which direction you go, I hope you recognize the power that exists in your own personal choice and the ability to impact the experience of the person that is coming next. The year ahead can and should be about a great many things both personally and professionally. My hope is that you find you can and will be an inspiration in your efforts. This cause is too great for your efforts to be anything less. Now the question remains, what will you do? I look forward to your updates with great anticipation.

Jason A. Wolf, Ph.D.
President
The Beryl Institute

Tags:  accountability  Advocacy  body of knowledge  choice  community of practice  consumer advocacy  Continuum of Care  culture  defining patient experience  employee engagement  Field of Patient Experience  global defining patient experience  global healthcare  HCAHPS  healthcare  improving patient experience  Interaction  Interactions  patient  patient engagement  Patient Experience  service excellence  thought leadership  voice 

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The Conversation on Patient Experience Improvement Continues: A Reflection on Three Years

Posted By Jason A. Wolf, Ph.D., Friday, September 13, 2013
Updated: Friday, September 13, 2013

Most people would suggest that change doesn’t happen overnight, and while I believe change does take time, it does not need to take a lot of time. In fact, change, like most things in life, requires nothing more complicated than a simple choice. It is this same idea – the power of choice - that I use to frame all my discussions on patient experience improvement.

I share this idea of choice and change on the week that The Beryl Institute itself turns three years old. As we have seen the patient experience movement grow and flourish, it too has been a journey of change and choice. From the very first member signing on in September 2010, to the now over 18,000 members and guests from 45 countries around the world, The Beryl Institute community has made big choices and as a result driven big change.


Over the course of the last few years I have written about engagement, involvement and community and I am excited to say that the state of The Beryl Institute community is strong. We have seen a growing use of the definition of patient experience. We have also experienced almost a doubling in organizations having a formal definition of patient experience (something we stress as critical) as revealed in the 2013 State of Patient Experiencestudy and represented in the recent powerful infographic of the findings. We have also been inspired by the growing "#IMPX” movement with increasing numbers of organizations creating compelling videos of their teams reinforcing the message – "I am the Patient Experience!

At the Institute, we have also worked hard to ensure all voices are engaged in the conversation on patient experience improvement. We have authored an extensive series of publicationsto be a resource to all those working to impact the patient experience – from the C-Suite to the front lines from students to patient and family members. This effort has been expanded by the launch of the first of its kind Global Patient and Family Advisory Council to ensure this critical perspective is central to all we do. It has been supported by not only our virtual community connections, but also the consistently growing annual Patient Experience Conferenceproviding practitioners the space to reconnect and reenergize every year.

In shaping the knowledge and information base for patient experience improvement, we have led the effort to create a comprehensive body of knowledge focused on developing patient experience leadership now and into the future and guided by the input of over 400 healthcare leaders around the world. We have also awarded over 25 patient experience grants to support direct research projects on patient experience improvement where it is taking place – on the front lines. Most recently we have announced the launch of The Patient Experience Journal, a multidisciplinary, peer-reviewed publication designed to share ideas and research, and reinforce key concepts that impact the experience of patients and families across healthcare settings.

The full historyof the Institute is rich, but more importantly it exemplifies the very power of choice and of community I mention above. It was the choices of so many that made these offerings and resources possible. It will be the continued contributions of community members that will maintain this growth and drive the patient experience movement forward. These choices have led to great change and our hope is to continue to support this growth by providing a gathering place for ideas, a dynamic space for interaction and a vibrant hub for continued dialogue on patient experience improvement. We have arrived at this point with the guidance, leadership and support of so many around the globe…for this we are forever grateful. We now humbly go forth knowing there is much more work left to do. Happy Anniversary to you, this passionate and engaged community. We celebrate how far we have come together and look forward to continuing this journey with you!

 

Related Body of Knowledge courses: History.

Tags:  choice  culture  HCAHPS  healthcare  improving patient experience  Leadership  patient  Patient Experience  service excellence 

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Patient Experience is About More than Making Patients Happy

Posted By Deanna Frings, Tuesday, May 7, 2013
Updated: Tuesday, May 7, 2013

My dearest friend recently received news that her breast cancer is back after 11 years of remission. She struggles daily with eating enough to maintain a healthy weight, feeling strong and motivated enough to walk in the pool to build her strength, and to find relief from the constant pain. I’m not sure the word happy is in her vocabulary these days. But expressions of gratitude, a decrease in her anxiety, and a feeling of comfort are certainly emotions she has experienced when interacting with her healthcare team.

During the past several years in my various roles leading patient experience efforts, I have had frequent conversations with physicians, leaders, and clinical staff about what patient experience is, what it’s not and why these efforts are so important.

Some physicians express frustration about measuring patient satisfaction. After all, "It’s impossible to make every patient happy, why are we spending so much time and money sending surveys?” I have also experienced hospital administrators share their belief that if staff would just be nicer to people, the scores would improve. And, I have witnessed nurses and other clinical staff push back on patient experience activities saying, "We are not Disney, we are not here to make sure people have a good time, we are here to take care of patients.”

As I think about the evolution of the Patient Experience (PX) movement, I understand these various viewpoints. My PX journey began when the organization I worked for hired a consultant to teach the importance of customer service. After about 18 months, this turned into an initiative called "Service Excellence: Our Values in Action”. We continued on this journey for 5-8 years and recently the language and movement changed to what we know today as Patient Experience. I fully embraced this change, as it is a demonstration of applying our ongoing learning of what PX is really all about.

I don’t believe the goal of delivering the best to the patient and their families should be framed within the context of making them happy. I don’t believe patients give us the gift of their feedback, respond to a survey or write a heartfelt note because people simply made them happy. I believe it’s about so much more.

I tell physicians that patient satisfaction surveys do not measure patient happiness, but they can determine whether you listened with a compassionate ear as they expressed their concerns and worries.

I vividly recall reading a letter from the niece of a patient after her uncle died. She expressed her deepest gratitude not only for the care and compassion her uncle received but also for the care and comfort she received at a most difficult time in her life. The letter she wrote focused on the nurse who called to inform her that her uncle passed away in the middle of the night. This nurse went on to explain that he did not die alone. Hearing this brought instant comfort to the niece. Was she expressing happiness in her letter? Of course not. Rather, she was thanking this nurse for the compassionate way in which she shared this difficult news.

I’m not saying that in healthcare we should not be nice to people or that those simple courtesies are not important parts of the way we deliver care. What I am saying is that we must reach higher, go deeper, and deliver care in the most compassionate way. That is why I fully embrace the next evolution in our PX journey.

Fred Lee talks about this in his three levels of care framework. Wendy Leebov’s works with clinicians building their skill in compassionate communications and Colleen Sweeneyraises awareness in patient’s biggest healthcare fears in her Empathy Project.

Hospitals, clinics, outpatient centers etc, do not have the same goals as Disney. We must look beyond the happiness factor. We must comfort, care, listen and convey compassion in every interaction. That is what the patient experience is all about and why I’m more than happyto listen to what our patients have to say about their healthcare experience.

Deanna LW Frings
Director, Education & Professional Development
The Beryl Institute

Related Body of Knowledge courses: Patient & Family Centeredness.

Tags:  choice  defining patient experience  Field of Patient Experience  global defining patient experience  HCAHPS  improving patient experience  Patient Experience  perception  service excellence  storytelling  value-based purchasing 

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7 Steps to Accountability: A Key Ingredient in Improving Patient Experience

Posted By Jason A. Wolf Ph.D. CPXP, Tuesday, October 2, 2012
Updated: Monday, October 1, 2012

As I continue to visit healthcare organizations and engage with leaders globally there are clear emerging trends at the heart of effective efforts to address the patient and family experience. In my recent series of blogs I suggest we must recognize the implications of patient perceptions as a focus of our patient experience efforts. I support this by reinforcing that culture is a critical choice for organizations to consider in terms of how they look to shape those perceptions. In fact we cannot overlook the centrality of culture to the very definition of patient experience overall. I add that it is on a strong cultural foundation that we can then ensure a sense of engagement for our staff and patients.

The missing piece in this important dialogue is that of building a foundation of accountability in our healthcare organizations. It has been identified as a top issue for healthcare leaders during my On the Road visits and at our Regional Roundtable gatherings. In looking at all the suggested paths and plans to accountability some general themes emerge.

Building a basis for accountability in organizations requires a number of committed actions. Without these organizations run the risk of falling short on their defined patient experience objectives. They include:

1. Establish focused standards/expectations – Determine and clearly define what you expect in behaviors and actions as you create a culture of accountability.

2. Set clear consequences for inaction and rewards and recognition for action – Be willing to reinforce expectations consistently and use as opportunities for learning.

3. Provide learning opportunities to understand and see expectations in action – Ensure staff at all levels are clear on expected behaviors and consequences.

4. Communicate expectations, reinforcing what and why consistently and continuously– Keep expectations top of mind and be clear that these are part of who you are as an organization in every encounter.

5. Observe and evaluate staff at all levels providing feedback and/or coaching as needed – Turn actual encounters, good or bad, into learning moments and opportunities to ensure people are clear on expected behaviors and actions.

6. Execute on consequences immediately and thoughtfully – Respond rapidly when people miss the mark (or when people excel) to ensure people are aware of the importance of your expectations.

7. Revisit expectations often to ensure they meet the needs and objectives of the organization – Remember standard and expectations are dynamic and change with your organization’s needs. They must stay in tune with who you are as an organization (your values) and where you intend to go (your vision).

Accountability has been tossed around more and more in conversations today in healthcare organizations as something that leaders want to see more of. The reality is that accountability is not just something you simply expect and it just miraculously appears, it is something you must intentionally create expectations for and reinforce. As with patient experience itself, accountability needs a plan in order to ensure effective execution.

I often speak of patient experience efforts as a choice; one that requires rigorous work. This is overcoming something I call the performance paradox, which helps us recognize that many things we see as simple, clear and understandable are not always easy, trouble-free and painless to do. Yet I would suggest we have no other choice. As a positive patient experience is something we owe to our patients and their families in our healthcare settings, creating and sustaining a culture of accountability is something we actually owe to our staff in supporting their ability to create unparalleled experience.

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

Related Body of Knowledge courses: Coaching and Developing Others.

Tags:  accountability  choice  culture  defining patient experience  employee engagement  HCAHPS  improving patient experience  patient  patient engagement  Patient Experience  perception  Regional Roundtable  service excellence 

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7 Steps to Accountability: A Key Ingredient in Improving Patient Experience

Posted By Jason A. Wolf Ph.D. CPXP, Tuesday, October 2, 2012
Updated: Monday, October 1, 2012

As I continue to visit healthcare organizations and engage with leaders globally there are clear emerging trends at the heart of effective efforts to address the patient and family experience. In my recent series of blogs I suggest we must recognize the implications of patient perceptions as a focus of our patient experience efforts. I support this by reinforcing that culture is a critical choice for organizations to consider in terms of how they look to shape those perceptions. In fact we cannot overlook the centrality of culture to the very definition of patient experience overall. I add that it is on a strong cultural foundation that we can then ensure a sense of engagement for our staff and patients.

The missing piece in this important dialogue is that of building a foundation of accountability in our healthcare organizations. It has been identified as a top issue for healthcare leaders during my On the Road visits and at our Regional Roundtable gatherings. In looking at all the suggested paths and plans to accountability some general themes emerge.

Building a basis for accountability in organizations requires a number of committed actions. Without these organizations run the risk of falling short on their defined patient experience objectives. They include:

  1. Establish focused standards/expectations – Determine and clearly define what you expect in behaviors and actions as you create a culture of accountability.
  2. Set clear consequences for inaction and rewards and recognition for action – Be willing to reinforce expectations consistently and use as opportunities for learning.
  3. Provide learning opportunities to understand and see expectations in action – Ensure staff at all levels are clear on expected behaviors and consequences.
  4. Communicate expectations, reinforcing what and why consistently and continuously – Keep expectations top of mind and be clear that these are part of who you are as an organization in every encounter.
  5. Observe and evaluate staff at all levels providing feedback and/or coaching as needed – Turn actual encounters, good or bad, into learning moments and opportunities to ensure people are clear on expected behaviors and actions.
  6. Execute on consequences immediately and thoughtfully – Respond rapidly when people miss the mark (or when people excel) to ensure people are aware of the importance of your expectations.
  7. Revisit expectations often to ensure they meet the needs and objectives of the organization – Remember standard/expectations are dynamic and change with your organization’s needs. They must stay in tune with who you are as an organization (your values) and where you intend to go (your vision).

Accountability has been tossed around more and more in conversations today in healthcare organizations as something that leaders want to see more of. The reality is that accountability is not just something you simply expect and it just miraculously appears, it is something you must intentionally create expectations for and reinforce. As with patient experience itself, accountability needs a plan in order to ensure effective execution.

I often speak of patient experience efforts as a choice; one that requires rigorous work. This is overcoming something I call the performance paradox, which helps us recognize that many things we see as simple, clear and understandable are not always easy, trouble-free and painless to do. Yet I would suggest we have no other choice. As a positive patient experience is something we owe to our patients and their families in our healthcare settings, creating and sustaining a culture of accountability is something we actually owe to our staff in supporting their ability to create unparalleled experience.

Jason A. Wolf, Ph.D.

Tags:  accountability  choice  culture  defining patient experience  employee engagement  HCAHPS  improving patient experience  patient  patient engagement  Patient Experience  perception  Regional Roundtable  service excellence 

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The Power of Interaction: You are the Patient Experience

Posted By Jason A. Wolf Ph.D. CPXP, Tuesday, December 6, 2011
Updated: Tuesday, December 6, 2011

In looking back at 2011, I have touched on a cross-section of topics on the patient experience – from service excellence andanticipation to value-based purchasing and bottom line impact. This year has led us to heightened awareness of the impact performance scores will have on dollars realized and increasing recognition that the patient experience is a priority with staying power. The Beryl Institute’s benchmarking study, The State of Patient Experience in American Hospitals, revealed both the great intentions and significant challenges that are at hand in addressing the critical issue of patient experience.

Our research supports, and I fundamentally believe, that there is a need for a dedicated and focused patient experience leader in every healthcare organization. Yet in the midst of all this attention, we may have overlooked the most important component – the immense power, significant impact and immeasurable value of a single interaction.

What does this mean? Interaction is simply defined as a mutual or reciprocal action or influence. The key is mutual action; something that occurs directly between two individuals. No interaction is the same, but it requires a choice by both parties to engage and respond as they best see fit. In healthcare settings, be it hospitals, medical offices, surgery centers or outpatient clinics, there are countless interactions every day. The question is: are they taken for granted as situations that just occur or are they seen as significant opportunities to impact experience? Perhaps in thinking about experience as a bigger issue, the importance of these moments of personal relationship has been missed.

What this means for improving the patient experience may be simple. Rather than waiting for that one leader to build the right plan or for your culture to develop in just the right way, you each instead recognize one key fact – you are the patient experience. I acknowledge there is a need for a strong leader and a solid cultural foundation on which to build, but at its core patient experience is about what each and every individual chooses to do at the most intimate moment of interaction. If these moments are used as the building blocks to achieve our greatest of intentions, patient experience will be the better for it. As you look to next year, whether you sweep the floors or sit in the c-suite, the choice should be clear. In today’s chaotic world of healthcare, the greatest moment of impact may be in the smallest of encounters. It is here that the most significant successes be they for scores, dollars or care will be realized. Happy holidays to you all!

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

Related Body of Knowledge courses: Organizational Effectiveness.

Tags:  bottom line  Continuum of Care  culture  defining patient experience  HCAHPS  improving patient experience  Interaction  Patient Experience  return on service  service anticipation  service excellence  service recovery  value-based purchasing 

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The Smart Thing to Do: Patient Experience and the Bottom Line

Posted By Jason A. Wolf Ph.D. CPXP, Tuesday, November 1, 2011
Updated: Tuesday, November 1, 2011
Most now agree that patient experience is not just a nice to do, it is a must do. The idea of patient experience has recently taken on greater significance, first, through the emergence of surveys such as HCAHPS that make performance transparent and followed by the reality that reimbursement dollars, performance pay and compensation are being tied to outcomes through policy being implemented around the world. Improving the patient experience is also what is right to do. It is about providing the type of care experience for patients and families that you would want for yourself and your loved ones.

But recognizing patient experience as both a must do and a right to do, is not enough. It should also be addressed as the smart thing to do. Why? The patient experience has true financial implications for healthcare organizations that reach well beyond regulations. With all that is done to address patient experience from the cultural, organizational and process sides, we also need to consider its financial implications. This is perhaps the area that patient experience champions have focused on the least, but could have the most significant impact in making the case for the important work being done.

Patient experience influences the performance of healthcare organizations on a number of fronts. In The Beryl Institute’s newest white paper, Return on Service: The Financial Impact of Patient Experience, three perspectives are suggested as we look at the bottom line impact of the patient experience: financial, marketing and clinical.

  • From the financial perspective, it has been shown that satisfied patients lead to higher profitability. In a 2008 J.D. Power study, it was discovered that hospitals scoring in the top quartile in satisfaction had over two times the margin of those at the bottom. These findings were supported by the 2008 Press Ganey paper, Return on Investment: Increasing Profitability by Improving Patient Satisfaction. The paper revealed that when hospitals were ranked by profitability into quartiles, the most profitable hospitals had the highest average satisfaction scores.
  • From the marketing perspective, we need to look no further than the power of word of mouth. In her 2004 article, Jacqueline Zimowski shared that a satisfied patient tells three other people about a positive experience. In contrast, a dissatisfied patient tells up to 25 others about a negative experience. The issue worsens, as for every patient that complains, there are 20 other dissatisfied patients that do not. And of those dissatisfied patients that don’t complain, only 1 in 10 will return. When you run the numbers, for every complaint you hear, you could be losing a potential 18 patients. In essence by not focusing on experience we are potentially driving patients away.
  • From the clinical perspective, we must be clear to recognize that experience and quality are not distinct efforts but critically interwoven aspects of overall care. Patient Experience is not just about pretty or quiet environments, positive service scripting or even consistent rounding. At the end of the day it is about ensuring our patients leave better than when they arrived (as often as we can). This was exemplified in a powerful way in the 2011 study, Relationship Between Patient Satisfaction with Inpatient Care and Hospital Readmission Within 30 Days,reported by Boulding et al. They examined quality factors (as defined by CMS Core Measures, specifically on acute myocardial infarction, heart failure, and pneumonia) and satisfaction factors (as determined by the two HCAHPS questions – How do you rate the hospital overall? and Would you recommend the hospital to friends and family?) in relationship to readmission rates within 30 days of discharge. The finding was surprising. The HCAHPS scores, i.e. experience outcomes, were reliable and even more predictable indicators of readmissions than quality indicators. In essence, patient experience, herein measured by HCAHPS was a distinct and measurable driver of readmissions, a key quality issue and a significant financial issue for healthcare organizations and one taking on even greater interest as it will impact future reimbursements that hospitals are eligible to receive.
As healthcare leaders take on the challenge of patient experience, it is important to recognize that it reaches well beyond simple measures of satisfaction. A commitment to patient experience has significant and measurable impact, not only in doing what is right for the people and communities you serve, but also in ensuring the best quality and most financially sound experience for all who are in and who deliver your care. To be responsible stewards for healthcare systems that are both vital and viable, it is essential to recognize and be willing to address the bottom line issues influenced by patient experience efforts every day. It is the smart thing to do!

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

Related Body of Knowledge courses: Metrics and Measurement.

Tags:  bottom line  culture  FInancial Implications  HCAHPS  improving patient experience  marketing  Patient Experience  press ganey  readmissions  return on service  service excellence  value-based purchasing 

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Patient Experience – A Delicate Balancing of Science and Art

Posted By Jason A. Wolf Ph.D. CPXP, Tuesday, October 4, 2011
Updated: Wednesday, October 5, 2011

With the emergence of HCAHPS in the US and similar measures in other countries and the financial implications now associated with these scores such as underValue Based Purchasing and the Excellent Care for All Act in Canada, efforts to address patient experience are at an all time high. Surveys such as the Institute’s Benchmarking Study now show patient experience to be a top priority for healthcare leaders. It seems these new regulatory pressures have heightened awareness, increased executive support and created a burning platform for action.

This elevation in attention has also presented a challenge. With new regulations, especially those tied to financial reward, arises the need to perform to the test. Our research has shown that US hospital’s priorities aligned often with the very domains being asked in the HCAHPS survey, from reducing noise to providing proper discharge instructions. These are not bad things on which to focus, but by simply focusing improvement on the questions themselves, the ‘science’ of patient experience, we miss the foundation, the culture (the ‘art’) on which to build.

In some ways addressing the questions is easy. We can measure our quietness at night and we can time ourselves on responsiveness, but we cannot manage service elements in the same manner as core quality measures, which are truly process driven, can be tracked via checklist and easily monitored. The science of service is not that cut and dry. Instead, it relies on a delicate balancing with the culture of the organization in which it is performed.

John Kotter and James Heskett (1992) have a nice way of framing culture in the workplace at two levels, the deeper level of shared values and the visible level of shared behaviors. This is the art of patient experience. We cannot create a checklist to ensure a shared base of values or behaviors exist, but without them the performance of the items being measured is at risk. We are presented with a need for delicate balancing – a measure set to manage what we are being evaluated (and paid) on and a culture on which our performance relies.

Through my On the Road visits and other discussions with healthcare leaders I have been privy to hearing about this delicate balancing first hand. The organizations that perform well in scores are doing more than teaching to the test or focusing on scores. Our paper The Four Cornerstones of Patient Experiencehelped frame the importance of a dedicated role and organizational focus in driving better outcomes (a clear blending of art and science) and my visits to leading performers have reinforced this message. For example at Inova Fair Oaks Hospital they insisted that you can try all the service tactics you want, but you first need a strong culture on which to build and at Medical Center of Arlington they helped us see that it is about aligning leadership and people, establishing clear expectations and living to them at all levels that was the foundation of their success.

The challenge is clear (and perhaps daunting); that true success in patient experience comes from our ability to manage the balancing of the science and the art. I say "balancing” as this effort is in constant movement, from a focus on measures to a focus on culture. There is not one perfect spot to stand, but sustained success comes from our ability to acknowledge the impact that both measures and culture have on providing the best experience for our patients overall. Here is to effective balancing!

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

Related Body of Knowledge courses: Metrics and Measurement.

Tags:  culture  Excellent Care for All Act  HCA  HCAHPS  improving patient experience  Inova  Medical Center Arlington  Patient Experience  service excellence  value-based purchasing 

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