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The Beryl Institute Patient Experience Blog
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Creating a Field of Patient Experience – A Call to Action

Posted By Jason A. Wolf Ph.D. CPXP, Tuesday, May 8, 2012
Updated: Monday, May 7, 2012

Something powerful took place at this year’s Patient Experience Conference and it took some time in reflection for me to sort it out. We opened the conference with the powerful video "I am the Patient Experience” showing the faces of the many individuals key to the Patient Experience. We then reviewed the efforts underway to create a Body of Knowledge, shaping a model for ongoing development of patient experience leaders, and the potential for formal certification. The days together were filled with the connections and learning central to the vision of The Beryl Institute (see the pictures and review the lessons learned).

It culminated with our closing speaker, Tiffany Christensen who brought us the voice of the patient and suggested something profound. She noted that our work in patient experience is truly a movement. In fact, what we are doing together is shaping a field. As the faces of participants declaring "I am the Patient Experience” flashed on the screen to close the time together, it was evident something bigger was happening than a conference or even the growth of a global community of practice.

Captured in the energy and spirit that filled those three days in April, was the same commitment and possibility that was shared by the over 300 individuals from 8 countries that have contributed to framing the 15 domains in the Patient Experience Body of Knowledge or even the over 8,000 members and guests that engage with the Institute community every month. The Body of Knowledge now stands for something bigger than just things we "need to know” to be effective practitioners in patient experience. It represents the foundation of a field grounded in knowledge and experience that can have lasting and profound impact on how those in healthcare work and how patients and families are ultimately cared for.

Creating a field is no small task and will not emerge from any one individual or organization. It must result from the voices of many, which is why I encourage your continued involvement in the Body of Knowledge effort. At The Beryl Institute, we look to be the catalyst, convener and coordinator of this important work. The next steps in the process will be the creation of work teams that will outline the key content for each of the domains of knowledge. Together with respected subject matter experts these outlines will help shape the learning needed to sharpen the skills of current practitioners and create a path to develop future leaders for the field. I invite you to learn more about the process and consider contributing to the work of these teams

I mentioned in a recent Hospital Impact blog that patient experience is not a fad, but is now a critical component of healthcare overall. We must work together to solidify the knowledge needed to lead, continue to support the research that will stretch our ideas and practice and come together as a global community that will take a stand for what we know is right in ensuring the best of experiences for our patients and their families. If we do this with the passion that I saw during our three days together at Patient Experience Conference 2012, there is no doubt that what we are doing is truly creating a field of patient experience.

Jason A. Wolf
Executive Director
The Beryl Institute

Tags:  body of knowledge  culture  Field of Patient Experience  improving patient experience  Interaction  open comment period  patient  Patient Experience  Patient Experience Conference  thought leadership  Tiffany Christensen 

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Loyalty – The True Reward for Unparalleled Patient Experience

Posted By Jason A. Wolf Ph.D. CPXP, Tuesday, April 3, 2012
Updated: Tuesday, April 3, 2012

Last week I had the opportunity to attend a conference on Healthcare Experience Design. This is an incredibly important part of the work in providing a positive patient experience. In fact, experience design has been identified as one of the fourteen core domains in the Patient Experience Body of Knowledge (Have youprovided your input yet?). The element of design focuses on possibility, not problems. I believe we need to ensure patient experience overall has that same intention.

The well-known design firm IDEO reinforces these principles in the way they work with partner organizations. They describe this as design thinking, "a deeply human process that taps into abilities we all have but get overlooked by more conventional problem-solving practices.” This is a powerful statement in that patient experience in many ways is just that, the ability to move beyond problems to something more meaningful, and beyond standard processes, to those that have real and lasting impact. In this shift from a problem solving to a design mindset, the potential power of a positive patient experience is unleashed.

This idea was reinforced by Gary Hirshberg, President and CE-Yo of Stonyfield Farm, who talked about the potential intersection of design and business function. He shared that while some organizations manage their priorities to reduce production costs and then direct significant dollars towards promotion and advertising, there is another opportunity. If we invest in our products and services to ensure the greatest quality experience, we can change the equation. This shift in focus is from one of awareness through advertising to one of attraction and engagement through loyalty. Hirshberg reinforced that you get to loyalty by doing what is right for your consumer, not by telling them how great you are. As I listened to this argument in the consumer product world, I found myself thinking about how this applies to healthcare.

In an era where patients and family members are becoming more consumer-savvy and the system is set up to provide for greater ways to actually comparison shop in the healthcare marketplace, how has healthcare responded? Have efforts in healthcare focused on awareness through advertising and promotion or have opportunities for loyalty been created and sustained? Has a system been built based on solving the problem of driving healthcare volume or has the industry shifted to the thoughts of possibility in designing for an unparalleled experience?

It is clear in healthcare reputation carries great weight, but how that reputation is presented also has an impact. Advertisements for awards, recognitions or even wait times can only carry an organization so far. They are the perceived, not lived experience. Rather it is in designing and enacting the actual experience through which reputation is solidified and loyalty gained. This suggests the importance of investing in what it takes to ensure the best patient experience versus simply the messages to convey value. In doing so the conversation shifts from awareness which will need to reinforced again and again via the next print ad, billboard or TV spot, to that of experience that will reach well beyond the walls of a facility or practice, through the words of those that have walked your halls, engaged with your staff and had the chance to be impacted by the experience overall. Loyalty does come by doing right. This is making the right investments in your overall patient experience. In doing so you move beyond solving the problems for your organization and instead reinforce what is possible for your patients, their families and your team.

Jason A. Wolf
Executive Director
The Beryl Institute

Related Body of Knowledge courses: Metrics and Measurement.

Tags:  body of knowledge  bottom line  culture  improving patient experience  leadership  marketing  Patient Experience  return on service  service excellence  team 

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Creating a Body of Knowledge for Patient Experience Leaders

Posted By Jason A. Wolf Ph.D. CPXP, Tuesday, March 6, 2012
Updated: Tuesday, March 6, 2012
In The Beryl Institute paper, "The Four Cornerstones of Patient Experience”, we discovered that when organizations choose to have a leader with committed time to guide patient experience efforts, those organizations outperform their peers in both HCAHPS performance as well as patient satisfaction results. Finding that intentional focus on an issue leads to better results is not surprising, but it is important to note that a focused individual made the difference.

This led us to ask, if we can show that having an identified patient experience leader is a critical component of success, and specifically in driving measures that have service, quality and financial implications for healthcare organizations, can we define what it is that this individual does?

We started with a small steering team of healthcare professionals from hospitals and organizations across the United States on a mind-mapping exercise to identify key areas of knowledge critical to patient experience leaders. This exercise led to the development of domains that started to frame a core body of knowledge. Job descriptions were explored from roles around the world, competency models were examined from related fields and organizations, and then broader input was sought engaging patient experience and healthcare leaders from the US, the UK, Australia and Canada. The feedback led to hundreds of pages of thoughts on the critical nature and true complexity of patient experience and of the knowledge needed to effectively address it.

The discovery was powerful; a body of knowledge for patient experience leaders that began to shape an identifiable field of practice. It also brought greater clarity to the findings in the "Four Cornerstones” paper. While a focused individual was critical, this alone would not drive patient experience success. Rather an individual needs the skill set and "know-how” to truly impact this central component of the healthcare world.

That leads us to today, where the input and work of over one hundred volunteer leaders and contributors provides an initial framework to explore and a new possibility for shaping the field of patient experience. On Monday, March 5 we unveiled the Patient Experience Body of Knowledge and the 14 domains of knowledge key to an effective patient experience leader. With all the work that has led to this point, it is now that a much broader conversation gets underway.

We invite individuals from all corners of the healthcare system, including patient experience practitioners, healthcare leaders and staff, physicians, patients, families and community members to contribute their voices to the process. For the next 6 weeks, through Monday, April 16, we will be gathering your input to further polish this work. We will share the results of this effort to start Patient Experience Conference 2012. At The Beryl Institute, we believe the patient experience is about every player in the healthcare process and should encompass the voices of all those it impacts.

In healthcare, experience is truly central to all we do. The opportunity to provide a framework for the important work taking place every day in healthcare organizations is a critical global dialogue. I invite and encourage you to join the conversation.

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

Tags:  body of knowledge  certification  community of practice  culture  defining patient experience  improving patient experience  leadership  open comment period  Patient Experience  service excellence  thought leadership 

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Whose experience is it anyway?

Posted By Jason A. Wolf Ph.D. CPXP, Tuesday, February 7, 2012
Updated: Tuesday, February 7, 2012
During two of my recent On the Road visits (one with Children’s National Medical Center and another for an upcoming story on Banner Health) what I observed and what came up in conversation caused me to pause and ask the question – whose experience is it anyway?

In one example, Kelli Shepherd, the Director of Service Excellence at Banner Good Samaritan Hospital, shared a subtle, but profound change in the language they were using. The shift was one in perspective – from "our” beds to "their” beds. A simple change, but one I believe challenges one of the central mental models I have seen in healthcare. We have often viewed patients as individuals that things are done TO, not necessarily done FOR.

I would not say we have turned healthcare into a heartless, mechanical process. Rather, I caution that what we may have done in not recognizing "ours” versus "theirs” is to design processes and systems and implement requirements and standards made to work best for us, not our patients and families. So what can we do to address this?

1. Clarify perspective. Are we building our programs, and even our patient experience efforts, from what we believe will best fit our needs? Or are we considering the perspective of patients and families as our guests? Stop and ask yourself, especially as you consider developing your patient experience effort, if the process is based on what is easiest for you or what is best for the patient?

2. Build an active process to engage patients, families and the community at large in how we can provide the best experience possible. Many organizations are now using patient focus groups not only to gather feedback post experience, but also to design processes and programs. At Children’s National, Patient Family Advisory Council members are embedded in many departments. They review and offer feedback on processes and provide an open avenue to ensure a broader perspective is available in all planning; they have even participated in the redesign of units.

3. Find ways to show you "listened”. The biggest return on experience investment is ensuring that patients and families not only feel heard in the moment, but also that the experience they are having overall reflects their wants and needs. Find avenues to show you are listening; be transparent about the input you seek and when and how you can (or cannot) use it.

As many of us in healthcare call hospitals the "house”, we must acknowledge that we are welcoming patients and their families into "our” house as guests. Our efforts should be focused on ensuring we provide the best experience possible. To do so we must recognize whose experience it is in the first place.

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

Tags:  Banner Health  Children's National Medical Center  improving patient experience  Patient Experience  service anticipation  service excellence 

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Your Patient Experience Priority for 2012 May Be as Simple as Taking the First Step

Posted By Jason A. Wolf Ph.D. CPXP, Wednesday, January 4, 2012
Updated: Wednesday, January 4, 2012

With all the predictions of new healthcare trends and the expanding requirements being placed on healthcare providers, one thing holds true – at the center of all these efforts and initiatives lies the patient. This is not patient-centeredness in the traditional sense of simply the care setting, but it is now clear that whether you are ready or not, the patient has taken center stage in our healthcare system.

For some, the patient experience was the fundamental driver of their efforts well before any requirements were raised; providing the greatest service and highest quality outcomes for the patients and families served at every touch point. Others have found new initiative in addressing patient experience with expanding financial implications. Yet many still struggle with where to focus, what to do or even if to act.

The harsh reality is that as of today over two-thirds of the initial performance period for Value-Based Purchasing is now in the books. With a closing date of March 31, 2012 and then the reality that reimbursements will be impacted just six months later, this is not the time to get stuck in a state of confusion. If you are not already moving, you still have time to act.

I have been asked by many healthcare leaders for the secret to the "best” patient experience. And while I will be the first to say I do not believe there is one specific formula that leads to patient experience success, I have offered a few considerations. In my recent blog with Hospital Impact, I reiterated the importance of four central strategies:

1. A clear organizational definition for patient experience.

2. A focused role to support patient experience efforts.

3. A recognition that patient experience is more than just a survey.

4. A commitment at the highest levels of leadership.

These suggestions are not complicated initiatives, but rather they should be a simple choice.

In every instance of high performance in patient experience what I observed above all else is that willingness to make a choice. For some it was a broad strategic effort where patient satisfaction was a key measure in performance compensation. For others it was finding that one area where they could begin to move the needle – creating a more quiet and relaxing environment, rounding with intention and empathy to ensure a patient and their family felt attended to, or simply communicating consistently that they were taking every action possible to ensure their patient’s pain was managed. I have suggested and will reassert here that excellence in patient experience emerges in the ability to balance its need to be a strategic imperative with clear measurable, tangible, and yes tactical action.

Most importantly, as my grandfather so wisely shared with me years ago, the more complicated we choose to make things, the more difficult they seem to accomplish. Patient experience is a critical issue, with increasing demands and pressures intertwined with a passion for care and an understanding that it is the right thing to do. This does not mean we need to make it bigger than we can handle. Or even that we need be discouraged if we have finally been able to make it a priority after others may seem "so far ahead”. The reality is that whenever and wherever you start is the right time and place if the intention is right and true. Now you have the choice, one as simple as committing to take that first step. My hope is that each of us, in every healthcare setting, has resolved to do something to improve the patient experience in 2012.

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

Tags:  bottom line  culture  defining patient experience  improving patient experience  Interaction  Patient Experience  service excellence  value-based purchasing 

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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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Service Recovery Should be the Exception, Not the Rule…Consider Service Anticipation

Posted By Jason A. Wolf Ph.D. CPXP, Tuesday, September 6, 2011
Updated: Wednesday, September 7, 2011

"Mind the Gap” is a phrase most often associated with the Tube in London. I hadn’t thought about it before, but in fact these famous words help frame the overall service experience. They remind us to be aware during this critical part of our journey and help us recognize that someone else is being mindful of our experience as well. This raises the question, why do we focus so much of our time on service recovery when we could be focusing on ensuring the best experience from the start? Minding the gap should be about our ability to anticipate our customer’s experience prior to it taking place at all.

This past weekend I passed a sign hanging on a lamppost posted by the city of Edinburgh that immediately caught my eye. It read "We are aware this light is faulty and are working to repair it as soon as possible.” It then provided contact information for further questions. Through the use of a simple yellow sign, a service experience was framed. Here too, it was clear someone was being mindful of the experience.

What do these examples show us? They reinforce the opportunity we have in creating positive patient experiences by anticipating the needs of our patients.

My current On the Road visit is with Inspiration NW, a part of NHS North West in the United Kingdom whose focus is on raising the profile and importance of patient experience (story to be published in the September Patient Experience Monthly). This incredible team has been working on the very issue of actively anticipating patient’s needs versus always reacting to them. One powerful tool they have introduced is Care Cards. Care Cards support patients and their relatives in exploring how the emotional needs and care preferences of patients can best be captured, monitored and addressed in real time as part of a quality-led care experience. The process reduces the sense of anxiousness patients bring to the care setting and ensures a stronger and more proactive approach to addressing a patient’s overall experience. This too serves as an example of anticipating needs, a "mind the gap” moment.

Even with anticipation, there will still be times where service recovery is necessary. The key is to make this the exception, not the rule. I myself have been guilty of espousing giving staff members the freedom to act in addressing service recovery issues without pushing for another freedom; the freedom to act in anticipation of patient needs. If service recovery is about restoring trust and confidence in the ability of an organization to "get it right”, service anticipation is about creating moments where people are wowed by our transparency and understanding of needs and know we will do right for them from the start. By being in action well before recovery is needed we can mind the gaps in service that may arise, instead providing winning moments that ensure a lasting and positive service experience.

Where have you seen or implemented service anticipation? I look forward to seeing your examples.

Jason A. Wolf, Ph.D.
Executive Director

The Beryl Institute

Related Body of Knowledge courses: Service Recovery.

Tags:  improving patient experience  Inspiration North West  NHS  NHS North West  patient  Patient Experience  service anticipation  service excellence  service recovery 

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Value-Based Purchasing is Underway…How Will You Distinguish Yourself?

Posted By Jason A. Wolf Ph.D. CPXP, Tuesday, August 2, 2011
Updated: Wednesday, August 3, 2011

I would not be the first to express concern if the only motivating factor for a healthcare organization or system to address the patient experience was due to the pending threat of reduced reimbursement connected to Value-Based Purchasing (VBP). Yet, I can also say that the attention this possibility has brought to the cause for how patients are engaged in the healthcare setting is also warmly welcomed. Managing this juxtaposition of feelings is what I find many organizations are now struggling with in addressing their patient experience efforts.

Many leaders accountable for improving patient experience outcomes are both supported by this elevated attention to policy, but also challenged by its parameters. Through the use of the measures incorporated in VBP one path for addressing the issue of service is seemingly set out. Succeed in certain domains of the HCAHPS assessment and you have a better chance of getting more of your withheld reimbursement dollars. (While I will not get into the full details of VBP, you can read more here.)

This sets up an interesting game of sorts in which many have seemingly begun to focus completely on the test (performance on the HCAHPS domains). This is not an impractical route to take (in fact we at The Beryl Institute are launching a series of interactive dialogues for members on these very topics), except that every other hospital aware of the ramifications of inaction are at least doing the same thing. The dilemma this poses is that if reimbursement through VBP is based on comparative measures to your peer organizations and everyone is prepping for the same test, what are you going to do to distinguish yourself?

Month one of the initial nine-month performance period is complete. In essence, the first inning is over and the question this raises is what have you done to move beyond simply increasing performance on the key HCAHPS domains? (Note I said moving beyond, not overlooking.) We have suggested, along with many others, that patient experience success is grounded in broader cultural improvements, in engaging your workforce in positive solutions and in finding new and powerful ways to involve patients in your delivery of service, before, during and after care. At the Institute we have gone as far as to suggest you need to consider such components of your patient experience process, from people’s first encounter with you through a scheduling experience to their post clinical interactions when dealing with the revenue cycleand collection process. It also encompasses the programs you initiate such as Patient and Family Councils, the processes you implement such as experience mapping or the important considerations you give to cultural competence.

While the domains being tested and tied to VBP drive you to look at internal issues, it is important to recognize that the respondents to these surveys – the patients and their families – are assessing you on encounters well beyond their clinical experience at the bedside. With that you still have an opportunity to distinguish yourself. Take some time to examine the results you have achieved so far and consider areas in which you can create broader opportunities for patient experience impact. You will find that by in engaging beyond the test, you can achieve even stronger and lasting results.


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

Tags:  cultural competence  culture  improving patient experience  Patient Experience  revenue cycle  service excellence  value-based purchasing 

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