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The Beryl Institute Patient Experience Blog
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Understanding expectations matters to experience excellence

Posted By Jason A. Wolf, Ph.D., Tuesday, February 10, 2015
Updated: Friday, February 6, 2015

In a recent personal encounter shared by our Director, Member Experience, Michelle Garrison, she told a story of her own healthcare experience related to a surgical procedure and how it made her feel as a patient in the process. Her experience and insights reinforced a critical point central to the conversation on experience excellence – expectations matter.

I first addressed this issue in the Patient Experience Blog two years ago when I wrote:

"Expectations are powerful. They influence what we see, how we act, and the way we react. They stir emotions and create real feelings from joy to anger, surprise to sadness. The reality of expectations is that they present an intriguing paradox in how they can and do influence the situations in which we find ourselves. Expectations are an individual and even very personal experience, yet at the same time they can be set by organizations, businesses and other people outside of one’s self. This makes expectation potentially the most valuable and perhaps most precarious tool in the discussion of consumer experience and in healthcare, the patient experience.”

As Michelle shared her story, she reinforced an important point from her personal experience. She noted, "We are continually looking for the best methods to help prepare patients and family members by ensuring they know what they are likely to face when they visit with a doctor, arrive at the hospital, leave a healthcare encounter and beyond. By setting their expectations ahead of time, we help prepare them and give them the opportunity for the best patient experience. However, even with the most comprehensive of processes in place, there are going to be times when expectations are not met and the patient experience will fall short.”

This was a profound statement for me as I realized in Michelle’s words reflecting on her encounter that she felt the provider would have provided expectations. It also raised an important point, and I dare say an opportunity. That in providing the best in experience we must also be willing to ask the questions and take the steps necessary to understand the expectations of those we are caring for.

In talking about her experience Michelle said "I was not the best of patients. Though, I am pretty sure if you were to ask my doctor, the nurses, anesthesiologist and the others who took care of me, they would not have anything bad to say about my behavior or me.” In asking why she felt that way, she added,

"Here is where I fell short. I did not ask enough questions and the questions that I did ask were not the right ones. I was not as informed as I could have been about what was going to take place and how I would feel after the procedure, and so my expectations did not match the reality of what occurred. I was given instructions both before and after, on the procedure and what to do if there was a problem, but there was nothing about how to deal with the lingering after effects and how I might feel. I mistakenly thought all of the information I needed would be given to me without my having to ask for it, but it was not. Of course, I could have reached out to my doctor, but instead I did what I am sure a lot of patients do, I turned to the internet to see if what I was experiencing was normal.”

This statement is powerful and eye opening in its potential reflection of the way many other patients or family members may feel in the midst of the healthcare system and their own experiences. This is a significant realization we may often miss, that while patients want to engage, they are not sure how to participate or what to ask. Or they believe what they need to know will be provided so don't think they even need to ask. In concluding her story, Michelle shared, "It is important to understand that patients and family members are not always going to ask all the questions they should or even the right ones. They may not know what questions to ask because they will assume, like I did, that the answers will be in that packet of paperwork they were given.”

I think we would all agree Michelle was not a "bad” patient, but perhaps quite the opposite, a patient that was trusting in the system to take care of her. Michelle’s procedure was successful and the system did its job, but the realization here is that there is an opportunity for much more. In many ways creating a process for clarifying and understanding the expectations of all participants in the care encounter be they patients or family members, doctors, specialists or support services and in doing so together could be one the most clear, simple and impactful ways to create the best in outcomes overall. Thanks Michelle for helping us to see and understand this point with greater clarity. You are the patient experience!

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

Tags:  expectations  patient engagement  patient experience  process 

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We Each Hold a Piece to the Patient Experience Puzzle

Posted By Jason A. Wolf Ph.D. CPXP, Tuesday, July 1, 2014
Updated: Tuesday, July 1, 2014

In my most recent Hospital Impact blog I wrote:

Experience is designed to fit your organization and the people in your care. No one provider, no one vendor, no one organization holds the ultimate answer to the experience riddle. The greatest successes I see are those organizations willing to pull from the best of all they can, across all the information available, to meet their unique needs. In proceeding, choose partners and resources that value and integrate your own organizational identity in any plan. That will take you the farthest down the path to experience success.

As I further reflected on those words, I was quick to see and acknowledge a bias I bring to this work. Over the last four years in growing the Institute and through the many years of my career before, I have come to not only value, but also see the true impact that collaboration and the sharing of ideas can have in helping "raise all boats.” Yes, collaboration in organizational life is designed to collectively "raise the tide”. It is something I have often seen a lack of in the competitive landscape of healthcare overall.

I am not saying I do not believe that competition is of value, drives creativity, resourcefulness and positive outcomes; in fact I have seen it do just that. Rather, competition in the critical areas of organizational life, particularly in healthcare and specifically in the experience we provide for patients, their families and our very own staff members is not the greatest path to success. Without question, competition has been a motivating factor in experience, one seen driving action as scores are publicly reported and actual reimbursements and other financial opportunities are at stake. This is of value as the attention given to positive experience leads to better outcomes and holds the potential for establishing significant market distinction.

Yet, what I suggest is that beyond this drive for distinction, the opportunity to learn from one another provides the greatest of potential outcomes for all. The challenge is not (nor should it be) around what to do, but rather your actual commitment to do something about it. I have not visited one organization or engaged with one audience yet that did not already inherently understand the fundamentals to success in driving the best in experience. (Note in discussing experience, I maintain it is the integration of quality, safety and service encounters.) The distinguishing factor I have continued to see is leadership vision and commitment, a willingness to invest and follow through, the right people focused on the right things and the openness to reach out, share successes and learn from others. It is this focus on execution that should (and does) drive true distinction.

This very philosophy, learning from one another, especially in the experience arena, is the central ideology on which The Beryl Institute itself is built. That in creating a true community of practice, with individuals and organizations willing to share their successes and open up about their misses and needs, we have the potential for the greatest impact in healthcare today. It is about creating an organizational experience where individuals, organizations and resource providers can bring new ideas to bear as you determine the best path forward.

While this is built into everything we do throughout the year, it may be no better realized than in the few days we spend together at Patient Experience Conference or at our Regional Roundtables each year. In these few days together, hundreds of people representing hundreds of organizations around the world come together, not to declare "their” way is the right way, but rather to share their ideas as they might work for you. In bringing together the greatest number of voices, open to the broadest range of ideas, you position yourself well for success. In fact with Patient Experience Conference 2015 already on the books, I would be remiss if I didn't encourage you to share your ideas via a conference submission or ensure you have your attendance slotted for your 2015 budget. You also have two great opportunities to join us and our host organizations Virginia Mason Medical Center and Boston Children’s for two great roundtable experiences.

Again, I come back to my words I shared above - no one provider, no one vendor, no one organization holds the ultimate answer to the experience riddle. I would offer they each hold a little piece of the bigger puzzle. If we are willing to engage in the dialogue, ask for what we need and share what we know, we are all better for it. Then, it is each of our jobs to ensure it is done and done well.

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

Tags:  collaboration  culture  execution  expectations  healthcare  hospital impact  improving patient experience  Patient Experience  Patient Experience Conference  Regional Roundtable 

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The Patient Experience Deserves More Than 63%

Posted By Jason A. Wolf Ph.D. CPXP, Tuesday, February 4, 2014

I have yet to meet anyone in healthcare who suggests patient experience is not important. In fact, I often hear it said to be "one of our top priorities”, "a central pillar in our strategy” or "a critical initiative for our organization”. I do not question the sincerity of these declarations or the intent they suggest. I also recognize in the highly dynamic world of healthcare today we are in a constant struggle to balance our priorities. With that, I offer these thoughts to shift our thinking in how we approach experience overall.

To frame what I mean about patient experience I return to the definitiongenerated by the members of The Beryl Institute community – the sum of all interactions, shaped by an organization’s culture, that influence patient perceptions across the continuum of care. I also want to challenge the perspective of some in equating patient experience only to service and question our inside-out focus in healthcare as we often operationally differentiate quality, safety and service. While we may operate these efforts in distinct and at times competing manners, I do not believe patients distinguish between these areas. Yes, we must focus on quality, safety and service and align the appropriate resources to each, but we must address these efforts from the eyes of our consumer and the perspective that they together create but one experience.

As I have continued to hear patient experience identified as a strategic priority, it has caused me to ask, does this mean based on needs there are then specific times when we actually focus on it (and therefore times we don't). That is, do we truly focus on every one of our priorities at all times? Continuing this thought, if patient experience is seen as an initiative, it has all but been declared a limited effort, for every initiative I have experienced in healthcare and elsewhere has a beginning, middle and therefore an end. Do we truly think the patient experience is an idea where the effort eventually concludes?

These ideas around alignment, priority and initiative were supported in the findings of the 2013 Benchmarking Study, The State of Patient Experience in American Hospitals. The research revealed something one could potentially overlook in all that was uncovered. In the U.S. Hospital System the individual with primary responsibility for patient experience spends 63% of their time on these efforts. In contrast, I do not know of a CFO that spends 63% of his time on finances. The data itself reinforces the opportunity we may very well be missing. Have we made patient experience a 63% priority? If we take that to the extreme, does that mean it is only something we consider for 63 out of every 100 patients we see? I do not believe any organization or leader has done this intentionally, but it does cause us to hopefully stop and think about how we lead and operate our organizations and systems.

I know those in healthcare are more committed than what the number reveals. We are an industry of caring and compassionate people who give all they can in every moment. But the data opens our eyes to the opportunities we have. Perhaps what we have lost in our efforts to address patient experience is our realization that experience is all we are about in healthcare. I know that if any one of us were laying on an exam table, recovering in a bed, or sitting holding the hand of a family member that we would not expect anything less than 100%. In fact I believe we would say we want the best in quality, safety and service – the best experience – in every encounter. I believe we all do want the best in patient experience for all those in our care. I hope we too agree the patient experience deserves more than 63%. So how can we start to do things differently today? I look forward to your thoughts.

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

Related Body of Knowledge courses: Metrics and Measurement.

Tags:  bottom line  change  choice  Continuum of Care  culture  defining patient experience  expectations  healthcare  improving patient experience  Interactions  partnership  Patient Experience  priorities  quality  safety  service  service excellence  strategy 

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Patients are Partners in Experience, Not Just Recipients of One

Posted By Jason A. Wolf Ph.D. CPXP, Thursday, June 6, 2013
Updated: Thursday, June 6, 2013

In my most recent Hospital Impact blog I noted that "how” we choose to do things in healthcare will and should trump the "what”. This is supported by my travels through numerous healthcare organizations where it is becoming evident that the core practices organizations are using to drive patient experience success are more and more consistent. While some might see this as limiting, I see it as encouraging.

Why is that? It means we are listening to one another, learning from each other and showing an incredible willingness to "steal ideas shamelessly” as a well respected CEO once shared with me in describing a component of their organizational success. That means the ‘what’ we do is not very different location to location. The distinguishing characteristic in experience is not the things you do, but the way in which your deliver. This is at the core of the very definition of patient experience as "the sum of all interactions, shaped by an organization’s culture”.

This ability to listen and learn from one another is a central value of all we do at The Beryl Institute. As a global community of practice we can (and must) learn from all edges of the community – those Institutions rated the "best” or seen as the "biggest” do not represent the only expertise. Rather it is in trying and executing of ideas in organizations of all shapes, sizes and focus through which excellence is supported and shared. It is based on this premise that the idea of a broad and inclusive range of voices has been so central to our work.

In returning to the conversation of "how”, I reflect on the recent conversations I had with 18 incredible patient and family advocates committed to the work of improving quality, safety and service for patients and families around the world in preparing the most recent paper from The Beryl Institute – Voices of Patients and Families: Partners in the Patient Experience. The stories these individual’s shared of compassion personified and at times the uglier side of care help us realize that there is power in how we choose to manage the interactions we have in healthcare every day. That it is truly more than the tactics, and rather the execution that matters.

The point I make here is all the tactics in the world amount to very little if all they are is something we do TO people in our care. The old language of provider and recipient may well still be used in healthcare, but its use is outdated and indicative of a system in need of change. Patients – yes, you and I, our children and parents, family and friends – are active parts of the healthcare equation, not passive recipients of it. We need to ensure we start acting this way. This perspective is exemplified through the work of such great organizations as the Society for Participatory Medicine.

While there are countless lessons shared by the individuals interviewed in the Voices paper, we inherently know many of them ourselves. Our contributors helped frame three central ideas in ensuring partnership in the care environment:

1. Acknowledge patients are not subjects in the healthcare process or "something” you should talk about or plan for in third person.

2. Recognize patients are not necessarily wired to actively engage in the healthcare process, due both to the complexity of healthcare and the nature of the system itself (that potentially diminishes the role of the patient in an unspoken hierarchy of expertise). You must ask, encourage, and act on the patient’s voice.

3. Consider coordinating efforts to identify and incorporate patient perceptions into the overall planning of care.

Personally, as I continue the journey of new fatherhood, I saw this play out in the very interactions we have had with our pediatrician. At our stage as new parents, we could be scolded, challenged or even talked down to about how we handle situations. Instead our doc engages us based on our questions, our hopes and fears. I know she is getting all the needed clinical work done, but she is including us as patients and family, as partners in the process. This is an active decision on her part, it is one that engages us in the care of our son and ensures a positive experience with every visit. "How” is a choice we can all make in healthcare and is one I believe will make all the difference.

 

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

Related Body of Knowledge courses: Patient & Family Centeredness.

Tags:  bottom line  choice  culture  defining patient experience  employee engagement  expectations  healthcare  improving patient experience  Interaction  Interactions  partnership  patient engagement  Patient Experience  patient stories  service excellence 

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The Power of Expectations: A Thought for the New Year

Posted By Jason A. Wolf Ph.D. CPXP, Wednesday, January 2, 2013
Updated: Wednesday, January 2, 2013

Expectations are powerful. They influence what we see, how we act, and the way we react. They stir emotions and create real feelings from joy to anger, surprise to sadness. The reality of expectations is that they present an intriguing paradox in how they can and do influence the situations in which we find ourselves. Expectations are an individual and even very personal experience, yet at the same time they can be set by organizations, businesses and other people outside of one’s self. This makes expectation potentially the most valuable and perhaps most precarious tool in the discussion of consumer experience and in healthcare, the patient experience.

The example of how personal expectations can modify the perception of reality has long been part of the healthcare world. As Chris Berdik notes in his new book, Mind over Mind, the power of expectations lies at the center of the placebo effect. Berdik makes a compelling case that what we expect from the world changes how we experience it. He notes that research into placebos is expanding to examine everything that affects a patient's expectations for treatment, including how caregivers talk and act and even the impact of the wealth of online information now available – and how those expectations can help or hinder healing. I believe the same is true as we look at the overall healthcare experience. Patients and families come with personal expectations and more often with ones that healthcare organizations worked to create. It is these very expectations that impact how individuals experience an organization and ultimately rate its performance overall.

I can share a non-healthcare example of this from just this past week. My wife and I had the chance to take a few days away for the holidays at a small inn near our home. We had heard great things about the service and quality of the experience and were excited by some of the extra amenities they offered. When we arrived we discovered our room was the only one missing the special amenities they touted in their promotions, and while the service was impeccable, this missed expectation had already impacted our experience. The hotel did all they could to accommodate and provide service recovery for our experience. To an extent they even exceeded what we would have anticipated in response, but it was the missed expectation that still lingered for us as guests.

Now imagine in the healthcare setting where our patients and families come with their own set of anticipations and clear expectations. Most do not choose to visit, but rather are dealing with illness or other issues that may be cause for great concern and even fear. They come with expectations of how they will be treated, but even more significantly they come to your doors with the expectations your organization has set through the stories shared and the messages disseminated via advertising or other means.

I saw an example of this at a recent hospital I visited. They were so proud of their new facilities, including new amenities, private rooms, etc. The advertisements and billboards they produced promoted the newness of the hospital. Yet, they still also had an older wing, where the rooms were dated, semi-private and lacked the sparkle and shine of the newer rooms. While the patient experience of the facility was not designed to be about the physical nature of the buildings, but rather the encounter people have with staff, they set the expectations publically that the facility itself was at the heart of their overall experience. In essence, they set expectations they could not always fulfill…and it set up the potential for disappointment before they even had the chance to make an impact.

The lesson here is simple, yet significant and one I think is critical to looking at the year ahead. For as much as we can control our efforts in healthcare, we must work to set the best and most realistic expectations we can for our patients and families. This is not what I have heard some describe as lowering expectations to outperform, but rather it is about setting the right expectations for what you want to deliver in your own organization and ensuring the means – both in resources and process – to deliver on it.

In maintaining a focus on providing a positive patient experience, consider starting the year by identifying the expectations you hope to deliver, ensuring your leadership and staff are aware of these touted expectations and establish a process to check your performance to these expectations at every point in the care experience. While you cannot dictate every expectation people bring with them to your doors, healthcare organizations can shape their own story in a way that ensures expectations are realized and the patient experience is one that will always be remembered. Wishing you fulfilled and exceeded expectations for the year ahead!

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

Tags:  choice  expectations  improving patient experience  patient  Patient Experience  service excellence 

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