Posted By Tiffany Christensen, CPXP,
Tuesday, April 9, 2019
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As funny as it may sound, the topic of “environment” within the Field of Patient Experience is somewhat controversial. Some professionals in this industry feel environment is the primary variable in patient experience while others are frustrated that it’s even part of the conversation at all. The 2018 Consumer Perspectives on Patient Experience 2018 study from The Beryl Institute shows that patients and families rank listening and communication as the key ingredients to a good experience while the age of the facility and parking are low on the list of importance. So how does environment fit into the puzzle of providing a good patient experience?
I went to see a friend of mine in ICU days after she’d had an unexpected brain bleed and hours of brain surgery. She had just come off the ventilator so this visit fell during a critical and tense time. During my visit, my friend began to vomit and appeared to be having difficulty clearing from her mouth and throat. I attempted to get help but, when I poked my head out the door, the nurses’ station seemed to be miles away and there were no clinicians in site. I went back into her room and attempted to get her on her side so she wouldn’t choke and fumbled around for the call bell. After a few minutes, a nurse came in and my friend was given the care she needed.
For days and weeks after that visit, that moment haunted me. What I remember most was the profound sense of being ALONE in there with a friend who was very, very sick. The ICU itself was beautiful and very large. So, large, however, it felt unsafe to have sick patients down long hallways far from any central point. Clinicians helping each other had to be far away from the patient they were caring for, essentially leaving patients unattended.
It strikes me that this ICU was an area of pride for this hospital; extremely high tech, modern, and, did I mention…large? But, that describes an environment that appeals to healthy people. From a clinical perspective, the mark was missed because those for whom the building was designed needed their clinician nearby, something this design failed to prioritize. It made me wish that I could ask the architects: “Who are you designing this for?”
For patients being cared for over time, there are often stages of recovery. In my life as a CF/Transplant patient, my hospital visits have usually had the same progression:
- Arrive, sick, tired and with the sole goal of getting into bed to rest
- Begin feeling better, get more engaged in my care plans and ask about discharge
- Feel better, get more and more irritated with everything in the hospital and anxiously await discharge
- Almost time to go home, consider writing a letter with everything I am noticing could be improved and wait, like a dog at the front door, for the next clinician to come by and give me news
- Go home, feel grateful for my care and recovery, forget all about the “improvement letter” and work on building strength to get back into my life
It may come as no surprise that, during steps 1 and 2, the environment around me doesn’t hit my radar (Unless it appears dirty. In that case, I worry about catching something new while there.). During steps 3 and 4, however, my environment impacts my state of mind. Staring at blank walls or signs that say “Call Don’t Fall” do little to help me distract myself from being enclosed and antsy. Soothing colors, wall art I can dive into with my eyes and options for natural light can bring some comfort. There is actually science around this but it’s not a science we use often in healthcare. (For one great example of this, explore the work of Danish artist, Poul Gernes, who believed that colors could have a stimulating effect on hospital patients and help reduce pain and suffering.)
During a recent stay in a hospital, I took a photo (see adjacent picture) of my primary visual focus during the time I was in-patient. This sliver of a window facing the hallway was the one part of the room with life and hope; watching people bustle by and wondering if this would be the next person to knock on my door. This window is most of what I remember from my hospital stay. This is what I would call “the lived experience” of a healthcare environment.
I got a call early on a Monday morning that my mother was at our local ED after suffering a stroke. My 3 siblings, 2 brothers-in-law and my father all descended on the ED to sit with her through the testing and admission process. Well, perhaps I should say “stand with her.” Like many EDs, there was little space for the family beside her bed, even if we went in 2 at a time. That was alright for my siblings and I but my father is in in his mid-eighties, has trouble walking and was distressed over his wife’s sudden change in health status. In some ways, I worried more that there was nowhere for him to sit than I worried about my mom at that point.
Watching him, and others, struggle with long walks from A to B (the walk from the ED to the in-patient unit actually required a car ride for him) and, once in a room, he seemed to receive little consideration as an elderly family member, made me wonder how often we consider family when designing spaces.
I have seen beautiful hospital lobbies with piano players and comfortable seating. I have seen hallways with compelling art pieces lining the walls. I have seen fountains and gardens on the grounds of healthcare facilities that take your breath away. These spaces are wonderful but are used quite infrequently in comparison to the space at the bedside, gurney-side or chair-side of a loved one seeking and getting care. I can’t help but wonder what might happen if we invested more in the spaces that most impact the patients and families rather than we often do on the common spaces? What if we focused on designing an environment that:
- Was always built for safety before aesthetics
- Supported the staff and clinicians in delivering efficient care without wasted steps, etc.
- Enabled the shortest path from A to B
- Was soothing and pleasing to the eye
- Had room for family and clinicians so that all felt comfortable and valued at the bedside
Perhaps the “controversy” about how much emphasis should be placed on environment is less about how MUCH it matters but more about WHAT matters in supporting the human experience of healthcare. Considering these elements and working to understand the true lived experience of those really using the healthcare spaces, would surely make “environment” a key driver in experience.
Tiffany Christensen, CPXP
Vice President, Experience Innovation
The Beryl Institute
Posted By Jason Wolf,
Wednesday, December 5, 2018
Updated: Wednesday, December 5, 2018
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This has been an exciting year for the patient experience movement in which an unwavering commitment to human experience has been elevated and expanded globally. In our efforts at the Institute we have had the opportunity to engage the voices of healthcare consumers on their views of experience and what drives their decisions, we introduced the Experience Framework to reinforce the integrated nature of the human experience in healthcare and now just last week released our latest study on the influence factors on patient experience.
This is significant in that in linking these efforts together we begin to see for the first time in practice and evidence that there is alignment around what we can and should do to ensure experience excellence. This work lays out a pathway that while not surprising has been sometimes difficult to ensure a commitment to in a healthcare system driven by transactions, checklists and processes that overlook the very essence of healthcare itself – the human caring at its heart.
I shared a story to open Patient Experience Conference 2018 about how my son Sam taught me a valuable lesson in the power of human connection and how simple and brave we must be to ensure these connections occur. He showed me sometimes it just takes commitment, the willingness to reach out and acknowledge another human being in front of you for who they are, not what they have or what they do. This too is what consumers told us they wanted, and it is what we discovered in the findings of the Influence Factors Study as well.
For the Influence Factors Study, over 1400 respondents identified the factors of greatest importance to patient experience. In addition, almost 300 high performing healthcare units (as defined by achieving and sustaining high percentage of scores in the top box of 9-10 in the overall rating question on the CAHPS survey) representing 175 organizations provided input as well.
The study revealed that for both respondent groups how patients and family were treated and how they were communicated with had the greatest influence on experience. This was followed closely by the teamwork and engagement of care teams and core clinical indicators such as responsible management of pain and care coordination. Interestingly enough what was shared here, that is that experience is driven by 1) how we treat people we serve, (2) how we treat each other and (3) how we provide the quality people expect, perhaps provides the triangulation of factors that sums up the potential of and opportunity for an elevated commitment to the human experience in healthcare overall.
This discovery reinforces that at the end of the day our opportunity to care for one another as human beings is the essence of our work in healthcare. This was supported in the alignment of the influence factor responses with the voices in the study, Consumer Perspectives on Patient Experience released this summer, which found that that top-rated items of importance to consumers were, in order, ‘listen to you’, ‘communicate clearly in a way you can understand’ and ‘treat you with courtesy and respect’. The most significant realization in this finding in comparison to what were identified as the top influence factors was that not only were the top items nearly identical, in essence effective communication and respectful treatment, but also that these items scored significantly higher response percentages in both studies. This had them stand out clearly as the top items in both surveys and coming from two very distinct respondent groups.
What this means is that what people are asking for from healthcare, it is evident healthcare organizations know and high performers provide. So, then what has been in our way of meeting those expectations and needs? I offer it has been healthcare’s commitment to process at the expense of people and transactions at the expense of interactions that has undercut its very capacity to achieve this ultimate goal.
This is not offered to diminish the complexity of healthcare we face today, but rather to call us to ask if we are the reason for the very complexity that gets in our way. If we were to focus on these simple things, to build processes, programs, technologies and innovations to support and sustain this focus on the humanity in healthcare, would we see something very different in how we look to lead healthcare globally. That is our opportunity and the story I hope you will find of interest in our latest paper: To Care Is Human: The Factors Influencing Human Experience in Healthcare Today.
With this we are called in healthcare to come back to ground with three considerations that can help us all lead the experience effort forward. These include:
- Patient experience must be seen with an integrated focus that ties together the many facets impacting how human beings on both sides of the care equation experience healthcare. It must be operationalized with this broad and inclusive perspective.
- Experience excellence, at its heart, is about the relational interactions we have in healthcare. It is grounded in the kind of organizations we build to sustain quality, safe and effective healthcare for all engaged. We must move beyond simple transactions and find comfort in the human complexities that are at healthcare’s core.
- To care is human and above all else that must be a rallying cry for what healthcare can and must be. Yes, medicine is a complex science, but healthcare is not just about medicine. When we mix that science with the art that healthcare ultimately represents, we get a symphony comprised of the greatest experts, but one that only works when all those expert parts play together. And if we do that, the outcome will be truly magnificent.
The Dalai Lama is quoted as saying, “The human capacity to care for others isn’t something trivial or something to be taken for granted. Rather, it is something we should cherish.” I would add it is something we must acknowledge will require hard work, unwavering commitment, a willingness to try and fail and a focused commitment to excellence.
The things healthcare has shown it knows to be true and the things consumers are asking for consistently come down to something so essential I could be blamed for saying it too much – that in healthcare we are human beings caring for human beings. So, whether I am walking the halls of a VA facility or waiting in an essential hospital’s emergency room, seeking new research innovations from an academic medical center or being cared for in my rural healthcare center, or standing on any continent in any health system, in any healthcare setting across the continuum around the world for that matter, this universal truth remains.
It then is up to us to consider how we balance the science that has driven healthcare with the art that is what will enable it to ultimately succeed. We can no longer say that all people want is for us to make them better. That has been healthcare’s driving outcome, but for the patients and families we serve, it has been a fundamental expectation that we do so. Where the real difference and ultimate distinction lies is in HOW we make them better, in the acknowledgement that in caring for the human in front of us and those who serve around us we are realizing the true potential healthcare has to offer.
Yes, to care is human, the evidence bears out its impact and value. And in giving ourselves the permission to hold that idea as central to all we do in healthcare we can and will reframe a system with a potential for care, wellness and healing we have only dreamed could be possible. Experience is not something else we must or should do, it is all one does in healthcare, it is time we acknowledge this and move forward with this new sense of possibility. What will be your first step?
Jason A. Wolf, PhD, CPXP
The Beryl Institute
defining patient experience
improving patient experience
patient and family
Posted By Tiffany Christensen, CPXP,
Monday, October 8, 2018
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It's been an important realization for me to see that the way in which I look at the patient experience is dependent on my orientation to it at the time. Most of the time, I look at it through my professional eyes, using the Experience Framework and the Eight Lenses of how to operationalize improvement.
When I am actually experiencing the need for medical care, my orientation shifts. Wearing the skin of a patient, the primary focus becomes:
- Physical sensations (pain, SOB, cold, etc)
- Emotional experience (worry, fear, elation, etc)
- Relational (engagement w/care team, co-design of plan, etc).
When I went into my ENT’s office a few years ago my priority was definitely based in the physical experience. I was having chronic headaches and every morning it was taking an hour for the headache to subside enough for me to begin my day. As a cystic fibrosis patient, I was unusual in that I had never had sinus surgery, so it seemed like a good and natural next step.
I liked my surgeon a lot. When we spoke, I felt like he really cared about my outcome and my quality of life. He did a good job of preparing me for the surgery itself. I went into the procedure confident in his ability and comfortable with our relationship.
When I first noticed that I couldn't smell anything after surgery, my surgeon assured me that my sense of smell might return. I was not aware that losing my sense of smell was a possible result of sinus surgery but I also wasn't very worried about it. Who really needs a sense of smell anyway?
It's been two years since I have been able to smell anything. My life has been more dramatically affected by my lack of a sense of smell that I could have ever imagined. My sense of smell, as it turns out, is directly related to my sense of safety, decency and love.
First, there is the safety element of it. There have been more times than I'd like to count where something was burning in the oven and I had no idea. If a friend hadn't been around during those times I can only imagine that it could have started a fire or at the very least filled my kitchen with smoke. It makes me very uneasy knowing that there may be things happening around me that are generating a smell as a warning sign that I am not able to heed.
In this culture, bad smells are considered indecent. As a person who cannot smell, I find myself in situations in which I am fraught with paranoia; worried that I may be unknowingly violating this decency. What if, when my friend stops by to visit, my trash smells? What if the dog smell in my car is overpowering? What if, God forbid, I smell? There's most certainly a layer of anxiety in my personal interactions that was never there before. (On the flip side, I will have to add, not being able to smell things like smelly trash cans is one of the perks of this issue!)
I really had to mourn the loss of my sense of smell when I fell in love. As it turns out, one of the most powerful senses that we use when we're falling in love is our sense of smell. Smell plays a huge role in the romance of falling in love. Smell is part of what builds a unique bond between two specific human beings. Smell is what you carry with you when you're missing the person that you love. The loss of smell during this important time in my life was incredibly sad. I now know that there's a direct line between my olfactory nerve and my heart.
I can easily understand why a conversation about the surgical side effect of losing a sense of smell would not be priority during my pre-surgical visits. When working with a CF/transplant patient, I'm sure there are much more pressing clinical and safety considerations. When we orient ourselves to the patient experience by way of a clinician perspective, the lived experience may get missed.
When we orient ourselves to the patient experience through the actual physical experience of being that person, however, it's easy to see that talking about the potential side effect of losing a sense of smell is absolutely something that needs to be part of the conversation. One might argue, it's even a potential reason to not move forward with an elective surgical option. While losing my ability to smell doesn’t prevent me from living a good life, it all adds up to a change in my life’s quality.
Would I have done anything differently had I known I would lose my sense of smell? I honestly can't answer that question. My perception of that overall surgical experience is, admittedly, now quite clouded from this outcome. I can’t help but feel as though my person-ness was not taken into consideration in the way that I hoped and believed that it was during the surgical consult process.
As we continue to explore and unpack the Experience Framework, it’s my hope that we will also begin to routinely ask ourselves to check our orientation to experience. When we hold the 8 Lenses up to the light we can ask ourselves: how does the picture change if we look at it through the eyes of a patient? A family member? A clinician? A leader? If we begin to see the Framework at 3-dimensional, so too will our efforts become 3-dimensional. I believe it is important for experience professionals to become more cognizant of the fact that there are different orientations to Experience Improvement and priorities will shift depending on that orientation.
And, if nothing else, I hope this blog reminds you to enjoy the smells of love all around you!
Tiffany Christensen, CPXP
Vice President, Experience Innovation
The Beryl Institute
Posted By Jason A. Wolf Ph.D. CPXP,
Tuesday, February 4, 2014
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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.
The Beryl Institute
Related Body of Knowledge courses: Metrics and Measurement.
Continuum of Care
defining patient experience
improving patient experience