Posted By Chantal Backman INF./RN, MHA, PhD,
Monday, December 10, 2018
Updated: Friday, December 7, 2018
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Older adults with multiple chronic conditions typically have more complex care needs that require multiple transitions between healthcare settings. Poor care transitions often lead to fragmentation in care, decreased quality of care, and increased adverse events. Emerging research recommends the strong need to engage patients and families to improve the quality of their care. However, there are gaps in evidence on the most effective approaches for fully engaging patients and families in their transitional care.
As part of The Beryl Institute’s 2015 Patient Experience Grant Program, our organization looked to use participatory visual narrative methods to explore older adults’ experiences of managing multiple chronic conditions during care transitions. By engaging older adults with multiple chronic conditions and their family members in the detailed exploration of their experiences during transitions across health care settings, we hoped to identify potential areas for future interventions.
Based on the study results, three areas for improvement specific to older adults managing chronic conditions during care transitions emerged:
- Strengthening support for person- and family-centered integrated care
Older adults and families in our study described the nurse as the central hub that links them to healthcare providers and community resources. In addition to the medical needs of this population, it was clear that appropriate assessment and mechanisms to support patients in the broader context of health, which includes economic, access, and social issues/barriers are needed. Older adults and families often do not know who to contact to obtain support. As one participant mentioned, the care is often focused on the medical issue, and thus providing a very “siloed” system. One consideration to facilitate better integration is assigning a primary provider as the central hub to be the link during the patient’s transitions across the health care system. Previous studies show that such system navigator roles have reduced readmissions to the hospital and return visits to the emergency department.
- Engaging older adults and families in their care management and care transitions in meaningful ways
Our study indicated that older adults and family members who were actively involved in their care were better able to navigate their journey through the health care system. This is consistent with other studies. Emerging research is focused on further engaging patients and families in their care. Further work is needed to develop personalized care which provides individualized access to relevant resources in order to better manage not only single but also multiple chronic conditions. One promising option would be to explore the use of technology to provide a personalized care plan approach to ensure safe, effective and person- and family-centered care transitions. The development of new technologies for personalized care could potentially help to facilitate and to manage multiple chronic conditions while navigating our complex healthcare system, thereby better empowering the patient and their families.
- Providing adequate support/resources for family members and informal caregivers
It is clear from this research and from other studies that family members and informal caregivers take an active role in helping patients during their care transition experiences. Further resources are needed to better support family members who play an active role in care. However, it is also important to assess a patient’s social context to determine if further support is needed, and whether or not there is the presence of informal caregivers and family members who can help to support the patient.
Our study reinforced the importance of active involvement in managing care transitions, positive experiences during care transitions, accessing community services and resources, challenges with follow-up care, lack of meaningful engagement during discharge planning as well as the presence of systemic barriers in care transitions. The results contribute to our understanding that person- and family-centered care transitions should focus on the need for active involvement of older adults and their families in managing care transitions.
To learn more about the study methodology and findings, visit: https://bmchealthservres.biomedcentral.com/articles/10.1186/s12913-018-3292-6
Dr. Chantal Backman RN, MHA, PhD is an Assistant Professor at the School of Nursing at University of Ottawa in Ottawa, Ontario, Canada
Posted By Magali Tranié,
Wednesday, November 14, 2018
Updated: Wednesday, November 14, 2018
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As one of the eight active lenses of the healthcare experience framework1, staff engagement is recognized as fundamental to the successful realization of a positive patient experience2.
An organization’s staff engagement strategy should comprise of numerous elements3, and some form of community giving activity should be one. It’s the holiday season after all, a wonderful time to remember the importance of helping others! Yes, it’s something close to my heart so I’ll admit I’m a bit biased, but there’s actual some science behind the benefits too.
According to research, giving back benefits not just the recipient(s), but your health and happiness and communities by creating social connections. Talk about a win-win-win!
So, if you’re ready to implement community giving as one of your staff engagement initiatives, here are four things to consider for maximum impact:
- Get Senior Leadership Support
The first step should be ensuring leadership buy-in, which should seem obvious since “culture & leadership” is another active lens of the experience framework1. For example, we list “community” as one of our company’s purpose along with associates, customers and their patients. We post this purpose all over our offices’ walls and desks as a way of making that commitment public!
- Leverage Your Field – or Simply Your Neighborhood
Your facility’s discipline can help guide you towards charities that are within your space. It makes sense for an imaging center to rally around breast cancer awareness, or for a cardiologist to support the American Heart Association, to point out the obvious. There are many healthcare-related non-profits to pick from – as well as many healthcare recognition days to leverage.
For instance, since we provide linen rental and laundry services to healthcare, we partner with some local chapters of Ronald McDonald Houses to clean their linen at no charge, and we donate to St. Jude Children's Research Hospital through payroll deductions, to name a few.
Alternatively, you can decide to support your local community too, directly impacting your staff and perhaps even patients. Is there a park nearby that needs a little TLC? A charity close to a staff member’s heart? Our ImageFIRST Fort Myers team had planned a Habitat for Humanity volunteering event only to find out one of their recent hire had been a beneficiary of Habitat!
Your patients may also be a great inspiration for ideas. In May 2018, we partnered with one of our customers Surgery Care Affiliates and nonprofit One World Surgery, which they are foundational corporate partner of. Our entire leadership team got to work to donate and assemble 250 backpacks of school supplies for young students in Honduras who cannot afford these basic necessities.
- Involve and Empower Staff
Once you get leadership buy-in, you’ll need a small committee. Build a team made up of positive and passionate “locker room leaders” who can spread the enthusiasm and create energy around the activities you decide on. Ensure their managers is on-board with their participation and commitment.
This team can help execute, gather ideas, give you a pulse of what’s important to your staff (so you can bring community giving activities that matter to them), and gather feedback after each event. For example, we found out some of our associates have difficulty leaving the office to participate due to recurring weekly work. We’ve modified our community giving activities to include events both outside and inside the office walls.
- Integrate Community Giving Activities Within Staff Engagement Calendar
After a kick-off meeting, set recurring quarterly meetings to plan the next three to six months. Work with your committee to develop a calendar of activities that you can integrate within your (hopefully) pre-existing staff engagement calendar.
Community giving is a wonderful way to engage your staff, so long as you plan ahead and dovetail it into your existing activities. Here’s a checklist and calendar to help you plan!
1. Wolf, J. A. (2018) Introducing a Framework for Experience in Healthcare. The Beryl Institute.
2. Wolf, J.A. (2017) The State of Patient Experience: A Return to Purpose. The Beryl Institute. https://www.theberylinstitute.org/page/PXBENCHMARKING
3. Gallup Q12 Survey https://q12.gallup.com/Public/en-us/Features
Magali Tranié is the Director of Marketing for ImageFIRST Healthcare Laundry Specialists. She has 20 years of experience working in various marketing disciplines, leading teams and contributing to employee engagement strategies. She is passionate about community giving, being an active weekly volunteer for a local animal shelter since 2006, giving annually to a variety of non-profits, participating to one-off volunteering opportunities throughout the year, and sponsoring a child in Rwanda since 2017.
Posted By Zal Press,
Wednesday, November 7, 2018
Updated: Wednesday, November 7, 2018
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Vernon Law, a baseball pitcher in the 1950’s is credited with saying "Experience is a hard teacher because she gives the test first, the lesson afterwards." As a patient living with a chronic condition for over 37 years, I can testify to the powerful truth behind the hard lessons that come from the lived illness experience. The pain and suffering endured are often excruciating in nature, and without question are lessons most of us would rather have done without. One of my colleagues refers to this education as her PhD in Lived Experience.
Progressive organizations around the world have learned one key lesson – that experience has to be at the table before lessons are fully learned. Patient involvement is now a global effort that numbers thousands of persons. It has evolved to the extent that Medical Sociologist Carl May describes it as “People with chronic conditions are now explicitly conceptualized as part of the healthcare workforce, are delegated tasks by the system and given performance targets. This can create new inequalities.”
In the context of May’s statement, the question emerges as to how to value the human resource component of involvement in the improvement exercise. What ostensibly began as a volunteer driven enterprise has evolved over time with various models of compensation and reimbursement deployed in different jurisdictions. This inconsistency across the care and research universe underscores May’s warning of inequalities.
As a patient advisor for over 8 years, I’ve been privy to increased chatter by patients on the topic of compensation. Many contend that their experience, time commitment, personal skills and expertise, make huge contributions to improving experience. They are evolving beyond the volunteer state to a partnership state in parallel with all the rhetoric coming from the system side about the nobility of partnering with patients. Meanwhile, the challenges of equity, equality, parity, etc. are being raised by patients but the culture of health care has for the most part resisted compensation as a part of a solution to these issues.
In an effort to provide guidance to organizations to tackle this thorny issue of compensation, myself and three patient colleagues landed on the following five principles that shed light on the patient perspective. With these principles as a starting point, organizations can open up the conversation about compensation with their patient advisor community.
- Barrier Removal
With diversity a key challenge to patient participation, compensation is a powerful tool that removes barriers and can ensure diversity and inclusivity. Without compensation, participants are only those who can afford to volunteer, limiting the involvement of all voices in the community the organization serves.
A fundamental power imbalance exists when all team members are paid except the patient partner. Patients bring experience, expertise and skill, just like all others in the team. To participate in these activities, patients sacrifice other duties. Overall, there is a cost to the patient to be engaged in improvement projects.
- Different Motivations
Patients participate for different reasons than the professionals with whom they collaborate. For professionals, the activity is part of their job, providing social capital, increased prestige and career advancement. These factors can impact future earning potential. For patients, these motivations are generally not the case and need to be understood in the context of the social and emotional values that inspire participation.
- Respect for Vulnerability
Patient motivations originate in their unique lived experience which brings with it a personal vulnerability. People expose their painful and intimate experiences in the name of improvement. It is not a risk free exercise and there can be traumatic, unintended consequences. This risk taking for the sake of improvement deserves respect and recognition of the value of this work.
Some people prefer not to be compensated while others view it as reflective of the type of commitment that is required. Patients often juggle time for medical duties, jobs, family, etc. Making participation a paid engagement generates deeper commitment given their competing interests.
This blog is meant to kick start a broader discussion on this topic. Along with three other patient leaders, I have co-authored an article in Patient Experience Journal which tackles this subject in greater detail, going beyond the principles to provide a guide for organizations that will equip them with the ability to address the perspectives of patient participants. Our hope is that the lessons learned from this exercise will advance the experience movement towards an authentic and respectful partnership between patients and organizations across the continuum of care.
Zal Press is past Co-Chair of The Beryl Institute Global Patient and Family Advisory Council and an active patient voice. His website is the most diverse collection of patient stories that enrich our understanding of the lived illness experience. He tweets as @patientcommando.
patient family advisors
Patient Family and Advisor Council
Posted By Samir Batra,
Monday, October 29, 2018
Updated: Thursday, October 25, 2018
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The role patient experience is playing in the provider environment today cannot be understated.
The Beryl Institute State of Patient Experience 2017 Study showcases the growth our industry has seen over time.
Organizations with individuals (CXO, Directors, Managers) with primary responsibility and direct accountability for addressing patient experience has gone from 22% of US hospitals to 58% in 2017 (n=944 US Hospitals).
On the other hand, consumers who say patient experience is significant to them in their healthcare decision making went from 67% in 2015 to 76% in 2017.
The importance of patient experience has been so far-reaching that boardrooms across the industry are taking account. In fact, according to the Advisory Board’s Annual Health Care CEO Survey in 2018, “meeting rising consumer demands for service” was in the top 5 priorities along with cost control, and exploring diversified, innovative revenue streams.
The good news is that there is overwhelming research that shows that improving patient experience not only leads to better quality outcomes, it, in fact, also leads to greater profitability for healthcare providers.
The not so good news is that while experience leaders are proactively focusing on experience, they are overwhelmingly finding themselves tasked with the other key initiatives in addition to their obvious focus areas (evaluating the patient, addressing patient feedback from surveys and reviews, execute improvement strategies) such as:
- Improving physician and staff well-being and experience
- Collaborating with quality/safety and performance improvement leaders and in some circumstances oversee the functions, drive patient engagement
- Establishing communication plans, manage interactions with patients – digitally and in person
With increasing demands on their time, patient experience leaders and executives have to turn to technology to facilitate the impact patient experience can have on the bottom line of a provider organization and the resulting patient outcomes. In fact, technology is so closely tied to the major initiative of “meeting rising consumer demands for service”, consumer technology and the ability to get access in the palm of your hand has driven the focus on providing more information and an exceptional care experience to patients alike.
And the importance of technology in the provider arena around patient experience is being noted by leading CIOs across the country as well.
A new study by Impact Advisors and Scottsdale Institute shows that more than 80% of CIOs reported that their high priority is finding ways to improve digital health engagement and optimizing the patient experience. The high level of interest “underscores a growing recognition – especially among industry leaders – about the critical need to be able to compete on convenience, access to care and value – as defined by patients”, states the report.
Hospitals and clinics have to offer technologies that make care more accessible, convenient and the experience more seamless.
Which leads me to the question: If CEOs are focused on consumer demands for service, the CIO is focused on technology related to patient experience; then what should the patient experience leaders do?
And the answer is clear - they need to take charge now and guide the technologies that are being looked at by their organizations that are focused not only on patient experience but also engagement.
On the other hand, patient experience leaders also need to get intimately involved and have their voices heard by technology innovators and pioneers developing solutions for the industry. The technology industry needs to hear from those who spend their daily lives creating a better environment and experience for patients and providers alike.
The time is now to collaborate, share and move the patient experience industry forward and bring a realistic consumer revolution to the table that is validated by the key stakeholders. One of the best ways to do so is to get involved in The Beryl Institute's PX Solutions Feedback Program. Solutions providers gain access to the subject matter expertise of patient experience leaders and decision makers to obtain feedback to evaluate and assist in developing or enhancing programs and services. The candid feedback provides the potential for widespread and global application for healthcare and the opportunity to reinforce the commitment to support the patient experience movement.
Experience leaders are in a unique vantage point to share their insights – and the time has come to take lead and help usher in a new era of breakthrough tech innovation!
Samir Batra has been in healthcare for 17 years and has worked with many global healthcare provider organizations in helping them achieve operational efficiency and implementation of their strategic plans. Majority of his work has focused on the patient experience, workflow and cost optimization and the effective use of technology. Currently, Mr. Batra is the Founder & CEO of BAHA Enterprises. BAHA is focused on helping health tech companies grow by raising capital, providing strategic advice and guidance, and validation of their solutions. Prior to BAHA, he spent over 10 years in executive roles at start-ups (Oneview Healthcare, CareInSync, pCare - TVRC, and GetWellNetwork) focused on applying technology to effect clinical and patient processes to improve the patient experience and drive engagement. Passionate about contributing to thought-leadership, he is active with HIMSS (NorCal Board Member), ATA (Start-Up Health Advisor - American TeleMedicine Association), and The Beryl Institute (Resource Advisory Council).
Posted By Kelly Makino,
Thursday, October 25, 2018
Updated: Tuesday, October 23, 2018
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One framework that is beginning to demonstrate considerable value as a resource for innovation in patient experience is design thinking, an approach that leverages the creative process to craft solutions for ambiguous challenges and has recently been gaining steam at a global level with proven success in a wide range of industries. This perspective has quite a bit to offer healthcare as well, and it’s easy to find some great literature on the innovative partnerships, impactful accomplishments and deeply empathetic moments that design thinking and healthcare have created together for patients.
Design thinking often brings to mind revolutionary leaps, but it also carries practical value for day-to-day PX innovation. By infusing the principles of design thinking into our daily work, we are able to create a culture that is ripe for wide scale innovation, and build a healthcare practice that is at home with ongoing evolution. To create some inspiration, here are some concrete examples of simple ways that one could put some of these principles into practice.
Walk through your health center and look at things like a patient. Focus less on what they are doing, more on what they are feeling at each step. How much thought has been given to designing their emotional journey through your system? What do the directional signs look like? Are they welcoming, or do they look like warning signs? Are they outdated? What message are they sending?
Also, look up. Staff rarely look at the ceiling, but patients do. How are those ceiling tiles doing? Where in your health center will your patients learn – without talking to anyone - the story of why your staff come to work every day? That they are your priority? That you will offer them the compassionate care they are seeking? Do they learn that when you want them to?
Lastly, how inclusive are the messages in your health center? Who is being left out of the welcome?
Mindful of Process
Do your employees know the full process of the patient experience or just the sliver they interact with? Carve out 30 minutes at your next staff meeting and do a Patient Journey Map with front line staff. It’s a great opportunity for them not only to showcase their knowledge but also to find places they can improve the system, support patients and have empathy for the humans in front of them.
It only takes a whiteboard, markers and supportive, thoughtful questions that challenge thinking, like: “What situation do you think a patient is in when they’re trying to make an appointment?” Or “Ok, now that they’ve taken their clothing off, how cold is the room? The floor?”
There is assumption in design thinking that the solutions to problems of an industry often can often be inspired by studying and collaborating with other fields. What fields have mastered your biggest challenges and have you really looked hard to find the answers to your problems outside medicine? Did you know that Formula 1 pit crews have helped medical teams improve the way they resuscitate newborns? However, the day Doug Dietz lost his MRI scanner to pirates is probably my favorite design thinking PX stories; and so, I will leave you with it as my closer. If you haven’t heard this story yet, please check out his TED talk.
Doug Dietz’s MRI scanner was the most effective he’d ever designed. But children were frightened of the dark, intimidating machine - they were so worried they couldn’t even lay still without “sleepy drops.” When he found this out Doug was upset - he didn’t get into product design to scare kids. And so, one day not long after, his MRI scanner was hijacked by some pirates at IDEO who turned it into a ship – complete with a gangplank. The problem didn’t stop at pirates, either. Another machine sank into the ocean, a third was lost in the woods on the way to the hospital, one accidentally launched into space.
Yet somehow, the staff of University of Pittsburg Hospital didn’t seem upset at all this chaos with their MRI machines, instead encouraging mischief, cranking up music, turning on a bubble-making disco ball, making the place smell like lavender and telling fantastical adventure stories that their littlest patients couldn't help but lie still and listen in fascination to. According to legend, if a patient is completely motionless for a certain time, fish will start to swim by in the magic adventure machine. Underneath all this pretend play, MRI scans are more effective, more accurate and need to be repeated less often than back in the old days when children had to be sedated to undergo these potentially life-saving scans because they so scared of the loud, terrifying MRI machines and gloomy UV lighting.
If that’s not PX innovation, I don’t know what is!
Kelly Makino, MSW is the director of Training and OD with Planned Parenthood of Orange & San Bernardino, based in the greater Los Angeles area. As a former LSW from the New York area, she is passionate about infusing person-centered approaches into healthcare that holistically advance the patient experience, support clinicians in their craft, and improve the systems that support them both. She is a graduate of Georgia State University, University of Pennsylvania, and is working on a doctorate at University of Southern California researching ways to improve communication training outcomes for people in clinical settings.
Posted By Julie Danker, LCSW, CPXP,
Thursday, September 20, 2018
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It may begin with the sound of the alarm, your eyes still closed, your body curled in the fetal position as for months now you have found this to be the most comfortable and secure position you can assume. As your arm shoots over to the nightstand to silence the alarm, thoughts begin to churn: What lies ahead, the monotony of your day, the dread of facing your work world coupled with the feeling of exhaustion from a restless night. None of this is providing motivation to begin the day, let alone leave the cozy cocoon of your bed.
‘I can’t be alone in feeling this way,’ I thought. ‘Is this relatable?’ I wondered, and so I inquired what burnout means to others and this is what I learned:
“I felt unappreciated at work and that this would never change.”
“I’m tired of my job and started to feel robotic.”
“I was sick of going to the same place over and over again. Literally sick to my stomach.”
“My brain felt like it was shutting off and I knew I was not doing my best.”
“I began hating Sunday, our family day, because I knew I had to go back to work on Monday.”
“I’m quitting because I need more joy in my life.”
There seems to be a variation in how we each see, feel, and define true burnout which is unique to the individual and reminds us we are not in a position to ever judge. If the experience of job burnout was truly black and white there could be an alert, not unlike the sound of that Monday morning alarm, to let us know we were going to be late to our best work life. How great would it be to be ahead of the game and implement strategies to reignite our passion for our jobs. Unfortunately, that is not the reality. We become calloused for various reasons, hardened from the effects of day to day and numb to the real source of our discontent. Pride can also prevent us from sharing our struggles and leaning on those we trust. And sometimes, we may fear what will happen if we do come to terms with our reality.
A universal truth that does exist is that burnout does impact an employee’s self-esteem and productivity and this bleeds into the culture of all organizations. This process occurs over time and it begins with finding the day very routine in which we enter into; to check off the boxes, to then start all over the next day. Phase two then begins with some realization of this monotony and identifying ways to increase the value of the work that we do; which is overextending ourselves to add to the workload, to then start it all over the next day. Phase three is where we need some recognition to the hard work we are doing; the creativity we bring to the table and the endless devotion we are giving. When this recognition, acknowledgment or appreciation is not reciprocated an individual begins to slowly lose motivation to continue to operate at this pace.
What does this picture do to the culture of an organization? Is the C-suite important? Are influential leaders important? Of course, they are, but can they do it all? Can they define and maintain a culture of collaboration and a great place to work independently? No! A GREAT organization is a collaborative force inclusive of each and every employee, at every touch point, to maintain a culture and environment that symbolizes the vision, mission and values of the organization. This starts with the individual who maintains the grounds as the patient drives onto the property, the employee who maintains the cleanliness of the entry as the patient enters the building, the greeter who welcomes every patient who enters the building and to those who care for each and every patient.
How do we get here? How do we prevent burnout? How do we empower each employee to have and bring value each and every day? It can be quite simple and something that leaders need to ask themselves: “Who mentored you to get where you are and how did they treat you?” Odds are, leaders’ value that person who stimulated an idea they had or helped create a pathway to help them achieve their goal of growing and leading within the organization. What if every leader treated every employee this way? Employees would see that this is an organization where leadership is as much invested in them as they are in themselves. This collaboration, support and investment defines an empowered individual who is going to show up each day acting as if this is their organization.
There are 5 MUSTS that all leaders need to encourage every employee to do:
- Take a Break. Not just during your workday but take your vacations too. Unplug, we all need this rejuvenation and if you do not recharge, you will fall short as this pace is simply unsustainable.
- Take care of you. Are you sleeping, hydrating and eating healthy? Not only do we need to refuel our bodies with proper nourishment to keep our energy and brain flowing in a healthy manner, but we also need to move around, pull our eyes away from the screens we find ourselves engrossed in each day, hour, minute and second.
- Find Humor. Are you laughing, finding fun in all that you do? If you are not, ask yourself WHY? Life is to be fun, work should be fun, and you should be fun! Fun brings joy and the best game you have to offer. Smile, laugh and be fun!
- Be a team player. Have you ever known a leader to be successful without a team? That is a simple NO. Life is about being a team player, linking arms with those you trust and relationships. You can never have a big enough team, continue to look for these key people and build upon one another’s strengths.
- Be a supporter. Support brings confidence; confidence in oneself and confidence in others. We feel more confident when we feel someone is supportive of us and our ideas. This does not mean you have to be a “yes ma'am” individual, providing constructive criticism or challenging feedback can also be viewed as supportive. Remember, it is in the means of how you deliver this communication. Communication is KEY in every relationship.
Leaders, too, need to follow these guidelines, for as with anything else if we do not take care of ourselves, we cannot care for others. Remember; we do have some control of our destiny. Never let pride, fear or that voice in your head hold you back. Life is short, precious and your chance to have fun! I challenge organizations to make burnout prevention a priority. Invest in your team and your ROI is limitless! This investment will have your employees waking up before the alarm, eager and ready to begin their day; by bringing ideas forward and positively influencing others.
Julie Danker, Chief Experience Officer for Smart-ER is passionate about Patient Experience and capturing the voice of the patient. Julie has worked many years in healthcare providing Social Work, Case Management, Patient Advocacy and functioning as the Director of Patient Experience. Julie is a Licensed Clinical Social worker and also holds the CPXP certification. In her role at Smart-ER, which is a Stage 2 technology company that automates communication the day after a healthcare encounter to check patient wellbeing and uncover any service issues, she has been able to learn a lot from the voice of the patient and improve services for providers and consumers. Julie enjoys spending time speaking nationally on this topic and working collaboratively with other organizations on improving the experience for all.
Posted By Sara Laskey,
Monday, September 17, 2018
Updated: Tuesday, September 18, 2018
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Someone recently posted on LinkedIn that the most important thing about customer service is the perception of the customer and not the perceptions of the employees. I’m not sure that I agree. Yes, experience, including patient/consumer experience is all about perception. However, exploring the excellent definition provided by The Beryl Institute (“The sum of all interactions, shaped by an organization's culture that influence patient perceptions across the continuum of care.”) it becomes clear that culture is key to perception. And culture is another way of saying the sensitivities and behaviors of our employees.
Employee perceptions are building blocks that make up the experiences we create for all who interact with our organizations. If our staff members and providers perceive they are valuable to the institution they will, in turn, treat others with value. If they feel appreciated by managers, they will act with appreciation to those they are managing and caring for.
As an example, let’s explore the spaces where we work. Cleanliness is something we measure and something our patients and visitors notice and associate directly with quality of care. Are we taking time to make sure that the bathrooms and shared spaces for our staff are as pleasant and clean as the spaces for our customers?
The locker and bathroom at one of the emergency departments where I worked was always understocked, the toilets were never cleaned, the call room beds never changed and the trash cans overflowed in the staff lounge. Old take-out containers lined the shelves in the lounge and cups of day old coffee were constantly cluttering the counters. If the organization couldn’t/wouldn’t provide us with a nice, well maintained locker room, why wouldn’t staff begin to treat the shared spaces with the same disrespect? This ultimately bled over into the public spaces that patients and families experience. The perceptions of employees were influencing the perceptions of the customer.
What was our solution? Not surprisingly it was multi-factorial. In this instance we instituted an idea called “Own Your Space”. We spend as many waking hours at work as at home and we all bear some responsibility for keeping our spaces well maintained. Too often we assume that our environmental service teams will not only take care of patients and the public but will clean up our messes as well. This isn’t a fair assumption. By asking staff to “Own Their Space” we gave them accountability and responsibility for their environment. Essentially, we needed to make our work spaces something we could be proud to call our home away from home. By recognizing what we could control it became a lot clearer what we could ask other teams (environmental services, operations) to help us improve.
To impact mood and atmosphere we worked with the Arts in Medicine department and identified a series of photographs taken by one of our own physicians. Staff members then selected which of these would be printed and displayed throughout the ED in both onstage and offstage areas.
Involving staff in in the design and upkeep of the work space impacts their well-being via accountability, respect and a sense of ownership. Patients and families have also benefited. They enjoy the artwork and they interact with an engaged and appreciated staff. Staff who feel as valued and valuable as the care they offer.
Dr. Sara Laskey was the inaugural CXO for The MetroHealth System in Cleveland Ohio. In that capacity she was responsible for all aspects of human-centered design and improving the experience for patients, families, visitors and staff. During her tenure she created three progressive culture-change programs culminating in the transformative “Caring People Caring For People – Welcome. Listen. Care.” workshops. Currently she is consulting for healthcare systems and progressive healthcare technology firms.
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Posted By Hope Brown,
Monday, August 27, 2018
Updated: Monday, August 27, 2018
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Proactive hospitals always strive to improve patient experience, knowing that the best way to obtain this valuable feedback comes directly from patients, relying on surveys to create measurable results to continually improve hospital practices. The Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) survey is one metric used to gain this valuable insight from patients. The key for this prized patient insight is to ensure that a reliable number of patients provide survey feedback. Response rate refers to the number of patients who responded to the survey, in relation to the total number of patients in the sample.
A quick review of HCAHPS publicly reported data shows the national average response rate has dropped since the initial program implementation. The average response rate in 2008 was 33%, compared to 28% in 2016. The decrease in response rate shows that today’s hospitals are receiving valuable feedback from a smaller percentage of their total population.
Why worry about response rate?
CMS stressed the importance of response rate to measure reliability in their April 2018 podcast highlighting ways to improve response rates. The Hospital Quality Institute (HQI), California HCAHPS Improvers Playbook identified a relationship between California hospitals’ response rates and HCAHPS scores. In addition, a nationwide in-depth analysis of the July 2016 - June 2017 publicly reported HCAHPS data found a correlation between all HCAHPS dimensions and response rate.
This table shares the correlations found in the nationwide analysis of Hospital Compare data. A correlation value is a number between -1 and 1. A positive relationship indicates that when one variable increases, the other measure is likely to increase as well. As you can see in this table, correlation values range from .310 - .506, exhibiting a moderate-positive relationship. As a practical application, for every in 1 point increase in response rate a hospital achieves, the hospital could expect to see an increase of .501 in their Overall Rating score.
With the possibility of all HCAHPS dimension scores increasing in relation to response rate, this has the potential to impact Value-Based Purchasing (VBP) reimbursements as HCAHPS dimension scores are associated with VBP points and Medicare reimbursements.
These values surprise even the most astute industry leaders; this relationship would be unlikely if feedback was received from a truly representative sample. Just as an increase in response rate is correlated with an increase in dimensions scores, the converse has been found—when response rate decreases, dimension scores tend to decline as well. This research suggests hospitals with low response rates may not be getting the best representation of their total population, negatively impacting their HCAHPS scores.
With recent research in mind, it’s critical that hospitals consider the importance of response rate to capture the true patient experience at their facility. Increasing and maintaining response rates allow a hospital to receive patient feedback on topics that matter most to patients, and allow for more accurate score in HCAHPS dimensions.
Since joining PRC in 2000, Hope has applied her expertise in statistical analysis, physician studies, and patient experience to help clients use data to improve customer service and achieve market leadership. She is recognized as a leading consultant to hospitals and health systems seeking to leverage best practice models to maximize Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) scores. Her skills in executive training and physician engagement, and her deep-seated knowledge of multiple product lines, round out a broad base of experience that has enabled her to contribute significantly in a number of key roles at PRC. Hope earned a Bachelor of Science degree in Biology from Trinity University in San Antonio, Texas.
Posted By Dan Peterson,
Tuesday, August 21, 2018
Updated: Tuesday, August 21, 2018
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What blind spot?
Simply stated, the patient’s financial experience. With patients on the hook for higher deductibles, larger copays and growing out-of-pocket costs, many are more concerned about the cost of care than their health itself. This reality is affecting whether people seek care and their satisfaction with the experience when they do.
Depending on the research you subscribe to, including this study published by WestHealth earlier this year, anywhere from 44%-64% of covered Americans are avoiding care because of concerns about cost. Whether due to an inability to meet their high deductibles or uncertainly about how to afford treatment, more and more patients are foregoing care entirely. The consequences for longer-term health and cost outcomes can be dire – for patients and the providers that care for them.
Among those who do seek care, many cite dissatisfaction with a host of financial matters including: 1) The lack of pricing transparency to make informed decisions, 2) Little or no access to payment planning to improve the affordability of care, 3) Confusing, inconsistent billing and 4) Cumbersome payment processing. Alone and together, these points of friction in the patient’s financial experience have a detrimental effect on their overall care experience.
A problem for patients. A problem for providers.
Patients aren’t the only ones feeling the pain. Providers are impacted by rising patient balances, high collection costs (including patient bad debt) and frustrated population health initiatives. Additionally, we hear from staff and clinicians that financial matters contribute significantly to difficult patient encounters.
The patient financial experience is a phenomenon that can’t be ignored. It’s created a new and growing class of patients-as-consumers. Consumers who are looking for care and value they can afford. This emerging demand is opening the door for competitors with new, potentially disruptive, care delivery models. Loyale Healthcare CEO Kevin Fleming addresses this very issue in a recently published blog post and video titled Adapting to a Changing Healthcare Playing Field.
Providers now find themselves in a situation that didn’t exist when most of their revenue came from payers – that of having to compete for the business and loyalty of their patients. And they’re competing in an environment conditioned by their patients’ experiences with companies like Amazon, Apple and Zappos. Increasingly, the providers that meet these expectations are the ones that will thrive in healthcare’s consumer age.
Three ways to fix the patient experience blind spot
- Measure patients financial experience satisfaction. Most providers rely on HCAAHPS survey results as the definitive reflection of their patients’ satisfaction. But these clinically-focused metrics overlook the financial dimension of care. As with any important strategic objective, routine intelligence-gathering in the form of patient surveys and data analysis should be conducted to establish benchmarks and set goals.
- Innovate. Enlightened healthcare providers are making investments in technology and reengineering processes to illuminate the patient financial experience and continually identify and correct the gaps. These organizations are recognizing that the patient experience begins long before diagnosis and treatment and lasts ‘til well after. Consequently, they approach the challenge holistically, from end-to-end.
- Personalize. Unlike institutional payers, patient-payers behave in wildly different and difficult to predict ways. Using predictive analytics technology, it’s possible to segment patient populations using a wide variety of inputs to deliver financial experiences that are satisfying for patients and revenue-positive for providers.
The Patient Experience movement championed by The Beryl Institute, its members and other industry advocates is a critical catalyst for important and positive change. Let’s make the patient financial experience a part of the communication. Let’s fix the blind spot.
Dan Peterson, Chairman and Founder of Loyale Healthcare (2016), is a serial entrepreneur with a passion for solving seemingly intractable organizational challenges with user-centered digital solutions. Previous ventures include CashNet (1990), a financial platform serving complex, multi-facility environments in higher education and ePAY Healthcare (2010), a pioneer in the development of online patient and provider experiences to improve patient service and provider financial outcomes. Mr. Peterson continues to serve on a number of technology company boards and is a sought-after authority on technology and innovation.
Posted By Jeffrey H. Millstein, MD,
Friday, July 20, 2018
Updated: Monday, July 16, 2018
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Earlier this year, our practice was asked to become part of a project enabling patients to view our progress notes along with other chart elements via our online portal. My initial reaction to this was curious, and a bit defensive, as was the case for my colleagues at our site. Don’t progress notes belong to us, the providers? Why should we have to share our tool?
In large scale studies, patients report feeling a greater sense of control over their health with this element of transparency. This is a continuation of a national movement toward greater patient autonomy and collaborative care which began with the creation of the “Patient Bill of Rights” in the 1970s. With the momentum unlikely to change in the foreseeable future, the question then becomes: do we resist this, or embrace the change? Making this win-win means re-evaluating the purpose and potential of our notes.
Until recently, I viewed progress notes as serving three purposes: documentation of what transpired during the visit and thoughts on diagnosis and treatment, providing information for colleagues reviewing the chart, and determining level of service for billing. Making shared notes most effective requires reframing our notes as primarily serving the interests of education, improving safety and reinforcing a caring connection. These are already a part of our core mission in patient care, so we can leverage our notes to those ends. They will still fulfill the other traditional goals, but with a shift in priority.
It has been demonstrated that patients often retain little from their office visits, which causes concern about safe adherence to prescribed regimens. Shared notes, along with teach-back, offer a strong opportunity to reinforce clinical plans. It requires adjusting our documentation style a bit, with some effort to avoid language that may be viewed as disparaging, clarify instructions and avoid abbreviations the patient may not understand. I have seen some providers create a separate section at the end of their notes titled instructions, beneath which are clear directions written specifically for the patient. I like to conclude my visits with a reminder, “Mr. X, remember that you can go on the portal and see my notes. If there is anything you forget about our plan, the notes are available for your review.”
There is no question that the EHR is a source of frustration, and a core contributor to clinician burnout. I will not mourn if someday I am able to delegate more EHR keystrokes to another care team member, but I view shared notes as an extension of my connection with patients. I can still view my notes as my own tool, but one which I choose to share in the interest of taking better care of people. Further, if my notes are collaborative in nature, then I can engage my patient while writing them, making the EHR less of a barrier. While there is a little extra up front effort, my patients may be safer and better informed. Who knows? It may even cut down on some after-hours calls and messages. Imagine that.
Jeffrey Millstein, MD is a practicing internist, and physician champion for patient experience at Clinical Care Associates of Penn Medicine.
Electronic Health Records