Join | Print Page | Contact Us | Your Cart | Sign In | Register
Guest Blog
Blog Home All Blogs
The Beryl Institute invites members to submit posts on patient experience related topics. For guidelines and information on submitting a post for consideration, contact michelle.garrison@theberylinstitute.org.

 

Search all posts for:   

 

Top tags: patient experience  healthcare  communication  patient  culture  Leadership  patient engagement  HCAHPS  empathy  physician  compassion  perception  physicians  survey  caregiver  data  employee engagement  family engagement  healing  Hospital  improving patient experience  community  Consumerism  Expectations  interactions  patient and family engagement  pediatric  person-centered care  relationship  service excellence 

The Invaluable Gift of Clarity

Posted By Mark VanderKlipp, Friday, January 19, 2018

With the holiday season over, your thoughts have undoubtedly turned from gift giving and New Year’s resolutions to “getting back to daily life.” As you do so, I’d encourage you to consider a resolution to provide a gift to your staff, patients and their families that keeps on giving: clarity.

In over 30 years as a designer, I’ve seen clients focus more on the tool (the identity, communication, policy, wayfinding system, mobile app, architecture, etc.) than they do on the anticipated behaviors of the people that support or interact with those tools.

To be sure, these are critical elements designed to support any patient experience initiative. My goal in writing this post is to help you see the value of designing for human interactions (engagement, connection, expectation, interaction, enlistment, orientation, learning) as well as the tools themselves.

In a 2015 HBR article1, the authors assert that “with very complex tools, the design of their ‘intervention’—their introduction and integration into the status quo—is even more critical to success than the design of the tools themselves. The more complex and less tangible the designed tool is, the less feasible it is for the designer to ignore its potential ripple effects.”

For most healthcare employees and consumers, there is no more complex, less tangible experience than a bewildering, impenetrable and continually changing health care system. The tools created to help engender clarity need to be thoughtfully designed, tested and integrated to assure they don’t add to the stress, both for caregivers and patients.2

Here’s an example: a formerly independent hospital merges with a much larger faith-based institution. The wheels are set in motion to design tools to support this merger: internal and external brand communications, updated facilities, wayfinding signage, EMR systems, billing systems, relationships with insurers, ambulatory clinic networks, HR policies and procedures, the list goes on and on.

As a clinical or clerical provider, I need clarity:

  • As an ambassador for this new faith-based brand, ostensibly very different from the old one, how is my behavior expected to change?
  • Will I be able to help design the process to successfully navigate the transition?
  • As new tools are designed and integrated, how will I be prepared to use them?
  • How can I, in my day to day role, bring clarity to our patients and their families?

As a patient or community member, I need clarity:

  • How will this impact me? How will it benefit me?
  • How will expectations of me, as a patient or community member, change?
  • How will the organization help make the transition easier?
  • Will there be physical changes? Will I be able to park and enter in the place I always have?
  • Who will help me? Will the people I’ve come to know and trust still be there?

The gift of clarity establishes the roots needed to visualize, design and deliver a a human centered healthcare experience: to understand the potential points of confusion, then meet individuals at each step in their journey with simple, consistent and well-supported tools. Whether these are designed to support small initiatives or large-scale transitions, anticipating the “ripple effects” of human interactions is critical to achieving sustainable success.

Creating an effective caregiving culture happens by design, not by default. It’s up to us as practitioners to break down silos, see gaps in communications, then test and iterate the tools designed to bring clarity to the questions that our staff, patients and their families bring to this world of healthcare experience.

Truly, there is no greater gift we can give. Happy New Year!

1. Design for Action, Harvard Business Review, September 2015 by Tim Brown and Roger L. Martin
2. 
Creating a Culture of Health: Design that Goes Beyond the Mobile Application by Dr. Joyce Lee MD, MPH “Doctor as Designer “ @joyclee

Mark VanderKlipp is an experience and systems designer, working in human-centered graphic design for over 30 years. He helps clients visualize the systems within which they function, empowering staff to deliver an experience that’s clear, relevant and human. He previously spent 24 years with a world-class wayfinding design firm, 13 as its president, where he was the lead strategist for diverse assignments in healthcare, higher education, civic, corporate, trails and tourism throughout North America. Mark is a 1987 graduate of the University of Michigan. In 2012 he earned his evidence-based design certification (EDAC) through the Center for Health Design, and in 2017 became certified in Systems Practice through +Acumen. He is also a founding partner of the customer experience consulting firm Connect_CX.

Tags:  clarity  design  engagement  expectations  interactions  tools 

Share |
PermalinkComments (2)
 

Using Shared Governance to Improve the Patient Experience

Posted By Gen Guanci, Thursday, January 4, 2018
Updated: Thursday, January 4, 2018

Those in health care know all too well that the patient experience is a top pain point for executives and therefore a top organizational priority. There is also no shortage of initiatives, programs and activities that focus on improving that experience. Committees and task forces are formed with participation from leaders across the entire organization. Education and action plans are developed and rolled out. Patient experience scores are closely watched for the anticipated improvement. Then, reality often sets it: There is no—or only minimal—improvement. How can that be? And what can be done about it?

What if you were to take the traditional approach to improving the patient experience—the approach where initiatives, programs and activities are developed by those outside the point of care and rolled out to those who must operationalize them—and flip it? Shared governance is a leadership model that does exactly that. In a shared governance culture, staff members are empowered to make decisions that meet a set of articulated expectations shared by leadership. Shared governance has proven to be a highly successful partner in crafting strategies that yield sustained improvements. Shared governance is built on a set of four overarching principles:

Partnership
Staff and leaders work together to improve practice and achieve the best outcomes.

Equity
Everyone contributes within the scope of her or his role as part of the team to achieve desired outcomes.

Accountability
Staff and leaders share ownership for the outcomes of work and are answerable to colleagues, the institution, and the community served.

Ownership
Participants accept that success is largely dependent on how well they do their jobs.

Using shared governance, groups of staff members (councils) are charged with the development of the specifics of the plan to address the opportunities for improvement. Let’s take the desire to have purposeful rounding be a standard of care. While the desired outcome is purposeful rounding, it would be up to the individual councils, groups, departments, or units to determine how this could be best operationalized in their area.  Here are some examples of what could happen when the people closest to the work in each department are empowered to make decisions about how to make rounding purposeful for their specific patient populations.

The Maternal-Child department determines that rounds will be done hourly between 6:00 a.m. and 11:00 p.m., then every two hours between 11:00 p.m. and 6:00 a.m.  They have made this decision to meet the needs of their patients to have a period of uninterrupted sleep.

The Surgical unit decides rounds will be a shared responsibility between the RN and the Clinical Assistants (CA).  RNs round on the even hours and CAs on the odd hours. For the same reasons as the Maternal-Child department, they too decide hourly rounding hourly will be done between 6:00 a.m. and 11:00 p.m., then every two hours between 11:00 p.m. and 6:00 a.m.

The Patient Experience council, made up of a mix of staff members from across the organization (i.e., environmental services, clinical, nutritional services, etc.) work together to develop a meaningful rounding experience for patients and staff members that includes addressing the best practices in rounding conversations. 

The expectation for each of the above groups was to craft a meaningful rounding experience that worked for the patient as well as the specifics of the individual units/departments. The plans, developed by staff members, are supported by colleagues as peer developed and rolled out the plans. Peers create the accountability with each other, and this in turn lessens the need for leadership to “manage” the plan. It also moves organizations from “us” and “them” to “we.” 

There is an ancient Chinese proverb that states “An owner in the business will not fight against it.” Using shared governance to craft a plan for sustainable improvement creates ownership at all levels of the organization.

Gen Guanci is a consultant with Creative Health Care Management where she works with organizations as they build a culture of excellence. Her work with Magnet® and Magnet® aspiring organizations focuses on improving the patient experience, work environment, clinical practice, and patient outcomes. Her expertise in shared governance has enable her to empower staff to generate outcomes that exceed national benchmarks.

Tags:  empowerment  expectations  governance  leadership model  ownership  Patient Experience  rounding 

Share |
PermalinkComments (0)
 

The Return on Investments of Empathy In Measuring Patient Experience

Posted By Dr. Avnesh Ratnanesan, Friday, March 10, 2017
Updated: Tuesday, March 7, 2017

Empathy in healthcare is both a traditional concept as it is a new-age buzzword. That’s because it has never lost its importance as a legitimate element of a patient’s healing process.

Simply defined, empathy is the capacity to walk in the shoes of another. Essentially, the ability to understand, appreciate and relate to someone else’s emotions. There is more chatter in the industry now about defining, teaching, learning and measuring empathy in healthcare than there has ever been.

Making emotions a visible part of your (formal or informal) measurement validates the feelings of patients which in turn, 3promotes patient satisfaction, enhances the quality and quantity of clinical data, improves adherence and generates a more therapeutic patient-physician relationship.

Ultimately, it all links back to the Net Promoter Score (NPS) or the Friends and Family Test (FFT). A key HCAHPS question, the NPS or FFT asks the patient point-blank if they would recommend the hospital to family and friends.

There’s your ROI.

EMOTIONS AND NPS

Human emotions are core to every patient experience. At every stage of the patient journey, there is a feeling, sentiment or attitude that will, collectively, define the experience for the patient at the end of their engagement with a healthcare setting.

Hospitals are often obsessed with benchmarking against other hospitals in term of their respective performance indicators, however there is a need to first benchmark against the EXPECTATIONS of your own patient population:

  • If the experience < expectations, then you have a satisfaction deficit which leads to frustration and anger
  • If the experience > expectations, then you have a satisfaction profit which leads to delight and excitement

Frustration and anger are detractors to the patient experience. If these emotions are experienced, then you can be sure that the patient is on their way to relay their negative experiences to others or not return, or both! Feelings of delight and excitement on the other hand naturally motivate patients to ‘promote’ your healthcare setting to others.

MEASURING EMOTIONS

Measuring emotions is key part of our 6E Framework, a step-by-step guide to producing a true holistic picture of patient experience. Its measurement impacts the full spectrum of this framework:

Understanding the real patient EXPERIENCE through EMOTIONAL data ENERGISES staff in their purpose and EXECUTION of solutions. Successes are repeated to produce EXCELLENCE in delivery and organizational capability in patient experience EVOLVES.

How do you draw these emotions out of a patient so you can understand, measure and respond appropriately? Some state it boldly, some 3hide their emotions through seemingly rational questions or casually drop a comment about their emotions, to test the waters on how it would be received in the healthcare setting. Pick up on these clues, don’t ignore it or change the topic.

For the uncertain and non-forthcoming patient, surveys are a great way to get emotional data. One would imagine that a survey asking about their emotions would not only surprise them but send a clear message that there is a space in that setting to talk about emotions, that a culture exists that encourages and supports emotions.

INTELLIGENCE FROM EMOTIONAL DATA

When the clinician and non-clinician are able to recognize the emotions around a patient, it allows them to be more authentic and honest in the support given to the person (not patient).

Clinicians are able to view the person’s emotions within a more accurate context and address it in specific ways: 2

  • Learning: Where the patient is fearful because of a lack of information, there is an opportunity for staff to help educate the patient to reduce his fear
  • Empowerment: Where the patient feels helpless in the face of his health, there is an opportunity for staff to develop the patient’s sense of power over the situation through education, tools and technology
  • Self-discipline: Where the patient is frustrated over their personal management of their health, there is an opportunity for staff to help the patient develop discipline through motivation, tools and technology
  • Feelings of control: Where the patient is overwhelmed with the amount of information around their diagnosis, there is an opportunity for staff to ensure that the communication of information is at a pace and volume that the patient is comfortable with and to involve the patient’s family members or friends in managing overwhelm.

When an organization can undertake the above in a systematic way, an ‘energy’ or a vibe starts to infiltrate through the ranks. Clinicians and non-clinicians start to discover or re-discover the meaning in their roles and the organization becomes more congruent with its purpose.

What’s the vibe like where you are?

Sources:

1. Empathy and Emotional Intelligence: What is it Really About?’, International Journal of Caring Sciences, Volume 1 Issue 3, Alexander Technological Education Institute of Thessaloniki, Greece http://internationaljournalofcaringsciences.org/docs/Vol1_Issue3_03_Ioannidou.pdf
2. Adapted/Inspired from information from a Chapter Abstract from Patient Emotions and Patient Education Technology:
http://www.sciencedirect.com/science/article/pii/B9780128017371000020
3. “Let me see if I have this right...”: Words That Help Build Empathy, Coulehan JL, Platt FW, Egener B, Frankel R, Lin CT, Lown B, et al. (2001). 

Dr. Avi Ratnanesan is a medical doctor with broad healthcare sector experience including hospitals, biotech, pharmaceuticals and the wellness industry. He is a leading expert who coaches and consults to senior executives, entrepreneurs, practitioners, organizations and governments.

Tags:  emotion  empathy  expectations  experience  NPS  Patient Experience  ROI 

Share |
PermalinkComments (0)
 

Understanding the Gap Between Patient Expectations and Reality

Posted By Barbara Lewis, Friday, June 21, 2013

Some events change our lives. They may be small actions that have a substantial impact or they may be traumatic events that forever alter our life. For me that event began to unfold when my younger sister, Joan, called me from the Intensive Care Unit where she had been hospitalized for an unknown infection. She expected to be released within a few days. Nonetheless, as soon as I hung up the phone, I booked a flight across the country to be with her. I spent 15 to 18 hours a day in her room recording and monitoring medications, test results and procedures. During the next few days as she improved, I put on my marketing hat and observed the hospital environment with both awe and surprise. After spending nearly three decades in marketing, much of that around customer or client satisfaction, I was fascinated with how the hospital functioned.

I decided to jot down my observations, which I planned to discuss with the head of the ICU on the day of my sister’s release. Unfortunately, Joan took a turn for the worse and died at the end of the second week. When I returned home, I found my notes. As a looked over the pages, deciding what to do, I thought that the head of the ICU might like to know my thoughts. I set to work on a document I called Joan’s Family Bill of Rights. I marveled at a group of unbelievable people who have dedicated their lives to healing the sick and comforting the dying. Yet, as a family member I felt invisible most of the time – a nuisance in the hospital room, who asked too many questions.

I emailed the document to the head of the ICU, who sent it to the head of the hospital and he, in turn, emailed it to the heads of the health care system. They contacted me to talk and within three months flew me to their facilities to make three presentations, which they videotaped for their training program.  I didn’t feel invisible any longer. Here was a health system that truly listened.

What surprised me was the number of people after each presentation who told me their stories. I realized that my experience was not unique and that patients and family members everywhere shared my own narrative. Joan’s Family Bill of Rights wasn’t just my story; it was universal. As the document was passed around in meetings and on the internet, an increasing number of nurses contacted me.

I asked myself, "How can I help?” I spent over a year researching my observations, such as compassion fatigue, situational awareness and the relationship between quiet and healing. I found that the Healthcare Consumer Awareness Hospital Process and Systems (HCAHPS) surveys were tracking patient satisfaction in hospitals across the country. I was surprised to learn that money was tied to the scores, which reflected certain patterns. For example, the well educated and younger generally score the survey lower, while the poor and less educated score the survey higher. I studied the questions and devised scenarios of high scoring or low scoring.

In my opinion, the discharged patients score the HCAHPS surveys based on the difference between expectation and reality. Patients come into hospitals with certain expectations. Every person has different expectations; however, in many cases those expectations can be generalized. For example, the more educated probably want more information about their condition. (HCAPHPS survey question: Patients Who Reported that Their Doctors {or Nurses} Always Communicated Well.) The gap between the expectation and the reality is where the survey scores reside.


There are at least five HCAHPS survey questions that are directly related to the patient’s journey through the hospital system. Low HCAHPS scores not only affect Medicare payment, but insurance reimbursements; future patients, who opt for other facilities; and donor defections, as well.

 

As businesses have been doing for years, it’s time hospitals understand the patients’ expectations, manage those expectations and shut the gap between the hope that patients have when they come into the hospital and the realization they are stuck with when they leave. Closing that gap means redesigning systems and altering behaviors.  It’s time to exceed patients’ expectations, which will not only boost HCAHPS scores, but have a substantial impact downstream as well.

 

Barbara Lewis has been a marketing consultant for over two decades. She began her career as a journalist writing for national publications from The Wall Street Journal to Ladies Home Journal. She has an MBA from the UCLA Anderson School of Management where she currently lectures. You can reach her at: BarbaraLewis@JoansFamilyBillofRights.com 

Tags:  Expectations  HCAHPS  ICU  Patient Experience  reality  survey 

Share |
PermalinkComments (0)
 

Stay Connected

Sign up for our informative series of monthly e-newsletters from The Beryl Institute.

The Beryl Institute
1560 E. Southlake Blvd, Ste 231
Southlake, Texas 76092
1-866-488-2379
info@theberylinstitute.org