This website uses cookies to store information on your computer. Some of these cookies are used for visitor analysis, others are essential to making our site function properly and improve the user experience. By using this site, you consent to the placement of these cookies. Click Accept to consent and dismiss this message or Deny to leave this website. Read our Privacy Statement for more.
Test | Print Page | Contact Us | Your Cart | Sign In
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, please contact us at info@theberylinstitute.org.

 

Search all posts for:   

 

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

Calculating and Understanding the Drivers of a Net Promoter Score in Health Care

Posted By Andrew S. Gallan, PhD, Monday, May 15, 2017
Updated: Thursday, May 11, 2017

In 2016, Advocate Health Care, the largest health system in the Chicagoland area, integrated into its performance measures a Net Promoter-like score, which they call a Patient Loyalty Score (PLS). Net Promoter Score (NPS) is a valuable metric, and it has been adopted by many companies in almost every industry. NPS is a simple, easy to use, and easily calculated metric that is intuitively associated with business health by assessing a respondent’s likelihood to recommend an organization to a friend or colleague.[1] Health care organizations are beginning to see its value, and are exploring how it is best calculated and used.

For Advocate Health Care, PLS is constructed using data from CAHPS and vendor surveys, and utilizes the likelihood to recommend question. Only a top-box score is defined as a promoter, and varying bottom scores are defined as representing a detractor. That is, for a five-point scale (ED vendor survey) the bottom three responses are categorized as detractors; for a four-point scale (HCAHPS) the bottom two are detractors; and, for a three point scale (CG-CAHPS) only the bottom score is a detractor.

Some issues with the measure include the referent (CG-CAHPS asks about likelihood to recommend the provider’s office, ED refers to the department, and HCAHPS asks about the hospital), and the limited scale width (the original NPS scale is 11 points). However, for me, having a patient-provided measure outweighs the issues, and I commend the organization for holding people accountable for patient perceptions of care. The strength of this metric is to create system-wide responsibility for a patient-provided measure, thereby ensuring that the patient’s voice is heard.

Like most organizations, Advocate Health Care is interested in earning increased rates of positive word-of-mouth recommendations. As a result, I recently engaged with Advocate as an Academic-in-Residence. In this role, championed by EVP & COO Bill Santulli, SVP & CNO Susan K. Campbell, and VP Information and Technology Innovation Tina Esposito, I performed analytics to identify drivers of PLS. The two important research questions that drove this project were:

  1. Which variables are the most important drivers of PLS?
  2. What can we learn from patient comments about potential drivers of PLS?

In order to investigate these questions, I was provided with almost two years of HCAHPS, CG-CAHPS, and ED survey data and patient comments. Top line results included the following:

Inpatient (HCAHPS): Nurses and personal issues (privacy, pain, and emotional issues) had by far the most impact on patients. Positive comments centered on comfort, communication, and care. Negative comments focused on food.

Outpatient (CG-CAHPS): The face-to-face interaction between a patient and physician is the “moment of truth,” and as such is what the patient apparently will use to evaluate the entire experience. Positive comments centered on comfort and communication. Negative comments focused on waiting and rude treatment. 

Emergency Department (Vendor Data): When patients are in the ED, taking care of personal issues will have the greatest impact on PLS. These issues include keeping patients informed about delays, caring about patients as people, pain control, and providing information about caring for yourself at home. Positive comments centered on comfort, communication, and care. Negative comments focused on feeling vulnerable and afraid in a busy and foreign environment.

As a result of this project, Advocate Health Care is now embarking on disseminating the results, integrating insights into daily practice, and evaluating additional questions that emerged from the analysis. I’d be interested in hearing more about what your organization thinks about NPS, how you use it, and what you have learned as a result!

[1] NPS was first proposed by Fredrick F. Reichheld, (2003), "The One Number You Need to Grow," Harvard Business Review, 81 (December), 46-54. For more on advantages and issues utilizing NPS in health care, see https://thepatientoutcomesblog.com/2012/11/12/net-promoter-score-in-health-care/

Andrew S. Gallan PhD is an assistant professor at DePaul University in Chicago, a member of the Editorial Review Board of Patient Experience Journal, and principal of Dignity in Action, Inc., a PX analytics and advisory company (www.dignityinactioninc.com). Andrew can be contacted via email: agallan@depaul.edu

Tags:  CAHPS  CG-CAHPS  data  drivers  HCAHPS  net promoter score  NPS  patient loyalty  patient loyalty score  survey 

Share |
PermalinkComments (0)
 

‘Sometimes’ is the Enemy of ALWAYS

Posted By Jake Poore, Friday, July 24, 2015

In Jim Collins’ famous book "Good to Great”, he says ‘good is the enemy of great’. His premise is that we often settle or become comfortable with good or good enough instead of striving for more... reaching for the last inch that drives great experiences.

Great companies not only create experiences that reach more heights (or go the extra mile), they also seem to get everyone in the organization to deliver it, consistently... creating a culture of always.

If good is the enemy of great in business, then ’sometimes’ is the enemy of ALWAYS in healthcare.

  1. If we say, "we’re always going to knock on the patient’s door, wait for their reply, enter, make eye contact, smile, wash hands and introduce ourselves”, and we do this often, sometimes or even most times... we fall short of a culture of always.
  2. Imagine seven nurses care for a patient of over a three-day stay. If five nurses do these behaviors always and two don’t feel this is important and skip it, we’ve created a culture of sometimes – and again, we’ve fallen short on the journey to become a culture of always.

Unintentionally, I believe, we’re creating a silo mentality where everyone does their own thing. That’s a fragmented way to lead any organization. It creates chaos, dissatisfied patients (and employees) and ultimately, low patient satisfaction scores.

For today’s healthcare administrators, this isn’t just something that’s nice to do; it’s a must-do. Federal financial reimbursement is tied to CMS surveys. And these surveys only give credit for "always” answers. If your facility scores a 0 to 8 (never to sometimes), you get zero credit. Clearly, a culture of always means survival.

The popular phrase "culture eats strategy for lunch” rings true. If your culture is weak, how your employees perform their daily job tasks will trump any corporate strategy. You may have good intentions, but they’re only as effective as the integrity of your organization’s culture.

Consider:

  • Some doctors shake hands with patients; some don’t.
  • Some sit and listen to the patient’s story before diagnosing; some interrupt within 18 seconds to "move along.”
  • Some nurses introduce themselves; some don’t.
  • Some offer to close your door for quiet from noise; most don’t.
  • Some food service workers offer to help elderly patients open plasticware and milk cartons; others drop and run.

Besides doctors and nurses, the average patient interacts with more than 100 care team members along their healthcare journey including call center employees, front desk reception, volunteers, transporters, security, food service, housekeepers, etc.

If culture is what we do every day, and we aim to create consistency to survive and thrive in healthcare, then we must create new daily habits as a team so everyone is on the same page. The key is redesigning the culture with input from every employee group.

It seems everyone is admiring this problem, but nobody has a clear solution. The real problem is we’re throwing spaghetti at the wall and hoping it will stick. The solution is to no longer teach to the test as a long-term strategy. To get to a culture of always, we have to change our culture.

Patients are like the canary in the coal mine. They’re sending up warning signals of a flawed culture because, just like the canary, they’re most susceptible in a toxic environment. And make no mistake - they’re calling us out on things that poison the patient experience.

How?
Through patient satisfaction surveys.
By telling friends and family about the level of care they received.
And by taking their business and their loyalties elsewhere.

 *Hear more from Jake Poore about patient loyalty and creating exceptional patient experiences at the upcoming San Francisco Regional Roundtable.

As Founder and President of Integrated Loyalty Systems, a company on a mission to help elevate the human side of healthcare, Jake (@jakepoore) knows what it takes to create and maintain a world-class service organization. He spent nearly two decades at the Walt Disney World Company in Florida helping to recruit, hire, train and align their 65,000 employees toward one end in mind: creating memorable experiences for individuals, not transactions for the masses. In 1996, Jake helped launch the Disney Institute, the external training arm of Disney that sold its business secrets to the world.

Tags:  culture  patient experience  patient loyalty  service excellence  team 

Share |
PermalinkComments (1)
 

Stay Connected

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

The Beryl Institute
1831 12th Avenue South, #212
Nashville, TN 37203
1-866-488-2379
info@theberylinstitute.org