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Connecting Revenue Cycle Enterprise-Wide to the Patient Experience
What was the opportunity, issue or challenge you were trying to address and in what setting?
As a front-end revenue cycle team, we saw a gap in how we were connecting our operations with the patient experience on a consistent basis. Our goal was to bring a patient-centric perspective into everything we do, every day, in every interaction. We wanted to give our leaders a ‘fresh eyes’ approach to find opportunities and observe performance through leadership rounding across the organization.
What process did you use to develop a solution?
We rolled out a performance system with our leaders which included patient experience practice training, consistent daily tiered huddles, visual systems, lean problem solving and rounding with a purpose (spending time where the work happens). The next phase was transitioning to a global practice of going where the work is happening (leadership rounds).
Because of our partnership with Optum360, the process we used to develop a solution was The Optum Performance System (TOPS) which is based on lean methodologies. TOPS is built on driving solutions derived from all levels of the organization. We worked closely with front-line employees, patients and leaders to ensure we clearly understood the problem and what was causing the problem; from there we developed solutions.
What outcomes were you looking to achieve?
The goal of the leadership rounds was to have visibility to learn and identify areas where the patient experience is working well and support opportunities. The key to leadership rounds is that they are NOT punitive, but to be open minded, supportive and find opportunities to improve.
We connect leaders by assigning a facility and sending out a schedule a week in advance.
On the day of rounds, we remotely connect the facilities together and start each session with a purposeful message focused on a theme aligned with our patient experience philosophy. We then break into teams and go observe the patient experience in action. We spend about 40 minutes observing and speaking with revenue cycle employees, clinical staff and patients/family members. We return as a group and remotely debrief, listening to what we did well and tracking improvement items for follow up. The entire session takes 90 minutes. We have been rounding since December 2016 and in the beginning it was a little challenging and somewhat uncomfortable, but we cannot see operating in any other way. We continue to gather feedback to develop our process gradually in our journey to excellence.
For metrics, we wanted to see our Press Ganey Patient Experience scores have a 20% improvement across the region for courtesy of the person who took your personal/insurance information, and our employee engagement improve 60% within the Front End Revenue Cycle. Overall we were looking to improve our patient experience courtesy measure as well as employee engagement across all facilities.
What specific steps did you take to address the problem?
In our quest to find a solution to connect our operation to patient experience we implemented leadership rounds, this allows us to observe the patient experience across all spectrums of the front end revenue cycle at all our facilities. The primary focus of leadership rounds is to observe the patient experience in action allowing for greater visibility, learning, recognition, innovation and support opportunities. We use leadership rounds to reinforce our core value concepts, cultural behavioral expectations, and our commitment to keeping all levels of leadership connected to the operations, while promoting and creating continuity for every interaction.
What resources, if any, did you engage – either internally or externally – to address the problem?
All of leadership in the area committed to two hours a month, because of the dispersion of facilities we also utilized WebEx to connect all the facilities at the start and close of the rounding sessions.
In addition, we utilized the following:
- Revenue cycle committee
- Process Improvement Training (LEAN)
- Patient Experience Training
We also developed an assessment tool that was used during rounds. We modified how our leaders were operating (mindset) to create more opportunities to huddle, for one on ones and have open forums.
What measures did you establish to determine the success of this effort?
We used the following to measure our results:
- Monthly review of PX measures through Press Ganey
- Weekly touch points via huddles
- Pulse employee engagement surveys
- Monthly employee 1:1s with a connection to our behavioral standards and expectations
What was the ultimate outcome of your effort?
Our patient experience courtesy measure improved by 20%, across all facilities, from 2016 to 2017. In addition our employee engagement increased by 60% in the most recent employee engagement survey results. As of 1st QTR 2018, our program has evolved to include all team members, giving them greater insight into how their work impacts all parts of the revenue cycle and ultimately the experiences of our patients.
Overall we increased by 20% improvement across the region for courtesy of the person who took your personal/insurance information.
What lessons did you learn you would share with others as they consider addressing a similar issue?
There were many opportunities identified within rounding such as:
- Not capturing Coordination of Benefit forms during the patient interview which can cause denials.
- Education to processes that impact revenue and the patient experience.
- Security opportunities with visitors avoiding long lines.
- Consistencies in executing our behavioral standards with different departments.
We would recommend a genuine willingness to identify inconsistencies within business processes and a commitment to make change is imperative to the transferability of this program.
We have a strong program built around an environment of transparency, accountability and continuous improvement. We openly identify issues and support proactive, innovative approaches to solving them. This has created positive interactions among leaders and staff. This is easily transferable to any area of our operations with the support of every level of leadership.
About Northwell Health
Northwell Health is a large, integrated organization comprised of 63,500+ caregivers, 23 hospitals and 650+ medical practice locations, spanning geographically across New York State.
Case Study Authored by: Carmen Fells, Patricia Froehling and Andrea Herbert