Can you hear the Voice of your Patient?

The patient is your customer. Lean Thinking teaches us to think Customer First, such that all improvement activities are directed towards bettering their experience. Before starting any improvement initiative, it is critical to understand the needs of your patients to ensure the changes pursued bring them real benefit.

‘Patient requirements, as expressed in the patient’s own terms, are called the Voice of the Patient. However, the patient’s meaning is the crucial part of the message.’

(Adapted from Evans and Lindsay, 1996)

You are encouraged not to proceed before first giving careful consideration to your patient’s definition of ‘requirement’. If at the end of this article, you can answer the following questions, you are one step closer to understanding the Voice of the Patient:

WHO are our patients?

WHAT do they want?

WHY do they want it?

WHERE do they want it?

WHEN do they want it?

HOW do they want it?

Bypassing the accurate outlining of patient requirements often leads to assumption and a skewed view of how to deliver services to them. Putting in the effort up-front will significantly help you to:

·      Figure out what your patients care about

·      Ensure your priorities and goals are consistent with patient needs

·      Determine patient needs that you can realistically meet.

If you service many different types of patients, consider grouping them into categories before exploring their individual needs. Quality guru, Joseph Juran suggests classifying customers into two main groups, namely ‘the vital few’ and ‘useful many’ (Juran, 1992). The examples below illustrate how segmenting your patients may help you better understand them - before analysing their needs:

·      Condition type (Figure 1)

·      Clinic attended (Figure 2)

·      Chronic vs. acute treatments

·      Physician or unit attending

·      Number or type of scripts.

Figure 1: Classifying patients by condition type

Figure 2: Classifying patients by clinic type

PRACTICAL ACTIVITY FOR YOU TO TRY: Hearing the Voice of the Patient

Identify the 20 percent of patient categories that create 80 percent of the demand on your facility, and devise methods to better understand their needs using these tools:

Create ‘Patient Listening Posts’:

• Use the results from a ‘complaint and compliment’ mechanism to summarise patient views.
• Interview patient-facing staff and establish comments often received.
• Review commentary made in relation to your facility on social networks such as Twitter and Facebook and also in the media and to independent channels of complaint.

Talk directly to patients:

• Interview patients waiting in queue
• Conduct surveys
• ‘Go see’ for yourself through direct observation.

Though their experiences are subjective, patient testimony is key to understanding the Voice of the Patient. So, summarise what you have learned and look for patterns in what patients report about current service levels.

Of course it is not always possible to resolve all of the issues raised by patients and staff. But, by filtering the results of your investigations, you can understand how much value the patient places on certain attributes of the service your facility offers. Dr Noriaki Kano’s so-called Kano Model talks to product development and customer satisfaction. It outlines three categories to consider which have been adapted to suit service improvement:

• Dissatisfiers are elements of service that reflect basic needs—for example the provision of a patient file or being assigned a doctor for a consultation. As these ‘must-haves’ are implied patients will not mention them unless they are absent.
• Satisfiers refer to elements of service that meet a patient’s need for performance. Patient satisfaction will centre around these—for example the speed, cost, quality of care and more.
• Delighters are service elements that bring in the excitement factor. They earn you brownie points with a patient who feels they have received a world-class service that has exceeded all expectation—for example a patient arriving at the pharmacy to find their script packed and ready for collection. Looking to the future, care could involve integrated systems providing ‘wow’ factor service elements.

PRACTICAL ACTIVITY FOR YOU TO TRY: Identifying Dissatisfiers, Satisfiers and Delighters

Consider how much value patients place on particular areas of service. List each of their top requirements on individual Post-It notes and stick them onto the model in figure 3 to map out these priorities:

Figure 3: Kano Model adapted to suit service improvement

The activities you have completed have shed valuable light on your patient identities and needs. You are ready to capture the Voice of the Patient which will be used an an input to the improvement strategy. See Table 1 for an example of how you might go about summarising this.

Table 1: Example of how to capture the Voice of the Patient

Read Making a Difference (Heathcote, 2016) and Clear Direction (Heathcote, 2014) to learn more about the Voice of the Hospital, the Voice of the Patient / Customer, the Voice of the Employee and how to combine them into an unambiguous, Clear Direction for change.