Elevating Patient Experience: “A Journey Towards Empathy and Excellence”

In today’s healthcare landscape, the patient experience stands as a cornerstone of quality care delivery.? Beyond the clinical treatments and procedures, it encompasses the holistic journey of individuals navigating through the complexities of healthcare systems. This article embarks on an exploration of multifaceted dimensions of patient experience within hospital settings, shedding light on the pivotal role of empathy, communication, and organizational culture in shaping these encounters.

Right from the first point of contact of the patients even before entering the hospital e.g. Website of the hospital, call center of the hospital to the post discharge follow-ups, each interaction contributes to the overall perception of care received.

Before starting our aspirational project of patient experience in my hospital, I happened to come across the book named “If Disney Ran Your Hospital”: 9 ? Things You Would Do Differently by Fred Lee and this book became an inspiration to me to think about patient experiences in the hospital in a very different perspective.

Author of the book Fred Lee worked as a Senior Vice president for Strategic Planning and Marketing at Florida Hospital in Orlando. Steve Heise, the then manager of the Business Programs Division at Disney, heard Mr Fred Lee speaking to a roomful of Hospital Managers on how to improve the patient experience and create an environment where caregivers love to work. At the end of the seminar, Mr Steve invited Mr. Fred for lunch and asked him to be a part of a team of facilitators and program developers at Disney University. The job of Mr Fred Lee there was to reshape an acclaimed program “The Disney Approach to Quality Service for the healthcare industry”. In addition, he also created a new program of customer loyalty.

Being a Disney cast member, the approach of Disney towards customer is what can be replicated at the hospitals. This book speaks about the patient experiences that can be enhanced by the hospital staff at every touch points that patients encounter.

This book has 10 chapters. In each article, I will speak about 1 chapter at a time.

So, let’s start with the first chapter.

Chapter 1: Redefine your competition and focus on what can’t be measured.

The first chapter is the “ ? thing” alluded to in the title of the book because it has more to do with what we already know than with the new concepts. It reminds us of a fundamental frame of reference rather than actual changes that must be made.

This chapter talks about defining our competition. It is only natural that to a physician, administrator, or a clinician, quality is primarily judged by clinical outcomes. And rightly so. What isn’t so obvious is that the satisfaction and loyalty of their customers are not primarily won on the field of who has the best clinical quality. But patients judge their experience by the way they are treated as a person, not by the way they are treated for their disease.

Below are the top drivers of the inpatient satisfaction survey report from Ganey Satisfaction Report, August 2003

These are:

1.????? How well staff worked together to care for you.

2.????? Overall Cheerfulness of the hospital.

3.????? Response to the concerns/complaints made during your stay.

4.????? Amount of attention paid to your personal and social needs.

5.????? Staff sensitivity to the inconvenience of hospitalisation.

6.????? How well nurses kept you informed.

7.????? Staff’s effort to include you in decisions about your treatment.

8.????? Nurses attitude towards your requests.

9.????? Skill of the nurses

10. Friendliness of the nurses

These questions were in the descending corelation of drivers of patient satisfaction. From this it can be noticed that how the questions with highest corelation are mostly from perceptions about how one is treated as a person, not clinical competencies.

Gallup Telephonic survey states Top 7 drivers of patient satisfaction as following that corelate most highly with “overall satisfaction”:

1.????? Nurses anticipated your needs.

2.????? Staff and departments worked together as a team.

3.????? Staff responded with care and compassion.

4.????? Staff advised you if there were going to be delays.

5.????? Nurses explained about medications, procedures and routines.

6.????? Nurses responded promptly to pain management.

7.????? Nurses responded in a reasonable amount of time.

So, in the battle for the supremacy of perceptions in the patient’s mind, our competition is anyone the patient compares us to. Unfortunately, they do not usually compare us to other hospitals. People don’t make an exception by saying “compared to other nurses she is okay but she couldn’t cut it as a waitress or any other service provider”.

So, this chapter says that the patient judges a quality by his or her perception of care and something that is very subjective and cannot be verified in the same way as clinical outcomes. The patient is judging the overall experience of being in a hospital. It frequently comes as a surprise to a hospital personnel when the clinical outcomes are excellent, but the patient is displeased or angry.

So overall it takes a different skill set to manage perceptions.

Every manager of the unit that has patient contact should be focusing regularly on these top drivers and requiring staff to be proficient in ways that create the key impressions that matter most to the patients. The first thing to have clear is that outcomes are delivered by teams, whereas impressions are delivered by individuals.

When it comes to perceptions, it’s what a person says or doesn’t say that creates the impression. For instance, let’s take an item that was number one on the Press Ganey survey for nearly a decade (now number 12): “Staff’s concern for your privacy.”

“How do we give the impression that we are genuinely concerned for their privacy?”

People do not notice concern unless we say something. A nurse may close the door and draw the curtain and begin a procedure, thinking everything has been done to protect the patient’s privacy. But it is only when the nurse says something like “I’m here to give you a bath, and just to make sure nobody barges in on us I have closed the door and I am going to pull your curtain too,” that she creates the impression that she is concerned about the patient.

Or let’s say that there is a lot of commotion at the nurses’ station late at night giving report to the next shift. A nurse quickly closes the patient’s door out of concern for the patient’s privacy. Yet the patient probably thinks, Why are they closing my door? I’ll bet they’re talking about me. The way to create the impression of concern is to say something to the patient like “Mr. X, would you like your door closed? We get pretty noisy out here while we’re giving report. It shouldn’t last much longer.” Only by concentrating on what is said while doing something did hospitals begin to see significant improvement in patient perceptions that staff showed concern for patient privacy.

To bring in cheerfulness in the hospital, we should have a same standard that Disney has. You never pass another individual in the hallways without greeting that person with a smile. Avoidance must be considered as a violation of the organization's culture, because with each avoidance we have a missed opportunity for the little courtesies that add up to an overall perception of cheerful, friendly place.

Culture Trumps Strategy:

What we say makes a bigger impression than what we do.

Let’s take the example of the top driver on the Press Ganey survey of patient perceptions, which is also at the top of the Gallup survey. They are perceptions about teamwork. We start with our question: “What can we say that gives the impression that we work together as a team?” Remember that when it comes to perceptions we are not dealing with reality, only impressions. So we come up with a script that requires every person to say, “Is there anything else you need?” before leaving a patient anytime anywhere. If the patient needs something that you cannot provide you will say, “I will tell your nurse.” That’s our strategy. Everybody learns it.

Everybody does it. And it’s guaranteed to give the impression that we “anticipate your needs” and “work together as a team.”

However, there’s a good chance the culture will sink this strategy in all but the most focused of patient care environments. How?

Well, let’s say Susan is a new housekeeper. She has been taught our script. During her first day on the job she says, “Mr. Lee, is there anything I have missed?” And then she adds, “Is there anything you need before I leave?” Mr. Lee says he needs his urinal emptied. She responds with the script, “Let me get your nurse.” Then Susan walks out into the nursing culture and presents Mr. Lee’s problem to a nurse. But the nurse appears irritated and snaps, “I’m too busy right now. Mr. Lee has a call button you know.” Do you believe Susan will continue to practice her script if the nursing culture does not seem to appreciate her interruptions? Not likely. The real question is: Will our culture support our strategies? Once we get this in mind, we realize that whatever scripts we teach people to say to patients need to be followed up by cultural expectations that are equally rehearsed. That’s how a good hospital can become a great hospital in patient perceptions.

What would be the result in this example if the culture is one where all nurses treat housekeepers, and everyone else from other departments, as valued members of the health care team? What could we teach them that would inspire that? Well, let’s back up to the point where Susan speaks to the nurse, and develop this sample script further and see what it can do for the culture.

Susan: I was just in Mr. Lee’s room and he needs his urinal emptied.

Nurse: Hi. I’m Janet. I don’t think I have seen you before.”

Susan: Hi. I’m Susan from housekeeping. This is my first day.

Nurse: (smiling) Well, welcome to our unit, Susan. This is a great unit. I hope we make you feel welcome working here. Now what was it Mr.Lee needed?

Susan: His urinal emptied.

Nurse: Thank you for telling me. We need all the eyes and ears we can get around here. It was nice meeting you, Susan.

Obviously I do not mean that these exact words be used every time, only that the sentiment of appreciation for the help of other departments gets communicated any time someone shares a patient’s need. If it does, do you think Susan will continue to take patient concerns to the nurses? Of course she will, because the culture supports her when she does.

But we can still improve this scene in an important way by going a bit deeper. Remember the purpose is to create the perception that we “work together as a team.” Why not instruct the nurse to say something like this when she enters Mr. Lee’s room:

Nurse: Susan told me you needed your urinal emptied.

Mr. Lee: Susan?

Nurse: Yes, the housekeeper who was just here. She told me.

Mr. Lee: Oh, yes.

Nurse: (while taking the urinal) Did you know today was Susan’s first day? Seems like a nice person, don’t you think?

When Press Ganey sends a questionnaire or Gallup calls Mr. Lee and asks, “How well did the staff work together to care for you?” what impression will Mr. Lee remember? He will probably remember how a housekeeper took his needs to the nurse, who obviously must like housekeepers because she knew her name and spoke nicely about her. What that nurse said to the housekeeper and Mr. Lee turns out to have the biggest impact on his perceptions, not the simple question, “Is there anything else you need, I have the time.”

The author of the book threw the last phrase in because it is common to teach it in hospitals in order to create the impression that nurses are not too busy to care for patients. However, anything that is a little out of the ordinary begins to lose spontaneity and not sound normal. It will never sound contrived or forced to say some phrases over and over, like “good morning,” “thank you” and “you’re welcome.” But a phrase like, “I have the time,” said by every single person begins to sound overly rehearsed and insincere. I think it should only be said when it fits a certain situation like when a nurse drops into the patient’s room unexpectedly and says, “You haven’t called me in a while. Do you need anything? I have the time right now.”

We could easily take every item on a survey and drill down from our scripts into the culture and do exactly what author of the book has done with this one item. It would be well worth the time to have the conversations that lead us to scrutinize our cultures, and hone our appreciation skills, especially if we are passionate about creating positive patient perceptions.

?

Focusing on complaints will miss what matters most:

Only four out of 100 dissatisfied customers will complain, according to research conducted by the Technical Assistance Research Program. Getting a person to complain about something like a nurse’s attitude is almost impossible while they are in the hospital because nobody wants to get into a “he-said, she-said” showdown with a clinical worker, especially when they could retaliate by ignoring the patient.

Most customers do not believe complaining will do any good. Since they can punish your organization invisibly by negative word of mouth, they won’t stick their necks out to let you know their true feelings.

To raise patient satisfaction scores, to get patient loyalty, a hospital’s best strategy is to focus on the things that most correlate with overall satisfaction, even if they get no complaints in those categories.

This means getting extra good at hiring cheerful, empathetic people where they must interact with patients.

It means teaching caregivers to actively solicit the needs of patients. It means teaching nurses to say something that shows they are concerned about a patient’s privacy when preparing for an immodest procedure. It means stressing the importance to all personnel of constantly briefing the patient on the status of his or her condition, delays, tests, treatments, and what medications are for. It means making sure everyone knows how to defuse the anger and regain the goodwill of an irate patient or family member. It means taking an active interest in the whole family and helping them feel they are part of the healing team. It means valuing the gift of empathy, instead of considering professional distance our standard for bedside caring. It means teaching the importance of all these things that patients do not complain about, but that dramatically affect their emotional state and consequently their feelings of loyalty.

Conclusion: Chapter 1 talks about empathy, compassion and communicating and creating a perception to the patient that we care!!