Three questions every patient experience program must be able to answer
Healthcare is abuzz with the words "patient experience." Everyone is talking about it, and a lot of noise has been created. So why should you read yet another piece on the subject? This article aims to distill the essence of a successful patient experience program by putting forth three questions that such a program should be able to answer. Keeping these questions front of mind will help maintain focus and guide leaders as they plan and execute their own programs. We begin with a brief examination of what specific benefits may be expected from a successful program. While the questions are simple, answering them in practice is not easy.
Simon Sinek puts it well when he says "always start with why." Why do we need a patient experience and engagement strategy at all? Have we not gotten by in the past just fine without one? Shouldn't clinical excellence be enough? Is it because everybody else is doing it (or at least talking about it)? For the answer, we must skip to the end for a moment. What will a successful patient engagement and experience program achieve for an organization? A successful patient engagement program yields three key capabilities which carry a variety of benefits.
First, a successful patient engagement program will enable a healthcare organization to capture all of the potential opportunities for care for a given patient. When a patient feels they have a relationship with an organization, they will be less likely to seek or even consider receiving care outside the organization. Apart from the obvious financial implications of this reduced leakage, effectively achieving a continuity of care becomes much more realistic. Capturing all appropriate care opportunities will also make it much easier to help patients to maintain their health through preventative care services which might otherwise be neglected. Second, a successful patient engagement program achieves the seemingly obvious goal of maximizing the patient care experience. Not only will this have an immediate positive impact on HCAHPS scores and corresponding medicare reimbursement, but will also help activate the referral machine, bringing new customers. According to the Brookings Institute, "When choosing a doctor, Patients prefer online reviews to government ratings." Interestingly enough, not only do happy patients tell their friends and strangers, but they are also less likely to sue. In a study published by Fullman, Garman, and Johnson, the researchers found that with each step decrease in patient satisfaction category on the five-step scale from "very good" to "very poor" the likelihood of a provider being named in a lawsuit increased by 21.7%. Of course, this study was only published in 2009, so we remain true to form and pace that we are just now getting around to acting on this. Finally, an effective patient engagement program more effectively manages the clinical and financial risk of caring for chronically ill patients, capturing the benefits of increased patient treatment compliance. We will not go into detail here about the consequences of medication non-adherence today, nor the financial, clinical, and regulatory risks carried by the health system in caring for chronically ill patients. We will simply acknowledge that patients are usually the weakest link in their own care management, and that it is unrealistic to expect that the average patient will make wise day-to-day decisions about their care with only sporadic and brief interactions with their care provider. We are all consumers driven by short term impulses and susceptible to social psychological manipulation. For a patient to make the right behavioral choices to maintain their health, the health system must establish and maintain a trusted relationship with the patient outside the four walls of the hospital.
To achieve these benefits, a successful program must be able to answer three key questions: Who is my patient? What are they thinking and feeling, and why? and How can I improve it?
Who is my patient? This seemingly simple question is the fundamental building block of the relationship. Not to mention that in the context of receiving care, the family or other appropriate caregivers may need to be included. We are all individuals with our own preferences and proclivities. We are also much more than our clinical record, no matter how detailed and sophisticated. Only 20-30% of our health outcomes are clinically determined, with 70-80% determined by our social circumstances. This means that for a health system to effectively treat a patient, the patient's complete persona, or as much of it as possible, must be known. Most if it will not be found in the clinical record. Being able to answer this question also requires that a patient identity be singular across health system itself. Between inpatient and outpatient settings, from department to department and on patient portal, nothing quite says that you don't know who I am like having to provide information more than once.
What is my patient thinking and feeling, and why? While this may seem like a multiple part question, the ultimate metric is the experience a patient is having at any point in time. Understanding the circumstances around this emotional state is crucial. Without the context of the experience, we cannot understand the all important "why?" It is also important to capture this in as real-time a manner as possible. If we find out that a patient had a bad experience, but only do so in vague terms several months after they have left the hospital, there is nothing that I can do to either improve the experience of that patient, but also prevent the other patients from having similar experiences. Experience itself is just a gauge that reflects the performance of the immensely complex machine that is the health system. We must be able to understand what caused the emotional state if we are to effect it. The way by which experience is captured is as important as the actual data collected. The last thing we want is for the data collection itself negatively impact the patient experience. The design and approach to the data collection must be consciously designed to minimize friction for the patient. This will ensure both the highest participation rate, as well as the data's fidelity. Every question must be scrutinized so that the most (and most actionable) information is captured with the least amount of effort. Use dynamic or "responsive" surveying to make sure the the questions you are asking remain pertinent and relevant. "Listening posts" must be inserted throughout the patient journey, from the virtual, to the physical. Every point of interaction with the patient colors their experience, not just the major events such as procedures. Also don't simply rely on standard questions. A recent study of patient narratives by R. Grob et al. found that standard patient experience surveys only capture 35% of the aspects of care that influence patient experience.
Once we understand who our patients are and what they are feeling, how can we change or improve their experience? This starts by getting the right information into the hands of the people who can act on it. This can be as simple as the right teams having real time visibility into the feedback provided by patients, such as the janitorial team scanning for cleanliness related comments, to more automated and integrated setups where the surveying system is integrated with operational systems so that a comment about cleanliness triggers a service ticket and routed to the appropriate team, or comments about a nurse's bedside manner are automatically attributed to the nurse assigned to the patient and recorded into the HR system to be considered at the next performance review. Even more elaborate setups can be envisioned where post-discharge surveys contain questions asking if the patient feels they understand their medication instructions, and if the patient answers "no," then either individualized education material or an in-person outreach is triggered. This can be set up to happen at scale through automation, effectively extending the reach and personal relationship with the patient beyond the 4 walls of the hospital. Periodic reminders and surveys can work to maintain the patient contact and engagement, and serve as early warning beacons for potentially worsening conditions which can be proactively acted upon before the condition deteriorates, all without the need for human intervention until it is needed.
Without understanding who our patients are, we cannot gather the right information to know how our patients are doing. Without the context of their experience and what is causing it, the data is just noise. Without the ability to take action, the insights we gain are just trivia. Successfully answering these three questions will be the hallmark of success of any patient engagement strategy. Successfully answering these questions will lead to better experiences for patients, increased revenues, reduced costs, improved outcomes and even reduced threat of malpractice lawsuits.
#Healthcare #PatientExperience #PatientEngagement
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- https://www.brookings.edu/blog/techtank/2018/03/29/when-choosing-a-doctor-patients-prefer-online-reviews-to-government-ratings/
- Fullam F, Garman AN, Johnson TJ, et al. The use of patient satisfaction surveys and alternate coding procedures to predict malpractice risk. Med Care 2009 May;47(5):1-7.
- GROB, R., SCHLESINGER, M., BARRE, L., BARDACH, N., LAGU, T., SHALLER, D., PARKER, A., MARTINO, S., FINUCANE, M., CERULLY, J. and PALIMARU, A.GROB, R., SCHLESINGER, M., BARRE, L., BARDACH, N., LAGU, T., & SHALLER, D. et al. (2019). What Words Convey: The Potential for Patient Narratives to Inform Quality Improvement. The Milbank Quarterly, 97(1), 176-227. Retrieved from https://onlinelibrary.wiley.com/action/showCitFormats?doi=10.1111%2F1468-0009.12374