What I Learned about Patient Experience as an Acute Care Patient

As experience management practitioners and strategists, we talk a lot about the patient/consumer experience of healthcare. We throw around terms like "human-centered" and "designing with empathy." But most of us rarely have the opportunity to actually live in an acute care patient's shoes (or bed.)

Earlier this year, I had that opportunity. I offer here my own case study (n=1) and lessons learned.

Part 1: Accessing Care

We live in a rural area more than 60 miles west of St. Louis, Missouri. When my symptoms began, we got in the car and started driving east. I'm familiar with all the hospital systems in the region. And yet, when my partner asked me where to go, I had no idea what to tell him.

So, I did exactly what 65% of healthcare consumers do when seeking care - I Googled "ER near me." I had to make a quick decision based on the information at hand. No time to research national rankings. No way to remember the billboard I drove past a year ago.

I chose the ER with the highest reviews within a 45-mile proximity. One click later, and we were following driving directions via Google Maps.

• PX Lesson: Digital presence matters - especially on Google. This is the most important digital entry point for care seekers - more important than your website or app. If you want to drive access to care (read: new patient volumes) you have to optimize your Google Business Profile.

Part 2: The Gauntlet (aka Waiting Room)

I had to be brought in via wheelchair. Unfortunately, the occupied seats lined the walls in such a way that my partner was forced to conspicuously roll me through a "gauntlet" of waiting people.

If you thought the Southwest Airlines boarding process was awkward, try holding back tears of pain while apologizing profusely to strangers every few inches as you force them to pull their knees to their chests to allow passage. Thank god for the anonymity of wearing a mask...

My anonymity was brief. I was called to the triage counter to provide my symptoms. I'm a short person and I couldn't stand up at this time, which meant I could barely see over the counter. Thus, I had to loudly describe my symptoms to the intake specialist as well as several patients seated about five feet away from me in the waiting area.

What made this even more frustrating was the fact that there was an area of the counter that was, in fact, lower in height. But for some reason, the intake person had me sidled up to the tall counter like a roller coaster operator at the carnival. (Must be this tall to ride.)

• PX Lesson: I'm sure the original designers of this ER didn't intend for this experience. Maybe someone tested rolling a wheelchair through when the seats were empty. Maybe a taller person tested the counter height and it seemed fine. It's important to consider all the variables when designing a physical space. That's a big concept experience designers love to research and prototype. But until someone designs the perfect waiting room experience, maybe we can fix the small stuff, like using the wheelchair-accessible counter for people in a wheelchair.

Part 3: I'm a Patient. Engage Me!

My most frustrating interaction came when I was in the exam room waiting to be evaluated.

A lovely, friendly woman entered the room with a rolling kiosk and said she needed to register me. A quick glance at her badge told me she was with revenue cycle. I provided my insurance and other intake information. Then she handed me an electronic tablet.

RC: Now, you need to check the box and sign electronically to indicate that you do not want us to contact you electronically. I already have it queued up for you to opt out.

Me: Wait, what? I'm confused. I want electronic communications.

RC: Oh, no this is just so we don't spam you. This way we won't send you any emails or texts.

Me: You mean like appointment reminders or billing alerts? I want those.

RC: Are you sure? Most people don't want all the spam.

Health systems have long struggled with patient engagement, even though "communication such as appointment reminders and follow up" is one of the top three most important factors in a 5-star experience. In my conversations with healthcare executives I often hear that they don't have a way to communicate with patients in real-time, either because they lack a mobile number on file or haven't updated their Notice of Privacy Practices in the last decade - both of which are easily remedied, by the way.

But in the case of this hospital, their efforts were being unwittingly sabotaged by their own well-intentioned staff. I later overheard a different revenue cycle person giving a similar "let's opt you out" spiel to a man in the room next to me. His response: "Oh, cool. I don't want spam!"

Meanwhile, I can just imagine the Quality team can't figure out why they get such a low ER survey response rate. The Marketing team is unable to run CRM campaigns to remind at-risk patients to get an important annual health screening. The Call Center doesn't send SMS appointment reminders. The Billing department cannot send an electronic invoice. Each of these digital consumer interactions enable the health system to provide better care, improve experiences, eliminate no-shows, and perhaps most compelling, get paid faster.

This is not spam. This is patient engagement!

By making one minor change to the registration script, here's how the conversation could have gone:

RC: We understand you're busy so you may appreciate electronic communication. For example, we can send you appointment reminders or give you a direct way to provide feedback about your experience with us. With that in mind, do we have your permission to communicate with you via text or email?

Me: Hell yes! Send me all the texts, baby!

• PX Lesson: That single default by the revenue cycle staff seems innocuous until you think about the downstream impact of purposely limiting patient communication. As CX and PX experts, we spend a lot of time and money developing experience journey maps, personas, etc. But if you look for the "low-hanging fruit" you may find a small adjustment will make a big difference in your ability to deliver better consumer experiences. For example, let's not actively discourage patients from recieving communications about their care!

Part 4: Follow Up

A few days after coming home, I was thrilled to receive my very first ED CAHPS survey via email. I talk about patient feedback with my clients every day, but I rarely get the chance to provide my own. I clicked on the survey and saw that it was lengthy, so I flagged the email to return later when I had more time. (The CAHPS survey length is ridiculous, but I save that digression for another day.)

Merely four days after receiving the email, I enthusiastically revisited the link to provide my feedback. Instead of the survey, I saw a dead end page with the message, "This survey has expired."

Now, I understand why certain CMS-mandated surveys have parameters like response deadlines as part of the methodology. However, an alternative would be to program the survey so that after a certain timeframe, the link takes the patient to a simple feedback form or "unofficial" survey that doesn't get included in the official reported sample.

Unable to fulfill my dream of being part of an official survey sample, I wanted to at least tell them about my experience. I searched throughout the hospital website for a way to share my feedback.

Alas, I was unable to find a patient feedback form. Foiled again!

• PX Lesson: All feedback has value. If a patient is willing to provide feedback, a hospital should collect it - anytime, anywhere. Opening more feedback channels isn't complicated and doesn't require new technology or processes outside of what is already available at every health system. It's an easy way to ensure you see the whole picture.

Conclusion

No one sat in a meeting and said, "How can we make the care experience more frustrating?" On the contrary, this hospital is full of people who have made it their mission in life to care for fellow humans. I'm certain this hospital's leaders have some major strategic initiatives to address big, complex issues. And that's great news for patients in the long run. But while we're solving for the complicated stuff, let's not forget that small changes can make a big difference.