Wednesday, 01 July 2015 23:24

The Patient Experience: Can You Control the Seemingly Uncontrollable?

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c gormanIt is interesting to consider that the value-based purchasing domain, whose scoring is based on criteria tied to the Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS), relies on what in any other circumstance would be considered skewed or flawed data. Unlike any other domain within the program, the scoring cannot be tied directly to fact- and evidence-based documentation.

CMS.gov provides the following definition: “The HCAHPS survey is the first national, standardized, publicly reported survey of patients’ perspectives of hospital care. HCAHPS (pronounced "H-caps"), also known as the CAHPS Hospital Survey, is a survey instrument and data collection methodology for measuring patients' perceptions of their hospital experience. While many hospitals have collected information on patient satisfaction for their own internal use, until HCAHPS there was no national standard for collecting and publicly reporting information about patient experience of care that allowed valid comparisons to be made across hospitals locally, regionally, and nationally.”

The Beryl Institute (www.theberylinstitute.org), whose overarching goal is improving the practices that define the patient experience through collaboration, offers a very clear and encompassing definition of the patient experience. They define it as “the sum of all interactions, shaped by an organization’s culture, that influence patient perceptions across the continuum of care.” The Merriam-Webster dictionary defines perception as “the way you think about or understand someone or something.”

Long before the advent of value-based purchasing, patient satisfaction has been on the radar of healthcare organizations nationwide. In the mid- to late 1990s a myriad of programs were introduced and enjoyed wide success and implementation. The Disney Leadership Institute for Healthcare and the Studer Group were on the tip of hospital administrators’ tongues nationwide. Who among us has not read, or at least heard of “If Disney Ran Your Hospital?”

Many have scoffed at these programs and dismissed them as hype. The feeling was that if patients need to come to the hospital, they will. But is that really fair and accurate? The findings say no. Patient satisfaction, which has evolved into the patient experience, is well worth the investment of time, money, and resources. No longer is a dissatisfied patient solely a risk to a hospital’s reputation. The stakes are much greater.

Disengaged or dissatisfied patients are more likely to experience:

  •       A medical error
  •       Hospital-acquired conditions
  •       Greater numbers of readmissions

Consider for a moment the Beryl philosophy, which includes the entire continuum of care. For many patients that continuum and their associated experiences begin prior to even arriving at the hospital. Their first touch point may be the scheduling of routine diagnostics, outpatient procedures, or pre-admission tests. Many organizations have created centralized call centers and portals to increase efficiency and availability of scheduling options. While this may appeal to millennials and some baby boomers, they do not represent the majority of the patient population. Roughly 60 percent of all hospital payments are derived from Medicare. Yes, there are many tech-savvy seniors, but think of your own frustration with IVR systems: How many times do you have to hit “0” for a “live person?” Is the implementation of technology-based solutions really the best approach to enhancing the patient experience? Or would the availability of a Navigator program be a better fit in some situations and with some populations? Are the technology-based solutions truly designed for the populations you serve? For example, in how many different languages is your patient portal written?

Let’s now consider another location on the journey through the continuum: discharge. While some may argue that discharge is a time of joy for patients, others would argue that it is a time of stress. Concerns about new diagnoses, new medications, dietary restrictions, and possibly, new daily practices (blood pressure monitoring, for example) are likely weighing heavily on many patients’ minds. Have they been sufficiently prepared for discharge? Or will things come as somewhat of a surprise? (“Mr. Jones, I have great news for you! Your doctor decided you can go home tonight instead of tomorrow morning!”) 

As with many aspects of healthcare, discharge planning and preparation is both an art and a science. Done well it results in great success; done quickly or carelessly it can result in medication complications, anxiety, readmissions, and a poor patient experience. A piece of the discharge process that cannot be overlooked or underestimated is the time it actually takes for the patient to be transported from the facility. Hospitals’ internal transportation delays and lack of available staff plague many facilities, and these factors often are cited as patient dis-satisfiers, not only during the discharge process but during the admission process and the stay itself.

Creating positive patient experiences is clearly worth the effort. Remember, with HCHAPS it is an all-or-nothing score. The new Hospital Five-Star rating system cannot be underestimated either. What if something can be done to help control the often “uncontrollable?”

Here are a few suggestions for empowering all team members along the entire continuum of care to control the patient experience:

  • Every team member must understand, remain focused on, and continually evaluate on the patient experience
  • Every team member must be educated and engaged in:
    • Recognizing a dissatisfied patient or family member
    • Expressing empathy for the dissatisfaction, whatever the cause
    • Scripts for responding to concerns
    • Processes for handling and addressing concerns:
    • During “normal” business hours
    • On off-shifts
    • On weekends and holidays
  • Team members should be kept in the loop on the concerns they have when escalated; they are the front lines and patients and families will ask them
  • Patient experience teams must be cross-functional
  • Positive outcomes and resolutions should be celebrated

Given the research supporting that disengaged or dissatisfied patients are more likely to experience a medical error, hospital-acquired conditions, and a greater number of readmissions – plus the simple reality that hospitals can be penalized on multiple areas within these domains related to just one patient and his or her experience – what will you do to “control the uncontrollable?”

About the Author

Catherine Gorman-Klug has over 30 years of experience in healthcare. In addition to a varied clinical background, she has extensive experience in project design, implementation, and management. As director of the Quality Service Line for Nuance’s Quality Management Suite, she is responsible for product strategy for the Clintegrity 360|Quality Measures, Performance Analytics, and Narrative Search Solutions. This includes monitoring the regulatory horizon to ensure that current and future Clintegrity 360|Quality solutions are compliant with new and revised regulations, including but not limited to TJC; CMS; HIPAA; value-based purchasing; and the American Recovery and Reinvestment Act.

A frequent speaker, author, and blogger on quality and compliance activities, Cathy truly understands the challenges industry stakeholders face, and she uses her experience to help them meet the ever-increasing and changing regulatory and accreditation requirements. Prior to her role with Nuance, Cathy served as a corporate director of regulatory requirements, privacy, and data security for an integrated health system.

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Last modified on Tuesday, 07 July 2015 23:35

Cathy, has over thirty years’ experience in healthcare. In addition to a varied clinical background, she has extensive experience in project design, implementation and management. As Director of the Quality Service Line for Nuance’s Quality Management Suite, she is responsible for product strategy for the Clintegrity 360 | Quality Measures, Performance Analytics and Narrative Search solutions This includes monitoring the regulatory horizon to ensure that current and future Clintegrity 360 | Quality solutions are compliant with new and revised regulations; including but not limited to TJC; CMS; HIPAA, value-based purchasing, the American Recovery and Reinvestment Act.

A frequent speaker, author and blogger on Quality and Compliance activities, Cathy truly understands the challenges industry stakeholders face, and uses her experience to help them meet the ever increasing and changing regulatory and accreditation requirements. Prior to her role with Nuance, Cathy served as a Corporate Director of Regulatory Requirements, Privacy and Data Security for an integrated health system.