At the risk of stating the obvious, all health care begins and ends with the patient. Yet, we are falling short on instilling behaviors and systems centered on the patient. In fact, hospitals have a dismal disappointment rate of 29 percent: According to the most recent Centers for Medicare & Medicaid Services HCAHPS survey, American patients believe they were treated at the best possible hospital a mere 71 percent of the time.
If you consider how hospitals, physicians and the industry as a whole are judged, the patient experience can make or break your reputation as well as the bottom line. My challenge to you is simple: Use common sense to create a solvable scenario for our leaders, employees and physicians who care deeply about being successful.
Patient surveys and the potential financial impact of value-based purchasing have elevated the patient experience to one of the most pressing issues currently facing health care organizations. The Beryl Institute's 2013 benchmark study, "The State of Patient Experience in American Hospitals," revealed that patients rank their care experience as one of their top priorities. Yet, a 2013 HealthLeaders Media study revealed that 58 percent of health care leaders have not made specific patient-experience investments.
In this time of unprecedented change, financial pressures and competing priorities, how will your hospital meet or exceed quality measures? How can you avoid the financial penalties associated with underperformance? How can you create systems of accountability and recognition to ensure that your culture achieves results?
Patient-centered excellence is the commonsense answer to these questions and more. Each patient is your hospital's core responsibility, but are you committed to providing service excellence? Is your staff taking the time to remember that "the gall bladder in 205" is really a retiree named Miss Peggy who volunteers as a crossing guard in her neighborhood? Does Mrs. Jones know without a doubt that her care and needs are your priority on any given day, despite emergency department volumes greater than 100,000 visits per year? If not, patient-centered excellence is not a priority at your hospital.
I am going to outline three proven techniques that can put your hospital on the right track to improving the patient experience.
Cultural Transformation through "Personnel" Attention
A Baptist Leadership Group poll given to 250 health care leaders ranked "people" last in their list of priorities. How can we ask our team to create exceptional quality, financial or experience outcomes if we are not developing and engaging the people who achieve our results? What does it take to transform a culture? Unfortunately, it does not happen overnight. Cultural transformation is a journey that begins with "personnel" attention. It involves learning new skills and creating opportunities to mentor staff and leaders.
To put this into perspective, I have yet to find a hospital that excels in patient-centered excellence that does not value and nurture its own personnel. From senior leaders to physicians, and the environmental team to valet drivers, your personnel must take ownership in your hospital. They must feel heard and respected and ultimately be a part of the conversation.
Take a moment to rate your hospital's commitment to patient-centered excellence. Answer the three challenge questions listed below.
If you cannot rate your teams predominantly between fours and fives, chances are you are encountering one or more of nine common barriers to cultural transformation:
- failure to set clear direction and mission;
- lack of staff ownership and buy-in;
- fragmented communication;
- lack of recognition and rewards;
- failure to hold staff accountable for performance;
- inadequate data-collection and measurement process;
- satisfaction with the status quo;
- insufficient leadership commitment and visibility;
- lack of an open and trusting environment.
I encourage you to review these barriers and then do the exact opposite.
An easy-to-remember but tough-to-implement mantra is "every patient, every time, every interaction."
Just as it is your leaders' job to set expectations with your personnel, your personnel must strive to set proper expectations with patients. The first step for staff is to try to understand the patient experience from the patient's perspective. The second step is to deliver a consistent experience to every patient, every time. Unless we understand the patient's perspective, we will be unable to deliver the best experience possible.
Another key factor for staff is knowing that there's a big difference between what's important to the patient and what's important to us as health care providers. Human beings are not used to being patients, so we have to help them know what to expect during their hospital stay. After all, they spend most of their lives outside the hospital. It is our role and privilege to understand and manage what the patient sees, feels and experiences.
An example of properly setting expectations is explaining what kind of noise a patient will hear at night, going so far as to illustrate that the patient might hear noises different from those in his or her home. Additionally, we need to tell the patient that "ultimately our job is to make you feel secure. We'll respond 24/7 and take care of you during your stay."
Accountability and the Patient Experience
Accountabilities predict the outcome. This is a fact that I have witnessed countless times. The challenge lies in properly evaluating behaviors and setting accountability measures. We are astute at holding people accountable for financial and quality measures, but the patient experience can be tricky. We need to establish, clarify and champion specific accountabilities for the patient experience.
Evaluation with consequence sustains results. The best way to illustrate this claim is to imagine the best nurse, physician and technician in your hospital. Now imagine the ones whom you would not want within 20 feet of your loved one. If you pulled annual performance evaluations from both, would there be a difference? If not, there is a lack of accountability and consequences. We need to remove this deficit to transform the patient experience.
Tools and tactics work best one at a time. The three I have outlined here — "personnel" attention, setting expectations and accountability — will get you on the right track. I guarantee that recognizing patient-centered behaviors will elevate your market position and financial performance. Patient-centered behaviors cost nothing, but they earn dividends. Are you prepared?
Katie Owens is the vice president and practice leader of BLG, a HealthStream company based in Pensacola, Fla. She is the lead author of "The HCAHPS Imperative for Creating a Patient-Centered Experience" (Baptist Leadership Group, 2011).