Patient surveys at one hospital kept signaling that there was a noise problem. After fiddling with air conditioners, cautioning clinicians about their voice levels and turning over almost every other stone, the problem still wasn't addressed. Turns out it was a squeaky wheel on a delivery cart that was driving patients nuts, and all that scrambling was for nothing.
That story was recently related to me by Patrick Ryan, CEO of Press Ganey, which specializes in bettering the patient experience. If that hospital had dug deeper and asked a few more questions, officials just might have found its squeaky wheel a little more quickly.
Digging deeper with your data and taking account of every patient's voice seems to be one of the main messages of Press Ganey's recently released report, Strategic Insights: Targeted Performance Improvement, which details how hospitals can move beyond the bare minimum and start truly transforming the patient's perception of his or her stay in the hospital. Doing the easy stuff just to ace the next survey or earn the next incentive payment probably isn't going to cut it anymore, I gathered from a phone call with some of Press Ganey's top officials on Friday.
"The amount of growth in terms of performance improvement over the years really shows that the age of low-hanging fruit is pretty much over," says David Costello, chief analytics officer. "It's really about mining the data at each individual hospital or facility level to find the biggest driver for that particular hospital or setting. And that's really where advanced analytics and enhanced data get you."
Hospitals have, no doubt, made huge strides in bettering the patient experience, Press Ganey notes. But HCAHPS and core measures are going to continue evolving in the coming years, changing how hospitals get paid. The outcomes domain — which includes mortality measures for acute myocardial infarction, heart failure and pneumonia — will be added to HCAHPS and the core measures to assess quality performance in 2014, according to the report. That will shift the overall weighting "substantially," and mean that simply sustaining the gains made this year won't be enough to satisfy the minimum requirements next year.
Taking the patient's experience to the next level starts with redefining the term, and moving it away from just improving satisfaction scores and making the visitor happy, according to Press Ganey. Rather, it's about reducing anxiety and suffering along each step of the patient's care path, by addressing not only the medical, but physical and psychological needs of each person.
The 32-question HCAHPS survey is just a starting point and hospitals should find ways to ask additional questions, tailored to each unique patient population, through electronic surveys to paint a "richer picture of the patient experience." "Give every patient a voice" seems to be the mantra of the report, as you're missing out on way too many comings and goings by just relying on a small sample size.
"Patients with more complex cases tend to rank a health system lower, and that makes sense because it's a much more difficult personal experience for them," Ryan says. "You'll also find patients in different demographics, whether it's education or age, will rank hospitals differently. We need to look at that as an industry and determine ways in which to address those experiences, as well as to consider how we should rank hospitals that have different demographics and different case mixes."
Gathering more robust data will also lead to decreased skepticism from clinicians. How can you question the completeness of a survey if everyone's voice is taken into account? On the flip side, hospitals need to survey employees, too, and engage them in transforming the organization. Providers with engaged, satisfied workers have reduced staff turnover, better clinical outcomes and higher HCAHPS scores than those who don't, notes Press Ganey. Experience gains can't be sustained without a strong organizational culture and an engaged workforce.
After visiting health care organizations all over the country, Ryan has been encouraged by the gains made by the industry thus far.
"I haven't met a hospital executive who isn't interested in driving performance improvement and finding ways to communicate better with the patient," he says. "I'm actually very encouraged by the way the market's responded and the level of interest here. If you look at the industry, we are challenged to provide better health care at a lower cost in the next five years. I go into it with a great deal of optimism given the information that we've gathered and worked with our hospital and health system partners to address. By bringing the patient's voice into the discussion, we will be able to drive a higher level of quality care, and do it efficiently, and that is the way in which we'll succeed in bringing health care costs under control."
What's your squeaky wheel? Share your patient experience stories in the comments section below.