A patient arrives at a hospital outpatient surgery center at 5:30 a.m., having followed his preparation instructions. This patient is not a morning person. He was driven to the surgery center in the dark and now roams through halls that are eerily quiet. There is only one registration clerk to check in all the arriving patients boarded for surgery that day.

How might this patient feel during the first minutes of his visit? He might be disoriented from the early hour, irritated at the delays, and hungry and thirsty, having not had food or water since midnight. He might be fearful about what's to come.

The patient is checked in and asked to have a seat in the surgical waiting room. He notices that other patients are called back ahead of him, raising his anxiety level. He begins to shift uneasily in his seat. "Why am I waiting? Have they forgotten me?" Minutes feel like hours and his discomfort grows with each passing moment. He then learns that the physician has changed his surgery to 2 p.m.

This patient was not served well. There were many moments throughout his visit when staff could have taken actions or said something to alleviate his anxiety and change his perception that he was just a number. Had the hospital used anxiety service mapping and given him the opportunity to provide real-time feedback about his thoughts and feelings, his experience could have been far more positive.

Measuring the Patient Experience

Anxiety service mapping goes to the heart of what all patients experience when they walk into a hospital — unnerving apprehension. Addressing anxiety head on can help hospitals to achieve significant inroads into improving the patient experience.

Anxiety mapping charts patient anxiety levels by identifying each "touch point" along the patient encounter. These touch points are real moments of truth for the hospital and its staff. If hospitals have a better understanding, from the patient's perspective, of what these moments of truth are and how each relates to meeting patient needs, they can create an anticipatory model for the patient experience along the continuum of care.

This concept can be valuable now that the Affordable Care Act has linked patient-experience assessments to Medicare reimbursement. The patient experience must be incorporated into hospital culture. It also must be measured in real time, managed and improved on an ongoing basis.

But there is a problem with measurement. Many hospitals still use antiquated comment cards, thinking they provide important insight into the patient's thoughts, feelings and experiences. But comment cards rarely offer accurate measurement because they usually are filled out by patients who either love the hospital or adamantly dislike it. It's easier for most patients to share their experience on Yelp, Twitter and Facebook than it is with hospital managers.

But the hospital also can use technology to collect feedback. For example, patients can use their smartphones, tablets or conveniently located kiosks to give the hospital real-time feedback online. Such data provide the opportunity for service recovery on the spot.

Anxiety mapping is an all-important first step to generating positive patient-experience assessments. But health care facilities should follow the example of other industries by measuring the patient experience in real time and using that information for improvement.

Moments of Truth to Reduce Anxiety

Here are a few examples of touch points in the patient experience:

If directions to a health care facility are confusing, signs within the facility are hard to understand and employees are indifferent, such moments of truth do not inspire patient confidence.

Conversely, if patients have clear instructions on where to park and where to check in, and the facility's staff are trained to make eye contact and greet patients cheerfully, these moments of truth set a positive stage for the entire patient experience. The hospital has let patients know that it cares about them from the moment they receive instructions about their appointment to their arrival at the facility and beyond.

This is referred to as creating advocates, patients who will risk their reputation with friends and family to recommend a hospital. Advocates return to a hospital when they have a choice and tell others about how great the hospital is.

Opportunities for Effective Communication

Consider the following patients, both between ages 35 and 40:

  • Patient A is coming for her first baseline screening mammogram without a family history of breast cancer. She is asymptomatic.
  • Patient B is coming for her first mammogram, but has a mother and sister who were diagnosed and treated for breast cancer.

These are two different scenarios with many different touch points where anxiety could be anticipated and key words and messages used to acknowledge and address patient apprehension. Managing communication is both an art and a science that requires a thoughtful and in-depth look into anxiety as a reaction to the unknown.

Patient A will not know what the procedure involves, where to change, how the technology works, what the technician will do, how much the procedure will cost and if insurance co-pays are necessary. Nor will she know if the procedure will cause pain, how much radiation exposure she will receive, when she can expect her results and who will give them to her. These things can be anticipated. Key words and messages can be scripted so staff can turn these moments of truth into opportunities to communicate and alleviate anxiety.

Following are suggested key words and messages that staff can use for Patient A:

  • This procedure will not take longer than 30 minutes.
  • Staff members will be with you every step of the way.
  • You are in very capable hands.
  • Our employees will explain the procedure, the radiation exposure and how breast compression gives an excellent view of the breast tissue.
  • You will be told who will interpret your results.
  • You will be told when your physician will receive the report.

Effective communication at any point along the baseline screening could trigger real-time feedback. Staff should be trained and encouraged to take an active role in asking Patient A to provide the hospital with her thoughts and feelings about her experience. Staff also should solicit this feedback from any family members who may be accompanying her.

Patient A can be given more than one means to respond. For example, attractive and attention-grabbing signs can be posted throughout the hospital, including waiting areas, to encourage feedback. The signs should feature a QR code or "tag" that allows Patient A to scan it with her smartphone or tablet. She then uses her keyboard to communicate with the hospital.

Patient A also can use her own computer or a hospital kiosk. The sign should provide a URL where she can access the hospital's website to upload her feedback.

Patient B may or may not be symptomatic, but she probably will be extremely anxious. She will fear that something might be discovered that will require perhaps additional views on her mammogram, a breast exam by a physician or additional testing such as an ultrasound to help distinguish between a solid mass and a fluid-filled cyst. If this is a suspicious mammogram, does that mean she will proceed to biopsy?

Patient B may have experience with this situation through her sister and mother. She knows that a breast cancer diagnosis is a real possibility due to family history. She may have been through a number of procedures with her sister or mother that included a biopsy, followed by mastectomy or perhaps reconstruction, radiation therapy, hormone therapy and possibly chemotherapy.

Each step in this process is precarious, and staff members simply must speak to the patient's anxieties as well as her real fears. Language centered on addressing fears is important to help minimize anxiety and maximize a positive experience.

Here are key words and messages that staff can use for Patient B. They include language that addresses fear of a cancer diagnosis:

  • Today's mammogram should take about 45 minutes.
  • Staff will be here to assist you every step of the way.
  • It is normal to have fears about outcomes.
  • We will address each of your concerns one at a time as you need us to.
  • We have time and you have our attention.
  • The breast care center assures you that you are in excellent hands.
  • Patients are comforted knowing that there is a breadth of experience in matters concerning benign and malignant breast disease.

There are all kinds of things for patients to worry about. It is up to the hospital to do its homework and map them out. It might be a good idea for staff members or third-party mystery shoppers to pretend they are patients and walk themselves through a visit from arrival to departure to identify touch points.

Opportunities for Culture Change

Anxiety service mapping should work for every patient every time. Measurement, management and improvement only can lead to better outcomes.

Lynn Sinclair Buehler is the director of service excellence at CoxHealth in Springfield, Mo. Martin R. Baird is the chief feedback officer for South Office LLC, in Boise, Idaho.