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Research by Marty Stempniak

Maximizing the patient's experience is a hot topic for hospital executives. While this notion isn't new, it's been pushed to the forefront because of satisfaction surveys, increased competition and the Yelp-ification of health care.

While many have made gains, some providers have struggled to transform the patient environment in a timely manner, or to sustain those improvements. Experts say that too many hospital leaders confuse optimizing satisfaction with advancing the patient experience.

"The experience is not about happiness. It's about patients being respected, being communicated with, and having their care coordinated in such a way that they can get the best possible clinical outcome for whatever their circumstances are," says Patrick Ryan, CEO of Press Ganey. "Let's look at the patient experience in total as reducing suffering and reducing anxiety. And when you do that, you look across the entire continuum of care, from the first phone call to the patient's being discharged."

Improving communication — on medication at the bedside and with both patients and their families — is a critical element of bolstering the health care experience, says James Merlino, M.D., chief experience officer for the Cleveland Clinic, one of the first providers to create such a position. If hospital leaders want to take the patient encounter to the next level, they need to focus on creating and sustaining a culture, aligned around patient-centeredness, along with engaging the people doctors are treating.

The biggest challenge Merlino sees hospitals facing in this effort is figuring out where to start, and defining exactly what the "patient experience" means.

"Everybody has a perspective on what you need to do to fix the patient experience, but if you don't take control of that debate and push all of your resources toward high-value tactics, you're not going to be successful," Merlino says. "I think what happens is people, organizations, leaders, managers tend to sputter out."

Some, working in the smaller community hospitals, worry that patient experience initiatives are overly focused on shiny bells and whistles at the bedside, which they can't replicate on their shoestring budgets. Large systems can hire extra staff to tackle an issue, but that's not an option at 162-bed Onslow Memorial Hospital in Jacksonville, N.C. Instead, leaders there are focused on simpler ways of improving their culture, such as using navigators to help comorbid patients find their way around the hospital and having care teams "huddle up" to assess the situation at hand and work on patient handoffs.

Despite a hospital's best efforts, there are always certain patients who behave "irrationally" and are determined to leave negative feedback on a survey, says Onslow CEO Ed Piper. The best you can do is to acknowledge and assure the patient that the culture is safe and caring, and set the stage for the best experience through careful communication and the display of human kindness from any staff member, clinical or nonclinical, who encounters the patient.

For Douglas Wood, M.D., director of strategy and policy for the Mayo Clinic Center for Innovation, truly transforming the health care experience is about meeting patients at home or wherever is most convenient, responding to their needs using all available resources through a team-based care model, and reorienting the delivery model away from bricks and mortar.
"We will realize fairly quickly that we need to change the focus of the health care industry to creating health, not just producing health care," Wood says. "And when you do that, it will change the focus away from the experience within hospitals and clinics to the true, complete patient experience. It's nice to have a hospital that has lots of amenities but, really, not too many of us look forward to scheduling a stay in a hospital as though we would look forward to going on a cruise."

This gatefold will explore how organizations can make systemic changes in the patient experience, using best practices and tools from some of the top performers.


Key Steps for Leadership

There are a few key steps that hospital and health system leaders can take to help systemically address the patient experience.

1. Foster staff understanding of the patient experience and the relationship it has with other aspects of care.

  • The relationship between the patient experience and clinical outcomes
  • The relationship between the patient experience and patient engagement
  • The role of the patient experience in the hospital's financial success

2. Demonstrate executive leadership involvement in improving the patient experience.

  • Continuously demonstrate, both visibly and verbally, that the patient experience is a top priority.
  • Make weekly executive rounds.
  • Monitor and share scores, celebrate success and encourage additional improvement.
  • Support staff efforts to succeed (tools, training, cheerleading).

3. Implement best practices.

  • Purposeful hourly rounding
  • Bedside shift reporting
  • Post-discharge phone calls
  • Scripts, logs, other tools
  • Monitoring, feedback coaching on all tactics
  • Staff bonuses tied to scores

Source: Press Ganey, 2013


HCAHPS Takes a bigger proportion of the pie

Providers must devote added attention to patient experience within the Medicare value-based purchasing program — reflected in hospitals' HCAHPS survey scores. Patients' perspectives of care will continue to equal 30 percent of VBP scores over the next three years, while other pieces of the pie are divvied up among different concerns.


Hospitals upping the game in communication

The average percentage of patients giving "top box" responses — or the most positive possible answer — on HCAHPS surveys has gone up consistently since January 2008 in two categories critical to the patient experience. About 81 percent of patients surveyed said their doctors "always" communicated with them, up from around 79 percent; and more than 78 percent said nurses "always" communicated with them, up from less than 74 percent.


Moving Away from Conveyor-Belt Care

To achieve the truly ideal patient experience, officials at the Mayo Clinic's Center for Innovation say that hospitals must move away from the old model of "conveyor-belt care" — in which the patient just moves along a line from provider to provider with no real coordination — to a team-based, "wrap-around" approach.

The Current Model: Conveyor-Belt Care

Today's model of care deals mostly in face-to-face interactions between patients and other clinicians, and is too focused on acute care and reactive medicine, according to Mayo.

The Future Model: Wrap-Around Care

In the new model, patients are put right at the center and surrounded by all sorts of clinical and nonclinical care providers; it is focused on population health, prevention strategies and a proactive approach that maximizes value and the patient experience.


Beyond Just Acing the Survey

Experts say that hospitals shouldn't get too caught up in just acing the HCAHPS survey, and should look at measures beyond that aren't addressed there. While each of the HCAHPS measures is admittedly important, enhancing the patient experience should not be limited to pursuing just these measures, according to the Advisory Board Co.


The Patient Experience Sphere

  • Ongoing emotional support
  • Family involvement and care team integration
  • Avoidable disruptions minimized
  • Compassionate, empathetic caregivers
  • Clear, actionable patient education
  • Up-to-date and thorough information
  • Physical and emotional needs anticipated

HCAHPS

  • Communication
  • Quiet at night
  • Information about medications
  • Discharge information
  • Cleanliness
  • Responsiveness
  • Pain management

Source: The Advisory Board Co., 2012


Case Study

Cleveland Clinic uses culture training to transform experience

The Cleveland Clinic has used culture training to help transform the patient experience from top to bottom in recent years. It has seen patient and staff satisfaction leap, thanks to its efforts. Forrester Research took a closer look at what strategies the clinic used to get to where it is today:

1. Cleveland Clinic's patient experience team found that all staff members must contribute to optimizing a patient's visit, including:

• Clinical staff (doctors, nurses, etc.)

• Administrative staff (check-in, billing, etc.)

• Facilities staff (janitorial, maintenance, etc.)

• Management (department heads, senior executives, etc.)

• Information technology

2. The patient experience team developed an organizationwide culture-change exercise that:

• Achieved C-suite buy-in and support

• Focused on vision and importance to the patient

• Used focus groups with patients and other stakeholders to design the process

• Implemented a 1,000-member employee pilot

3. Every staff member went through a culture-change exercise, eight at a time:

• $11 million enterprise cost

• All employees, including doctors, were randomly assigned tables. An employee facilitator walked each attendee through:

  • Mission and vision
  • Expected service behaviors
  • HEART — Hear the story, Empathize, Apologize, Respond to the problem, Thank the patient (service recovery)
  • "Serving leader" leadership model introduction
  • Value exercise

4. Cleveland Clinic boosted its measurable scores following the effort:

• Patients reported higher satisfaction and complaints decreased on HCAHPS scores.

• Staff appreciated the program; employee engagement increased and 92 percent reported satisfaction.

Source: Forrester Research Inc., 2012