At the core of a patient’s visit to a health facility is the “patient experience,” an all-inclusive consideration of everything the patient goes through from arrival to discharge and final transport. In truth, the experience extends even farther on either end of this physical journey to include scheduling at the front end and billing at the back end.
Additionally, “experience” includes not only the fact-based aspects of treatment and interactions, but also the patient’s perception of these things. As Lee Atwater said about politics 30 years ago, “Perception is reality.” The same observation applies to health care.
Positive patient perception is clearly a good thing for a healthcare facility, while negative perception can be quite worrisome. Word-of-mouth communications, social media, and online reviews can be very impactful, either positive or negative.
Patient experience is a very broad and very important outcome for the healthcare process. How do your processes and team members impact it?
Assessing the patient experience process
As with all processes in the healthcare system, addressing patient experience starts with understanding the patient flow. However, the most valuable part of the experience assessment will come not from internal observations and measurements, but from feedback of patient perception.
This can be done with formal surveys, with less extensive but structured patient input, with documentation of unsolicited feedback, and with observation of patient comfort and happiness. Patient comments and language can be used to create actionable directions for staff to implement operational improvement in the patient experience process.
As an example of this multi-faceted data gathering approach, Carolinas Healthcare System looks at aggregate scores for the standardized HCAHPS survey, administers a “perception of care” survey for discharging patients, and makes available “WOW” cards for patients, family members, and staff to identify any particular outstanding examples of patient care.
You have the feedback…Now what?
Patient feedback is likely to be all over the map. Some information processing here is helpful to organize the input before making decisions and taking actions. This can range from starting with a simple pareto of the categorized feedback comments to implementing quality function deployment (house of quality) to translate patient perception to operational specifics. Root cause analysis is implemented to understand the patient's’ experiences and perceptions and determine a plan to address the appropriate factors.
For example, if patients say they were cold in the prep or recovery area, an immediate response might be to turn up the heat. However, this might present a conflict in operations, as the facility maintains a low temperature for optimal control of hygienic conditions.
Applying problem-solving tools to identify root cause might uncover several issues in this case, such as these:
- The patient is immobile in a bed, wearing a lightweight, cap-sleeve, immodest wrap gown. She really is cold relative to active, normally dressed staff working in the area.
- The patient’s fluids or anesthesia medication are uncomfortably cool, actually lowering core temperature, even to the point of hypothermia.
- The patient is alone in new, foreign, and antiseptic surroundings, creating a sense of coldness.
Each of these issues could be addressed in a “warmth deployment project” using such tactics as providing full-sleeve flannel gowns or pre-heated cloth warming blankets, checking to see if the patient is comfortable, using heated air blankets, creating warm tones and decorations in the prep and recovery areas, allowing a family member in the prep and recovery area when the patient is conscious, and implementing a TLC approach to patient interaction in these areas. Remembering that perception is reality, if the patient feels that she is being showered with warmth in care, psychological warmth may overcome the reality of chilly prep and recovery rooms.
The peak and end rule
Noted behaviorist Daniel Kahneman actually looked at customer experience using the example of a medical procedure. He reported that the patient experience after a short but painful colonoscopy was remembered as much worse than a patient experience with the same peaks of pain and discomfort, but with an extended length of time at a lower pain level at the end of the procedure. The patient remembers the lower level of the most recent part of the procedure, the end.
Psychologist Paul Marsden takes it a step further, saying: “Customer experience is worthless. Memories of customer experience are priceless.” His recommendation is to begin by focusing on the peak and end, attempting to create positive memories of the experience at the most emotionally intense moment and assuring that the end experiences are also positive.
For a patient experience, the most physically intense moment might be the procedure itself: a surgery, therapy, or examination. However, for some of these events, the patient might be anesthetized or otherwise subdued. Thus the most emotionally intense moment might be before or after these procedures.
The patient expects competence during the actual procedure. The clear communication of expectations before the procedure, the gentle care coming out of anesthesia, and the empathetic sharing of outcome, if done well, can be very positive experiences and create memorable favorable perceptions of the peak.
The end point in the patient’s mind might not even relate to any actual medical procedures. Delays at discharge, errors in billing, or rude transport staff at time of discharge can generate poor patient perception even among patients who gush with gratitude for the medical staff who saved their lives.
As a plan for addressing and enhancing patient experience is created and deployed, communications, empathy, and compassion must be implemented at the peaks and ends, as well as all touch points in the patient care process.
Addressing problems in patient experience
Any customer-facing operation can have mistakes or simply undesirable outcomes that create bad experience, perception, and memories among customers. When mistakes happen in the health care facility, the team needs to have a service recovery plan. In other words, by understanding and addressing the problem and the patient’s perception of the problem, the team can recover a positive perception and turn the experience from negative to positive.
Much work has been done to establish service recovery strategies in healthcare and elsewhere. Research indicates that fixing a service problem can turn a disgruntled customer or patient into a loyal one. The Agency for Healthcare Research and Quality has outlined a strategy for dealing with service recovery. It’s very valuable to have this type of strategy available and communicated to all staff members so that dissatisfaction can be addressed immediately or escalated and resolved.
Steps to address the patient experience opportunity
Let’s summarize the components of dealing with patient experience:
- Gather data from patients, using the actual “voice of the patient.”
- Identify root causes for poor patient experiences and perceptions.
- Implement standards for processes at all patient touch points, starting with a particular focus on “peak and end” process steps.
- Deliver regular training, not only on the technical aspects of jobs, but also on effective patient interaction.
- Reinforce desired behaviors by staff in patient interaction.
- Deploy a service recovery strategy to address problems that do arise, so that negative perceptions can be changed to positive memories.
- Maintain ongoing excellence by continuing the process with regular feedback, perhaps by implementing a patient advisory council.
As with other improvement plans, the first step is to find out where you are with your lean assessments. To do this, check out the recording of our recent webinar, Making Lean Assessments Work For Your Business.