There was a time, very recently, when Jason Wolf, PhD, the president of the Beryl Institute in Washington, DC, could talk about patient experience and people would think he was referring to the food you get in hospitals or whether the parking was easy. The amenities and the physical environment of a hospital are, indeed, part of the patient experience. But, it is so much more, and now he sees more people with a good grasp of that, particularly within the healthcare industry, he says.
His sentiments mirror the institute’s patient experience leadership survey findings. The survey involved more than 1,500 healthcare organizations, about 770 of which were U.S.-based hospitals. It took place during February and March 2015, and the full results will be released later this summer. In an interview with Hospital Peer Review, Wolf talked about some of the findings in advance of the report’s publication.
First, he says he was gratified to see more hospitals are doing away with the committee structure (down 12 points from the previous survey to 14% of respondents) to handle issues of patient experience and putting an executive in charge of it instead (up to 42% in the current survey, from 22% in the previous iteration). “That’s pretty significant, along with the increasing size of the staff they are committing to this area,” Wolf says. Wolf shared data illustrating that full-time staff committed to working in patient experience is three to five for 19% of U.S. hospital respondents, and five or more for another 33% — 8% and 9% jumps, respectively, since the 2013 survey. “I think people are finally heeding the message that if this is important, we have to commit resources to it.”
A bit more than a third of the patient experience executives surveyed say they spend all their time in that role, he notes. “Thirty-eight percent of the 63% who have someone specific in this role — that’s a big deal for something that is a relatively new idea to the industry.” Another 78% of the group spend half or more of their time working on patient experience activities.
The data show the hospital-based respondents, both domestic and foreign, value patient experience second only to patient safety and quality of care when listing top priorities, even above cost management. About half the hospitals have some sort of formal definition in place for patient experience, and 87% report they have enacted a patient experience framework. Neither of the numbers for those two elements jumped more than a couple of percentage points since the last time the survey was done two years ago. The two years before, the jump was around 20 percentage points.
“The data are interesting,” he says. “These are indirect indicators when we ask, ‘Do you have a definition or a structure?’ I think we can see that people are getting involved in the discussion. If 87% have a structure and 43% have a definition, then we know people are getting involved and talking about this. But there are still a bunch of people who don’t know what to do — the 36% difference between the two, you could guess.”
Some of the conversation still revolves around patient satisfaction surveys, which are the primary way patient voices are heard, according to the Beryl survey. Data around how U.S. hospitals engage patient voices broke down like this (previous survey percentage in brackets):
• 91% get information from government mandated surveys like HCAHPS [86%],
• 78% get information from other surveys [80%],
• 71% get information from post-discharge phone calls [70%],
• 55% use patient or family advisory committees [32%],
• 49% use bedside surveys or other ways of gathering information prior to discharge [42%],
• 45% monitor social media [N/A],
• 41% look at outside rankings like Leapfrog Group or U.S. News & World Report [N/A], and
• 37% use patient and family focus groups [29%].
“I think the biggest thing we need to work on in patient experience is the delineation between these things — the idea that certain things are part of patient experience and certain things are not. Everything is the patient experience,” he says. “If the safety of the patient and the quality of the encounter are interrelated, then they have to be equally important.”
There are plenty of data showing the biggest impact on patients having a positive experience is the quality of care and positive clinical outcomes, Wolf notes. “It’s not just about food, or parking, or the physical environment of the hospital that we commonly think of as patient satisfaction. Those are amenities. We do our quality improvement activities, but if we don’t improve our people and our interactions, too, then it doesn’t matter. You won’t have long-lasting results. You have to put the patient at the center of everything you do, of every project.”
A lot comes down to having visionary leadership and a culture that understands how healthcare has shifted from the business of healthcare to the patient’s experience, he says. Survey findings support this, with respondents saying the biggest push toward great patient experience is good leadership and the biggest hurdle is being pulled in too many directions at once.
“If you think of experience as somehow segmented from good clinical outcomes, you will probably fail,” Wolf says. “But if you provide good experience, you will get good outcomes.”
There is no excuse for not engaging in advanced patient experience activities, he says. In the survey, demographic data showed small hospitals, rural facilities, and academic powerhouses alike all having representatives with strong patient experience leadership — and among those facilities that were lagging behind. “I think, though, that most hospitals by now understand that this is important.”
The problem for many, he says, is that they view it as another task on the to-do list: Make the patient experience an important thing in the hospital. “If you do that, you set yourself up to fail,” he says. “ICD-10, Meaningful Use, EHRs — these are tools and initiatives that can benefit you and your patients. But, if you can’t create a good encounter, those tools don’t matter. Patient experience underlies everything. If your people and processes are not focused on the patient, you will not succeed. This is the shift in the way healthcare is operating now. The way the person gets the IV needs to be safe, clean, and friendly every time. Then the other things follow. That’s not just Lean or quality care. That’s what patient experience is.”
Just under 75% of survey takers from U.S. hospitals say additional focus on patient experience comes improved patient outcomes. You also get improved patient loyalty, community reputation, and financial outcomes, but those are far down the list: 52%, 43%, and 24%, respectively.
Wolf thinks explaining the importance of patient experience in those terms will help get those who are not yet on the wagon to make that final leap. If they don’t, they will find they are likely to lose money, particularly in an era when value is part of the payment equation, and value includes patient experience: By 2018, half of all fee-for-service payments for Medicare patients will be on the line.
“Its easier to focus on those other things — those tangible things like coding and computers,” he says. “But, remember that everyone in the organization is part of the patient experience whether they touch the patient or not. Every role is critical to quality and safety. I was talking to risk managers about this in June and they often come to a discussion after something bad has happened. But what if they started thinking about it in advance? What if they started thinking about the experience the patient has from when they walk into the hospital? How could that help reduce risk in the future?”
Staff training in patient experience can help get everyone thinking through the patients’ eyes, and about 60% of the U.S. hospital respondents think increased resources should — and might — go to this area, the survey data note.
If you focus on the end user, not the end of the experience, you are more likely to ensure a quality encounter and a better outcome. “As quality managers, your challenge is to change the way you do your job so that you understand that patients are having an experience, and consider that in everything you do. We have checklists and core measures, and a framework that obviates the knowledge that there is a person involved. The same things need to get done every day. But pivot a little, and think with the patient in mind. At the end of the day, that slight shift will have you at a different endpoint, a better one.”
For more information on this topic, contact Jason Wolf, PhD, President, The Beryl Institute, Washington, DC. Email: Jason.firstname.lastname@example.org.