Indiana University (IU) Health in Indianapolis, the largest health system in the state, has invested heavily in patient experience initiatives, appointing an executive director of experience design and eight regional experience design leaders.

IU Health leaders also began conducting real-time surveys of patients in 2018, with more than 700,000 surveys collected so far. Management bonus plans now include meeting patient experience goals, and a net promoter score was created to show whether patients will recommend IU Health for care.

In 2015, the CEO of IU Health recognized that the industry was becoming much more consumer-driven and wanted to challenge the system to think more about becoming consumer-centric in its approach to delivering healthcare, says Jennifer Baron, executive director of experience design for IU Health.

Health system leaders spent 2016 speaking to more than 17,000 healthcare consumers in Indiana and 7,000 of its own employees about how to become more consumer-centric.

The system also benchmarked both within the healthcare industry and outside to understand what IU Health might have been missing in serving consumers, Baron explains. That work yielded two major conclusions.

“One was that we needed to shift from everything we were saying about wanting patients to be satisfied with a single transaction and start thinking about how patients travel across multiple care locations in their healthcare journey,” Baron says. “Their journey may begin with doing a web search to find care, through multiple locations to receive that care, and then back in their home receiving a bill. We knew we needed to expand our focus on that entire journey and develop relationships that drive loyalty.”

The other big lesson was that healthcare consumers want to be engaged with improving healthcare. “Previously, we were guilty of gathering in the conference room and maybe putting a patient pain point on the table that we wanted to solve, with the best of intent solving that problem in the way we thought was meaningful,” Baron says. “But we were always missing having a patient at the table with us to design new experiences and care models, to partner with our patients.”

Five-Year Improvement Plan

The year of research led to a five-year strategy for evolving into a more patient-centered organization. Baron was hired in 2016 to oversee experience design, with a team of 10 employees who would develop tools and frameworks that make it easy for patients to give feedback and improve experiences. At the same time, the system deployed eight regional experience design leaders to its hospitals.

The new focus on loyalty led to evaluating the financial impact of loyal patients vs. detractors. Loyal customers, called promoters, retain better, purchase more, and refer family and friends, Baron explains.

IU Health adopted a systemwide net promoter score (NPS) in 2018 as its primary patient experience measure by using patient surveys. The patient feedback survey was redesigned, including shortening it from 60 to 80 questions down to just six to 12. The previous survey was delivered by mail, often six weeks after patient care, and results might not be processed and delivered for three months. The new survey is delivered electronically within 48 hours.

NPS Improves

The survey also moved away from the focus on overall satisfaction to the likelihood of recommending IU Health with a 0-10 score. The NPS is measured at the system, regional, and individual facility levels. The scores are updated in real time.

“We were very silo-driven previously, with a different survey for inpatient, outpatient, and physician offices. We also had these groups and committees that were focused on ensuring that we did well on those surveys,” Baron says. “Through this work, we changed our focus to just one survey and one measure that is inclusive of all care settings. We have one experience score instead of three, which helped with our cultural move to have everyone work better together.”

The first-year goal for the NPS was to improve at a statistically significant rate, Baron says. At the end of 2018, IU Health had exceeded that goal and set a new goal in 2019 to reach top-decile performance within five years.

IU Health’s NPS was 74.71, while top-decile performance was around 80. The goal was to reach 75.71 by the end of 2019, and then improve to 80 by 2023. By June 2019, IU Health had achieved a systemwide NPS of 76, above the full-year 2019 goal, Baron reports.

“Our hospital facility inpatient NPS at the system level has improved four points, our ED NPS has improved by five points, and all of the other outpatient ancillary services have improved by five points also,” Baron says. “Overall, at the system level, we’ve had a net promoter score increase of a little over two points.”

Empathy Walks Help Leaders

IU also changed how it distributes information about patients to team members.

“Team members learn about patient feedback during team meetings, their daily huddles, and a number of other ways. We post patient survey results every week in an executive conference room also for leadership to see,” Baron says. “We also put more focus on recognizing team members for their effect on patient feedback, including a trophy that different teams earn each month.”

IU Health also began holding “empathy walks” using audio recordings from actual patients at points along their care journey. Hospital leaders and staff, including IU Health board members, use the audio recordings, similar to those used at museums and historical sites, to walk “in the shoes” of a patient. This gives everyone a near first-hand perspective on what it is like to be a patient at IU Health, explains Karen Cernock, manager of experience design capability.

“It helps them understand the whole experience, what it’s like to park at one of our facilities, to be lost and not know where they’re supposed to go, to receive great care from our providers,” Cernock says. “We record the patients telling bits and pieces of their stories as they walk through the facility. A small group of leaders may start at the vestibule of the emergency department, listening to how scared they were for themselves or their loved ones, what it was like at that moment in time for them.”

Looking Beyond Healthcare

IU Health pays attention to performance in all care settings, not just in hospital, including “retail” settings such as physician offices and labs. Adopting NPS lets IU Health compare its performance to non-health companies, including Amazon, Nordstrom, and Apple. This provides more perspective and context to the board and patients, Baron explains.

“My goal is to stop talking about the patient care experience because it is has become so well-embedded in the culture of our health system,” Baron says. “A lot of the tools and operations we have developed are designed to take our leaders in that direction and start thinking differently about ownership for that broader patient experience.”