Patient experience: Perception is everything
Patient experience: Perception is everything
It’s not what you do, but what they think you do
You’ve had that experience before: You say something innocuous and someone takes umbrage. You meant no harm. Indeed, you did not mean it the way they took it at all. But in the end, it does not matter what you meant; it matters what they experienced. And it is the same with patient care. If you do everything exactly the way you should with a smile on your face, but a patient is having a bad day, she’s not going to see it the same way.
So how do you make sure the patient experience is a good one — at least as far as you can? Some answers may lie in The National Patient Experience Study, released in May. It was conducted by J.D. Power and Associates for the Beryl Institute and focuses on the importance of “listening to the patient voice.” Based on a survey of 3,500 recently discharged patients, it found that the average experience of a patient in the hospital exceeded by a small margin the experience of guests in a luxury hotel — the hotel guests gave a score of 822 out of 1000, while the average for hospital patients was 825.
The key indicators of a positive experience were:
• patients getting to their room within 20 minutes after admission, or 90 if being admitted from the emergency department;
• being able to talk to their doctor when they want to;
• nurses always describe the plan of care for the day;
• call buttons are answered promptly;
• physicians and other staff thank the patient for choosing their hospital;
• the hospital calls to check on the patient post-discharge.
Staff matter most. Nearly half the score came down to what happens with physicians and nurses, and the procedures the patient had — 19% for nurses, 15% for physicians, and 12% for tests and procedures. A quarter of the experience was measured against the discharge process. Just a fifth was down to environment — so much for all the expensive redecorating at hospitals.
Be concerned. Key to a good experience were staff who had a good “emotional intelligence,” the report states. That means staff who are empathetic, kind, and show concern are going to help give patients a much better experience than someone who is whip-smart when it comes to IQ, but not so great when it comes to personal interactions. Helping staff to improve their emotional intelligence if they are lacking could help to improve this key factor in patient experience, the study notes. Feeling your nurse or doctor has shown “genuine concern” can color the entire hospital experience — a good nurse can make 200 thread count sheets feel like 500 thread count Egyptian cotton.
Show empathy. The report talks about the importance of empathy and divining how patients are thinking. This translates into explaining things to patients in a way they understand. If providers show this level of empathy, the patient experience is much more likely to be good than if they do not.
Say thanks. One of the most telling statistics in the study related to the simple act of thanking a patient for choosing your facility. If you do this, the patient was likely to give an average of about 7 positive recommendations. If you forget, you’re looking at about a half a recommendation for your facility per patient.
Ask for input, provide information. Patients who felt they were discharged at the right time were much more likely to have been asked what their goals for treatment were than not. Asking for patient input about desired outcomes makes for a better experience. Also related to positive experience were having nursing staff that gives information about the care plan for a given day, knowing that the physician is readily available to answer questions, and if the patient knows when he or she would be having tests and procedures.
It is not all about you. With about a third of the score related to admission and discharge, the report notes that hospitals should be aware that what happens before and after the patient comes to you is also important in the overall patient experience. You aren’t in a bubble. Make sure that intake and outflow are smooth, too. It reflects on you even if it isn’t within your control.
Leadership = patient experience
At Barnes-Jewish Hospital (BJH) in St. Louis, patient experience is important enough that there is a director-level position just for that. Sean Rodriguez, MBA, was hired into the position about two and a half years ago. He says that while a lot of hospitals focus on “service” when they think of patient experience, it is about much more than that. “This isn’t like service excellence you hear about in the hospitality industry. This includes much more than that.”
BJH uses three different metrics to look at patient experience: the HCAHPS survey, a patient satisfaction and experience survey created for them by Professional Research Consultants, and an internal database that tracks complaints and incidents and keeps trend data on both.
One thing they implemented was leader rounding on patients. At least once a day, the unit or department head will go around and step into each patient room to ask a set of structured questions of patients to determine whether anything is amiss. Questions might include something like whether the patient used the call button, and if so, did he or she get a response quickly? “Responsiveness is an area we have focused on for improvement,” he says.
Leadership goes through training at least twice a year to refresh these skills and learn how to work with staff members that might be falling short of expectations. Low performers are subject to increased leadership rounding and coaching for improvement. For instance, if a particular nurse isn’t remembering to fill in the patient whiteboard with his name and the patient pain score and other data, the leader will round with him and prompt the proper behavior. “It is not meant to be punitive,” he says.
Leadership training leads to a lot of questions about the data that is collected, Rodriguez says. “We do not use it as statistically precise information in this instance. Instead, it is used to give us a direction, to show us where to start in our conversations with patients.” If they are getting low scores on responsiveness, leadership will want to ask about the timeliness of call button response, the time of day patients called and whether there is a pattern that indicates a staff shortage or some other problem not related to a particular staff member. “It is not about a number on a scale. You have to dig deeper than that and ask more questions.”
For instance, there is a question about noise at night. Most people figure that hospitals are noisy and patient complaints about noise at night are related to ambient sounds. Not so at BJH, where further questioning pointed to a different problem: One of the occupants of a semi-private room was having visitors late at night. “That wouldn’t be obvious if you just looked at the numbers on a survey response,” he says.
One other way to dig deeper is to make use of family and friends of patients. Often, Rodgriguez will host a patient and family forum over lunch. “Family members notice everything. Patients are often overwhelmed or in pain or medicated. But the family sees it all.”
The focus for improving patient experience has always been on changing the culture at BJH, he says. “We have leadership institute events twice a year. The first time, we talked very little about patient satisfaction, but a lot about employee engagement. We talked about values conversations and how to talk to a low performer or lagging team member. We look at how to have good conversations with anyone on the team, whether they are excellent performers or somewhere in the middle.”
Barnes-Jewish also focuses on making its mission and values actions, not just words. Like all organizations, the values are full of meaningful words like integrity, respect, and excellence. Rodriguez wrote action sentences to go with each. So integrity became, “I will be positive and committed to our mission.” Each of those sentences had related mandatory behaviors — following policies and procedures of the department, adhering to the privacy rules of HIPAA, for example. And each of those mandatory actions has its own toolkit, video, and training manual. This is spread throughout the organization.
And how does this impact patient experience? From the top down, Rodriguez says, the culture is all about accountability and doing everything possible to make the patient experience safe and positive. So far, so good, he says. “We have come far, but that does not mean we’re done yet. We still have a ways to go as an organization.”
For more information on this story, contact Sean Rodriguez, Director of Patient Experience, Barnes-Jewish Hospital, St. Louis, MO. Telephone: (314) 362-4138.
Youve had that experience before: You say something innocuous and someone takes umbrage. You meant no harm. Indeed, you did not mean it the way they took it at all.Subscribe Now for Access
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