Experience the Patient

This article appears in the June 2012 issue of HealthLeaders magazine.

In our annual Industry Survey, leaders cite patient experience and satisfaction as their organization's top priority, and 59% place it among their top three priorities. And yet when assessing how their organization is doing in that regard, only 18% choose "very strong." While 47% describe their organization's patient experience as "strong," 35% classify it as "neutral," "weak," or "very weak." What is behind the industry's inability to do better in an area that leaders regard as a top priority, and what can be done to improve?

Eleanor Keller
Director of Inpatient Service
OSS Orthopaedic Hospital
York, PA.

A lot of what we do is make sure our staff is taking excellent care of our patients—making sure their pain is under control, making sure their needs are met on their time—because the time that a need is met to me may be different from anybody else.

A lot of people have become complacent and don't seem to put the priority on patient satisfaction. We have a lot of competition and many of our patients come to us because of word of mouth from other patients who were satisfied, and we don't want to lose that. A lot of organizations don't see that. They might think, "I'm good and everyone is going to want to come to me."

We've only been open about a year and a half. So it was not so much changing the behavior, but as people came on board we had them recognize that this is what we want to be and this is what we have to do to get there—and we had to make sure they were on board with that.

In established hospitals, it's always harder to change behaviors to what you want, but when you interview, you interview for the behavior.

Edwina Henry
Director of Quality and Risk Management
ENNIS (Texas) Regional Medical Center

We are too passive. We throw those patient experience questions out there and we only react to the results we get. We aren't sitting down face-to-face with these folks and asking them to tell us what it means from their perspective.

From my experience, one aspect we worked ad nauseum was "the food is lousy." As it turns out, the patients weren't happy with the food because it was bland or "you only send me this or that," and they had no understanding of what diet they were supposed to be on. There was no communication with nursing on the plan of care and understanding that there is a no-fat diet or a no-salt diet or a bland diet for problems with ulcers.

We use a lot more task-based practices than critical-thinking and team skills. Although we see it, we don't exactly know how to fix it so we don't communicate well. Everyone is in there to do their task and says, "I don't want to be involved in anything else." That crosses over to the patient: "Well, I'm just supposed to give you this pill. I'm not supposed to really worry about whether you know what it is." So there is a disconnect there.

We need to engage families to help us understand what makes patients happy, to get some idea of where the gap is and how to close it.

Deborah Visconi
Director of Operations 
Morristown (N.J.) Medical Center

In order to improve the patient experience, it is critical to make satisfaction a top priority and area of focus for the organization. A key factor in being successful is the involvement of the entire healthcare team. So you have to include your physicians, nurses, ancillary staff, support departments, because everyone is critical to achieving the same goal.

It goes back to focus, priorities, and accountability. Most of our challenges are in the domain of communication. To achieve success in improving patient satisfaction, you have to establish accountability and focus the organization to put satisfaction as a top priority. In leadership we say, "Oh, yes, this is really important." But when we get distracted with other initiatives it can be easy to lose sight of the bigger picture of improving the patient experience.

If you do hourly rounding and you do it right, you diminish the patients having to press the call bell to meet their needs. If you are rounding on the patient every hour, you should be able to address those needs before they ask you. Hourly rounding is a key tactic that is critical in improving the patient experience by allowing the healthcare team to anticipate and meet the patients' needs before they have to ring the call bell. It helps us to understand what responsiveness means to each individual patient and their caregivers.

We've started putting the behavioral expectations in very specific detail into the performance appraisal for all employees, and patient satisfaction is part of your performance expectation.

Susan Stone
CNO, Sharp Memorial Hospital
San Diego

On overcoming obstacles: When you ask people "Are you patient-centered?" they say "Of course." But the definition of what it means is truly different for each hospital, and that has been a barrier in the healthcare industry. An extraordinary experience for the patient comes from the attitudes and behaviors that are exemplified by the personnel. And if you refocus your workforce on the priority of the relationship, they will have much greater success.

On listening: It is very important that the voice of the patient is involved in every aspect of the facility. We meet monthly with our patients and get their opinions on the work that we are doing. In addition there are some best-practice models of patient- and family-centered care that have demonstrated significant differences in outcomes related to the HCAHPS survey.

On the business case: When you get down to it, when you are talking about people who look at the bottom line and ask about the return on investment, it hasn't been clear to them about what that difference can be. In the study we did regarding patient-centered care models over five years, the patient satisfaction was significantly higher, the cost was actually lower in the facility that had implemented that model of care, and the return on investment was a lower length of stay. That is a success story. Those are the kind of success stories our industry needs but few have been in the literature for healthcare executives.

This article appears in the June 2012 issue of HealthLeaders magazine.

Reprint HLR0612-1