Bigger isn't always better when it comes to healthcare organization size and the patient experience. When a local or independent hospital becomes part of a larger health system, patient experience can suffer, sometimes in subtle ways.
In Minnesota, 16 independent hospitals have become affiliated with health systems such as Mayo Clinic and Sanford Health since 2005. According to a Minnesota Public Radio audience panel, patients whose hospital joined a health system were pleased with the enhanced local access to medical services, but found less friendly atmospheres than before the mergers. For some patients, the loss of local control was a big deal.
Minnesota's circumstances are not unique—HealthLeaders Media's August Intelligence Report found that multi-facility health systems are more likely than individual hospitals to place patient experience outside of their top three priorities. Hospitals (60%) are also more inclined than health systems (46%) to place patient experience among their top two priorities.
So how can healthcare marketers bridge this patient experience gap? Does improved access have to come at the cost of experience? Nina Setia, chief experience officer for NYU Langone Medical Center, has some answers.
Setia stepped into her role as CXO at the four-hospital system, which has a total of 1,069 beds, nearly one year ago. She has found improving the patient experience at a large organization simultaneously challenging, satisfying, and exciting. She focuses on providing the staff tools to empower them to improve the patient experience, through skills development, hands-on coaching, and even rounding with physicians or staff.
"The challenges in this role are tied to both the size and scope of the medical center," she says. "Implementing strategies can be complicated in a large institution such as ours. Critical to our success in this area is having leadership support behind all patient-centered initiatives we implement." If an organization's top leaders don't recognize it as a priority, improving the patient experience becomes much more difficult, she says.
Once leadership support has been secured and demonstrated, it's important to develop an overall strategy to create a world-class patient experience and to create an infrastructure to support the operational aspects of the role, Setia says. This infrastructure includes HCAHPS scoring but goes well beyond.
"Although the HCAHPS questions specifically focus on the inpatient stay, we need to remember that is beyond the walls of the inpatient unit," she says. "Access to the hospital, first impressions, last impressions, billing, and way-finding all play a part in the patients' overall perception of their experience, whether specifically measured or not."
A team-based approach to patient experience is needed for large academic medical centers and health systems, she says. At NYU Langone, this means coaching physicians and staff on how to engage patients to achieve better satisfaction outcomes based on their interactions. The patient experience team and medical staff discuss strengths and opportunities regarding courtesy, respect, listening, and explanation of the patient's condition in a language they can understand.
Setia says she and her team train medical staff to ask the patient "What questions do you have that I can answer before I leave?" instead of "Do you have any questions?"
"Just slightly rephrasing the question sounds more inviting," she says. "When we ask 'if' instead of 'what,' most of the time the patients will say they don't have any questions. [But] patients always have questions, and when they don't get to ask them, it only makes them more anxious."
As for how to make the patient experience at academic medical centers and health systems more like that of community hospitals, a positive, patient-centered culture is vital, Setia says. A key factor in patient satisfaction is hospital employee morale.
"Patients often choose a large medical center because of its academic affiliation and large specialty base for assisting with the most complex health concerns or even the most common," she says. "They will expect the environment to feel large and complex but that doesn't mean that there is less emphasis on individual attention. We can still focus on individualized patient care at the bedside."
Marianne Aiello is a contributing writer at HealthLeaders Media.