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Patient Experience: Old School Approach May Be Best

Jacqueline Fellows, for HealthLeaders Media, September 4, 2013

Health system leaders were inspired by the imaginative methodology and jumped in with both feet, establishing six teams of 12 people who worked for six months starting in mid-2011 on recommendations for improving patient experience. Holt says the extended time period actually helped to develop the culture required to implement and maintain its patient experience improvements.

"You have incremental improvement that turns into transformational change," she says. "It's really about cultural change and maintaining that, which is probably twice as hard as getting to cultural change."

One of the first things the groups did was develop a definition for patient experience. It was tricky, says Holt, because the term isn't explicitly defined in the healthcare industry. Holy Redeemer describes patient experience as:

"Intentionally crafted interactions that are personal and individual in nature, require participation, and meet unrecognized needs, resulting in a relationship that provides unique value to customer and the organization."

Establishing a formal definition gave Holy Redeemer the foundation it needed to develop the kind of patient experience it wanted to deliver. Leadership decided to go for the wow approach—they wanted to dazzle patients, families, and employees. This is where the creative thinking comes in.

Holt says the health system developed what is called a story structure to communicate to patients Holy Redeemer's story, which is "a rich, interconnected set of stories from the heritage of our founders to the stories of those we serve and serve with every day." The story element is meant to connect with patients on a level that is more human and also communicate that Holy Redeemer is a patient's partner in health.

"Every one of us has a life story we're writing," says Holt. "I really think this is about changing the nature of the relationship that we have with people. The basis that we have right now as an industry is based on, 'What healthcare do you need, and how can I serve that up to you?' I think where all the reform and the trends in the industry are moving us toward is really about helping people be well and live their life to the fullest."

Delivering on a brand promise

To help employees understand how they were supposed to interact with patients, Holy Redeemer developed five categories of behavior types that are tied to the system's brand promise, "Caring for you and about you." For example, "Offering a warm, calming, and welcoming presence" is part of the healing presence category. Another category, expert care, describes employees as "Assuring, qualified staff with excellent skills and a quest for continuous learning." There are three more categories, each with behavior and communication goals for employees when interacting with patients, families, and each other.

Holt says the work also included dreamscaping—think of it as very creative brainstorming—which is a term that describes how Holy Redeemer designed patient experience scenes, so to speak, around how they want patients to feel. "Patient experience can't be just about building new environments. The dreamscaping isn't just about the space; it's about what happens in the space."

The culmination of dreamscaping and storytelling was built out in Holy Redeemer HealthCare at Bensalem, a 22,000-square-foot outpatient clinic devoted to delivering the ultimate patient experience. The facility opened in October 2012 and includes primary care, obstetrics and gynecology, and breast surgeons as well as lab and imaging services.

At Bensalem, winding hallways are called boulevards, waiting rooms are called living rooms, and an experience guide meets you in the center of the lobby at a table designed to look like a tree trunk. A green canopy of hand-blown glass leaves hangs from the ceiling giving the illusion of an abstract tree. The natural theme extends throughout the building, from a six-foot-long fireplace built into a wood-slatted wall to the artwork to the calming paint colors.

According to Holt, the theme was a way to turn a physical space into a story structure, which is meant to prompt patients to think about their own health story. A coffee bar, Kindles loaded with the most recent magazines, and a choice of music in the exam room all are extras meant to help ease patient anxiety that comes with going to a doctor, and also enrich the patient experience. Once in the exam room, patients have 12 music channels to listen to, and nurses record patient preferences for their next visit.

Anecdotally, Holt says this environment is improving the experience patients have, noting the example of a special-needs patient who frequently has to have his blood drawn. "In the history of this patient's experience, he had always been very upset and always exhibited anxiety at a high level," she says. But that changed with '70s music playing in the background during his visit. "With the music we put into the exam rooms, he calmed down for the first time ever and let us draw his blood without any kind of anxiety. Those kinds of stories are not things we're going to capture in a survey, but those are the real impacts."

There is also a real impact that surveys are capturing. Holt says it hired a mystery shopper company to visit Holy Redeemer's other similar outpatient facilities. The mystery shoppers acted like patients and were then surveyed about their experience to get a baseline assessment. On average, Holt says, other, similar practices to Bensalem averaged a 76% satisfaction rate, while Bensalem averaged a 98% satisfaction rate.

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1 comments on "Patient Experience: Old School Approach May Be Best"


Steve Wilkins, MPH (9/4/2013 at 9:32 AM)
The patient experience for most hospital and integrated systems begins not with a hospital stay...but with a visit to a hospital-employed physician or a member of their medical staff. CG-CAHPS is fine but it's limited in terms of the details it provides individual clinicians...meaning that it is not very actionable. Plus it depends upon patient recall of events that may have occurred moths ago. A new "old school" that has been used for years in medical schools is something called conversation analysis where the exam room conversations between physicians and patients are recorded and then deconstructed with the goal of assessing the clinician's patient communication skills. Clinician skills can be benchmarked against best practices...as well as their peer groups. The results are highly prescriptive and actionable at the individual clinician level. The analysis is done by trained independent reviewers. Steve Wilkins, MPH www.adoptonechallenge.com