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Creating Accountability for Patient Experience

Philip Betbeze, for HealthLeaders Media, February 13, 2012
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UCLA's reason for being
If Merlino sees patient experience as a critical part of the care process, David Feinberg, MD, sees it simply as the reason for being for Ronald Reagan UCLA Medical Center, for which he is the CEO.

Put simply, Feinberg is a believer that if patient experience is excellent, most everything else that's a priority for the hospital or health system will fall into place. Which is why he is self-deprecating about UCLA's achievement of 99th percentile in HCAHPS scores.

"Our HCAHPS scores are good, but we're not doing well in patient satisfaction," he says. "We've had a meteoric rise from 38% to 99th percentile. We perform at the very top regarding HCAHPS questions. That being said, we're terrible because to get to 99th percentile, you have to get 85 out of 100 people to give you that answer on their survey. That means we've failed even though we're the best, because we've failed with 15 people out of the last 100."

He says, with no hint of guile, that the scores need to be 100 out of 100 before he can boast that they've gotten anywhere.

Yet his hospital represents the top 1%, in a manner of speaking, meaning it must be doing something right.

His biggest challenge, he says, was instilling a team spirit about patient care throughout the organization.

One of the guiding philosophies is that it's not just about the people who touch patients. "Whether you're in IT, or billing and collections, or frontline nurses, docs—wherever you fit—you're part of a healing team."

That's fine for a major academic medical center in one of the nation's largest cities, which has far more resources than the average community hospital, but Feinberg takes care to mention that much of the work is commonsensical and that being attentive to the customer's needs doesn't cost much, if anything, and often leads to better, more coordinated care, and thus, a lower ultimate cost of care.

Anyone in a leadership position should be able to start with culture, anyway, says Steve Whitehurst, chief customer and strategy officer with BerylHealth, which consults with hospitals on patient experience.

"Of course, it all starts with the culture and leadership engagement," he says. "CEOs may talk about the patient experience, but if they don't drive this message down into the organization, it doesn't work."

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3 comments on "Creating Accountability for Patient Experience"


Sue Wintz, BCC (2/15/2012 at 12:14 PM)
Excellent article that states clearly that patient experience can't be measured only by focusing on numbers. As a board certified chaplain, when I am asked to see an "unhappy patient", what I hear from patients is a wide range of emotions, beliefs, and values that have not been addressed in their plan of care. Whether the room is clean or the transporter greets them with a smile doesn't replace the need for patient and family centered care that looks beyond superficial "fixes." As health care providers, we often forget in our routine work that the experience is new to our patients: they are fearful, anxious, trying to find meaning in their illness or injury and what lies ahead. The other issue that is key is the statement in the article: "We needed a culture of engaged and satisfied caregivers. If we don't get that, we don't get to any other level." I agree that there must be buy-in from leadership, however leadership needs to come to the clinical units, spend time with the staff and patients, and really understand the load that is placed on caregivers - from MDs and RNs down to housekeepers. Simply pronouncing that one more layer of expectations on already burdened staff isn't going to make the difference. Find out what it is that engages the workforce and what needs to be done to bring their level of satisfaction up. Chaplains often hear from staff that they, too, are wrestling in the midst of their workload to find meaning and a sense of respect for what they do. The experience of staff does matter when an organization is seeking to increase the satisfaction of their patients; one cannot be addressed without the other. Leadership: ask your chaplaincy staff about the importance of beliefs and values on both patient and staff experience. You will find valuable input.

Kristin Baird, RN, BSN, MHA (2/14/2012 at 9:07 AM)
Thanks for a great article. The real teeth behind a great patient experience is the culture which requires dedicated leadership and clear accountability. I often see healthcare leaders panicking about HCAHPS and then scurrying to enroll front line staff in "smile lessons." In this attempt to fix what's broken, they end up with a short term surge followed by a return to "business as usual." The examples you cite here demonstrate that it takes a compelling vision articulated by top leaders and driven by front line managers who hold staff accountable and know how to coach,mentor, model and manage for consistent service behaviors. That won't happen through sheer hope, it must be by design and without ever taking your eye off the ball. As for a definition - I ascribe to The Beryl Institute's which is - "the sum of all interactions, shaped by an organization's culture, that influence patient perceptions across the continuum of care."

Jason Wolf (2/13/2012 at 4:11 PM)
You pose an interesting challenge as it pertains to the patient experience. In speaking with leaders around the country your article captures some of the very keys we saw that can drive patient experience success. First and foremost is a DEFINITION. In working with healthcare leaders around the US they helped us define the patient experience as "the sum of all interactions, shaped by an organization's culture, that influence patient perceptions across the continuum of care". In fact, recent research from The Beryl Institute has shown that only 27% of healthcare leaders actually have a definition for patient experience. The key in the definition is as Dr. Merlino shares about the Cleveland Clinic experience or Dr. Feinberg talks about at UCLA, that the patient experience occurs at every potential encounter. More importantly it is grounded on the culture of an organization...the people, expected and accepted behaviors and the very way in which a healthcare organization engages with its patients and families. The last key in the definition is that patient experience is not just within the four walls of the clinical experience...but must be part of a systemic effort that starts well before the clinical encounter and continues well beyond its completion. Second, after definition, organizations need to consider a FOCUSED ROLE to drive patient experience efforts. Dr. Merlino serves at a senior level as the Chief Experience Officer for the Cleveland Clinic. While not everyone needs that title, having a senior level leader with not just accountability, but full ownership for the overall experience ensures greater success. Third, healthcare organizations need to recognize that experience is MORE THAN A SURVEY, teaching to the test only gets you good test scores, not necessarily powerful experiences. Lastly as your article suggests is the COMMITMENT OF LEADERSHIP. It may seem cliché to say it starts at the top, but the same study mentioned above revealed that the top driver of patient experience success, recognized by more than 72 percent of respondents, was strong, visible support from the top. Would love to know other's thoughts on these priorities as well as these research results.