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Creating Accountability for Patient Experience

Philip Betbeze, for HealthLeaders Media, February 13, 2012
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He says that's a great way to begin a discussion about HCAHPS not being the final arbiter of patient experience or quality, "because it's a great measure of 'always.' If my mom was getting care, do I want her to say that someone ‘always' did this or that—whatever question is being asked—or that her nurse was compassionate and took good care of her?"

He says he sees a lot of working to the test and toward obtaining the "always" answer.

"When you put them to a test that requires an ‘always' answer, it doesn't give them any opportunity to impact the patient experience," he says. "I don't believe a lot of hospitals are going past HCAHPS scores. About 20% are doing it because there's a penalty associated with it, and most of the rest are lagging and not doing anything about it."

UCLA's Feinberg says, without a hint of hyperbole, that from a leadership standpoint, patient experience is his "singular focus."

He practices what he preaches by rounding on patients for a couple of hours each day, and he makes it clear that he expects his management team to do so as well, if not to his extent from a time standpoint. He insists that everything else should be subordinate to what he calls a "laser focus on making sure the next patient gets that best care."

When others, including patients, see examples of great care through actions or patient referral, he makes a point of celebrating it, making sure the individual who exceeded expectations gets the credit.

"When we fail, we share that broadly as well," he adds. He encourages the staff—anyone who comes in contact with a patient—to probe patients and their families to "see where we messed up," he says. "I give out meal coupons and Starbucks coupons. We're pretty service minded."

He says service recovery, in the form of responding when things go wrong, is key to retaining patients over the long term, and that's what he's most concerned about—test scores are only one way of measuring how well they are meeting that goal.

"We're clearly far from perfect, but when those things happen, we're aggressive in seeing if we can make amends," he says.

Every unit, every shift, huddles around metrics and reviews handwritten notes as well as current HCAHPS scores and core measures scores. That kind of daily reinforcement helps tie workers more closely not only to how to recover from mistakes, but also to the patient's needs, refocusing them on what's most important.

"The best thing we've ever done to improve employee satisfaction is not to focus on it. Rather, we've focused on patient satisfaction," says Feinberg. "People here want to take care of others. If we're doing that, they're more satisfied in their jobs. I don't care if we ever become an employer of choice. We want to be a place that patients choose. If you get it right for the patient, your employees are happy, because their job is easier and you've tapped into their purpose."


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


Philip Betbeze is senior leadership editor with HealthLeaders Media.
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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.