How Norris Cotton Cancer Center Achieves Excellent Patient Experience

Dartmouth-Hitchcock Health's cancer center has scored at or above the 95^th percentile for patient experience by Press Ganey.

For the second year in a row, Dartmouth and Dartmouth-Hitchcock's Norris Cotton Cancer Center has received a national award for exceptional patient experience.

Patient experience is a crucial element in patient-centered care. Key components of patient experience include timely appointments, easy access to information, and good communication with healthcare providers, according to the Agency for Healthcare Research and Quality.

Norris Cotton Cancer Center, which has its main campus in Lebanon, New Hampshire, and five satellite facilities in New Hampshire and Vermont, has earned the Press Ganey Pinnacle of Excellence Award for patient experience for the second year in a row. "To earn that recognition, we had to compete with healthcare institutions nationally—not just cancer centers. Winning the Press Ganey Pinnacle of Excellence Award means that over a three-year period our cancer center scored at or above the 95^th percentile in patient experience," says Steven Leach, director of the cancer center.

Norris Cotton Cancer Center excels in several facets of patient experience, he says. "One of the big things we stress is responsiveness—responding to patients as quickly as we can. We let them know that we have their information, that we have them in our electronic health record system, and that we are in the process of scheduling their appointment. Access is important. We have a target to see patients as quickly as possible after diagnosis."

Effective communication with patients is a top priority at the cancer center, Leach says.

"It is important to give our patients an opportunity to communicate. We have several tools that we provide to our patients to help them tell us what matters most to them. For example, we are in the process of rolling out a new digital app called Patient Wisdom, where our patients can pre-populate information about them before a visit. They can share who they are, who their loved ones are, what they do for a living, and what they do for fun. They can share what matters most to them and what they want their visit to focus on. With Patient Wisdom, our physicians and nurses have access to this information, when they walk into the exam room, on a tablet. They literally have in their hands what the patient wants them to know," he says.

The cancer center provides patients with easy access to care, Leach says.

"Another way that we generate a good patient experience at the Norris Cotton Cancer Center is we provide care close to where patients live at one of our six cancer center sites in New Hampshire and Vermont. For many patients, the patient experience also involves having convenient access to multidisciplinary teams. They don't have to drive to one office to see a medical oncologist then drive to another office to see a surgical oncologist. We offer one-stop shopping under one roof," he says.

The cancer center offers many support services, Leach says.

"We also provide extensive patient and family support services that range from disease-specific support groups, to art therapy, to music therapy, to massage therapy, to a whole host of classes, including meditation and cooking. We offer classes in creative writing to help our patients express their ideas and help find their own meaning in what they are going through. In the disease-specific support groups, patients can tap into the collective experience of both fellow patients currently being treated and cancer survivors," he says.

Patients are deeply involved in their care at the Norris Cotton Cancer Center, Leach says.

"We pride ourselves in co-producing a patient's care with the patient and their family. This idea of co-production is that an optimal clinical experience does not involve a unidirectional transfer of information from a physician or a nurse to a patient. Rather, the transfer of information is bidirectional. The real expert in the room regarding the patient's needs and best interest is the patient. So, we listen to our patients," he says.

Measuring patient experience

The cancer center monitors patient experience, Leach says. "We track several metrics for patient experience. Some of them are just simple questions. 'How satisfied are you with your care?' 'Would you recommend our cancer center to a friend or family member?' 'Were you treated as an individual?' Those are the kind of questions that populate our patient experience questionnaires."

Patient experience at the cancer center is also reflected in demand for services and assessments by national organizations, he says. "Part of patient experience is measured in ongoing demand for our services. Reputationally, we rank very high in measures such as the US News & World Report survey. We recently were accredited by the American College of Surgeons Commission on Cancer. Those national surveys and accreditations are based on objective metrics that include patient outcomes and delivery of safe care."

Impact of coronavirus pandemic on patient experience

The pandemic has had significant impacts on patient experience at the cancer center, Leach says.

"There have been periods when we have not been able to invite family members to be in the room with their loved one during visits with the oncologists. Sometimes, that was just heartbreaking, but it was the right thing to do to keep our patients, their family members, and our clinical teams safe. We still have a limited number of visitors, which can be challenging. We also had to switch our entire program of patient and family support services to a virtual format. For more than a year, all of our offerings such as yoga classes, meditation classes, and sessions for music therapy and art therapy were converted to a virtual, Zoom format."

Workforce shortages linked to the pandemic have also affected patient experience at the cancer center, he says. "COVID has led to upheaval in the clinical workforce in healthcare. We are struggling with staffing issues. If not managed appropriately, that can have a negative impact on the patient experience."