Despite what you think, patients aren't really rating you on whether you 'always' communicated well with them or 'always' controlled their pain well. Ultimately, they're rating you on whether they got better.
It may not be fair, a Carilion Clinic senior executive says, but outcomes are how patients ultimately judge your organization, and that judgment will eventually be reflected in your patient experience scores.
Of course, outcomes are often not in the direct control of the hospital, clinicians, or other employees. Nevertheless, your patient experience scores will most closely track whether patients, following their hospital visit or visits, are still able to do what they were able to do prior to their hospitalization.
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Why? For one, the simple reason of survey bias. Those who have good outcomes are coming back less often than those who have bad ones, generally. That may ultimately skew results. But the main reason is even simpler.
Steve Arner |
"We do lots right, but if they go home and they can't do what they used to do, they're not satisfied," says Steve Arner, senior vice president at seven-hospital Carilion Clinic and president and chief operating officer of Carilion Roanoke Memorial Hospital, the system's 703-bed flagship. "When we think about making sure people have the right outcomes, we have to think about what that means to the whole person."
What it means to hospitals and health systems whose revenue (not to mention the fulfillment of their healing missions) depends at least in part on patient satisfaction, is that they need a better way to gauge how they are doing at improving the chances of good health outcomes of the patients in their care.
Some organizations, by contrast, are probably paying too much attention to how they can improve performance on the multitude of narrow areas patients are asked to score in patient experience surveys. Patient experience is more than box-checking though. It's a reflection of an accumulation of experiences.
Focusing on the questions in a vacuum can lead to a misapplication of talent and resources if organizations aren't cognizant of the importance of the overall holistic goal—restoring patients to health. Restoring patients to complete health can't always be done—we're all going to die after all—but regardless, it's how patients will rate your organization, and working toward a goal of health restoration, somewhat paradoxically, can lead to better performance on those darn surveys.
A Shift in Thinking
Another problem with focusing on the questions themselves and on patients' responses to them is that by the time you get the results, they are weeks or months old—ancient history.
That's unacceptable latency in a customer-service sense, says Arner, who adds that that's how hospitals and health systems should increasingly view themselves—as customer service organizations. A shift in thinking is required.
"It's frustrating to not be able to give and receive real-time feedback to what's going on," says Arner. "If it's later, there's no self-interest for the patient, and staff can't do much with it either. We need rapid cycle improvement and real time feedback and service recovery while the patient is still here."
The health system wanted to think about patient experience differently, in that it's a service issue, not an issue with whether patients would check off the right boxes in a survey. Also, says Kathleen Baudrau, Carilion Clinic's senior director of nursing quality, relationships between clinicians, hospitals and patients can't be pedantic anymore. Instead, they need to encourage patient and family participation in developing a care plan for after discharge.
"We were purposeful in calling it 'interactive patient care,'" says Baudrau. "That helped our team think about it differently."
To better execute on that vision, a technology-based platform was a must. It would be critical to improve patient health literacy, to provide a tool for patients and family members to watch videos about medication administration, for example, and learn more information about their diagnosis—information pre-vetted by the clinicians on Carilion's own staff.
"We wondered how well we could engage them in their own self-care, and whether quality and patient safety could be improved through this philosophy," says Baudrau.
The technological solution Carilion's leaders ultimately chose helps patients and families not only with their immediate needs for comfort while in the hospital, but more importantly, can help the hospital improve the patient's post-discharge care pathway to ensure the best chance at the good outcome they're shooting for.
Tech Help
"A challenge is that when our unit directors get HCAHPS results, those results are anonymous, and they lag, so if a score is not good in one area, there's nothing actionable," says Baudrau. "With this system, they can identify a measure they need to move and can ask a daily question, approved by CMS, to allow them to follow up on patient responses. That often allows for real time service recovery."
In September 2014, Carilion installed tablet-based equipment at the patient's bedside that uses information from GetWellNetwork to help coordinate care, vet, and standardize clinical information and interactions, and compile performance measures in real time. It's integrated into the patient stay. Patients and their families use it for everything from ordering food to developing a care plan for post-discharge and medication education and reconciliation, among other tools for both patient and staff. They can use it post-discharge too.
"We've always said we have patient-centered care, but this is a paradigm shift from the old hierarchical or pedantic relationship," says Baudrau. "It's a shift not only for the clinicians, but also for the patients and families. With today's shorter stays, we don't have them very long and a lot of this has to happen in the [physician] office and at home. When we provide the information using the network we have a library that is evidence-based and clinicians here vet this information so that they agree with and understand the information they're getting."
One key advantage from an operational perspective, Arner says, is that the system allows for real-time service recovery and doesn't rely on the imprecise messages HCAHPS surveys convey.
"We can follow up immediately and trend and track," he says. "It used to be you would try something and six to seven months later, you would see that measure tick up, but you were not really sure if it was because of what you did because of the time lag," he says. "Also, with 700 beds, we might have had good compliance in one unit, but not in another and we wouldn't know it for months."
Philip Betbeze is the senior leadership editor at HealthLeaders.