Reigniting our Intention for Patient Experience Improvement

In just the last few days I had the privilege of spending time with the team at Cincinnati Children’s and then speaking with caregivers, staff, patients, family and community members as part of the Ontario Ministry of Health’s Central Local Health Integration Network Quality Symposium. While vastly different organizations and experiences that crossed an international border I was struck and even moved by the passion and commitment I see growing around the patient experience.

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This is no better exemplified then by the growth of our community at The Beryl Institute and the efforts that have been inspired by each of you. The dialogue on patient experience improvement is growing, not just due to surveys, or even at-risk dollars (though we would be mistaken not to acknowledge its influence). It is not just driven by shifts in policy or even an emerging consumer mindset that has brought the concept of personal choice to healthcare decision-making. We may best describe it instead, by the “perfect storm” of personal awareness, professional passion, and external influence all culminating in this moment. And this is your moment as an individual committed to patient experience improvement.

This culmination guides what we have been inspired to create through our community and in the coming weeks will make available to support this powerful intention. My hope as a servant for the needs of the over 20,000 members and guests of The Beryl Institute and the countless others committed to this movement is that we provide the framework, resources, learning and connections to foster continuous motion.

We start in just a few days with Patient Experience Conference 2014, a physical gathering to engage with one another in learning, sharing, challenging and inspiring efforts. It will be soon followed by Patient Experience Week, a new annual event, inspired by members of the Institute community, to celebrate healthcare staff impacting patient experience. Taking pause during this week provides a focused time for organizations to celebrate accomplishments, reenergize efforts and honor the people who impact patient experience everyday.

In the midst of these major events, are two dynamic resources designed to support the very intention I see burgeoning. The first, the release of the initial Patient Experience Body of Knowledge learning modules, brings this community effort guided by almost 500 voices to its next stage, in providing core learning for current and aspiring patient experience professionals. From this focus on practice we will also see a push for greater research with the launch of Patient Experience Journal (PXJ) and its Inaugural Issue bringing together the voices of academic and practical research from around the world to inform and even challenge our work.

In the weeks ahead, and in the weeks and months beyond, our task together must be to refresh, renew and reignite our intention through these and other efforts. The task at hand may be no simpler, yet never more complex. Your work as champions of patient experience is a relentless effort of doing what is right in every moment. Consider this a rallying cry in a month where powerful people and strong efforts will collide in great possibility. So what can you do about it? I offer:

  1. Acknowledge that whatever role you play, what every title you hold, whatever resources may be at your call, you are a leader for patient experience improvement.
  2. Recognize that complexity may be our greatest foe in dealing with what at its core is our commitment as human beings caring for human beings – keep it simple, that is where great power can be found.
  3. Commit to engaging others in your efforts – be it the voices of patients and families, the insights from community, the experiences of peers or colleagues. While at times it may feel lonely on this journey, know there are so many more carrying this passion with you.
  4. Focus relentlessly on where you can make a difference; the operative concept being there is a place that each and every one of you has a difference to make.
  5. Don’t let complacency be the enemy of your intention; yes there are now scores to earn, objectives to achieve, targets to shoot for, but don’t be afraid to do what you know is right in the end.

The team at Cincinnati Children’s reinforced what I have seen on many On the Road visits and the participants in Ontario exemplified it in their efforts. We all have a vested interest in improving patient experience – be it for ourselves, our loved-ones, our friends, or ourcommunities. This is a cause worth working towards and one in which I hope we will always remember the power of strong and true intention.

Jason. A. Wolf, Ph.D.
President
The Beryl Institute

How Will You Inspire the Patient Experience Movement? Four Considerations for 2014

InspiredI am inspired. The New Year has arrived with great energy at The Beryl Institute. We start 2014 as a global community of practice of over 20,000 professionals, focused without hesitation on ensuring the best in experience for patients, families and one another in healthcare.

I am inspired by the continued commitments expressed for this work: by The Beryl Institute’s Patient Experience Scholars who met recently to share their research and reinforce their willingness to encourage and support others; by the members of the Global Patient & Family Advisory Council who want to influence how patients and family members are heard and engaged in making a profound difference in healthcare; by the many contributing to the development of the Patient Experience Body of Knowledge courses soon to be available to the community; and by many more.

I am inspired by how in the first two weeks of a new year, such commitment and intent can emerge, built on all that has come before and focused with purpose on the great opportunities ahead. As I reflect on this idea, a question emerged and perhaps a challenge for each of us to consider:

How will you inspire the patient experience movement in the year ahead?

I pose this question with the hope that actions and considerations from the smallest moments of unparalleled kindness to the largest strategic triumphs all find room to take root and grow. Inspiration comes in all shapes and sizes, but in this diversity it has strong commonalities – it causes us to feel a sense of something special and powerful. It provides a boundless energy to influence, lead, change and make a difference. This is an exciting prospect in seeing that each of us can choose to have an impact. And while no two actions will be exactly alike, I do want to offer a few thoughts on how you can continue to frame your patient experience efforts to inspire yourself and others.

As we return to the definition of patient experience, I continue to experience its relevance time-and-time again in the application of these words to central actions associated with excellence. In reviewing its words – the sum of all interactions, shaped by an organization’s culture, that influence patient perceptions, across the continuum of care – I again see clear directions on moving your own experience efforts forward. They include:

1. Reinforce strategic focus. Patient experience has proven itself to be a relevant part of the healthcare conversation. It has surpassed the challenges of being dubbed a fad; it too has shown it has stronger legs than just serving as a policy framework. Experience is a central strategic pillar to organizational performance and success. Patient Experience in its broadest sense should be a clear and transparent component of every healthcare organization’s strategy.

2. Clarify and map your critical interactions. Experience doesn’t happen on billboards or in espoused actions, it happens at the most personal moments, at those points of engagement between one individual and another. The ultimate tool in patient experience improvement is your self, your heart, your hands and arms, your minds, your compassion and your common sense. We have a huge opportunity to map the interactions that occur on the patient path to ensure we consider the most effective way to respond at every touch point.

3. Model desired behaviors. Simply put, if interactions drive experience, then the behaviors that comprise them are the conduits that direct these interactions in one way or another. Organizational culture is shaped by behaviors, they represent the people, presence and purpose of an organization overall and no slogan, policy or program will trump the power of individual behavior. We must model, observe, coach and improve constantly to impact experience outcomes.

4. Expand your listening. As we ended 2013 exploring the Voices of Measurement, we learned that the power of data is only as valid as what we choose to do with it. Collection or reporting data for the sake of data misses the opportunity for learning and relevant action. To capitalize on the value of the voices that surround us in healthcare we must expand our listening. Experience is measured first in the direct voices of healthcare consumers, who remain our most significant mirror into our own efforts, but it is also found in the voices of our peers and colleagues. We are only capable of achieving our strategy through our people. They are much more than pawns to direct, but rather living resources accountable for ensuring excellence.

Perhaps these ideas will help spark your own thoughts on how you will choose to inspire the patient experience movement. Regardless of which direction you go, I hope you recognize the power that exists in your own personal choice and the ability to impact the experience of the person that is coming next. The year ahead can and should be about a great many things both personally and professionally. My hope is that you find you can and will be an inspiration in your efforts. This cause is too great for your efforts to be anything less. Now the question remains, what will you do? I look forward to your updates with great anticipation.

Jason A. Wolf, Ph.D.
President
The Beryl Institute

The Conversation on Patient Experience Improvement Continues: A Reflection on Three Years

Most people would suggest that change doesn’t happen overnight, and while I believe change does take time, it does not need to take a lot of time. In fact, change, like most things in life, requires nothing more complicated than a simple choice. It is this same idea – the power of choice – that I use to frame all my discussions on patient experience improvement.

I share this idea of choice and change on the week that The Beryl Institute itself turns three years old. As we have seen the patient experience movement grow and flourish, it too has been a journey of change and choice. From the very first member signing on in September 2010, to the now over 18,000 members and guests from 45 countries around the world, The Beryl Institute community has made big choices and as a result driven big change.
Over the course of the last few years I have written about engagement, involvement and community and I am excited to say that the state of The Beryl Institute community is strong. We have seen a growing use of thedefinition of patient experience. We have also experienced almost a doubling in organizations having a formal definition of patient experience (something we stress as critical) as revealed in the 2013 State of Patient Experience study and represented in the recent powerful infographic of the findings. We have also been inspired by the growing “#IMPX” movement with increasing numbers of organizations creating compelling videos of their teams reinforcing the message – “I am the Patient Experience”!

At the Institute, we have also worked hard to ensure all voices are engaged in the conversation on patient experience improvement. We have authored an extensive series of publications to be a resource to all those working to impact the patient experience – from the C-Suiteto the front lines from students to patient and family members. This effort has been expanded by the launch of the first of its kind Global Patient and Family Advisory Council to ensure this critical perspective is central to all we do. It has been supported by not only our virtual community connections, but also the consistently growing annual Patient Experience Conference providing practitioners the space to reconnect and reenergize every year.

In shaping the knowledge and information base for patient experience improvement, we have led the effort to create a comprehensive body of knowledge focused on developing patient experience leadership now and into the future and guided by the input of over 400 healthcare leaders around the world. We have also awarded over 25 patient experience grants to support direct research projects on patient experience improvement where it is taking place – on the front lines. Most recently we have announced the launch of The Patient Experience Journal, a multidisciplinary, peer-reviewed publication designed to share ideas and research, and reinforce key concepts that impact the experience of patients and families across healthcare settings.

The full history of the Institute is rich, but more importantly it exemplifies the very power of choice and of community I mention above. It was the choices of so many that made these offerings and resources possible. It will be the continued contributions of community members that will maintain this growth and drive the patient experience movement forward. These choices have led to great change and our hope is to continue to support this growth by providing a gathering place for ideas, a dynamic space for interaction and a vibrant hub for continued dialogue on patient experience improvement. We have arrived at this point with the guidance, leadership and support of so many around the globe…for this we are forever grateful. We now humbly go forth knowing there is much more work left to do. Happy Anniversary to you, this passionate and engaged community. We celebrate how far we have come together and look forward to continuing this journey with you!

Jason A. Wolf, Ph.D.
President
The Beryl Institute

The Power of Expectations: A Thought for the New Year

Expectations are powerful. They influence what we see, how we act, and the way we react. They stir emotions and create real feelings from joy to anger, surprise to sadness. The reality of expectations is that they present an intriguing paradox in how they can and do influence the situations in which we find ourselves. Expectations are an individual and even very personal experience, yet at the same time they can be set by organizations, businesses and other people outside of one’s self. This makes expectation potentially the most valuable and perhaps most precarious tool in the discussion of consumer experience and in healthcare, the patient experience.

The example of how personal expectations can modify the perception of reality has long been part of the healthcare world. As Chris Berdik notes in his new book, Mind over Mind, the power of expectations lies at the center of the placebo effect. Berdik makes a compelling case that what we expect from the world changes how we experience it. He notes that research into placebos is expanding to examine everything that affects a patient’s expectations for treatment, including how caregivers talk and act and even the impact of the wealth of online information now available – and how those expectations can help or hinder healing. I believe the same is true as we look at the overall healthcare experience. Patients and families come with personal expectations and more often with ones that healthcare organizations worked to create. It is these very expectations that impact how individuals experience an organization and ultimately rate its performance overall.

I can share a non-healthcare example of this from just this past week. My wife and I had the chance to take a few days away for the holidays at a small inn near our home. We had heard great things about the service and quality of the experience and were excited by some of the extra amenities they offered. When we arrived we discovered our room was the only one missing the special amenities they touted in their promotions, and while the service was impeccable, this missed expectation had already impacted our experience. The hotel did all they could to accommodate and provide service recovery for our experience. To an extent they even exceeded what we would have anticipated in response, but it was the missed expectation that still lingered for us as guests.

Now imagine in the healthcare setting where our patients and families come with their own set of anticipations and clear expectations. Most do not choose to visit, but rather are dealing with illness or other issues that may be cause for great concern and even fear. They come with expectations of how they will be treated, but even more significantly they come to your doors with the expectations your organization has set through the stories shared and the messages disseminated via advertising or other means.

I saw an example of this at a recent hospital I visited. They were so proud of their new facilities, including new amenities, private rooms, etc. The advertisements and billboards they produced promoted the newness of the hospital. Yet, they still also had an older wing, where the rooms were dated, semi-private and lacked the sparkle and shine of the newer rooms. While the patient experience of the facility was not designed to be about the physical nature of the buildings, but rather the encounter people have with staff, they set the expectations publically that the facility itself was at the heart of their overall experience. In essence, they set expectations they could not always fulfill…and it set up the potential for disappointment before they even had the chance to make an impact.

The lesson here is simple, yet significant and one I think is critical to looking at the year ahead. For as much as we can control our efforts in healthcare, we must work to set the best and most realistic expectations we can for our patients and families. This is not what I have heard some describe as lowering expectations to outperform, but rather it is about setting the right expectations for what you want to deliver in your own organization and ensuring the means – both in resources and process – to deliver on it.

In maintaining a focus on providing a positive patient experience, consider starting the year by identifying the expectations you hope to deliver, ensuring your leadership and staff are aware of these touted expectations and establish a process to check your performance to these expectations at every point in the care experience. While you cannot dictate every expectation people bring with them to your doors, healthcare organizations can shape their own story in a way that ensures expectations are realized and the patient experience is one that will always be remembered. Wishing you fulfilled and exceeded expectations for the year ahead!

Jason A. Wolf, Ph.D.
Executive Director
The Beryl Institute

Engagement: A Cornerstone of an Unparalleled Patient Experience

Over the last decade, engagement has been a consistently evolving strategic management term, first from the perspective of employees and more recently in healthcare with a line of sight on patients and families. In the simplest of terms, I see engagement as the involvement that someone has in a process or effort. Common discourse has had it tend to the positive by asserting employee engagement is a desired state versus just an action or behavior. Recent research (Shuck and Wollard, 2009) on the term employee engagement noted that with its rapid increase in use the definition of engagement has become muddied. Yet across the descriptions of this phenomenon there was consistency in describing engagement as a personal decision (not an organizational one) and one grounded in individual behaviors (as they relate to organizational goals).

This has significant implications for both employee and patient engagement.  In the end it is about creating the environment in which individuals can choose to actively engage. Organizations cannot create engagement. Rather they can create the environment and reinforce the behaviors in which engagement can grow and thrive. This has significant implications for our work in healthcare overall.

Some have said that patient engagement is the latest buzzword for how we work to involve patients and families in the overall care experience. As a concept it has ties to safety and quality and links to the discussions on the application of meaningful use. Patient engagement is focused on ensuring patients take actions in order to obtain the greatest benefits of the healthcare services available to them.

The Nursing Alliance for Quality Care (NAQC) has deemed patient engagement “a critical cornerstone of patient safety and quality”. Their efforts have outlined a comprehensive set of nine principles to consider when engaging patients in their care. They stress “the primary importance of relationships” between patients, families and providers of care as key to effective engagement overall. This work stresses the foundation of relationship and partnership as central to the care experience.

These ideas are essential elements in how we identify experience overall at The Beryl Institute. At the very heart of the definition of patient experience is every interaction that occurs between a patient, family and the healthcare system in which they find themselves, from the deepest of relationships to the briefest of encounters. I believe we need to consider engagement more broadly and link its contributing values to the cornerstones of quality, safety and service. Together, quality, safety, engagement and service establish the legs on which the most comprehensive and positive patient experience can be built.

The same perspective can be taken when looking at the employee aspect of engagement. If engaging employees is around the behaviors of individuals that contribute to the goals of an organization, there is truly one means by which we can influence this action – the culture on which we build our very organizational existence. This leads us again to how we define experience at The Beryl Institute.

In reinforcing that the patient experience is “the sum of all interactions”, as we noted above, “based on an organization’s culture”, then healthcare organizations must have a strong commitment to not only create a positive environment for our patients and families, but one that supports the efforts of our staff, employees, and associates as well. In my travels to hospitals on behalf of the Institute both in the U.S. and abroad, I am continuously reminded that there is great power in the culture of an organization to drive excellence in experience. It is the foundation on which care givers and those that support them act and it shapes the environment in which care is delivered.

In considering engagement, I encourage us to move beyond the concept as a “nice to have” in our organizations, to a “must have” if we are to provide the best experience for patients and families alike.  Engagement is not what we directly create, it is the result of doing the rest right – of creating vibrant and supportive cultures of service, quality and safety – of care at the highest order at every touch point across the continuum of care. If we do so and do so well we ensure the greatest of perceptions from our patients and the unparalleled experience we would want for our families and ourselves and we know they undoubtedly deserve.

Jason A. Wolf, Ph.D.
Executive Director
The Beryl Institute

Regardless of U.S. Supreme Court Decision, Patient Experience is Central to the Future of Healthcare

One question I was consistently asked in anticipation of last week’s U.S. Supreme Court decision was what impact the outcome would have on the importance of patient experience. My response was unwavering; that if healthcare organizations are simply driven by policy or perceived political pressure they might want to reconsider their true purpose and very existence. Regardless of the outcome of last week’s decision, I believe the increasing focus on experience in healthcare is more than practical or pragmatic; it is central to the highest quality healthcare encounter.

This week I was posed the question again during a workshop I had the privilege of leading titled Shaping Healthcare Experience: The Power of Interaction. The audience included healthcare and service professionals from across Europe. The discussions that were ignited and the passion with which the participants engaged in the subject supported my belief that the effort to achieve excellence in patient experience is not simply a phenomenon in the United States or one simply driven by policy. This is also reinforced by the fact that over 23 countries are represented as members and guests of The Beryl Institute itself. Patient experience is a without question a fundamental and global discussion.

Whether it is global perspective or political or policy motivations, those of us engaged in healthcare in whatever capacity need to consider the impact of our work on the experience of patients and families. As I discussed in my workshop, we are all touched by healthcare in some way either directly or indirectly through family or friends. More so we are aware of not just the outcomes, but also the stories we take from those encounters. Those stories are comprised of powerful and important interactions – as suggested by the Institute’s definition of patient experience as “the sum of all interactions…” In the workshop I posed the question of which interactions are most important in the healthcare encounter. After a long brainstorming effort the realization was that every interaction from the most critical clinical interventions to the almost unnoticeable or mundane encounters collectively equate to the experience people have and all are equally important.

At their core, each of those interactions is about a choice. As healthcare organizations you choose how to structure processes or determine what behaviors and expectations to establish and reinforce. With this, healthcare organizations are also held to the individual choices their people make at every touch point across the care continuum. It is here where you may be making things more complicated then necessary. By focusing on policy or political constraints you overlook the simplest of human factors; that people most often want to do the right thing. What must be done as leaders is to provide the support, the environment, the culture in which the right choices can be made, the right interactions provided and the best of experiences ensured.

I hope we can shift the discussion on experience from “why” and “what”, from policy or politics, to understanding there is a fundamental choice to provide the best experience possible for our patients, families and guests. In the desire to engineer this process we overlook the basic fact that healthcare at its core is human beings caring for human beings. In recognizing this, you ensure patient experience is a central and driving force to a continuously improving global healthcare system. It just starts with a simple choice.

Jason A. Wolf, Ph.D.
Executive Director
The Beryl Institute

Whose experience is it anyway?

During two of my recent On the Road visits (one with Children’s National Medical Center and another for an upcoming story on Banner Health) what I observed and what came up in conversation caused me to pause and ask the question – whose experience is it anyway?

In one example, Kelli Shepherd, the Director of Service Excellence at Banner Good Samaritan Hospital, shared a subtle, but profound change in the language they were using. The shift was one in perspective – from “our” beds to “their” beds. A simple change, but one I believe challenges one of the central mental models I have seen in healthcare. We have often viewed patients as individuals that things are done TO, not necessarily done FOR.

I would not say we have turned healthcare into a heartless, mechanical process. Rather, I caution that what we may have done in not recognizing “ours” versus “theirs” is to design processes and systems and implement requirements and standards made to work best for us, not our patients and families. So what can we do to address this?

1. Clarify perspective. Are we building our programs, and even our patient experience efforts, from what we believe will best fit our needs? Or are we considering the perspective of patients and families as our guests? Stop and ask yourself, especially as you consider developing your patient experience effort, if the process is based on what is easiest for you or what is best for the patient?

2. Build an active process to engage patients, families and the community at large in how we can provide the best experience possible. Many organizations are now using patient focus groups not only to gather feedback post experience, but also to design processes and programs. At Children’s National, Patient Family Advisory Council members are embedded in many departments. They review and offer feedback on processes and provide an open avenue to ensure a broader perspective is available in all planning; they have even participated in the redesign of units.

3. Find ways to show you “listened”. The biggest return on experience investment is ensuring that patients and families not only feel heard in the moment, but also that the experience they are having overall reflects their wants and needs. Find avenues to show you are listening; be transparent about the input you seek and when and how you can (or cannot) use it.

As many of us in healthcare call hospitals the “house”, we must acknowledge that we are welcoming patients and their families into “our” house as guests. Our efforts should be focused on ensuring we provide the best experience possible. To do so we must recognize whose experience it is in the first place.

Jason. A Wolf, Ph.D.
Executive Director
The Beryl Institute

The Power of Interaction: You are the Patient Experience

In looking back at 2011, I have touched on a cross-section of topics on the patient experience – from service excellence and anticipation to value-based purchasing and bottom line impact. This year has led us to heightened awareness of the impact performance scores will have on dollars realized and increasing recognition that the patient experience is a priority with staying power. The Beryl Institute’s benchmarking study, The State of Patient Experience in American Hospitals, revealed both the great intentions and significant challenges that are at hand in addressing the critical issue of patient experience.

Our research supports, and I fundamentally believe, that there is a need for a dedicated and focused patient experience leader in every healthcare organization. Yet in the midst of all this attention, we may have overlooked the most important component – the immense power, significant impact and immeasurable value of a single interaction.

What does this mean? Interaction is simply defined as a mutual or reciprocal action or influence. The key is mutual action; something that occurs directly between two individuals. No interaction is the same, but it requires a choice by both parties to engage and respond as they best see fit. In healthcare settings, be it hospitals, medical offices, surgery centers or outpatient clinics, there are countless interactions every day. The question is: are they taken for granted as situations that just occur or are they seen as significant opportunities to impact experience? Perhaps in thinking about experience as a bigger issue, the importance of these moments of personal relationship has been missed.

What this means for improving the patient experience may be simple. Rather than waiting for that one leader to build the right plan or for your culture to develop in just the right way, you each instead recognize one key fact – you are the patient experience. I acknowledge there is a need for a strong leader and a solid cultural foundation on which to build, but at its core patient experience is about what each and every individual chooses to do at the most intimate moment of interaction. If these moments are used as the building blocks to achieve our greatest of intentions, patient experience will be the better for it. As you look to next year, whether you sweep the floors or sit in the c-suite, the choice should be clear. In today’s chaotic world of healthcare, the greatest moment of impact may be in the smallest of encounters. It is here that the most significant successes be they for scores, dollars or care will be realized. Happy holidays to you all!

Jason A. Wolf, Ph.D.
Executive Director
The Beryl Institute

The Smart Thing to Do: Patient Experience and the Bottom Line

Most now agree that patient experience is not just a nice to do, it is a must do. The idea of patient experience has recently taken on greater significance, first, through the emergence of surveys such as HCAHPS that make performance transparent and followed by the reality that reimbursement dollars, performance pay and compensation are being tied to outcomes through policy being implemented around the world. Improving the patient experience is also what is right to do. It is about providing the type of care experience for patients and families that you would want for yourself and your loved ones.

But recognizing patient experience as both a must do and a right to do, is not enough. It should also be addressed as the smart thing to do. Why? The patient experience has true financial implications for healthcare organizations that reach well beyond regulations. With all that is done to address patient experience from the cultural, organizational and process sides, we also need to consider its financial implications. This is perhaps the area that patient experience champions have focused on the least, but could have the most significant impact in making the case for the important work being done.

Patient experience influences the performance of healthcare organizations on a number of fronts. In The Beryl Institute’s newest white paper, Return on Service: The Financial Impact of Patient Experience, three perspectives are suggested as we look at the bottom line impact of the patient experience: financial, marketing and clinical.

  • From the financial perspective, it has been shown that satisfied patients lead to higher profitability. In a 2008 J.D. Power study, it was discovered that hospitals scoring in the top quartile in satisfaction had over two times the margin of those at the bottom. These findings were supported by the 2008 Press Ganey paper, Return on Investment: Increasing Profitability by Improving Patient Satisfaction. The paper revealed that when hospitals were ranked by profitability into quartiles, the most profitable hospitals had the highest average satisfaction scores.
  • From the marketing perspective, we need to look no further than the power of word of mouth. In her 2004 article, Jacqueline Zimowski shared that a satisfied patient tells three other people about a positive experience.  In contrast, a dissatisfied patient tells up to 25 others about a negative experience.  The issue worsens, as for every patient that complains, there are 20 other dissatisfied patients that do not. And of those dissatisfied patients that don’t complain, only 1 in 10 will return. When you run the numbers, for every complaint you hear, you could be losing a potential 18 patients. In essence by not focusing on experience we are potentially driving patients away.
  • From the clinical perspective, we must be clear to recognize that experience and quality are not distinct efforts but critically interwoven aspects of overall care. Patient Experience is not just about pretty or quiet environments, positive service scripting or even consistent rounding. At the end of the day it is about ensuring our patients leave better than when they arrived (as often as we can). This was exemplified in a powerful way in the 2011 study, Relationship Between Patient Satisfaction with Inpatient Care and Hospital Readmission Within 30 Days, reported by Boulding et al. They examined quality factors (as defined by CMS Core Measures, specifically on acute myocardial infarction, heart failure, and pneumonia) and satisfaction factors (as determined by the two HCAHPS questions – How do you rate the hospital overall? and Would you recommend the hospital to friends and family?) in relationship to readmission rates within 30 days of discharge. The finding was surprising. The HCAHPS scores, i.e. experience outcomes, were reliable and even more predictable indicators of readmissions than quality indicators. In essence, patient experience, herein measured by HCAHPS was a distinct and measurable driver of readmissions, a key quality issue and a significant financial issue for healthcare organizations and one taking on even greater interest as it will impact future reimbursements that hospitals are eligible to receive.

As healthcare leaders take on the challenge of patient experience, it is important to recognize that it reaches well beyond simple measures of satisfaction. A commitment to patient experience has significant and measurable impact, not only in doing what is right for the people and communities you serve, but also in ensuring the best quality and most financially sound experience for all who are in and who deliver your care. To be responsible stewards for healthcare systems that are both vital and viable, it is essential to recognize and be willing to address the bottom line issues influenced by patient experience efforts every day. It is the smart thing to do!

Jason. A. Wolf, Ph.D.
Executive Director
The Beryl Institute

Value-Based Purchasing is Underway…How Will You Distinguish Yourself?

I would not be the first to express concern if the only motivating factor for a healthcare organization or system to address the patient experience was due to the pending threat of reduced reimbursement connected to Value-Based Purchasing (VBP). Yet, I can also say that the attention this possibility has brought to the cause for how patients are engaged in the healthcare setting is also warmly welcomed. Managing this juxtaposition of feelings is what I find many organizations are now struggling with in addressing their patient experience efforts.

Many leaders accountable for improving patient experience outcomes are both supported by this elevated attention to policy, but also challenged by its parameters. Through the use of the measures incorporated in VBP one path for addressing the issue of service is seemingly set out. Succeed in certain domains of the HCAHPS assessment and you have a better chance of getting more of your withheld reimbursement dollars. (While I will not get into the full details of VBP, you can read more here.)

This sets up an interesting game of sorts in which many have seemingly begun to focus completely on the test (performance on the HCAHPS domains). This is not an impractical route to take (in fact we at The Beryl Institute are launching a series of interactive dialogues for members on these very topics), except that every other hospital aware of the ramifications of inaction are at least doing the same thing. The dilemma this poses is that if reimbursement through VBP is based on comparative measures to your peer organizations and everyone is prepping for the same test, what are you going to do to distinguish yourself?

Month one of the initial nine-month performance period is complete. In essence, the first inning is over and the question this raises is what have you done to move beyond simply increasing performance on the key HCAHPS domains? (Note I said moving beyond, not overlooking.) We have suggested, along with many others, that patient experience success is grounded in broader cultural improvements, in engaging your workforce in positive solutions and in finding new and powerful ways to involve patients in your delivery of service, before, during and after care. At the Institute we have gone as far as to suggest you need to consider such components of your patient experience process, from people’s first encounter with you through a scheduling experience to their post clinical interactions when dealing with the revenue cycle and collection process. It also encompasses the programs you initiate such as Patient and Family Councils, the processes you implement such as experience mapping or the important considerations you give to cultural competence.

While the domains being tested and tied to VBP drive you to look at internal issues, it is important to recognize that the respondents to these surveys – the patients and their families – are assessing you on encounters well beyond their clinical experience at the bedside. With that you still have an opportunity to distinguish yourself. Take some time to examine the results you have achieved so far and consider areas in which you can create broader opportunities for patient experience impact. You will find that by in engaging beyond the test, you can achieve even stronger and lasting results.

Jason A. Wolf
Executive Director
The Beryl Institute