Monday, September 8, 2014

Patient Experience And Patient Satisfaction: Nine Things Hospitals, Healthcare Get Wrong

The more that patient satisfaction and the patient experience come to the foreground in healthcare, the more often I see these concepts misunderstood, thought of as undue obligations, and/or gone about entirely the wrong way. Here is some straight talk about patient experience and patient satisfaction I find myself emphasizing often (as a consultant and speaker) in hospitals and other healthcare environments. Patient satisfaction isn't the enemy of medical outcomes.  Done right, the work you do on patient satisfaction, on improving the patient experience, improves medical outcomes as well.  In the hospital, and upon discharge. This should be obvious, but our ingrained conception of win/lose, zero-sum gets in the way of seeing this clearly.  A good night’s sleep - nurses coming when you need them without making you suffer in agony -scheduling that is prompt and makes sense - physicians involving the patient and family in treatment and follow-up: Of course these improve outcomes.  It’s (sorry, neurologists) a no-brainer. Improving the patient experience is about systems as much as it is about smiles.  It can mean hiring industrial engineers to time how long it realistically will take to wheel a patient from appointment to appointment, so that the idea of a schedule can be taken as a serious concept and you're not letting down patients and gumming up the system all day.  Inevitably, improving such systems will improve smiles in the end. Improving the patient experience and patient satisfaction is about smiles, not just systems.  The systems and processes you've put in place that work for most of your patients in most situations emphatically will not work for all of your patients in all situations.  And when a patient doesn’t fit into your system, or a patient’s circumstances don’t fit into your  list of expected scenarios, you need smiling, helpful, empathetic employees, administrators, managers, executives who will address what needs to be done (including simply delivering an apology) regardless of the fact that they had hoped their systems would suffice.  Part of this is that everyone in your organization needs to learn to handle customer complaints and concerns:  "I can't help you, I'm the wrong person" is unacceptable; "Absolutely: let me get you to the person who can take care of that" can work wonders. Cues to indifference are everywhere–and it's where much of patient dis-satisfaction lives. Healthcare professionals avoiding eye contact with "civilians." Med students hurrying self-importantly down the halls, nearly running down the slow-moving patients who won't get with the program.  Patients ignored by nurses who haven't yet clocked in and therefore don’t realize they are already (poorly) representing their institution. Doctors in the hallway loudly carrying on about the relative benefits of different Canyon Ranch vacations they’ve taken. Two radios playing at once from two administrative areas (with the patients waiting, inevitably, somewhere in between the two. Unless your musical tastes run to Charles Ives, the resulting dissonant acoustics are uniquely unpleasant.). Vending machines that are left long out of service.  Vending machines that require exact change, but your hospital doesn't have a change machine. It's important to offload the transactional: Humans are important in all service environments, including healthcare, but there are some things that automation does better, and that self-service may do the best.  Filling out patient-related forms is one of these. Your patients and their families have a lot of positive experience these days with efficient online and mobile-based models, and it makes them impatient with inefficiency and duplicate processes. You're not doing it right if you're not ruthlessly attacking delays: I wrote an article recently about how Cleveland Clinic manages now to guarantee that any patient can have an appointment with the appropriate care provider the same day they call in. (after 4 PM this guarantee rolls to the next day). You can do this too: it’s not easy, it won’t be comfortable at first. But it makes a lot of sense. Smaller changes that help include: Stop batching/delaying the distribution of lab results – Consider if it's time to implement one of the newer technologies that allows patients to reach nurses directly (ex: Vocera communications' system) rather than waiting for someone to notice a call light and eventually respond. ... But realize that great customer service must be delivered on a customer’s schedule.  Your quest for speed cannot become a quest to hurry patients. Doing that it going to lead to frustration and, ultimately, noncompliance and other outcome problems. Your quest for efficiency can often be at odds with your quest to improve the customer experience, if you don't realize that there is value in being inefficient when it comes to that untidy link in the chain: the patient. You have to do everything you can experience your care as your patients do.  Park where the patients do.  See how easy it is/isn’t to get to the front door on crutches.   Take a tour of your hospital with someone who hasn’t been there before, and let them show you whether they can really find where they’re going.  You’ll be amazed how many mis-aligned, out of date, confusing signs you have. It all makes intuitive sense to you, of course, because you have been in your building enough times that you know your way around in your sleep (Probably, I suspect, literally.)  And, once a year, do a "full bladder exercise": Everyone who works with patients should drink two or three liters of water–it is incredible how your perception of a "reasonable delay" between call button and response changes when you have a full bladder. If you want to ace your HCAHPS and other measurements, don't think too specifically; think instead in terms of “halo effect”: The halo effect I'm referring to is the human tendency to cut you slack when they have a generally positive impression of you.  let a generally positive experience with you “infect” areas in which you may not have been entirely up to snuff.  Taking a sample HCAHPS question where your goal is to have an answer of "always" (for example: "During this hospital stay, how often were your room and bathroom kept clean?" ). "Always kept clean" is, strictly speaking, an impossibility.  Not even Four Seasons or Ritz-Carlton can pull that off; they may tidy your room three times a day, but that's plenty of time to trash it in between. Yet it is possible to get an "always" response from a patient.  Because the way patients remember is more holistic (sorry, I know that word can lead us down an icky path; I promise I won't use it again)  than you think it is.  An overall extraordinary experience with your facility and organization. will convince a patient to cut you slack while a generally poorly treated patient is going to grade you literally on your HCAHPS. And a literal reading of/response to the HCAHPS questions isn't going to turn out all that well for anyone. Micah Solomon is a customer service, patient satisfaction and patient experience consultant,  speaker, and author.

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