4 Things That Detract From Patient Experience

Recent studies, surveys, and HealthLeaders coverage highlight patient experience drawbacks for healthcare organizations.

What are four things that detract from a positive patient experience at healthcare organizations?

HealthLeaders collected recent studies and surveys, and talked to healthcare leaders about what areas can negatively affect the patient experience, and what executives can do to solve these issues. Here are the four big pitfalls to avoid to create a positive patient experience.

1. Patient discrimination

Black parents are about twice as likely as parents who are White, Hispanic/Latinx, or of other races to experience unfair treatment in healthcare settings, according to a recent study.

Earlier research has documented discrimination or unfair treatment based on race, ethnicity, and other personal characteristics. In healthcare settings, discrimination or unfair treatment has been linked to negative consequences for healthcare quality, trust in the healthcare system, and treatment adherence.

The recent study, which was conducted by the Urban Institute, is based on data collected from parents with children under the age of 19. The data was drawn from the June 2022 Urban Institute Health Reform Monitoring Survey. That survey had a sample size of 9,494 adults.

The study features several key findings:

• 13% of parents said they were treated unfairly in healthcare settings based on race or ethnicity, language, health insurance type, weight, income, disability, or other characteristics
   
• 22% of Black parents said they were treated unfairly in healthcare settings, which was 10 percentage points higher than unfair treatment reported by parents who were White, Hispanic/Latinx, or additional races
   
• 3% of all parents said that their children were treated unfairly in healthcare settings because of the parent's or child's race, ethnicity, country of origin, or primary language
   
• 9% of Black parents said that their children were treated unfairly in healthcare settings because of the parent's or child's race, ethnicity, country of origin, or primary language
   
• 40% of Black parents and 30% of Hispanic/Latinx parents said they were concerned that they or a family member would be treated unfairly in healthcare settings in the future because of race, ethnicity, or primary language

Healthcare organizations can address patient discrimination by having robust diversity, equity, and inclusion programs. They can also provide clinicians and other healthcare workers with culturally competent care training.

2. Making patients coordinate their own care

Two-thirds of U.S. adults surveyed by The Harris Poll reported that managing healthcare is "overwhelming" and "time-consuming."

The survey was conducted by The Harris Poll on behalf of the American Academy of Physician Associates (AAPA). The survey, which features data collected from more than 2,500 adults, was conducted from Feb. 23 to March 9.

The survey was conducted to get the patient perspective on U.S. healthcare, AAPA CEO Lisa Gables, CPA, said in a prepared statement. "So much has changed in healthcare since the pandemic, and the focus has largely been on the strain that healthcare teams are experiencing. Certainly, we have to address that as we know it impacts the resiliency and strength of our healthcare workforce. However, AAPA wanted to understand from the patient perspective what is and isn't working in healthcare today."

The survey included two key findings:

• Survey respondents reported that they spend the equivalent of an eight-hour workday per month coordinating healthcare for themselves and/or loved ones
   

• The survey found 54% of adults reported that their health would improve if healthcare providers helped them figure out the healthcare system

The survey shows patients are struggling with the healthcare system, which can impact patient experience and health outcomes, John Gerzema, CEO of The Harris Poll, said in the survey report. "What struck me from the research we conducted on behalf of AAPA is how clearly the findings demonstrate how the system itself is getting in the way of people being able to take care of themselves as well as the ones they love. The system is costly, confusing, and it takes too long to get needed care."

To alleviate this, small hospitals and physician practices should assign nurses to navigate healthcare services, and health systems and hospitals can employ care managers, community health workers, and nurse navigators to help patients.

3. Failure to follow-up on diagnostic tests after telehealth appointments

Research finds that patients are less likely to get follow-up diagnostic tests after a telehealth appointment than after an in-person visit. To address this problem, health systems and hospitals need to provide better follow-up services.

A recent study published by JAMA Network Open found that diagnostic loop closures for colonoscopies, cardiac stress tests, and dermatology referrals were worse for patients after virtual visits than for those patients seeing their doctor in-person.

The research, conducted by affiliates of Harvard Medical School, Beth Israel Deaconess Medical Center, Brigham and Women's Hospital, Northeastern University, and Stanford, suggests that health systems are not providing the appropriate support after a telehealth visit to ensure follow-up tests are done. That includes sending messages to the patient after an initial visit to schedule and follow through on diagnostic tests.

Without that follow-up to close the loop, diagnostic tests are not taken and the care plan is interrupted. This could mean patients are not alerted to serious health concerns such as cancer or advanced cardiac disease.

"When investigating notable differences in loop closure for orders placed during telehealth visits, our findings suggest that differences in loop closure may be inherent to telehealth as a modality," the study team concluded. "One potential mechanism to explain this may be the lack of systems in place to help patients complete test and referral orders. During in-person visits, members of the support staff team sometimes help patients schedule their tests at checkout; however, this support is absent during telehealth visits. After the visit, patients do not receive any communication reminding them to schedule the test or referral, which may further limit loop closure."

"Other potential explanations include the possibility that it may be more difficult to remember information provided during telehealth visits, that telehealth may present unique communication barriers, or that it may be more difficult to engage patients in shared decision-making during virtual visits, thus decreasing patient engagement with test and referral orders," the study team added.

4. Extended lengths of stay

Length of stay is ultimately a key metric for how well hospitals care for patients, says Marjorie Bessel, MD, chief clinical officer of Banner Health. "When your length of stay is appropriate, it means that everything that sits under that—how well you take care of patients, how well you work them up, how well you treat patients once you understand what disease process they have, and how well you anticipate the patient's needs post-discharge—is functioning well."

Weak management of length of stay is a driver of emergency department boarding of patients, which results in a major hit to patient experience, says Peter Charvat, MD, MBA, chief clinical officer of the Bon Secours Richmond market. Bon Secours is part of Bon Secours Mercy Health, and the Bon Secours Richmond market features seven hospitals.

"Oftentimes, we find that some of the initial testing and treatment for patients may not be started when they are boarded in the ED. Boarding can also overwhelm an ED. As we discharge patients appropriately out of the hospital, we can free up inpatient beds and pull patients from the EDs to start their inpatient care," he says.

Bessel and Charvat offer six strategies to manage length of stay.

1. Preventive care: Health systems should encourage their patients to receive preventive care. During the coronavirus pandemic and in the post-pandemic period, many patients did not receive routine preventive care, which has led to sicker patients in hospitals and longer lengths of stay.

2. Operational efficiency: Hospitals need to focus on the efficiency of their internal operations, Bessel says. "How fast can you get things moving? How fast can you get a patient worked up to get a diagnosis? How fast can you get the right treatment for the patient? And how quickly can you help the patient recuperate so they are stable enough to be discharged to the next level of care?" she says.

3. Manage transitions to post-acute care: Sometimes, length of stay is extended because of limited access to post-acute care services such as skilled nursing or home health. "Post-acute placement such as with skilled nursing, inpatient rehab, and home health care can be problematic if our post-acute partners are not able to provide services on a timely basis," Charvat says. Hospitals need to start their discharge planning early and hold conversations with post-acute care partners as soon as possible, he says.

4. Managing high-demand services: Hospitals need to coordinate high-demand services such as MRI exams or move high-demand services to the outpatient setting when possible after a patient is discharged, Charvat says.

5. Embrace a team approach to discharge: Hospitals can use daily rounding on patients in the morning to identify barriers to discharge and work through those barriers, Charvat says. "We have the hospitalists, nurses, care management team, and other members of the care team going through each patient every day. The team looks at the goals for discharge, the expected discharge date, how the patient is tracking toward discharge, the tests and treatment needed, and successfully transitioning the patient from the inpatient setting."

6. Establish mobility: One of the more recent efforts to reduce length of stay at Bon Secours has been to establish early mobility of patients, Charvat says. "The sooner that a patient who is admitted can get up and start having mobility, we can identify a safe disposition for the patient and whether the patient needs any ongoing therapy or special services at home or in the post-acute setting."

Editor's note: This story was updated on 12/13/2023 at 10:40 a.m.