Download this special HealthLeaders eBook on tech and patient experience as part of the celebration of Patient Experience Week!
Are you looking to enhance your patient experience? Think tech. This HealthLeaders eBook features three stories that focus on how technology can contribute to a good patient experience.
In the first story, Senior Vice President and Chief Experience Officer Rick Evans at NewYork-Presbyterian says technology has drastically changed how health systems address patient engagement and activation, adding that within their strategic initiatives, NYP not only focuses on an overarching strategy to engage with the patient but also to create convenience.
In the second story, find out how Denver Health is using the Cheers customer relationship management module developed by Epic to get in front of its patients and talk to them about care management.
In the third story, see how "inbox ninjas" can close gaps in primary care between doctors and patients. Bassett Healthcare has hired staff members to review doctors' email inboxes and to act on patient messages requiring immediate attention.
Learn as you listen to this special podcast produced specifically for Patient Experience Week!
HealthLeaders wraps up Patient Experience Week, Dec. 11-15, with a special podcaston patient experience best practices.
HealthLeaders Senior Editor Eric Wicklund talks with Rick Evans, senior vice president and chief experience officer at NewYork-Presbyterian, about how the health system is using new technologies and strategies to optimize the patient experience.
Healthcare executives offer insights on strengths of patient experience programs, performance in HCAHPS scores, and barriers in patient experience efforts.
After shifting away from an emphasis on patient experience during the struggles of the COVID-19 pandemic, health systems and hospitals are renewing efforts to ensure their patients have a positive experience.
A recent HealthLeaders Intelligence Report, "Reengaging the Patient Clinical Experience," surveyed more than 100 healthcare executives about the strengths of their patient experience programs, performance in HCAHPS scores, and barriers in their patient experience efforts. Here's three things the survey taught us about patient experience in 2023.
Exec confidence in patient safety is high, but engaging family members in care needs work
When asked about their organization's strength in areas of patient experience, combined survey responses of "very strong" and "somewhat strong" highlighted four areas, including patient safety (95%), clinical outcomes (94%), patient satisfaction (86%), and delivering what the patient values (80%).
But William Worrell, CEO of United Medical Centers (UMC), a federally qualified health center based in Eagle Pass, Texas, and advisor of this Intelligence Report, says that hubris could be playing a role in the responses.
"Sometimes people value themselves a little higher than they may actually be," he says. "With patient safety, there's always issues that arise and we can always improve."
The biggest area of improvement among respondents is family engagement in patient care, for which more than one-third of respondents (38%) graded themselves as "somewhat weak."
Worrell says family support for patient care is always a challenge but is critically important to clinical outcomes.
"If you're not having family to buy in to change lifestyles, you're not going to change that patient," he says.
At UMC, Worrell says UMC started healthy eating classes for patients with diabetes and their families "to help get them all onboard, and that's helped a lot."
HCAHPS scores only saw moderate improvement in 2023
Eighty-two percent of respondents report either moderate (43%) or minor (39%) improvements to their HCAHPS scores in their efforts to boost patient experience, with only 7% claiming major improvements.
Worrell says the pandemic was "horribly disruptive" for UMC because physicians were missing vital contacts with patients for preventive care such as mammograms and other cancer screenings.
As for the 7% of respondents who reported major improvements in HCAHPS scores, Worrell says "that's pie in the sky. I don't think they saw that."
Avoid the 'cattle call' and find the funding to boost patient experience
When asked to identify the biggest hurdle for their patient experience program, 22% of respondents cited workplace culture, 21% said funding, and 18% said "other priorities."
At UMC, Worrell says culture includes "a smiling face at the front desk."
"It's the push for the employee to help the patient all the way through their experience and avoid that feeling of a cattle call," he says. "You want the patient to feel like their needs were met and everything was to their liking and [you are] trying to help them."
As with everything else in healthcare, Worrell says funding is also a significant barrier.
"The more funding you have, the more you can focus on clinical outcomes," he says. "But labor costs and everything else have gotten so high that funding is a necessary evil."
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.
Find out how they plan to boost patient experience in the years to come.
The COVID-19 pandemic put patient experience on the back burner, but a survey from HealthLeaders suggests that this key component of value-based care has come back as a priority for healthcare providers.
The need to focus on patient experience never went away. It became a lower priority during the pandemic, when healthcare providers had to address more pressing concerns such as addressing patient surges.
With the nation's return to relative normalcy following the height of the pandemic, and the expected renewed push to value-based care underway, an emphasis on patient engagement—specifically the patient experience—is back.
How are healthcare providers doing on their patient experience efforts?
HealthLeaders' most-recent survey on patient experience found that healthcare providers report making inroads on patient experience metrics, while also acknowledging that more work remains.
"How will healthcare leaders improve their organizations' patient experience within the next three years?"
In this survey, HealthLeaders posed this open-ended question to healthcare executives to find out what these leaders are doing to boost patient experience at their hospitals. To gather the results, HealthLeaders conducted the 2023 Patient Clinical Experience Survey through an online poll as part of our series of thought leadership studies. More than 100 executives at healthcare provider organizations responded.
In reviewing their responses, similar themes stood out, such as dedication to staff training and education, listening to patients, and acting on patient suggestions, wants, and needs. Here are some answers that differed from those themes. All survey respondents' comments were anonymous.
"I believe patient navigators will play a huge role in improving patient clinical experience. Having the ability to assist patients in navigating the healthcare system is very important for successful patient outcomes and patient satisfaction. In today's health systems, patients are often left feeling overwhelmed with the decisions they have to make or even knowing where to start to make the decisions. Patient navigators can walk patients through these processes and enable them to make the right choices for their healthcare." —VP of clinical services at a small physician organization
"Work on relationship-based care and change the culture." —CNO at a small hospital
"More engagement with patients' families, etc., for appropriate discharge planning." —VP of quality at a medium-sized health system
"Moving the priority of the clinical experience up in the strategic plan so that it receives the needed focus." —CFO at a medium-sized health system
"Hire the best people. Reward and celebrate their successes quarterly!" —COO at a small hospital
