Intel Report: Patient Experience

Healthcare leaders focus on building organizational cultures based on patient experience excellence and strive to provide it across the care continuum.

This article first appeared in the July/August 2016 issue of HealthLeaders magazine.

Healthcare providers remain focused on building organizational cultures centered on patient experience excellence, using technology and an assortment of training programs to engage nurses, clinicians, care managers, and an expanding range of nonclinical and back-office staff in this mission.

However, having moved beyond simply training to meet the demands of HCAHPS, the patient experience movement is preparing for the next big challenge: providing patient experience excellence across the continuum.

To begin with, it is no easy task transforming organizational culture within healthcare organizations—they are generally large institutions with a diverse range of professional and nonprofessional staff, representing a long list of departments and functions.

Further complicating matters, patient care is increasingly taking place outside the four walls of hospitals, having migrated to myriad ambulatory and outpatient locations, convenient care clinics, skilled nursing facilities, and home health providers.

FREE REPORT: Patient Experience: Transforming Culture Across the Continuum 

As the industry assumes greater responsibility for patient care across the continuum because of the move to population health, who will be responsible for maintaining patient experience quality and consistency?

For many healthcare organizations, the answer is hiring a dedicated C-suite executive to drive their patient experience effort.

In the 2016 HealthLeaders Media Patient Experience Survey, 46% of respondents say their organization has a chief experience officer or an individual with similar responsibilities, up from 40% in last year's survey and 30% the previous year.

Having a C-suite executive responsible for the organization's patient experience effort is a necessary step to successfully managing patient experience across the continuum.

Pam Guler, MHA, FACHE, CPXP, LSSMBB, is vice president and chief patient experience officer at Adventist Health System, a faith-based health system headquartered in Altamonte Springs, Florida, with locations across 10 states, and the lead advisor for this Intelligence Report.

She says that the patient experience mission has expanded to encompass the full continuum of care as healthcare organizations focus both within and outside of the hospital setting, and increasingly migrate to a population health model.

"Our patients and families deserve an exceptional experience and care, and this is a key part of our mission. We focus across the continuum of care, and both patient and consumer experience is extremely important to our organization. We're very dedicated to whole-person care, addressing mind, body, and spirit at each point on the healthcare journey for our patients and families."

Patient experience improvement
This year's survey splits patient experience improvement areas into two broad categories—patient-focused and organization-focused—in order to better examine the areas in which providers are seeking improvement in an effort to meet their patient experience program goals.

The goals for patients and organizations, while generally in alignment for patient experience, are at times different.

For example, the top three patient-focused areas in which respondents say their organization seeks improvement in an effort to meet its patient experience program goals are patient satisfaction (79%), patient safety (65%), and clinical outcomes (54%).

Note that the response for delivering what the patient values (29%) falls in the middle of the range; while measuring factors such as satisfaction, safety, and quality may be core objectives, at some point, understanding the patient's perspective of value should also be considered.

For organizations, respondents indicate by a wide margin that HCAHPS or other CMS survey scores (79%) is the top organization-focused area in which their organization seeks improvement in an effort to meet its patient experience program goals. Responses for clinical outcomes (58%) and clinical staff engagement (46%) round out the top three responses.

Note that responses for business-oriented areas such as reimbursement (29%), market share (25%), and patient experience program return on investment (15%) are clearly in the second tier, indicating that business concerns are generally not among the key drivers behind patient experience programs.

That said, a greater share of organizations with a chief experience officer (20%) than those without one (11%) mention patient experience program return on investment, perhaps indicating that serving in the C-suite brings some financial accountability to the position.

Tracking and measuring patient experience success
One of the keys to improving an organization's patient experience program is timely and accurate tracking of performance. Discovering that a patient has had a subpar experience a month after the event occurred doesn't do anyone any good—the ultimate goal for most organizations is to receive feedback while the patient is still on-site.

Even so, HCAHPS or other CMS survey (82%) is the leading tracking method by a wide margin—this is likely because such benchmarks are a mandate for most organizations, and certainly not because of its timeliness.

Forming a second tier of responses are postdischarge phone calls (63%) and third-party survey service (non-CMS) (53%). Interest in acquiring timely patient satisfaction data is behind the growing use of postdischarge phone calls and social media (39%)—this year's responses are up eight points and nine points, respectively, over last year's survey.

Postdischarge calls are also an activity that can help ensure that care coordination is taking place appropriately across the continuum.

"Social media impacts us, whether a given person making a social media comment is a consumer that hasn't interacted with us yet, or maybe they're a patient who is a part of our care continuum," says Guler.

"Social media is an incredible platform for listening to the voice of your patients and consumers, and hearing that feedback and then being able to respond."

Patient experience improvements
It comes as no surprise, therefore, that the top patient experience improvement areas over the next three years are identifying concerns while patients are still on-site (58%), followed by increased rounding (51%) and staff-patient communications training (48%).

Interestingly, monitoring social media (7%) receives the lowest response of all—it's tied with patient financial engagement (7%)—yet respondents show fairly strong interest in its use, with 39% saying that they currently monitor social media to track and measure the success or failure of their patient experience activity.

Perhaps when it comes to patient experience, face-to-face feedback through rounding and other staff interactions is more preferable than communicating online, which is less personal and not always done in real time.

The leading responses for patient experience infrastructure improvements over the next three years are analytics for monitoring patient experience performance (70%) and patient portals for medical records, appointments, etc. (69%) by a wide margin. Marketing, PR, or communication services (46%) and facility upgrades (45%) comprise the second tier of responses.

According to respondents, two of the top three infrastructure areas expected to provide the biggest improvements are analytics for monitoring patient experience performance (29%), patient portals for medical records, appointments, etc. (24%), and facility upgrades (17%). These are the same three areas that led responses in last year's survey.

Patient experience communication
Respondents in our survey say that nurses are the top group to receive patient experience communication training (91%), followed by other clinical staff (83%), physicians (76%), and nonclinical staff (75%). These results are nearly identical to last year's survey.

While it is encouraging that more than three-quarters (76%) of respondents conduct such training with physicians, given the importance of doctor-patient communication in patient experience and the critical role that physicians play as care team leaders, there is room for improvement.

Note that the response for training executive staff (63%) also reflects a missed opportunity, although the result is five points higher than in last year's survey. Executive staff set an example for all employees, and meaningful patient experience training at this level of the organization has the potential for wide-ranging influence.

Interestingly, among organizations with a chief experience officer or an individual with similar responsibilities, 68% have training for executive staff, compared to 59% among those without such a position.

At the bottom of the response list is off-site care partners (24%), a group that plays an important role in providing care across the continuum. While its response is up five points from last year's survey, more work needs to be done in this area as well. Off-site care partners will represent an ongoing challenge as the focus shifts to coordinating care across the continuum—providers understand that they need to manage patient experience across the continuum, but their capabilities aren't there yet.

According to respondents, the most successful patient experience training program groups based on highly effective ratings are executive staff (50%), nurses (42%), and care managers (42%).

At the other end of the spectrum, physicians (19%) and off-site care partners (18%) receive the lowest responses for highly effective, and they receive the highest responses for slightly ineffective at 17% and 11%, respectively. Physicians (4%) also receive the highest response for highly ineffective, all of which points to the need for a greater focus on physician training.

Most difficult HCAHPS component
Respondents say that doctors communicating well (21%) is the most difficult HCAHPS survey measure, followed by receiving a rating of 9 or 10 on a scale of 0 to 10 (14%), and help is delivered as soon as patients want it (12%). The results for physicians communicate well reinforce the need for a greater emphasis on physician communication training.

The second-tier survey results are very tightly clustered, with nine of the 10 responses falling in the 2%–14% range, indicating that, while some respondents have difficulty across a broad range of HCAHPS survey measures, other than physician communication, no one measure dominates.

Most important patient experience areas
According to respondents, the top three areas where a positive patient experience is important are the emergency department (65%), discharge and follow-up (52%), and inpatient rooms (46%).

The reasons behind these results are quite practical in nature: A positive first impression in the ED encourages patients to use other hospital services in the future, and performing well at discharge and follow-up can help reduce hospital readmissions and reinforce a positive experience.

And because patients spend the majority of their time in inpatient rooms, this is an important opportunity to evaluate an organization's room cleanliness and noise levels.

Biggest stumbling block
Respondents say that difficulty changing organizational culture (31%) and abundance of other priorities (27%) are the biggest stumbling blocks for their patient experience programs. The remaining five stumbling blocks form a second tier that is clustered in a tight group, with responses ranging from 6% to 8%.

Interestingly, achieving organizational culture change is typically driven by senior leadership, yet only 8% of respondents say that lack of leadership commitment is the biggest problem. Perhaps the answer may be found in the second-highest stumbling block: abundance of other priorities (27%). Note that the problem is not abundance of higher priorities (7%), an indication that healthcare organization CEOs must set the agenda to ensure culture change.

In addition to being a CEO responsibility, it would also make sense that changing organizational culture falls under a chief experience officer's purview. However, it's worth noting that the presence of a chief experience officer does not necessarily solve the issue of culture change.

In fact, 37% of organizations with a chief experience officer or an individual with similar responsibilities and 25% of those without one cite that as the biggest obstacle to creating an effective patient experience program. Perhaps having a chief experience officer on board enables greater recognition of the problem; but ultimately, it is up to the CEO to solve.

At Adventist Health System, Guler says that a strong organizational culture has been extremely important to the progress in patient experience. "Culture is critically important to experience. We haven't had as much of a challenge with that in our system, and we do recognize that employee engagement is critical to experience. We use Gallup for employee engagement and we're a top performer, but we're all on a journey and we all want to ensure the most engaged culture because that directly translates to the best patient experience.

"I have the privilege of overseeing patient experience for a very large system, with campuses of all sizes in a wide range of communities across the country, all committed to one mission. Each campus may be at a slightly different point in their journey with patient experience, and one of our primary goals is to meet those campuses where they are on their journey and continue to elevate and sustain all to a consistent experience across our system."