Patient Experience Excellence

Achieving a patient experience culture of excellence at healthcare organizations means having a dedicated chief experience officer to manage patient experience, and using process improvement methodologies such as Lean or Six Sigma.

This article first appeared in the July/August 2017 issue of HealthLeaders magazine.

Building a culture of patient experience excellence within a healthcare organization should be a relatively straightforward undertaking.

A strategy must be developed, resources and manpower allocated, and leadership responsibility assigned. Execution of the strategy should be a simple matter of following the strategic road map. 

However, perfecting organizational culture in healthcare can be especially challenging. According to respondents in the 2017 HealthLeaders Media Patient Experience Survey, for example, difficulty changing organizational culture (31%) is the biggest stumbling block to creating an effective patient experience program at their organizations.

Part of the reason that transforming organizational culture within healthcare organizations is so difficult is their size and complexity: They are typically large institutions with a diverse range of professional and nonprofessional staff, representing a long list of departments and functions.

Further, patient care is increasingly taking place outside the four walls of hospitals and includes the full range of the continuum—primary care offices, ambulatory and outpatient locations, convenient care clinics, skilled nursing facilities, and home health providers—often placing it outside the reach of direct management control.

In response to the complexity of this undertaking, many providers have added a dedicated chief experience officer to their leadership team to help manage the organizational culture process.

According to the survey, 45% of respondents say that their organization has a chief experience officer or an individual with similar responsibilities. But while hiring such an executive is an important step in fostering a culture that embraces patient experience excellence, more is needed given the many challenges.

Sven Gierlinger is vice president and chief experience officer at Northwell Health, an integrated health system serving the greater New York area that includes 22 hospitals, 6,675 hospital and long-term care beds, and more than 550 outpatient facilities.

Gierlinger is also the lead advisor for this Intelligence Report. He points out that difficulty changing organizational culture also relates to the evolution of the healthcare industry to a more consumer-oriented model.

"I think that the healthcare industry hasn't looked at [the] patient as a customer like they have in other industries because payment is insurance-based. The patient is now becoming more of an educated consumer. For that type of culture, especially for an employee that has worked in healthcare for decades, it may be difficult shifting that perspective. Leaders of today must learn from and respect the past in order to move forward and adapt to an uncertain future."

Importance of Process Improvement Methodologies 

Along with establishing leadership accountability through the appointment of a chief experience officer, the use of process improvement methodologies to enhance patient experience performance has also proven to be an effective strategy.

For example, 64% of respondents say that their organizations use process improvement methodologies such as Lean or Six Sigma to improve patient experience, indicating that a greater share of respondents are using process improvement than using a chief experience officer. 

Perhaps not surprisingly, the use of process improvement methodologies is correlated with organizational size, which makes sense given the difficulty of managing patient experience across a large enterprise and the corresponding need for a more disciplined approach.

Note that a greater share of respondents from health systems (77%) and hospitals (74%) than physician organizations (26%) say that they use process improvement methodologies to improve patient experience. And based on net patient revenue, a greater share of large organizations (82%) than medium (76%) and small organizations (50%) say that they use this.

Patient Experience Improvement Areas

The survey divides patient experience improvement areas into a number of different categories—patient-focused, organization-focused, staff-related—to better examine the areas in which respondents are seeking improvement in an effort to meet their organization's patient experience program goals. 

It is encouraging that the leading staff-related patient experience improvement areas over the next three years are identifying concerns while patients are still on-site (53%), increased rounding (52%), and real-time patient feedback (41%) and staff-patient communications training (41%) in a tie. 

Rounding provides the most immediate feedback. Note that rounding and the presence of a chief experience officer on staff or the use of process improvement methodologies are correlated.

For example, among organizations with a chief experience officer, 62% mention increased rounding, compared to 45% without such a position.

Further, among organizations that use process improvement methodologies, 64% mention increased rounding, compared to 29% among those who do not use this approach.

Positive Patient Experience 

Respondents in our survey say that the top three areas in which a positive patient experience is most important for their organizations are discharge and follow-up (51%), the emergency department (50%), and outpatient/ambulatory visits (45%).

A positive patient experience at discharge and follow-up is beneficial, because it can help reduce hospital readmissions.

Likewise, a positive first impression in the ED may encourage patients to use other hospital services in the future, and a positive experience in an outpatient/ambulatory visit also helps promote the potential use of a provider's inpatient capabilities.

"If you don't create a great first impression, it's much harder to achieve a positive lasting experience," Gierlinger says. "If you have a bad experience, it can play out in a variety of ways. I think that, visually, what you see when you first walk in a space is extremely important. And when that first human contact or interaction is warm and inviting, with a smile—it makes you feel comforted and safe, and that's ultimately what we all want from any healthcare experience." 

Gierlinger also notes that when going over survey ratings and doing patient interviews, he's not necessarily interested in only reviewing the low scores.

He says it can be illuminating to look beyond the scores to understand the patient's perception of his or her care, and cites an emergency department example, an area where Northwell Health has applied process improvement methods extensively.

"I want to figure out what's the difference between good and great, what's the difference between 'probably recommend' and 'likely to recommend,' because our leaders who are rounding mostly find satisfied patients with no issues, but you don't really know if they gave you a 'probably' or 'definitely recommend.'

"A good example of this is when we identified that how we insert the IV in the emergency department is actually painful, which posed an issue. Many patients actually told us that this intervention was extremely stressful and painful, and our clinicians were not as compassionate as they would have hoped. When looking at our inpatient survey, I believe this had a significant impact on our pain management scores. Asking our patients about pain actually triggered a response to the pain they received from the IV in the emergency department. To really move the dial on performance improvement, we must be mindful of the whole experience through the lens of our patients."