Why is it so difficult to make patients feel cared for, treated with kindness and respect, and include the patient and family in the patient’s healthcare plan?
Even the simple things like delivering a meal on time and at the right temperature or answering a call – bell in a timely manner seem like an impossible goal at times. Why is sustaining positive change that enhances the patient experience almost impossible to achieve? We know it is the right thing to do. The staff wants to deliver kind, compassionate care, and CMS has tied reimbursement through their VBP program to patient experience. Unfortunately, after the initial uptick, there has been a leveling off and little sustained improvement overall. Is it legacy thinking that often puts the needs of the organization over the needs of the individual? The “This is the way we’ve always done it” attitude?
Since the mid-nineties, I have been an advocate for promoting patient experience starting with our groundbreaking work in redesigning patient experience through-put and the initiation of an Express Admission Model at Muhlenberg Regional Medical Center in Plainfield, NJ. (Keyes, Maryanne; Biedron, Janet October 1995).
I am a Registered Nurse and a former hospital executive and have held various positions in multiple health care settings. In my lived experiences in healthcare, I have witnessed transformative changes in the delivery and documentation of care but not in the enhancing of the patient’s experience with that care. I ask myself, why?
Hospital Overwhelm
There is no doubt that hospitals struggle with a myriad of complex issues impacting the ability to focus on and sustain a culture of patient centricity and a positive patient experience. Hospitals are often busy, high-stress environments with multiple departments with various levels of healthcare providers involved in patient care. This can make it challenging to coordinate and provide a consistent positive experience for patients.
Due to the nature of providing care in a variety of ways outside the hospital setting, patients admitted to hospitals are often high acuity with complex medical conditions and will require extensive care and attention from staff. This can make it challenging to provide a positive experience for patients who may be experiencing pain, discomfort, confusion, anxiety, or any one of many concerns.
In most hospitals, especially in hospitals that do not have large endowments, they have limited resources including funding, staff, and time which makes it difficult to invest in patient experience initiatives. Senior leadership has multiple and often conflicting priorities along with governmental regulations compliance leaving little time for the perceived “nice to have versus need to have.”
There are many hospitals demonstrating that improvement in the patient experience is possible through a combination of patient-centered initiatives, technology, and the effective use of resources. So, we know it is possible. But what is the secret sauce?
Secret Sauce to Patient Experience?
In reviewing some of the top guns such as the Cleveland Clinic, The Mayo Clinic, Kaiser Permanente, Geisinger Health System, and the University of Pittsburgh Medical Center to name a few, a common theme emerges. Effective communication, patient feedback systems and closing the loop with patients is imperative to enhance the patient experience and to sustain the changes needed to be patient obsessed.
It is important to do regular surveys to elicit feedback, but it is also important that we respond promptly to that feedback. Patients appreciate it when concerns are heard and addressed by the provider. Hospitals should make changes when appropriate based on that feedback. The feedback and necessary changes required must be shared with staff and support a culture of continuous improvement focused on the patient and their families.
No longer can we govern by what we have previously done. It is a new era, and patients who are consumers of health care know what they want, and we must learn to incorporate their needs and preferences into our delivery of care.
In a recent HBR article, the author further drives home the point that patients are not loyal customers, and providers need to do a better job of understanding how patients make healthcare decisions; what motivates them; and how, where, and why they engage with the broader healthcare system, both traditionally and non- traditionally (Jain, Sanjula, April 2023).
In addition to responding to patient feedback as leaders, we must also focus on our cherished employees. Do we value them? Do they have the resources needed to do their best work? Do we shadow them as they go about their duties, thus having a clear understanding of the challenges? Do we even know them?
I remember as a young nurse, my Director of Nursing (a title in the past for the Chief Nursing Executive) would round every day on every unit, and she would address every employee by name. I thought to myself at the time, how does she do that? But I remember to this day, almost 50 years later, how impactful that human connectedness was, and I felt valued. Health care employee burnout is real. How we as leaders address this so our caregivers can stay engaged is paramount to any patient experience cultural shift to occur.
Patient Experience Drivers
The Beryl Institute, with their research partner SMG, published a research report, The State of Patient Experience 2021. The key findings are as follows:
- Patient experience remains a top priority: Despite the challenges of the COVID-19 pandemic, patient experience remains a top priority for healthcare organizations.
- Telehealth has become more important: The pandemic has accelerated the adoption of telehealth, with many organizations investing in technology and resources to improve the patient experience in virtual care settings.
- Staff engagement is critical: Staff engagement is a critical factor in delivering high-quality patient experience. Healthcare organizations need to invest in their staff and provide resources to support their well-being and engagement.
- Health equity is a growing concern: Health equity has become a major concern in patient experience, with many organizations focusing on ways to address disparities and improve access to care for underserved populations.
- Patient feedback is essential: Patient feedback is essential for improving the patient experience. Organizations need to actively solicit feedback from patients and use that feedback to drive improvements in care delivery.
As health care leaders we intuitively know this. The gap is between knowing the value of positive patient experience, and more broadly, in our human experience as health care professionals, and the doing- making the human experience of health care a reality is the issue. Simply stated, the difference of knowing and doing.
It seemed like a striking inconsistency that when asked about the best and worst aspects of leadership in the Beryl Research report, the most widespread support (46%) was having a designated patient experience leader and/or team, while the most common obstacle (41%) was having other organizational priorities that overshadowed patient experience. To me, this implied that patient experience was valued in theory but not in practice.
In sum, I don’t know if there really is a secret sauce, but it does come down to a few key points: Know your patients, know your staff, and do everything in your power as a leader to listen to understand so patients and staff are heard, and take those actions to improve their experiences. Let’s begin there.
References
Jain, Sanjula. Health Care Systems Need to Better Understand Patients as Consumers. HBR. (April 10, 2023).
Keyes, Maryanne and Biedron, Janet. Express Admission: an experiment in front-end redesign. Nursing Management, Chicago. Vol 26, Issue 10. (Oct.1995):39.
