The culture of patient experience

A prerequisite to developing a value-based organizational culture that has patient experience at its core is the full commitment of the organization's executive leadership and board to guiding the organization through the changes that a value-based system will require.  Long before patient expectations can be influenced, the organization must clearly and concisely articulate to internal and external stakeholders the role that value plays in the organization, promote multidisciplinary collaboration, and define the specific roles that clinicians and administrators play in the creation of value in order to establish a sustaining culture of patient experience.

Why is this so important?  The answer is as simple as delivering on promises.  Once the organization takes its value proposition to the consumer, it had better be prepared to back up its claims because:

• effective branding and marketing creates expectations;
• expectations are viewed by the customer as a promise; and
• failing to deliver on promises is not an option in a competitive, consumer-driven system where information on cost and quality is widely available. 

Healthcare providers will either reinforce or contradict their branding/marketing at each patient encounter.  Patients are expecting the organization to deliver on its promises and are watching and judging at each touch point.  Second and third impressions are just as important as first impressions.  Unhappy and frustrated patients express themselves online with negative reviews.  Delivering, or failing to deliver, on promises directly impacts the organization's competitive position. 

For providers to thrive under healthcare payment and delivery model reform, the patient experience must align with the patient expectation.

Healthcare providers are continually repositioning to respond to national- and state-based payment and delivery model reforms such as the Inpatient Quality Reporting program, value-based purchasing, bundled payments, ACOs, Meaningful Use, primary care "medical homes" and initiatives to speed the adoption of best practices.  These and other initiatives are designed to directly impact the value equation in terms of cost, quality or both.   Ultimately, they impact the bottom line, brand and reputation, and clinical outcomes rankings for healthcare providers.  Performance on patient experience is explicit in some of these programs and implicit all of them.  To the degree that healthcare providers are able to tout success in these programs, they are able to use that success to further build their brand and set expectations for consumers.

Still, there is a great chasm between what hospital and health system leaders perceive versus what their customers are demanding, and the problem has grown under the consumer-driven Affordable Care Act.  A 2012 HealthLeaders Media survey asked hospital executives about priorities for improving patient experience.  The top recommendations included interactive bedside computers, quiet time to ensure rest, new facilities, private rooms and food on demand.  In contrast, the results of CMS satisfaction scores, which have been published online since 2008, indicate that patients desire cleaner rooms, happy people, greater respect, improved communication and attentiveness to their needs and concerns.  When executives running large healthcare organizations fail to design their patient experience strategies around needs identified by their patients, value suffers. 

Guiding Principles for Excellence in Patient Experience

Patient experience is personal and must involve emotion – particularly in the forms of empathy and compassion – at all touch points.  Merriam-Webster defines "empathy" as the ability to understand and share the feelings and emotions of another and "compassion" as a sympathetic consciousness of others' distress, together with a desire to alleviate it.

A 2015 American Society for Quality survey found that 83 percent of patients desired improved communications between patients and caregivers as a priority for improved patient experience.  Leadership that prioritizes a patient-centered philosophy among staff also ranked high at 81 percent while 71percentof respondents said organizations should view improvement in quality of patient experience and service delivery as being of equal priority to financial and clinical performance measures.  These results demonstrate that patients have a strong desire for their healthcare services be delivered with empathy, compassion and other emotional connection that recognizes the personal nature of the service.

According to HealthLeaders Media, 84 percent of healthcare leaders rank patient experience among their top three priorities, but more than half have not made specific patient experience investments.  Still, a majority of hospital executives (73 percent) indicate their organization does not have a formal definition for patient experience, so they are addressing the issue through noise reduction and improvements in the discharge processes and patient rounding.  There is a material need for industry leadership in helping to set standards and define the patient experience.  This is beginning to take shape with the efforts of large healthcare delivery systems and patient advocacy organizations.

The Beryl Institute, a global community of practice dedicated to improving the patient experience through collaboration and shared knowledge, released in April its initial findings from the 2015 State of Patient Experience study.  According to the research, patient experience remains a top priority for organizations across all segments.  Committed leadership, investment in resources and strong culture are identified as primary drivers in patient experience success.  Experience priorities are shifting to communication and clear inclusion of patient, resident and family voice.  Clinical outcomes are seen as measures most impacted by positive patient experience.  Consumers view patient experience as a significant factor in healthcare decisions.

The Beryl Institute identifies the following eight essential actions for organizations committed to patient experience improvement:

1. Identify and support accountable leadership with committed time and focused intent to shape and guide experience strategy.
2. Establish and reinforce a strong, vibrant and positive organizational culture and all it comprises.
3. Develop a formal definition for what experience is to their organization.
4. Implement a defined process for continuous patient and family input and engagement.
5. Engage all voices in driving comprehensive, systemic and lasting solutions.
6. Look beyond clinical experience of care to all interactions and touch points.
7. Focus on alignment across all segments of the continuum and the spaces in between.
8. Encompass both a focus on healing and a commitment to well-being.

Austin B. Kirkland is the principal & founder of Outperform, LLC and a member of The National Society of Certified Healthcare Business Consultants.