It's becoming increasingly obvious to me that healthcare is entering a completely new world — one in which the patient experience is absolutely paramount.
During my long career, I've seen a lot of changes in how the healthcare system deals with patients. When writing three books on healthcare leadership and leading Modern Healthcare for three decades, serving the patient was at the top of my mind. Then, in recent years, I've had a number of opportunities as a patient to experience customer service — or the lack thereof.
I've noticed over the years that a lot of lip service has been paid to what patients are experiencing. Now, however, it seems to me that the discussions are more forthright and candid. The whole industry is going through a reshaping and reordering process that many people are calling "the patient experience revolution."
Healthcare consultant David Zimmerman, a good friend of mine, envisions patients rising up in "an insurrection against indifference." He believes this revolt is unstoppable, and he warns that our income as providers is at stake.
In this new world, success will depend on how seriously we respond to patients' needs. They want to be treated with dignity and decorum. Rather than just getting a lot of smiles, they truly want better service.
Joseph Fifer, the president and CEO of HFMA, put it well in a recent column: "In this era of consumerism, people expect better information, better processes and a better understanding of what they're getting for their money. This goes way beyond the superficial consumerism of the past."
Why this revolution is happening
There are quite a few reasons why the patient experience revolution is happening at this moment in time.
One has to do with the rise of high deductibles and other out-of-pocket costs that many patients now have to pay. It’s no big surprise that patients who are expected to cover the first $5,000 or more of care might be a bit more cost-conscious than someone with first-dollar coverage.
As they pull out their wallets, patients are discovering they have a world of choices in the healthcare delivery system. They don't even have to stick with hospitals and their ORs, outpatient clinics and services. Now patients can go to ambulatory surgery centers, freestanding imaging centers, urgent care clinics or concierge practices — to name a few.
And you better believe it – the enlightened patient of today is quite willing to try something new. In a nationwide survey last year by Dignity Health, 90 percent of people said if they received unkind treatment, they'd consider finding a new provider.
The patient experience is also beginning to play a major role in how hospitals and doctors are paid. Part of the payment is now often based on measurements of how patients are treated, such as the HCAHPS survey. Hospitals are finding that performing well on the HCAHPS survey is not so easy. When CMS unveiled HCAHPS scores for U.S. hospitals this April, only 251 received the highest score — five stars — and 101 received the lowest score of one star. CMS has put these findings up on Hospital Compare website, for all patients to see.
Reimbursement methodologies are also changing. In January, the government announced that by 2018, half of Medicare spending outside of managed care will be for value-based contracts – including accountable care organizations, medical homes and bundled payments. These payments require keeping patients loyal to your organization. Again, that needs to be done through patient engagement.
Patients have been dehumanized
It's all too easy to dehumanize patients. You put them in that hospital gown with the opening in the back and tell them to wait on a cold metal chair. I've been in this role. You can sit there for a long time with all sorts of employees streaming by, oblivious to your presence.
Erie Chapman, the former president and CEO of OhioHealth, has compared patient experience to that of a prisoner. You have been stripped down, put into a regulation outfit, and you even get a number. Thank God it doesn't last very long for most of us!
Chapman then made an interesting comment: If patients are viewed as prisoners, then staff can view themselves as prison guards. According to the Dignity Health survey, two-thirds of Americans have experienced unkind behavior in a healthcare setting. These experiences include failure of a caregiver to connect on a personal level, rudeness and poor listening skills.
What patients want isn't very complicated. They want to be treated in a friendly way, with compassion, and receive running explanations about what's going on. And they don't want to wait for hours for some simple test!
Poor patient experiences are also linked to poor quality, and we know quality needs to be improved. A 2012 report by the Leapfrog Group brought the quality problem home for me. One in four Medicare patients will leave a hospital with a potentially fatal issue they didn’t have prior to hospitalization.
Bad patient experiences whittle way at a hospital's reputation. In a study last year by the National Research Corporation, hospitals with poor patient experiences were four times more likely to have poor reputations than good ones.
Attitudes are changing
We used to talk about patient satisfaction, and now we talk about patient experience. We have a new word because it's about so much more than patient satisfaction. It's also about creating connections with patients, and about how they navigate whole the system.
This involves making a change in attitude. Not so long ago, the healthcare industry emphasized – indeed, it often celebrated — dispassionate indifference. Being dispassionate – even at the risk of not seeming to care for the patient – was considered part of being scientific. You weren't supposed to get too concerned about being friendly, much less creating a personal connection patient or worrying about patients' feelings.
When a few brave pioneers announced they would pay more attention to the patient experience, many people scoffed and sneered. A few rude or incommunicative nurses or even a few dirty rooms weren't worth all the fuss, because patients came to hospitals to get healthy, not to be a five-star hotel.
But the patient engagement movement survived all this sneering and continued to gain steam.
After all, focusing on patient experience revolution made sense. The word "healthcare" contains the word "care" — as in actually caring for patients. It really wasn’t much of a surprise to find out — as countless studies have shown — that clinical quality and service quality are inextricably intertwined. For example, a dirty room often points to a higher rate of infection.
On amore profound level, studies showed that when patients feel mistreated by staff, it actually affects their ability to heal. The experts made an astonishing discovery that kindness actually improves outcomes. Patients have less pain and anxiety, and the healing process goes faster.
Another research finding: When patients don't have warm feelings for their caregivers, they're less likely to share important clinical information with them. So much for patient satisfaction being inconsequential!
The patient is your boss
Day after day, customers are treated with indifference and rudeness, because they're thought of as outsiders with inconvenient requests. But customers are not outsiders — they're the lifeblood of our business.
A few years ago, I was talking with a friend of mine, Terry Mulligan, the vice-chairman of MedAssets, the supply chain and revenue cycle management firm. He said he asked his salespeople who it was they reported to. They'd say to their supervisor, of course! No, Mulligan told them, you report to the patient.
That story made me think — what if we actually began viewing the patient as our boss? This is a transformative notion that I believe few people in any industry have truly grasped — focus on the end-users and learn what they want. When you take the customer's point go view, you'll notice all kinds of improvements!
Many people in healthcare are uncomfortable with the term "customer," but it's absolutely the right word. The customer deserves everyone's undivided attention and respect. Customers are not dependent on us — we're dependent on them.
Patients are the lifeblood of healthcare. They shouldn’t be viewed as interruptions in our day. They are the purpose of it. They bring us their needs and wants, and we are there to fulfill them.
When I hear people telling callers, "That isn't my department, try calling this number and someone should be able to help you," I get a little peeved. The person answering the phone should own that call and make sure the needs of the customer are met with a sense of urgency. The caller should be treated with dignity.
Changing the organization
Focusing on the patient experience means retooling the organization.
Many hospitals have created a new position: the patient experience officer, or SXO. There were 100 SXOs at last count — at institutions as diverse as the Cleveland Clinic, UC San Diego Health System and Johns Hopkins Medicine.
According to James Merlino, the former SXO of the Cleveland Clinic, a key outcome of the work is improving communication on all levels. "When physicians communicate better with nurses," he says, "coordination of care is improved. Then physicians communicate with patients and families more effectively, and compliance with treatments improves."
You don't necessarily need to hire an SXO to improve the patient experience. But you do need make sure your staff understands and embraces its new mission. All too often, connecting with patients isn't part of their training.
Without proper training, staff interactions with patients can seem scripted and even robotic. Rather, these interactions need to become – as one healthcare executive put it – "individual service encounters and opportunities to touch lives with kindness."
Every single person in the organization should be on board with the customer concept, and leadership must show the way. When you treat your employees with dignity and respect, they in turn will treat patients that way.
In a hospital, every employee should be involved with patients — even housekeepers, the IT department and human resources. This means they ought to be able to spend a few minutes taking with patients or walking them to a destination that they may have trouble finding. Their work schedule should not be so constricted that they are unable to do this.
Taking a moment to treat patients with empathy is not time wasted. Happy and engaged patients make everyone’s job easier. The drive for more efficiency shouldn't overwhelm the opportunity for patient engagement. Too often patients are ignored or objectified as we delve into their paperwork, herd them through the hospital and try to be super-efficient.
The moment of truth
As I said at the beginning, I've had several opportunities to experience the healthcare system as a patient — including hip and knee surgery and heart bypass surgery. Not all of this has been negative. In fact, I've had quite a few positive experiences, and they’ve given me a chance to stop and ponder just how marvelous our health system would be if patients came first.
At one point, I had to come to the hospital to get blood drawn a few days in advance of hip surgery. As I walked up to the registration desk, I was a little wary about how I'd be treated. I'm used to getting minimal eye contract and feeling a little infringed upon by the whole process.
But I was startled to see that the woman behind it was beaming at me. She gave me stickers that said, "Smiles are Contagious — Catch One!" and she proceeded to prove the point. She was veritably brimming with energy, enthusiasm and goodwill. The woman's name was Sharon Brooks, and whatever they pay her, it can't be enough. She's probably done more for the image of the place than all of its advertising campaigns put together.
In the parlance of customer service, my meeting with Sharon was "the moment of truth." It's when the patient first comes into contact with the organization. It's a crucial moment, because your lasting impression of the whole institution usually depends on the way you were treated at that point. If it's a bad impression, it's hard for everyone else to get rid of it, no matter what they do.
Make sure to pay attention to your patients in the "moment of truth" as well as the rest of the care continuum. Provide a really great experience, and your organization will flourish and prosper!