Duke Health’s Integrated Practice places patient experience at its core. We discuss it daily, report weekly, and constantly seek insights to enhance our patients' experiences. Our dedication to Excellent Care, Outcomes, and Experience sets Duke apart.
Despite consistently performing in the top quartile to top decile based on standardized surveys in 2019, we recognized a need for a deeper understanding of our large patient population's experiences to provide personalized care for each patient.
We engaged our clinicians and staff and delved into our data to understand the experiences of different patient segments - race, age, gender, ethnicity, and geography. This analysis shifted our perspective on patient experience in Ambulatory.
We examined response rates and scores across various patient segments, care settings, specialties, and clinicians. Key findings include:
Race:
- Black, Asian, and multi-racial patients showed low survey response rates despite high visit volumes.
- White patients generally gave higher scores than other races.
Age:
- Baby Boomers and the Silent Generation (Ages: 55 – 92) responded to surveys at least twice as much as other generations.
- Generations Z and Alpha rated Physician Communications and Global Rating lower for Telehealth In-Person Visits (scores were better for Telehealth for all other Generations).
- Younger patients (under 40) generally gave lower scores than older adults.
Gender:
- Female and Male patient response rates were similar.
- Females, comprising about 60% of our visits, provided lower average scores than males.
These findings may or may not surprise you, but they have significant implications and have reshaped our discussion about patient experience data:
- Patients experience our care and systems differently.
- Summarizing/averaging data unintentionally marginalizes younger, non-white patients' voices in diagnosing concerns and improvement initiatives.
- Celebrating success and high scores in certain areas may not necessarily reflect performance but the demographic of patients seen – older, white, male patients tend to give higher scores.
We are now working to better understand and manage our teams' and patients' experiences, focusing on increasing response rates for African American, Asian, under 40, and female patients - groups with historically lower response rates and scores. While this may temporarily decrease our summarized scores, it will provide the real feedback necessary to understand the issues and make improvements.
We have implemented a daily management and improvement system, the Duke Quality System, where patient feedback is a distinct section in our daily huddle boards. We actively seek genuine feedback from patients about unmet expectations. Our local teams provide all necessary support and responses in service recovery and evaluate the root causes to adjust processes and prevent future recurrence.
Adapting to changing patient expectations – influenced by current health status, digital care, coordination of care, social drivers of health, mental health, cultural norms, and other factors – is crucial. A system that identifies shortcomings and empowers the right team to respond and adjust standards to current patient expectations is key.
Ultimately, an experience management program requires continuous feedback and a culture obsessed with evolving to meet demands every day, with every patient. We are fortunate at Duke to have caregiving teams dedicated to this mission.