Imagine this pie-in-the-sky scenario: A patient comes to the emergency department. There's no wait and they are taken straight back to a room where a smiling physician is waiting at the bedside to listen to and act upon the patient's healthcare concerns. Getting through registration, diagnostics — that's all a breeze. And in the end, a happy patient gets discharged efficiently, committed to taking their medication and seeking follow-up care.
OK, back to reality. While every hospital would like to provide that smooth of a patient experience, there are many potential stumbling blocks. There are long waits and challenges when it comes to coordination of services. There is paperwork and a litany of questions being asked — often repetitively — as a patient moves through the visit.
All of this can cause what Press Ganey calls "operational friction," which happens when a hospital's administrative process ticks off the patient before they have even seen a clinician. Then it becomes a nurse's job, and soon after the physician's job, to calm frustrated and angry patients, according to a January 2023 Press Ganey article.
"When doctor and patient finally meet, their interaction is hampered by an underlying tension and mistrust that's difficult to overcome," Jessica Dudley, MD, chief clinical officer of Press Ganey, wrote in the article. "Operational friction places burden on both patient and caregiver. Through shortcomings of the system and processes, the patient experiences undue friction on the front end, and that friction is absorbed by the doctor. It's frustrating for all involved."
Dr. Dudley said it's not uncommon for hospitals to get divided into "organizational silos" which "often get in the way of a care team's ability to focus on the patient's journey."
5 steps to rubbing out operational friction
- Get the front-line team involved: "Start small and go big. In order to deliver high-quality healthcare, we need reliable people and reliable processes," Dr. Dudley said.
To make changes that have a meaningful effect, the front-line team has to be part of the conversation. Where are the challenges in the processes? What small things that can be done that might make a big difference. Once the small changes are identified, go big when it comes to implementing them.
To avoid an "us-vs.-them mentality" or the "blame game," Dr. Dudley said. It's important to have a vision and "survey, engage and enable front-line workers to speak up and speak out."
- Don't blame the messenger; fix the problems. It's not unusual for nurses and physicians to be "held accountable when a patient's experience is less than ideal," Dr. Dudley said. "In reality, their effectiveness might have been hampered by inefficient workflows, insufficient staffing or scheduling, outdated processes or policies and other factors."
All of this affects patient experience. However, by fixing operational frictions before they affect the patient-physician relationship, hospitals can reduce clinician burnout and improve systems and change policies.
- Everyone has the same goal. Dr. Dudley said that too often departments look inward and forget that every "silo" is one part of the whole team. "Instead of 'wearing the jerseys' of individual departments, we should be wearing the organizational jersey," she said.
All patients require coordinated care in a hospital. This means there will be interaction between a variety of caregivers. Again, silos create operational friction, and that can "get in the way of a care team's ability to focus on the patient's journey."
Instead, all team members should work to "create a continuous patient experience" so information isn't lost and frustration doesn't build, she added.
- Work together. Be a mentor or be a mentee. Everyone, no matter who they are or how many years they have been at the job, can teach someone and can learn from someone.
"Coaching and training are essential as we strive to create virtuous cycles that will enable us to deliver the best care possible, as well as friction-free experiences. Whether it's communicating with patients, showing compassion, or learning how to listen better, there's nothing more critical than empowering ourselves and others to be lifelong learners," Dr. Dudley said.
Finally, she said, paying attention to the data collected regarding patient experience can drive "positive, sustainable change."
- Follow the data. It's no secret that age, gender and race matter when it comes to the physician-patient relationship — these help inform whether or not a hospital is experiencing trickle-down organizational friction.
If data collected from patient feedback reveals challenges, pay attention and make changes that will ease those situations.
"Data can reveal volumes about our patients, our organizations, our employees, and the crucial intersections between them," Dr. Dudley said.