Today's push for superior customer service is being underscored by the financial incentives/disincentives embedded in Medicare payment methodology.
Strategists also point to the long-term reality of population health management and its ability to reduce future costs by those covered under an accountable care organization or similar risk-bearing model. It simply makes sense that systems invested in keeping their members healthy will want to keep them loyal and part of the system's covered lives.
Forward-thinking organizations are adapting customer relationship management programs from other industries, streamlining customer service recovery efforts, deepening training efforts and increasing the use of customer service goals in their pay and bonus programs. Others are using their data analytics and multiple survey tools to discover which customer service efforts produce value in the eyes of the patient or their family. Architects are designing customer-centric facilities. Caregivers are pushing for systems that combine the fields of patient safety, risk management, customer service and process management to achieve the best outcomes for everyone involved.
Vision and strategy
In the most forward-leaning organizations, new definitions of the "vision" or strategies that are designed around customer service are appearing. For example, Virginia Mason Medical Center in Seattle, Wash., has developed a five-year strategy with three goals: integration of quality and service; partnership with patients and families; and engaging, developing and activating their people. There are extensive plans and benchmarks concerning each of these areas. According to Virginia Mason Director of Patient Experience Susan Haufe, "The activities and goals that we have in place are far more reaching that simply tracking HCAHP scores."
At Cone Health in Greensboro, N.C., the effort to define great customer service goes beyond a simple definition or set of benchmark data. The system produces a series of short films showcasing patients, families and caregivers using inspiring patient stories. These patient stories are typically filmed in their homes and connect staff to the obstacles of everyday life and how Cone Health's caregivers support patients' recovery efforts. Films are viewed at a department level so that staff members can discuss its message with their peers and manager.
According to Chad Brough, executive director in Cone Health's Office of Patient Experience, the films have changed the context of the patient experience throughout the entire health system. "These real life stories told from the patient's perspective help everyone see the difference we make at Cone and the stories hit home. They make our commitment to exceptional care far more than a slogan or statistical goal."
At Phoenix-based Banner Health, staff members are looking beyond inpatients to deliver a coordinated, consistent and exceptional experience across their entire delivery system. Pat McNulty-Collins, director of service excellence at Banner's North Colorado Medical Center in Greeley, Colo., says the organization is looking to move toward a complete customer-centric culture as part of its core strategy: "The patient's experience begins with the very first contact; it is imperative that all staff are engaged in delivering exceptional care and service to our patients. Our patient focused approach has transcended to the ambulatory environment". Banner has more than 300 clinics and employs more than 1,000 physicians and advanced practice providers.
Summa Health in Akron, Ohio, has implemented a variety of efforts to pull together its service recovery program and CRM efforts. Carmen Natale, Summa's system director of patient experience, believes thatit is no longer enough to implement strategies that only address service, but they must also address value and outcomes. Strategies ranging from pre-visit education about not only procedures but also what to expect during their hospital stay to post-visit follow-up improve experience and reduce readmissions. This is the value sweet spot all CRM activities must target. More about Ms. Natale's thoughts can be found in the August 2013 edition of Healthcare Financial Management.
Data analytics
Patient experience consultant Mary Malone finds that clients are using data analysis as a starting point. Once they find pockets of outstanding service, they'll conduct additional investigations to benchmark the unit/department in order to replicate the successful results. "The data analysis is also becoming more sophisticated," Malone says. "The survey data can be linked to additional patient data and operational data and the results can be used to pinpoint areas where improvement is most needed."
Another example of data analytics at work comes from Presbyterian Health System in Albuquerque, N.M., where post-discharge phone calls have been correlated with high customer satisfaction and lower readmission rates. "PHS has demonstrated over the past three years that patient HCAHPS scores are 12 percent to 15 percent higher for patients who receive calls within 72 hours of their hospital discharge," says Donna Agnew, Presbyterian's administrative director of process excellence and patient experience. "Additionally, the hospital readmissions for chronic illnesses are reduced through coordination between discharge planners, home care and the Discharge Patient Call Center at PHS."
Patient and family focus
The importance of patients' and families' input into hospital plans and operations has also grown in recent years. While many systems have established a "patient/family advisory council", some health systems are taking things a step further by placing patients on numerous committees throughout the organization. Advocates feel this creates a culture of focus on the patient.
Greenwich (Conn.) Hospital has taken a slightly different approach. Executives have established an infrastructure to assure that patients are given a strong voice in operations and improvement. "We reach out and speak personally to each individual who offers feedback where we have fallen short of expectations," says Christine Beechner, the hospital's vice president of patient and guest relations. Within days of receiving that feedback, accountability is assigned to managers who report weekly to a steering committee chaired by the hospital's CEO.
"These actions are not designed to improve HCAHPS," Ms. Beechner says. "They are focused on improving the patient's experience."
Adapting a program developed by Sheila Brune, Michael Bennick, MD, at Yale New Haven (Conn.) Health has created a variation of her living history program. Bennick has trained undergraduates at Yale University to obtain the personal stories of patients at YNHH using open-ended interviewing skills and the teach-back methodology to ensure a better understanding of the person in the patient bed. The "living history" focuses attention on the person and not their disease. The entire care team bears witness to stories that transform their understanding of the people for whom they are providing care.
Hennepin County Medical Center in Minneapolis is using its patient- and family-centered care focus as a touchstone for their customer service efforts. Toward that end, they have developed the following definition: "We partner with our patients and families to deliver an extraordinary experience that creates comfort and ease in a meaningful way." Hennepin Director of Patient Experience Services Sheila Moroney says, "Improved HCAHPS scores are not the outcome we are driving for. What we are driving for is truly patient-centered care. If all of the elements of this definition are in place, the scores will tell us how well we are doing in delivering on this promise."
"To deliver patient- and family-centered care, we need to create experiences that patients and families want, not what we think they want," she says. "We are using experience-based designs as the foundation to improve the patient experience. This work takes us beyond standard scripting and other rote activities and is organized more around an emotional IQ,, addressing people (how we interact with our patients and each other), processes (patient-centered, timely, accurate, efficient, effective) and place (having a healing environment)."
Hennepin uses stakeholder assessment to define the desired emotional targets of each experience and then intentionally designs the behaviors, processes and environmental elements that will deliver on those targets and their brand.
"So, for example, our new pediatric intensive care unit team interviewed families, older peds patients and staff to understand what they wanted to 'feel' when they were in the unit," Ms. Moroney says. "Loved, confident and embraced were the top results. These words take us beyond traditional words like 'welcomed' and help the staff to aspire to something more extraordinary. Our next steps include mapping the entire experience to ensure that everything we say and do, and the way we do it, evokes these emotional targets."
Evidence-based design
The role of planners and architects in designing a new hospital facility to incorporate numerous patient safety and satisfaction elements is easily found at Columbus-based OhioHealth's Dublin, Ohio, facility or at Detroit-based Henry Ford Health System's West Bloomfield, Mich., facility. The results of these efforts appear to be paying off in multiple ways.
At OhioHealth, evidence-based design has helped lead to improved staff and patient satisfaction scores as well as numerous improvements in metrics ranging from hand washing to noise levels. "There are many design lessons we have learned and plan to incorporate into future projects as we continue to pursue high levels of customer satisfaction," says Nancy Riggs, OhioHealth's system vice president of service excellence.
Henry Ford Health System's Sven Gierlinger, vice president of hospitality and service culture, says, "One of the guiding principles we applied in the creation of Henry Ford West Bloomfield Hospital was, 'Creating memorable experiences.' It is an environment that enlivens the senses and instills wellbeing, from the moment you arrive at the front door all the way through the entire experience. 'This does not feel like a hospital,' is the most common response from our patients and their loved ones. As a result, the community has embraced the hospital as their community center for health and wellbeing, and our patient satisfaction scores have been in the top decile since the opening of the facility more than four years ago."
Hardwiring excellence
While training programs have long been the initial "dues" paid by organizations wishing to improve their customer service levels, those appear to a mere starting point. Organizations who have applied research to define optimal ways of onboarding new staff are providing customer service training at multiple levels during an employee's first two years. Training is being personalized and distributed to the employees work units so that they see the concepts put into everyday action.
"We are imbedding supportive HR practices throughout [Arlington-based]Texas Health Resources in order to 'hardwire' great customer care," says Bonnie Bell, THR's executive vice president of people and culture. "Position descriptions and employee manuals identify expectations, annual increases and bonus eligibility is based on meeting or exceeding customer service goals, and corrective action is enlisted as necessary to assure that staff understands the critical nature of customer service."
Many health systems have established customer service goals as a go/no go touchstone for its executive compensation plans. In these organizations, industry experts believe that a precipitous administrative change in focus and support for customer satisfaction improvement has occurred.
The quality/safety/service intersection
Some efforts are underway to better understand and manage the intersections of good customer service, patient safety, evidence-based care, risk management and patient- and provider-centric care.
One such effort is underway at CRICO.
CRICO — a recognized leader in evidence-based risk management — is essentially a group of companies owned by and serving the Harvard medical community. CRICO and its affiliated division CRICO Strategies work with a wide range of hospitals and clinicians across the country to use data analytics and the information it provides to improve patient and provider safety.
"We have used data to explain and frame how teamwork, and improved communication skills, makes a difference in clinical outcomes for everyone involved in care," says Richard Corder, assistant vice president at CRICO Strategies. "Our patients and their families are more engaged because clinicians are explaining care in ways that make sense to them and resonate. Caregivers are more confident that the group of people they are working with have practiced and simulated the behaviors and norms that create high functioning, safe teams. We are using data to learn, educate and improve. Everyone benefits."
While some systems are exploring organizational models suggesting the combination of these functions, lessons of organizational visibility and commitment to superior customer care are dampening a wholesale rush to such departmental consolidations. As one (anonymous) Leader's Board member put it, "Our CEO doesn't want customer service to be lost as a priority. Service is about people and culture, and these functions tend to have a focus that is more about data."
Process improvement efforts
Operating efficiency is also an increasing focus that involves or is driven by customer service leaders. Emergency room wait times, discharge processes and even form design are subjects of such re-engineering. Lean techniques are being employed, and organizations are finding that customer-centric service design can also lead to lower costs.
At UK Healthcare in Lexington, Ky., the patient discharge process was revised from top to bottom. "A patient's understanding of what to do after discharge is vital to good patient outcomes," says Angela Lang, UK's enterprise director in the office of patient experience. "We are on a journey to refine this process with a goal of every patient fully understanding their discharge instructions. "
Future trends
The future of customer service will likely find a balance between data and people, culture and clinical efficiency, costs and customer-defined value. Customer service experts will likely play an increasingly critical role in that transformation.
This evolving role for customer service leaders within health systems is underscored by the topics being covered by The Leader's Board for Service Excellence. Topics and case presentation surrounding health literacy, patient empowerment, engaging families in a patient's care and shared decision-making and data analytics were selected by the members as the focus for its February 2014 "members-only" session.
"These are the types of issues the group's members believe represent the next frontier in how customer service principles will translate into better care and an improved health status of those served" says Leader's Board member Gwen Faust, a senior consultant at HealthStream.
Bill Bodnar is the founder and president of The Leader's Board, LLC, which operates executive education and benchmarking groups for healthcare executives from across the U.S.
As president of The Leader's Board, Mr. Bodnar is in regular contact with healthcare providers, consultants and thought leaders. This ongoing exposure to a national base of nearly 100 health care organizations ranging from Johns Hopkins to the Cleveland Clinic to Utah's Intermountain Healthcare to Sutter Health System provides him with a unique view of what is happening in the industry.
Mr. Bodnar spent 27 years working in several hospital systems in senior level positions prior to establishing The Leader's Board. His area of focus included strategic planning, marketing, mergers, fund development, legislative affairs, customer service and facility construction.
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