As 2023 begins and we reflect on yet another challenging year for patient experience work, the pandemic's lingering effects continue to reverberate in our organizations. What have we accomplished during the year, and what has been learned about the work needed to restore the experience?
At NewYork-Presbyterian, we were successful in improving our patient ratings last year when compared to 2021. Looking at HCAHPS indicators nationwide, our results may be bucking the trend. National benchmarking reports are showing that most HCAHPS domains have remained flat – and some have declined further – from already historically low levels in 2021. This is bad news for patients and families in many communities.
Why are patient ratings not improving? The obstacles we faced at the start of last year, while having improved, are still present as 2023 begins. Staffing levels continue to be a challenge across nearly every category of team member. Vacancy rates in many places have improved through the year, but are not at pre-pandemic levels. Turnover rates also remain high. This churn of staff creates a potent barrier to consistency, which is at the bedrock of an excellent patient experience.
New staff – which we are delighted to welcome to our teams – also need to be acclimated and trained. This creates further instability in the experience. The trickle-down effect of these staffing dynamics echoes across patient ratings. It affects communication, responsiveness, patient education and other core experience elements. Staffing challenges also slow down other processes related to patient experience, such as patient throughput through our institutions.
Another very significant source of headwind for patient experience improvement remains the surges that are washing over hospitals across the country. We’ve all heard of the “tripledemic” of COVID-19, respiratory syncytial virus and flu. These are filling up emergency departments – both adult and also pediatric – across the country. Surges combined with staffing challenges and subsequent patient throughput delays are a truly formidable blow to a great patient experience.
Scores for emergency department admissions are nearly always lower than other hospital admission scores. This is not intended as an insult to our dedicated and hardworking ED teams. Rather, it is a function of the largely unplanned nature of ED visits and admissions. Surges and throughput challenges only amplify this dynamic.
All of the above combine in a way that makes it even harder for our teams to meaningfully connect with patients. And, quite simply, it has made the patient experience improvement work more complicated and harder than ever.
But all is not doom and gloom. What have we learned this year?
We believe NewYork-Presbyterian’s ratings have risen because we have focused very deliberately on expanding the ecosystem of connection for our patients and families and reducing the burden on the front line. In a time where we are still rebuilding staff, tactics that leverage technology to get needed information to patients are a huge win. Using our portal, and even our TVs, allows our staff to deliver needed education in a more efficient way. It doesn’t replace the one-on-one education that can only happen between two people in real time, but it can augment it. Piloting virtual interactions to enhance the admissions and discharge moments may also help. We have launched these here at NYP, and we are exploring whether these interventions meet patients’ needs and help our staff keep moving through their workflow. Initial signs are very encouraging. Both patients and our team members are positive about this work. We believe this focus on expanding opportunities for interaction has helped us achieve some stability and is helping us to turn around our experience and our ratings.
In 2023, team training has also taken on a heightened role. I’ve actually been a skeptic about “service training” as an effective way of improving patient experience. Effects tend to fade rapidly if there isn’t robust leadership reinforcement before, during and after training periods. But, like in many other ways, 2023 is a bit different. We have the biggest percentages in our history of new staff at all levels. We have new clinicians (and many new grads) providing bedside care. We have new housekeepers and transporters. And, we have new team members answering our phones and staffing our front desks and entrances. This infusion of energy is fantastic – but it comes with an imperative to make sure these new colleagues are properly trained and oriented on our best practices. Basic employee orientation will not adequately cover this. In addition, even some of our veteran team members need the equivalent of a “PX booster shot” after a long period of time when long-standing care delivery models and workflows were upended. Thus, we are learning that this is a period where training programs should be resurrected to help us all recover.
We need to incorporate this learning and innovation into our patient experience strategies going into this new year. As we finish up another challenging year and look toward the next, there is reason for optimism. Hopefully, the winter’s surges will give way to a further easing of the pandemic and our staffing challenges will stabilize further. This will open up space for deeper staff engagement and a strengthening of the connections we need to establish with our patients and families. Ultimately, we hope this will be reflected in both rising patient ratings and team engagement scores for us all in 2023.