Designing patient experience improvement initiatives isn't easy. There are myriad ways patients and providers can suffer communication disconnects. Sometimes it's not clear that both parties aren't on the same page until it's too late. The keys to achieving success when working in patient experience are to dig deeper into what the patient is actually experiencing and to frame solutions appropriately, according to Deirdre Mylod, PhD, Press Ganey's senior vice president of decision analytics and research, and executive director of the Institute for Innovation, a nonprofit organization that Press Ganey is launching and supporting.
"It's important to start by restating everything in terms of patient experience," she says. "Patient experience is not just their satisfaction or opinion but their report on the quality of care. Patients don’t separate their experience from what actually happens to them, and it shows in care evaluations."
Understanding the patient perspective
When a patient is dissatisfied, he or she may not be able to accurately articulate what is causing a problem. The most innovative hospitals will go above and beyond when investigating patient feedback. Take, for example, a patient who complains of noise in a unit at night. "Typical tactics might be to monitor noise levels, have quiet times, post signs to remind people of noise or give patients earplugs," Dr. Mylod says. "But there's a second layer: Why is quiet an issue for patients? Perhaps it's not quietness that is the problem, but that people are not sleeping: People who are asleep don't hear noises. Hospitals must think outside of the box to find if the stated problem is, in fact, the actual problem."
An added difficulty in managing patient feedback is addressing baseline patient expectations. Patients may have unrealistic expectations which, if left unmet, may feed inaccurate perceptions of quality of care. It is important to identify areas, such as pain management, for which this may be true.
"For a patient that will inevitably experience pain as part of a procedure, providers must set an appropriate expectation for the patient. Having correct expectations makes the experience of pain less frightening, less unexpected and more under the patient's control," says Dr. Mylod.
But meeting basic expectations isn't always as simple as that. Sometimes patient expectations serve as proxies for quality, even if those expectations aren't directly care-related. A study at the Cleveland Clinic showed that patients who perceived that a hospital was unclean associated it with poor quality, even if that hospital provided excellent care. A similar effect presented itself in another Cleveland Clinic study on staff responsiveness and patient experience. Research showed that call-light response time was a critical issue for patients, even if the call-light request was not vital. Patients felt that if they weren't attended to quickly enough for non-critical issues, they might not get care in time if they were to have an emergency.
Helping providers find solutions
Aligned, top-down leadership is essential to successfully addressing patient expectations and improving the care experience. According to Dr. Mylod, aligned leadership is more successful in promoting personal responsibility among providers. "Your executive suite must embrace quality interventions and hold people accountable to their roles. If leadership is not aligned, it may create insurmountable challenges to success."
Another important point on the provider side is to focus on how changes are conveyed to staff. Management must ensure that all employees understand the reasons behind patient-centric policies. "Telling someone to adopt a new behavior on top of everything else to raise satisfaction scores is much different than telling that person that the new behavior reduces suffering. For new policies, all providers should be able to answer what's different from the status quo and why it will impact patients," says Dr. Mylod. "When interventions are not having the desired impact, it's often because they are being driven by training and talking only. Raising awareness during training about the results of the intervention is very important, but it must be clear what will be different as a result of the intervention."
Finally, because the patient experience is multilayered, Dr. Mylod says it's important to embrace every patient's voice. Using census-based surveying can provide a deeper source of demographic data with which to understand patients. It's then possible to segment that data to use as an operating tool in real time to address issues for separate patient populations and direct care to where it is wanted and needed. And once that care is directed, it's important to keep using the census data to track care implementation.
"Often a behavior is effective, but it's not happening as often as it should," says Dr. Mylod. "It's important to be systematic about what consistency for a given behavior you expect and how you work towards that behavior. Combine these expectations with proper training and education, and then everything will tie back to what's happening for your patients, allowing them to have a better experience."
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