Improving the Patient Experience: A Four-Part Approach to Delivering the Care Patients want and need

IchBODg Harvard Business Review ANALYTIC SERVICES White Paper IMPROVING THE PATIENT EXPERIENCE A Four-Part Approach to Delivering the Care Patients Want and Need Sponsored by SIEMENS Healthineers SPONSOR PERSPECTIVE The health care market is becoming increasingly competitive. Why? Because patients and families are taking more initiative in steering their health care experiences. In the U.S. alone, estimates show that active patient choices can impact more than 60% of health care spending. The future of the global health care market lies in delivering high-value care that concentrates on the patient experience. At Siemens Healthineers, we believe patients will become empowered consumers. As consumers, they want options that respond to their personal needs. These DR. RALPH WIEGNER options include control over their data, and digital access to educational and HEAD OF IMPROVING medical services that will enable participation in their own care. Patients will PATIENT EXPERIENCE increasingly expect diagnostic procedures and treatment paths to be personalized SIEMENS to incorporate their preferences and needs. HEALTHINEERS We support health care providers on their journey toward improving the patient experience, the sum of all interactions influencing patient perceptions, across the continuum of care. This continuum of care starts with engaging people before they become patients. By creating cohorts of individuals at risk, and proactively promoting preventive care, medical providers can anticipate the onset of disease and take prophylactic steps to avoid it. Large-scale proactive outreach and education to patients and families helps patients make more informed choices about the care they need. Once in a care setting, patients expect a quick diagnosis with convenient and timely access to appropriate tests. A majority of patients and providers consider diagnostics a key factor in improving the patient experience. Patient-friendly technology actively mitigates anxiety and increases diagnostic accuracy. When the diagnostic experience is positive, missed appointments are reduced, and the opportunity for care increases. The next touchpoint in the continuum of patient care is treatment. Preferred patient outcomes cannot be predicted and must be aligned between patient and care provider. Outcomes that matter to patients typically include pain-free diagnosis and treatment; faster recovery with fewer side effects, complications, infections, and revisions; and better well-being and quality of life overall. Technology can better patient outcomes by, for instance, leveraging new minimally invasive treatments or imaging-enabled precise robotic surgery. Finally, once patients are successfully discharged, if health care providers want to impact patient well-being and sustain patient loyalty, they will need to deliver positive interactions repeatedly over the long term. Patients expect reliable access to caregivers for advice and support while also demanding control over the availability of their personal health information to others. If health care providers want to impact patient well-being, they will need to continually support good wellness literacy efforts and encourage healthier behavior. This four-part approach can lead to transformations that improve the patient experience. GET MORE INSIGHTS AT siemens.com/healthcare-insights IMPROVING THE PATIENT EXPERIENCE A Four-Part Approach to Delivering the Care Patients Want and Need INTRODUCTION HIGHLIGHTS For nearly all of history, the medical profession has measured its effectiveness largely by one metric: clinical outcomes. Today, the focus can’t be that narrow. ▪ Patients now expect the same sort of Thanks to a combination of market and regulatory trends, there’s a new emphasis personalized, frictionless interactions on tracking and improving not just patient outcomes but the entire human with their health care providers that experience of being a patient. “We’re all consumers, and eventually all patients,” they get from other organizations. observes Shannon Phillips, chief patient experience officer for Intermountain ▪ Facilities that deliver disappointing Healthcare, a Salt Lake City, Utah-based not-for-profit that offers hospital and patient experiences are four times medical services in Utah and Idaho. “Seeing patients through that lens has been more likely to have poor reputations slow to take hold in the health care industry, but it is critical that we do so.” than are those delivering good experiences. While it may mean different things to different people, “the patient experience” ▪ as used here applies to the broad, holistic journey that nearly everybody who The patient experience is built on the totality of experiences the patient becomes a patient undertakes from the very onset of symptoms. There’s a visit to a has at multiple touch points along health care professional for an initial diagnosis and treatment, a second diagnosis the patient journey—from symptoms and more treatment in some cases, the challenge of adhering to treatment to diagnosis to treatment to post- protocols, and finally the clinical outcome—resolution of the illness or injury or, treatment outcomes. alternatively, the progression of disease and ultimately death. ▪ Technology plays an important role The patient experience is formed by everyone who comes into contact with the in the patient experience. It can help patient along that journey, from front-desk receptionists to the nurses and doctors in delivering advanced care and enabling better patient-provider who provide direct care. Even the physical and virtual environments in which communication. patient-provider touch points occur leave an impression. Opinions are formed by every variable, from the efficiency with which appointments are scheduled and completed to the quality of the technology employed to diagnose and treat the patient to the comfort and décor of the facilities where care is delivered. The goals of improving the patient experience are multifold. Beyond producing happier and more satisfied patients, health care providers also hope to see patients become more trusting of the medical advice they receive, and hence more inclined to follow it—which can lead to better clinical outcomes and so reduce costs throughout the health care system. They also seek to build better reputations for their organizations in the communities where they operate, which may help them attract more patients. Additional goals include improved financial performance, especially now that reimbursement rates for care in some countries—including the U.S., under the Medicare program—are now tied, in part, to patient satisfaction scores and improved regulatory compliance. The latter can be especially important in areas where patient satisfaction scores now factor into the renewal of credentials for physicians, such as in the U.K. White Paper | Improving the Patient Experience Harvard Business Review Analytic Services 1 The challenges associated with this in managing their health and wellness new focus on the patient experience and, early in their care, optimizing the are twofold. The first is identifying the diagnostic experience using patient- most important aspects of the patient friendly technology. Throughout the experience; the second is figuring out patient journey, health care providers how to improve in those areas. also should seek to deliver outcomes Fortunately, many leading health care that matter to their patients—including organizations have already undertaken fewer side effects and complications, extensive efforts to improve the shorter recovery times, and positive patient experience. Their initiatives long-term therapy results—by have generated quantifiably positive personalizing treatment. Finally, results, suggesting a way forward providers should seek to sustain patient for other organizations that wish to loyalty by making it easy for patients join them. It can be envisioned as a to access their health care data and four-part framework that begins with their caregivers, and by improving care engaging patients and their families continuity via automated outreach. PART ONE Engaging Patients and The Landscape Has Changed: Behind the New Focus Their Families As noted earlier, the patient experience on Patient Experience is built on the totality of experiences the patient has at multiple touch Over the past two decades, new customer-centered technologies have reshaped the points along the patient journey—from way consumers interact with their service providers, from their favorite online shopping symptoms to diagnosis to treatment sites to their auto insurers. Now patients expect the same sort of personalized, and post-treatment outcomes. And frictionless interactions with their health care providers that they get from other part of that experience is their own organizations. engagement, and that of the their families, in their care. When they don’t get the interactions they crave, patients can quickly let the rest of the world know, thanks to social media as well as a wide range of information-delivering “This is critical,” says Phillips. “And if websites, which have made it easy for the new breed of medical customer to share we’re not purposefully attentive to it, with other consumers his or her experiences with health care providers and, in turn, shame on us.” to be informed by the experiences of others. NRC Health Corp., a Lincoln, Neb.- In preparing to better engage patients based research and consulting firm, reports that facilities that deliver disappointing and their families, health care patient experiences are four times more likely to have poor reputations than are those providers may find it helpful to map delivering good experiences. the patient journey and all patient In short, there’s been a broad social shift away from a world populated primarily with touch points, getting help from outside passive patients to one where medical consumers want to be more deeply engaged in experts if they do not have the skill their health care and are more cognizant of who can accommodate their wishes. sets or bandwidth to do it on their own. This mapping process starts with Despite this revolution in consumer expectations, in many cases the health care identifying who owns each touchpoint, community has been slow to adapt. While providers routinely acknowledge the such as the payer (usually an insurer), importance of the patient experience in their communications and marketing materials, the hospital, the pharmaceutical they often fall short in executing on the promise. In some cases, providers fail to provider, or the physician. Next, see patients as the people they are in the rest of their daily lives, leading to patient providers need to identify who frustration. In other instances, providers fail to appreciate that patients come into the influences each touchpoint—reception health care system with widely varying expectations about outcomes, quality of life, how staff, nurses, imaging technicians, treatment decisions will be made, and how treatment will be delivered. doctors, etc.—and what influences Against this backdrop, consumers often conclude that their customer experience as a that touchpoint, from the physical environment in which care is delivered patient is not the same as those they get in the rest of their daily lives. They feel poorly to the technology used to deliver it. informed about the status of their condition or their care. And all these sentiments lead, again, to frustration. Finally, providers need to identify what makes for a good or bad experience Health care providers who fail to acknowledge this new environment and don’t take each step of the way. steps to be part of it risk being passed by in favor of those who do. At Intermountain Healthcare, executives encourage local leaders 2 Harvard Business Review Analytic Services White Paper | Improving the Patient Experience Once the patient journey and all touch points have been mapped, providers can begin to think about how to better engage medical consumers and their families during the sojourn, recognizing that they may need the support of outreach and education programs. and caregivers to “walk the journey” Northwell Health, a New Hyde Park, of the patient—actually showing up at N.Y.-based not-for-profit health one of the organization’s health care care network, is piloting a “kill the facilities and going through the process clipboard” initiative in which patients of receiving care. This has led to some are able to self-schedule for treatments startling discoveries. and visits, either online or via their “I’ve done this myself,” says Phillips. mobile devices. The goal is more than “I went to clinics where our experience just to achieve greater efficiency—it’s scores were poor to try to find out to mirror the ease with which patients what was getting in the way of giving are able to shop for goods and services extraordinary care. I wanted to in other parts of their lives and give know what the pain points were for them more control over and choices in patients and our caregivers. In one their care. of the first clinics I visited, we found When patients arrive at a Northwell that simply by making sure we were Health facility—assuming they’ve been calling in all patients’ prescriptions seen in the Northwell system in the to their pharmacies by the end of the past—they’re greeted by staff prepared day, we were able to eliminate a lot with “patient profiles” in which of frustrated calls from patients the the organization has recorded their next morning. At another clinic, we preferences and dislikes. This makes found that local leadership was not it easier for frontline care providers including the patient registration staff to take those preferences into in the clinic’s morning huddles, where consideration when interacting with the team would talk about what was patients. The radiology department happening that day. In fact, the people at New York–Presbyterian Hospital/ attending the huddle didn’t know Weill Cornell Medicine in New York the name of the patient registrar on City has developed a similar capability duty that day. Obviously, this wasn’t by redesigning its information systems conducive to effective communication to track patients’ personal preferences and could have a negative impact on and medical information over time. the patient experience.” Other efforts to improve the patient Once the patient journey and all experience focus on patients’ touch points have been mapped, surroundings when they are receiving providers can begin to think about care. This can range from providing how to better engage medical more attractively designed treatment consumers and their families during rooms, perhaps with relaxing images the sojourn, recognizing that they on the walls or faux windows depicting may need the support of outreach and an outdoor scene, to offering activities education programs. that some patients find relaxing and Leading health care providers have therapeutic. At its Roberts Proton discovered many ways to improve Therapy Center, the University of in this area, and they are already Pennsylvania Health System, a delivering a more pleasant and diverse research and clinical care frictionless patient experience. organization based in Philadelphia White Paper | Improving the Patient Experience Harvard Business Review Analytic Services 3 Intermountain Health is among the growing ranks of providers making it easier for patients to directly access their medical records, including doctor’s notes, and allowing them to be more engaged in their care. and more commonly known as Penn phone or email. “It’s another way Medicine, offers a variety of quality- to break down barriers between the of-life programs—including yoga, practice and patients, and improve art therapy, meditation, and virtual communication,” says Keith Hentel, reality experiences—that patients and executive vice chairman of the caregivers can utilize. department and associate professor Penn Radiation Oncology, which of clinical radiology at Cornell operates the Roberts Proton Therapy University’s Weill Cornell Medical Center, also offers its patients a patient College. Where patients enter the engagement community in the form of hospital’s radiology facilities, the a “proton therapy alumni group” that department has even installed facilitates interactions between former electronic signs that cycle through and current patients via meetings information about the practice and and newsletters. The group also helps encourage patients to ask to speak set up so-called proton pairs, each of with a radiologist if they wish. which matches a current patient with One of the most difficult situations a former patient who can serve as a that patients face, of course, is having mentor and provide support. something go wrong in their care or In a somewhat similar vein, treatment. In the U.K., Great Ormond Intermountain Healthcare has created Street Hospital at University College a Partners in Healing program that London, which specializes in treating trains family members or other children, has created a patient advisory caregivers to help with a patient’s liaison service in which legally trained care while that person is hospitalized. hospital representatives, some of them “We have found that if caregivers volunteers, are available to patients to participate in parts of the care, the help resolve any complaints or issues patient and the family aren’t just before they become worse. “This has more engaged in their care—they are resulted in a significant reduction far more confident about their care in the number of formal, written when they go home,” Phillips says. complaints we receive from patients, “We also have reduced significantly because resolution has been reached readmissions for those patients, which or clarified in advance of things getting contributes to reducing costs too.” out of control,” says Catherine Owens, consultant radiologist. Before, during, and after treatment, patients who want to be more engaged For many patients, one of the most in their care are sometimes frustrated frustrating aspects of health care by their inability to connect with happens after the fact, when bills start their doctors and nurses. At New rolling in from the various providers York–Presbyterian/Weill Cornell, the involved in their care, or when department of radiology has created they need to access their records. a dedicated consultation service that Intermountain Health is among the gives patients access to an expert— growing ranks of providers making it an advanced practitioner such as a easier for patients to directly access radiologist assistant or a nurse, or their medical records, including even a radiologist if necessary—via doctor’s notes, and allowing them to be more engaged in their care. 4 Harvard Business Review Analytic Services White Paper | Improving the Patient Experience While all of these initiatives help to patients who might otherwise be more actively engage patients and subjected to difficult diagnostic their families, providing high-quality regimens. The latest high-speed X-ray care is always the most critical part of and CT scanners can eliminate the that experience. And that begins with need for patients to follow precise fast, accurate diagnosis and treatment breathing commands during X-rays, using patient-centric, patient-friendly for example—improving the chances technology. of getting good scans—or obviate the need for anesthesia with small children. Up-to-date CT machines also PART TWO Optimizing the Diagnostic may facilitate the use of lower doses of Experience radiocontrast agents during scans or, Technology plays an important role in some cases, no radiocontrast agents in the patient experience. It can at all. And they can allow patients help in delivering advanced care with kidney disease to be examined in and enabling better patient-provider cases where, in the past, poor kidney communication. function might have precluded that kind of testing. Health care providers seeking to extract maximum utility from Because technology is still deployed by technology can start by investing in humans, providers also can improve high-quality equipment outfitted with the patient experience by using the latest features—within budgetary technology to improve the caregiver constraints, of course. This can experience. Outfitting hospitals, include equipment with sensors and clinics, and offices with high-quality, integrated data analytics capabilities user-friendly equipment can reduce that can alert the provider when stress on caregivers, which in turn can preventive maintenance is required, help create a more pleasant, patient- minimizing downtime. friendly environment—especially when caregivers have been properly Regardless of how sophisticated trained on how to use the equipment. their diagnostic and treatment The same holds true for having technology is, providers also can equipment on hand capable of treating improve the patient experience by patients with unique challenges— ensuring their equipment is properly e.g., children, patients who are maintained. This key detail, too, can unconscious, obese patients—to make reduce downtime and so minimize the process of giving and receiving the number of times diagnosis or care easier and more comfortable. treatment is delayed. Health care providers can further “My job is to ensure we have the ensure maximum utility of their best possible equipment available, technology by adjusting workflows the most up to date if we can to make technology less intimidating afford it, and to ensure that our to patients. They might, for example, equipment is maintained in a way equip technicians who perform CT that’s professional,” says Great scans with electronic tablets they HEALTH CARE PROVIDERS Ormond Street Hospital’s Owens. can use to do all patient consulting “We constantly work to improve the and prep in the exam room rather CAN FURTHER ENSURE quality of our imaging by interacting than from a remote control room, so with our complex machines, working patients feel less isolated and perhaps MAXIMUM UTILITY OF closely with our medical physicists less apprehensive. and equipment manufacturers to get THEIR TECHNOLOGY BY the best possible images at the lowest Taking technology to the patient ADJUSTING WORKFLOWS possible doses of radiation and to can help, too. Mobile scanners, for reduce morbidity.” example, can eliminate the risks and stresses associated with transporting TO MAKE TECHNOLOGY Having state-of-the-art scanning immobile patients for diagnostic technology, such as X-ray and tests. And telemedicine—using LESS INTIMIDATING TO computed topography (CT) scanners, telecommunication technology to PATIENTS. can be especially important for treat patients remotely—can allow White Paper | Improving the Patient Experience Harvard Business Review Analytic Services 5 of results depends to a great extent on doing all the fundamental blocking and tackling that leads to good clinical outcomes, from making precise diagnoses to delivering effective and efficient care using the best available tools and technologies. ROBOTICS AND NEW IMAGING TECHNOLOGIES On the latter front, an ever-expanding array of minimally invasive surgical ARE INCREASINGLY ENABLING POSITIVE CLINICAL procedures and therapies are OUTCOMES, TOO. improving patient outcomes by reducing trauma, scarring, and pain, and by reducing both the risk of infection and the time needed for the patients to access health care that patient’s body to heal. Laparoscopy, otherwise might be inaccessible which typically involves inserting to them, especially if they live far tubes bearing tiny cameras and from urban centers. It can also allow surgical instruments into the body patients using equipment kept at through small incisions, is a good their homes to remotely share with example. Prior to 1990, the only their doctors important metrics like common applications for laparoscopy their blood sugar level, heart rate, or were simple gynecological procedures blood pressure. and gallbladder surgery. Later, it was Allowing patients to be seen in their used to operate on the intestines, liver, own surroundings or to share health and other organs. Within the past five data remotely may reduce anxiety years, doctors have begun using it to remove clots in the brain without in some cases. “Telemedicine has been particularly helpful for our rural opening the patient’s skull. In fact, doctors can now reach tumors in the communities by allowing us to keep people closer to their homes,” says most remote reaches of the body via Intermountain Healthcare’s Phillips. “It minimally invasive procedures, and lets us bring care to their bedside and send in drugs to destroy those tumors, geographically close to their family and in some cases eliminating the need for support system, which is great for the traditional surgery. patient experience.” Robotics and new imaging Finally, for many patients, it is the technologies are increasingly waiting—to receive care, to find out enabling positive clinical outcomes, what their diagnosis is—that is one of too. Robotics allows surgeons to operate more precisely than they the most frustrating parts of the patient could on their own, improving their experience. Health care providers can dexterity, and can even allow them to help on this front by integrating their operate remotely. imaging technology with their existing IT infrastructure so they can quickly Still, medicine remains both art share diagnostic results with patients. and science, and different patients will have different expectations for success, meaning the outcomes that PART THREE Delivering Outcomes That matter most can vary from one patient to another. As much as possible, then, Matter to Patients the desired patient outcomes should No matter how pleasant or fast the be personalized to and discussed process of receiving care, the best with each patient at an individual patient experiences will always include level. Caregivers need to relate to positive outcomes that matter to the and empathize with the patient, and patient—including, typically, fewer leading health care organizations side effects and complications, shorter are doing a number of things to recovery times, and positive long-term encourage this behavior. Northwell therapy results. Achieving those types Health, for example, is training 6 Harvard Business Review Analytic Services White Paper | Improving the Patient Experience To engage patients consistently and with intention, Northwell Health also has focused on embedding purposeful, proactive rounding into the care delivery model. over 67,000 of its employees on the Efforts like those described above at importance of improving the patient Northwell Health and Penn Medicine and customer experience. It is also can improve the likelihood that health providing a full-day, evidence-based care providers deliver outcomes that communication and empathy skills matter to their patients. course to physicians, with more than 700 providers having gone through the program to date. PART FOUR Sustaining Patient Loyalty To engage patients consistently and Patient loyalty is as important to a with intention, Northwell Health also hospital as customer loyalty is to a has focused on embedding purposeful, retailer or consumer brand. Satisfied proactive rounding into the care patients are more likely to be loyal delivery model. Incorporating the patients, and to speak favorably about core elements of information sharing, the hospital to friends and family and pain management, and anticipation on social media. They also are more of personal needs, Northwell likely to return for subsequent care. has positioned itself to set clear expectations and create individualized, Patient experience experts contend relationship-centered plans of care. that loyalty is built on trust, which health care organizations can promote To help head off frustration and in a variety of ways. It may start with complaints from patients waiting for providing high-quality personalized care during periods of overcrowding, care and attention and delivering Northwell Health also employs patient outcomes that matter to patients, representatives who are tasked with but it also includes making it easy a form of this purposeful rounding, for patients to access their health meaning they proactively reach out care data and their caregivers (e.g., to those patients to explain what is through increasingly common patient happening and why—helping them portals), by improving care continuity set expectations and making them feel via automated outreach, by making better informed. information about their physicians In another example, Penn Medicine is more accessible and transparent, using patient satisfaction surveys and and by quickly acknowledging and scores as a road map to improvement. responding to mistakes in care. Specifically, it tracks the widely utilized Northwell Health, for example, PATIENT EXPERIENCE AND Press Ganey scores it receives from is making the survey results and Press Ganey Associates, drilling down comments—good and bad—about EMPATHY EDUCATION into the results to determine how its physicians that it receives from facilities and providers can do better. patients freely available to the public INITIATIVES HAVE PLAYED Fern Nibauer-Cohen, director of patient on its website. In addition to creating engagement and business development more informed and trusting patients, A ROLE IN DRIVING at Penn Radiation Oncology, says Press this kind of transparency can serve as NORTHWELL HEALTH’S Ganey scores and patient satisfaction an accountability tool for physicians. surveys are “the Holy Grail for us, and Northwell incorporates patient EMPLOYEE ENGAGEMENT a reference baseline to which we refer feedback into a star rating performance quite a bit to determine how we’re system and again makes those ratings RANKINGS TO THE 80TH doing and what our patients are saying and patient comments available to about us.” the public. PERCENTILE. White Paper | Improving the Patient Experience Harvard Business Review Analytic Services 7 Patients also become more trusting of their it doesn’t happen again are healing for patients and families, reduce the health care providers when they sense those incidence of lawsuits, support learning from what goes wrong, and heal the suppliers are truly hearing what the patients caregivers, who also find themselves emotionally traumatized. are saying and giving them an appropriate “People think it’s like a car accident, amount of their time and attention. where if you admit to having done something ‘wrong,’ you are then legally culpable,” says Owens. “But actually that’s not the case. If you speak to the Medical Protection Society in London or the Medical Defence Union, you’ll hear that the most common reason for patients to continue with litigation is Patients also become more trusting of because they don’t feel they’ve had a their health care providers when they candid discussion and full explanation sense those suppliers are truly hearing and an apology, and don’t feel that what the patients are saying and people have been honest with them. I giving them an appropriate amount of think many organizations—including their time and attention. To that end, our own—have in the past perhaps Intermountain Healthcare is working been guilty of not being totally hard to make sure its caregivers have transparent and not explaining what not only the tools they need to do has gone wrong in detail and, where their jobs well, but also the time and necessary, issuing an apology. One support they need in order to do those jobs in a caring manner—without of the messages we get now from becoming disconnected or burned our legal advisors at the Medical out. “I encourage people to think Protection Society is that you can about simplifying the jobs we do,” says apologize without being ‘guilty.’ You Intermountain Healthcare’s Phillips. “A can say, ‘I’m very sorry for what has simple exercise we went through earlier happened,’ and you’re not saying that this year was to write down everything you’ve done something terribly wrong. we expect a frontline bedside nurse in You’re simply apologizing for what has a hospital to do. It turns out it’s quite happened and for whatever negative daunting. It is not doable. So we’ve had implications that may have had for to sit down and talk about that, and the patient.” identify the key vital behaviors that will cover the most important requirements The Real-World Benefits without asking our nurses to do the of Improving the Patient impossible. Otherwise, we’re simply Experience going to exhaust them.” Studies suggest that a good patient Elsewhere, Intermountain Healthcare experience correlates with better is setting up an early disclosure and patient outcomes—perhaps the most resolution program, under which it compelling reason of all for health seeks to quickly acknowledge and care organizations to work hard to investigate verified medical errors and improve the patient experience. A talk about them as soon as possible study published in JAMA Surgery, with patients and their families. For a in which a team of researchers at long time, many health care providers UCLA evaluated the link between have shied away from apologizing for the patient experience and clinical mistakes, fearing it could work against outcomes for more than 100,000 them in the event a patient brings legal patients, found that those who were action. There’s growing evidence, treated at hospitals with top-quartile though, that apologizing and being scores on the Hospital Consumer fully transparent about what went Assessment of Healthcare Providers wrong and what is in place to ensure and Systems (HCAHPS) survey had a lower likelihood of death, failure to 8 Harvard Business Review Analytic Services White Paper | Improving the Patient Experience rescue, and minor complications than Intermountain Healthcare and New did those treated at hospitals scoring in York–Presbyterian/Weill Cornell have Challenges of lower quartiles. experienced encouraging results, A study by Cooper University Health too. At Intermountain, patient Improving the Patient Care in Camden, N.J., published in satisfaction scores have improved, the Journal of Patient Experience, while the organization’s “patient Experience Begin with came to similar conclusions, finding harm index” has fallen significantly— Changing Culture that hospitals with higher patient by 43% in the first half of 2018. All experience ratings had “lower rates of Intermountain caregivers have error- readmissions for patients with acute prevention training, giving them tools Among the many challenges of myocardial infarction, congestive to optimize communication across improving the patient experience, heart failure, pneumonia, stroke, teams. Additionally, the clinics and changing culture may be the biggest. units where teams have “walked” It requires that leadership clearly chronic obstructive pulmonary disease and joint replacement.” the patient journey and engaged buy into and promote the idea that in additional caregiver training on improving the patient experience is a Meanwhile, the U.S. Department of coaching for caring have reached high priority. Health & Human Services’ Agency top-quartile or better performance Even where that leads to success, for Healthcare Research and Quality for their provider ratings on the sustaining culture change can be reports that the patient experience outpatient side of the business, and on difficult. As Gierlinger at Northwell correlates positively with disease nurse and physician communication Health notes, health care organizations prevention and management. “For on the inpatient side. At New York– need to make sure patient experience example,” it says, “diabetic patients Presbyterian/Weill Cornell’s radiology initiatives aren’t viewed as “flavor demonstrate greater self-management department, Press Ganey scores of the month” undertakings to be skills and quality of life when they have risen “dramatically,” according set aside after an initial push. One report positive interactions with to Hentel, and are now consistently way his organization tries to combat their providers.” Within the report it in the high 90s on a percentile this is by breaking down some of its also notes that “studies of patients basis. Meanwhile, after centralizing longer patient experience education hospitalized for heart attack showed the scheduling center for all of its programs into smaller pieces that can that patients with more positive outpatient sites and implementing a be repeated with employees at later reports about their experiences with sophisticated rules-based scheduling dates. The company also has frontline care had better health outcomes a year engine that allows schedulers to focus leaders huddle periodically with their after discharge.” on patients rather than constantly teams to reinforce positive patient It is intuitive that better patient referencing a large scheduling manual, experience behaviors. experiences lead to more satisfied and it has seen its scheduling center “call loyal health care consumers. abandonment rate” fall to about 1%, Beyond culture, hospitals trying to or about four percentage points better improve the patient experience can The real-world experiences of than industry standards. Although it be challenged by factors such as leading health care organizations may be difficult to establish causation, overcrowded facilities that are often, suggest there are, in fact, many Hentel notes that the radiology for the moment, out of their control. benefits beyond improved clinical department also has been capturing One way to mitigate potential patient outcomes—including higher employee more business. frustration in that situation is to do engagement and patient satisfaction what Northwell Health is doing: scores, fewer patient complaints, In Philadelphia, Nibauer-Cohen deploying dedicated personnel to care new marketing opportunities, and is convinced that efforts her for those patients, set expectations, increased levels of business—to be organization has taken to improve answer questions, and provide any derived from improvements to the the patient experience are driving assistance they might be able to patient experience. additional business. One outcome deliver. Striving for efficiency in all from the proton therapy alumni aspects of operations can also help At Northwell Health, Sven Gierlinger, group, she says, has been powerful turn around challenging experiences. vice president and chief experience testimonials from patients, which, officer, says patient experience and in some cases, have been used in empathy education initiatives have Penn Medicine’s marketing activities, played a role in driving its employee including very targeted digital engagement rankings to the 80th campaigns. That has led, in turn, from the 46th percentile nationally. to philanthropic contributions and Meanwhile, he says, patient increased self-referrals to the proton satisfaction scores for its physicians therapy practice. Nibauer-Cohen in the HCAHPS survey have been notes that the proton patient alumni climbing approximately 7.5% annually. group has allowed a community of White Paper | Improving the Patient Experience Harvard Business Review Analytic Services 9 STUDIES SUGGEST THAT A GOOD PATIENT EXPERIENCE CORRELATES WITH BETTER PATIENT OUTCOMES—PERHAPS THE MOST COMPELLING REASON OF ALL FOR HEALTH CARE ORGANIZATIONS TO WORK HARD TO IMPROVE THE PATIENT EXPERIENCE. patients to come together on both “You may not be charging ahead IMPROVING THE local and national levels and share hard enough.” their experiences about the benefits of PATIENT EXPERIENCE proton therapy. 3. Look for quick wins. Trying to do too much at once seldom works well, IS A MULTIFACETED Finally, in the U.K., Owens reports no matter what the endeavor. By that Great Ormond Street Hospital has breaking patient experience initiatives UNDERTAKING THAT experienced a significant reduction in into manageable pieces, health care formal complaints since adopting its providers can demonstrate success REQUIRES COOPERATION patient advisory liaison service. more quickly—and make it easier to ask for more money or resources to THROUGHOUT ALL undertake additional initiatives. Advice and Best Practices: LEVELS OF A HEALTH 10 Takeaways ENGAGE PATIENTS AND Improving the patient experience is a CARE ORGANIZATION. THEIR FAMILIES multifaceted undertaking that requires 4. Listen to and build trust with cooperation throughout all levels of patients. Patients who trust their a health care organization, from the health care providers are more likely C-suite to the front lines of patient to follow their doctor’s instructions, care. It also requires that organizations leading to better clinical outcomes and take a holistic view of the entire lower costs. Trust is built in part by patient journey, and strive to improve listening empathetically to patients, the patient experience at every touch being open and honest with them, and point between patient and provider in delivering the kind of care they expect that process. and deserve. “Often,” Gierlinger says, In short, it’s hard work. “decisions are made in the boardroom without anybody speaking with Health care executives at organizations the patient in the hospital bed or already deeply engaged in this the examination room. Constantly work offer the following advice for listening to the patients, whether by others seeking to do the same. Their looking at the data or speaking directly suggestions cover preparation for the with them, is critical.” Owens concurs, undertaking and each part of the four- suggesting that providers create an part framework for improving the ongoing program of encouraging patient experience. patient feedback. GET STARTED OPTIMIZE THE DIAGNOSTIC 1. Make sure senior leadership buys EXPERIENCE into the idea and visibly supports it. 5. Employ the best possible “If leaders don’t buy into the idea technology, and measure results. that improving the patient experience This applies not only to the diagnostic is important, then the next layer experience but also to clinical in the organization will not—and outcomes, both of which can have certainly the frontline staff won’t,” a bearing on the patient experience. says Gierlinger. Phillips notes that Providers that systematically track health care providers should designate results will uncover areas where they a senior leader to be accountable for can do better. the patient experience. She also adds that leadership should be encouraging DELIVER OUTCOMES THAT MATTER caregivers to be constantly mindful of TO PATIENTS why they are doing what they do—of 6. Take time to discuss potential connecting to purpose. Understanding outcomes. Because different patients that, she says, can drive empathy for will have differing expectations about the patient, and more personalized clinical outcomes—and about how and humanized care. they envision their post-care lives— 2. Expect pushback. “If you don’t it is important that physicians and get pushback, you are probably not other caregivers explain all options doing the right thing,” says Gierlinger. available to them, and take the desires White Paper | Improving the Patient Experience Harvard Business Review Analytic Services 11 “We’ve seen that when we deliver a better of the health care industry in the past has been to try to hide mistakes,” she experience, patients trust us more, says. “Today, we are advised by our insurers and legal counsel to straight which makes them more likely to comply away apologize. And you can apologize without being guilty. You can say, ‘I’m with our recommendations,” says Northwell sorry for what happened, for the pain it’s caused you.’” Health’s Sven Gierlinger. 10. Think of patients as humans, not health problems. “At Intermountain, we’re trying to be holistic and person- centered, not disease-centered,” says Phillips. “As our people work on what’s getting in the way of a great patient of patients and their families into experience, we’re seeing that their account when mapping out a plan of experience scores, as measured by the treatment. public, have improved. And by the 7. Take advantage of new advances way, safety measures and quality of in medicine, including minimally care measures are getting better too, invasive procedures and robotics, to because they’re teaming differently. facilitate better clinical outcomes. No Our people are working together in matter what type of clinical outcome service of an extraordinary experience a patient is hoping for, efficient for the patient.” and successful delivery of care that Ultimately, the key takeaway for health minimizes pain and recovery times care providers is to remember that will be crucial to providing it. the patient experience is comprised 8. Treat bad news about the patient of myriad of details that, when experience the same way you’d handle addressed holistically, can improve bad news about the organization’s clinical outcomes. finances. “If we have a few months “When we ask patients why they gave in a row when the patient experience us a certain rating, we find that they is declining, we have a problem,” don’t think just about the service says Gierlinger. “Phones should be component of the experience,” says ringing. We should be convening and Northwell Health’s Gierlinger. “They rallying the troops. Our patients are think about it in a much more holistic suffering—they’re having a worse way. Outcomes are part of it. Quality customer experience than they’ve had of care is part of it. Trust is part of it. in the past. What are we going to do And we’ve seen that when we deliver about it?” a better experience, patients trust us more, which makes them more likely SUSTAIN PATIENT LOYALTY to comply with our recommendations 9. Promote honesty and and more likely to partner with us in transparency—even when it may seem their care. And that leads to better counterintuitive. For example, Owens outcomes and cost savings. It’s almost says the most common reason patients a self-perpetuating cycle. That’s why pursue and stick with litigation against improving the patient experience has health care providers is that they feel become so important.” they haven’t received an apology or that their provider hasn’t been open and honest with them. “The culture 12 Harvard Business Review Analytic Services White Paper | Improving the Patient Experience 1GBOmg Harvard Business Review ANALYTIC SERVICES hbr.org/hbr-analytic-services CONTACT US [email protected] Copyright © 2018 Harvard Business School Publishing. MC211511118