Insights Series Issue 3: "A blueprint for an impactful patient experience program"

Siemens Healthineers Insights series Issue 3 The scientific overlay is not that of the individual pictured and is not from a device of Siemens Healthineers. A blueprint for setting up an impactful patient experience program A paper on ‘Improving patient experience’ with an introduction by Jason A. Wolf, PhD, CPXP siemens-healthineers.com/improving-patient-experience SIEMENS Healthineers About Siemens Healthineers Insights series Today, every health system struggles with rising costs and varying quality. Diagnoses and treatments are designed for typical patients. Delivery of care is fragmented and focused on volume. The patient experience journey is in its infancy. And healthcare doesn’t leverage the full potential of data. How can we change that? At Siemens Healthineers, our insights make it possible to turn challenges into opportunities. 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Please visit siemens-healthineers.com/insights-series Paper A blueprint for setting up an impactful patient experience program Introduction It is important to note that initiatives to improve influ- ence factors are not distinct efforts either, but rather The experience era1 has taken hold from the perspective of healthcare consumers, all of what in healthcare. It calls for new ways of they encounter is part of their experience and therefore thinking about how care is delivered, it is essential these are considered together as one. This essential need builds on the broad framing of ‘To Care and it is driving how those who seek is Human: The Factors Influencing Human Experience in care – the healthcare consumers – will Healthcare Today’3 where I shared, “What the study into make their future healthcare choices. the influence factors of experience shows is that people This reality is reinforced by the findings of in healthcare see themselves and acknowledge those they serve as humans, as people, first. In the end, it is the examination shared here, conducted the things that speak to people as human beings that in partnership by The Beryl Institute and have the greatest impact in healthcare.” Siemens Healthineers. Jason A. Wolf, PhD, CPXP The influence factors of patient experience described President, The Beryl Institute in this paper are firmly grounded in the essence of healthcare, namely, reinforcing earlier discoveries from the voices of consumers2 and underlining that what healthcare organizations know must be central to their work. On the pages that follow, these ideas have been turned into action. The ultimate measure of success for discoveries such as those in this study is the ability to create pathways to take rich and practical data to build THE BERYL processes for assessment and action that lead us forward. INSTITUTE This paper does just that in providing a powerful model with which one can engage, reflect on one’s efforts, and determine opportunities for action and improvement. About The Beryl Insitute The Beryl Institute is a global community of practice Most importantly, and I believe essential to any useful dedicated to improving the patient experience through model: this paper reinforces a critical point in its conclusion. collaboration and shared knowledge. The Influence The experience era is not a time of complacency or an Factor Study is the foundation of the December 2018 idea with boundaries; rather, as the authors share, what publication: ‘To Care is Human: The Factors Influencing Human Experience in Healthcare Today.’ In conjunction the true nature of this research and work reveals is that with this paper, The Beryl Institute is releasing a series the commitment to human experience is never finished, of case studies from high-performing organizations and it never should be. participating in the research. Siemens Healthcare GmbH, 2019 3 40% of U.S. citizens are not satisfied with their interactions with hospitals. Executive summary Use our scorecard to identify white spots and areas for improvement in your patient experience efforts. As only 60% of U.S. citizens are satisfied with their inter- actions with hospitals, it is no surprise that patient experience is rated as a top priority in the U.S.4 According to The Beryl Institute study ‘The State of Patient Experience 2017: A Return to Purpose,’ the top three healthcare prior- 99% of hospitals have started patient ities for 2019 to 2022 are: improving the patient experience, experience programs. employee engagement, and cost management.5 Outside the U.S., the focus on patient experience is also growing and a commitment to experience overall is taking 74% of hospitals have hold. In a global study, more than 80% of over 1,600 only just begun, or are healthcare organizations identified themselves as having not well-established. ‘established’ or even ‘well established’ experience efforts, while just 1% of respondents reported that they had ‘not yet started.’5 These numbers reveal that it is no longer 26% of hospitals report about why to set up patient experience efforts, but that it well-established patient is important to identify what priorities and practices lead to experience programs. sustained success for your organization. Reason enough for Siemens Healthineers and The Beryl Institute to conduct More than 1,600 hospitals surveyed, including a study in 2018 with more than 1,100 patient experience 944 U.S. hospitals and 246 non-U.S. hospitals professionals, including 294 from high-performing units3 from 25 countries5 and 175 patients and their family members to find out the most important influence factors on patient experience. The participants rated more than 35 different factors. We used the results of high-performing units and patient organizations and summarized them in the attached scorecard that displays the most influential factors along the continuum of care. You can use this scorecard to gauge your system-wide patient experience efforts as well as to identify gaps and potential improvement areas. 4 © Siemens Healthcare GmbH, 2019 The challenge It's not always clear what efforts have the most impact when building a successful and sustainable patient experience program. But identifying the right initiatives can lead to better clinical outcomes and financial performance. Many healthcare organizations are investing in improving the patient experience from different angles, and there is no single best approach. As in many other markets, the Only 5%of hospitals patient experience landscape in the U.S. still looks very unhomogeneous:6 According to Becker's Hospital Review as of April 28, 2017, 3,499 hospitals had a Hospital received a five-star Consumer Assessment of Healthcare Providers and patient rating. Systems (HCAHPS) summary star rating as a measure for patient experience. Of those hospitals, about 18% have one or two stars, 76% have three or four stars, A WW WW 2,20% but only about 5% have a five-star rating. So what are 16,09% * * * * w high-performing organizations doing differently? 42,67% * * * ** 33,67% ***** 5,37% In any case, hospitals with high patient-reported experience scores have better clinical quality and higher HCAHPS ratings for profitability. Recent research from the Deloitte Center for patient experience for Health Solutions revealed that for every 10% increase in 3,499 hospitals in 2017 the number of patients giving a hospital a top HCAHPS score, there was a 1.4% increase in net margin compared to hospitals given lower scores.7 even in partly-nationalized health systems like in Germany, or nationalized systems as in the UK, where This is also supported by programs such as Medicare’s the link between revenue and patient experience is Hospital Value-Based Purchasing Program that financially weaker, governments are starting to prioritize patient reward hospitals that have better patient-reported experi- experience. Positive patient experience is an innovation ence scores. Patient experience can make a difference to driver. This can influence the commissioning of services financial success, especially in markets like the U.S. But and, therefore, revenue. Siemens Healthcare GmbH, 2019 5 “Safe and reliable care is the foundation on which any effective experience is ultimately built.” Jason A. Wolf, PhD, CPXP The solution Engage patients and families to set an expectation for a hospital stay Understanding patient experience priorities is the basis for an impactful The continuum of care starts with engaging patients patient experience program. and families before they go into a hospital. Can you learn to speak a new language in five days? If patients are not medical experts, this is what they face. Medical terminol- We asked 1,478 patient-experience professionals from ogy and jargon is confusing. It is essential to communicate 19 countries about the factors that have the most influ- with patients and their families in a way they understand, ence on patient experience, with non-U.S. responses and that is customized to their needs. It's helpful to make representing 16% of the sample. This included almost time for questions before procedures and treatments start. 300 high-performing healthcare units and 175 patients Answering questions helps create expectations for the and their family members. High-performing healthcare upcoming stay, and a partnership between patients and units were identified in the following way: across the caregivers. Equally important is partnering with families. United States, organizations were invited to propose They can help maintain treatment plans after discharge, internal units that had scored a top rating of nine or ten thereby improving adherence and avoiding readmissions. in the overall rating question of the Hospital Consumer Assessment of Healthcare Providers and Systems HCAHPS survey (or equivalent). Acknowledging a single HCAHPS Optimize the diagnostic experience to make survey is just one indicator of success. For control purpos- better treatment decisions es, high-performing units were defined as those that have achieved and sustained a HCAHPS overall rating of Good teamwork among the care team is the foundation nine or ten over the last six months of collected data. for executing diagnostic episodes with empathy, efficiency, and transparency. Patient-friendly technology improves The top influential factors were then identified by analyz- the effectiveness and comfort of the diagnostic experience. ing the ratings of high-performing patient experience This fosters opportunities for care by actively mitigating units as well as patients and family members. At least anxiety and thereby lowering the number of missed 70% of these respondents rated these factors as having appointments. Another aspect is easy access to care ‘great’ or ‘the greatest’ influence. They combine with healthcare providers can improve by offering point-of-care other ‘must-have’ factors that mostly relate to the facility, diagnostic testing or tele-radiology closer to patients. By and hospitality, and were rated as having ‘great’ or ‘the achieving all of the above, healthcare providers can opti- greatest’ influence by at least 50% of respondents. All mize the diagnostic experience, which is the foundation factors are summarized in a scorecard (see pp. 7 and 10) for making the best possible treatment decisions. that is structured along the continuum of care and briefly described as follows: 6 © Siemens Healthcare GmbH, 2019 Top influence factors for patient experience – Elements of effective patient experience programs * Engage patients > Optimize the Deliver outcomes Sustain and families diagnostic experience > that matter to patients > patient loyalty Effective communication Teamwork among Coordination of care during Engagement level with patients /families the care team and between encounters of employees How patients /families Effectiveness of diagnostic / Serious and responsible Previous encounters with are personally treated testing experience pain management a healthcare organization Opportunity for a patient to Comfort of diagnostic / Quality / safety practices evi- Communication/education ask questions of care provider testing experience dent during a care encounter about prescribed medications Partnering with/engaging Ease of access to care Clinical outcomes of the pre- Check-out/discharge process patients and families scribed treatment/therapy Must-haves in the 90 – 100% Percent of survey participants continuum of care 70 – 90% (healthcare providers, patients 50 – 70% and family members) rated the importance of influence factors Clinical team well-being with ‘greatest’ or ‘great’. Commitment of leadership Cleanliness of facility Clear signage and wayfinding Noise level in facility Siemens Healthcare GmbH, 2019 7 “High-performing organizations acknowledge the need for evident quality and safety practices, effective diagnostic and testing experiences, and clear coordination of care.” Jason A. Wolf, PhD, CPXP Deliver outcomes that matter to patients Must-haves for positive experience The coordination of care during and between encounters Regardless of organizational size, clinical focus, or exper- without information loss at handovers is key for a seamless tise, there are some factors that influence patient per- patient experience, and is the foundation for delivering ception from the moment they enter the hospital. These outcomes that matter to patients. This includes reducing ‘must-haves’ are not always the highest rated, but describe waste and non-value-adding activities along the care the setting they are entering. These include cleanliness, pathway. Responsible pain management means offering way-finding, and noise level in the facility. Often, these pain-free diagnosis, and treatment with fewer side effects factors are easily manageable and represent quick wins and complications. During a care episode, patients expect for positive patient experiences. clinical measures to follow quality and safety practices, and that the prescribed therapy delivers a clinical outcome with To achieve all of the above, the well-being of the clinical a fast recovery and better quality of life. Technology can team is crucial: when hospital management supports a support improving patient reported outcomes by leveraging, culture that fosters employee health, it's easier to retain e.g., minimally-invasive treatments or imaging-enabled talent, achieve high employee satisfaction, and ultimately precise robotic surgery. positively influence all interactions that shape patient perceptions across the continuum of care. Sustain patient loyalty beyond the stay Employee engagement is the basis for a good experience during a stay in the hospital. Loyalty starts with the most recent stay. This is important because the patient always compares recent encounters with health systems and care providers with previous experiences. Loyalty depends on the sum of interactions the patient has in the hospital, including onboarding and discharge. At the end of a Suggested follow ups hospital stay, a structured discharge is a valuable procedure siemens-healthineers.com/improving-patient-experience in preparing the patient for his post-stay care. Before the patient checks out, asking for feedback about the hospital • The Beryl Institute Study: To Care is Human: stay and answering questions about billing and continued The Factors Influencing Human Experience in care alleviates stress and creates a more positive overall Healthcare today • HBR Report on improving patient experience experience. By providing the patient with access to their • Economist paper on patient experience health records, supporting health literacy, crafting inte- grated care plans, and educating about prescribed medica- In conjunction with ‘To Care is Human’ paper, The Beryl tions, the patient can plan his aftercare, leave the hospital Institute will release a series of case studies from high- with confidence, and reduce the chance of readmission. performing organizations participating in the research. 8 © Siemens Healthcare GmbH, 2019 Are you focusing on the right factors? Rate your measures from 1 to 4. 4 Fill in ‘1’ for Low – We haven't really tracked it. ‘2’ for Initiating – We have analyzed the pain, and started to initiate activities around it. ‘3’ for Ongoing/learning – We have several activities ongoing and are tracking KPIs and learning how we can improve. ‘4’ for Expert – We have optimized the issue and know how to best execute. Engage patients > Optimize the > Deliver outcomes diagnostic experience that matter to patients > Sustain and families patient loyalty Effective communication Teamwork among Coordination of care during Engagement level with patients /families the care team and between encounters of employees How patients /families Effectiveness of diagnos- Serious and responsible Previous encounters with are personally treated tic /testing experience pain management a healthcare organization Opportunity for a patient to Comfort of diagnostic / Quality / safety practices evi- Communication/education ask questions of care provider testing experience dent during a care encounter about prescribed medications Partnering with/engaging Ease of access to care Clinical outcomes of the pre- Check-out/discharge process patients and families scribed treatment/therapy Must-haves in the You will need Adobe Acrobat Reader or another PDF reader continuum of care program to fill out the form. You can download these at no Clinical team well-being cost in the Internet. Commitment of leadership Cleanliness of facility Clear signage and wayfinding Noise level in facility Siemens Healthcare GmbH, 2019 9 Are you focusing on the right factors mature patient experience initiatives, are in the bottom to improve your patient experience? boxes, and low numbers in the top boxes, you may want to Find out how to evaluate your scorecard: shift priorities. Put more effort in the top box initiatives and decrease efforts in the bottom ones. If your initiatives don't match any of the boxes, you are currently focusing On pages 7 and 10 you can find the highest-rated on factors that are not seen as the most important factors factors that influence the patient experience along the to improve the patient experience. Consider shifting these continuum of care. For example, ‘Effective communication resources to other initiatives. with patients and families’ is the most important influence factor in the phase ‘Engage patients and families.’ The relevance of the influence factors decreases toward the lower part of the graphic. This doesn’t mean partnering 2 Starting patient experience programs with patients and families is unimportant in that phase. It was still rated by more than 70% of survey respondents If you start from a scratch, it is a good idea to have a as having ‘great’ or ‘greatest’ importance. Further, the multidisciplinary team that understands your hospital ‘must-haves’ should be part of broader patient experience strengths and specialties and includes the front line and programs because they reflect basic needs. The score- provider perspective. The team can use the scorecard card can be used in different phases of your patient structure to discuss which of the phases and influence experience efforts: factors you want to improve. Whatever you choose, it is important to define who is driving this implementation and how to measure it. The experts we interviewed for 1 Gauge your existing patient the study recommend focusing on a few important experience efforts initiatives to start – this helps drive execution alongside the normal workload and demonstrate success quickly. Prepare a list of your patient experience initiatives and map it to the phases and influence factors in the boxes. Rate the initiatives with a number reflecting the maturity of your initiative. Keep it simple and use the spread between one and four. Please see the description of the rating in the scorecard on page 10. Check if you have high numbers in the top boxes under each of the phases. If you have high numbers there, you are working on the influence factors that have been identified by high-performing patient experience institu- tions and patients and their families as the most important influence factors. When your high numbers, i.e., more 10 © Siemens Healthcare GmbH, 2019 Conclusion Literature The United States is a leader in examining and measur- 1 Wolf JA. The experience era is upon us. ing patient experience activities. This may be due to a Patient Experience Journal: Vol. 3.2; 2016. consumer-centric culture, but not every hospital is in fact 2 Wolf JA. Consumer Perspectives on Patient a top performer in patient experience. The landscape is Experience 2018. The Beryl Institute; 2018. very heterogeneous, but transparent. Outside the United 3 Wolf JA. To Care is Human: The Factors States, developments in patient experience are also Influencing Human Experience in driven by health systems, politics, and consumers. Healthcare Today. The Beryl Institute; 2018. 4 Hero JO, Blendon RJ, Zaslavsky AM, and Improving patient experiences offers many opportuni- Campbell AL. Health Affairs. Understanding what makes Americans dissatisfied with ties for healthcare providers, hospitals, and patients. It their health system: An international is important to understand patient experience holisti- comparison; March 2016, [Online] cally for your strategy to be successful. But you also URL , have to focus on your own organizational needs as you [Accessed 14. February 2019]. define your levers for improving the patient experience. 5 Wolf JA., The State of Patient Experience: Matching these to the most important influence factors A Return to Purpose, 2017. will identify and help develop the most value-adding, 6 Advisory Board, New CMS patient patient-centric, and long-lasting initiatives. Providing a experience star ratings are out. See how better patient experience is not a one-off project, but a hospitals fared on our map; May 2, 2017, continuous improvement cycle that has to consider orga- [Online] URL , [Accessed: 14. February 2019]. 7 Betts D, MBA. Deloitte Center for Health Solutions. The value of patient experience: Hospitals with better patient-reported experience perform better financially; 2016. [Online] URL , [Accessed: 14. February 2019]. 8 Senot C. and Chandrasekaran A. HBR Paper, What has the biggest Impact on Hospital Readmission rates; 2015. [Online] URL , [Accessed: 14. February 2019]. 11 © Siemens Healthcare GmbH, 2019 Insights series, issue 3 About the authors Dr. Ralph Wiegner Vice President, Global Head of Improving Patient Experience and Marketing Strategy at Jason A. Wolf, PhD, CPXP Siemens Healthineers President at The Beryl Institute Ralph Wiegner and his team engage in thought leadership Jason A. Wolf is a passionate champion of and recognized and portfolio-related activities for improving the patient expert on patient experience improvement, organization experience. He is a member of both The Beryl Institute and culture and change, and sustaining high performance in the Solutions Provider Advisory Board at The Beryl Institute. healthcare. As president of The Beryl Institute, Jason has Prior to joining Siemens Healthineers, he spent several led the growth of the organization into the leading global years with McKinsey & Company, where he worked on community of practice and thought leader on improving various European and international assignments. Ralph the patient experience, engaging over 55,000 members holds a PhD in theoretical physics from the University of and guests in more than 70 countries, and establishing the Erlangen, Germany, and completed a number of research framework for the emerging profession of patient experi- engagements at Oklahoma State University, USA. ence. Jason is the founding editor of the ‘Patient Experi- ence Journal,’ the first open-access, peer-reviewed journal committed to research and practice in patient experience improvement. He also established and currently serves as president of the Patient Experience Institute, an indepen- dent non-profit committed to the improvement of patient experience through evidence-based research, continuing education, and professional certification. Jason is a sought- after speaker, provocative commentator, and respected author of numerous publications and academic articles on culture, organization change, and performance in health- care, including two books on organization development in healthcare and over 40 white papers and articles on patient experience excellence and improvement. Jason also received the American College of Healthcare Executives (ACHE) 2018 Dean Conley Award for his article ‘Patient Experience: The New Heart of Healthcare Leadership,’ published in the spring 2017 issue of ‘Frontiers of Health Services Management.’ 12 © Siemens Healthcare GmbH, 2019 At Siemens Healthineers, our purpose is to enable healthcare providers to increase value by empowering them on their journey toward expanding precision medicine, transforming care delivery, and improving patient experience, all made possible by digitalizing healthcare. An estimated 5 million patients globally benefit every day from our innovative technologies and services in the areas of diagnostic and therapeutic imaging, laboratory diagnostics, and molecular medicine, as well as digital health and enterprise services. We are a leading medical technology company with over 120 years of experience and 18,000 patents globally. Through the dedication of more than 50,000 colleagues in 75 countries, we will continue to innovate and shape the future of healthcare. Siemens Healthineers Headquarters Siemens Healthcare GmbH Henkestr. 127 91052 Erlangen Germany Phone: +49 913184-0 siemens-healthineers.com Published by Siemens Healthcare GmbH · HOOD05162002994181 · online · 7363 0519 · ©Siemens Healthcare GmbH, 2019