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With Medicare implementing its value-based purchasing system in October, patient experience has moved into center stage, with incentives given to organizations that meet quality and HCAHPS patient satisfaction targets. But just what is patient experience-and how does a hospital go about improving it?
Last year, The Beryl Institute issued a white paper on the financial impact of patient experience. In this interview, coauthor Jason Wolf, PhD, executive director of the institute, discusses why healthcare organizations should embrace patient experience and the benefits that can result.
Wolf: We define patient experience as the sum of all interactions, shaped by an organization's culture, that influence patient perceptions across the continuum of care. Experience is not restricted to the four walls of the clinical setting. It starts from that very first encounter with scheduling or with a physician outside the hospital setting. It may even be through the stories shared by a friend or community member that influence a patient's perspective. It is important to recognize the patient experience encompasses a broad range of touch points well before and after the clinical encounter. Of interest is that our research has shown only 27 percent of U.S. hospitals have a definition for patient experience. Without definition how can one have a basis for action? We encourage healthcare settings to adopt or adapt this definition to help guide the patient experience direction.
Wolf: Patients can now go online and compare one hospital to another in every HCAHPS domain. At the same time, with the implementation of value-based purchasing these scores will now have a real impact on the pocket books of hospitals and health systems. This is a significant reason why patient experience has garnered much greater attention in healthcare strategy and leadership today. I also hope it's not the only reason. There is a growing recognition that improving the patient experience actually leads to better clinical outcomes, and positively impacts quality of care and the bottom line for hospitals and health systems. The organizations that have been most successful in improving the patient experience are not solely motivated by financial incentives or penalties. They are motivated by a desire to do what is right for patients.
Wolf: I don't think anyone would argue that engaging your customers in a way that increases their satisfaction tends to lead to higher engagement and ultimately profitability. A study we reported in our paper by J.D. Power and Associates shows that hospitals scoring in the top quartile in satisfaction have around two times the margins of those at the bottom. A similar study by Press Ganey shows that those organizations that are more profitable tend to have higher than average satisfaction scores. Satisfaction should not be equated directly to experience, but it is definitely one indicator in a broader conversation about experience overall. There is clearly a link between the way patients respond to their experience, or the way that they see a facility operating from a quality-and-outcomes perspective, and profitability. In fact, a study just released this spring from Ohio State University shows that organizations that focus on creating both high experiential and clinical quality far outperform their peers in operating margin.
Wolf: The marketing perspective is about the power of word of mouth. We all recognize that-as many billboards you put up on the side of the road or how many ads that you run-the perception of your organization ultimately comes down to what patients and their families and friends hear about your organization when they talk to each other, be it at PTA meetings or at the local market. Research reinforces that dissatisfied people tend to share their poor experiences broadly. One study specific to health care showed that dissatisfied patients tend to tell up to 25 others about a negative experience. What's interesting is that, based on that same research, for every patient who complains, there are 20 others who don't. This has a significant implication on the bottom line. When dissatisfied patients don't complain, we don't even know there's a problem to address. More importantly, only 1 in 10 of those individuals will actually choose to return to your facility. That's lost revenue and a lost opportunity to create lifetime loyalty.
There is a broad clinical impact of experience as well. In line with the Ohio State Study I mentioned, research conducted last year by Duke University showed that experience measures based on HCAHPS were more indicative of whether someone would be readmitted to the hospital than clinical quality measures. The bottom line is that experience matters.
Wolf: I always stress that organizations need to start with a clear definition of what patient experience is and how it supports what your organization is trying to accomplish. I've seen a lot of organizations focus simply on tactics. Although these tactics are important to moving a hospital or health system's overall patient experience strategy, healthcare organizations need a framework in which to operate. Having a clear definition for your organization keeps staff aligned, focused, and intentionally moving in the same direction. It also ensures you are moving toward your desired experience targets and that your efforts support those objectives at every step.
The second critical piece of an effective patient experience strategy is clear leadership vision and support. Senior leaders should reinforce the fact that experience is a critical aspect of their hospital or health system's organizational strategy. Linking the importance of quality, safety, and service ensures a comprehensive and effective patient experience effort. Commitment to a positive patient experience should also be demonstrated throughout the organization, from those who deliver patient care at the bedside, to those who support the delivery of care, to those who call to collect on an outstanding bill. These all are moments in which we encounter the patient and their family. We should also remember that although there are many encounters from our perspective, the patient ultimately only has one experience.
Another critical choice is designating a leader who has primary accountability for patient experience. Ensuring that someone can fully focus on this effort-whether that person is a director of service excellence, vice president of service, or chief experience officer-is also is fundamental. The role cannot be just tacked onto someone else's responsibilities: "Well, you're the CNO; you're now the experience person as well." Research we've conducted in the past year shows that organizations with a committed patient experience role have outperformed other organizations in their HCAHPS and overall satisfaction scores because they've been able to ensure an unwavering focus, a committed strategy, and consistent execution around experience.
For many organizations, that may be a hard choice to make in the face of limited resources. But at the end of the day, the benefits, potential outcomes, and impacts on the bottom line can be significantly enhanced by having someone specifically in charge of patient experience-someone who is responsible for strategy, execution, identification of tactics, and implementation of the entire patient experience plan. That's the differentiator for hospitals and health systems. Our patients and their families deserve nothing less.
Jason A. Wolf, PhD, is executive director, The Beryl Institute, www.theberylinstitute.org.
Publication Date: Monday, August 13, 2012
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Dale Hockel, senior vice president of operations, and Jim Fanelli, CFO, TriMedx, share strategies for elevating clinical engineering through innovative management programs.
Russ Graney, founder and CEO for Aidin, and John Laursen, head of business development for Aidin, share insights on how to improve care transitions between acute and post-acute care settings and incentivize high-quality patient outcomes.
Scott Elston, strategic accounts manager, GE Healthcare Services, describes how substantial cost reduction in health care requires rethinking business strategy and asset use.
Robert Williams, MD, director, Deloitte Consulting LLP, and Arielle Freiberger, product strategist, ConvergeHEALTH by Deloitte, explain how sophisticated retrospective, real-time, and predictive data analytics can inform decision making to reduce costs and improve care.
Stuart Hanson, director of business development (healthcare solutions) at Citi Retail Services, discusses how improving the payment experience can benefit consumers and healthcare providers.
Scott Schmidt, vice president, Cerner RevWorks, LLC, shares insights on best practices for maximizing a revenue cycle management partnership.
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