Quality Improvement

Putting the Consumer at the Center of QI

August 23, 2018 11:32 am

Today’s consumer-centric healthcare innovations increasingly aim to combine improvements in patient satisfaction with upgrades in care quality. Some of these initiatives could even hasten recovery after surgery and bolster staff productivity.

“Quality has been ingrained in most healthcare organizations for some time—what has been lacking is a focus on customer service,” says Chanin Wendling (
pictured at right), associate vice president of Geisinger in Motion at Geisinger in Danville, Pa.


But that is changing as many forward-thinking healthcare organizations implement consumer-centric technology to both improve their quality performance and satisfy patients who are increasingly more attuned to getting their money’s worth from their care.

The following examples illustrate how healthcare organizations are engaging consumers in their efforts to improve quality.

Improving Outcomes with Apps

To improve patient engagement, Geisinger has developed a variety of smartphone apps that target specific groups of patients with chronic conditions. “We try to get patients to pay attention to their health care in a way that aligns with their everyday life,” Wendling says. “We are not asking them to do something out of the ordinary—picking up their smartphone is something that most patients are doing constantly.”

Some apps are designed to help patients prepare for procedures like colonoscopies, spinal surgery (click on the screenshot below), and bariatric surgery. An app designed for parents with newborns in the neonatal intensive care unit (NICU) helps families track their baby’s progress, provide feedback to clinicians, and connect with other NICU parents.

A few of Geisinger’s mobile solutions have had a positive impact on quality metrics. For example, a weight management text-message program helped enrolled patients drop their BMI by 0.5 more than a control group after a 12-week pilot. A text-message diabetes management program helped patients achieve a 0.5 reduction in HbA1c levels. Every one-point drop in A1c levels results in an annual savings of $8,000 per patient, Wendling says. 

In both programs, patients receive short but encouraging text messages to help them maintain their momentum with various lifestyle changes. Wendling’s 10-person team of business analysts and project managers helps enable these technologies by working with Geisinger’s clinicians and IT department. “We see clinical needs and customer technologies and try to match them up,” she says.

Her team also develops questionnaires that patients can complete via the patient portal. One questionnaire alerts physicians to issues that could lead asthma patients to the emergency department (ED). If needed, a physician can suggest treatment or medications that can avert an ED visit. “If we can prevent an ED visit and a potential admission, we’re saving thousands of dollars each time that we’re able to do that,” Wendling says 

They also use digital questionnaires to monitor how patients are progressing after spine surgery and some cancer treatments. By screening the impact of the procedures on quality of life, physicians can adjust the care plan as needed.

These digital tools are available to all Geisinger patients, even those who are not members of a Geisinger health plan, Wendling says.

Designing Responsive Patient Rooms

Jefferson Health, a 14-hospital system based in Philadelphia, is testing “smart” hospital rooms that respond to the consumer and may help improve quality outcomes, says Neil Gomes (pictured at right), chief digital officer and senior vice president, who oversees Jefferson’s digital innovation and consumer experience (DICE) Group. The group annually coordinates more than 120 projects that are designed to improve the patient experience using digital tools.

Jefferson has outfitted seven hospital rooms at their flagship hospital, Thomas Jefferson University Hospital, with cognitive technology embedded in the ceiling or via a device on a table that listens to patient and family requests. These rooms and supporting technologies are being tested, but when they go live, patients in the smart rooms could control the temperature and lighting in their rooms as well as change channels and adjust the volume on their television using voice commands. They also could inquire about menus and learn when their next meal is coming from a “concierge” that speaks back to them.

The technology has quality applications as well. For example, the smart rooms could prompt patients with reminders to ambulate, which can help speed their recovery and their time to discharge. The concierge also can survey the patient about how they are feeling and alert a clinician, if needed.

The technology also has the potential to help clinicians reduce the amount of time they spend on nonclinical tasks like adjusting the thermostat. “It takes some of the pressure off of nurses and other clinicians and gives them more time to focus on the clinical aspects of care,” Gomes says. It also creates a better experience for the patient by providing a fast response to a nonurgent request when a nurse may be dealing with an emergent issue. 

Listening to Patients to Improve Care

Banner Health, a 28-hospital system based in Phoenix, has implemented a tool that captures patient feedback more quickly than traditional patient satisfaction surveys such as the Consumer Assessment of Healthcare Providers and Systems (CAHPS). Using such a tool enhances both the timeliness and volume of meaningful insights that help improve quality and safety at a reduced cost, says David Kriesand (pictured at right), vice president of the Consumer Experience Center at Banner Health. 

He points to patient survey comments that uncovered the importance of caregivers’ word choice during discharge from the ED. Specifically, “If we tell the patient that it is safe go home—versus it is OK to go home or time to go home—that gives them the confidence to take care of themselves,” Kriesand says. In addition, a survey identified a need for gait belts in Banner facilities that serve elderly patients. 

“Through the use of the new tool, we have uncovered the impact of operational efficiencies on customer/patient loyalty, whereas CAHPS is more focused on the clinical aspects,” he says.

Banner Health surveys patients at 20 different points along the patient journey, from scheduling to discharge and, soon, billing. To make sure the feedback is fresh, patients receive an automated phone call or digital survey within 24 to 48 hours of the transaction, Kriesand says.

The surveys also provide an opportunity for patients to share free-form comments instead of merely selecting multiple-choice answers. “That information provides so much rich feedback that we can mine that data for insights,” Kriesand says. Using the new feedback tool, Banner Health can reach out to 100 percent of its discharged patients at basically the same cost as surveying 12 percent of its patient discharges previously.

Lessons Learned

Experts offer the following advice to healthcare leaders who want to put the consumer at the center of their QI efforts.

Make it easier for staff to solve problems. The DICE Group at Jefferson developed an administrative-rounding mobile app that helps staff become “fixers.” Each week, several hospital administrators meet and use the app on their tablets as they visit with employees and patients to uncover issues that can negatively affect quality or the patient experience. This might mean an elevator that is not working, a torn pillowcase, a squeaky bed, or a room that may not have been cleaned to the patient’s liking.

Using the app, staff can report an issue, submit a photo of the problem, and triage the issue instantaneously to the right department or outside vendor. The goal is to solve the issue within 48 hours. “Most of the time it is much sooner, because if someone gets such a discrete problem, they feel good when they are able to solve it right away… [they get] instant gratification,” Gomes says. Unlike a patient experience survey that is usually sent after a patient leaves the hospital, this process helps staff improve patients’ experience while they are still in the hospital.

Gomes credits the app and the dedication of the leaders who regularly engage in the rounding process for helping Thomas Jefferson University Hospital receive a four-star hospital quality rating from the Centers for Medicare & Medicaid Services—a two-star jump that translates to better financial performance as well as a competitive edge in the market. The app has been rolled out to all hospitals within the health system.

Stay up to date on tools. To keep current on consumer-centric technology while still controlling the influx of vendor meeting requests, the Geisinger in Motion team sets aside a half-day a month for vendor presentations.

Realizing Other Benefits

Consumer-centric healthcare organizations recognize that using these tools to enhance care quality and the patient experience can improve financial outcomes as well. “As patients have more choices, they are going to be looking for those experiences that are easier,” says Kriesand, who previously worked in the financial services industry.

For example, providers have an opportunity to streamline the referral process to improve access. “If we deploy technology to eliminate the need to fax and streamline the authorization process from a customer’s point of view, we will reduce costs,” Kriesand says/. “By reducing costs, a healthcare system will be able to reinvest in the business to drive more revenue down the road.”

Laura Ramos Hegwer is a freelance writer and editor based in Lake Bluff, Ill.  

Interviewed for this article: Neil Gomes, chief digital officer and senior vice president for technology innovation and consumer experience, Thomas Jefferson University Hospital and Jefferson Health, Philadelphia; David Kriesand, vice president of the Consumer Experience Center, Banner Health, Phoenix; Chanin Wendling, associate vice president of Geisinger in Motion, Geisinger, Danville, Pa. 


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