Why is it
important to provide patients with the best experience we can?
The
most obvious and noblest of reasons is because it is the right thing to do. We should be treating our patients,
caring for them in a manner that we would want for ourselves, our families and
our friends. As Michael Dowling, President and CEO of the North Shore-Long
Island Jewish Health System often reminds staff, many of our patients are us,
our relatives and friends. We should be treating all patients as such (Author’s
attendance at Mr. Dowling’s presentations.).
A
second reason focuses on the theme of choice as related to how our patients
view the quality of care we provide. Deming tells us that quality is meeting or
exceeding our customer’s needs and expectations. Deming also tells us that
loyalty is achieved when we exceed those expectations (Aguyao, 1990; Deming,
1982). Changing how health providers view their patients as customers continues
to have its detractors, but few would argue, that increasingly patients have
choices, and all in health care now have multiple competitors. If our
organizations are to become and continue to be facilities of choice, there is a
need to be distinguished from our competitors.
Pyzdek (2001) in his description of the
Kano Model of Customer Expectations explained that meeting basic levels of
quality is something that is taken for granted. Meeting them does not result in
satisfaction, but not meeting them is a source of dissatisfaction. There are
expectations that customers believe are important and the more they are met the
more satisfied the customer. The provision of providing exciting quality occurs
when the customer receives more than what was expected and this level of
quality becomes increasingly important as competitive pressures for nurses
present internal customer problems with dissatisfaction with peers or
supervisors. Similarly, Bertel (2003) referred to events and practices that
dissatisfy customers as the must-haves, which if unfilled would serve as
sources of dissatisfaction. Bertel used the term delighters which would not
cause dissatisfaction if not present, but when they are present serve to truly
satisfy or delight the customer.
A
third reason and most recent interest in the patient experience came from
HCAHPS, a CMS-developed patient
satisfaction questionnaire. In October
2012, HCAHPS’ (Hospital Consumer Assessment of Healthcare Providers and Systems)
patient satisfaction scores were utilized by CMS in the calculation of reimbursement
for patient stays HCAHPS is not only an instrument that affects reimbursement,
its results are publicly reported, permitting comparisons by the public (CMS,
2015).
Creating and Managing Expectations
Creating
expectations initially derives from the informed consent process. This process
should have included communication regarding diagnosis, agreed upon course of
treatment following an explanation of alternatives, with risks and benefit
(Bord, 2014). Patients must have an opportunity to pose questions and to have
those questions answered in a manner they can understand. The process must also
include an awareness that the patient understands what has been conveyed and an
agreement by the patient for a course of care. The process occurs between the
physician and the patient.
Once
hospitalized, patients are obviously “managed” much more by other hospital
staff who have a responsibility to make patients aware of what to expect during
their stay. With their experience, other hospital staff have greater expertise
regarding what is likely to happen to and for patients, and in what sequence,
than patients could possibly have. Initial expectations also derive from past
experiences with the facility, discussions with others, experiences with other
facilities, and information derived from the media, “report cards,” various web
sources etc.
Likewise,
mindful that effective communication must be a two-way process, staff have a
responsibility to seek out questions and comments from patients regarding their
needs and expectations (similar to a consent process), and to appropriately
respond to these, both in terms of words and actions to best meet those needs
and expectations. The voice of the patient-customer regarding their expression
of needs and expectations is often critical to how quality is perceived by the
patient (Stroud, n.d.). Bertel, (2003)
described the centrality of meeting customer needs in the Six Sigma model with:
“Failure to listen to and understand the Voice of the Customer can be fatal”
(p. 171). Further, Solomon (2015) stated: “If you want to stem patient dissatisfaction, stop giving off cues of
indifference and uncaring.”
Managing expectations, requires transparency
of information between staff and patients on an ongoing basis. Treatment plans
may have to be altered due to either patient condition, physician direction or
hospital “circumstances.” Solomon (2015) provides the following additional
items regarding how to improve the patient experience (Bullets rather than
numbers have been utilized here):
Get every employee thinking about purpose, not just functions… To create successful medical outcomes and hospitable human experiences for our patients’ is a purpose.
‘Sorry’ may be the hardest word, but it’s a word that everyone on your team needs to learn. Resolving patient issues means knowing how to apologize for service lapses…It means getting rid of the defensiveness …when confronted by a patient upset with what she perceives to be a service gaffe. Instead, take your patient’s side in these situations, immediately and with empathy, regardless of what you think the “rational” allocation of “blame” should be. And spread this approach throughout your staff through role-playing and other training devices, so it will serve you fully every time a patient hits the fan.
Teach your employees – every single one – how to handle a patient or family member’s complaint or concern.
If you want to improve, strive to create a blame-free environment.
Understand that improving patient satisfaction is about systems just as much as it is about smiles.
Cultural Change toward a Customer ApproachGet every employee thinking about purpose, not just functions… To create successful medical outcomes and hospitable human experiences for our patients’ is a purpose.
‘Sorry’ may be the hardest word, but it’s a word that everyone on your team needs to learn. Resolving patient issues means knowing how to apologize for service lapses…It means getting rid of the defensiveness …when confronted by a patient upset with what she perceives to be a service gaffe. Instead, take your patient’s side in these situations, immediately and with empathy, regardless of what you think the “rational” allocation of “blame” should be. And spread this approach throughout your staff through role-playing and other training devices, so it will serve you fully every time a patient hits the fan.
Teach your employees – every single one – how to handle a patient or family member’s complaint or concern.
If you want to improve, strive to create a blame-free environment.
Understand that improving patient satisfaction is about systems just as much as it is about smiles.
Increasingly
patients don’t want to be considered as patients; they want to be considered
customers. They want to know and agree to how they will be treated, what should
happen, what are the outcomes, what to expect when they leave the hospital,
what to expect about their health. We cannot effectively respond to these
expectations with a departmental/silo mentality. We must break down these
silos, learn to work as interdepartmental, inter-professional teams, although
past models of professional education did not foster this approach, and change
in these educational models is needed (National Center for Healthcare
Leadership, 2011).
Contributed by Dr. Walter Markowitz, Adjunct Faculty
References
Aguayo, R. (1990). Dr. Deming: The American who taught the
Japanese about quality.
New York:
Simon and Schuster.
Bertel, T. (Ed.). (2003). Rath and Strong’s Six Sigma leadership
handbook. Hoboken, NJ: John Wiley and Sons, Inc.
Bord, J. (2014). Informed consent. Retrieved from https://depts.washington.edu/bioethx/topics/consent.html
CMS. (2015). HCAHPS factsheet. Retrieved from http://www.hcahpsonline.org/Files/HCAHPS_Fact_Sheet_June_2015.pdf
Deming, W. E. (1982). Out of the crisis. Cambridge, MA: MIT Press.
National Center for
Healthcare Leadership. (2011). Michael
Dowling accepts 2011 Gail L. Warden Leadership Excellence Award. Retrieved from https://www.youtube.com/watch?v=ZHCOzlYMyxQ
Pyzdek, T.
(2001). The Six Sigma handbook: A
complete guide for greenbelts, blackbelts, & managers at all levels. New
York: McGraw-Hill.
Solomon, M. (January
11, 2015). 8
ways to improve patient satisfaction, patient experience and (by the way)
HCAHPS scores. Retrieved
from http://www.forbes.com/sites/micahsolomon/2015/01/11/8-ways-to-improve-patient-satisfaction-and-patient-experience-and-by-the-way-improve-hcahps-scores/
Stroud, L. (n.d.).
Defining CTQ
outputs: A key step in the design process. http://www.isixsigma.com/methodology/voc-customer-focus/defining-ctq-outputs-key-step-design-process/
(Note: Dr.
Markowitz was the Director, Strategic Planning, North Shore-Long Island Jewish
Health System.)
