Patient Experience: What does this mean? | Beyond Philosophy Consultancy

7/29/2019 Patient Experience: What does this mean? | Beyond Philosophy Consultancy

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Patient Experience: What does It

mean?

Patient vs Customer Experience:

Fundamentally different or similar.

Two dimensionsof top percentilepatientsatisfaction.How to improve the patient

experience - Sustainably?

What does it take to achieve

patient experience excellence?
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any hospitals in the USA are concerned with patient experience especially with HCAHPSreimbursement rules come into effect. However, there is confusion about what customerexperience actually refers to. A Health Leaders Media survey of hospital and health systemsenior leaders that states that 34% chose patient-centred care, 29% selected "an orchestratedset of activities that is meaningfully customized for each patient," and 23% said it involved"providing excellent customer service." The remaining 14% said it was creating a healingenvironment which seems most aligned to whats measured by HCAHPS. It is not justsemantics. The definition used makes a difference because it determines what a successfuloutcome will be or not.

The honest truth is that while many hospitals will always have been concerned with thepatient experience they did not have a clear vision of what it actually is. Successful outcomeswere measured by a variety of yardsticks. HCAHPS may not be a panacea but it is an aligningforce that is basically says patient experience is everything outside of clinical care andinvolves all parts of the hospital. This understanding of patient experience follows what isknown from the larger customer experience space. Customer experience as a disciplinestarted to take off in 1998 with the seminal HBR article Welcome to the ExperienceEconomy. Beyond Philosophy provided the unifying definition of customer experience asfollows:

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There are three key points here. Patient experience is about 1) the whole organisationdelivering, 2) the rational as well as the emotional experience and 3) dealing with the intuitiveperceptions (i.e, gut feelings) of patients.

There are three key points here. Patient experience is about 1) the whole organisationdelivering, 2) the rational as well as the emotional experience and 3) dealing with the intuitive

perceptions (i.e, gut feelings) of patients.

A Customer Experience is an interaction between an organization and a customer as perceivedthrough a Customers conscious and subconscious mind. It is a blend of an organizationsrational performance, the senses stimulated andemotions evoked and intuitively measuredagainst customer expectations across all moments of contact.


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Patient experience is about the whole organisation delivering

Patient experience is about the rational as well as the emotional experience

Patient experience is about dealing with the intuitive perceptions

The health Leaders Magazine article makes it clear that hospital leaders are in general

just coming to terms with the first point that patient experience is about an

interaction between the hospital and a patient. This simple phrase packs a lot of weight.

It does not say that patient experience is about an interaction between the front line and

the patient any individual or individual department and the patient.

Think of patient experience as being an iceberg. The part that is above the water is the

rational experience. This would be all of the normal things you would expect anypatient or health care professional to state is important facilities, competency, etc. Aspatients answer questions about what they want or like, they must process an answer.The act of processing the answer means that the most obvious logical sounding thingswill make it through and this is what they answer.

The part that is below the water level is the emotional experience. This part of theexperience is difficult for the hospital to see. Think of this as the bedside manor thewhole hospital displays. To be frank, this is where the biggest opportunity is to improvepatient satisfaction. So the trick here is to develop the hospitals ability (remember weare talking about the whole hospital) to view the emotional experience. It is certainlymore difficult to address what you cannot see.

Think about it, most patients are not trained medical practitioners. They generallyhave limited practical ability to assess the experience on the basis of sound clinicalpractice. Instead, they pickup clues and make inferences about the overall experience. Aclassic article that describes this phenomenon in a hospital is Clueing in Customers.The point is that this gut reaction on the part of patients is often dependent on thelittle things (i.e., clues ) in the experience. These clues could be such things as thequality of the toilet tissue, visible cleanliness of seating, name tags turned right wayaround, etc. things that people do not tend to primarily focus on in a healthcare

setting.

Any hospital executive that is looking to make significant improvements in its patientexperience needs to keep the above definition and its implications in mind. Overlookingor inadequately considering any of the three key points will significantly hinderprogress.


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recently presented at the Beryl Institute conference on patient experience. While there, I hadthe pleasure of listening to a few of my fellow speakers like Fred Lee (author of If Disney Ranyour Hospital), Al Stubbelfield (CEO, Baptist Health Care Corporation), Colleen Sweeny(Patient Empathy Project) and Tiffany Christensen (author of Sick Girl Speaks) plus a fewothers. One of the messages that were fairly consistently dropped was how different thepatient experience is fromcustomer experience.

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In fact, Fred Lee suggested similar to the following create a table with Patient heading onecolumn and Customer on the other. Then start asking yourself how these two are different.You might get something like the following:

The list could continue but the point has been made; this little exercise would seem to leadone to the conclusion that the patient experience is fundamentally different from customer

experience. And this is true if one is focused on the actual experience of the individualsinvolved. I dont have trouble with the notion that a patient is different from a customer of anamusement park, retail establishment and so forth. I do however have trouble with the faultyfollow-on notion that patient experience might therefore be considered separate fromcustomer experience.
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The paradox is that customer experience accounts for these differences. It is ALWAYStrue that the specific experiences of any given segment in any given sector tend to befundamentally different on a number of parameters (as demonstrated above). So theparadox is that customer experience is outside-in in its approach and accounts for thediffering rational and emotional expectations of the customer (however defined).

My caution and advice to the manypatient experience directors out there is to learn theprinciples and approaches from customer experience. The principles of customerexperience can be applied to any setting. Do not get confused by the fact that the actualexperience a hospital provides is fundamentally different from the experience providedby a mobile telco. The paradox can be summed up in the following diagram:

While the shape and colour of specific experiences differ (ie, patient experience is inreality different from a retail likecustomer experience), the starting point for customerexperience thinking is with the customer (however defined). Proper customerexperience makes no grand statement about what all customers will like or dislike.What works beautifully for some will fail miserably for others. So the starting point isan understanding of the rational and emotional experience expectations of customers(however defined). After all, not all patients are created equal. It is quite easy to imaginethat the experience expectations of a patient for minor cosmetic procedure might beentirely different than those of a patient for bilateral mastectomy and so on. Theexperience they perceive is in part dependent on what they think the experience shouldbe and in part on what is actually delivered and how. When the experience expectationsare fairly close to the current perceived experience, satisfaction will be high; when it isnot satisfaction will be low. This is true for all segments and populations.

So is patient experience fundamentally different or similar to customer experience? Theanswer is paradoxical. The experience of a patient is fundamentally different from atypical retail based customer experience but it the principles by which patientexperience operate are the same.
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anaging patient satisfaction is a key strategic goal for healthcare providers on both sides of theAtlantic. With patient satisfaction scores being directly linked to financial gain and loss,hospitals in particular are forced to re-evaluate their way of being and consider their patientsperception of who they are and how they operate. This has great implications to how thingsare executed because now they cant afford not to ask themselves: But how does this affect ourpatients satisfaction? In addition to the traditional Will this improve our clinicaloutcomes?; Will this makes us more efficient? etc.

But how do you achieve top percentile satisfaction?In the work Beyond Philosophy did with Memorial Herman Hospital System a few years ago,we came to an important revelation aboutpatient experienceand patient satisfaction.

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There are two key elements to patient satisfaction: clinical outcome and emotional outcome.Clinical outcome is defined in a broader sense and entails the effect derived as a result of themedical treatment and associated service standards that hospitals deliver. It has to doanything with the medical procedures and practices, the communication of those, efficiency,timeliness, routines and any practice in the hospital which directly or indirectly impact thepatients medical wellbeing. This answers the question: What do we do? Emotional outcomeentails the intangible, more difficult to measure effects of the interaction that impact directlyor indirectly patients emotional wellbeing. It comprises the subtle clues; little detailssignalling the intent behind the actions (e.g. tone of voice, facial expressions, colour of tiles

etc.). This answers the question: How do we do the things we want to do?
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Any healthcare provider will tell you that the two are not independent (ask anyphysician), if fact they are strongly correlated and in some parts are the cause of eachother, but never the less they produce 2 distinct effects and are worth paying attentionand systematically addressing. Do not expect that if the one goes well the other willfollow. A timely service, reduced noise and detailed explanation of the effects of a drugdo not guarantee satisfaction. More importantly, while you cant always control theclinical outcome (things go wrong, not all conditions have a positive outcome, budgetsare short, staff is short etc.), you can always pull the leavers on the emotional outcomedimension to affect satisfaction.

Below is a diagram explaining how the 2 dimensions interact and to deliver apatient experience that has a certain type of effect on patients behaviour andsatisfaction:
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Negative clinical & negative emotional outcome

Positive clinical outcome & negative emotional outcome

Positive emotional & negative clinical experience

This type of experience will get you in the low to average patient satisfaction score range. Thereason is that regardless of how quick, accurate, regular or effective you are in delivering themedical treatment, the feeling behind it can significantly leave patients with the impressions thatyou are merely ticking the box and more importantly, that it is the people who deliver the goodexperiences, not the hospital. Recommendation boils down to the physician no the hospitalbrand.

Interestingly, when the medical treatment is not favourable but the management of the deliveryis emotionally positive and engaging, patients tend to score average to high on satisfaction.Under these circumstances patients tend to rationalise the reasons for the poor clinical outcome(e.g. the condition is untreatable, medicine offers no better solutions, its a small hospital withlots of patients etc.) and essentially excuse the hospital. Reason is that the emotional outcomeserves as compensation and more importantly leaves them with the impression that theintentions were good and in place. It is like going through a tough period with your partner: youare more forgiving and willing to move on when you feel and believe there is love between youand good intentions.

This is the ideal experience you can provide your patients with. This is the reason patients scorehospitals in the top quadrant on the satisfaction scale. Patients not only appreciate the staff, butsee the experience as purposefully designed and delivered by the hospital.

This experience is what gets patients to score the hospital low on the satisfaction scale. Whenadmitted, patients are at their most vulnerable and while some become hyper sensitive andothers hyper tolerant to the environment waiting to only get through it, all are human and wantthe best. Being submitted to diagnostics, anticipating results, spending nights alone in anunknown environmentall this makes the hospital experience negative to begin with. Failing tomeet expectations, having to deliver negative news all while failing to show care or compassionis essentially rubbing salt to the wound. As a result patient walk out of the experience feelingnegative about the hospital and the staff.

Positive emotional & negative clinical experience


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What are the implications?

Aim at understanding and managing both dimensions of patient satisfaction: emotional andclinical outcomes.

Emotional outcomes have a significant impact on patient satisfaction that can and should besystematically managed.

Ask yourself and your staff if you know what those emotional outcomes are?

Ask yourself and your staff how you can design positive emotional outcomes in your

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t a recent Beryl Institute conference on Patient Experience, Rhonda Dishongh, DirectorofPatient Experience Design at Memorial Hermann Hospital System and I presented acase brief on our work there. This time, our talk was focused on Achieving patientexperience excellence through cultural transformation. Rhonda was keen to get themessage out that the key to sustainable improvements in Patient experience andtherefore patient satisfaction is cultural transformation. This transformation has to beorganic grown and nurtured from the inside. It will not happen simply by mandate.You will not make it happen by creating great sounding policy alone.

If you boil it all down, there are four key ingredients to successful cultural

transformation:

Leadership

The leaders are required to demonstrate and set the stage for the transformation.They need to be servant leaders - leaders who live the new cultures values. TheServant Leader was coined by Robert K. Greenleaf in The Servant as Leader.

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Measurement

It is obvious you will have HCAHPS as one source of measurement but that is amandated outcome metric you want to improve. You need interim local metricsas well to give direction to the change. It is these local metrics that alert you toopportunities to coach, compliment and correct in-between HCAHPS scoring.

Motivation

The trick is to get employees to be internally motivated. One of the benefits of thehealthcare sector is that many of the workers in the sector are there because theywanted to make a difference. They feel there is a greater purpose than just earninga nice pay check. Patient experience transformation works in your favour in thislight. It just needs to be translated as such. What does not work is external basedmotivation- money and management by fear and intimidation are externalmotivators. They can generate behavioural change (often negative) but in isolation

they never produce positive sustainable cultural transformation.

Coaching

The trick is to get employees to be internally motivated. One of the benefits of thehealthcare sector is that many of the workers in the sector are there because theywanted to make a difference. They feel there is a greater purpose than just earninga nice pay check. Patient experience transformation works in your favour in thislight. It just needs to be translated as such. What does not work is external basedmotivation- money and management by fear and intimidation are externalmotivators. They can generate behavioural change (often negative) but in isolation

they never produce positive sustainable cultural transformation.


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Patient experience excellence has brought MemorialHermann Hospital System astonishing rewards:

5% increase of market share within the first 2 years

Profit where loss was predicted

Patient satisfaction scores jump by 20% on average across the board within a year

Operational efficiency

National recognitions such as the Press Ganey Success Story Award, 2011; Gold Circle Award:Operations, 2011; Presidents Cup for Best Performance Overall, 2011 and NAATP QualityImprovement Award, 2011 to name a few.

More importantly, their success has been gradually growing ever since they began theirjourney back in 2005. When in 2007 Beyond Philosophy stepped in to help translate intentinto action and practice, Memorial Hermann had already set themselves the goal to becomerenowned for the experience they knew they could deliver. It took less than a year to archivesuccess.


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Assess and understand,

Define your intention and patient experience vision

How? For easier understanding and the purposes of this blog we

will categorize their efforts in 3 steps:

Build a culture around your vision

The first two steps are crucial to ignite the movement. Through the assessment (theright one might I add, not just any assessment, one that looks at thefull patient experience and journey) you will educate your staff and give them theright perspective to understanding patient satisfaction. Here is a secret to help yousucceed in this: instead of presenting to your staff what the complicated surveys say,get them involved in doing the assessment themselves.

Through step two, i.e. defining and clearly articulating your patient experiencevision, you will be able to make a clear statement to the organisation on what isexpected, desired and a definite no-no. A helpful hint: while acrostics and roll-off-the tongue wording help better than technical or nebulous sounding statements, toactually make your vision relevant and attractive to employees you will need toincorporate an emotional element and paint a picture with it. Create a story thatwill imprint on their heart, not brain.

So the first two steps will help you get started and show results very shortly afterexecuting. However, true and sustainable excellence comes only by creating aculture that has patient experience understanding and vision embedded in its DNA.As the saying goes: Give a man a fish and you feed him for a day; teach a man tofish and you feed him for a lifetime.. One of the greatest challenges many hospitalsas well as commercial organisations face is sustaining success in changing

environments, in high turnover and scares resources situations (all applicable tohospitals). And being able to exceed patient expectations as they get savvier but alsomaintaining employee morale and eagerness, requires a ubiquitous and enduringcharacterising of the culture the hospital nurtures and radiates. Step 3 of the

journey to providing outstanding patient experience entails a culturaltransformation- coaching your staff to be the driver and source of patientexperience excellence. To do this you will need to first create patient experience-centric habits and spread the practices organically through the organisation,horizontally and vertically.
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Patient Experience: What does this mean? | Beyond Philosophy Consultancy

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