- In some hospitals, patients can walk in to see a harpist playing in the lobby. Other hospitals let patients have the Sunday paper delivered right to their bedside. Although seemingly luxurious, these amenities have actually sparked a debate in the healthcare industry – should hospitals use these tactics to support patient satisfaction, or should quality care drive a quality patient experience?
Since the rise of healthcare consumerism, organizations have increasingly invested in efforts to drive patient satisfaction. Entities receive payments for high satisfaction scores, after all, and hospitals want to make sure patients will return should they fall ill again or recommend the facility to a friend.
But some of these investments – especially the harp-playing, gourmet-dinner eating, newspaper-reading ones – aren’t always in line with what providers value. Shouldn’t hospitals focus on quality of care rather than becoming a five-star resort? These swanky patient expectations shouldn’t be dictating hospital investments to this level, some clinicians have argued.
Truth be told, some of these more “luxury” items do serve their purpose, said Thomas Lee, MD, CMO at Press Ganey and a primary care doctor at Brigham and Women’s Hospital in Boston.
Walking into the BWH lobby to hear harp playing can be nice, Lee acknowledged, and is probably relaxing for nervous patients waiting to be admitted into the hospital.
Other displays for patients can be helpful, too. Patients want to be confident in their doctors, and Lee said doctors need to look the part to instill that confidence.
“This is why you should wear a white coat,” Lee said in an interview with PatientEngagementHIT.com. “This is why you should actually have your necktie on if you're a man and you should have the necktie knot all the way up. You should not be looking like you're George Clooney in a TV show or something. Show you can do things to inspire confidence.”
But ultimately, Lee also understands the issue of too many flashy patient satisfaction efforts.
“I understand why doctors are frustrated,” Lee conceded. “You don't see ‘was there a harpist in the lobby?’ showing up on our analyses of what really is driving patient experience.”
This debate between patient satisfaction and patient experience dates back to the 1999 and 2001 Institutes of Medicine reports To Err is Human and Crossing the Quality Chasm, respectively.
These reports revealed that patient experience is a process and requires an understanding of what patients go through in the hospital. It is not a yes-or-no checkbox about whether a clinician fulfilled a certain duty or a hospital offered a certain amenity.
“It's not whether consumers are satisfied, yes or no; it's what they're going through that became the focus,” Lee explained. “We’re recognizing that uncertainty and delays and confusion are forms of suffering that actually matter to people.”
“What matters to patients, what comes out in patient experience reports, is the stuff that we doctors and other clinicians really think is important too,” Lee added.
Quality of care, clinician teamwork and care coordination, and empathy have consistently risen as the top patient experience factors in Press Ganey analyses. Factors such as wait times and amenities are rarely statistically significant.
“When we look at the factors that drive patients’ confidence in their care, it's the ‘how’ factors that matter,” Lee explained. “Did there seem to be teamwork? Was there compassion? Was there good communication? Our analysis suggests that if we on the provider side get the ‘how’ right, patients will cut us some slack on what happens in the hospital.”
To its credit, the healthcare industry is beginning to understand this. Amidst the efforts to please patients on a shallower level, healthcare organizations are employing strategies to create a more positive patient experience and to meet patients’ true needs of quality and value.
In a recent Press Ganey report, Lee and his colleagues found that hospitals are improving on delivering a good patient experience. Between 2013 and the first quarter of 2017, the number of hospitals receiving top-box scores on the HCAHPS Overall Satisfaction score rose steadily from 70.3 percent to 73.3 percent. Lee maintained that this is a notable feat in healthcare.
This increase led to a punchy conclusion: if a hospital did not improve its patient experience scores, it actually fell behind the curve. Hospitals at the median for patient satisfaction in 2013 would find themselves in the 35th percentile in 2017, Lee explained.
This is not because more hospitals know how to game the system, he said. Instead, more hospitals are constantly improving, taking into account the care coordination, empathy, and quality factors that are driving a positive patient experience.
“The overall arc of history is in the direction of healthcare getting better,” Lee stated. “Everyone is working harder to try to meet patients’ needs and it is paying off. It may never feel great but there's definitely progress being made.”
Hospitals are succeeding because they are recognizing that patient satisfaction and positive experiences come from understanding what the patient is going through, not simply checking a box. Patients reflect positively on their hospital stay when they know their providers offered quality, empathic, and coordinated care.
Organizations can deliver on those three factors through a more thoughtful and targeted approach. Beginning with acknowledging the importance of care coordination and teamwork, providers can meet the needs of patients and ensure they have as calming an experience as possible.
“There are so many people involved in care today,” Lee noted of the importance of teamwork. “Literally dozens of people are involved in your care when you're admitted for even routine things. A typical admission for heart failure involves more than 60 people, for example.”
“It's just plain frightening,” Lee added, acknowledging that hearing different messages from different care team members can be stressful. “There's so many more people involved in care today, so the challenge of actually functioning like a team is a huge priority. And it's not going to get taken on without making it an explicit issue with providers.”
Lee said doctors can improve teamwork and the appearance of coordination by being up-front with patients.
When he can’t make it into the office, for example, Lee calls his patients and explains to them exactly how other clinicians will be communicating with Lee for the day. Lee updates patients on how he will monitor patient care and keep in contact with the care team.
This is critical for his practice because it assuages any patient concerns about coordination of care, Lee stated.
Lee also recommended hospitals look to their staff to assess care coordination and care quality. Patient insights are critical, but staff insights can offer a new look into any lapses in communication or areas for improvement.
Upping the level of patient feedback transparency can also push providers to prioritize the patient experience, Lee said.
Many hospitals have created vast strategies for dealing with negative online feedback. Mitigating these issues early and privately tends to be a go-to tactic, with the ultimate goal being that the poster rescinds his original comment.
Lee advised against this, however. Complete comment transparency – the good, the bad, and the ugly – will help hold clinicians accountable during their patient interactions.
“This raises people's game by encouraging them to be reliably at their best,” Lee explained. “If there were a comment or two about me on the web saying, ‘he didn't know what had happened to me during the hospitalization,’ that would be devastating for me. I work very hard to prevent that from happening.”
There will always be room for improvement in the healthcare space, Lee said. It is simply the nature of healthcare professionals to consistently strive to be better.
“Patient experiences can always be better,” Lee concluded. “The attitude that people have now on the provider side is that they recognize we'll never be good enough. We must keep on pushing to try to decrease the suffering and anguish and uncertainty that patients are going through. And that means learning and it means adapting.”