The patient experience: How you can know
Wednesday, July 18, 2018
How you can know. This is not a question; it is a statement. Albeit, it is the appropriate question to ask in most industries where any management discipline is applied.
Let’s examine patient experience and how you can know what is actually happening from the patient’s perspective in your health system.
There are serious challenges to measuring patient experience, and these challenges have recently taken on increased significance as the industry tide shifts.
The “patient as consumer” is seen in headlines time and time again, and discussed by providers, executives and boards of directors at meeting after meeting. This shift may have more than one cause, but the general focus is increased financial burden of patients for a growing portion of the cost of their care.
Also at stake are federal dollars that are, in part, tied to patient satisfaction. Thus, hospitals across our nation are taking new interest in measuring, and then attempting to improve, the patient experience.
Let’s set up the landscape for our discussion with some history about measuring or monitoring business processes.
Back in the 1920s, what is commonly known as the "Hawthorne effect" was discovered in a Western Electric plant on the outskirts of Chicago. The Hawthorne effect, now accepted in all contemporary management circles, is that the observation (measurement) of something influences the outcome.
The Hawthorne plant experience taught us that people’s performance generally improves when they are being monitored or measured. The result: a readily accessible and powerful management lever to improve performance — simply start measuring.
It stands to reason that merely measuring the people (employees) who are interacting with the patient will influence their activity and related outcomes in a positive manner.
In a moment we will talk about the practical impact of measurement in one small, but important, sliver of healthcare. But first, let’s provide a comparison with which we are all familiar.
We all recognize the small, dark semi-globes that protrude from the ceilings of department stores, casinos and other public venues. We recognize them as security cameras or, as they are sometimes referred to, the “all-seeing-eyes.” Most of us appropriately assume that there is a room somewhere with a dozen flat-screens being monitored by security personnel.
The behavior of all rational people is influenced by the mere presence of those security cameras. Their presence has been proven to decrease shoplifting, and this is true even when the cameras are broken, fake or when there are no humans actually viewing the video. Just the potential for measurement, if the subjects are aware of it, has a demonstrable impact on behavior.
This teaches us something important as an adjunct to the Hawthorne effect: it is not the measurement of the subjects that influences behavior as much as it is the perception and the potential of being monitored.
Let’s jump forward a few decades from the discovery of the Hawthorne fffect to a loosely related management principle often attributed to both Edward Deming and Peter Drucker.
There is some debate about who first postulated or promoted this principle, but the simplest rendition of it is: you can’t manage what you don’t measure. This is not strictly true, but there is a lot of practical value in it.
What is true is that the better the data you have about a process, the better equipped you are to manage that process. In short, relevant measurement data does help you manage better.
In contrast to Hawthorne, this principle requires that you actually collect data, as opposed to individuals’ perception that they might be measured or monitored.
So in combining our Hawthorne effect discussion with the principle of measurements being necessary to effectively manage as promoted by Deming and Drucker, we will offer this conclusion: The patient experience in healthcare can only be optimized after we accomplish a thorough, end-to-end measurement of the people, processes and systems that interact with the patient.
Behaviors will improve and become more compliant as measurement systems are implemented, and the hard data that is actually collected enables management to analyze that data as a foundation for changes that drive operational improvements.
Outcomes vs. Process
The sort of data required to better manage the patient experience includes information about healthcare processes themselves, not just the outcomes of those processes. Some simple environments have proponents suggesting that measuring only the outcomes is adequate.
This is true when both the process is simple and the outcome is not of great consequence. Examples of this simple environment would be a cash-only mobile car wash service or a lemonade stand. The outcomes of cars washed or lemonade sold is probably adequate for some general assessments.
But the proposition of only measuring outcomes is sorely inadequate when something possesses a degree of complexity or when the outcome is important. Think about an Olympic swimmer never analyzing the details of his or her stroke. Think about a professional golfer not looking at dozens of details within his or her swing.
These examples demonstrate why video recording has become a primary tool in the analysis and management of these athletes’ stroke and swing, respectively. There are details in these processes that until measured and the resulting data is analyzed, leave many potential improvement opportunities overlooked and unaddressed.
Obviously, healthcare processes are different than golf swings or swim strokes. However, they do have complexity that is more akin to golf and swimming than to lemonade stands.
The point is that healthcare processes that directly impact the patient experience involve a complex network of people, processes and systems that jointly culminate in the production of some outcome.
And if athletic achievement is best aided by applying available measurement tools to thoroughly understand and improve athletic processes, should we not bring similar measurement tools to the patient experience touchpoints in healthcare, especially when the outcomes are so important?
The aforementioned sliver of healthcare that deserves special attention in today’s healthcare environment is that of patient presentation. That is, when an individual presents him or herself at a facility and encounters a provider organization’s representative in a face-to-face interaction.
These initial five minutes cover several topics that must be addressed to help this individual become a patient. Topics typically include confirmation of basic demographics, insurance eligibility, financial obligations, planned course of care, physician relationships, an introduction to facility and other social services and more.
These five minutes are critical because they typically represent (in the mind of the patient) the starting point for the life of a patient encounter with the hospital — indeed, for the launching of a patient relationship.
Prior to these five minutes, they may be a member of a health plan and a patient of a community physician, but now they are crossing the chasm and making the shift toward becoming a patient of your health system.
While many of the topics in this first face-to-face conversation are initially addressed in pre-registration and patient scheduling phone interactions, they are finalized in this all-important initial face-to-face conversation. We are all familiar with the common phrase "this call may be recorded for quality and training purposes" when any type of customer service call occurs in the general marketplace.
The measurement of these interactions is important and is typically managed with some rigor. But why do we stop there?
Why do so few provider organizations apply the same measurement discipline to face-to-face conversations, when registration actually occurs, as they do to the pre-registration phone calls?
The financial performance of all health systems suffer when this conversation is not completed in a high-quality manner. Stated more directly, those health systems not measuring this critical first five-minute conversation are risking revenue and patient satisfaction.
One evidence of this is the rate of claim denials by health plans due to inaccurate or incomplete registration information. Another evidence is the increase in cash collections prior to discharge in those health systems that do measure and bring management focus to this first five minutes.
Experience has shown that with measurements in initial face-to-face patient presentations, all parties benefit with improved tone and content on all information exchanges — and health system financial performance, patient satisfaction, employee morale and third-party accountability all improve.
If it is true that relevant data helps you manage better, then this author suggests it is time that our health systems bring new measurement tools to bear on the crucial first five minutes of an encounter, when the individual is making the transition and becoming a patient.
Looking only at the outcome of completing a patient admission is woefully inadequate given the complexity of the process and the importance of the outcome. The process deserves detailed measurement and sharp focus and analysis.
The title of this article poses the question, "How can you know?" what any patient’s experience is, and the answer is clear about "How you can know."
You can know by measuring the conversation held in the crucial first five minutes with any new patient with face-to-face recording technology. The benefits of this are clear.
The quality of this encounter is likely to improve once it is being recorded and monitored, as our reflection on the Hawthorne effect makes plain. And a practical extension of this will validate that the message, "this conversation is being recorded for quality and training purposes," will soon become a standard best practice in healthcare management. It already is in many of our nation’s most respected health systems.
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