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

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Essential Notes
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Patient Experience What does It mean?

• Patient vs Customer Experience Fundamentally
  different or similar.
• Two dimensions of top percentile
• patient satisfaction.

How to improve the patient experience -
Sustainably?
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What does it take to achieve patient experience
excellence?
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Many hospitals in the USA are concerned
with patient experience especially with
HCAHPS
reimbursement rules come into effect.
However, there is confusion about what
customer experience actually refers to. A
Health Leaders Media survey of hospital and
health system senior leaders that states that
34 chose patient-centred care, 29 selected "an
orchestrated set 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 healing
environment which seems most aligned to
whats measured by HCAHPS. It is not just
semantics. The definition used makes a
difference because it determines what a
successful outcome will be or not. The honest
truth is that while many hospitals will
always have been concerned with the patient
experience they did not have a clear vision of
what it actually is. Successful outcomes were
measured by a variety of yardsticks. HCAHPS may
not be a panacea but it is an aligning force
that is basically says patient experience
is everything outside of clinical care and
involves all parts of the hospital. This
understanding of patient experience follows
what is known from the larger customer
experience space. Customer experience as a
discipline started to take off in 1998 with
the seminal HBR article Welcome to the
Experience Economy. Beyond Philosophy
provided the unifying definition of customer
experience as follows
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A Customer Experience is an interaction between
an organization and a customer as perceived
through a Customers conscious and
subconscious mind. It is a blend of an
organizations rational performance, the
senses stimulated andemotions evoked and
intuitively measured against customer
expectations across all moments of
contact. There are three key points here.
Patient experience is about 1) the whole
organisation delivering, 2) the rational as well
as the emotional experience and 3) dealing with
the intuitive perceptions (i.e, gut feelings) of
patients. There are three key points here.
Patient experience is about 1) the whole
organisation delivering, 2) the rational as well
as the emotional experience and 3) dealing with
the intuitive perceptions (i.e, gut feelings) of
patients.
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• Patient experience is about the whole
  organisation delivering
• 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.
• Patient experience is about the rational as well
  as the emotional experience

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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 any patient
or health care professional to state is important
facilities, competency, etc. As patients 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 things will make it through and this is
what they answer.

• The part that is below the water level is
  the emotional experience. This part of the
  experience is difficult for the hospital to see.
  Think of this as the bedside manor the whole
  hospital displays. To be frank, this is where the
  biggest opportunity is to improve patient
  satisfaction. So the trick here is to develop the
  hospitals ability (remember we are talking about
  the whole hospital) to view the emotional
  experience. It is certainly more difficult to
  address what you cannot see.
• Patient experience is about dealing with the
  intuitive perceptions
• Think about it, most patients are not
  trained medical practitioners. They generally
  have limited practical ability to assess the
  experience on the basis of sound clinical
  practice. Instead, they pickup clues and make
  inferences about the overall experience. A
  classic 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 the little
  things (i.e., clues ) in the experience. These
  clues could be such things as the quality
  of the toilet tissue, visible cleanliness of
  seating, name tags turned right way around, 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 patient
  experience needs to keep the above definition and
  its implications in mind. Overlooking or
  inadequately considering any of the three
  key points will significantly hinder progress.

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I recently presented at the Beryl Institute
conference on patient experience. While there, I
had
the pleasure of listening to a few of my fellow
speakers like Fred Lee (author of If Disney Ran
your Hospital), Al Stubbelfield (CEO,
Baptist Health Care Corporation), Colleen
Sweeny (Patient Empathy Project) and Tiffany
Christensen (author of Sick Girl Speaks) plus a
few others. One of the messages that were
fairly consistently dropped was how
different the patient experience is from
customer experience. In fact, Fred Lee suggested
similar to the following create a table with
Patient heading one column 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 lead one
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 individuals
involved. I dont have trouble with the notion
that a patient is different from a customer of an
amusement park, retail establishment and so
forth. I do however have trouble with the faulty
follow-on notion that patient experience
might therefore be considered separate from
customer experience.
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The paradox is that customer experience accounts
for these differences. It is ALWAYS true that the
specific experiences of any given segment in any
given sector tend to be fundamentally different
on a number of parameters (as demonstrated
above). So the paradox is that customer
experience is outside-in in its approach and
accounts for the differing rational and emotional
expectations of the customer (however
defined). My caution and advice to the many
patient experience directors out there is to
learn the principles and approaches from
customer experience. The principles of
customer experience can be applied to any
setting. Do not get confused by the fact that the
actual experience a hospital provides is
fundamentally different from the experience
provided by 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 in reality
different from a retail like customer
experience), the starting point for customer
experience thinking is with the
customer (however defined). Proper
customer experience 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
is an 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 imagine that the
experience expectations of a patient for
minor cosmetic procedure might be entirely
different than those of a patient for
bilateral mastectomy and so on. The
experience they perceive is in part dependent on
what they think the experience should be and in
part on what is actually delivered and how. When
the experience expectations are fairly close to
the current perceived experience, satisfaction
will be high when it is not satisfaction will be
low. This is true for all segments and
populations. So is patient experience
fundamentally different or similar to customer
experience? The answer is paradoxical. The
experience of a patient is fundamentally
different from a typical retail based customer
experience but it the principles by which patient
experience operate are the same.
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Managing patient satisfaction is a key strategic
goal for healthcare providers on both sides of the
Atlantic. 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
patients perception of who they are and how they
operate. This has great implications to how
things are executed because now they cant afford
not to ask themselves But how does this affect
our patients satisfaction? In addition
to the traditional Will this improve
our clinical outcomes? 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 about patient experience and patient
satisfaction. 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 the medical treatment and
associated service standards that hospitals
deliver. It has to do anything with the
medical procedures and practices, the
communication of those, efficiency, timeliness,
routines and any practice in the hospital which
directly or indirectly impact the patients
medical wellbeing. This answers the question
What do we do? Emotional outcome entails the
intangible, more difficult to measure effects of
the interaction that impact directly or
indirectly patients emotional wellbeing.
It comprises the subtle clues little
details signalling 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 any
physician), if fact they are strongly correlated
and in some parts are the cause of each other,
but never the less they produce 2 distinct
effects and are worth paying attention and
systematically addressing. Do not expect
that if the one goes well the other will
follow. A timely service, reduced noise and
detailed explanation of the effects of a drug do
not guarantee satisfaction. More importantly,
while you cant always control the clinical
outcome (things go wrong, not all conditions have
a positive outcome, budgets are short, staff is
short etc.), you can always pull the leavers on
the emotional outcome dimension to affect
satisfaction. Below is a diagram explaining how
the 2 dimensions interact and to deliver a
patient experience that has a certain type of
effect on patients behaviour and satisfaction
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Negative clinical negative emotional
outcome This experience is what gets patients to
score the hospital low on the satisfaction scale.
When admitted, patients are at their most
vulnerable and while some become hyper sensitive
and others hyper tolerant to the environment
waiting to only get through it, all are human and
want the best. Being submitted to diagnostics,
anticipating results, spending nights alone in an
unknown environmentall this makes the hospital
experience negative to begin with. Failing to
meet expectations, having to deliver negative
news all while failing to show care or compassion
is essentially rubbing salt to the wound. As a
result patient walk out of the experience feeling
negative about the hospital and the
staff. Positive clinical outcome negative
emotional outcome This type of experience will
get you in the low to average patient
satisfaction score range. The reason is that
regardless of how quick, accurate, regular
or effective you are in delivering the
medical treatment, the feeling behind it can
significantly leave patients with the impressions
that you are merely ticking the box and more
importantly, that it is the people who deliver
the good experiences, not the hospital.
Recommendation boils down to the physician
no the hospital brand. Positive emotional
negative clinical experience Interestingly, when
the medical treatment is not favourable but the
management of the delivery is 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 with lots
of patients etc.) and essentially excuse the
hospital. Reason is that the emotional outcome
serves as compensation and more importantly
leaves them with the impression that the
intentions were good and in place. It is like
going through a tough period with your partner
you are more forgiving and willing to move on
when you feel and believe there is love between
you and good intentions. Positive emotional
negative clinical experience This is the ideal
experience you can provide your patients with.
This is the reason patients score hospitals in
the top quadrant on the satisfaction scale.
Patients not only appreciate the staff, but see
the experience as purposefully designed and
delivered by the hospital.
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What are the implications?
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Aim at understanding and managing both dimensions
of patient satisfaction emotional and clinical
outcomes. Emotional outcomes have a significant
impact on patient satisfaction that can and
should be systematically managed. Ask yourself
and your staff if you know what those emotional
outcomes are?
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• Ask yourself and your staff how you can design
  positive emotional outcomes in your experience.

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At a recent Beryl Institute conference on Patient
Experience, Rhonda Dishongh, Director

• of Patient Experience Design at Memorial Hermann
  Hospital System and I presented a case brief on
  our work there. This time, our talk was
  focused on Achieving patient experience
  excellence through cultural transformation.
  Rhonda was keen to get the message out
  that the key to sustainable improvements in
  Patient experience and therefore patient
  satisfaction is cultural transformation. This
  transformation has to be organic 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. The Servant Leader was coined
  by Robert K. Greenleaf in The Servant as Leader.

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• Motivation
• The trick is to get employees to be internally
  motivated. One of the benefits of the healthcare
  sector is that many of the workers in the sector
  are there because they wanted to make a
  difference. They feel there is a greater purpose
  than just earning a nice pay check. Patient
  experience transformation works in your favour in
  this light. It just needs to be translated as
  such. What does not work is external based
  motivation- money and management by
  fear and intimidation are external
  motivators. 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 the healthcare
  sector is that many of the workers in the sector
  are there because they wanted to make a
  difference. They feel there is a greater purpose
  than just earning a nice pay check. Patient
  experience transformation works in your favour in
  this light. It just needs to be translated as
  such. What does not work is external based
  motivation- money and management by
  fear and intimidation are external
  motivators. They can generate behavioural change
  (often negative) but in isolation they never
  produce positive sustainable cultural
  transformation.
• Measurement
• ? It is obvious you will have HCAHPS as one
  source of measurement but that is a mandated
  outcome metric you want to improve. You need
  interim local metrics as well to give direction
  to the change. It is these local metrics that
  alert you to opportunities to coach, compliment
  and correct in-between HCAHPS scoring.

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• Patient experience excellence has brought
  Memorial Hermann 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
Quality Improvement Award, 2011 to name a few.
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More importantly, their success has been
gradually growing ever since they began their
journey back in 2005. When in 2007 Beyond
Philosophy stepped in to help translate intent
into action and practice, Memorial Hermann had
already set themselves the goal to become
renowned for the experience they knew they could
deliver. It took less than a year to archive
success.
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How? For easier understanding and the purposes
of this blog we will categorize their efforts in
3 steps Assess and understand, Define your
intention and patient experience vision Build a
culture around your vision The first two steps
are crucial to ignite the movement. Through the
assessment (the right one might I add, not just
any assessment, one that looks at the full
patient experience and journey) you will educate
your staff and give them the right perspective to
understanding patient satisfaction. Here is a
secret to help you succeed 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 experience vision, you will be able
to make a clear statement to the
organisation on what is expected, 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, to
actually make your vision relevant and
attractive to employees you will need to
incorporate an emotional element and paint
a picture with it. Create a story that
will imprint on their heart, not brain. So the
first two steps will help you get started and
show results very shortly after executing.
However, true and sustainable excellence
comes only by creating a culture 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 to fish and you feed him for a lifetime..
One of the greatest challenges many hospitals as
well as commercial organisations face
is sustaining success in changing
environments, in high turnover and scares
resources situations (all applicable to
hospitals). And being able to exceed patient
expectations as they get savvier but also
maintaining employee morale and eagerness,
requires a ubiquitous and enduring
characterising of the culture the hospital
nurtures and radiates. Step 3 of the
journey to providing outstanding
patient experience entails a cultural
transformation- coaching your staff to
be the driver and source of patient
experience 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.