Patient Experience Journal (PXJ, The Beryl Institute)
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Improving the patient experience through provider communication skills building
Get PDFThe doctor’s interpersonal skills are arguably the most important to clinical outcome and patient experience. A peer-facilitated, communication skills-building course for physicians has been provided twice annually since its inception in 2004. The course was designed to increase personal awareness, as well as to help physicians develop new communication and interpersonal skills. Satisfaction data from 3,561 patient surveys on 80 providers who attended the course between 2006 and 2010 were analyzed one year before and one year after course participation. After completing the course, the proportion of “excellent” ratings of provider service (the highest rating on a 5-point scale) increased by 2% to 5.6%. The most notable improvements in service attributes under the provider’s control and covered in the course content were: involving the patient in care decisions (P \u3c .001), explaining medical condition (P=.002), and the provider’s knowing the patient as a person (P = .004). Other improvements were noted in courtesy (by 3.4%, P=.027), listening (by 3.5%, P=.036), and overall quality of care from the provider (by 3.5%, P=.027). Attributes not directly under the provider’s control – nursing quality, teamwork, spending enough time, and likelihood to recommend – were included in the analysis; year-over-year changes in these were not significant. Further, providers who participated in the course, when compared to those who did not, experienced an 18-percent decrease in patient complaints. Improvements in perception of excellent provider communication and other service-related behaviors suggest this training approach may be useful in improving patient satisfaction, patient experience, and payment in value-based models
What matters most to patients? Participative provider care and staff courtesy
Get PDFAlthough there is growing recognition of the importance of having satisfied patients, we know little about what aspects of care matter most to patients. The sources of patient satisfaction and how care delivery can influence them need more empirical study. The objective of this study was to identify which aspects of a patient’s experience of care are most important to patient satisfaction, and how dimensions of care relate to clinic size, economic performance, and employee job satisfaction. To explore our question, longitudinal survey data were obtained on patients and employees over two years (1996 and 1997). Relationships between patient satisfaction and the two most critical care experience dimensions, clinic size, economic performance, and job satisfaction were examined. As of result, six major dimensions of patients\u27 experience of care were identified: 1) participative provider care, 2) staff courtesy, 3) self-reported sickness, 4) waiting, 5) staff follow-up, and 6) medical explanations. The first two factors, participative provider care and staff courtesy, account for more than 37% of the total variance in patients’ experience of care. Patient satisfaction is negatively and significantly correlated with clinic size but not correlated with job satisfaction, physician productivity, or clinic profitability. The article concludes suggesting that the personal relationships of a patient with his/her doctor and clinic staff are the strongest predictors of patient satisfaction. Patient satisfaction was found to be unrelated to the employee job satisfaction, physician productivity, and clinic economic performance
To serve patients is our greatest privilege
Get PDFIn his guest editorial, Dr. David Feinberg of UCLA Health System reminds us of the power of patient voice and the lessons we should be open to learning from those we serve every day. He offers, It is a blessing for us to work in an environment where we have the opportunity every day to touch someone’s life so deeply. We must never lose sight of that. It is our responsibility to not just treat our patients, but also to embrace them
Creating and sustaining a culture of accountability for patient experience
Get PDFImproving the quality of the patient experience has become an imperative for healthcare organizations. Value-based payment models include patient perception data, and a negative experience can impact an organization’s finances. Sustainable improvement requires more than quick-fix cosmetic enhancements, ‘flavor-of-the-month’ service trainings, or bonuses for front-line staff. Organizations must actually improve the patient experience. Doing so requires a culture of accountability and a systematic framework for collecting and acting on patient perception data.
This article revisits Mayo Clinic Arizona\u27s (MCA) 7-prong model for improving service quality: (1) multiple data sources to drive improvement; (2) accountability; (3) service consultation and improvement tools; (4) service values and behaviors; (5) education and training; (6) ongoing monitoring and control; and (7) recognition and reward. The focus of this article is Prong 2, creating and sustaining a culture of accountability for acting on service quality data to improve the patient experience.
The model has demonstrated efficacy in specialty and primary care areas. Based on our experience since the model’s publication six years ago, we still contend that a comprehensive approach to improvement produces the best results. We have fine-tuned our approaches to leadership engagement, data transparency, reporting and accountability processes to ensure action on the data, and leveraging the committee structure and front-line staff. To help other organizations on their patient experience journey, we share the methodologies, tools and resources used to create and advance the culture of accountability for patient experience at MC
“Working the system”: The experience of being a primary care patient
Get PDFHealth care providers and system administrators are in the midst of a paradigm shift; moving from paternalism toward an egalitarian approach. For patient centred care to occur, health care providers must prioritize patient needs; provide information regarding treatments while taking patient preferences and expectations into account. While there is literature regarding patient centredness, there is less information from the patient perspective about the experience of being a patient and the influence on behaviour. Using phenomenological research methods and the theory of planned behaviour as a theoretical framework, this study addressed the questions, a) what is the essence of being a primary health care patient, and b) what influence do beliefs, attitudes, and experience have on people’s behaviour as a patient? Nineteen individuals participated. Seven shared elements of being a primary health care patient were identified and contributed to the development of a composite vignette. The patient experience was a socially oriented, governed and reinforced cyclical process. Patients described themselves as actively engaged in their health care – “working the system” to get what they needed, when they needed it. Patients changed their beliefs, attitudes and behaviour as a result of experiences with their physicians, and their perceived success or failure in acquiring the best health care possible. Being a patient was not a single, observable behaviour, but rather a set of contextually dependent strategies patients’ directed at the specific goal of getting the best healthcare possible. The theory of planned behaviour was unsuitable for understanding patients’ beliefs, attitudes and behaviour
A daughter’s frustration with the dearth of patient- and family-centered care
Get PDFPatient involvement in decision-making is an increasingly recognized ethical imperative, one that requires attention to health literacy. Health care that is truly patient- and family-centered, however, is the exception rather than the rule. This first person account of a hospitalization describes the lack of patient and family inclusion in decision-making, failure to use plain language and other health literacy strategies, and disregard for patient and family preferences. The author concludes that if the health care system is going to shift from paternalistic to patient- and family-centered, providers must be trained how to communicate and partner with patients and families. Even the most skilled health professionals, however, will not be able to deliver patient- and family-centered care if the system they work in is not designed to foster or support such care. Committed hospitals will integrate patient- and family-centered care throughout their organizations. This includes their mission statements, quality improvement activities, personnel policies, decision and self-management support, and patient portals. Payment policies can encourage, but are a blunt instrument to drive, health care toward patient and family-centered care. The author references resources to help hospitals make systematic changes to hard wire health literate and patient- and family-centered care
The role of governing boards in improving patient experience: Attitudes and activities of health service boards in Victoria, Australia
Get PDFThe authors sought to determine the attitudes of public health service board members and senior executives toward patient experience and to describe the governance activities of the boards in this area. The study was based on an online survey of 322 board members from 85 public health services and semi-structured interviews with 35 board members and senior executives from 13 public health services in Victoria, Australia. The results showed that while some health service boards had high aspirations and clear plans for improving patient experience, others remained sluggish or even cynically resistant to changing their existing models of care. Interviewees associated with highly active boards described initiatives to improve patient experience at multiple levels in the organisation - from boardroom to bedside. Among less active boards, efforts to improve patient experience tended to be more ad hoc and there was greater uncertainty about how to scale up or systematise. The authors conclude that addressing the gap between the responsibility of boards to address patient experience, and the reality of their governance activities, requires a nuanced understanding of the attitudes and activities of board members. The approaches taken by “positive attitude, high activity” boards could be showcased as exemplars for others
Customer service vs. Patient care
Get PDFIn a competitive market where financial resources are limited, many of the popular approaches to improving the patient experience involve large capital investments in such things as hotel style amenities and expensive technology. The author argues that marketing based on a model of the patient as a traditional ‘customer’ is ill conceived and contributes unnecessarily to the high cost of healthcare while lacking a true understanding of, or an appropriate response to, the most basic needs of hospitalized patients that lead to patient satisfaction.
Experience Framework
This article is associated with the Patient, Family & Community Engagement lens of The Beryl Institute Experience Framework. (http://bit.ly/ExperienceFramework) Access other PXJ articles related to this lens. Access other resources related to this lens