Patient Perspectives on Outstanding Experiences: The Impact of Emotionally Intelligent Staff

Transcription

1 Patient Perspectives on Outstanding Experiences: The Impact of Emotionally Intelligent Staff Richard W. Millard, Ph.D. J. D. Power and Associates Acknowledgements. John Clark, Jay Meyers Ph.D., and Kristine Westman contributed to this report. Improving the Patient Experience

2 The Beryl Institute is the global community of practice and premier thought leader on improving the patient experience in healthcare. The Institute serves as a reliable resource for shared information and proven practices, a dynamic incubator of leading research and new ideas and an interactive connector of leaders and practitioners. The Institute is uniquely positioned to develop and publicize cutting-edge concepts focused on improving the patient experience, touching thousands of healthcare executives and patients. The Institute defines the patient experience as the sum of all interactions, shaped by an organization s culture, that influence patient perceptions across the continuum of care The Beryl Institute

3 The Power of Perception There are several critical sub-textual issues I see emerging in the conversation on improving the patient experience. They include the importance of engagement and accountability, of perceptions and patient voice. Of significance to these issues is their very connection to the definition of patient experience itself the sum of all interactions, shaped by an organization s culture, that influence patient perceptions across the continuum of care. When we examine the finding s of the study presented in this paper, we are drawn to the very same ideas; that there is power in the voice of patients (if we are intentional in our listening) and that above all else it is the behaviors of healthcare staff at all levels that have the most impact on the experience for patients. The author reinforces this point based on his findings in suggesting: It is also important to consider that interpersonal skills of staff do not have a positive impact unless patients recognize the impact in terms of their own personal experience. It is their perception that matters. This is also supported by the findings in The Beryl Institute s recent research conducted on noise in hospitals, where healthcare organization s clearly identified the behaviors of their people as the greatest source of noise and therefore the lever through which appropriate quiet could be achieved. In examining the very power of interactions, acknowledging the central role of culture and supporting the intention of patient perception as central to the care experience was also supported by the research findings in this paper that two of the most critical points where opportunities exist were during the admissions process and at discharge returning to the definition, across the continuum of care. We must remember a patient s experience starts well before and continues well after their stay in a hospital or at the conclusion of a clinical experience. We have an opportunity and I would suggest an obligation to think about the experience from this broad systemic perspective. This paper leads us to consider five key takeaways that return us to the fundamentals of healthcare and any care experience. They also help us to recall the power of what I believe is at the core of our greatest challenges and frustrations as well as successes and joys in healthcare we are ultimately humans caring for humans with all the intricacies, diversity and needs that come with that. In revealing these takeaways the research not only refocuses us on the critical concepts in a caring experience, it provides us the evidence to suggest these are not just nice to dos, but must dos in healthcare today. In fact it seems, our patients and their families the healthcare consumer expects it. I know some continue to struggle with the ideas that perceptions matter in healthcare today, saying our people are sick, they don t want to be here, and stressing we are not the Ritz or Disney or Southwest Airlines. All of this is true, which means we have an even greater challenge in addressing the patient experience. But we must, as the research here shows, make this a central priority of our healthcare efforts. Will every patient or family member be thrilled all the time, I would not suggest that to be the case, but that is not an excuse for us not to try and ensure each patient has the same chance to be wowed, not just healed, by our care every day. That is what we would want for ourselves and that is what we would want for our families and friends. It is how you will distinguish the value and impact of healthcare today. Jason Wolf Executive Director The Beryl Institute

4 4 Listening to the Voice of the Patient: The National Patient Experience Study The communication skills of hospital staff are what have the largest influence on patient experience, and events before and after hospitalization also exert a surprisingly large impact. These are over-arching conclusions highlighted by the National Patient Experience Study (NPES), a national survey conducted by J.D. Power that examined the experiences of 3,500 recently-discharged inpatients. This paper outlines details from the study, demonstrating how the quality of staff interpersonal skills influences overall patient experience. Hospitalization is an emotionally-charged encounter. A hospital where patients are satisfied is one where frontline staff exhibit a level of emotional intelligence as exemplified by their ability to listen, express compassion, and understand and manage emotional responses. This study demonstrates how these behavioral qualities combine with features and environments of a facility and its processes to produce the best possible patient experience. Customer experience is important across all industries, regardless of whether a service is being provided or a product is being consumed. Does the importance and sensitivity of healthcare make it an exception? A patient is more than a customer. The word patient is derived from the Latin verb for suffering, and a sufferer expects (and deserves) more of their service encounters. Whether or not skills such as active listening, empathy and compassion are learned or innate, their application in personal interactions is still measurable. They are present when the patient says they are present. This is the power of perception and why it is crucial to listen directly to the voice of the patient. When patients rated their hospital as 8 or less, only 30% said they would probably or definitely recommend the hospital. More positive word-of-mouth recommendations and expanding brand equity- an especially important consideration as hospitals are among the largest employers in many communities, and subject to regulatory influences that are shaped by public opinion Improved reimbursement, in part based on Value Based Purchasing within HCAHPS NPES exists to define benchmarks that can be used to specify actions that will positively influence patient experience. It is oriented to capture the voice of the patient. Listening is necessary to understand the components of the patient experience, and to define what produces satisfaction. Among patients who rated their hospital as 9 or 10 on the HCAHPS question for best hospital possible, 88% said they would probably Framework to Describe Influences on Overall Experience Customer satisfaction research is designed to specify actions that will enhance business outcomes; this is also applicable for hospitals. Clinical outcomes are not the only dimension of patient experience. Hospitals that deliver the best patient experience are able to enjoy a list of additional benefits. These may include: Higher levels of employee engagement, along with more successful recruitment and less turnover Figure 1

5 Patient Perspectives on Outstanding Experiences: The Impact of Emotionally Intelligent Staff 5 or definitely recommend it to a friend, relative or colleague. When patients rated their hospital as 8 or less, only 30% said they would probably or definitely recommend the hospital. The quality of the patient experience not only influences HCAHPS performance, but affects what patients will tell others about the hospital. A Framework for Patient Experience An effective framework for patient experience begins with identifying what drives satisfaction within specific contexts. A hospital experience does not take shape in the same way as a banking experience, or when purchasing a car, or when interacting with a mobile phone carrier. Yet, most service experiences share common elements, including People, Presentation, Product, Price and Process (Figure 1). These elements are reflected to varying degrees as drivers of satisfaction for any product or service experience. The patient experience can also be deconstructed by measuring the specific contribution that comes from these areas. People are especially important in healthcare services. For hospitals, the quality of communication with hospital staff is perhaps the largest influence. Presentation may refer to qualities of the facility, which can vary between hospitals. For example, environmental concerns (room amenities, or food) can produce a measurable impact on satisfaction. The study found that the admission and discharge process is also influential, perhaps more than might be expected. Price is more difficult to address within healthcare service research because it is less transparent than in most other industries. Creating a Portrait of Outstanding Patient Experience What characterizes a superior patient experience from one that is merely average? The NPES provided a rich source of information to portray these differences. [see NPES Inset for more details on the research method]. It provided an opportunity to measure the voice of hospital patients in terms of whether service expectations were met or exceeded versus the quality of clinical care. To do so, it asked about topics such as the quality of staff encounters versus the quality of actual medical or nursing care that was provided. To better understand and analyze the data collected, an index score was compiled to quantify the voice of the customer. This score also helps to compare service quality across a wide range of industries. The index score is expressed on a scale from 100 to 1,000. It is used to measure a patient s overall hospital service experience and to identify what drives a favorable experience. Hospitals generally produce a higher level of satisfaction than is found in many other industries or services when following a similar methodology. For example, the overall average index score for an inpatient experience is 825 in NPES, equivalent to 822 as reported for luxury hotels in the J. D. Power 2012 North America Hotel Guest Satisfaction Index Study SM (Figure 2). Index scores are calculated on the basis of factors determined to drive patient experience. This makes it possible to understand the relative influence that different components of a hospital stay may have on overall experience. The factors include those that are focused on encounters with professionals specifically nurses, doctors and then experience with general procedures; processes that correspond to the greeting and farewell steps of hospital patient experience including: admission and discharge and two that evaluate environmental influences focused on the facility overall and food. While there may be additional factors organizations can consider, hospitals may use their own data on these factors to understand their It is also important to consider that the interpersonal skills of staff do not have a positive impact unless patients recognize the impact in terms of their own personal experience. It is their perception that matters.

6 6 performance in comparison to the national benchmarks gathered as part of the study. Through this research NPES sought to describe what most influences patient experience. The impact that each factor had based on the voice of the patient can be seen in Figure 3. The data show that two areas have a significant impact in overall perception of patient experience performance that of encounters with professionals and procedures (equating to 46%) and the importance of focus on the entire continuum including admission and discharge (with 35%). The Paramount Importance of Interpersonal Skills Of all the factors the study identified as impacting patient experience, the quality of interaction with hospital employees has the greatest influence. Taken together, Nurses, Doctors and Procedures account for nearly half (46%) of what drives overall experience. The ability of professional staff to show empathy and foster emotional connections with patients is a large part of achieving better ratings in these areas. Even if these seem like soft skills, they can still be measured. Successful Average Overall US Inpatient Experience, Compared to Some Other Industries Studied at J.D. Power Distinguished Hospital, Inpatient Hotel Guest, Luxury Pharmacy, Store Pharmacy, Mail Order Auto Insurance 804 Distinguished Hospital, Emergency Full Service Investor Retail Banking Health Insurance, Employer Sponsored Health Insurance, Individually Purchased North America Airline Hotel Guest, Economy/Budget OVERALL EXPERIENCE Figure 2

7 Patient Perspectives on Outstanding Experiences: The Impact of Emotionally Intelligent Staff 7 Factors that Drive Inpatient Experience and Their Relative Influence ENVIRONMENT ADMISSION & DISCHARGE 11% 12% 8% TESTS & PROCEDURES 12% 23% 15% 19% HCPs Admission Discharge Nurses Doctors Tests & Procedures Food Facility Figure 3 measurement requires listening to the voice of the patient, not just relying on assessments of individual staff. It is also important to consider that the interpersonal skills of staff do not have a positive impact unless patients recognize the impact in terms of their own personal experience. It is their perception that matters. Many of these qualities rely upon having emotional intelligence. 2 This kind of intelligence is not like what is measured by an IQ. It refers to how well people handle the social dimensions of human experience. Individuals who possess a high IQ may demonstrate impressive thinking skills or a great aptitude for learning yet still have difficulties reading social contexts and knowing how to manage interpersonal relationships. These qualities can be tremendously important in creating an environment for a good patient experience. The central attributes of emotional intelligence include: Self-awareness Self-motivation Managing one s own emotions Being able to recognize emotions in others Being able to handle other people s emotions Emotional intelligence surfaces in many of the descriptions patients offer in discussing their best hospital experiences. Empathy, compassion and concern are critical job skills for any staff in contact with patients. These are core components of emotional intelligence, especially the abilities to read and express emotions. Staff lacking these qualities may find themselves in low spirits when confronted with the demands of patient care. This can consequently produce a poorer experience for the patients they encounter. People who can be genuinely empathic are more attuned to the personal needs of people around them.

8 8 Demonstrating emotional intelligence is not only the basis for an outstanding patient experience, but it also means it is more likely that the hospital may be evaluated more favorably in a variety of ways. The Importance of Showing Genuine Concern When patients feel that nurses and doctors have shown concern for their needs, many other indicators of overall patient experience tend to be more favorable as well. This is not the same as simply listening, as is measured by the Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS), since it requires greater emotional involvement. Listening however is a component of showing concern, particularly active listening Doctors and Nurses are Rated Lower at Concern Among Patients Reporting Less Trust and Confidence in Their Hospital Following Discharge Among patients who say that they are probably or very likely to recommend their hospital based on their experience, nurses and doctors each received an average rating of 8.9 (on a 1-10 scale) for concern. However, among those who say they probably or definitely would not recommend their hospital the average rating is much lower, at 5.2 (for concern by nurses) and 5.5 (for concern by doctors) Less Trust Same Trust More Trust and Confidence and Confidence and Confidence 1-10 RATING, CONCERN FOR YOUR NEEDS Doctors Nurses Figure 4 In the study, patients rated the empathy of nurses and doctors in terms of concern for your needs. Both types of clinicians received similar ratings. When patients felt that these healthcare professionals exhibited concern, a variety of other important outcomes were favorably rated as well. Among patients who say that they are probably or very likely to recommend their hospital based on their experience, nurses and doctors each received an average rating of 8.9 (on a 1-10 scale) for concern. However, among those who say they probably or definitely would not recommend their hospital the average rating is much lower, at 5.2 (for concern by nurses) and 5.5 (for concern by doctors). Being able to demonstrate concern to patients is one potentially important way of helping to promote good word-of-mouth recommendations and reinforce a positive overall experience. When patients perceive genuine concern from doctors and nurses, it produces a beneficial impact in multiple

9 Patient Perspectives on Outstanding Experiences: The Impact of Emotionally Intelligent Staff 9 ways. This is especially reflected in whether they trust the hospital. Patients who reported that their stay produced more trust and confidence in their hospital gave ratings of 9.2 for concern exhibited by nurses and doctors. If they reported that their stay resulted in less trust and confidence in their hospital, the equivalent rating for concern was only 5.2 for nurses and 5.3 for doctors (Figure 4). Showing empathy and concern helps to establish the kind of hospital experience where problems or disappointments (which may inevitably occur) can be handled without jeopardizing overall patient satisfaction. When staff express concern toward patients, it can help improve impressions of the hospital, not just the nurse or doctor Recommendations from Patients that were Thanked or Not Thanked for Choosing their Hospital 6.99 Correctly Reading What Patients Think or Feel Empathy means more than showing compassion, since it also requires an ability to correctly anticipate what a patient might be thinking or feeling. Self-awareness is a foundation for this skill. Being able to conceive of one s own reaction in a similar circumstance is part of what makes it possible to know how to communicate in ways that patients will appreciate and comprehend. This is reflected in HCAHPS questions about Nursing and Doctor Communication, which were also included in the study for bridging to HCAHPS. Being able to explain things in a way that patients will understand can first require having established a good appreciation of the patient perspective. Problems are less frequently reported by patients who said that nurses or their doctor always explained things in a way that they could understand. Among patients reporting no problems with their room or hospital staff, 75% said their nurses always explained things in a way they could understand, and 72% said that their doctors did the same. Bedside explanations are one concrete action which may potentially help to enhance overall patient experience as reflected within HCAHPS AVERAGE NUMBER OF POSITIVE RECOMMENDATIONS Figure 5 Thanked NOT Thanked Being able to establish this level of understanding takes time. For example, one of the diagnostic items within NPES is whether nurses took time to explain what they were doing at the bedside. This action seems to be reflected in overall ratings of the hospital experience. Within the HCAHPS question of overall rating (score 0-10), 97% of the patients who gave ratings of 9 or 10 said that nurses adhered to this practice. Among other patients, 81% said that nurses explained what they were doing at the bedside. Bedside explanations are one concrete action which may potentially help to enhance overall patient experience as reflected within HCAHPS. The study also looked at whether adequate time is being invested in patient needs when procedures occur. Doctors and nurses are not the only hospital staff that 0.6

10 10 must show emotional intelligence. Many other kinds of professionals can shape the patient experience too. Patients who say that they had greater trust in the hospital following their stay were much more likely to say that staff explained to them what to expect whenconducting tests or procedures (94% of the time). In contrast, among patients who said that they trusted the hospital less following their discharge, only 54% said that procedures had been adequately explained. Taking time to provide explanations about procedures can also have an impact on how patients will speak of their experience to others. Among patients who say they would recommend the hospital, 91% say that procedures were explained. Only about half of patients that are unlikely to recommend their hospital say that staff told them what to expect when procedures occurred. It takes a good ability to understand patients in order to know what kind of descriptions they will expect before a procedure occurs. Along with this, it may take additional time to assure that these explanations are adequately conveyed. Conveying Thanks Courtesy is widely acknowledged as a potentially important driver of patient experience, yet it may be difficult to operationalize in terms that will enable hospitals to improve their performance at conveying respect for patients. Within the study, one form of courtesy that appears to especially differentiate more favorable levels of patient experience is whether or not thanks were offered for choosing the hospital. In the midst of many other events that may occur during the discharge process, this overtly simple step may be easily overlooked. One measure of the importance of this action is made clear in the study by looking at the type of subsequent recommendations to friends, relatives or colleagues. Patients saying that they were thanked for choosing their hospital report an average of about 7 positive recommendations (6.99). For patients who say they were never thanked, the average number of positive recommendations falls to only 0.6. (Figure 5) Saying thanks is a frequently recommended step within efforts to improve communication with patients, for example, within the AIDET mnemonic that concludes with a step thanking the patient. 3 The findings suggest that this step alone may have an important impact in other ways too. Among patients who say that they had more trust and confidence in their hospital after their stay, 69% say that the staff or doctors thanked them. In contrast, patients who reported lower trust and confidence following their stay reported having been thanking only 19% of the time. When staff express appreciation for being able to provide care, it may help to produce a better perspective for the patient, one that can favorably affect their overall perception of the hospital. Responding to Personal Needs Responsiveness, or reacting quickly to personal needs is an important part of service quality in many areas where customer satisfaction is measured. It is particularly relevant for hospital care. Patients who report an outstanding experience often say that the staff were highly responsive. As with ratings for concern, nurses and doctors receive similar evaluations at this. Responsiveness seems to characterize the institution rather than the type of healthcare professional, Problem resolution is an opportunity for hospitals to demonstrate their commitment to patients, perhaps even by apologizing or thanking the patient for having pointed out a concern that might affect other patients.

11 Patient Perspectives on Outstanding Experiences: The Impact of Emotionally Intelligent Staff 11 Information Disclosure and Perceptions of Length of Stay Among patients who felt that they were discharged at the right time Among patients who felt that they were discharged too soon Among patients who felt that they were not discharged soon enough % saying that their doctor asked to discuss what the patient wanted or expected from treatment % who were asked what they should expect for treatment and recovery 75% 51% 54% 90% 41% 37% % saying their doctor answered all their questions 95% 58% 60% % saying nurses described their care plan for day 82% 52% 56% % who were told when to expect tests and procedures 87% 70% 70% Figure 6 or individual clinician that is caring for a patient. Responsiveness is evaluated within NPES as an attribute within factor ratings of Doctors and Nurses. It is measured in different ways for each type of healthcare provider as outlined in the study. For doctors, it is reflected in terms of how often it was possible to speak when the patient wanted or needed to. Patients who say that they were always able to speak with their doctor are far more likely to recommend their hospital: 44% say that they probably or definitely would, compared to only 14% of those who probably or definitely would not recommend their hospital. The same is true for nurse responsiveness, as demonstrated by call-button response time (using the same question that is part of the HCAHPS VBP). Patients saying that their nurse always responded as soon as they wanted are much more likely to recommend their hospital. Only 19% would not recommend their hospital, compared to 58% that say that they probably or definitely would. The ability of doctors and nurses to respond may sometimes be constrained by limited staff resources. However, both of these diagnostic indicators of patient experience rely on individual perceptions rather than directly observed findings. Patient perceptions of responsiveness may also be influenced by the caregiver, who is signaling a desire to reduce suffering through the speed by which they respond to requests. Responding With Information Being able to read emotional cues from patients is the basis of being able to communicate in ways that will be understood. Some patients prefer more information rather than others, and it is important for staff to be able to adapt their descriptions to the listener. NPES also incorporated HCAHPS questions on the quality of doctor and nurse communication, The results show that the most favorable type of patient experience is oriented towards disclosure, transparency and taking time to provide explanations. Sharing information may help to foster more favorable impressions of the hospital. Among patients who say that they had more trust and confidence after staying there,

12 12 96% said that their doctor answered all their questions compared to 48% who reported lower trust following their stay. In practical terms, responding with information may also affect patient perceptions of whether they received the correct amount of care. Figure 6 compares patient perceptions of whether they felt that they were in the hospital for the right amount of time. Patients who felt that they were hospitalized for the appropriate length of time are more likely to have received information in specific ways. These communications may have been from a doctor, nurse or other staff that gave information about tests or procedures. In each case, these steps are diagnostic of whether patients report that they were in the hospital the right amount of time. One form of courtesy that appears to especially differentiate more favorable levels of patient experience is whether or not thanks were offered for choosing the hospital. Good Interpersonal Skills Contribute to Service Recovery Efforts Too Patience Admission Experience Rating and Likelihood of Recommending Their Hospital Not all patients report problems during their hospitalization. The study showed that only 16% of patients said that they experienced any problem with their room or the hospital staff. When problems do occur however, they can jeopardize their overall experience. Staff service and staff attitude are the most common types of problems that patients reported in NPES, both reported more frequently than concerns over quality of care. Hospitals are no different than many areas where customer experience is measured, in that overall experience ratings are influenced by whether or not there have been service problems. While staff are the most frequent source of problems, they also possess the greatest opportunity to solve them when they arise AVERAGE ADMISSION EXPERIENCE RATING, 1-10 Definitely / Probably Will Recommend Definitely / Probably Will NOT Recommend Figure 7 While an ideal state would be to not have problems, when they do occur, the question is how gracefully are they resolved? Patients that encountered problems can still have a superior overall experience but this usually requires being able to effectively address and resolve their concerns. A large majority (82%) of patients who had encountered any problem and gave overall experience ratings of 9 or 10 said that their problem was resolved. In contrast, fewer than half (43%) of patients with overall experience ratings of 8 or less said that their problems had been resolved. It s possible problem resolution is an opportunity for hospitals to demonstrate their commitment to patients, perhaps even by apologizing or thanking the patient for having pointed out a concern that might affect other patients. Service recovery efforts can sometimes be helped by

13 Patient Perspectives on Outstanding Experiences: The Impact of Emotionally Intelligent Staff 13 pushing decision authority to the frontline staff that can offer immediate help. 4 Here again our point is reinforced; strong interpersonal skills emerge as a prerequisite for being able to make the best from bad situations. Resolving problems is one of the most trying demands that any hospital employee can face, simultaneously requiring skills that go beyond having technical knowledge of procedures and outcomes. Truly understanding the situation can require active listening skills and empathy, and effective problem resolution may call upon an ability to regulate one s own emotional response in the presence of patients who could already be anxious or even agitated. Some problems simply won t be fixed. It can take advanced interpersonal skills to communicate in a way that the patient will appreciate and understand. Not everyone may be emotionally prepared for these kinds of challenges. Enhance Patient Experience by Looking Beyond the Floor While the study highlights the importance of interpersonal communication skills, it also contains findings that suggest the importance of looking at procedural steps before and after hospitalization. This is in line with The Beryl Institute s definition of patient experience that suggests the patient experience is across the continuum of care, not simply in the clinical setting alone. The two factors reflecting the Admission and Discharge experience together account for 35% of the Overall Patient Experience Index score which demonstrates the importance of paying attention to events that occur before a patient reaches the floor, as well as ones that may affect their experience after leaving it. Patients saying that their nurse always responded as soon as they wanted are much more likely to recommend their hospital. Greetings and farewells have a surprisingly large impact. The study showed that discharge is twice as influential as admission and first impressions and parting impressions have a lasting impact. This is similar to what has been found in studies of the hotel experience. Hospitals sometimes attempt to learn from the hospitality industry by looking at how hotels please their customers. The hospital experience is more high touch than for hotels. Even with hotels in the Luxury segment, the Check-in and Check-out process, along with the Reservations factor, account for no more than 21% of the Guest Satisfaction Index score in the J.D. Power 2012 North America Hotel Study. This is still much less than the influence of admission and discharge on the overall inpatient experience. Hospitals that focus more on the quality of personal interactions during admission and discharge may be able to modify patient experience at particularly critical stages of assessment by patients and families. Patients who say that they would probably or definitely recommend their hospital rated their admission experience at an average 7.98 (on a 10-point scale) compared to only 4.84 among patients who would probably or definitely not recommend their hospital (Figure 7). To improve performance in this area, one metric that hospitals may consider adopting is to focus on the time that it takes a patient to reach their room. The study suggests that there is a break-point at 20 minutes for planned admissions and 90 minutes for admissions from Emergency. If these service levels are not achieved, then there is a significantly greater probability that overall patient experience ratings will decline. Communication skills can play a role here during the admission process too. Patients who said that the reason for any delay was explained also said that they gave more than twice as many positive recommendations about the hospital after being discharged (average 5.99 positive recommendations if the delay was explained, compared to 2.55 positive recommendations if the delay was not explained). How the greeting process is handled may produce an impression that lasts even after being discharged. If delays do occur, these represent opportunities to apply service recovery skills that will help set more favorable expectations for the rest of the patient s stay. Slightly over half (56%) of patients in the study said that someone from the hospital called to check on how they

14 14 were feeling after being discharged. Patients who received this type of contact were much more likely to provide a rating of 9 or 10 for Best hospital possible (using the HCAHPS overall rating question); 70% said they had been contacted, compared to 39% of patients that rated their hospital 8 or lower. The average number of positive recommendations from patients who received a post-discharge call was 7.19, compared to 0.64 for those that did not. This is another overtly simple step, like offering thanks for choosing the hospital, or asking about expectations of treatment, which may potentially produce a lasting beneficial influence. How Can Hospitals Begin to Improve Patient Experience? Knowing what drives a favorable patient experience also makes it possible to identify specific actions that hospitals can take to improve their performance. However, not all of these actions are likely to improve the patient experience as directly as others. Key Performance Indicators (KPIs) designate which ones should be prioritized when developing performance improvement objectives. KPIs, calculated from NPES benchmarks, represent impactful targets for hospitals seeking to improve the experience of their patients. These targets enable hospitals to focus their efforts in those areas where the results may be most noticeable. KPIs typically identify a criterion against which hospitals can measure their performance over time. One example could be to track the percentage of patients who say that their doctor or nurses always communicated in a way that they could understand. These are especially impactful KPIs. They are also useful indicators since they are included within the HCAHPS question set for VBP. Relevant KPIs can vary by hospital, by service line or setting, for instance, inpatient, outpatient and emergency settings can each have separately designated KPIs. Figure 8 shows examples of KPIs defined from the study and that are commonly recommended within inpatient settings. These are usually most actionable when they refer to accomplishment of a specific event. It is rarely feasible for a hospital to reach 100% achievement with any KPI. Therefore break points are defined to signify levels where improvements may be expected to result in noticeably higher overall experience ratings. A Selection of Inpatient Key Performance Indicators On admission, patients reach their room within 20 minutes (or 90 minutes, if admitted from Emergency) Patients are always able to talk to their doctor when they need / want to Nurses always describe the care plan for the day Patients always get help as soon as they want after pressing the call button Doctors and staff thank the patient for choosing their hospital After discharge, the hospital calls to check on patients Figure 8 It can also be suggested that there will be a greater impact on patient experience through acts of commission than ones of omission. The study shows that certain actions that address common shortfalls of hospital care (and which serve important clinical purposes) may not necessarily produce as much of an impact on the patient experience as steps that improve the quality of communication with patients. Hourly rounding, noise control and pain management, for example, all appear to be more crucial for preventing dissatisfaction than increasing satisfaction. In examining the data and listening to the voice of the patients, it is recommended that healthcare organizations focus on what can be done to improve the patient experience, more than on what can be prevented. Being able to produce a quiet environment is a more positive objective than eliminating noise. Achieving comfort is sometimes more appreciable than only eliminating pain. The same orientation applies in considering how to manage problems. Problems are sometimes inevitable, but the efforts that are taken to solve them may be what matters most in the end. Avoiding problems is only part of the story- it is how they are handled that will ultimately

15 Patient Perspectives on Outstanding Experiences: The Impact of Emotionally Intelligent Staff 15 shape overall patient experience. This brings us back to the very importance of the central action through which we can influence experience our direct interactions. Using studies such as the NPES or even surveys such as HCAHPS to measure levels of patient experience helps in establishing benchmarks, and in distinguishing exceptional from normal performance. Yet, while facility ratings may influence patient satisfaction, they ultimately play a less influential role than staff behavior or the quality of steps in the process of hospitalization. Smoothly managing the logistics across the continuum of care is critical, and around admission and discharge is particularly important. But it is emotionally intelligent staff, applying excellent communication skills, and focusing on the power of positive interactions, which may be the most important ingredient. It is their actions that will fundamentally distinguish an outstanding patient experience from one that is simply satisfactory.

16 16 The National Patient Experience Study J.D. Power independently conducts the National Patient Experience Study (NPES) to describe variations in US hospital patient experience, and to define best practices for achieving superior performance. Benchmarking is an important objective of NPES, because hospital patient experience in the highest quintile (i.e., 80% or higher) is eligible for certification by J.D. Power within the Distinguished Hospital Program. NPES is how J.D. Power defines benchmarks for distinguishing levels of hospital performance that signify an outstanding patient experience. It also provides a rich source of information on how favorable patient experiences are qualitatively different, and what contributes most to hospital satisfaction. It can be used to identify the specific processes or actions that may enable hospitals to improve their performance. The most recent wave of NPES, reported in this article, occurred during the 4th quarter of 2011 and 1st quarter of 2012, consisting of 10,205 patients commenting upon their hospital experience occurring no less than 6 months prior to being interviewed. This wave interviewed recipients of inpatient, emergency and outpatient services. The survey is administered a 20-minute telephone interview across a regionally balanced sample furnished through random-digit dialing. The survey is linked to HCAHPS through the inclusion of several bridging items that correspond to each of the patient experience domains used for Value Based Purchasing (VBP).

17 Patient Perspectives on Outstanding Experiences: The Impact of Emotionally Intelligent Staff 17 About the Author Richard W. Millard, Ph.D. J.D. Power and Associates Richard Millard is senior director and practice leader for healthcare at J.D. Power and Associates. He has been measuring patient experiences and the interactions among healthcare stakeholder groups for the past 25 years. He has previously held positions at Buffalo General Hospital and at hospitals affiliated with The Johns Hopkins University School of Medicine, the University of Washington School of Medicine and the University of Rochester School of Medicine and Dentistry. He can be contacted at References 1 Bean, J & Van Tyne, S (2011). The Customer Experience Revolution. St. Johnsbury VT: Brigantine Media, p Goleman, D (1995). Emotional Intelligence. New York: Bantam Books Lee, F (2004). If Disney Ran Your Hospital. Bozeman MT: Second River Healthcare Press.

18 18 Also from The Beryl Institute 2012 The Role and Perception of Privacy and its Influence on the Patient Experience This paper explores the results of a significant study exploring the implications of patient perceptions of privacy and the impact this has on the overall patient experience. It shares perceptions of patients as they reflected on what happened to them during care. The insights move us beyond the limiting constraints of considering privacy simply as a regulation, to better understand what ultimately matters to patients at the bedside as they engage in healthcare and create their own perceptions of experience. It provides practitioners a new lens through which to examine privacy and to explore the impact that can be created in every healthcare encounter. Structuring the Patient Experience Effort: An Inquiry of Effective Practice This paper explores how health care organizations are structuring their patient experience activities and the trends that may be contributing to positive results. It is meant to serve as a catalyst for ongoing sharing and dialogue about patient experience activities, representing the practices shared by over 70 healthcare organizations. The data can be used to guide the ongoing efforts to support and improve patient experience across the industry. Charting a Course to Quiet: Addressing the Challenge of Noise in Hospitals The paper shares the findings of The Noise Project, a joint research study between The Beryl Institute and Making Hospitals Quiet. Over 240 responses were gathered from hospitals across the United States with participants answering questions such as: What processes are hospitals putting in place to address this priority issue? How are they structuring their efforts? Where in their facilities are they focusing their attention? What kind of success are they realizing? The paper also shares best practices to address this critical topic as a key component in providing a positive patient experience. Physician Perspectives on Patient Experience Investigating the importance of physicians in the overall experience of patients, this paper incorporates numerous views in exploring physician perspectives on patient experience. First, Dr. Latha Shankar shares her knowledge based on hands-on experience in the urgent care setting. She offers insight on the importance of various topics within the scope of patient experience including communication, active listening, lasting impressions, and the importance of quality care. Additionally, the paper includes six interviews with respected physician leaders from across the United States that offer thoughtful opinions on the various issues surrounding physician engagement in patient experience. These provocative insights underscore the importance of physicians in all facets of patient interaction. Benchmarking the Patient Experience: Five Priorities for Improvement This white paper explores qualitative data obtained in the 2011 benchmarking study, The State of Patient Experience in American Hospitals. While the original research report provided an overview of the study findings, this paper takes a deeper dive to share specific actions discovered that help shape a systemic solution to improving overall patient experience. It includes verbatim responses on how survey participants are addressing top patient experience priorities including: Reducing Noise, Discharge Process, Rounding, Responsiveness of Staff/Communication and Pain Management.

19 Patient Perspectives on Outstanding Experiences: The Impact of Emotionally Intelligent Staff Return on Service: The Financial Impact of Patient Experience Creating PEAK Patient Experiences The Role of Cultural Competence in Delivering Positive Patient Experiences The State of the Patient Experience in American Hospitals The Revenue Cycle: An Essential Component in Improving Patient Experience Enhancing the Patient Experience Through the Use of Interactive Technology 2010 Four Cornerstones of an Exceptional Patient Experience Insights into the Patient Experience Research Brief Zeroing in on the Patient Experience: Views and Voices from the Frontlines Perspectives on a Patient-Centered Environment Customer Experience: A Generational Perspective Character Counts: Integrating Civility into the Healthcare Culture Balancing Consumer and Physician Influence: Finding the Sweet Spot in Healthcare Marketing Mystery Shopping the Patient Experience High Performing Organizations: Culture as a Bottom-Line Issue

20 Improving the Patient Experience