Patient Journey Mapping: Understanding the Relational Patient Experience in Ambulatory Primary Care

Transcription

1 Patient Journey Mapping: Understanding the Relational Patient Experience in Ambulatory Primary Care Jason Vallee, PhD, Vicki Patric & Jodi Stewart AMGA Webinar April 13, 2016

2 Hello! A little bit about us Jason Vallee, PhD, Director, Achieving Excellence, Dartmouth-Hitchcock Community Group Practices Vicki Patric, MS, Director, Quality & Patient Safety, Dartmouth-Hitchcock Community Group Practices Jodi Stewart, Communications Manager, Achieving Excellence, Dartmouth-Hitchcock Community Group Practices

3 What is Dartmouth-Hitchcock? Academic Health System Serving NH, VT and Beyond

4 Building a Sustainable Health System Serves a patient population of 1.9 million in New England. System includes the Norris Cotton Cancer Center, one of only 41 National Cancer Institute-designated Comprehensive Cancer Centers; the Children's Hospital at Dartmouth- Hitchcock, the state's only comprehensive, full-service children's hospital as noted by the Children's Hospital Association; 30 outpatient clinic locations including clinics in Manchester, Concord, Nashua, and Keene, NH and Bennington, VT; and affiliate hospitals in New London and Keene, NH, and Windsor, VT. Provides access to more than 1,000 primary care and specialty providers in almost every area of medicine.

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6 Let s Talk About Our Patients Journey

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8 What drives patient experience? We asked 127 Leaders, Providers, Nurses and Staff Many had the same answer

9 Clinical Outcomes

10 Is technical expertise enough?

11 Specific Drivers of Patient Satisfaction Scores For survey item: Rate all aspects of the outpatient visit the following 5 drivers determine whether or not a patient will respond favorably: 1. Sensitivity of all staff to your special needs and concerns 2. Overall care received from provider 3. Length of time waiting in the waiting room 4. Overall ease and convenience of making an appointment 5. Length of time waiting in the exam room 72% of the variation can be explained by the patients responses to these 5 driver items* *Listed in descending order of importance

12 Drivers of Patient Satisfaction of Overall Care by Provider Provider's technical skills Thoroughness of care Sensitivity of staff to patient needs Helpfulness of treatment recommendations Provider's personal manner How well provider responded to patient concerns

13 Defining the Experience The Transactional Patient Experience refers to entirety of the complex processes that the patient is subject to during their interactions within the D-H health system. TPX are the hard systems and processes. The Relational Patient Experience is the entirety of the complex human interactions during their relations within the D-H health system. RPX are the soft, or people skills, our patients experience.

14 The Differences Transactional PX: The entirety of work flow processes. The things we do to our patients. Making an appointment on the phone or online Conducting pre-visit paperwork Registration Waiting rooms (These are often the focus of process improvement methodologies (i.e. Six Sigma).) Relational PX: The entirety of the complex human interactions during a patient s experience with a health system. Showing care and concern Relating to the patient and showing rapport Introducing yourself and role Displaying excellent communication skills (These are the soft skills that accompany the transactional handoffs.)

15 The JUSST Model Needs vs. Expectations Justice My care team treats me with dignity and respect. S/he knows that I need to be treated fairly. Understanding two way listening for understanding & making sure you are understood. Security I believe my care team will take good care of me, will keep my interests in mind, and provide a safe environment in my time of need. Self-esteem My care team respects that when I am injured or hurt, it can also make me feel less than confident. S/he addresses my need to understand the process of healing. Trust My care team is genuine and speaks from a place of truth. S/he follows through with actions that support what they have said to me.

16 We needed to develop a process and strong visual representation for our employees to fully understand the totality of the experience that our patients go through in Primary Care in order to implement improvements focused on their specific needs.

17 We wanted to visually document Emotions Feelings Reactions From the patient s perspective during an office visit and reveal how effectively we are supporting or eroding the relationships we build with patients.

18 Process of Creating a Journey Map Had Three Main Objectives 1. Show entirety of process. For most employees, this was the first time they actively thought through all of the different ways we relate to our patients. 2. Create an experience/exercise that connects staff/providers to the actual emotions (relational needs) of our patients experience. 3. Create accountability by tying to employee performance objectives, creating greater focus on patient needs.

19 Our Methodology Step 1: Develop a high level work flow of the typical primary care visit process. The major stops along the way.

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21 Our Methodology Step 2: Identify behaviors that delight and dissatisfy our patients in their primary care journey using quantitative and qualitative analysis. Review ambulatory patient satisfaction (quantitative) data: - Overall rating of provider - Overall rating of visit - Care & concern of all staff to the patients special needs and concerns

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23 Held two, 2-hour sessions with over 120 leaders in the organization. - Came up with statements that create either a positive or negative feeling for the patient within each process step (the delighters and the dissatisfiers).

24 Our Methodology Step 3: Sort enormous amounts of data into categories of description, using affinity sorting method, to form groups or themes of feelings.

25 Our Methodology Step 4: Validate data with our patients , one-on-one interviews to ensure we had identified the breadth an depth of the relational patient experience. 2. Patient focus groups to determine the intensity of the experience (the degree of importance categories had on overall patient satisfaction).

26 Presenting the Relational Journey Map

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30 The Report Out The initial 120 internal leaders were brought together again for report out of journey map. Opportunities, tactics and measures were identified by group in order to develop departmental projects and performance goals.

31 Measures & Opportunities

32 Outcomes Achieved Departmental projects were identified and initiated. Individual performance goals were set and tracked in our performance system becoming part of individual performance appraisals. Personal behavioral commitments (separate from departmental goals) were made where individuals could commit to specific behaviors somewhere in the journey.

33 Journey Map Success!! Instrumental for analyzing the true voice of the patient. Aligns individual and departmental goal-setting to create accountability, celebrate successes, develop opportunities for improvement, and IMPROVE THE PATIENT EXPERIENCE. Exemplifies a powerful way to create an emotional connection for staff and providers reminding them of the emotional components of a health care experience and the true purpose of caring.

34 But, there s much more needed to achieve and sustain excellence Examples of some tools that we use at Dartmouth-Hitchcock

35 Achieving Excellence Seminar Sessions with leaders Monthly training opportunities with leaders related to various Service Excellence topics Intranet information capture Reward & Recognition programs

36 Video quick learns ( PX Moments ) ie. Technology in the Exam Room, 10/5 Rule At Your Service enewsletter Monthly newsletter to leadership team Leadership briefs White papers on various leadership development and service expectations

37 Provider Ambassador Team Peer to peer coaching Provider Resiliency Training PX Week 8 week session by trained facilitator Recognition, thanks and celebration

38 We are what we repeatedly do. Excellence, then, is not an act, but a habit. - Aristotle

39 Questions???

40 For More Information Contact: Jason Vallee, PhD or Vicki Patric, MS or Jodi Stewart or