Over the years, a dedicated The cadre of health care workers has spoken of the importance of measuring and improving patients’ experiences Hospital And other health care settings, but their concerns were often trumped by other priorities. Now that the Medicare and Medicaid Services (CMS) centers have started deciding on hospitals Quality of care for their patient And patient experiences – and punishing ones with suboptimal performance – hospitals are paying more attention to their patients’ satisfaction. Lisa Allen, Chief Patient Experience Officer at Jossa Hopkins Medicine, speaking at the upcoming American News Hospital conference tomorrow, Talked with US News about how elongation is changing health care for satisfied patients. (The interview has been edited for length and clarity.)
Where do we stand in relation to patient satisfaction?
I think the intensity of interest in the board now is much higher, more senior level [of directors’] Level – because CMS has taken into account the patient’s experience as a matrix to be used by them [to measure] Hospital performance.
What is the penalty for a poor patient-experience score? How much can the hospital cost?
We have some quality-based reimbursement in Maryland. It is very closely connected [CMS’ approach, known as] Value based purchase. 2 percent of our revenue is at the risk of quality-based reimbursement, of which, this year, 45 percent [of that amount] … Is based on the patient’s experience.
Lisa Allen is the Chief Patient Experience Officer at Johns Hopkins Medicine.Courtesy Johns Hopkins Medicine
This is right. This is too much money. And then of course there’s the fidelity factor, the word-of-mouth factor – all of those things are hard to measure. Hopkins, like other large academic medical centers, has a lot of revenue internationally that do not cater [the government surveys]. Ensuring that we treat those patients in a compassionate manner is critical to the business – and their satisfaction is not easily measured.
And are patients who are often paying the full cost of their care, not the discounted fees negotiated by insurers?
What does it mean that the board of directors is now involved?
When it used to be a small group of passionate people [patient satisfaction], We could not get the resources, attention or platform we needed to help everyone understand how we all play a part in the care of patients. It is now talked about all the time, not only at Johns Hopkins Hospital, but in most health care organizations where I have colleagues. It is on the agenda of strategic planning and board every quarter. It is talked about quality, safety and patient experience [meetings]. It is not really seen, “Let’s teach people how to smile,” those drunken things, now it is seen what we do. … People really understand that you cannot cure a disease. You must create an environment of healing. If you as a patient do not care, it is a patient loss.
We use different versions of [Agency for Healthcare Quality and Performance’s] CAHPS (Consumer Evaluation of Healthcare Providers and Systems) Survey. We measure a lot. We also use patient letters, patient comments to advisory committees – if we have complaints, we learn from complaints – and we learn through observation. How you listen to the patient’s voice is known from many aspects. We know that at the national level [there’s] Nearly 30 percent response rate to surveys, and it is biased towards the more highly educated. This is a national problem. We need to think about how we hear the voices of all our patients.
Johns Hopkins is a huge venue. How do you ensure a consistent patient experience across all hospital units and services?
Part of this is by announcing shared goals, and it really starts at the top with the board and strategic planning. It involves making a common language. We have communication style that we teach people. We have an approach to teach caregiver communication. It is also making people accountable and [these capabilities] In our hiring practices, performance reviews and coaching. We now have coaches who work with teams. Still, I cannot say that we are 100 percent there. It is very complex, involves a lot of people. … It’s really a journey.
How do different personality types play in it?
In every field, I see real champions and brilliant communicators. In every field, I have also seen people who need some help. … Some people are incredibly talented, but not just great communicators in stressful situations.
How does being an anthropologist inform your role in evaluating a patient’s experience for a hospital?
So much we bring [involves] Expectations: You have expectations from health care providers about how they are going to treat people and you have expectations of patients about what is going to happen to them. Much of what happens in this very tense conversation is based on expectations and culture. For me, as an anthropologist, this is fascinating. I started my career in New England. I remember a migrant population roaming the region. New England Health Care Foundation [found itself] Trying to figure out how to work with these patients. We now have such a multicultural workforce and multicultural patients. A lot of what we see [the world of] The patient’s experience is around cultural conflict. … you have different expressions of pain, different feelings of grief and different support systems – and a lot of these things come into play … because you’re bringing people together at a time When they are actually most stressed.
How can you tell when you do everything right?
This information comes to us from many different sources: workforce busyness, satisfaction in the work they do. From the patient, it is an expression of gratitude and emotion as if they are partners in their care. Some I have read over the years included some touching letters that died in a hospital setting, but, in a way that the family was treated – the way the patient was treated. Because they were dying. That care, that compassion, that sense of family that people can never forget.
What type of accountability does a unit have on a problem?
We know – we know this nationally – that we see more satisfied patients if they have elective surgery or obstetric procedures. If you are coming for a planned surgery, you have got your life in order, someone is taking care of the dog, your mail has been stopped, your loved one has set aside time for work – everything Is planned In medicine, people are not as happy. They [may] Coming through the emergency department, they often have chronic conditions, their lives are not settled at home. We do a lot to try to reduce for those patients, but we do … see low scores. We know that going in for therapy would be unfair to say, “You’re not doing this with the OB floor either,” because it’s a very different experience.
How do you deal with those issues?
We have champions on the units. We involve vocal, front-line managers in this journey. It maintains their busyness every day. I do not see this as a one-time intervention. I think that’s where a lot of things fail: “Let’s throw these best practices against a wall and see what sticks.” You really have to make it in the culture and the way we work.