We're going to talk about measurement. How do we measure the patient experience? So, one of the things that we start with, is that expectations lead to the experience, which equals the patient's reality. Along the way, we have opportunities to delight or disappoint our patients. This is a simplified patient journey map, but it's something that we suggest that you do when you're looking at improving the patient experience. You can look at arrival or registration, the appointment, the procedure, the stay and discharge. And along those paths, look at what delights or disappoints your patients. So how do we measure or gather feedback on our performance? Surveys, which I'll spend a little more time talking about, are one method. Focus groups are also very beneficial and you can do patient journey mapping in those focus groups. We also have patient and family advisory councils, where we discuss how we're doing, what we could do better and bring new ideas. Shadowing or observation or secret shopping is another way that you can gather feedback on your performance. And then patient rounding, either you can have executive rounding, nurse rounding, service line leaders, concierges, again checking in with your patients and your employees to find out how you're doing on the patient experience. And finally there's post visit discharge phone call. So how did the transition go to home. And is there anything that we could have done better. And this is often linked to reduction in readmissions. And finally there's complaints, compliments and grievances. And again these are stories that patients tell us that can help us improve. Doing a root cause around these, will also be beneficial in understanding how you're performing. It's really important to report transparently and create an accountability system. And there are many ways to review the data and these include looking overall at your organization or you're moving to your complaints, compliments and grievances and internally looking at scores and comments. And you can do this based on a service line such as medicine, surgery, oncology, you can get down to the unit or the floor level. You can do it by provider, especially with the medical practice survey and then demographics, often that tells us a lot. Are there issues with one patient population versus another that you want to be sensitive to? Maybe it's around their ability to move, so responsiveness of call bell may be more important to one group than another. What matters to our patients? So I have a letter that I'm going to read just briefly that helps explain how you can use a letter to understand what's important. And this is a letter that a patient who had spent 35 days on one of our oncology units said. He said the staff were attentive, compassionate and thoughtful. This extended across the entire team. We felt like we were members of the family, not just patients with a number. I don't recall hearing one cross word throughout the stay. Truly you have achieved what healthcare is seeking. You have a high degree of patient engagement and satisfaction. We could call our team members by name but truly, we might miss one. It would be difficult to name someone because everybody provided optimal care. And he goes on to say, at our very lowest moment in life, your team lifted our spirits, encouraged us in ways they may never truly know and promoted hope and help in a manner we will never forget. And he wanted to thank us for all we did for him and for his wife who was the patient. And you can see there's a lot of we and our and I think that's important. Also you didn't hear about the medical care, what you really heard about was the caring and that's a theme that we'll be continuing to talk about. So when you look at measurement along the patient journey, we have the adult inpatient emergency department medical practice, ambulatory surgery, Pediatrics, outpatient services and home and health care, and each of these surveys, focuses on slightly different components that are important to the patients at that stage in their journey. HCAHPS, which I'm going to talk about a little bit more because that's one if you're in the United States we have pay for performance tied to. And that looks at several domains. Communication with nurses, doctors, communication about medicines, looking at if you understood what your new medication was for and somebody explained side effects. The environment, the cleanliness, the quietness, the responsiveness of the hospital staff, both to toileting needs and to the call bell, pain management, which will be moved out of the pay for performance component for right now, and discharge information and finally care transitions. With communication with nurses and doctors, it looks at how the doctors and nurses explained things to you, listened to you and treated you with respect and courtesy. And from that letter you could tell that those were important parts. And finally we have two overall ratings and those overall ratings look at your overall rating of care and your likelihood to recommend. So, some of the questions as I mentioned are listening, explaining, respect and courtesy, understanding your medication and next steps in your care, the discharge and the follow up. These questions were derived from focus groups around the country with patients and families about what was important to them. So let me stop and ask you to consider this. When you're in an elevator, how often do you want it to reach its destination? Never, Sometimes, Usually, Always? So for most of us, the only acceptable response to this question would be always and that's the same when we're measuring patient experience. We want our patients to have that always experience. People will often think that all the angry patients fill out surveys or those that were disappointed in their care. But that's not true and you can see that from this slide. 82 percent of our patients said the nurses always communicated well and the next largest component was usually. Sometimes was the next one with three percent and we had no patients who said never. So our goal is to move the usually to the always. Comments are another way of understanding what your patients want. And this is a Wordle with comments and you can see words like caring, liking, concerned, uncomfortable. You can learn a lot from what your patients are telling you in the comments, and that explains why they rated you the way they rated you. So how are you sharing your information? Do you analyze your data deeply? Because that's a really important piece of improving the patient experience. And finally what is your organizational structure to create accountability?
