A Few Things I’ve Learned About What It Takes to Become a Patient-Centered Organization – Learning #4

Learning #4: Understanding the patient experience requires a strategic plan, the proper tools, and humility.

Frameworks and tools exist to help organizations better understand their processes from the patient’s perspective, designed to help organizations strategize around improvement, innovation, and redesign to enhance quality, safety, and productivity.

Implications: Understanding what your patients experience when they are in your facility requires humility. This may not be what you think it is; a recent article outlines major components of humility: “Recognition of what she owes to others, comparison with a reality that is greater than her, and finding something that has a high objective value that leads her to acknowledge her smallness.”1 It is a positive virtue that motivates an individual to be open to others, to listen carefully to others, and to assume an attitude of looking for guidance.

It is from this perspective that a leader creates a humble organization; one that has a desire to understand what patients and families go through to obtain care from and with your organization. Thus, putting yourself into the shoes of another, through Shadowing, is an important tool to understand care from the patient and family perspective. Shadowing is a cultural change agent, an orientation tool, and a reminder of your organization’s mission. What you see will go beyond your pre-conceived notions of what it is like to be a patient. It will connect you to other human beings, their vulnerability and goals, and bring out your sense of empathy.

Once you have Shadowed patients, it is imperative to map the process using care experience flow maps, service blueprinting, or other tools to create a clear image of what is. Comparing what you have designed to what customers expect using the Gap Model of Service Quality will help you to reimagine what could and should be, and to redesign the process to best accommodate the patient. By using this methodology your department will also most likely save costs and improve safety.

Making a commitment to seeing your organization’s processes from your patients’ perspectives is not easy – it requires a high level of dedication from top leadership. A Servant Leadership model applies as well, where leaders put the needs of others before their own needs. After all, as humility research reminds us, “the humble leader is precisely the person who is best qualified to transform his firm into a profitable, successful, and respected organization.”

1 Argandona, Antonio (2015), “Humility in Management,” Journal of Business Ethics, 132 (1), 63-71.

A Few Things I’ve Learned About What It Takes to Become a Patient-Centered Organization – Learning #3

Learning #3: Improving the patient and family experience cannot be distinguished from clinical care.

Patient experience, safety, and quality are categories of care constructed by organizations which often serve to separate rather than to integrate processes. They are inter-related; we cannot affect one without impacting the other two.

Implications: Watch what you say, and how you say it. Artificially dichotomizing “care” and “cure” does nothing to help your patients and their families in recovery. All it does is feed those in the organization who don’t want “patient satisfaction programs” to impact what they do. When you look at care experiences from the patient’s point of view, everything is everything. Patients want to feel safe and secure, to perceive that they are getting the best possible care, to be assured that they know what is happening and will happen, and to be heard.

How can any of these be pigeon-holed into safety, clinical quality, or experience alone? Doesn’t active listening directly impact shared decision making? And doesn’t timely and proper communication directly impact safety (falls, medication errors, etc.)? Doesn’t discharge planning, discussions about home and social support systems, and clear instructions on new medications and follow-up visits directly impact readmissions? So why should one aspect be distinguished from the others?

For example, many organizations will show a near-100% compliance providing discharge instructions to patients and families. However, patient surveys such as HCAHPS reveal a significantly lower percentage of patients recall this information. Some organizations interpret this disparity as the patient’s fault: “We checked the item, so it must have happened. It’s not our fault that the patient can’t remember.” If an organization receives 70% top-box scores for discharge information, 30% of patients don’t recall critical information designed to improve safety, outcome, compliance, and to reduce no-show appointments and readmissions. Instead of attributing the source of blame, an organization would do well to assess why 30% of their discharged patients can’t recall discharge information. Are there language issues? Is the discharge process confusing or too technical for some patients to recall? Can your organization better involve family members and other caregivers in the discharge process?

The best organizations discuss all aspects of care together – for instance, the impact on quality and patient experience when safety protocols are redesigned, the impact of new quality guidelines on safety, costs, and patient perceptions of care, etc. You may consider appointing one person in every meeting to provide feedback on every strategic initiative from the patient’s point of view. This way, the patient’s voice is continually infused into planning and tactics.