How Home Health Can Achieve the ‘Wow Factor’ with Patients

When home health providers think of the “patient experience,” high-quality care is likely what comes to mind first. In reality, physical care may just be one aspect of an outstanding patient experience.

The real definition of patient experience can be beyond what providers and caregivers are used to, Joyce Boin, principal consultant at Strategic Health Care Solutions, explained to Home Health Care News.

“All patients assume as a home health provider you are sending a competent caregiver. The ‘wow factor’ comes in when you expand that idea even further than just great care,” Boin said. “The above and beyond comes from compassion and empathy.”

Patient Experience Project

In addition to caregivers showing compassion and empathy, another way home health providers should train caregivers to go above and beyond is by teaching how to engage patients in the care process, Andrew Gallan, an assistant professor at DePaul University who researches the patient experience, told HHCN.

This engagement could be as simple as asking the patient one or two extra questions to learn more about them, or explaining certain aspects of the patient’s recovery to keep them engaged in what’s happening.

Gallan has made the patient experience in health care his focus. He began his research in hospitals, but moved into the home care sector through a project with an Illinois home health provider, Advocate at Home, where he and Boin partnered together.

The project consisted of three phases that took just over two years. First, a survey was conducted among home health patients to see where caregivers stood in terms of quality of care. Then Gallan pinpointed the top drivers of the patient experience and created an index to track for those things. The items he tracked included communication with home health staff members, taking care of emotional needs and overall perception.

Second, Gallan did phone interviews with the patients to try to find out more details about the areas in phase one. In phase three, Gallan attended ride-alongs with home health staff to witness the caregiver/patient relationship firsthand. In total, Gallan made about 40 patient visits in the city of Chicago, the suburbs and rural areas of Illinois.

The results of the project found that patients overall had very good relationships with their home health providers, but they were reluctant to talk about their emotional state.

“Home health providers did a very good job of delivering the actual care, but the relationships formed could have been better,” Gallan explained. “The caregivers could have been better active listeners. Something as small as putting away computers or tablets and taking a few extra minutes to ask a few more questions could help create a clearer picture of the patients’ emotional state.”

Making goals very clear can also improve the overall patient experience, added Gallan.

“If patients can identify a goal, they can see a light at the end of the tunnel,” he said. “It’s a highly motivating thing. If caregivers can help them identify those goals, patients can make significant progress.”

Though the project is over now, Gallan continues to work with Advocate at Home to help implement the full patient experience and build upon the project’s findings.

Investing the Upfront Time

Caregivers can improve the patient experience is to work on building a strong relationship with the caregiver by encouraging patients to become engaged. Allowing caregivers to spend more time on visits sounds like it could be inefficient, but investing time upfront to build relationships and develop goals with patients actually has a positive impact on recovery times, according to Gallan.

“I know some of the pushback about being more engaging with patients is because it will take more time, but my response is that if it’s done well, it’s not going to be that much more time down the road,” he said. “And then, if the patient knows what’s expected of them from the beginning, once the nurse comes in they don’t have to reinvent the wheel.”

Building a strong relationship between caregiver and patient can also help put family members at ease.

“It’s a cause of concern and anxiety for some families when their loved ones are receiving in-home care,” said Boin. “The idea of having caregivers as somewhat of a support system is what value-based purchasing is really going to buy. If caregivers can deliver on that, the patients and caregivers will become more efficient.”

Written by Alana Stramowski


Calculating and Understanding the Drivers of a Net Promoter Score in Health Care

The Beryl Institute Blog Series:

In 2016, Advocate Health Care, the largest health system in the Chicagoland area, integrated into its performance measures a Net Promoter-like score, which they call a Patient Loyalty Score (PLS). Net Promoter Score (NPS) is a valuable metric, and it has been adopted by many companies in almost every industry. NPS is a simple, easy to use, and easily calculated metric that is intuitively associated with business health by assessing a respondent’s likelihood to recommend an organization to a friend or colleague.[1] Health care organizations are beginning to see its value, and are exploring how it is best calculated and used.

For Advocate Health Care, PLS is constructed using data from CAHPS and vendor surveys, and utilizes the likelihood to recommend question. Only a top-box score is defined as a promoter, and varying bottom scores are defined as representing a detractor. That is, for a five-point scale (ED vendor survey) the bottom three responses are categorized as detractors; for a four-point scale (HCAHPS) the bottom two are detractors; and, for a three point scale (CG-CAHPS) only the bottom score is a detractor.

Some issues with the measure include the referent (CG-CAHPS asks about likelihood to recommend the provider’s office, ED refers to the department, and HCAHPS asks about the hospital), and the limited scale width (the original NPS scale is 11 points). However, for me, having a patient-provided measure outweighs the issues, and I commend the organization for holding people accountable for patient perceptions of care. The strength of this metric is to create system-wide responsibility for a patient-provided measure, thereby ensuring that the patient’s voice is heard.

Like most organizations, Advocate Health Care is interested in earning increased rates of positive word-of-mouth recommendations. As a result, I recently engaged with Advocate as an Academic-in-Residence. In this role, championed by EVP & COO Bill Santulli, SVP & CNO Susan K. Campbell, and VP Information and Technology Innovation Tina Esposito, I performed analytics to identify drivers of PLS. The two important research questions that drove this project were:

  1. Which variables are the most important drivers of PLS?
  2. What can we learn from patient comments about potential drivers of PLS?

In order to investigate these questions, I was provided with almost two years of HCAHPS, CG-CAHPS, and ED survey data and patient comments. Top line results included the following:

Inpatient (HCAHPS): Nurses and personal issues (privacy, pain, and emotional issues) had by far the most impact on patients. Positive comments centered on comfort, communication, and care. Negative comments focused on food.

Outpatient (CG-CAHPS): The face-to-face interaction between a patient and physician is the “moment of truth,” and as such is what the patient apparently will use to evaluate the entire experience. Positive comments centered on comfort and communication. Negative comments focused on waiting and rude treatment.

Emergency Department (Vendor Data): When patients are in the ED, taking care of personal issues will have the greatest impact on PLS. These issues include keeping patients informed about delays, caring about patients as people, pain control, and providing information about caring for yourself at home. Positive comments centered on comfort, communication, and care. Negative comments focused on feeling vulnerable and afraid in a busy and foreign environment.

As a result of this project, Advocate Health Care is now embarking on disseminating the results, integrating insights into daily practice, and evaluating additional questions that emerged from the analysis. I’d be interested in hearing more about what your organization thinks about NPS, how you use it, and what you have learned as a result!

[1] NPS was first proposed by Fredrick F. Reichheld, (2003), “The One Number You Need to Grow,” Harvard Business Review, 81 (December), 46-54. For more on advantages and issues utilizing NPS in health care, see

Andrew S. Gallan PhD is an assistant professor at DePaul University in Chicago, a member of the Editorial Review Board of Patient Experience Journal, and principal of Dignity in Action, Inc., a PX analytics and advisory company ( Andrew can be contacted via email: