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.

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