Patient Experience: What does It mean? Patient vs Customer Experience: Fundamentally different or similar.

. Two dimensions of top percentile patient satisfaction.

How to improve the patient

experience - Sustainably?

What does it take to achieve patient experience excellence?

any hospitals in the USA are concerned with patient experience especially with HCAHPS reimbursement rules come into effect. However, there is confusion about what customer experience actually refers to. A Health Leaders Media survey of hospital and health system senior leaders that states that 34% chose patient-centred care, 29% selected "an orchestrated set of activities that is meaningfully customized for each patient," and 23% said it involved "providing excellent customer service." The remaining 14% said it was creating a healing environment which seems most aligned to whats measured by HCAHPS. It is not just semantics. The definition used makes a difference because it determines what a successful outcome will be or not. The honest truth is that while many hospitals will always have been concerned with the patient experience they did not have a clear vision of what it actually is. Successful outcomes were measured by a variety of yardsticks. HCAHPS may not be a panacea but it is an aligning force that is basically says patient experience is everything outside of clinical care and involves all parts of the hospital. This understanding of patient experience follows what is known from the larger customer experience space. Customer experience as a discipline started to take off in 1998 with the seminal HBR article Welcome to the Experience Economy. Beyond Philosophy provided the unifying definition of customer experience as follows:

A Customer Experience is an interaction between an organization and a customer as perceived through a Customers conscious and subconscious mind. It is a blend of an organizations rational performance, the senses stimulated andemotions evoked and intuitively measured against customer expectations across all moments of contact. There are three key points here. Patient experience is about 1) the whole organisation delivering, 2) the rational as well as the emotional experience and 3) dealing with the intuitive perceptions (i.e, gut feelings) of patients. There are three key points here. Patient experience is about 1) the whole organisation delivering, 2) the rational as well as the emotional experience and 3) dealing with the intuitive perceptions (i.e, gut feelings) of patients.

Patient experience is about the whole organisation delivering The health Leaders Magazine article makes it clear that hospital leaders are in general
just coming to terms with the first point that patient experience is about an interaction between the hospital and a patient. This simple phrase packs a lot of weight. It does not say that patient experience is about an interaction between the front line and the patient any individual or individual department and the patient.

Patient experience is about the rational as well as the emotional experience

rational experience. This would be all of the normal things you would expect any patient or health care professional to state is important facilities, competency, etc. As patients answer questions about what they want or like, they must process an answer. The act of processing the answer means that the most obvious logical sounding things will make it through and this is what they answer. The part that is below the water level is the emotional experience. This part of the experience is difficult for the hospital to see. Think of this as the bedside manor the whole hospital displays. To be frank, this is where the biggest opportunity is to improve patient satisfaction. So the trick here is to develop the hospitals ability (remember we are talking about the whole hospital) to view the emotional experience. It is certainly more difficult to address what you cannot see.

Think of patient experience as being an iceberg. The part that is above the water is the

Patient experience is about dealing with the intuitive perceptions Think about it, most patients are not trained medical practitioners. They generally

have limited practical ability to assess the experience on the basis of sound clinical practice. Instead, they pickup clues and make inferences about the overall experience. A classic article that describes this phenomenon in a hospital is Clueing in Customers. The point is that this gut reaction on the part of patients is often dependent on the little things (i.e., clues ) in the experience. These clues could be such things as the quality of the toilet tissue, visible cleanliness of seating, name tags turned right way around, etc. things that people do not tend to primarily focus on in a healthcare setting.

Any hospital executive that is looking to make significant improvements in its patient experience needs to keep the above definition and its implications in mind. Overlooking or inadequately considering any of the three key points will significantly hinder progress.

recently presented at the Beryl Institute conference on patient experience. While there, I had the pleasure of listening to a few of my fellow speakers like Fred Lee (author of If Disney Ran your Hospital), Al Stubbelfield (CEO, Baptist Health Care Corporation), Colleen Sweeny (Patient Empathy Project) and Tiffany Christensen (author of Sick Girl Speaks) plus a few others. One of the messages that were fairly consistently dropped was how different the patient experience is from customer experience. In fact, Fred Lee suggested similar to the following create a table with Patient heading one column and Customer on the other. Then start asking yourself how these two are different. You might get something like the following:

The list could continue but the point has been made; this little exercise would seem to lead one to the conclusion that the patient experience is fundamentally different from customer experience. And this is true if one is focused on the actual experience of the individuals involved. I dont have trouble with the notion that a patient is different from a customer of an amusement park, retail establishment and so forth. I do however have trouble with the faulty follow-on notion that patient experience might therefore be considered separate from customer experience.

The paradox is that customer experience accounts for these differences. It is ALWAYS true that the specific experiences of any given segment in any given sector tend to be fundamentally different on a number of parameters (as demonstrated above). So the paradox is that customer experience is outside-in in its approach and accounts for the differing rational and emotional expectations of the customer (however defined). My caution and advice to the many patient experience directors out there is to learn the principles and approaches from customer experience. The principles of customer experience can be applied to any setting. Do not get confused by the fact that the actual experience a hospital provides is fundamentally different from the experience provided by a mobile telco. The paradox can be summed up in the following diagram: While the shape and colour of specific experiences differ (ie, patient experience is in reality different from a retail like customer experience), the starting point for customer experience thinking is with the customer (however defined). Proper customer experience makes no grand statement about what all customers will like or dislike. What works beautifully for some will fail miserably for others. So the starting point is an understanding of the rational and emotional experience expectations of customers (however defined). After all, not all patients are created equal. It is quite easy to imagine that the experience expectations of a patient for minor cosmetic procedure might be entirely different than those of a patient for bilateral mastectomy and so on. The experience they perceive is in part dependent on what they think the experience should be and in part on what is actually delivered and how. When the experience expectations are fairly close to the current perceived experience, satisfaction will be high; when it is not satisfaction will be low. This is true for all segments and populations. So is patient experience fundamentally different or similar to customer experience? The answer is paradoxical. The experience of a patient is fundamentally different from a typical retail based customer experience but it the principles by which patient experience operate are the same.

anaging patient satisfaction is a key strategic goal for healthcare providers on both sides of the Atlantic. With patient satisfaction scores being directly linked to financial gain and loss, hospitals in particular are forced to re-evaluate their way of being and consider their patients perception of who they are and how they operate. This has great implications to how things are executed because now they cant afford not to ask themselves: But how does this affect our patients satisfaction? In addition to the traditional Will this improve our clinical outcomes?; Will this makes us more efficient? etc. But how do you achieve top percentile satisfaction? In the work Beyond Philosophy did with Memorial Herman Hospital System a few years ago, we came to an important revelation about patient experience and patient satisfaction. There are two key elements to patient satisfaction: clinical outcome and emotional outcome. Clinical outcome is defined in a broader sense and entails the effect derived as a result of the medical treatment and associated service standards that hospitals deliver. It has to do anything with the medical procedures and practices, the communication of those, efficiency, timeliness, routines and any practice in the hospital which directly or indirectly impact the patients medical wellbeing. This answers the question: What do we do? Emotional outcome entails the intangible, more difficult to measure effects of the interaction that impact directly or indirectly patients emotional wellbeing. It comprises the subtle clues; little details signalling the intent behind the actions (e.g. tone of voice, facial expressions, colour of tiles etc.). This answers the question: How do we do the things we want to do?

Any healthcare provider will tell you that the two are not independent (ask any physician), if fact they are strongly correlated and in some parts are the cause of each other, but never the less they produce 2 distinct effects and are worth paying attention and systematically addressing. Do not expect that if the one goes well the other will follow. A timely service, reduced noise and detailed explanation of the effects of a drug do not guarantee satisfaction. More importantly, while you cant always control the clinical outcome (things go wrong, not all conditions have a positive outcome, budgets are short, staff is short etc.), you can always pull the leavers on the emotional outcome dimension to affect satisfaction. Below is a diagram explaining how the 2 dimensions interact and to deliver a patient experience that has a certain type of effect on patients behaviour and satisfaction:

Negative clinical & negative emotional outcome

This experience is what gets patients to score the hospital low on the satisfaction scale. When admitted, patients are at their most vulnerable and while some become hyper sensitive and others hyper tolerant to the environment waiting to only get through it, all are human and want the best. Being submitted to diagnostics, anticipating results, spending nights alone in an unknown environmentall this makes the hospital experience negative to begin with. Failing to meet expectations, having to deliver negative news all while failing to show care or compassion is essentially rubbing salt to the wound. As a result patient walk out of the experience feeling negative about the hospital and the staff.

Positive clinical outcome & negative emotional outcome

This type of experience will get you in the low to average patient satisfaction score range. The reason is that regardless of how quick, accurate, regular or effective you are in delivering the medical treatment, the feeling behind it can significantly leave patients with the impressions that you are merely ticking the box and more importantly, that it is the people who deliver the good experiences, not the hospital. Recommendation boils down to the physician no the hospital brand.

Positive emotional & negative clinical experience

Interestingly, when the medical treatment is not favourable but the management of the delivery is emotionally positive and engaging, patients tend to score average to high on satisfaction. Under these circumstances patients tend to rationalise the reasons for the poor clinical outcome (e.g. the condition is untreatable, medicine offers no better solutions, its a small hospital with lots of patients etc.) and essentially excuse the hospital. Reason is that the emotional outcome serves as compensation and more importantly leaves them with the impression that the intentions were good and in place. It is like going through a tough period with your partner: you are more forgiving and willing to move on when you feel and believe there is love between you and good intentions.

Positive emotional & negative clinical experience

This is the ideal experience you can provide your patients with. This is the reason patients score hospitals in the top quadrant on the satisfaction scale. Patients not only appreciate the staff, but see the experience as purposefully designed and delivered by the hospital.

What are the implications?

Aim at understanding and managing both dimensions of patient satisfaction: emotional and
clinical outcomes.

Emotional outcomes have a significant impact on patient satisfaction that can and should be
systematically managed.

Ask yourself and your staff if you know what those emotional outcomes are? Ask yourself and your staff how you can design positive emotional outcomes in your
experience.

t a recent Beryl Institute conference on Patient Experience, Rhonda Dishongh, Director of Patient Experience Design at Memorial Hermann Hospital System and I presented a case brief on our work there. This time, our talk was focused on Achieving patient experience excellence through cultural transformation. Rhonda was keen to get the message out that the key to sustainable improvements in Patient experience and therefore patient satisfaction is cultural transformation. This transformation has to be organic grown and nurtured from the inside. It will not happen simply by mandate. You will not make it happen by creating great sounding policy alone.

If you boil it all down, there are four key ingredients to successful cultural transformation:

Leadership The leaders are required to demonstrate and set the stage for the transformation.
They need to be servant leaders - leaders who live the new cultures values. The Servant Leader was coined by Robert K. Greenleaf in The Servant as Leader.

Motivation The trick is to get employees to be internally motivated. One of the benefits of the
healthcare sector is that many of the workers in the sector are there because they wanted to make a difference. They feel there is a greater purpose than just earning a nice pay check. Patient experience transformation works in your favour in this light. It just needs to be translated as such. What does not work is external based motivation- money and management by fear and intimidation are external motivators. They can generate behavioural change (often negative) but in isolation they never produce positive sustainable cultural transformation.

Coaching The trick is to get employees to be internally motivated. One of the benefits of the
healthcare sector is that many of the workers in the sector are there because they wanted to make a difference. They feel there is a greater purpose than just earning a nice pay check. Patient experience transformation works in your favour in this light. It just needs to be translated as such. What does not work is external based motivation- money and management by fear and intimidation are external motivators. They can generate behavioural change (often negative) but in isolation they never produce positive sustainable cultural transformation.

Measurement It is obvious you will have HCAHPS as one source of measurement but that is a
mandated outcome metric you want to improve. You need interim local metrics as well to give direction to the change. It is these local metrics that alert you to opportunities to coach, compliment and correct in-between HCAHPS scoring.

Patient experience excellence has brought Memorial Hermann Hospital System astonishing rewards:
5% increase of market share within the first 2 years Profit where loss was predicted Patient satisfaction scores jump by 20% on average across the board within a year Operational efficiency National recognitions such as the Press Ganey Success Story Award, 2011; Gold Circle Award: Operations, 2011; Presidents Cup for Best Performance Overall, 2011 and NAATP Quality
Improvement Award, 2011 to name a few. More importantly, their success has been gradually growing ever since they began their journey back in 2005. When in 2007 Beyond Philosophy stepped in to help translate intent into action and practice, Memorial Hermann had already set themselves the goal to become renowned for the experience they knew they could deliver. It took less than a year to archive success.

How? For easier understanding and the purposes of this blog we will categorize their efforts in 3 steps:
Assess and understand, Define your intention and patient experience vision Build a culture around your vision
The first two steps are crucial to ignite the movement. Through the assessment (the right one might I add, not just any assessment, one that looks at the full patient experience and journey) you will educate your staff and give them the right perspective to understanding patient satisfaction. Here is a secret to help you succeed in this: instead of presenting to your staff what the complicated surveys say, get them involved in doing the assessment themselves. Through step two, i.e. defining and clearly articulating your patient experience vision, you will be able to make a clear statement to the organisation on what is expected, desired and a definite no-no. A helpful hint: while acrostics and roll-offthe tongue wording help better than technical or nebulous sounding statements, to actually make your vision relevant and attractive to employees you will need to incorporate an emotional element and paint a picture with it. Create a story that will imprint on their heart, not brain. So the first two steps will help you get started and show results very shortly after executing. However, true and sustainable excellence comes only by creating a culture that has patient experience understanding and vision embedded in its DNA. As the saying goes: Give a man a fish and you feed him for a day; teach a man to fish and you feed him for a lifetime.. One of the greatest challenges many hospitals as well as commercial organisations face is sustaining success in changing environments, in high turnover and scares resources situations (all applicable to hospitals). And being able to exceed patient expectations as they get savvier but also maintaining employee morale and eagerness, requires a ubiquitous and enduring characterising of the culture the hospital nurtures and radiates. Step 3 of the journey to providing outstanding patient experience entails a cultural transformation- coaching your staff to be the driver and source of patient experience excellence. To do this you will need to first create patient experiencecentric habits and spread the practices organically through the organisation, horizontally and vertically.