SlideShare a Scribd company logo
Dr. Eric Miller
Paladina Health
The Evolution
of the Patient
Experience
2
3
History of Patient Satisfaction
● First references 1950s
● Surveys appear 1980s
● WH Report & Crossing the Quality Chasm early 2000s
● HCAHPS standardized survey released in 2006
● Movement toward outpatient care/consumerism 2010
4
The Power of the Consumer
5
But, the question we all should be asking…...
Better Satisfaction = Better Quality of
Care
6
Patient Satisfaction vs Clinical
Competence● Should we really be that concerned with satisfaction?
● Press Ganey & Gallup
○ Top 10 Drivers of Patient Satisfaction
● Clinical Competence is Assumed
7
“Patients judge us, not by the way they are treated
for their medical condition, but by the way they are
treated as a person.”
8
Physician Satisfaction
● Physicians want security
● Security is not rooted in patient satisfaction, but in
patient loyalty.
9
“Recommendations don’t come from meeting basic needs
or expectations, they come from having a WOW
experience.”
Fool’s Gold
● Consider Patient Satisfaction Fool’s Gold
● Disney’s sole focus in on the percentage of patients
giving them the highest possible score on surveys.
10
“A satisfied patient has no story to tell.”
The Evolution of the Patient Voice
11
Patient
Satisfaction
Service Excellence
Patient Experience Principles
If Disney Ran Your Hospital
● Consider Satisfaction Fool’s Gold
● Value Courtesy more than Efficiency
● Measure to Improve, not to Impress
● Empower every Employee to Say YES
12
Patient Experience Principles
Hardwiring Excellence
● Build a Culture Around Service
● Key Words at Key Times
● Hardwire Service Actions
13
Patient Experience Principles
A Case for Compassion
● Hospital Post-discharge Survey
● 185 Unsolicited Positive Compliments
○ 4 @ Competence
○ 61 @ Courtesy/Politeness/Respect
○ 120 @ Compassion/Kindness/Empathy
14
Patient Experience Principles
Patient-Centered Care
● Find out what is important to the patient
● Focus on patient convenience
● Promote Patient empowerment
15
All excellent principles, but it seems like we’re missing something?......
16
Relationship-Centered Care
Patient
PCP
Medical History
Medical Training
Symptoms
Experience
Values
Current Evidence
Goals
Prescriptive Authority 17
Relationship-Centered Care
Patient & PCP
18
Marketing DPC
“There is a profound difference between selling and
marketing. Selling is trying to get people to want what you
have. Marketing is trying to have what people want.
When you have what people want, it makes selling
unnecessary.”
19
20
Shared Decision
Making
“What fits your
busy schedule
better,
exercising one
hour a day or
being dead 24
hours a day?”

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The Evolution of the Patient Experience

  • 1. Dr. Eric Miller Paladina Health The Evolution of the Patient Experience
  • 2. 2
  • 3. 3
  • 4. History of Patient Satisfaction ● First references 1950s ● Surveys appear 1980s ● WH Report & Crossing the Quality Chasm early 2000s ● HCAHPS standardized survey released in 2006 ● Movement toward outpatient care/consumerism 2010 4
  • 5. The Power of the Consumer 5
  • 6. But, the question we all should be asking…... Better Satisfaction = Better Quality of Care 6
  • 7. Patient Satisfaction vs Clinical Competence● Should we really be that concerned with satisfaction? ● Press Ganey & Gallup ○ Top 10 Drivers of Patient Satisfaction ● Clinical Competence is Assumed 7 “Patients judge us, not by the way they are treated for their medical condition, but by the way they are treated as a person.”
  • 8. 8
  • 9. Physician Satisfaction ● Physicians want security ● Security is not rooted in patient satisfaction, but in patient loyalty. 9 “Recommendations don’t come from meeting basic needs or expectations, they come from having a WOW experience.”
  • 10. Fool’s Gold ● Consider Patient Satisfaction Fool’s Gold ● Disney’s sole focus in on the percentage of patients giving them the highest possible score on surveys. 10 “A satisfied patient has no story to tell.”
  • 11. The Evolution of the Patient Voice 11 Patient Satisfaction Service Excellence
  • 12. Patient Experience Principles If Disney Ran Your Hospital ● Consider Satisfaction Fool’s Gold ● Value Courtesy more than Efficiency ● Measure to Improve, not to Impress ● Empower every Employee to Say YES 12
  • 13. Patient Experience Principles Hardwiring Excellence ● Build a Culture Around Service ● Key Words at Key Times ● Hardwire Service Actions 13
  • 14. Patient Experience Principles A Case for Compassion ● Hospital Post-discharge Survey ● 185 Unsolicited Positive Compliments ○ 4 @ Competence ○ 61 @ Courtesy/Politeness/Respect ○ 120 @ Compassion/Kindness/Empathy 14
  • 15. Patient Experience Principles Patient-Centered Care ● Find out what is important to the patient ● Focus on patient convenience ● Promote Patient empowerment 15 All excellent principles, but it seems like we’re missing something?......
  • 16. 16
  • 17. Relationship-Centered Care Patient PCP Medical History Medical Training Symptoms Experience Values Current Evidence Goals Prescriptive Authority 17
  • 19. Marketing DPC “There is a profound difference between selling and marketing. Selling is trying to get people to want what you have. Marketing is trying to have what people want. When you have what people want, it makes selling unnecessary.” 19
  • 20. 20 Shared Decision Making “What fits your busy schedule better, exercising one hour a day or being dead 24 hours a day?”

Editor's Notes

  1. First - how to measure Later - quantify relationship between Pt Sat and Quality of Care Surveys became common & required 1980 -> 2000 WH Report & Q C were published in the early 2000s which really shed light on the issue of not only patient dissatisfaction with US healthcare, but the associated quality lapses- In 2006 govt response to address this “Quality Chasm” was to publish HCAHPS: which was an attempt to standardize survey Hosp Consumers Asses of Healthcare Providers & Systems - Really, last 10 years we’ve seen this issue of pt sat become an important force in the outpatient arena, but this time its not being driven by the Govt or Regulations, but by the patients themselves. It has mirrored the Rise of Consumerism in our society
  2. You all will quickly recognize the logo of all these companies, and if you think about what they share, you’ll also quickly recognize that what they all share is the use of current Tech Tools: web-based platforms, smartphone Apps, & even social media for the purpose of harnessing the collective power of the consumer voice People have come to expect that they should be able to transparetly see the reviews of past customers to inform their purchasing, and it should be no surprise that they are starting to demand in in their healthcare as well The reality is that in today’s culture, the patient voice has a powerful impact on our practice whether or not we ever send out a single patient satisfaction survey.
  3. However, the one fundamental question we all should be asking, particularly the clinicians in the room, is “Does Better Satisfaction really equate with Better Quality of Care?…….
  4. There is the question of Pat Sat VS Clinical Competence Should we really spend much energy on Patient Satisfaction? Isn’t it true that what patients really want is high quality medical care? Two of the largest collectors of Pt Sat data...Publish yearly Top 10 Drivers Year after year, almost every one of them> how treated as a person, not clinical competence Competence Assumed Patients Judge Us…. Preaching to the choir - DPC providers get this >> Loyalty matters Now this next example is clearly not from a DPC Practice. Probably a large FFS Practice in a huge health system. It is an example of NEITHER Clinical Competence NOR Patient Satisfaction
  5. The Receptionist says: “ Now if your in traditional FFS practice with 3000 patients and a 2 month waiting list, maybe you don’t need to be so worried about Pt. Satisfaction But if you are in DPC, you realize that highly satisfied patients are essential to maintaining and growing your membership
  6. So what is it that Physicians want? We all want many of the same things out of our careers: sense that we are making a difference, meaningful relationships with our patients, work-life balance, fair, reliable income, …... Well certainly in DPC, Physicians want SECURITY But here’s the secret: X Security is rooted not…... X: Recommendations….
  7. In the Disney book I referenced at the start, there is a concept that really stuck with me - it cautioned not to chase Fool’s Gold. X: Fool’s Gold: meaning if we aim to simply satisfy our customers, we certainly won’t thrive, and we may not even survive Focus on the highest possible scores on their surveys because they know those are the people who are their promotors - they will rave about their experience. X: In his book, Fred Lee repeatedly states “A satisfied…..
  8. In the last few decades, as HC organizations have recognized the Fool’s Gold in chasing patient satisfaction, it has led to an evolution in understanding the patient voice. Early on, we just spoke of Patient Satisfaction In the 90s the concept of Service Excellence gained popularity and we saw my hospitals institute Service Excellence Programs In the last 15-20 years however, we’re speaking more broadly of the Patient Experience So let’s look at a few Patient Experience principles that we can borrow from experts in the industry…..
  9. From the Disney book, we can borrow principles from an company that has built an empire based of providing a WOW Experience…… X: We’ve already talked about the Fool’s Gold of satisfied patients X: Creating a culture where you Value Courtesy more than Efficiency X: We should make sure we measure our results to Improve rather than to Impress. Our goal is producing a better product, not a better marketing cam X: Empower every employee to say YES. Receptionist empowered to solve a patient’s problem or to provide instant service recovery
  10. From the Studor books, here are a few key principles about how to build this culture of service excellence into your practice. From their research, they’ve found that Key Words can have a profound impact in how patients perceive us. Simple phrases like: “Is there anything else I can help you with today?” Or “Thank you for coming in today.” go a long way in conveying to our patients that we care about them and are here to serve them. Similarly, hardwiring certain Service Actions into your office practice can make a big difference Examples like having your staff follow AIDET for their rooming process or having a cadence of routine f/u calls to patients.
  11. But if we really want to know what one thing makes the biggest impact on our patients experience with their healthcare, we should take a lesson from the research highlighted in one of these books. X: The author calls this “A Case for Compassion” X: Examined hundreds of Pt Satisf Surveys sent to patients post Hospital discharge X: Out of those hundreds of surveys then found 185 UNSOLICITED + Comments Of those 185….. X/X/X That is 30:1 in favor of Compassion over Competence
  12. Over the last few decades, this Patient Experience Concept has led HC organizations to promote Patient Centered Care
  13. The Physician…...You……& Me. At its heart, Primary Care is about a relationship between a Physician and a patient.
  14. I’ve began to speak to our providers about Relationship-Centered Care rather than Patient-Centered Care On one side you have the Patient, who is the source of truth for their… On the other side, the PCP brings their….
  15. When you bring those two together, with time you can develop a X: Therapeutic Relationship built on Trust and Mutual Understanding in an environment that is Safe to be honest and authentic. X: Then as you work on Shared Decison Making around Common Goals, you have a change to get meaningful Lifestyle Changes X: It is only in the context of that Relationship-Centered Care that I believe patient can experience what they really desire most, that being Compassion & Empathy. I’ll leave you with a quote that I think is so appropriate for those of us in Direct Primary Care…….X
  16. I