Dr. Eduard Portella, International consultant

1. The patient experience in
health services
State of art
Eduard Portella
eportella@antares-consulting.com

2. The patient has always been our reason for being... so?
2

3. Social changes have changed the population's
perception of health services
03
Expected
quality
Desired
quality
Perceived
quality
Provided
quality
Patients Health
professionals
Patient
satisfaction
Performance
• Integration
• The immediate
• Personalization
• Platforms...
• Information
• Decide on my life project
• Participate
• …

4. The patient has always been our reason for being …
• Co-design of services
• The patient partner
• Health literacy
• Know your opinion
• Fostering participation
4
… but this situation has evolved considerably!

5. What are the characteristics of today's patient?
Interested in health
Stays informed
5
Demanding, as a consumer
Participates in the decision-making
process

6. For what and how should we monitor the
evolution of patients' expectations...?
A State of Art on patient eXperience to try to answer
two questions...
06
To know the evolution of patient orientation in
health services and to benefit from these lessons

7. The evolution of trends...
Reengineering (TQM)
Measuring satisfaction
Empowerment
The patient expert
Accessibility
Patient eXperience
07

8. 8

9. Satisfaction questionnaires... value analysis or a trap?
9
Satisfaction surveys bring value when dealing with patients' real expectations
satisfaction
+-

10. Satisfaction questionnaires... value analysis or a trap?
10
Satisfaction surveys bring value when dealing with patients' real expectations
satisfaction
importance
- +
+
-

11. Satisfaction questionnaires... value analysis or a trap?
11
Satisfaction surveys bring value when dealing with patients' real expectations
satisfaction
importance
- +
+
-

12. Not integrating patient expectations involves risks,...
12
… for example, making efforts without any perceived value!
Importance of expectations
Efforts of
the organization
+
-
+-
• Discharge from hospitalization
• Noise at night
• Know the planned itinerary
• Coordination of professionals
• Knowing who I'm talking to
• Explain the purpose of the visit
• Pain management
• …

13. 13
The implementation of informed consent has not guaranteed real
understanding for informed patient decision making
From the desire to create a culture of empowerment to the
implementation of an administrative and defensive form
The first debate on patient empowerment was frustrated …

14. The active participation of patients started very early in some
situations... but without creating a trend
14
Mental health
Diabetes

15. • Understand the offer
• Access to information
• Use common terms to
explain the offer
• Different entry points:
telephone, face-to-
face, internet...
• Time slots
• Quality of
communication to
patients and families
• Consistency of the
information provided
• Patient flow of care
pathways
• Appropriate spaces
15
Readable Available Welcoming
Accessibility is a term from the 1970s, which today has
become a multidimensional concept
Accessible
• Response times
• Queue management

16. As a result of these evolutions, the emergence of the patient
eXperience means a new paradigm
The evolution of
improvements in care
and its facilitators
16
Patient
eXperience
Reengineering (TQM)
Measuring satisfaction
Empowerment
The patient expert
Accessibility

17. Patient eXperience is...
Patient eXperience is the sum of all interactions within an organization that
influence the patient's perception of the provided services.
Improving the patient eXperience means working on...
It is an expression of the organizational culture
• The people with whom the patient must interact
• The care or administrative processes organized by the institution
• Space design
17

18. Patient eXperience
A perception
A sum of interactions
Throughout the patient’s journey
A manifestation of the organizational culture
… and also implies an update of the Quality concept
18

19. In the new care model, the objective is to change
the paradigm of relationships
Yesterday
Asymmetrical information
Passive contact person
Paternalism
Patient doctor
Tomorrow
Symmetrical information
Active partner
Participation
Consumer-Care Team
19
Source : La participation des patients : Pour quoi est-ce important et comment l’obtenir ?, Santé en
Devenir, Institut d'analyse stratégique et d'innovation du Centre universitaire de santé McGill (IASI-
CUSM), mai 2015

20. In this evolution, ICTs play an increasingly important role in
changing patients' values
20
About 2 out of 3 people have done health research, before or
after an episode of use.
Doctors are beginning to recommend the sources of medical
information on the Internet.
Social networks are increasingly playing a role as a gateway to
health information.
Currently, more than 200,000 health applications are available.
Source: IMS Institute for Healthcare Informatics

21. How do we get this ?
• Reduce information asymmetry
• Patient participation in the design of services / flows / space design /.....
• To know the expectations of the population which makes it possible to inform the
patient in a constant way and to promote the personalization of the management
21
Patient eXperience involves a profound organizational transformation, which
involves....

22. At this moment we already have tools, a metric under
construction and many examples
• Shadowing
• Always events
• Patient Journey Maps
• Value-Stream-Mapping
• Design thinking
• Mystery shopping
• …
22

23. At the Cleveland Clinic, the first response to a request for
assistance is immediate
23
Assigned number
Patient
research
Appointement
the same day if
you call before
12pm
Appointment
the next day if
you call after
12pm

24. The MyCare program informs the patient in a constant way on
an essential question in the management of expectations
24
Results of the MyCare program at the Mayo
Clinic
1. Better predictability
2. Reduced variability
3. Shorter stays
4. Cost reduction
5. Better health outcomes
6. Better patient satisfaction
Posters or online videos for new patients can
also be useful to describe the hospital's
environment and procedures.
Source: Cook DJ, Thompson JE, Dearani JA, Prinsen SK. How Mayo Clinic Is Using iPads to Empower Patients. Harv Bus Rev. 2014
February 24
Source: Merlino JI, Raman A. Health Care’s Service Fanatics. Harv Bus Rev. 2013 May;91(5):108-16

25. In the cultural change to be undertaken, it is necessary for all
staff to understand what it is like to be a patient
25
Interactive videos encourage nurses, physicians and staff to think empathetically
and creatively about the attention they could develop with patients, list patient
preferences and explore best practices.
Source: Cass D. Bringing the Customer’s Voice into Medicine. Harv Bus Rev, 2014, November 24. Available at:
https://hbr.org/2014/11/bringing-the-customers-voice-into-medicine
Lee TH, Cosgrove T. Engaging Doctors in the Health Care revolution. Harv Bus Rev. 2014 Jun;92(6):104-11

26. Co-creation and living labs
26

27. 27

28. Initiatives that generate significant benefits for institutions:
low cost - high impact
• A positive impact on clinical outcomes
• Provokes the need for action
• Better consideration of the human dimension
• Awareness of patient expectations
• Partnership between patient – professionals
• United team around the patient
• Valorization of the hospital
• …
28

29. Today we need to focus on health outcomes rather than
volume, Value Based Healthcare
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From volume to value
Source: The strategy that will fix healthcare, Michael E. Porter and Thomas H. Lee, October 2013 Issue, Harvard Business Review
Improve one or more of
the results without
increasing costs
Reduce costs without
improving results
« Value is defined as the health
outcomes achieved in relation to the
costs of achieving these outcomes.

30. 30
Eduard Portella
eportella@antares-consulting.com
Thank you very much
for your attention