MIT Medical kicked off a project to improve patients' experiences by creating a "patient journey map" to identify opportunities for enhancement. They interviewed staff and reviewed surveys to map the experience of a fictional patient, Josh, as he received care for a knee injury. MIT Medical then introduced the JUSST model to focus on patients' core needs of justice, understanding, trust, security, and self-esteem. Initial results showed modest improvements in patient satisfaction scores after implementing the model and related projects across departments.

1. Exceptional patient care begins when patients feel that they have had a great
experience with our organization. In the fall of 2016, MIT Medical kicked off a multi-
year journey to move our patients’ experience from good to great.
Abstract
Improving the Patient Experience at MIT Medical
Together with The Customer Group (TCG), a consulting group specializing in customer interactions and experiences, we
interviewed more than 50 staff members and reviewed thousands of patient-satisfaction survey comments to create a
patient journey map.
The journey map follows the experience of a fictional patient — “Josh,” an MIT junior — whose patient journey begins with
a knee injury sustained during a flag football game. His journey takes him through several MIT Medical services, including
urgent care, radiology, laboratory, pharmacy, primary care, specialty care, mental health, and billing and an off-site
diagnostic facility.
Each point in Josh’s journey highlights a workflow area. By focusing on our successes and our opportunities for
improvement, we are working to positively and measurably improve the patient experience.
Creating a Patient Journey Map
In partnership with TCG, MIT Medical rolled out the JUSST Model to all staff. JUSST is an
acronym for five steps that are designed to improve every employee-patient interaction:
Justice (Respect) – “My care team treats me with dignity and respect. They know that I need
to be treated fairly.”
Understanding (Listening) – “My care team listens to me. They try to understand me, and
they make sure I understand them.”
Security (Safety/Quality) – “I believe my care team will take good care of me, keep my interests
in mind, and provide a safe environment in my time of need.”
Improving employee demeanor – implementing the JUSST ModelJUSST Model
5 Core Needs of Patients
JUSST Model
5 Core Needs of Patients
JUSTICE
UNDERSTANDING
TRUST
SECURITY
SELF-ESTEEM
JUSTICE
UNDERSTANDING
TRUST
SECURITY
SELF-ESTEEM
Respect me. Care about me.
Treat me like I am as important
as any other patient.
Listen to me.
I want to know you really hear
what I’m going through.
Keep me safe.
I already feel vulnerable and I’m
asking for your help and
reassurance.
Relate to me.
I want to feel like a person, not just
a number or the next patient in line.
Follow up with me.
Keep your promises if you can
and talk to me if you can’t.
Let me hear from you.
Treat with dignity and respect.
Build rapport - introduce yourself.
Share decision making.
Make eye contact.
Slow down, take time to listen.
Ask for clarity if you are not sure.
Don’t make assumptions.
Reframe to ensure you are on the same page.
Make them feel safe.
Empathize - show you’re there to help.
Let them see you use good hand hygiene.
Keep their PHI safe.
Validate their concerns. Don’t minimize.
Explain your process, don’t assume.
Thank them for connecting with you.
Make them feel they are important to you.
Follow up in the time you said you would.
Under promise and over deliver.
Communicate, and do so positively.
Manage up the people, process, and org.
Be honest.
Self-esteem (Personal)– “My care team respects that when I am injured or hurt, it can also make me
feel less than confident. They address my need to understand the process of healing.”
Trust – “My care team is genuine and speaks from a place of truth. When they tell me they will do
something, they follow through.”
We introduced the JUSST Model in January 2017 at a department-wide kick-off breakfast, and teams
across MIT Medical developed “JUSST projects” to help expedite changes. Projects ranged from
increasing patient privacy (Justice: “respect me”) to hand hygiene (Security: “keep me safe”) to renewed
efforts to obtain each patient’s preferred method of contact (Trust: “follow up with me”) and more.
We continue to craft our vision of the future state of the patient experience at MIT
Medical. We will continue to turn our opportunities for improvement into actionable
items by encouraging service teams to tackle more JUSST-based projects. We will
continue to measure our success through patient-satisfaction scores and other
measures.
Next Steps
We have seen modest but
steady improvement in
patient satisfaction scores
since implementing the
JUSST Model.
Results MIT Medical
Press Ganey Patient Experience Results
50
55
60
65
70
75
80
Sep-16
Oct-16
Nov-16
Dec-16
Jan-17
Feb-17
Mar-17
Apr1-14'17
Apr15-30'17
May-17
Jun1-18'17
Jun19-30'17
Jul-17
Ease of Access: Percent Responding "Very Good"
Ease of getting clinic on phone Convenience of our office hours Ease of scheduling appointments
Courtesy of registration staff Information about delays Wait time at clinic
Pre Journey
Map
CFIO &
Service
JUSST
Training
Provider
JUSST
TrainingPOST CFIO
& Service
JUSST
Training
Pre Journey
Map
JUSST
Breakfast &
Project
Assignments
CFIO &
Service
JUSST
Training
Provider
JUSST
TrainingPOST CFIO
& Service
JUSST
Training
POST
Provider
JUSST
Training
70
75
80
85
90
95
100
Sep-16
Oct-16
Nov-16
Dec-16
Jan-17
Feb-17
Mar-17
Apr1-14'17
Apr15-30'17
May-17
Jun1-18'17
Jun19-30'17
Jul-17
Overall Impressions: Percent Responding "Very Good"
Staff worked together Likelihood of recommending practice
Pre Journey
Map
CFIO &
Service
JUSST
Training
Provider
JUSST
TrainingPOST CFIO
& Service
JUSST
Training
Pre Journey
Map
JUSST
Breakfast &
Project
Assignments
CFIO &
Service
JUSST
Training
Provider
JUSST
TrainingPOST CFIO
& Service
JUSST
Training
POST
Provider
JUSST
Training
Staff members played a “patient experience BINGO”
game, and employees who completed their cards were
eligible for prizes.
Patient Experience Bingo!
We celebrated National Patient Experience Week by polling our patients to
solicit stories about their experiences of excellent care. We then celebrated
our staff—in public—in view of patients.
Patient Experience Week Nominations
Other Programs
Other Programs
Monday Tuesday Wednesday Thursday Friday
Deliver an
uplifting note to
someone’s office
or workstation.
Learn two new
things about
someone; share
two things
about yourself.
Have a healthy
snack.
When talking
to a patient or
family mem-
ber, use the
person’s name.
Hold the
door open
for someone
who isn’t right
behind you.
Keep your cell
phone in your
pocket while
walking through
hallways for an
entire day.
Offer to walk a
patient or visitor
to his or her
destination.
Ask a patient or
family member
how their day is
going, and listen
to the answer.
Offer to help
a coworker
with a task.
Spend five minutes
watching the fish
tank on the second
floor, reading a book,
meditating, or just
sitting still and
breathing deeply.
Say hello to
10 people
within the first
two hours of
your day.
Thank two
coworkers for
all they do.
☑Free space!
Keep your cell
phone in your
pocket while
walking through
hallways for an
entire day.
When talking
to a patient or
family member,
use the person’s
name.
Compliment
a patient or
family member.
Introduce
yourself to a
staff member
you don’t know.
Enhance your
local “environ-
ment” in some
way. [Describe
below.]
While walking
through the
building, smile at
10 different people
who are at least
10 feet away.
Ask a patient or
family member
how their day is
going, and listen
to the answer.
Take a walk
outside. Take 10
deep breaths.
Smile.
Go above and
beyond for a pa-
tient or visitor.
[Describe
below.]
At the end of an
interaction, ask:
“Is there anything
else I can help
you with?”
Introduce
yourself to a
staff member
you don’t know.
Take a break
to stretch for
at least 45
seconds three
times today.
Patient Experience Bingo
Notes:
PRE-ENCOUNTER
TREATMENT
Activity/Interactions
DISCOVERY
Patient
Journey
Map
CURRENT STATE, SEPTEMBER 2016
FORM AN
IMPRESSION
NAME
AGE
HOMETOWN
MAJOR/DEPT
MIT
INSURANCE
Josh attended Venice Beach public schools and
participated in a California Partnership Acade-
my STEMM (Science, Technology, Engineering,
Math, and Medicine) program at Venice High
School. Josh and his three brothers have always
been fascinated with building things. During
his childhood, a walk-in closet in the family
home was dedicated to storing the boys’
collection of more than 10,000 LEGO pieces
and other building materials.
At MIT, Josh immediately gravitated toward
Mechanical Engineering, eventually choosing
MechE’s Course 2-A program, which allows
students to design their own curriculum
around a set of core requirements. This has
allowed Josh to pursue his interest in robotics
by taking courses in electrical engineering,
computer science, and artificial intelligence.
Though he never expected to join a fraternity,
Josh found himself swept up in the rush
process as a freshman, pledged MIT Sigma Chi,
and now says he can’t imagine surviving MIT
without the support of his “brothers.”
Josh remains close to his parents, though he
doesn’t see them often. He talks to his mother
by phone at least once a week and communi-
cates regularly with his father by email.
Josh Junior
20
Venice Beach,
CA
Mechanical
Engineering
(Course 2A)
Basic
Map Key
Point of Pain (doesn’t work)
Point of Delight (works well)
Opportunity
Moment of TruthMOT
1
P1
D1
O1
Sees the MIT Medical
posters regularly in his
fraternity and on campus
Josh and parents both receive
letter/brochure on MIT Medical
RESEARCH
Peruses MIT Medical website
URGENT CARE PRIMARY CARE MENTAL HEALTH SERVICES & COUNSELING
INJURY
Wakes up with even more
swollen knee; calls UC to check
on their hours
INITIAL
TREATMENT
LABS/
BLOOD DRAW
ORTHOPEDICS
RADIOLOGY
Triage Nurse rooms Josh
in the Triage Room
Provider consult; Provider is concerned about
possible infection and tear; orders blood test and
xrays, and also mentions need for MRI
Given crutches and brace (DME),
but not told there wil be a charge
Goes to the Lab for blood test
Moved to the exam room; waits to
see an Urgent Care Provider
Wheel-chaired to
Lab-Radiology
The front desk assistant calls
Coolidge to schedule the MRI
Calls insurance company; long hold on
wait; they ask clinical questions; finally
gets an authorization code
Told by front desk staff that he needs
to contact his insurance company to
get pre-authorized
Uses changing room to remove
pants and place in locker
X-rays taken by
Radiology Tech
Urgent Care is able to get Josh in to see an
orthopedist at MIT the next day
Has blood drawn
Sits back down in Lab/Rad
waiting room
Checks in to Urgent Care
Calls MIT Medical at 2am and
is transferred to Fonemed;
RN says to go to UC in the AM
Arrives at the MIT Medical
Center for Urgent Care
ORTHOPEDIC
FOLLOW-UP
PCP CONSULT
Orthopedist sees Josh and
confirms need for MRI
Checks in for follow-up
(2nd Floor)
Consults with Orthopedist; review of MRI;
no further treatment beyond rest is needed
Upon review of blood work, Josh is told his blood sugar
is high and he should schedule time with a PCP
Selects a PCP and schedules appointment
Asks question about his Rx via FMH
Receives a FMH appointment reminder,
as well as a Televox reminder call
Checks in with PCP; confirms
Contact Info and Med History
Provider calls Josh’s name in the waiting room
and escorts him to the Exam Room
PCP Exam in Exam Room
Leaves (no checkout process)
Directed to the Referral Office
for a referral need
Receives a Visit Summary via FMH
ENTERENTER
NEXT
ENTER
AVG WAIT: 21 DAYS
Completes the online Health Quiz, but still
decides to waive Extended Insurance
Heard as a freshman some negative
comments about MIT Medical
Checks in at Ortho (same as Lab/Blood);
confirms contact info and meds
Tech calls Josh back for X-ray
NEXT
P11
D4
O1
P1
P6
P7
P8
P12
Goes back to Urgent
Care Exam Room and
sees Provider
PHARMACY
Receives prescription for
percocet and anti-inflammatory
Walks to pharmacy to fill prescription
(opioid requires paper script) Fills out the Prescription Request
form and places into the box
Offered the Pharmacy Consult ;
declines as Doc spoke with himP14
20 MINS LATER...
P15
MRI
Calls and confirms appt with
Coolidge Imaging
Gets picked up by cab at MIT
Completes MRI; report
available same day
Takes cab back to MIT campus
Where do
I get my cab?
Surprised to learn he has to pay
out-of-pocket for his Rx
P16
I have to pay?
“COMMUNITY
CARE CENTER”
RN encourages Josh to
request help from SSS
(”S3
” or Student Support
Services) if needed
Checks his Lab Results on
Follow My Health
The CCC RN visits Josh in his
fraternity to assist with his walking
around with the brace
P17
...NEXT DAY
MOT
2
MOT
3
Receives a Visit Summary via FMH
A MH outreach event is presented
by a Mental Health Liaison
Feels depressed about his knee
injury and his first B at MIT
Liaison at the fraternity convinces Josh to
make an assessment appointment
Checks in at front desk
“Intake” appt with provider
Schedules additional
appointments with provider
Receives a text reminder
for appointment
Joins Group Therapy for depression which
reduces need for additional treatment
POST CARE
BILLING
SURVEY
Receives and completes
Patient Satisfaction survey via email
ENTER
Receives a charge on Student Account
for the crutches and brace
Must clear account with Bursar prior
to being allowed to graduate
MIT processes a claim with
Josh’s parent’s insurance
Eventually, payment is received
by MIT and the partial credit is
applied to Josh’s account
P48
P47
MOT
4
P23
P24
P25
P26
P27
O11
P18
P19
P22
P21
P20
P44
P45
P46
D9
NEXT
O17
Calls the Urgent MH Line and has a “first contact”
with a provider (part of AccessPlus Pilot);
schedules initial “Intake” appointment
55% IN 7 DAYS 95% IN 14 DAYS
P39
P40
JOSH!
O12
O13
O14
P28
O15
D7
D8
P29
P30
O16
P31
P32
P33
P34
P35
NEXT
P36
P37
P38
Hurts knee in a flag
football game
MOT
1
P2
P3
P4
P5
O4
O5
P9
O6
Checks-in with Lab for blood draw
P10
O7
D3
P13
O8
O9
O10
O3
D1
O2
P10
D5
D10
O18
O19D2
D6
P41
P42
P43