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THE PATIENT EXPERIENCE 

A Key Indicator of Hospital Patient Safety and Improvement



Dr Avnesh Ratnanesan
CEO, Energesse





2
PATIENT EXPERIENCE. CONSUMER ENGAGEMENT. INNOVATION
Western Sydney Local Health District
SouthWest Sydney Local Health District
CSIRO Health
& Biosecurity
3
HEALTHCARE 

QUADRUPLE AIMS
1. Don Berwick et al Health Affairs 2008 Triple Aim, Insitute of Healthcare Improvement 2. Bodenheimer et al Annals of Family Medicine 2014
4
“When our Patient Experience measures improved,
so did our Quality and Safety measures ”
 
- Sir Robert Naylor, 

CEO, University College London Hospitals NHS Trust

Sustainable Health Transformation 2014



LINKING PATIENT EXPERIENCE WITH QUALITY AND SAFETY 



5
EVIDENCE LINKING PATIENT EXPERIENCE AND SAFETY 



6
WHAT IS Patient Experience (PX) ?
The sum of all interactions, shaped by an organization's culture, 

that influence patient perceptions across the continuum of care.” 

-Beryl Institute
7
Patient
Satisfaction
Customer
Service
Net Promoter
Score
Consumer Engagement
(Standard 2 NSQHS)
Feedback &
Complaints
Surveys
Qualitative Research
Quantitative
Research
Patient Stories
HOW DO WE MEASURE ‘PATIENT EXPERIENCE’ NOW?
8
9


WHAT DO CONSUMERS/PATIENTS NEED and WANT?
Ref: Ian Worden, MMD, MHI, Better patient engagement
10
MANAGEMENT CHALLENGES
Measuring the Experience 

1. Surveys paper/telephone – disparate systems 

2. Quantitative only, not WHY (qualitative) – difficult fixes

3. Minimal minority engagement 

4. Tick-box exercise

Analysing insights and pain points
1. Delayed survey results - up to 18 months 

2. Reports & Benchmarks – Too high level, uncoordinated & lack intelligence 
Translate feedback & survey data into improvements
1. Low priority (too survey-focussed)

2. Complex ROI

3. No clear KPI’s 

4. Ad hoc actions 

5. Poor front line engagement
11
OUR THOUGHT LEADERSHIP DELIVERY IN MEASURING AND
IMPROVING PATIENT EXPERIENCE: 6 E 



13
E.1 = EXPERIENCES
14
E1. EXPERIENCE - MAP WHOLE PATIENT JOURNEY



Surgery Hospital Inpatient
General Practice
& Allied HealthRehabilitation Medication
OutpatientHome
Workplace
Supplements
Health/Life Insurance
15
UTILISE MULTI-CHANNEL APPROACH
Online
Text Message (SMS)
Email
Kiosk and Tablet
Automated Telephone Surveys
Postcards and Drop-boxes
16
CAPTURE EXPERIENCE - REAL-TIME SURVEYS & FEEDBACK

17
FREE TEXT COMMENTS = ACTIONABLE ROOT CAUSES
“Nurse Sarah was very rushed, I did not understand
her advice about how much medication to take.
The floor on this ward is also very slippery and I
almost fell”.
18
MES EXPERIENCE
The digital platform that helps you
measure the patient experience &
emotions in real-time
Award Winning Program – 2 Western Sydney
Local Health District Quality Awards: Chairman’s
Award & Bob Leece Award 2017
19
WESTMEAD HOSPITAL – MULTI CHANNEL MEASUREMENT
20
WESTMEAD HOSPITAL – TRANSPARENCY OF PX RATINGS
21
E.2 = EMOTIONS

22
EMOTION ANALYSIS OF PATIENT FREE TEXT COMMENTS
23
AUTOMATED CODING 

‘VOICE OF THE PATIENT’

24
25
E.3 = ENGAGEMENT
26
27
FRONT LINE WORKFORCE CHALLENGES
1. Engaging Staff and Clinicians to take action 

2. High demands – Time constraints, fatigue, burnout 

3. Resource constraints 

4. Behaviour change - Defensiveness towards results

5. Internal competition and staff ‘politics’ 

6. Prioritise Outcomes vs Experience e.g. “I treat the tumour, not
the patient”
1. Harvard Business Review May 2013 Healthcare’s Service Fanatics 2. Bodenheimer et al Annals of Family Medicine 2014
28
E3. ENGAGEMENT =
Leadership
Employee Engagement
Staff Culture
Wellbeing 

Empathy & Compassion
Meaning & Purpose
Love & Joy
Ref: 1. Covey SR & Link G Smart Trust, 2012 Free Press. 2.Sisodia R et al, Firms of Endearment, Sisodia et al 2007 Prentice Hall. 3.
Bodenheimer et al Annals of Family Medicine 2014
29
E.4 = EXECUTION


30
CASE STUDY EVIDENCE OF OUTCOMES

Hertfordshire Partnership University NHS Foundation Trust
Service Question
July-
Sept
2015
Action Taken
Oct-Dec
2015
Change
Albany Lodge
If you came here from another
service, were you kept informed
throughout the process
22%
At all staff meetings the team now discuss
how the Trust can improve the transfer
process so patients are better informed
54% + 32%
Aston Ward Do you feel listened to? 57%
1:1 time was put aside for service users to
express all their thoughts and feelings
100% + 43%
RAID (Lister)
Do you know how to mental
health support out of hours?
90%
Service Users provided with mental health
helpline cards with relevant contact details
100% + 10%
Holly Lodge
Has your mental health
medication and any side effects
been explained to you?
50%
Staff time was put aside to explain and
provide more information on medication in
1:1 and group sessions
73% + 23%
31
E.5 = EXCELLENCE


32
● HCAHPS Survey scores and Performance
measures (Net & Operating Margins and
Return On Assets)
PATIENT EXPERIENCE

& VALUE-BASED CARE 



33
E.6 = EVOLUTION


34
The Future of Employee Engagement & Safety


OUR THOUGHT LEADERSHIP DELIVERY IN MEASURING AND
IMPROVING PATIENT EXPERIENCE: 6 E 



Does anyone measure experience and patient safety?
37
THOUGHT LEADERSHIP
TECHNOLOGY TRAINING
EVOLUTION = SOLUTIONS TO TRANSFORM EXPERIENCE
Research
Consulting & Advisory
Speaking
MES Experience –
Patient & Staff Survey
Platform
PX Training Program
- 6 E’s
38
1. “
“Improving the Patient Experience & Consumer Engagement”
avnesh@energesse.com 02 8091 0918

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Safe and Secure Hospitals

  • 1. 
 
 
 
 THE PATIENT EXPERIENCE 
 A Key Indicator of Hospital Patient Safety and Improvement
 
 Dr Avnesh Ratnanesan CEO, Energesse
 
 

  • 2. 2 PATIENT EXPERIENCE. CONSUMER ENGAGEMENT. INNOVATION Western Sydney Local Health District SouthWest Sydney Local Health District CSIRO Health & Biosecurity
  • 3. 3 HEALTHCARE 
 QUADRUPLE AIMS 1. Don Berwick et al Health Affairs 2008 Triple Aim, Insitute of Healthcare Improvement 2. Bodenheimer et al Annals of Family Medicine 2014
  • 4. 4 “When our Patient Experience measures improved, so did our Quality and Safety measures ”   - Sir Robert Naylor, CEO, University College London Hospitals NHS Trust Sustainable Health Transformation 2014
 
 LINKING PATIENT EXPERIENCE WITH QUALITY AND SAFETY 
 

  • 5. 5 EVIDENCE LINKING PATIENT EXPERIENCE AND SAFETY 
 

  • 6. 6 WHAT IS Patient Experience (PX) ? The sum of all interactions, shaped by an organization's culture, that influence patient perceptions across the continuum of care.” -Beryl Institute
  • 7. 7 Patient Satisfaction Customer Service Net Promoter Score Consumer Engagement (Standard 2 NSQHS) Feedback & Complaints Surveys Qualitative Research Quantitative Research Patient Stories HOW DO WE MEASURE ‘PATIENT EXPERIENCE’ NOW?
  • 8. 8
  • 9. 9 
 WHAT DO CONSUMERS/PATIENTS NEED and WANT? Ref: Ian Worden, MMD, MHI, Better patient engagement
  • 10. 10 MANAGEMENT CHALLENGES Measuring the Experience 1. Surveys paper/telephone – disparate systems 2. Quantitative only, not WHY (qualitative) – difficult fixes 3. Minimal minority engagement 4. Tick-box exercise Analysing insights and pain points 1. Delayed survey results - up to 18 months 2. Reports & Benchmarks – Too high level, uncoordinated & lack intelligence  Translate feedback & survey data into improvements 1. Low priority (too survey-focussed) 2. Complex ROI 3. No clear KPI’s 4. Ad hoc actions 5. Poor front line engagement
  • 11. 11
  • 12. OUR THOUGHT LEADERSHIP DELIVERY IN MEASURING AND IMPROVING PATIENT EXPERIENCE: 6 E 
 

  • 14. 14 E1. EXPERIENCE - MAP WHOLE PATIENT JOURNEY
 
 Surgery Hospital Inpatient General Practice & Allied HealthRehabilitation Medication OutpatientHome Workplace Supplements Health/Life Insurance
  • 15. 15 UTILISE MULTI-CHANNEL APPROACH Online Text Message (SMS) Email Kiosk and Tablet Automated Telephone Surveys Postcards and Drop-boxes
  • 16. 16 CAPTURE EXPERIENCE - REAL-TIME SURVEYS & FEEDBACK

  • 17. 17 FREE TEXT COMMENTS = ACTIONABLE ROOT CAUSES “Nurse Sarah was very rushed, I did not understand her advice about how much medication to take. The floor on this ward is also very slippery and I almost fell”.
  • 18. 18 MES EXPERIENCE The digital platform that helps you measure the patient experience & emotions in real-time Award Winning Program – 2 Western Sydney Local Health District Quality Awards: Chairman’s Award & Bob Leece Award 2017
  • 19. 19 WESTMEAD HOSPITAL – MULTI CHANNEL MEASUREMENT
  • 20. 20 WESTMEAD HOSPITAL – TRANSPARENCY OF PX RATINGS
  • 22. 22 EMOTION ANALYSIS OF PATIENT FREE TEXT COMMENTS
  • 23. 23 AUTOMATED CODING 
 ‘VOICE OF THE PATIENT’

  • 24. 24
  • 26. 26
  • 27. 27 FRONT LINE WORKFORCE CHALLENGES 1. Engaging Staff and Clinicians to take action 2. High demands – Time constraints, fatigue, burnout 3. Resource constraints 4. Behaviour change - Defensiveness towards results 5. Internal competition and staff ‘politics’ 6. Prioritise Outcomes vs Experience e.g. “I treat the tumour, not the patient” 1. Harvard Business Review May 2013 Healthcare’s Service Fanatics 2. Bodenheimer et al Annals of Family Medicine 2014
  • 28. 28 E3. ENGAGEMENT = Leadership Employee Engagement Staff Culture Wellbeing 
 Empathy & Compassion Meaning & Purpose Love & Joy Ref: 1. Covey SR & Link G Smart Trust, 2012 Free Press. 2.Sisodia R et al, Firms of Endearment, Sisodia et al 2007 Prentice Hall. 3. Bodenheimer et al Annals of Family Medicine 2014
  • 30. 30 CASE STUDY EVIDENCE OF OUTCOMES
 Hertfordshire Partnership University NHS Foundation Trust Service Question July- Sept 2015 Action Taken Oct-Dec 2015 Change Albany Lodge If you came here from another service, were you kept informed throughout the process 22% At all staff meetings the team now discuss how the Trust can improve the transfer process so patients are better informed 54% + 32% Aston Ward Do you feel listened to? 57% 1:1 time was put aside for service users to express all their thoughts and feelings 100% + 43% RAID (Lister) Do you know how to mental health support out of hours? 90% Service Users provided with mental health helpline cards with relevant contact details 100% + 10% Holly Lodge Has your mental health medication and any side effects been explained to you? 50% Staff time was put aside to explain and provide more information on medication in 1:1 and group sessions 73% + 23%
  • 32. 32 ● HCAHPS Survey scores and Performance measures (Net & Operating Margins and Return On Assets) PATIENT EXPERIENCE
 & VALUE-BASED CARE 
 

  • 34. 34 The Future of Employee Engagement & Safety 

  • 35. OUR THOUGHT LEADERSHIP DELIVERY IN MEASURING AND IMPROVING PATIENT EXPERIENCE: 6 E 
 

  • 36. Does anyone measure experience and patient safety?
  • 37. 37 THOUGHT LEADERSHIP TECHNOLOGY TRAINING EVOLUTION = SOLUTIONS TO TRANSFORM EXPERIENCE Research Consulting & Advisory Speaking MES Experience – Patient & Staff Survey Platform PX Training Program - 6 E’s
  • 39. “Improving the Patient Experience & Consumer Engagement” avnesh@energesse.com 02 8091 0918