Communication is the cornerstone of healthcare. Effective communication is not only critical to meeting patient needs and providing safe, high-quality, and patient-centered care, it is necessary to how we manage healthcare delivery. To facilitate meaningful improvement, the road to healthcare transformation must be paved with good communication—vertically from the top down and the bottom up, and horizontally across the continuum of care delivery.
This means more than declaring an open-door policy among system leadership and encouraging managers, caregivers, and patients to take advantage of it. It requires a consistent and deliberate effort to weave communication best practices into the culture of an organization, continually evaluate the effectiveness of those practices through patient and workforce surveys, and hold individuals and teams across the organization accountable for their role in advancing communication excellence.
To achieve this, it is necessary to understand that in today’s healthcare culture, the manner in which information is conveyed is as important as the information itself. This is because care delivery involves countless patient handoffs between providers, units, departments, and facilities, as well as interactions with multiple administrative and care professionals of various backgrounds and levels of training. Every handoff and interaction—whether it’s among caregivers or between caregiver and patient—involves an exchange of information. To be effective from clinical, administrative, and interpersonal perspectives, the information shared must be accurate, thorough, and clear, and the sharing itself must be open, honest, and compassionate.
A robust body of evidence supports the argument that good communication skills are an essential competency skill for delivering value-based, patient-centered care. Multiple studies have linked improved communication to better patient outcomes, safer work environments, decreased adverse events, decreased transfer delays, and shortened lengths of stay (Disch, 2012). One literature review demonstrates consistently positive associations between caregiver communication behaviors and patient outcomes, including patient recall, patient understanding, and patient adherence to therapy (King & Hope, 2013).
The extent and quality of caregivers’ communication with patients and with each other have also been shown to drive how patients perceive their care experience. For example, effective communication among care team members and with patients and their families has been linked to an increased likelihood for patients to recommend the organization and to rate their overall care more highly (Fulton, Malott, & Ayala, 2010).
Research from Press Ganey has identified nurse communication in particular as a “rising tide measure.” Specifically, when hospitals improve nurse communications with patients, they see associated gains in other patient experience measures: responsiveness of hospital staff, pain management, communication about medication, and overall patient experience scores (Press Ganey, 2013).
Further, communication is a cornerstone of workforce engagement. Strong communication among healthcare team members has been shown to influence the quality of working relationships and job satisfaction (AHRQ, 2017), and clear communication about task division and responsibilities has been linked to reduced workforce turnover, particularly among nursing staff (DiMeglio et al., 2005).
Taken together, these data suggest that, when healthcare professionals communicate effectively—conveying critical information in a timely or easily understandable manner, clearly spelling out orders or instructions, and answering questions thoroughly and thoughtfully—they deliver safer and higher-quality care. Research indicates that the care is also more cost-efficient and cost-effective—essential considerations in the value-based healthcare equation.
Poor communication among care team members and with patients, family members, and postacute care facilities at discharge can result in confusion around follow-up care and medications, potentially leading to unnecessary readmissions and preventable malpractice litigation. In one study using six years of data from nearly 3,000 acute care hospitals, researchers determined that communication between caregivers and patients has the largest impact on reducing readmissions. Specifically, the results indicate that a hospital would, on average, reduce its readmission rate by 5% if it were to prioritize patient communication in addition to complying with evidence-based standards of care (Senot, Chandrasekaran, Ward, Tucker, & Moffatt-Bruce, 2015).
By educating patients at discharge and giving clear, specific discharge instructions to postacute care providers, hospitals can reduce readmissions and increase patient loyalty, which indirectly influences the operational bottom line.
The fact that communication affects the safety, quality, and experience of care as well as caregiver engagement is consistent with research linking these critical performance areas to the patient-centeredness of care. It also aligns with the findings from new cross-domain analyses indicating that these elements are highly interrelated with one another and with financial outcomes (Press Ganey, 2017).
To the degree that communication is the common thread binding each of these areas, and that improvement in any of these areas can influence performance across all of them, health systems seeking to improve the safety, quality, and patient-centeredness of their care must identify and break down barriers to effective communication and adopt strategies that strengthen caregivers’ professional and interpersonal communication skills.
Toward this end, a number of evidence-based best practices can enhance communication skills and improve outcomes. Some examples include:

• Implementing a comprehensive provider/team communication strategy comprising a standardized communication tool, such as the Situation, Background, Assessment, Recommendation (SBAR) technique, to facilitate prompt and appropriate communication about patient status; daily, multidisciplinary patient-centered rounds using a daily goals sheet; and care team huddles during every shift.
• Investing in communication skills training for all staff. Good communication skills are not innate; they are taught, and they require practice and monitoring.
• Making leadership support for communication initiatives highly visible. Leaders must create an environment of open communication by modeling appropriate behavior, setting expectations, and investing in support systems within the structure of the organization. Leaders and managers at all levels of the organization should promote patient-centered communication as a requirement for providing safe, high-quality care.

The ability to explain, listen, and empathize can profoundly impact relationships with patients and colleagues, which in turn can influence individual and organizational performance on clinical quality, experience of care, and financial outcomes. For this reason, health systems should invest in monitoring and developing these skills in the current workforce, and the industry as a whole should support initiatives that focus on building these skills in the physicians, nurses, and healthcare workers of tomorrow.

About the author
James Merlino, MD, is the president and chief medical officer, strategic consulting, Press Ganey Associates.
 
ReferencesAgency for Healthcare Research and Quality. (2017) Team strategies and tools to enhance performance and patient safety (TeamSTEPPS), Department of Defense and Agency for Healthcare Research and Quality. Retrieved from http://www.ahrq.gov/qual/teamstepps/
DiMeglio, K., Padula, C., Piatek, C., Korber, S., Barrett, A., Ducharme, M. … Corry, K. (2005). Group cohesion and nurse satisfaction: Examination of a team-building approach. Journal of Nursing Administration, 35(3), 110–120.
Disch, J. (2012). Teamwork and collaboration. In G. Sherwood & K. Barnsteiner (Eds.), Quality and safety in nursing: A competency approach to improving outcomes (1st ed.) Ames, Iowa: John Wiley & Sons, Inc.
Fulton, B. R., Malott, D. L., Jr., & Ayala, L. (2010). Award-winning outpatient service: Finding the common thread. The Journal of Medical Practice Management, 25(4), 202–206.
King, A., & Hoppe, R. B. (2013). “Best practice” for patient-centered communication: A narrative review. Journal of Graduate Medical Education, 5(3), 385–393.
Press Ganey. (2013). Nurse communication: A rising tide measure. Performance Insights. Press Ganey Associates.
Press Ganey. (2017). Achieving excellence: The convergence of safety, quality, experience and caregiver engagement. 2017 Strategic Insights Report. Press Ganey Associates.
Senot, C., Chandrasekaran, A., Ward, P. T., Tucker, A. L., & Moffatt-Bruce, S. D. (2015, July 21). The impact of combining conformance and experiential quality on hospitals’ readmissions and cost performance. Management Science, 62(3), 829–848. doi:10.1287/mnsc.2014.2141

Healthcare IT News By Tom Sullivan

The art of patient experience has gained purchase in the healthcare space and, as it has in other vertical industries, among UX gurus and IT shops alike.
“Patient experience is everything, bricks-and-mortar, valet parking, that first greeting is part of the patient experience,” said Sue Schade, principal of StarBridge Advisors and a veteran healthcare CIO.
In fact, experts are already starting to expand the idea of experience beyond hospital walls.
John Supra, vice president of solutions and services at the Care Coordination Institute, added that the patient experience starts in people’s homes, communities and even workplaces.
Mobile apps that alert users to ED wait times or hospitals that send out Uber drivers to ferry consumers to medical appointments are two increasingly common examples. And Supra said that employers frequently create the expectations their workers have about patient experience.
Taking it a step further: One could argue that the consumer experience of buying an automobile does not begin at the dealership or even car commercials on television but, instead, it starts with the emotions that spark when seeing a shiny new convertible drive down the road.
Can something similar be said for hospitals?
“We need to think about experience more broadly,” Supra said. “I challenge us to think more broadly about where experience starts and ends.”
Yulia Kogan, director of information technology at Northwell Health, is taking on Supra’s challenge.
Hospitals such as Northwell and Ascension, in fact, are already working to broaden the patient experience.
“We can’t speak about experience without pre- and post-visit,” Kogan said.
And that’s just a start. Kogan added that patient experience -- much like the idea of patient engagement -- naturally varies from one person to the next.
“Our challenge is to make sure all patients have a good experience regardless of the physical location or if the services are virtual,” Kogan said.  
Schade echoed that, saying that everyone who touches a patient needs to be consumer-focused.  
“It’s how the users remember the experience,” said Lisa Fewell, director of healthcare innovation at Ascension Information Services. “We may think we’re providing a great experience but their perspective rules the day.”

The Center for Medicare and Medicaid Services’ Readmission Reduction Program establishes reimbursement penalties for hospitals with excessive preventable readmissions. Penalties can amount to up to a three percent reduction in a hospital’s Medicare reimbursement.  Since its launch in 2012, total savings to CMS have totaled about $927 million, not including an estimated $528 million in reimbursement cuts for FY 2017. 
The hospitals with the highest estimated revenue losses due to penalties for FY 2017 under the Readmission Reduction Program are shown in the table on the next page.  While a hospital’s readmission rate target is determined on an individual basis, all but three of the hospitals had an all-cause readmission rate higher than 15.6 percent, the average rate of all other hospitals that were assessed. Most of the top 20 hospitals also had higher-than-average case mixes, which are associated with more readmissions but are adjusted for in the Readmission Reduction Program. 
The number of hospitals penalized under the Readmission Reduction Program has grown steadily from 2012 to 2016, with a significant jump between 2014 and 2015. Starting in 2015, CMS introduced two new readmissions measures for COPD and total joint replacement, which is a likely explanation for the increase. Despite the rising number of penalized hospitals, CMS has credited the program with a nationwide eight percent reduction in readmission rates from 2010 to 2015. A review of the data also shows that 1,722 hospitals, or about half of hospitals in the program, received penalties for all five years. The total number of hospitals receiving the maximum penalty has also increased since 2014, reaching 63 for FY 2017, as seen in the graph below. The number is far below that of 2013, but the original maximum penalty was only a one percent reimbursement cut, growing to two percent in the second year, and was applied to hospitals that would currently face a deeper cut.

Readmission rates and patient satisfaction are good measures of quality, according to a recent study conducted by researchers from Boston-based M.I.T. and Nashville, Tenn.-based Vanderbilt University.
Value-based care initiatives hinge on the healthcare industry's ability to identify and reward quality care, meaning an understanding of which quality metrics are actually linked to better patient outcomes is critical. This study, published by the National Bureau of Economic Research, compared outcomes of similar patients delivered somewhat randomly to hospitals with varying quality levels based on ambulance company preferences.
Here are the three main findings.

1. Hospitals with higher process measures, or measures considered to improve outcomes — like giving heart failure patients discharge instructions or giving preventative antibiotics to surgery patients one hour before incision — were associated with lower long-term mortality.

1. Lower patient satisfaction scores were linked to higher odds of readmission and death.

1. Hospital readmission rates had a strong positive effect on the odds of readmission, and hospital mortality rates even more strongly predicted the odds of mortality.

"We conclude that the measures used today by CMS to reimburse and rate hospitals on their quality are reliable and valid indicators of hospital quality, not only for patients treated for the conditions they measure but for other types of emergency care," the authors wrote.
Read the full paper here.

 Copyright ASC COMMUNICATIONS 2017. 

Healthcare organizations can take specific action to mitigate the burden of unnecessary regulations without sparking political battles or slogging through policy changes, according to a viewpoint published in JAMA.
Written by three leaders from the Institute for Healthcare Improvement — Donald Berwick, MD, president emeritus, senior fellow and former CMS administrator; Saranya Loehrer, MD, head of the North America region; and Christina Gunther-Murphy, executive director — the viewpoint details an initiative to identify and eliminate unnecessary rules. Some were originally well-intended, but outdated; some were misinterpreted and their application no longer provided value; while others were simply obstructive regulations.
To identify rules perceived as unnecessary, 24 healthcare organizations from the IHI's Leadership Alliance tapped staff and patients for their feedback during a "Breaking Rules for Better Care Week" in January 2016. They asked, "If you could break or change any rule in service of a better care experience for patients or staff, what would it be?" Across the organizations, 342 rules were identified — and a few common themes emerged.
Here are the 10 most common rules, norms and/or habits staff and patients say hospitals should break.

1. Visiting hours and policies that restrict visitors' time with patients — 15 mentions
2. CMS' three-day rule, which requires three consecutive days of inpatient stay for Medicare to cover skilled nursing facility care — 13 mentions
3. Licensure rules that prohibit clinicians from working to the top of their license — 13 mentions
4. Limited same-day appointments and direct access to physicians over the phone —10 mentions
5. Long wait times for appointments, surgeries and discharges (i.e. no double booking, providing discharge schedules, etc.) —10 mentions
6. HIPAA regulations and misunderstandings that lead to delays and communication issues — 8 mentions
7. Lack of engagement with family members and loved ones — 6 mentions
8. Unnecessary interruptions to patient sleep throughout the night — 5 mentions
9. Duplicative paperwork — 5 mentions
10. Infrequent patient ambulation — 5 mentions

After the exercise, many of the organizations took action to ensure rules were interpreted correctly and true to their original intent through staff education, clarification from regulatory agencies, changing local policies and lobbying policy makers, according to the viewpoint.
"Healthcare leaders may be well advised to ask their clinicians, staffs and patients which habits and rules appear to be harming care without commensurate benefits and, with prudence and circumspection, to change them," the authors concluded.
Read the full article here.

The 10 most common sentinel events reviewed by the Joint Commission did not change much from 2015 to 2016 — only dialysis-related events and perinatal death/injury fell off the list completely, and medication errors and criminal events took their places.

The Joint Commission did review fewer sentinel events in 2016 than 2015 — 824 last year compared to 936 in 2015.
Unintended retention of a foreign body remained the most common patient harm event that occurred in hospitals, ambulatory care settings and other care locations for the third year running, according to the Joint Commission's sentinel event data summary released earlier this month.
The top 10 sentinel events that occurred in 2016 are as follows:
1. Unintended retention of a foreign body — 120 reported
2. Wrong-patient, wrong-site, wrong-procedure — 104
3. Fall — 92
4. Suicide — 87
5. Unassigned (category unassigned at time of report) — 70
6. Delay in treatment — 54
7. Other unanticipated event (including asphyxiation, burn, choked on food, drowned or found unresponsive) — 47
8. Operative/post-operative complication — 45
9. Medication error — 33
10. Criminal event — 32
See the full list from 2015 here.

A patient who feels listened to and genuinely cared for is a more compliant patient. A caregiver who feels trust and mutual respect at work will function at his or her highest level. But you won’t find either of these measures on the Hospital Consumer Assessment of Healthcare Providers and Systems survey.
Unfortunately, due to financial incentives associated with HCAHPS and a growing focus on value-based care, we tend to equate patient experience with HCAHPS. In doing so, we have departed from a richer assessment of how patients actually experience care. We’re missing part of the story.
The HCAHPS survey was originally designed to produce data about patients’ perspectives to enhance safety and accountability in health care. While HCAHPS does not measure the patient experience in its entirety, it does measure key aspects of care such as pain management, responsiveness of hospital staff, discharge information and so forth.
Measuring true patient experience and care value is more complex. Metrics must also include assessment of teamwork, communication, and the connection between patients and caregivers. The quality of the relationships creates the environment and culture of the workplace, which permeate all aspects of the patient experience.
Getting the whole storyA more comprehensive view of patient experience can uncover gaps and, ultimately, improve the patient experience. When we understand the need for a deeper level of engagement among our care teams and patients, we improve the value of care as well. The safest, highest-quality and most efficient care is achieved when patient experience levels are high. Appreciating this intimate connection can bring meaningful improvement.
In addition to HCAHPS, providers should examine other factors shown to be important to patients:

• The care team’s genuine concern and compassion.
• The amount of time caregivers spend with patients.
• The level of respect shown to patients.
• The ability of caregivers to listen to patient questions and concerns.
• The ability of caregivers to communicate and work as a team.

We need to focus on the quality of our interactions with patients. Do patients feel truly cared about, listened to and respected? Are we taking enough time to answer their questions? The most positive patient experiences arise from workplace cultures that understand the value of the patient relationship, and build teamwork, communication and processes that strengthen our engagement.
Culture firstPatient experience derives from workplace culture — the fertile ground upon which all else grows. Work must begin here to realize gains elsewhere.
A strong culture consisting of teamwork, communication, trust and mutual respect will drive outcomes and safety in positive directions for both providers and patients. A strong workplace culture can have a tremendous impact on creating highly functional and reliable teams and in reducing physician burnout.
High levels of teamwork are proven to reduce health care–associated infections, reduce medical errors and increase employee safety. Leaders who make a deep commitment to nurturing a culture built on relationship-based, patient-centered communication can expect a 5-to-1 return on their investment.
The power of communicationSo how do we nurture teamwork? Communication training for all staff, led by physicians, nurses and administrative leaders, is an excellent place to start. Effective physician and caregiver communication drives the highest-value care with an exceptional experience for both the patient and the caregiver team.
Communication breakdowns account for more than half of all preventable errors. Studies have shown that the best technologies and strategies will fall short if we do not have teams with the capacity to communicate, learn and improve. Excellent communication among members of the health care team decreases mortality in hospitals, and enhances staff morale and engagement.
We have a limited amount of time to influence our patients. Ninety percent of health care happens in patients’ daily choices outside the physician office and hospital. Excellent communication during the other 10 percent can buoy our efforts to help patients achieve success in their health journeys.
It’s the moment-to-moment conversations — the way we interact — that let people know how much we care. If we don’t get this right, the rest of our efforts will not flourish.
Data that makes a differenceTo truly understand — and improve — the patient experience, we need to take a look at how we measure just as much as what we measure. The HCAHPS survey was developed through a rigorous validation process. The methodology most often used to generate survey responses, however, falls short: It represents only a portion of patients we serve. Typical response rates in urban areas are in the 15 percent to 20 percent range. The U.S. response rate was 29 percent in 2015 — down from 35 percent when HCAHPS started in 2006. This can result in responses from patients who are most dissatisfied or, alternately, highly satisfied, missing the 70 percent to 85 percent of patients between the ends of the spectrum.
To capture a higher response rate and achieve a more representative patient voice, we should consider other survey methodologies, such as phone-based surveys that can have response rates in the 40 percent range and capture a broader spectrum of the patients served.
By not capturing the voice of more patients, we compromise data accuracy and reliability. Providers then create tactical solutions based on individual domains of HCAHPS, which may represent only a small segment of patient views. Those solutions fail to result in sustained gains.
When we address a more complete set of patient experience metrics — those defined by a broad spectrum of patients over the past decades — we can achieve greater impact. We can implement more meaningful interventions that are far more sustainable than tactical solutions.
There are several ways to create a culture of excellence:

• Evaluate survey methodologies. Choose one that maximizes response rates rather than one that focuses on the size of the survey audience.

• Don’t be limited in what you measure. Include additional metrics in your HCAHPS that can help measure patient experience over time.

• To most accurately assess the culture you are creating, evaluate a composite of metrics that assess clinical outcomes, safety, efficiency, experience and the joy of practicing medicine.

• Work on culture first. Tactical solutions and checklists are helpful — but only when implemented in a culture that will nurture the tactical solutions. Focus on culture first, then layer on tactical and technical solutions.

• Focus on skills-based work that nurtures effective, efficient and compassionate communication. Culture is intimately related to our moment-to-moment conversations, so it is important to engage in peer-led, skills-based communication training.

Be patient. Culture change and improvement occur slowly and gradually. Creating a patient-centered, team-based culture rooted in trust, mutual respect and compassion sows the seeds for sustained improvement in clinical outcomes, safety and efficiency.
The resulting overall patient experience will stand up to any future HCAHPS and better position providers to overcome current and future health care challenges. It will restore joy and resiliency in the workplace as caregivers and leaders reconnect with the purpose of serving their communities.
William Maples, M.D., is the chief medical officer of Professional Research Consultants and the executive director of the Institute for Healthcare Excellence. He is based in the Jacksonville, Fla., area.

As leaders in the health care community, we know that physicians are faced with an increasing number of stressors, such as productivity goals and documentation requirements, that lead to higher burnout rates.
What is more detrimental, and even more critical, is the resulting deterioration in physician-patient relationships. Collectively and individually, physicians are losing some of their capacity to form connections that are not only essential for an excellent patient experience but also for quality of care and safety. Quite simply, the demands of their work and the lack of effective skills to address them strain physicians' ability to consistently deliver care in an efficient, caring, high-quality fashion.
Restoring relationshipsOrganizational culture determines how health care providers interact with one another and their patients. More and more physicians are losing the ability to be present in their work, foster meaningful conversations and navigate emotional challenges.
Improved efficiency and effective patient engagement are often treated as if they are mutually exclusive. But through my experience as a physician and instructor, I have seen the power that several simple but fundamentally important skills can have on the physician-patient relationship. Rather than being an inevitable casualty of the changing health care environment, patient engagement is the road to improved efficiency, quality, safety and financial stability. Equipping everyone with the skills needed for success will improve culture, quality, patient experience, and provider and staff satisfaction as well as reduce physician burnout.
Your health care team members need five skills to restore relationships in their own practices:

• Presence and mindfulness.
• Reflective listening.
• Information gathering and agenda setting.
• Recognizing and responding to emotion.
• Gratitude and appreciation.

These skills apply wonderfully to patient encounters as well as to interactions between co-workers, friends and family. At their essence, they are familiar to all but may need some nurturing. They are skills that can be learned, practiced and mastered by anyone.
Presence and mindfulnessThere are innumerable tasks competing for a physician’s attention. Not being in the moment can lead to distractions, and what may seem like innocuous occurrences can have lasting and devastating results. Fifty percent of preventable errors result from breakdowns in communication among members of the care team, according to the Institute for Healthcare Excellence. Breakdowns can range from the dramatic (a wrong-site procedure) to the more subtle (a patient who leaves saying: “That doctor is probably pretty good, but you can’t talk to him. He didn’t seem to want to know my concerns.”) These instances, repeated from provider to provider, further erode patients’ trust in the health care system.
Statistics such as this are not surprising given the increased complexity of communication in health care. However, effective teams overcome these complexities by practicing presence and mindfulness.
Both formal and informal practices of teaching presence and mindfulness are readily available. For example, strong communicators understand that you must be present in the moment to be effective. Taking a deep breath and time for calm before knocking on the exam room door can take physicians to a place of presence.
Reflective listeningEncourage your physicians and care team members to try this sometime in their next encounter with a co-worker, patient or even family member: Actively listen. See what happens when you do not interrupt — at all — and just listen. Don’t click through the electronic health record. Don’t review the chart in front of you, read emails or look at your phone. After you’ve listened, reflect what you heard back to the person.
If care team members practice these skills they’ll be astonished to discover how valuable it is to feel heard as well as how much information they can obtain in a short period of time. This skill is not just about making others feel good: The degree to which patients can tell their own stories affects outcomes. Headaches are more likely to resolve. Hypertension improves. Patients miss less work.
Information gathering and agenda settingThese are really two skills but are inextricably combined. Pressed for time, physicians often find themselves immediately launching into the details of a patient’s first complaint. Studies have shown that it is often the second or third complaint that is of greatest importance to the patient.Is it any surprise, then, that studies have also shown that 80 percent of patients feel their doctors are too busy to listen?
Encourage physicians to take this alternative approach instead: First, solicit the patient’s list of concerns. Don’t go into detail. Just elicit the list. Say, “What else?” Once you have the response, work with the patient to determine what will be done during the encounter. The output looks more like: “We agree problem A is important. You expressed concern about B, and I would also like to address C.”
Think about how this scenario could greatly improve the patient-physician relationship.
Recognizing and responding to emotionTeaching physicians and the care team how to recognize and respond to emotion can be the most intimidating communication skill but is often the most valuable. Too many times, physicians find themselves in front of frustrated patients or having a difficult conversation with a co-worker. Knowing how to identify the friction, acknowledge it and address it is critical to any relationship.
First, take some time to recognize the emotion: “You look frustrated (confused, angry, upset, etc.).” Then, respond, perhaps with a helpful tool I’ve used in my physician training. The tool is called "PEARLS":

• Partnership: “Let’s tackle this together.”
• Empathy: “That sounds hard.”
• Apology/Acknowledge: “I wish I had better news.” “Sorry I was late.”
• Respect: “That was tough. You handled it well.”
• Legitimization: “Anyone would be (confused, sad, irritated) by this situation.”
• Support: “I’ll be here when/if you need me.”

It may take a bit of practice, but acknowledging emotion and responding with these skills makes a big impact.
Gratitude and appreciationHow often are you thanked for your work? When it happens, how does it feel? How often do you give sincere thanks to your colleagues, your physicians or staff? If you did that more, how might it affect the strength of your relationships? Simply showing appreciation regularly builds and solidifies long-lasting, productive relationships.
These skills are simple but require purposeful development and implementation. It is easy to lose them in the midst of hectic days and increasing demands. With consistent practice and use in clinical, professional and personal lives, these skills are a path to stronger physician-patient relationships and a shift in organizational culture. With that foundation, improvements in quality, safety, efficiency and patient experience can flourish.
Timothy Poulton, M.D., is a family medicine physician with Mission Medical Associates, part of the Mission Health System in Asheville, N.C. He also serves as faculty for the communication in health care curriculum at The Institute for Healthcare Excellence.

Identifying Approaches to Improve the Patient Experience By: Jeff Paulson

Identifying Approaches to Improve the Patient ExperienceThis is the second in a continuing blog series based on the findings from the Sodexo 2016 Healthcare Compendium, a compilation of research that examines the increasing trend toward a focus on value in the healthcare sector. Read the full article Understanding and Managing Patient Fear in the Hospital Setting.

With the exception of the birth of a healthy baby, most people view the prospect of hospitalization with varying degrees of fear, from normal anxiety to full-blown terror. The reasons are as varied as the individuals, but often are based on the feeling of a loss of control and depersonalization. Creating a positive patient experience requires an understanding of what’s behind individual fears and adjusting the systems and protocols to relieve them as much as possible.

Why should hospitals be concerned about anything other than clinical outcomes? A patient is admitted for a condition, gets treated, and is discharged to their primary physician’s care. This impersonal approach has undergone radical changes with the rise of patient consumerism and the Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) survey.
The concept of the Patient Experience has emerged as a result of the shift toward a patient-centered care model. From a business perspective, hospitals that focus on all aspects of the patient’s experience are more likely to see improvements in their patient satisfaction survey data and HCAHPS.

While there is as yet no standard definition of the Patient Experience, the reality is that people often have a choice about which hospital they go to, and they base that choice on how they are treated as a person as much or more than on clinical outcomes. And, the results of the HCAHPS surveys determine the hospital’s Medicare reimbursements that are essential to fiscal viability. An increasing number of private insurers also rely on Patient Experience information in setting their reimbursement levels. Clearly, improving patient-centered care and focusing on patient feedback is no longer simply the right thing to do—it’s now a business imperative.
A hospital’s approach to patient care should logically be based on several considerations. Patient fear is one component.  The Patient Empathy Project conducted by Colleen Sweeney of the Beryl Institute revealed the following concerns:

• Infection
• Incompetence
• Death
• Cost
• Medical mix-ups
• Needles
• Rude doctors and nurses
• Germs
• Diagnosis/prognosis
• Communication issues
• Loneliness

As detailed in the research article Understanding and Managing Patient Fear in the Hospital Setting, these fears are often interlinked—patients worry, for example, that incompetence and communication issues can lead to medical mix-ups, exposure to germs, infection and possible death. A lack of communication and real or perceived rudeness on the part of hospital staff exacerbates fear when people think they aren’t being listened to or given the right information. And then there’s loneliness. Medical care normally accounts for just 10% of a patient’s hospital stay, so they are left alone most of the time. As a patient in the Empathy Project said, “It’s in that loneliness that fear comes in, because all you can do is worry.”

According to Sodexo’s research and the resultant Behavioral Segmentation Tool—Personix™—patients’ attitudes can be categorized in one of six different ways that affect how they handle their fears: Self-Centric, Attention-Seekers, Minglers, Acceptors, Worriers and Loners. These attitudes can change as a result of specific experiences during the hospital stay.

Medical professionals realize that patients’ fear reactions to their experience produce cognitive, physiological, behavioral and affective reactions that can derail a speedy and safe recovery, regardless of the particular fear or an individual’s attitude classification. Fear makes the patient’s treatment experience seem far worse than it really is, heightening discomfort and raising the risk of inaccurate vital sign measurements such as blood pressure, often caused by the “white coat syndrome,” a phenomena that could lead to unnecessary medication. At its worst, fear can even keep people from seeking the treatment they need.

So what’s the solution?  Both hospital staffs and primary care doctors can make a big difference by approaching patients with compassion and respect, offering emotional and psychological support and arming them ahead of time with plenty of information. Other interpersonal aspects involve enabling self-care, giving families a voice in decision-making, and providing the patient with clear, transparent information. Meanwhile, functional aspects refer to the basic conditions of care. These include effective and timely treatment, providing the patient with a safe, comfortable and clean environment, and coordinating smooth transitions and continuity between healthcare teams.

Knowledge and preparation create a more confident frame of mind, enabling patients to face hospitalization feeling more informed and in control. This lays the foundation for a positive patient experience and in many cases, a better outcome—and both the patient and the hospital benefit.















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KEYWORDS: HEALTH | HCAHPS | HEALTHCARE | HEALTHCARE INNOVATION | PATIENT | PATIENT EXPERIENCE | PATIENT FEAR | PEOPLE | PERSONIX | RESEARCH & POLICY | SODEXONEWSROOM: Sodexo, Inc.
CONTENT: Blog