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    The Patient Experience

    3/8/2016

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    Maximizing the patient's experience is a hot topic for hospital executives. While this notion isn't new, it's been pushed to the forefront because of satisfaction surveys, increased competition and the Yelp-ification of health care.
    While many have made gains, some providers have struggled to transform the patient environment in a timely manner, or to sustain those improvements. Experts say that too many hospital leaders confuse optimizing satisfaction with advancing the patient experience.
    "The experience is not about happiness. It's about patients being respected, being communicated with, and having their care coordinated in such a way that they can get the best possible clinical outcome for whatever their circumstances are," says Patrick Ryan, CEO of Press Ganey. "Let's look at the patient experience in total as reducing suffering and reducing anxiety. And when you do that, you look across the entire continuum of care, from the first phone call to the patient's being discharged."
    Improving communication — on medication at the bedside and with both patients and their families — is a critical element of bolstering the health care experience, says James Merlino, M.D., chief experience officer for the Cleveland Clinic, one of the first providers to create such a position. If hospital leaders want to take the patient encounter to the next level, they need to focus on creating and sustaining a culture, aligned around patient-centeredness, along with engaging the people doctors are treating.
    The biggest challenge Merlino sees hospitals facing in this effort is figuring out where to start, and defining exactly what the "patient experience" means.
    "Everybody has a perspective on what you need to do to fix the patient experience, but if you don't take control of that debate and push all of your resources toward high-value tactics, you're not going to be successful," Merlino says. "I think what happens is people, organizations, leaders, managers tend to sputter out."
    Some, working in the smaller community hospitals, worry that patient experience initiatives are overly focused on shiny bells and whistles at the bedside, which they can't replicate on their shoestring budgets. Large systems can hire extra staff to tackle an issue, but that's not an option at 162-bed Onslow Memorial Hospital in Jacksonville, N.C. Instead, leaders there are focused on simpler ways of improving their culture, such as using navigators to help comorbid patients find their way around the hospital and having care teams "huddle up" to assess the situation at hand and work on patient handoffs.
    Despite a hospital's best efforts, there are always certain patients who behave "irrationally" and are determined to leave negative feedback on a survey, says Onslow CEO Ed Piper. The best you can do is to acknowledge and assure the patient that the culture is safe and caring, and set the stage for the best experience through careful communication and the display of human kindness from any staff member, clinical or nonclinical, who encounters the patient.
    For Douglas Wood, M.D., director of strategy and policy for the Mayo Clinic Center for Innovation, truly transforming the health care experience is about meeting patients at home or wherever is most convenient, responding to their needs using all available resources through a team-based care model, and reorienting the delivery model away from bricks and mortar. 
    "We will realize fairly quickly that we need to change the focus of the health care industry to creating health, not just producing health care," Wood says. "And when you do that, it will change the focus away from the experience within hospitals and clinics to the true, complete patient experience. It's nice to have a hospital that has lots of amenities but, really, not too many of us look forward to scheduling a stay in a hospital as though we would look forward to going on a cruise."
    This gatefold will explore how organizations can make systemic changes in the patient experience, using best practices and tools from some of the top performers.



    Key Steps for LeadershipThere are a few key steps that hospital and health system leaders can take to help systemically address the patient experience.
    1. Foster staff understanding of the patient experience and the relationship it has with other aspects of care.
    • The relationship between the patient experience and clinical outcomes
    • The relationship between the patient experience and patient engagement
    • The role of the patient experience in the hospital's financial success
    2. Demonstrate executive leadership involvement in improving the patient experience.
    • Continuously demonstrate, both visibly and verbally, that the patient experience is a top priority.
    • Make weekly executive rounds.
    • Monitor and share scores, celebrate success and encourage additional improvement.
    • Support staff efforts to succeed (tools, training, cheerleading).
    3. Implement best practices.
    • Purposeful hourly rounding
    • Bedside shift reporting
    • Post-discharge phone calls
    • Scripts, logs, other tools
    • Monitoring, feedback coaching on all tactics
    • Staff bonuses tied to scores
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    Better doctor-patient communication linked to reduced readmissions

    2/8/2016

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    Although many hospitals invest in hotel-like amenities to improve the patient experience, leaders would be better off spending more money on improving caregiver-patient communication, the number-one factor in preventable readmissions, according to research published inManagement Science.

    Researchers, led by Claire Senot of Tulane University and Aravind Chandrasekaran of Ohio State University, measured the effects of
    ​ two different aspects of patient care on readmissions: the communication-focused aspect, which focuses on the caregiver's ability to engage the patient in meaningful conversations, and the response-focused aspect, which corresponds to the caregiver's ability to respond quickly to a patient's explicit needs. 

    Their research, combined with in-depth case studies of several acute care hospitals, found that hospitals would reduce their 30-day readmission rates by 5 percent if they invested in training programs to teach caregivers' interpersonal skills and empathy to improve communication with patients, in addition to complying with evidence-based care. But hospitals that invested in monitoring systems and RFID location systems to help caregivers quickly respond to patients' requests, combined with process of care, would reduce readmissions by 3 percent.  

    Hospitals must walk a tightrope between improving both process-of-care measures and patient experience measures, both of which affect their reimbursements, Senot and Chandraskaran wrote in Harvard Business Review. Caregivers widely perceive satisfaction-focused measures as subjective and unscientific, and of little value in the quest to improve outcomes. Indeed, experts have raised concerns that satisfaction measures could take the focus off of tangible outcomes.

    Meanwhile, many hospitals pay less attention to improving caregiver communication because of high training costs, according to the authors. They also note that technical skills take priority over patient communication at medical schools. However, improving the communication aspect is actually cheaper than improving the response aspect by about $14 per patient, according to the study. "These results have important implications for where hospital administrators should invest to improve the overall healthcare delivery system in the United States," the authors wrote in HBR.

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    Patients leaving hospitals often don’t understand care plans

    1/20/2016

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    (Reuters Health) - Many patients leaving the hospital don’t understand follow-up care plans because the instructions are tailored to people with higher reading levels and more education, a recent U.S. study suggests.

    The American Medical Association already recommends that written health information be targeted to a sixth grade audience because nearly half of the U.S. population is only marginally or functionally literate, with an elementary- or middle-school reading level, the researchers note in the American Journal of Surgery.

    But the current study of discharge instructions given to about 500 trauma patients leaving the hospital found that only one fourth had the reading skills necessary to adequately understand their dismissal notes.

    Part of the problem is that these notes are written for two very different audiences – patients and families who need simple instructions and their doctors, who are accustomed to medical jargon, said senior study author Dr. Martin Zielinski, a trauma surgeon at the Mayo Clinic in Rochester, Minnesota.

    “Even if patients believe they understand what occurred during their hospitalization and the instructions they are to follow upon dismissal, they can become confused after they leave the hospital environment as their memory can be clouded by medications they were administered, the stress of hospitalization, and, particularly within our patient population, traumatic brain injuries such as concussions,” Zielinski said by email.

    To assess how easily the trauma patients in the study might decipher their discharge notes, Zielinski and colleagues used two standard formulas for determining reading levels based on the total words, syllables and sentences in texts.

    Most of the 314 patients in the study who had education data available had a high school degree, while 22 percent had at least some college education. About 4 percent of these patients were functionally illiterate, with reading levels at fifth grade or below, and another 40 percent were marginally literate with a sixth- to eighth-grade reading level.

    On average, the notes required at least a high school education to understand, the analysis found. By one measure the instructions were typically written at about a 10th grade reading level, while the other assessment found the notes might be easily understood by 13 to 15 year old students.The difficulty of deciphering these notes didn’t appear to be different based on whether patients had surgery or how long they stayed in the hospital.

    Patient reading level didn’t appear to influence the odds of returning to the hospital within a month of discharge or the likelihood that they would call the hospital with questions, the study found. But often, when these things happened, the patient had a reading level too low to understand the discharge notes. Limitations of the study include the lack of education data on all patients as well as the exclusion of non-English speakers, the authors note. Researchers also didn’t give patients reading tests, relying instead on the highest level of education attained to estimate literacy skills.

    Even so, the results highlight that patient discharge notes are currently written for education levels too advanced for many patients to understand, the authors conclude. To ensure patient comprehension, these notes should be written for a sixth grade audience. “Careful design of discharge instructions, with input from patients themselves, would help us create more comprehensible tools,” said Dr. Kevin O’Leary, a researcher at the Northwestern University Feinberg School of Medicine in Chicago who wasn’t involved in the study.

    It’s possible that electronic health records might be part of the solution, O’Leary added by email. These programs might allow doctors to assess how easily patients can read instructions in real time and prompt physicians to adjust their wording as needed to make it simpler to understand. “Providing feedback for clinicians as they create the instructions would help them revise the wording to improve readability,” O’Leary said. In addition, when patients or their families have trouble understanding their care instructions after getting home, they can still call the nurses’ station on the hospital floor where they were treated, or call their doctor’s office to ask questions.
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    Three things every medical office should be doing

    12/10/2015

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    1. Simplify all communications to a 5th grade level and drop the medical jargon, making it easy to understand for the majority of patients. Speak in plain English, or, in many cases, speak plainly in the native language of the patient.

    2. Complement oral instructions by providing patients with easy-to-read educational materials on diagnosis and treatment.

    3. Implement the “teach back” method, prompting patients to explain the information a medical provider has given them in their own words. If your doctor is not doing these things, talk to him or her about streamlining communications at the office.
    ​
    Our country has expanded health care coverage thanks to the Affordable Care Act, but too many individuals cannot read their prescription instructions; they do not understand their hospital discharge papers; they cannot decipher their treatment plans; and they misinterpret their diagnoses and prognoses. The results can be damaging, costly, and even deadly. Only when health care professionals begin to clearly communicate with patients will we be able to mitigate health literacy problems and ensure better health care outcomes.
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    Health literacy: Too important for the back burner

    6/15/2015

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    In an article he penned for City Limits, Dr. Matthew Weissman, chief medical officer of New York-based nonprofit Community Healthcare Network, noted that inadequate health literacy can result in hospitalization, avoidable emergency room visits, confusion about prescription drugs and even the worst-case scenario of death. Insufficient health literacy costs the country as much as $236 billion per year, Weissman stated. At first, this number may seem unbelievable, but it becomes considerably more plausible when you consider these statistics:
    • Just 12% of adults are proficient in health literacy, according to findings from the National Assessment of Adult Literacy.
    • More than eight in 10 (82.1%) of adults in the United States had contact with a healthcare professional in 2012, the most recent year for which statistics were available, according to the Centers for Disease Control and Prevention's Summary Health Statistics for U.S. Adults: National Health Interview Survey, 2012. For children, this figure was even higher at 92.8%.
    "Too many individuals cannot read their prescription instructions; they do not understand their hospital discharge papers, they cannot decipher their treatment plans and they misinterpret their diagnoses and prognoses," Weissman stated. "The results can be damaging, costly and even deadly. Only when healthcare professionals begin to clearly communicate with patients will we be able to mitigate health literacy problems and ensure better healthcare outcomes."
    "Patients bear some responsibility for their own medical care."
    Asking the right questions
    Although doing everything possible to help patients is part of a physician's job, patients also bear some responsibility for their own medical care, Weissman asserted. With this in mind, he listed three questions that patients should be sure to ask at every doctor's appointment:
    • "What is my main problem?"
    • "What do I need to do to address this problem?"
    • "Why do I need to take this action?"
    If prescribed medication, patients should make sure they understand the basics: what the medication is for, how much to take, how often to medicate themselves, what side effects may occur and what to do if they experience these, etc. Similarly, if they need to undergo tests, they should know what each test is for, when and where it will be conducted if the doctor can't perform it there and then, how it will be carried out, any side effects they can expect and how long they will have to wait before getting the results.
    In a blog post for the Daily Trojan, a University of Southern California publication, USC student Francesca Mares-Do noted that research has revealed many patients don't understand the conditions from which they suffer. Mares-Do asserted that lack of proactivity on their part often contributes to their confusion.
    "Ask the questions that need to be asked or clarify again just to make sure you understand," advised Mares-Do. "You might feel embarrassed for not understanding what the doctor said the first time, but you'll feel twice as foolish for leaving without ever knowing what he meant."
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