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

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.

Download the research