William Maples, MD

William Maples, MDAs is often the case in healthcare and business, no one single tool provides sufficient information to create sustainable solutions for a challenge at hand. And so it goes with the HCAHPS (Hospital Consumer Assessment of Healthcare Providers and Systems) survey.

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	Due to the financial rewards or penalties associated with HCAHPS, we have equated 

 with HCAHPS and have moved away from richer assessments of how patients experience the care we provide.

	Measuring true patient experience is more complex than what is measured in the survey. To fully understand the patient experience, metrics must include assessment of teamwork, communication, and the relationships/connections between caregivers and patients. The quality of these relationships creates the environment/culture of the workplace, which is intimately linked to the ability to deliver safe, quality, and efficient care.

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	Although HCAHPS does not measure the patient experience in its entirety, it does measure aspects of care such as pain management, responsiveness of hospital staff, discharge information, etc. The critical elements, which are not assessed in the HCAHPS survey, include teamwork and the compassionate connection between patients and caregivers. This results in the absence of essential information providers and healthcare organizations need to develop meaningful solutions aimed at enriching the environment/culture in which care is delivered.

	By focusing on patient experience, one also focuses on the value of care provided to patients. The safest, highest quality, and most efficient care is achieved when patient experience levels are high. It is important to appreciate this intimate connection.

	Patient experience should not simply be likened to satisfaction with a hotel stay. It has very little to do with amenities and has everything to do with teamwork, communication and the connections built between caregivers and patients. From the patient’s point of view: “What kind of relationship do I have with my caregiving team?”

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	In addition to HCAHPS, providers should also examine these areas shown to be important to patients:

	·      Does my healthcare provider team truly care about me and my health?

	·      Does my care team give me the perception that they have enough time for me, and do they actually provide enough time for me?

	·      Does my team respect me as an individual and my beliefs?

	·      Do they truly listen to me?

	·      Do my caregivers work well as a team and possess strong communication skills?

	When we address a more complete and accurate set of metrics that define an exceptional patient experience – those defined by patients over the past decades – we make it possible for caregivers and healthcare organizations to implement meaningful interventions that are far more sustainable than tactical solutions.

	Our work needs to focus on creating a memorable exchange where there is emotional attachment and partnership with the care team, with the patient at the center. We need to focus on “how” that care is delivered and the environment/culture from which it is delivered.

	To truly deliver an excellent patient and caregiver experience, we must invest in work that enriches the workplace culture. When we focus on solutions, which foster teamwork, effective communication, and mutual respect, we create a highly functional team, which supports the delivery of high care value.

	Research has shown high levels of teamwork are associated with reduced healthcare-associated infections, reduced medical errors and an increase in employee safety. By creating an exceptional experience, we create a culture of safety.

	Communication training is key in this effort, and is necessary for all members of the healthcare team. Every individual of the healthcare team should be provided the opportunity to nurture their communication skills with this work being led by physician, nurse and administrative leaders. It is the moment-to-moment conversations – the way we interact – that lets people know how much we care. If we do not get that right, everything else we do will not flourish.

Physicians and Culture: The Power of Connection

	The single most important factor in creating an excellent patient experience is the relationship between the patient and the physician. Physicians spend a great percentage of their time communicating with patients, fellow caregivers, and each other. The way in which they connect to patients and the caregiver team creates the culture and tone of the work environment. This ultimately impacts the health of patients by allowing them to understand and implement the care plan resulting in optimal outcomes and safe care.

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	Primary care physicians are quarterbacks for their patient’s care. That partnership needs to be very strong. It is not just one office visit or one hospital visit. It is the care across the continuum of life. The patient needs to trust and have confidence in their team and feel their team truly cares about their health.

	This is particularly important when specialist care is needed. This requires trust to be built across the entire care team to allow the development of well-orchestrated care plans that can be executed by the patients we serve.

	Ninety percent of healthcare happens with patient’s daily choices outside the physician office and hospital. If physicians and hospitals do not have strong connections with patients during the remaining 10 percent, we cannot expect patients to be successful in their journey to health.

	It is important to get this right sooner than later. By the year 2022, it is estimated that 18 percent of a physician’s individual salary will be tied to quality and patient experience metrics.

	Patient experience derives from workplace culture. Work and efforts to enrich the culture must come first. We must develop trust and respect built on effective, authentic, and compassionate communication. Caregivers and patients will thrive in this environment, which fosters teamwork.

	During recent years, we have focused on countless “best practice” tactics in hopes of delivering excellent clinical outcomes and exceptional experiences. Unfortunately, these tactics and checklists have produced limited results. When we create a culture of excellence that delivers patient-centered, team-based care rooted in trust and compassion, we drive clinical outcomes, safety, and efficiency. We also restore joy and resiliency for the caregiver team.

Articles

As is often the case in healthcare and business, no one single tool provides sufficient information to create sustainable solutions for a challenge at hand. And so it goes with the HCAHPS (Hospital Consumer Assessment of Healthcare Providers and Systems) survey.

Author | William Maples, MD

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