Improving the patient experience

Editor's note: Following is an edited excerpt of the transcript for Modern Healthcare's March 20 editorial webinar, “Patient Satisfaction: Boosting Scores and Improving Quality.” The panelists were Dr. Frank Byrne, president of St. Mary's Hospital, Madison, Wis.; Dr. Seth Glickman, assistant professor of emergency medicine, University of North Carolina School of Medicine, Chapel Hill; and Gilbert Salinas, director of patient and community relations, Rancho Los Amigos National Rehabilitation Center, Los Angeles. Modern Healthcare quality and patient safety reporter Maureen McKinney moderated a discussion addressing whether it's fair to tie a portion of hospital payment to HCAHPS metrics, and how hospital leaders can improve their performance. A link to the webinar can be found at modernhealthcare.com/webinars.

Maureen McKinney: Do we know enough about the evolving science of patient experience and patient satisfaction to be able to link payment to hospital scores, or are there still too many unknowns?

Dr. Seth Glickman: I think we've done a lot of work as a policy community with key stakeholders over the past decade or so to really advance the science of measuring the patient experience, so I think attaching it to payment is certainly fair within the context of healthcare reform and moving towards more patient-centered care. ... I think there can be unintended consequences when you put too much emphasis or tie too much payment to specific areas.

One issue is that we have a really good understanding based on studies in the literature that the patient experience is linked to things like care coordination and communication, but the whole notion of how we apply these concepts to actually incentivizing organizations to transform or improve the patient experience I think we don't know much about, and I certainly think it needs to be evaluated very closely moving forward.

McKinney: Are there ways that you think that HCAHPS can be improved?

Dr. Frank Byrne: I've grown up in the era where many times as clinicians our first defense was the data is bad, it's wrong. We can't let the perfect be the enemy of the good. I think these standards will evolve over time. I think the measures will improve. But if you look at some of the things that are included as metrics for value-based purchasing, who's going to argue that reducing 30-day readmission rates is not a good thing for patients? Who's going to argue that giving patients written discharge instructions when they are discharged with congestive heart failure is a bad thing? ... I think we're in a much better place than we were 10 or 15 years ago.

We also now have tools available to document. Last year, we achieved a 99.5% compliance rate with giving patients written discharge instructions at the discharge. We missed three patients all year, and I'm pretty confident that those patients got the instructions but that we just didn't scan it into the Epic electronic health record so we couldn't prove it. And by the way, that 99.5% compliance—we were in, I think, the 60th or 70th percentile. We were not eligible for the value-based compensation we would have gotten. So that's a good thing for patients.

Glickman: One issue is ceiling effects. If you actually look at the distribution of scores ... they're clustered around a really tight response range, so very small changes can have fairly significant impact on rankings. I think also from a policy standpoint, we also need to continue to allow organizations to innovate and be able to embrace innovative approaches to managing service operations and McKinney: What role do you think social media can play in improving patient satisfaction?

Byrne: Social media has obviously exploded over these past several years, so we have a very active social media presence, and we use it not only to push information out, but we also get a lot of feedback. We've seen things on social media and have been able to reach out to people and say, “Gee, we didn't know that occurred. We're sorry,” and, “How can we make it right?” So we're using all forms of social media at this time as a way to facilitate bidirectional communication. ... It's definitely an important communication tool.

Glickman: There was actually a publication recently which compared HCAHPS scores, I believe, and Yelp ratings online and actually found a fairly strong correlation between the two, which to me was somewhat validating that we're not just measuring disgruntled patients but can get a better understanding of how our organization is perceived by our patients.

McKinney: How do you achieve or at least tackle all of the required metrics within HCAHPS when you work in an extra lean environment?

Gilbert Salinas: We have to be very creative in recruiting volunteers in our Patient Advisory Council. And when we talk about going to the frontline staff and the frontlines, you can't get more frontline than your patients. So we went to our patients for help with a lot of these measures and activities and programs that we implemented throughout our facility. We found many champions throughout our system (in our frontline staff) that were more than willing to be involved with improving the patient experience. It can create a lot of work. We put on presentations and trainings for the entire facility at all different shifts and levels of the facility, but it's eventually paid off. For many of our staff, they feel empowered to go out and create better systems for our patients.