A recent project that Manley and his team worked on was assessing online reviews about Ascension's emergency departments to improve patient experience. Manley's team read all the reviews online and assigned each a star rating from 1 to 5, with 5 indicating an excellent experience. Ascension found that about 75% of negative reviews noted long emergency department wait times while positive reviews touted the friendly staff but didn't often mention short wait times.
Taking that data, Ascension is testing new interventions. For instance, the system is working on a protocol to have an ED team member check in with any patient who has been waiting for at least 30 minutes to ask them how they are doing and explain why the wait is long. Another pilot project involves speaking with patients shortly after they have arrived to explain the triage process.
Manley said Ascension's research found patients didn't understand the process and felt anxious about their condition when they had to wait. “If we can do little things for people who are feeling that way, those people are going to have a better experience even when the wait times might not change,” he said.
Calhoun at Avera also touted the benefits of having an internal research arm. “It offers more continuity with our focus and our tactics than if we were piecing it together,” she said.
But even health systems that don't have a consumer insights department can make meaningful inroads in research. Henry Ford Health System has increased its research work over the past few years to improve the patient experience as its footprint grows.
“Our desire to grow and attract patients is a big reason why we have focused on the customer experience because you can't grow if you don't have good customer satisfaction—your reputation will kill you,” said Gwen Gnam, Henry Ford's chief nursing officer and vice president of patient-care services.
After conducting an extensive review of the patient experience literature, Henry Ford decided to implement leadership rounding in 2012.
Nurse managers on each of the units are expected to speak one-on-one with half of the patients on their floors daily. The nurses ask patients at least five questions about their experience, which they log on a tablet. Negatives like cold food or confusion about care are expected to be addressed immediately.
The data logged by the nurses are analyzed regularly to address frequent complaints. One trend Henry Ford spotted initially was confusion around discharge. So the system began new protocols, including speaking with the patient and family members 24 hours before the expected discharge to go over the care plan. Henry Ford has seen a 50% improvement since 2012 in the percentage of people who have answered that they understand the discharge process.
“Patients have a choice of where to go and that has accelerated the need for us to be more convenient and communicate better because we want them coming to us,” said Vanessa Mona, director of care experience at Henry Ford.
University of Missouri Health Care also doesn't have its own consumer insights department but has worked with a company to measure its net promoter scores, which is a relatively new research tactic in healthcare that assesses customer loyalty.
“We can understand how patients are going to behave in the future,” said Kevin Gwin, chief patient experience officer at MU Health Care.
Either over the phone or in an email, patients are asked if they would recommend MU Health to either a family member or a friend. The survey has a 30% response rate in its inpatient setting and a 10% response rate in its ED.
MU Health has used net promoter scores to understand the experiences of patients treated in different sections of the ED. The surveys showed patients in some sections gave negative scores while those in other sections reported positive scores. Focusing on the sections with negative scores, Gwin and his team asked patients what could be improved.
In response, MU Health installed better seating and added privacy curtains. The net provider score for one section of the ED improved from a baseline of -18.8% in November 2016 to September 2017 to 25% in the second quarter of 2018.
“Most systems when seeing a mediocre or low number in their ED don't know where to start,” Gwin said. By using net promoter scores, “it provides these breakthroughs about where to focus solutions.”
The stakes are high for health systems to adopt innovative solutions such as those that address patient needs.
“The retailization of healthcare is here,” Klein said. “Years ago, consumers would compare you to another hospital or doctors. What's changed is consumers are asking why can't you be like an Amazon?”