The patient-experience report card: Gauge your readiness to move to the next level

There's probably no organization in the healthcare universe that isn't at least talking about patient experience.

But after interviewing hundreds of them, from small providers to massive hospital systems, we've learned that most are still struggling to attain optimal performance. They want to make patients happy, but they are unable or unsure how to achieve consistent results.

They've got legitimate reasons for lagging behind: While they all know patient satisfaction is important, many are in merge-or-die mode, which comes with a host of regulatory scrutiny. More pressing problems, such as controlling the cost of care, are demanding top executives' attention. Almost all hospital CEOs say patient experience is on their radar, making it into the top-10 list of concerns. But it rarely cracks the top three.1

Smart organizations know that has to change. As the competitive landscape shifts to a world of mega-systems, patient experience will provide one of the few ways to differentiate, and ultimately succeed.

To understand the state of patient experience, Prophet and GE Healthcare Camden Group conducted intensive research among healthcare executives and created a maturity model based on our findings. We learned that most organizations fall into four broad stages of performance, and there are steps to take to transition from one stage to the next. An honest appraisal of where an organization is now is the only way to get better.

Level One: Learning
Leaders of these organizations know that patient experience is critical, but because of competing priorities, aren't focused on diagnosing problems systemwide.

That's not to say there aren't efforts underway. There have likely been a few attempts already, usually a series of "one-off" fixes in discrete parts of the system. And there may even be ideas for driving larger changes. But what marks these systems is a disjointed approach. Solutions are neither vertical (across all parts of the system) nor horizontal (making fixes throughout the consumer journey).

"Our current mindset is how we set our long term vision and strategy. Success should not be measured on patient satisfaction alone..., the ultimate measure will need to be customer loyalty," said Mike Yost, Vice President, Marketing, Outreach and Experience at Indiana University Health. "We want customers that are advocating for us with their friends and colleagues and to accomplish this we'll need to delight them more often than not."

Typically, there are gaping inconsistencies across offices and systems. And perhaps most significantly, no one executive or department owns responsibility for improvements: There's no dedicated patient-experience team, and there's no agreement on which metrics to use as benchmarks.

"Best-in-class consumer experience requires a cross-functionally developed, long-term plan that serves as the organization's roadmap," says Reynick Martinez, chief marketing officer at Presence Health, Illinois' second-largest health system. "This 'roadmap' needs to be reviewed and updated periodically with new insights. Our team understands this and is instilling this in our process. To deliver the best experience, our insights and planning need to be on-par with consumer marketing experts like Procter & Gamble and Walmart."

Climb to the next level:
--Build organizational readiness and galvanize the organization to make improved experience a critical priority. Start building hypotheses about low-hanging fruit fixes, and investments required to make them.
--Identify the individual(s) and teams responsible for patient experience across the system. Who will drive improvement across the continuum and facilitate the spread of best practices across venues and business units?
--Establish metrics for success across hospitals, physician groups, post-acute and ambulatory services, defining key performance indicators.

Level Two: Committing
As organizations advance, they move toward a better articulation of goals and are now intent on figuring out a more comprehensive strategy. They've diagnosed many problems. And they're beginning to delve more deeply into their Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) scores. Patient feedback is collected from multiple perspectives—from hospitals as well as physician groups.

They're in the process of developing a comprehensive strategy: their North Star. And this guiding vision includes a roadmap to key investments, building the right team, and metrics.

So while patient experience has arrived on the performance dashboard, the approach is still disjointed, like a team of rowers preparing to start training for their first big race. They know they need to work together and row in the same direction. They are in agreement about the destination, but it's still an awkward work in progress, and people aren't sure how to translate the concept into action.

"We've crossed the attitudinal bar so we can start working on this in earnest," says Matt Gove, chief consumer officer for Piedmont Healthcare, an Atlanta-based system operating throughout Georgia. "That being said, we know we're at the very early stages. We have a clear plan that our leadership team understands, but we're still a long way from making sure that managing experience becomes part of our culture. We need some quick wins to have the organization sustain the investment and move up the ladder."

Climb to the next level:
--Conduct a thorough review of the organization from the patient's perspective. Where are the biggest breakdowns, and where does the experience hinder care outcomes or create the most consumer frustration?
--Make sure the team is working with a comprehensive set of key performance indicators, including specific compensation incentives tied to improvements.
--Celebrate wins by shining a spotlight on them; find ways to "double down" on investments and early bets that are starting to pay off; assure winning practices are shared across the organization.

Level Three: Accelerating
Leaders of companies in this phase are making progress, and can prove it. They have clear internal alignment on the problem and investment needed. And they are following this North Star throughout their system, with clear goals and accountability.

They are starting to see quick wins, and the experiments conducted in the previous stage are creating momentum. When efforts fail, they protect employees from feeling discouraged or "redesign fatigue" by using careful post-mortems, which allow them to build failure insights into future efforts.

Investments have been made in streamlining scheduling, creating single points of contact for billing issues, and using technology (such as patient portals) to improve communication both with internal teams and consumers. And the entire experience spectrum is starting to feel more connected.

But there are gaps. Satisfaction scores still vary significantly within the organization. An academic medical center, for example, may have top scores in some services, even employing navigators in oncology and cardiology to help patients wade through a morass of scheduling hurdles. Yet its outpatient clinics may be over-crowded, with long waits for appointments.

Climb to the next level:
--Complete the synchronization across points of care and moments of the consumer journey, like handoffs between discharge and outpatient visits, or between primary care doctors and specialists
--Establish standards across the system, optimizing technology for virtual visits, responsive communication and outreach.
--Start augmenting the "fix what's broken" mindset by looking for new ways to surprise and delight consumers.

Level Four: Embedding
These organizations are the fastest moving boats in the race, with people, processes and technologies all pulling together. They are integrated and aligned to give patients better care and service and have moved from data-based to insight-based improvements. They are continually updating their roadmap, correcting their course as they move forward.

They have a strong understanding of their customers—not just the ones they have now, but the ones they hope to acquire. And they are using those insights to build new, seamless experiences. They are realizing cost savings from earlier changes and can reinvest in even more improvements.

Stumbles and hiccups lead to better conversations, and there's genuine enthusiasm for making continual improvements. An organization has arrived at this highest level of patient experience when key players recognize that last year's innovations—like same-day visits for physician practices—are now commonplace and that they need to keep finding new ways to impress patients. And at the highest levels, they can link better experiences to better health outcomes.

This may include facility design and ambiance but when it does, its ambition is not just "updating," it is to make fundamental changes to how care is delivered and experienced by patients, family and caregivers, An example is One Medical, a California-based system, which is disrupting primary care. It has eliminated waiting rooms, assuring convenience with patient portals and email communication.

Another is Kaiser Permanente, which is in the midst of constructing wellness centers called "health hubs" so vast and inviting that patients show up early and linger after appointments, using walking trails, taking classes, and exploring digital educational offerings. But—and this is critical—it isn't viewing these centers as the end result of experience initiatives. They're just one more stop on the way to what comes next.

Continuous reinvention becomes a natural part of the organization as it moves from thinking about patient experience to consumer experience. That means it reinforces its brand whether the patient is perfectly healthy or has multiple chronic conditions. And they frequently find inspiration from industries outside healthcare, using them as guideposts for consumer expectations.

That's the highest level of evolution, and what smart organizations are striving for: Constantly improving experience, and the understanding that this is a journey, not a destination. The goal is moving beyond basics to the finer points of experience, creating moments of surprise and delight. Taken together, they can build a brand signature, unlike any other competitor.

1. Source: American College of Healthcare Executives 2014 Survey: Top Issues Confronting Hospitals in 2014

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