NewYork-Presbyterian CXO Rick Evans: How do you maintain patient experience during the pandemic?

It is clear that the COVID-19 pandemic has challenged healthcare in almost every conceivable way. It has had a powerful impact on the key metrics of any healthcare organization. Quality, financial, employee engagement and patient experience metrics have all been affected in ways we are still trying to understand.

Healthcare organizations measure patient experience through surveys and other means. Some of these metrics — like HCAHPS measures for adult inpatient experience — are published widely and connected to reimbursement. These surveys measure patient perceptions of aspects of the experience that they are uniquely qualified to judge. For example, courtesy, communication, cleanliness and preparation for discharge are all assessed. In my decades of experience looking at patient feedback and working to improve care to better meet patient and family needs, it all comes down to a few essential elements: communication — individually and as a team — and establishing connections with patients. 

If you think about these core elements of patient experience, it is easy to see how COVID-19 has impacted them. 

Think about the measures we must have in place for all of us to stay safe. For example, the wearing of PPE is essential. Yet, PPE puts a significant physical barrier between us and the patient. Verbal communication across masks and face shields becomes more difficult. The nuances of body language and non-verbal cues are compromised. Even the ability to sit close to a patient at eye level has been virtually eliminated. 

There is also a need to minimize repeated entry into exam and hospital rooms. We have needed to become very efficient with our bedside and exam room interactions — both for safety and also because the necessity of donning and doffing PPE takes time away from actual interaction time. This compromises the precious time we have to communicate, educate and answer questions. It inhibits our ability to do this basic but important interactive work. 

There are other effects from COVID as well. Limitations on visitation and family presence at the bedside — although necessary — have further harmed our ability to connect and communicate. Often, family members are key helpers in assuring patients receive information and understand it. With less presence at the bedside, this often vital communication link has been greatly diminished. Everyone has suffered because of it — patients, their loved ones and our healthcare teams. 

So, how do we maintain the patient experience in the face of these real challenges? The answer is we adapt.

At NewYork-Presbyterian, we have long had a robust set of best practices that help our care teams communicate and connect more effectively with patients. COVID-19 has caused us to rethink how these can be used in the current environment.

We have worked with our teams to find ways to communicate through the PPE we wear. We have developed scripts to help set expectations and help patients "know the person" behind the gown and mask. We have fostered efforts to humanize the PPE we wear with clearer indications of who we are and our roles. We have spoken about how to use body language — for example, our eyes which can be seen — to convey empathy and compassion.

We have focused on maximizing our time in the room, using techniques like "agenda setting" for ourselves and with patients upon entering the room so we can focus on and meet as many needs as possible while we are at the bedside.

We have used technology to stay in contact with family members and share important patient education and discharge information. And, our age-old practice of post-discharge phone calling has taken on renewed importance.

Non-clinical disciplines have also been mobilized. COVID-19 has heightened patient concerns about cleanliness and disinfection in our hospital rooms and practice sites. We have developed new materials to convey transparently to patients about what is being done to assure all areas are disinfected. 

There is another element to all of this adaptive work. Our care teams are weary from the long journey through this pandemic. They are as dedicated as ever to caring for patients and also to providing an experience that is compassionate, empathetic and respectful. But, as I have already shown, the barriers to success are real. 

Thus, as I have described in this column, we have had to respond to staff with practical adaptations of best practices that acknowledge and respond to the actual situation on the ground. In doing this, we demonstrate respect for the reality of everyday work in our facilities, but we also keep our focus on the patient experience and goals in front of us. 

Working on and improving patient experience has always required a delicate balance of finding evidence-based interventions that work for both patients and the teams that care for them. When we find that "sweet spot," everyone wins. Patients and families feel connected and understand what is happening and their part in it. Care team members gain a feeling of success and fulfillment because they too are connecting with the people they serve. 

COVID-19 has forced us to find new ways to achieve this balance in an unbalanced time. But we will continue to find creative ways to bridge this gap. That's how we will keep everyone's hearts and minds — both staff and patients — in this work not only during the pandemic, but after it has passed. May that day arrive soon! 

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