NewYork-Presbyterian CXO Rick Evans: We are in a patient experience crisis

I've had the privilege of working to improve the patient experience in hospitals and healthcare settings for over 20 years. I've been part of teams that have successfully "moved the needle" year over year in challenging markets like Boston and New York.

Over this time, we saw the introduction of the national HCAHPS surveys that focused attention on the critical issue of patient experience in healthcare outcomes. We've seen a body of knowledge develop regarding patient experience, including deep understanding of patient experience data, development of evidence-based best practices and integration of patient experience as a key metric for any healthcare organization's success. We've continued to make progress in improving patient experience amid a rapidly changing healthcare environment. But I have never seen us in a situation like the one we are in at this moment.

As the pandemic continues, a related crisis in patient experience is unfolding before our eyes, and it is unlike anything we have seen before.

Patient ratings of the care they receive, which initially rose at the start of the pandemic, are plummeting across the country. A recent report on the "Impact of COVID-19 on Patient Experience" released by Press Ganey, an organization that administers surveys for hospitals across the nation, detailed precipitous drops in HCAHPS measures over the last year. Overall rating of hospital care dropped by 4 percentage points and patients' likelihood to recommend their hospital dropped by 4.5 percentage points. These declines come after years of these measures rising each year. For those who aren't familiar with how patient experience data moves, this is a huge drop. It represents a marked reversal of a longtime trend of improvement.

What is behind this drop? And what must we do to address it?

As I walk the halls of our hospitals at NewYork-Presbyterian, and as I speak with colleagues around the country — patient experience leaders, nursing leaders and others — there is consensus on what is happening. We are experiencing a troubling convergence of human and industry factors that have brought us to this moment.

First, the human factors are related to the toll that COVID-19 has taken and continues to take on all of us — both patients and healthcare staff. Early in the pandemic, patient ratings of their experience rose. We were in a crisis, and there was deep appreciation for healthcare workers. In New York, we saw that appreciation reflected in our ratings and also heard it every night at 7 p.m. when people would come to their windows to applaud and cheer. That was spring 2020. It's winter 2021, and the cheering has stopped. Everyone is exhausted. Tempers are short. The nation is divided on critical issues like mask-wearing and vaccinations. We have moved from a brief period of unity into an edgy and tense period. This plays out in all of our perceptions of healthcare, of our work and of each other. And, it is showing up in patient experience scores everywhere.

Then, there are industry factors, which exacerbate everything I described above. Emerging staff shortages that existed before the pandemic have dramatically worsened and are affecting every sector of our workforce — nurses, physician assistants, support services team members and more. We've all read about "the great resignation" and how many people in healthcare are rethinking their careers as we approach the end of the pandemic's second year. Supply chain shortages also make every shift just a little harder.

The pandemic's effects on hospital budgets further constrain our ability to address all of the above. Visitation restrictions remain and further strain interactions in our hospitals and at the bedside. Behavioral health-related issues and conflict situations have also increased in many care settings.

This is a daunting list of challenges. All are interrelated and all erode the core elements of patient experience: our ability to connect with one another, communicate effectively and provide empathy when it is needed most. This is the patient experience equivalent of "long-haul COVID," and hospitals, patients, and staff are feeling it everywhere.

Here at NewYork-Presbyterian, we are trying to address these unprecedented challenges with a multi-faceted approach. We continue to maintain and build a robust array of programs to support our staff and nurture grit and teamwork. Like nearly every hospital in America, we have become more creative than ever in recruiting and retaining staff in a very competitive job market. We are reassessing our patient experience best practices and incorporating other teams from corporate and back-office areas to partner with our strained clinical front line to "spread the work and share the burden." And, we are accelerating efforts to leverage technology to enhance the patient experience where there are "pain points" in our patients' journeys through our system. We are trying to build on something we learned during this pandemic — that we can change quicker than we ever thought when we need to.

The arrival of the pandemic was devastating in so many ways — especially here in New York. But we rose to the challenge with teamwork and creativity. Responding to its latest effect, a corresponding patient experience crisis, will require the same dedicated effort. I believe if we commit ourselves to this work, we will not only be able to turn the tide toward recovery and further improvement, but also reshape what patient experience is and should be even when the pandemic is behind us.

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