Getting "Clued In" to the Patient Experience Yields Bottom-Line Results

A critical effect of the dynamic changes continuing to take place in healthcare is the rise of consumerism and, most importantly, the role of patient experience. Patient experience not only impacts consumer perception, but also clinical efficacy.


That is why it's not surprising that "patient experience" remains a top priority among American hospitals and hospital systems, according to the Beryl Institute's study, "The State of Patient Experience 2013."  A full 70 percent of hospitals surveyed ranked patient experience as top priority for next three years, up from 64 percent in 2011.

With the goal of improving patient satisfaction scores, patient experience in healthcare has become center stage. Many hospitals are making investments in quality and process improvement. They are recognizing that they have customers, and they are using patients and their families as a sounding board and integrating their feedback in hospital and healthcare design.

But, hospitals aren't going far enough, and this is of deep concern. Experience is not a process, nor is it simply the result of process improvement. Organizations are under-leveraging how they're using input from families and patients. They haven't yet made the mindshift to focus not on what patients and families think but on how they think. They're performing 21st-century medicine, but when it comes to experience management, they are stuck in 20th-century thought.

In the Old World way of thinking, you're focused on asking for opinions and suggestions as input. In the New World, organizations use deep insight to understand how they think about their experience, and then design, build and manage the customer experience accordingly. Many simply haven't yet made this transformation, and they're suffering because they're trapped in a dated perspective of thinking in an industry that is changing rapidly. Organizations need to be more adaptive and able to sense what patients don't even know they desire. Doing so is paramount.

Being clued in the patient experience changes everything
When your patients and their families are at your hospital, you're constantly delivering a barrage of clues they process unconsciously against deep-seated mental frameworks or models. How they process these clues affects their emotions, which, in turn, influence their attitudes and ultimately their behaviors. What they see, smell, hear, taste and touch will create their "experience" and affect them emotionally — even though they aren't even aware it's happening. Research tells us that 95 percent of our mental processing takes place unconsciously. That's right, only 5 percent of your patients' decisions are based on conscious rational thought.

To engage patients, hospitals need to dig deep into this uncharted 95 percent of experience processing. They need to look at the experience from what I call "customer-back" rather than from the "company-out." There's a lot of talk today on brand building and what the brand needs to project to affect customers' impressions of its product or service. However, I turn this notion inside out. I believe the only way hospitals can make that coveted emotional connection with patients and families is by thinking and looking at everything from the "patient back" — by identifying the emotions patients and families want to feel as a result of an experience and then designing and managing the clues embedded in experience to elicit these emotions.

For example, patients and families are likely to want the environment of your hospital to make them feel confident, safe, calm, included and informed. Are the clues you're delivering intentionally designed and managed to elicit the emotions they want to feel?

Hospitals should consistently evaluate experiences through their customers' eyes and delve into patient experience on both rational and emotional levels, assess the range and variety of clues patients/families encounter and uncover gaps between current and desired experience.  

For instance, realizing that a trip to the emergency room is inherently stressful and nerve-racking, Nemours — a health system that operates children's hospitals and clinics in Delaware, New Jersey, Pennsylvania and Florida — was committed to improve the experience for their patients and families. Working with Experience Engineering, Nemours learned that more than anything else, patients and families visiting their EDs want to feel understood, secure and confident. Armed with this voice-of-customer intelligence, they've begun piloting a number of clue-driven initiatives to elicit these emotions.

Nemours learned that having the child seen swiftly by the physician upon arrival in the ED minimizes parents' anxiety and reassures them their child is in good hands. As a result, Nemours has put a physician right in triage so the patient is seen right away upon arrival. There is also now a "pivot nurse" within the triage phase who provides a quick assessment and quickly moves with the patient and family to the place where care will be provided.  

Other piloted changes aimed at making patients and families feel more understood, secure and confident include:

  • To minimize the times patients and families have to tell their story what brought them to the ED and their health history, intake interviews are now conducted via "team huddles" in which the team of physicians and nurses who will be caring for the child interviews the patient and family together.  Not only is the process quicker for the patient and family, but because all medical staff involved in the case hear the same information, the chance of miscommunication among team members is eliminated.
  • When nurses change shifts, the hand-off is conducted right at the patient's bedside, involving the family in conversations about the patient's condition, how care will be continued during the shift, what tests and procedures are expected to take place during the shift, etc.
  • Given the variety of physicians, nurses and staff that are involved in a patient's ED care, all hospital personnel wear color-coded uniforms so the patient and family feel more secure knowing what that person's role is.
  • Research validated the effectiveness of several programs Nemours already had in place such as its procedure to have ED staff call patients and their families within 24-48 hours of discharge to see how the patient is doing and to make sure discharge instructions are understood.

"Some of the changes are very simple to implement, yet they provide great security and confidence to our patients and their families," says Mariane Stefano, vice president of service and operational excellence at Nemours. "And through our real-time monitoring of patient feedback, we know we're delivering a quality patient experience."

Engaging patients drives the bottom line
The more patients' experience elicits their desired emotions, the more they value the experience and the more engaged they become. Yes, patients are consumers, and they know it — up to a point. Patients exchange money for services, and they want their money's worth. But healthcare is much more than a financial transaction. It's also highly emotional. And engaged patients have a better experience because it is psychologically and emotionally gratifying.

In fact, it's been shown that engaging patients on an emotional level directly impacts a hospital's bottom line. Research by Gallup shows that patient engagement consistently predicts hospital performance on an array of crucial business outcomes, including EBITA per adjusted admission and net revenue per adjusted admission. Additionally, recent research by Press Ganey Associates indicated that hospitals that perform better on patient experience of care measures have lower 30-day readmission rates.

It's also important to understand that the impact of a patient's visit doesn't end when they walk out the door. The type of experience a patient has can also impact the decisions of his or her friends and family. On average, patients who are satisfied tell three other people about their positive experience, while those who are dissatisfied tell up to 25 people. And, social media has multiplied this effect — instead of telling a handful of people about a bad experience, patients can now tell an ever-growing network with the click of a mouse. A recent survey by PwC of more than 1,000 people found that one-third of consumers rely on social media, such as Facebook, Twitter or YouTube, for gathering or sharing medical information. Of that one-third of consumers,  41 percent, said that social media influence decisions about their choice of a specific hospital, medical facility or physician.

Diving deep into the experience from the inside out helps hospitals get into the hearts and minds of patients and families. By understanding the unconscious drivers that impact customer behavior, hospitals can transform from giving haphazard and undifferentiated experiences to intentionally designing and delivering experiences that gives them a competitive edge.  

Lewis P. "Lou" Carbone is the founder, president and chief experience officer of Minneapolis-based Experience Engineering, Inc., and the author of "Clued In: How to Keep Customers Coming Back Again and Again," which received a the celebrated Fast Company Reader's Choice Award. Widely recognized as the founder of customer experience management, Mr. Carbone has spent more than two decades leading the world in the development of experience value management theory and practice in a broad range of industries. 

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