Evidence-Based Practices and Data Analytics Drive Improvements in Patient Experience
Patient experience was a prominent theme that resonated throughout the entire two-day agenda of this year’s Healthcare Leadership and Improvement Conference in Toronto.
A multi-faceted examination of this critical topic pushed well beyond current systems for tracking patient satisfaction to detailed examinations of the specific practices needed to produce measurable patient experience results that, in turn, drive better clinical outcomes and better organizational performance.
Many of these practices engage patients, staff and physicians in ways that empower patients to become actively involved in models of care that are increasingly responsive to their needs. Effective tactics and strategies are available and, as conference speakers demonstrated repeatedly, they are backed by a large and rapidly growing body of research.
The evidence is compelling: patient experience is evolving rapidly into a sophisticated, data-driven science that forms a key strategic pillar for our leading healthcare organizations.
Practices that improve patient experience
Dr. Ted James, surgical oncologist and medical director at BIDMC/Harvard and Studer Group coach and speaker, organized the evidence-based practices that improve patient experience into a “CARE” framework – Communication, Accommodation, Respect and Engagement:
- Communication is the “cornerstone of patient-centred care”. Practices range from inviting questions and avoiding jargon, to simple tactics like making eye contact and sitting by the bedside. The quality of time spent with patients can be improved dramatically, even when the quantity of time available is constrained.
- Accommodation involves building strong connections with patients to incorporate their input into the care process. Team-based care that ensures full coordination of multidisciplinary providers is a big part of this imperative.
- Respect is a broad principle encompassing consideration for each patient’s dignity, autonomy and individuality. In practice, it means apologizing for unreasonable delays, making sure patients are always informed, and many other measures that reflect an attitude well-captured by Don Berwick: “We are guests in our patients’ lives”.
- Engagement includes practices such as rounding on physicians and staff that are aimed at creating a “culture of service”. Dr. James acknowledged that practices must be applied with discipline and consistency, but also recommended that organizations “standardize, but don’t micro-manage to the point that innovation and inspiration are stifled.”
This summary of practices was accompanied by a review of evidence supporting the strong correlations between patient experience and clinical quality. A systematic analysis of 55 studies found consistent positive associations between patient experience, patient safety and clinical effectiveness across a wide range of diseases, settings, outcomes and study designs.i
One of the best examples of an evidence-based practice that generates predictable patient experience results is AIDET®, the communication tool that ensures each patient encounter includes five key components – Acknowledge, Introduce, Duration, Explanation, and Thank you.
A practical workshop on the rationale and the “how-to” of AIDET® was led by Maureen McCafferty, Studer Group coach. AIDET® is a tool for process standardization that reduces the variation that can lead to sub-par experiences and potential errors. At the same time, it provides the flexibility referred to by Dr. James, allowing providers to adapt and respond to each situation and each individual. AIDET® serves to reduce patient anxiety and increase their confidence in care providers.
Leveraging the data on patient experience
Lynne Mahony, coach leaders for Studer Group Canada, led two intensive breakout sessions on the Canadian Patient Experience Survey – Inpatient Care (CPES-IC), developed by the Canadian Institute for Health Information (CIHI).
CPES-IC is a comprehensive patient experience survey. It is currently being adopted voluntarily by organizations across Canada, with the potential to serve as a standardized national patient experience measurement and benchmarking system. CPES-IC incorporates the HCAHPS (Hospital Consumer Assessment of Healthcare Providers and Systems) survey, which has been mandatory for 10 years in the U.S., where survey results are linked to healthcare funding.
Studer Group’s U.S. partners have consistently outperformed national averages on HCAHPS metrics, and the company has developed a full portfolio of resources to help organizations manage and leverage these data. Lynne Mahony presented lessons learned for Canadian health leaders who are or will soon be working with CPES-IC. Some examples include:
- Focus on survey results that align to patients’ most pressing needs (e.g. pain control, responsiveness, etc.) when planning how to start your improvement journey.
- Help your team understand how they will be measured, what the data mean, and how their progress is assessed. It is not about how well they are liked, but how frequently and consistently they perform the specific behaviours that create quality patient experiences.
- Speak to both the “head” (the data) and the “heart” (the patient stories that reconnect us to the why of healthcare) when communicating about patient experience.
Another relevant – and highly innovative – measurement system was introduced by Craig Swanson, president and co-founder of Insignia Health. The Patient Activation Measure® (PAM) quantifies the degree to which patients are engaged in their own care and wellness. PAM was developed at the University of Oregon in response to research indicating that 70 percent of our health outcomes are influenced by our own behaviours and decisions.ii It has been validated by more than 300 peer reviewed studies.
PAM generates data that can predict health outcomes and guide patient engagement practices. Interventions can be targeted and tailored to meet the needs of specific patient groups, so results are accelerated and resources are optimized.
It is a system that helps unlock the full potential of patient engagement. Craig Swanson referred to a pertinent quote from healthcare technology specialist Leonard Kish: “If patient engagement were a drug it would be the blockbuster drug of the century and malpractice not to use it”.iii
iDoyle, C., Lennox, L., & Bell, D. (2013). A systematic review of evidence on the links between patient experience and clinical safety and effectiveness. BMJ open, 3(1), e001570.
iiWorld Health Organization, Commission on Social Determinants of Health, Final Report, 2007
iiiKish L J, The blockbuster drug of the century: an engaged patient, Health Standards, August 2012 www.healthstandards.com, Accessed June 9, 2017