It’s About Improving the Experience
Wednesday, September 28 2011
I am amazed by, sometimes frustrated with and occasionally guilty of a misplaced focus on what is truly important about improving the health care experience. It starts with language and how we think about making improvements. Too often the focus is on the numbers. We talk about how to “improve the scores” and/or “increase the top box percent.” Granted, some of this comes from the relationship between numbers/scores and reimbursement and the need to do well and improve. But here’s the problem that I see with basing our conversations and language in the numbers and scores: It removes the human equation from the picture. The numbers are an outcome; the focus should be on how we improve the experience for the patient, family, visitor, employee, physician and community. If we improve what it feels like to be a patient or family member, the scores will follow.
My spouse has been seeing a specialist now for about a year, with office appointments and lab tests occurring about every three months. Although the physician is one of the best in the specialty and the medical outcome positive (with the need for continued appointments diminished), the patient and family experience has not been good. We sent back a negative survey, providing comments to help the medical practice better understand the patient’s experience.
This practice, like others, has to start by placing itself in the patient’s shoes, seeing how he or she would be affected by processes and actions. In our family provider’s case, the primary focus seems to be on the practice rather than the patient. Choices for appointment times are limited, with no evening or Saturday hours. My spouse works late on Tuesday evenings and has the mornings off, but there are no office hours on Tuesday mornings. Once a month, Fridays are completely open for him, but there are no Friday appointments, either.
Perhaps worse, appointments are “pushed” out to patients by mail with no interaction between the scheduling staff and the patient or family. In one of the mailings, we are told the doctor wants to see my husband again in three months. No appointment was made in consultation with him before he left the office in the prior visit. Instead, about a week after the appointment, the letter arrived, telling him the date and time of the next appointment. We are left to rearrange work schedules to accommodate the practice’s needs.
The most recent appointment, scheduled three months ago, was changed twice by the practice before it finally occurred. Both times, a call came from the office (one of the few times phone interactions were not automated) stating that an emergency surgery necessitated the rescheduling of our appointment. And, as usual, the new time was pre-determined by the office, not the patient and office together.
Could, and should, we leave this practice? Probably, yes. Will we? Probably not, because like many other patients and families in similar situations, a year or more has been invested with this physician, the outcome is positive and the prospect of starting all over again elsewhere is not that appealing. But the next time a survey is received, the individual scores will probably not change, and may be lower. If other patients’ experiences are similar, the overall scores of the practice will not improve.
I’m sure this practice would like to improve its scores (at least I hope so). To begin to achieve that successful outcome, the focus needs to be on improving the experience of the patient. That starts with flipping established processes and procedures to focus on the patient rather than the staff, physician, and office.
My hope is that whenever a provider receives scores for satisfaction, clinical outcomes, or quality measures, it should consider how to improve patients’ experiences, health and safety, but start by thinking like a patient.