Improving the Patient Experience is About More Than Communication

Hospitals, doctors’ offices and ambulatory care facilities typically take a traditional approach to improving patient satisfaction, focusing almost solely on communication strategies. From our research, we know that certain behavior modification strategies create provider-patient interactions that demonstrate respect, create a feeling of safety and security, and help patients feel the provider spent sufficient time addressing their concerns. Techniques such as addressing patients with formal titles (e.g., “Mr. Smith” or Mrs. Jones,” rather than “honey” or “sweetie”), establishing and maintaining eye contact, acknowledging patients’ fears and concerns, rounding hourly on patients and sitting down when speaking with a patient can be effective in improving patient satisfaction. And yet, these strategies aren’t enough in isolation.

Imagine the nurse who consistently demonstrates all the key patient communication competencies, showing genuine care and concern, and rounding hourly to keep the patient informed. Now imagine those nurse/patient interactions in an environment fraught with delays, poor coordination of care and miscommunication among care providers. Patient satisfaction surveys provide hospital and medical practice leaders with data regarding communication effectiveness, but also on processes and patient flow. Poor ratings on questions about the speed of the admission process and the discharge process even when the patient is kept informed about delays; responses to questions about wait times; and responses regarding tests and treatments all point to patient flow and operational dysfunction that negatively affect the patient’s experience.

With such a big focus on patient satisfaction, many hospitals have begun to incorporate Lean and Six Sigma methodologies to streamline operations. Although reducing process variability and eliminating unnecessary steps in processes improves efficiency, unless hospitals identify the root cause of delays in bed availability, wait times in the emergency department, boarding in the post-anesthesia care unit (PACU) and delays in patient discharges will improve only marginally. Some hospitals have begun to recognize that variability in the numbers and types of procedures scheduled throughout the week affects inpatient bed availability. Queuing analysis and simulation modeling, applied holistically, have been used successfully to reduce variability, predictably admit patients to the correct type of bed and discharge them in a timely fashion following an expected course of treatment. This methodology improves patient satisfaction and the entire patient experience, and, more importantly, improves patient outcomes. Efficiencies gained in the hospital using this approach further translate to length of stay reductions, improved physician and nursing satisfaction and improved financial indicators.

I recall a nurse telling me that after the third or fourth time of rounding hourly on her patient, keeping him informed and apologizing for the delay in going to his inpatient unit, that it didn’t matter how nice, how caring, how concerned or how compassionate she was, his experience was not positive. So while effective, consistent and caring communication with patients and family members is vital to improve the patient’s experience, excellent communication in the absence of excellent patient flow and processes is not enough. Identifying and fixing the root causes of poor patient flow will enable hospitals to deliver the type of experience that patients expect.

Consider implementing a rapid diagnostic area in your ED to manage your low acuity patients quickly and safely without utilizing treatment beds in the ED. Keeping these patients out of the “back” creates ED bed capacity without adding physical beds, and reduces length of stay and the left-without-being-seen rate. Contemplate separating unscheduled, urgent/emergent cases from your scheduled cases in your procedural areas to prevent “bumping” of elective cases. This will reduce wait times for patients who need an emergency procedure and enable elective cases to occur as scheduled, thereby improving patient and physician satisfaction, and reducing overtime in the OR and cath lab. Finally, consider smoothing the flow of scheduled, elective patients through your OR and other procedural areas, which will smooth the current peaks and valleys on the inpatient floors and prevent the typical midweek scenario hospitals endure of placing patients in any bed, just to get them out of the ED or PACU.

Finally, realize that the hard science of Lean, Six Sigma, queuing theory and simulation modeling to improve patient flow and the patient’s experience must be combined with the soft side of collaboration, education and compelling rationale for making significant changes. Improvements made around the margins will provide just that – marginal improvements. Dramatic and sustained improvement requires bold changes and cutting-edge leadership.

As Albert Einstein once said, “We can't solve problems by using the same kind of thinking we used when we created them.” I encourage you to try a different approach to achieve the results you envision.