Today’s hospital leaders are facing unprecedented challenges to their short- and long-term operational and clinical success. There’s no shortage of areas to address, including the changing regulatory and reimbursement landscapes, cybersecurity, and of course, the complexities of delivering care amid a global pandemic. So, it’s not surprising that many have put patient experience initiatives on the back burner. But in my humble opinion, waiting to address this critical component of care delivery is a mistake.
For one, value-based care remains the prevalent operating model for our health systems. While we may get some temporary reprieves from regulators, reimbursement will remain tied to patient experience surveys. What’s more, ED and HCAHPS scores correlate with improved clinical quality and outcomes. In other words, empathy and compassionate communication appear to lift other aspects of clinician performance.
For evidence that hospitals can move the patient experience needle even during an unprecedented global pandemic, look no further than the emergency department at Providence Holy Cross Medical Center. Between August 2020 and May 2021, as emergency department patient experience scores plummeted nationwide, Holy Cross’s scores soared from the 37th percentile to the 85th. Their secret weapon: a unique collaboration between Holy Cross and its Vituity emergency physicians.
Meeting “Impossible” Patient Satisfaction Goals
Providence Holy Cross Medical Center of Mission Hills, California, is a 377-bed community hospital serving the San Fernando, Santa Clarita, and Simi Valley communities. Its ED is certified as a Level II Trauma Center, STEMI Receiving Center, and Primary Stroke Center. Holy Cross ED providers care for a diverse patient population, including many Spanish speakers.
The busy department faced patient experience challenges before the pandemic. Medical Director Jason Fisher, MD, and Department Director Suzanne Silva, RN, worked hard to address nursing turnover and provider burnout. But just when things were looking up in early spring 2020, the first wave of the novel coronavirus swept across Southern California.
Initially, patients were appreciative of emergency measures. Providers received a bump in their scores for physician communication, courtesy, and respect. However, as the pandemic ground on, frustrations flared. Patients didn’t understand why their loved ones couldn’t accompany them inside the ED, and they felt disconnected from their masked and gowned clinicians. As a result, satisfaction scores plunged.
The Holy Cross ED team could easily have blamed their flagging patient experience (PX) scores on COVID-19. However, these clinicians were deeply committed to serving their patients at the highest level. They also knew patient experience was a priority for hospital leadership and that Vituity had the tools and expertise to help.
“By focusing on programs, partnerships, and people, even the busiest ED can equip its team with tools for success.”
Dr. Swati Mehta, MD,CPXP
Improving Patient-Provider Communication
Lack of communication was one reason PX scores plunged nationwide during the pandemic. In general, hospitals did a poor job communicating the reasons for PPE, visitation policies, and other pain points. Patients were already anxious, and this silence further inflamed them. The takeaway: During a disaster, we need to overcommunicate to maintain trust.
Unfortunately, providers are naturally skeptical of communication skills training. After all, some of them have been conducting patient encounters for 20-plus years. They may wonder what’s left to learn. They don’t realize that we all have blind spots in our interpersonal skills.
One way to start breaking down this resistance is to offer concrete tools and protocols. This challenges the belief that patient communication is a “soft” skill. Holy Cross’s collaborative action plan included several such tools:
- 6H model—This framework helps providers deepen their human connection with patients through six action steps: hear, heed, help, (be) honest, heal, and hope. ED leadership held an interactive communication skills workshop to introduce the model and help team members practice it through patient scenarios and role-playing.
- Leader rounding—Medical and nursing leaders visited patients to ask about their experiences. When needed, they provided on-the-spot service recovery.
- Care cards and room signage—These tools provided information in English and Spanish about the providers, care plan, and expected wait times.
- Commit to sit—Team members took time to sit at the bedside when rounding on patients.
In the year since the collaborative, Holy Cross ED providers have done an excellent job of enculturating these tools. They are, in fact, one of the first ED departments to fully implement the 6H model. The results speak for themselves. Between 2019 and 2021:
- The number of patients reporting that physicians took time to listen increased by 8.8%.
- Patient reports of doctors’ concern for their comfort increased 8.5%.
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Improving Hospital Reputation
Improved patient experience can drive positive patient recommendations that in turn enhance hospital and clinician reputations. To this end, Vituity offers the eQI survey program at each of its ED practices.
EQI gathers feedback through brief electronic surveys texted or emailed to patients immediately after discharge. As part of their action plan, the Holy Cross team decided to capitalize on this real-time feedback.
During coaching calls with the collaborative faculty, team leaders reviewed eQI scores and comments. Together, they identified common patient pain points and made plans to address these. Team members also began calling back dissatisfied patients to perform timely service recovery.
As a result, between 2019 and 2021:
- Average eQI satisfaction scores rose from 4.3 to 4.5 (out of 5).
- The number of patients likely to recommend Holy Cross increased 10.6%.
Actions Steps That Improve Patient Experience
At Vituity, we frame patient experience initiatives around three P’s: programs, partnerships, and people. Think of these factors as three legs of a stool. If one fails, the whole thing topples.
To provide a framework for the initiative, the Holy Cross ED team participated in Vituity’s Patient Experience Collaborative. This five-month experiential learning program involved 10 Vituity practice sites. Due to the pandemic, the fall 2020 collaborative was conducted 100% virtually.
Collaborative participants, who include leaders in medicine, nursing, and hospital administration, work with faculty to create patient experience action plans. The Holy Cross team focused on communication skills, leader rounding, and the “commit to sit” model of patient rounding. Participants received regular coaching calls from the collaborative faculty to review data, track progress, and troubleshoot issues.
Front-line providers can put as many programs into place as they want. But to succeed longer term, they need support from nursing and hospital administration.
At Holy Cross, Director of Patient Experience Jody Spector, MPH, truly embodied this spirit of partnership. Spector used her hospital-wide role to engage adjacent departments like radiology and ancillary services in the ED initiative. She broke down silos by sharing data and helping to standardize expectations. When she noticed physicians getting overwhelmed with callbacks, she recruited nurses to pitch in. Her ability to partner effectively with all stakeholders was a major catalyst for success.
Front-line providers are a health system’s greatest PX assets. So how do we bring them on board?
It’s important to remember that the team’s experience is the patient’s experience. This is doubly true in the context of a pandemic or disaster. Before focusing on patient experience, all Holy Cross ED physicians and advanced providers completed Vituity’s Resiliency Course. By taking care of themselves, they were better positioned to care for others. In addition, leadership supported team morale by offering positive feedback, celebrating wins, and sharing positive patient comments.
Tools for Emergency Department Success
The Holy Cross experience shows that it’s always possible to serve our patients with greater compassion and empathy. By focusing on programs, partnerships, and people, even the busiest ED can equip its team with tools for success.