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Posts Tagged ‘Atmosphere’

When going through a surgery, the surgery itself would almost unquestionably be the major and focal treatment of the patient during hospitalisation. However, there is an envelope of procedures, treatments and other activities that make up the experience of the patient at the hospital. Furthermore, pre-surgery and follow-up procedures can also be accounted for in the whole experience. Patient experience is receiving increasing attention and greater weight in managing healthcare systems in recent years, side by side with the clinical demands of medical care. Although we cannot fully equate the status of ‘patient’ with ‘customer’ because of the highly specialised aspects and requirements of the medical domain, there are many activities and moments of interaction in which it is fair and right to view the patient as a customer.

Healthcare services are not immune to the growing power of consumers and their higher expectations, as customers, that have become omnipresent in many fields of services and products. Consumers expect greater awareness of their needs and respecting their rights. Yet there are unique challenges in adopting a ‘customer-centric’ approach with medical patients because clinical considerations come first in the responsibilities of medical professionals.  It is a challenge, for instance, to convince doctors and nurses that improved patient experience is more than ‘nice but not necessary’ or that this is not ‘a luxury given their tight schedules’. Another challenge is balancing between the undoubted authority of medical doctors in their domains of clinical specialisations and the need of patients to be informed, assured and comforted about treatments they should receive. How a clinical treatment is communicated and delivered to a patient can influence considerably his or her experience in a positive way; moreover, there are many less critical procedures and interactions through which doctors, nurses and assisting care providers can further improve the patient experience.

A commonly accepted definition of patient experience developed by the Beryl Institute defines it as “The sum of all interactions, shaped by an organization’s culture, that influence patient perceptions across the continuum of care“. First, having a supporting culture is paramount to the successful assimilation of a patient experience approach. Second, there is a recognition among researchers and experts that patients’ experiences should be addressed through their perceptions reflecting what has happened to them (e.g., during clinical procedures, interactions with doctors); measures of satisfaction are inadequate because satisfaction is construed relative to individuals’ prior expectations, without informing what might have to be corrected. Third, steps along a whole journey or continuum of medical care of the patient should be accounted for (e.g., from hospital admission to discharge, covering care given within and outside the hospital walls). A customer-centred approach in the context of healthcare is recognised as Patient-Centred Care which focuses on improving patient experiences.

In a special report of the NHS Confederation (UK) on patient experience, the authors note the complexity of improving patient experience on top of striving to provide high-quality clinical care. In addition to the latter, it should be acknowledged that “Experience is also determined by the physical environment the patients are in and how they feel about the care they receive, including the way staff interact with them“. The report authors state punctually: “Improving the experience of all patients starts by treating each one of them individually to ensure they receive the right care, at the right time, in the right way for them” (boldface highlight added)[1].

Improvements in patient experience in a hospital ward (e.g., cardiology, orthopaedic) seem to happen in small steps, in small details; the staff may not fully appreciate their value to patients and their family relatives . Better experience may arise from greater awareness of the worries, concerns or inconveniences of patients by doctors, nurses and assisting caregivers. It may be achieved by listening to the patients and being more patient and soft with them. It is not an easy demand: the staff may have two or three dozens of patients to attend to in the ward, and yet the staff has a duty to help and make the hospital stay as easy as possible for each patient. One should not overlook the importance of an emotional touch, feelings shown by and with patients. Keeping a peaceful and calm atmosphere in the hospital ward also contributes to patients’ experience and prospects of healing. Doctors in particular can help to improve the patient experience by willing to explain and inform a patient (and family) in plain words and empathy about his or her condition and treatments required, especially upon request (i.e., respecting the right of a patient to be informed). Additionally, doctors should not leave patients out of decisions made about them, where the patient demonstrates interest and capacity in being involved.

Much of the conduct described above can be seen happening more frequently than say five or ten years ago. One may encounter specific members of staff who make an extra effort to help, talk with a patient a little longer, answer questions at the nurse counter or in the patient’s room, and they do it kindly and voluntarily. Yet there is also observable variability where some members of staff appear less committed to providing a better treatment to patients with dignity, compassion and respect; patient experience does not seem to concern those staff members. Efforts in hospitals to increase awareness and training of staff about forms of conduct that improve patient experience, and their value to patients, have to address remaining pockets of inconsistency.

We should also look at processes in administering care to patients as they may have further impact on patient experience in addition to the quality and safety of medical care. For example, it is greatly important to pass and share information about patients between nurses and doctors within a shift and between shifts. Understandably, medical staff may not be able to give a full detailed update about every patient in the brief during change of shifts. But even during a shift there may not be enough time to pass information between staff members (e.g., a change in treatment for a particular patient). It is therefore crucial that staff members update patient records in the computer information system regularly and consult the records frequently to make sure information is not lost, forgotten or missed by the next staff member attending to the same patient. It can matter, for instance, when the patient or family inform staff about medication the patient is taking regularly (or should avoid), or regarding any change ordered in medication administered during hospitalisation. More generally, it would help to avoid situations where staff members ask patients or family the same question several times. Failure to record and pass customer information is a problem well-known and documented in customer service, yet in this case shortcomings in passing patient information can have more critical consequences. Therefore, ensuring that information is available to administer the right treatment at the right time would improve the quality and safety of patient care and thereby his or her personal experience.

Improving patient care and experience by physicians relies on better understanding of patients’ needs which could be achieved by working on three key priorities: competency, teamwork, and compassion; being successful would help in driving loyalty of patients to physicians (James Merlino, MD, an expert advisor with Press Ganey Associates in an interview with Micah Solomon of Forbes, 11 May 2017). It sounds, nonetheless, that this trio of priorities is fundamental and could contribute in multiple settings to patient care by physicians with the mentioned benefit to individual physicians, their clinics or hospital wards (private or public). [Note: Merlino suggests also incorporating patient segmentation and nurturing caregiver engagement as requisites to improving patient experience.]

A study of patient interviews at Royal Bolton Hospital in the UK, cited by the NHS Confederation report, identified two themes that appear to relate to pivotal concerns of many patients: “no needless pain” and “no feelings of helplessness”; the researchers were able to sort interviews along these two leading themes and later held discussions with hospital staff on the issues raised in the interviews. In another example given, the report refers to relationships built with patients and their families, and among staff and executives: a data-driven methodology, Patient and Family Centred Care, developed at the University of Pittsburgh Medical Center assesses different care pathways where each care pathway is studied and an ideal patient experience is outlined respectively. A project is developed in collaboration between professional staff and management to carry out these experience-oriented care plans.

As suggested above, a calm and pleasant atmosphere in the hospital ward can have a positive effect on patients’ feelings (e.g., soothing, relaxing). Contributors to the desirable atmosphere are the behaviour of medical and assisting (nursing) staff but not least also the design, furnishing and atmospherics of the physical environment in a hospital ward. Colours, windows and the sunlight they allow into rooms, warm materials (e.g., wood) and ergonomics, artwork hung on walls, and even pleasant odour should help in generating an atmosphere conducive to better healing (e.g., stronger improvement in the clinical condition of the patient, shorter hospital stay). In fact, research supports positive effects of the environment and ergonomics on healing of patients but also on staff sentiment and conduct (e.g., by reducing fatigue and stress).

According to a review of literature prepared by the Economist Intelligence Unit, sponsored by Siemens Healthineers (healthcare division), improved patient experience has been shown to have positive impact on clinical outcomes and care delivery for patients, financial outcomes for hospitals (efficiency, cost reduction), and morale and productivity of staff. The review further supports the importance of improving patient experience throughout the continuum of care: before, during, and after hospital admission; it should also engage patients, staff, system and interfaces inside the hospital and outside (e.g., pre-surgery and follow-up treatments and clinical examinations may be provided by the hospital and complemented in other clinics)[2].

Patients themselves also believe in the positive effect that better experience can have on their healing prospects. A consumer survey (2018) conducted by Beryl Institute found that 69% of consumers believe a good experience contributes to their healing / good health outcomes. It was also learned from consumers that being listened to, communicated to them in a way they can understand, and being treated with dignity and respect are the three most important factors to them influencing their (patient) experience.

Patient experience cannot be separated from the overall programme of care they receive in the hospital; it embodies all that happens to them, the treatments they receive and interactions they have with members of staff, and how they feel about it all. As healthcare professionals increasingly appreciate, it would be wrong to brush away this subjective and emotional viewpoint of patients on their experience in the hospital or see it as inferior to the clinical aspects of medical care. They go hand-in-hand, and as research has shown improved experience of patients is likely to have a positive impact on their clinical condition and healing prospects. A broad perspective on patient experience is nonetheless necessary, encompassing any components of care that are part of hospitalisation or tied to it; involving different types of staff (doctors and nurses, assisting caregivers, and administrative staff as well); and it could take a step forward and consider care given inside the hospital and outside it. Improvements in patient experience can already be discerned in the past decade; yet this is an area of continued work and effort where more can be done to create even better and more consistent patient experiences.

Ron Ventura, Ph.D. (Marketing)

Notes:

[1] “Feeling Better? Improving Patient Experience in Hospital”, The NHS Cofederation, 2010

[2] “Improving Patient Experience”, Siements Healthineers Global, 13 June 2018 (Whitepaper)

 

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When evaluating a restaurant, the quality of food is not like other factors considered — it has a special status. The same goes quite as much for other food establishments like coffee-houses. The customers or patrons may trade-off several factors which include the food, service, venue, price and location, yet food quality usually gets a much greater weight than the other attributes, suggesting that the decision process is practically not fully compensatory. The quality of the food, its taste and how much we enjoy it, is a “pre-condition” to dining at a restaurant. However, the balance with other attributes is important; in some cases, failure on those other attributes can be detrimental to the willingness of consumers to return to a restaurant or a coffee-house.

  • Some coffee-houses effectively function as ‘coffee-restaurant’ establishments by serving meals of a variety of food items suitable for every time of day (from eggs, salads and toasts to soups, pasta, hamburger or chicken-breast schnitzel with supplements).

Suppose that Dina and Mark, a fictional couple, are dining at a restaurant and find the dishes served to them being well-prepared and they enjoy very much the food’s taste. However, they are very unhappy with the sluggish service they get and inappropriate answers of the waiter, and feel the atmosphere in the restaurant is not pleasant (e.g., too dark or too noisy). The experience of Dina and Mark can be greatly hampered by factors other than food. How superior should the food be for our diners to be ready to tolerate bad service or a place they do not feel comfortable to be in for an hour or two?

On the other hand, Dina and Mark would likely expect the food (e.g., a dish like ‘risotto ai funghi’ [with mushrooms]) to uphold to a certain gratifying standard (i.e., that the ingredients are genuine, the texture is right, and the dish is overall tasty). If the food is not perceived good enough and diners do not enjoy it, this takes out the point of considering dining at the restaurant altogether. But if the food is good though not so special or great, yet the patrons Dina and Mark feel the staff truly welcome them, treat them warmly and cater to sensitivities they may have, they could still be happy to dine at such a restaurant again, and again. When the food is already satisfactory, additional facets of the experience such as great service and a pleasing ambience can increase substantially the desirability of a restaurant or coffee-house as a place consumers would  like to patronize. We may be looking at a decision process where at first food is a non-compensatory criterion, yet above a certain perceived threshold the balance customers-patrons strike between food and other attributes of their experience becomes more intricate and complex.

Browsing reviews of restaurants that are shared on TripAdvisor’s traveller website can provide helpful clues on how customers-patrons relate to food and additional factors in their appraisals of their experiences at restaurants. Reviews were sampled of Italian and Asian restaurants in Tel-Aviv and London (members-reviewers may be city locals, national and international travellers — examples are quoted anonymously so that reviewers and the specific restaurants they review are not identified by name).

Reviewers most often open by referring to the food they have had at the restaurant; next they may give their assessment of the service they have received, design and atmosphere, price or value, and location of the restaurant. Thus, a review may start by appraising the food as good / great / delicious, and then stating that the service was good / nice / efficient. Nonetheless, it is not uncommon for diners-reviewers to open with an assessment of the service they have received at the restaurant. There seems to be a greater propensity to open the review with service when it is superb, but also on the contrary when it is terrible. Occasionally a review will refer firstly to the atmosphere in the restaurant, which is formed by aspects such as interior design or décor, lighting, music and overall ambience. Atmosphere will appear first or at least early in the review particularly when it is superior or inferior.

Additionally, we can distinguish between reviews that are composed of a few short argument-like statements about the food, service and other attributes, and reviews that tell a story (i.e., a narrative-like review). There are diners-reviewers who go especially into detail of the dishes or items of food they, and possibly their companions, have ordered, and their opinion of the food. Yet reviewers may also describe how they were treated by the serving staff, particularly when they felt exceptionally welcome and cared for or annoyed and undesired. Reviews that have a narrative give a stronger impression of the course of dinner to the reader who can more easily visualize it.

It seems that when diners-reviewers say the food is ‘good‘, they do not throw it out of hand; they do mean that the food is truly good, fresh and tasty. This appraisal should be interpreted as a base threshold for being satisfied with the food. When the food is more than ‘good’, reviewers explicitly express it with adjectives like ‘great’, ‘delicious’, ‘fabulous’ or ‘amazing’. Conversely, descriptions of the food as ‘average’, ‘OK’, and moreover as ‘mediocre’, are certainly not compliments, more likely suggesting the food was barely satisfactory. Unless there was something else especially good about the experience in that restaurant like its service or venue, the reviewer would probably have little motivation to return.  Consider for example a reviewer who said about an Italian restaurant in Tel-Aviv: “The ONLY redeeming factor is, in my opinion, the ambience, which is really cozy and relaxed. Too bad they don’t serve food to match” (capitals in origin, rating: 2 ‘rings’ out of 5). Similarly, a reviewer of an Asian restaurant in London complimented it for its “friendly and attentive” waiting staff, but concluded: “So there were a lot of positives about this place, but I’m afraid the food just wasn’t good quality. It was very bland and boring” (rating: 2 ‘rings’). On the other hand, a review of an Asian restaurant in Tel-Aviv offers the opposite case wherein the reviewer states “AMAZING food, OUTRAGEOUS service” (title, capitals in origin), and ends with the conclusion “basically terrible service which was definitely the opposite of the wonderful tasty food we were served” — the rating for this restaurant experience: also 2 ‘rings’.

  • A prospective diner who looks for a restaurant to try for the first time may find the choice task confusing and daunting when reviews of the same restaurant are quite the opposite of each other in their content. Still, it usually does not take too long to realise the ratio of positive to negative reviews given to a restaurant, in addition to the chart of distribution of ratings it received.

Service appears as the second most important factor after food in a restaurant. Patrons want the waiting staff to be friendly and respectful (this of course is a two-way street), be attentive and not letting them feel forgotten, and to be flexible and kind enough to accommodate their personal sensitivities or preferences (e.g., less spicy, nuts-free, replace polenta with rice as supplement). Less pleasant or efficient service will not necessarily make diners-reviewers reject the restaurant if its food is excellent, but they could drop one grade off its rating (e.g., from 5 to 4). Inversely, when the diners-reviewers are happy with the quality and taste of food, then also meeting a warm and helpful waitress — or sitting in comfort in a beautifully designed venue — can make the whole experience so much better. Reviewers repeatedly emphasise when, on top of their pleasure of the food, they are impressed by a waiter or waitress who smiled to them, was friendly, attentive and helpful, and made them feel at home. A reviewer of an Italian restaurant in London explains why it is her favourite: “Quite simply, the food is absolutely gorgeous. Wonderful ingredients and very well cooked. But most of all the welcome that we received and service that we got from everyone is great” (rating: 5).

A particular aspect of service is the length of time a customer has to wait either to be seated at a table or while dining. Many restaurants take table reservations, but not all do. Not taking reservations is legitimate, but it is far less acceptable and even offensive when staff at a restaurant (including coffee-restaurants) run a waiting list at the doorstep and appear pleased with letting prospect customers gather and wait outside as if to show around how popular their establishment is; if you complain they may even hint at you how much they do not really need your patronage. Such past experience may have made a British reviewer visiting an Italian restaurant in Tel-Aviv be thankful when: “The staff were very pleasant and found us a seat on a very busy afternoon without behaving as if they were doing us an enormous favour”. In a different case, at an Asian restaurant in London, a reviewer commented: “Long wait to be seated, despite the place being half empty, as the servers were running around serving tables but not seating people”. Considerate restaurant proprietors may keep seats reserved for people waiting (e.g., next to the bar), and may even offer them a free drink if waiting is extended.

While at the table, diners dislike when waiters appear to forget them behind or somehow miss sight of them (e.g., waiting for menus, for taking order and bringing courses ordered, for the cheque). A reviewer in Tel-Aviv was critical pointedly of servers who “it seems lost interest”, and started chatting with their colleagues or playing on their phones. Waiting staff are expected to stand by, being ready to answer requests or voluntarily enquire if diners need anything. An American reviewer at another Italian restaurant in the city, coming “late one night”, appreciated that “my waitress made an effort to check on me regularly”. At an Italian restaurant in London, a reviewer noted that on arriving early for a meeting, “I was offered a newspaper to read while I waited which I thought a rather nice touch”; overall, he commended the service whereby “the staff proficiently and effortlessly ensured everyone felt special and were looked after”. Seemingly little touches matter!

In restaurants of fine cuisine it seems justified to wait patiently longer for an order (e.g., 20 minutes for a main course) as it could mean that the dish is freshly prepared with care for you in those very moments from start to finish [an advice received from my father]. In many ‘popular’ or casual restaurants, however, it would be much less the expectation, though it could depend on the type of food and how complicated it is perceived to prepare the dish. Furthermore, the sensitivity of customers-patrons to time spent could be subject to the occasion (e.g., meeting and dining leisurely in the evening vs. a pre-theatre dinner or a lunch break).

Reviews tend not to address directly the time until a dish ordered is served but more generally relate to the waiting time at any stage while being at the table. Some relevant references were traced in reviews of Asian restaurants in London: (a) A reviewer noted that “service can be slow” and “a bit hit and miss” (although the food and atmosphere were good); (b) Waiting for food was raised by a reviewer as an issue for concern: the waitresses seemed “understaffed” and having “stressed looking faces”, with the result that “We sat around with no food or drink for over 20 minutes before we could grab a waitresses’ attention” (the food was “fantastic” and the rating given could otherwise be 5 rather than 4 — the reviewer “would defiantly” return); (c) A reviewer who was overall happy with the friendly and efficient service and “freshly cooked and tasty delicious” food particularly remarked that the “food came quickly”.

The aesthetics of interior design of a restaurant or coffee-house can also have an impact on consumers’ attitude towards the place and on their behaviour. The style, materials, colours, surrounding decorations, furnishing, lighting etc. are instrumental in the way the design helps to create a certain atmosphere and mood (e.g., cold or warm; traditional or top-notch modern; quiet, ‘cool’ or energetic).

John Barnett and Anna Burles of ‘JB/AB Design’, a London-based agency specialising in design of coffee shops, offer six instructive guidelines on the ways design on different levels can contribute to brand experience. They start with creating a happening in the coffee shop (‘The shop is a stage’), followed by using appetizing imagery of food (‘customers eat with their eyes’); being authentic and relevant; persuasive visual merchandising; creative ambience; and giving customers good reasons to come and ‘gather around a table’ in  the coffee shop. Their recommendations sound mostly if not all adaptable to more types of food and drink establishments, including restaurants. In setting an authentic design, they advise to ‘say it like you mean it’ all round the shop : “The whole shop is a canvas for imagery and messaging that forms the basis of a conversation with your customers”.

Reviewers-diners talk less frequently of aspects of interior design and description of the space of the venue; broader references are made to atmosphere or ambience. In the case of an Italian restaurant in the Tel-Aviv area with an elegant modern design, three different reviewers noted it has “a very nice décor”, that it is “very spacious and modern”, and the “interior is beautiful, a lot of air”. A reviewer relating to an Italian restaurant in London wrote: “The décor seems a little dated, but there were some fun touches”. This reviewer also addressed music played in creating a pleasing atmosphere (“alternated nicely between Frank Sinatra and Luciano Pavarotti — perfect!”). A reviewer-diner mentioned earlier, who was impressed by the newspaper gesture, also said of that Italian restaurant: “The ambience was extremely relaxed and the décor is comfortable, plush and smart”. An Asian restaurant in Tel-Aviv was described by a reviewer as “pleasant, with very informal atmosphere, soft background music, and industrial/downtown décor”.

Some appraisals of design and atmosphere sound somewhat more reserved though still positive. For example, a reviewer said of a luxury Asian restaurant in London that it is “very dark inside, but somehow it is also very cooling place”. A reviewer in another luxury Asian restaurant was very impressed by a modern-futuristic design yet felt uncomfortable with it: “The place is playing with your perception, slightly disorienting with its colours and stairs and reflecting surfaces”. The reviewers quoted above were largely very happy with the food as well as the service. In just one case observed, a reviewer of an Asian restaurant in Tel-Aviv became very upset with the food and proclaimed “Sorry! But when we decide to go to the restaurant, we wish to have a good meal, NOT ONLY a trendy design” (capitals in origin, rating: 1). In this case the “rather nice designed place” could not compensate for a poor food experience. Customers-patrons welcome inspiring and modern designs, but the design must also feel pleasing to the eye and comfortable — be creative with designs but not be excessive.

A top priority for restaurants, and to a similar degree also for coffee-houses, remains taking the most care of the quality and taste of the food they serve. However, it is essential to also look after additional factors or facets that shape the customer’s experience such as service, design and atmosphere, price or value. The kind of service customers-patrons experience is especially a potential ‘game-changer’. Additionally, consumers may not be coming to a restaurant or coffee-house for its design but if it looks appealing the design and atmostphere can make the stay more comfortable and enoyable, and encourage patrons to stay longer, order more, and return. Food is a central pivot of customer appraisals, yet other facets of the experience can tilt it either way: spoil and even ruin the experience or instead support and enhance it.

Ron Ventura, Ph.D. (Marketing)

 

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