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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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