The patient experience needs to be improved: here’s how


by James Merlino, MD

The patient experience is the right thing to do, and a business necessity. But improving it is not necessarily easy.

The fact is, large medical centers are at a real disadvantage when it comes to performing well on HCAHPS. The Centers for Medicare & Medicaid Services (CMS) do not discriminate or differentiate the scores of small community hospitals from those of large academic tertiary care referral centers. They look at everybody with the same glasses, under the thinking that patients at all locations deserve the same level of service.

In terms of HCAHPS reporting by CMS, a rural hospital with 30 beds is rated the same as Cleveland Clinic’s 1,200 bed main campus. Clearly all patients deserve great care and great caring. But providing great service at a place with 30 beds is one challenge, and providing great service at a place that is 40 time larger is a significantly more complicated task.

Large, academic medical centers, such as Cleveland Clinic, are specifically challenged by this dichotomy because their patient populations are dramatically different from those at small community hospitals. Large academic medical centers often treat the sickest patients who have more complicated conditions because they can provide a level of care that simply isn’t available at the smaller community hospitals.

With this responsibility comes a liability in terms of patient experience scores.

Patients who have a severe, complicated illness are more likely to stay in the hospital longer and to have more pain. Our HCAHPS scores have shown that these patients are also less satisfied with their overall patient experience. So if a large academic medical center wants to be in the 90th percentile nationwide on HCAHPS scores, it has to go above and beyond. It has to make patient experience an organizational priority.

So how then, do large medical centers go about improving and maintaining an excellent patient experience?

When I took the role of Chief Experience Officer, I told my CEO that there are no fifty-thousand-foot solutions to improve service quality or the patient experience. Simply put, you cannot drive patient experience from the board room.

Instead, creating and maintaining an excellent patient experience requires two things.

1. Consistent patient experience processes that function well, such as standardized communication methods and protocols that impact the patient experience.

2. Exceptional people who care to deliver on those processes.

For the most part, processes in hospitals work pretty well. However, the challenge is that organizations have to build and maintain a culture of employees who are engaged and satisfied. So we focus on specific efforts to engage our employees and educate them about why the patient experience is so important.  We help them understand how our patients view us and what we do, and stress the importance that every interaction our caregivers have with a patient impacts the patient’s overall opinion of our organization. We let our employees know that they’re part of something more important than just coming to work and doing a job.

Ultimately, positive results can only occur when every employee is personally responsible and active in driving safety, quality and the patient experience.

James Merlino is the Chief Experience Officer for the Office of Patient Experience, and staff colorectal surgeon at Cleveland Clinic. He blogs at Engaging The

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