Patient experience scores are being dragged down by process problems

Which statement fits your organization the best?

Option A: Our organizational strategies, incentives, goals, and mantras are driven by patient experience.

Option B: Our organizational strategies, incentives, goals, and mantras are driven by quality and safety.

It may be hard to say an organization can be one without the other since, after all, experience is a byproduct of quality. The two are so interrelated that there is often a cloud of confusion regarding what to focus on, where to place priority and deciding where investment is needed. Is quality also experience, or is experience what drives quality? Where do we start eating this elephant?

A while back, I penned a four-part series on the power of perception and how it relates to the way health care consumers perceive their care. In those installments, I offer my 1-2-3 approach for influencing the health care consumer experience. However, I did not go into much detail regarding the complicated and confusing relationship between quality and patient experience (q/e). In fact, there is so much confusion on this matter that health care organizations often fall victim to the q/e muddle by way of deploying misguided strategy in their efforts to improve. As a result, priorities are developed that are incongruent with what matters to patients, executives have inflated “service” related incentives, and organizational investments for improving experience end up being, quite frankly, superficial as they fail to address the root cause/s of unmet needs and expectations. Let me be clear with my opinion: Quality first.

Let’s do a throwback to the traditional IOM definition of quality: safe, timely, effective, efficient, equitable, and patient-centered. This gold standard definition infers that when these aspects are met, “quality” is also present. Is there ever a scenario where these aspects are met, yet a consumer’s experience is not? It’s possible, but not probable. See, when they say a square is a rectangle but not every rectangle is not a square – the same is true here … quality is experience, but a positive experience is not always a reflection of quality.

I can assure you — patient experience scores are not being dragged down due to overwhelming people problems, rather it is due to process problems. When you find low scores on experience surveys related to things like discharge information or understanding medications, the issues will resolve when the improvement attention is placed on the cause. This requires one to zoom in on the work streams related to how those aspects of care are delivered, and not an overkill of analysis on the experience scores themselves. When the focus shifts to the accountable party (i.e., operations), it allows for addressing inefficiencies, redundancies, competencies, and process flow related to the service rendered. It is then, and only then, will sustainable progress be realized in improving the consumer experience.

Redirecting focus is the easy part, sticking with it is where things test the waters of organizational change. Focusing on quality and process means that ugly realities must be faced. If done properly, the kickbacks, slackers, HODADs, good ol’ boys (and gals), and BTITWWADIs will all be called out. This is scary, uncomfortable, and takes some guts. [Side bar: HODAD is a term I learned from Dr. Marty Makary, and it means “Hands of death and destruction.” BTITWWADI (pronounced bitty waddy) stands for: “But this is the way we’ve always done it.” I’m sure you have heard this as an excuse for why things can’t change!] Focusing on process, business models and the rules of engagement require a culture of safety and accountability (driven from the top) is in place. Therefore, many places end up manipulating their logic and chose the route of least resistance — working to improve experience in a silo. Therefore, health care leaders place their focus on measuring interactions, engagement, and social sensitivities rather than holding their feet to the fire for achieving high-quality outcomes. Consumer experience, and associated service metrics, are not a predicate to high quality and reliable processes — rather, they are results thereof. Quality first.

In summary, patient experience should be utilized as a balance measure when improving quality. For example, if reducing LOS is a quality goal and in doing so, patients feel rushed (as quantified on experience surveys), then there is some balancing of tactics and approach that need to happen. The focus should remain on the outcome (LOS) while the tweaking and calibrating is done by way of your balance measures (experience). One thing to keep in mind is that with all outcome and balance measures, there should also be credible process measures.

These are the things that can be measured and influenced in real time such as huddles, risk assessments, team-based care, etc. Process measures are the drivers to the outcome — we fine tune with balance measures such as patient experience. Make sense?

Trisha Swift is a health care executive.

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