Identifying the driving forces in patient care to improve satisfaction & outcomes
Healthcare, especially since the beginning of the COVID-19 pandemic, has been changing rapidly. Forward-looking healthcare providers must innovate in the areas of patient satisfaction, safer care and better outcomes. Understanding the latest trends in patient experience is a great place to start.
Telemedicine with a human touch
According to a recent McKinsey & Company report, the use of telehealth has increased 38 times from the pre-pandemic baseline. COVID-19 has normalized telehealth and telemedicine as part of the patient experience, with people expecting easy access to healthcare on their own terms.
“Patients today want quick access to the best healthcare they can receive and really appreciate the ability to get in touch with a provider pretty much from anywhere, anytime,” says Mike Greiwe, M.D., CEO of OrthoLive, a telemedicine platform for orthopedic surgeons that provides orthopedic care both virtually and through its hybrid service model. “It’s incumbent upon healthcare providers to offer that type of care. It’s what patients want, and it’s something telemedicine can deliver.”
But patients still appreciate and look for a personal connection to their healthcare providers, adds Monte J. Goldstein, M.D., Chief Medical Officer at Virtua ASC Joint Ventures. “When the pandemic started, I think the general feeling was that telemedicine would really be the new norm, and that patients would be accepting of electronic contact. But what we’re seeing is that patients are coming back to the personal experience to the point where medical providers can’t keep up, even though telemedicine is an option,” he says.
OrthoLive’s hybrid virtual/in-person care model is an interesting example of how providers can scale the services they offer while still providing a human touch.
Though it currently offers predominately virtual care, the company is growing its hybrid model by working inside other providers’ facilities and has plans to open up its own offices as well. This means, for example, that a rural hospital system can create an orthopedic service line and have access to experts using OrthoLive while keeping their patients inside the local health system.
“We are going more and more toward this hybrid model, where we have in-person and virtual clinics set up so patients can see trusted providers in their local communities, 24/7/365. We think that’s going to be the future,” says Dr. Greiwe.
Connecting data for deeper insights
Health systems are required to measure patient experience in order to receive full reimbursement from Medicare. The Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) is a national standardized survey of patients’ perspectives of hospital care. This data is useful but limited, says Karla Miller, PharmD, BCPP, Chief Patient Safety Officer at HCA Healthcare. That’s why many health systems, such as HCA Healthcare, are moving beyond the HCAHPS survey, gathering real-time feedback from patients, and utilizing data and findings to inform quality care.
“When you look at just the HCAHPS measurement, it’s hard to get an understanding of what areas you really need to drill down into. But when you combine that with real-time feedback through your rounding process, social media or grievance process, then you can get a better understanding of what’s driving the patient’s experience and help ensure teams are empowered to provide superior, patient-centered care,” says Miller.
Demographic, operational and clinical data from electronic health records are also being used to better understand patient populations and their needs. “We work very hard to pull in all these data elements and use them to develop targeted initiatives, drive action plans and create tools to improve the care experience,” says Miller.
Data teams learned that when patients are in the emergency department for more than a certain amount of time, they are far less likely to give positive feedback. “That makes sense, but we need to really understand why,” says Miller. “Is it because they don’t understand why they’re there or what’s taking so long? That’s where you have to do a deep dive to understand how the patient survey data matches with their overall healthcare experience.”
Building on COVID-19 innovation
Like many hospital leaders across the country, those at Franciscan Health Crown Point, a community hospital in northwest Indiana, had to find creative solutions to the challenges of the pandemic. By leveraging technology to deliver COVID-19 care more efficiently and safely, they’ve been able to innovate in ways that improve patient care and experience beyond the pandemic.
One of their first concerns at the beginning of the pandemic was the availability of personal protective equipment (PPE), explains Erik P. Mikaitis, M.D., MBA, FACP, CPE, Vice President of Medical Affairs and a HealthTrust Physician Advisor. The team at Franciscan Health Crown Point developed a consultation process using an iPad on an IV pole where only the hospitalist, nurse and respiratory therapist would meet with a COVID-19 patient in person, and the rest of the medical team would join virtually.
“The three of them would go into the room to see the patient, and the tablet connected them to a conference room where four subspecialists and support team members could join in remotely,” says Dr. Mikaitis. This reduced the amount of PPE used and also limited the number of people exposed to the virus.
From this experience, they developed a virtual “telesitter” solution for a subset of patients who required supervision but weren’t on suicide precautions. “We decided to see if we could tweak the tablet process to use in that capacity,” he says. They started with one certified nursing assistant (CNA) sitting with six tablets monitoring six separate rooms. “So instead of six people sitting in rooms, we had one person watching six at once. They would provide redirection through the tablet or call a nurse if required.”
Franciscan Health Crown Point saw about a 45% reduction in falls during that pilot group in the first three months and reduced the staffing requirement by about 26%.
Retail convenience
Retailers such as Walgreens and CVS are accelerating their expansion into healthcare. For example, Walgreens plans to open 500 to 700 primary care offices in their stores over the next five years.
The popularity of retail healthcare can’t be ignored by health systems. Patients are attracted to the easy access, sometimes delivered at a lower cost than traditional providers. “It’s got health systems talking about retail strategies. How do we match retail pricing? How do we engage on that level to offer that availability and access?” says Dr. Mikaitis.
Despite the increasing popularity of retail healthcare, Dr. Mikaitis thinks health systems still have the advantage—as long as they find a way to match the convenience that retailers offer. “The ball is in the healthcare system’s court right now, and it’s going to depend on how they react in terms of what happens in the long run,” he says. “People have relationships with healthcare systems. If your primary care provider is affiliated with a health system, and that’s where you have your elective surgeries or you’ve delivered your kids, you start building a relationship with the system.”
The whole patient experience
To truly understand and improve the patient experience, providers need to look at the whole spectrum of experiences—the complete journey a patient takes from their first interaction with the healthcare system to their last. Though historically patient experience has been seen as a care provider task, we’re understanding now that its scope is much wider, explains Miller.
“It’s a collaboration between the care team and everyone surrounding the patient—from the person cleaning the room to the person bringing in their meal tray. But it’s also more than that,” Miller says. “It’s the overall experience from the time a patient starts interacting with the healthcare system all the way until they’ve been discharged and someone has followed up with them.”
In an increasingly digital world, the patient journey is becoming more convenient and efficient. But medicine will always need the human touch.
“The fundamental thing that we all need to hold onto, as physicians and as clinicians, is that very esteemed, very cherished doctor-patient relationship,” says HealthTrust Physician Advisor Jason Mouzakes, M.D., FAAP, Professor of Otolaryngology and Pediatrics at Albany Medical Center Hospital.
Here’s what healthcare providers should keep in mind about balancing humanity and technology:
1. Prioritize the patient over the technology
“How important is it to sit at the computer, elicit a history and type things in, versus the humanity of sitting across from somebody on a stool and really listening carefully to what they have to share?” asks Dr. Mouzakes.
The drive for efficiency with digital tools mustn’t take away from making a personal connection with your patient. “The priority is being present and being focused, and making that person understand that their complaint or their health concern is the number one concern for you at that moment,” says Dr. Mouzakes. Consider the impact of your body language, sit face-to-face with patients and put away any unnecessary digital devices during your conversation.
2. Overcome digital distance
Telemedicine comes with extra challenges when it comes to creating personal connections. “One thing that gets lost in telemedicine is the ability to look into a patient’s eyes and at their facial expressions, and see how impacted they are by the story they’re telling,” says Monte J. Goldstein, M.D., Chief Medical Officer at Virtua ASC Joint Ventures.
Video calls help bring back that connection and provide a unique opportunity to get to know a patient in their own home. A few minutes of small talk can really help to put a patient at ease. Active listening techniques, pausing to give patients an opportunity to open up and responding to them empathically, when appropriate, are all ways to create that one-on-one connection in person, over video or even just on the phone.
3. Take extra care with the patient portal
Patient portals have been a huge advance in the transparency of data and empowerment of patients, but, says Dr. Mouzakes, the challenge is that patients can receive test results through the portal without a doctor’s guidance or analysis.
“For many of our patients, trying to interpret that data can be somewhat unsettling. I think it puts a bit more pressure on us as physicians to preempt just posting those results,” he suggests, noting that if doctors take time to talk through possibilities with patients ahead of time, it can add much-needed context to test results in the portal.
4. Understand technology & how best to use it
Technology has enormous potential to help deliver better care to patients, but hospital systems must remember that humans are still in charge of that tech and can control how it’s used.
“I think we were blindsided by how quickly we would be required to use all the new technology that was given to us. We need to be better prepared, and that includes physicians, nurses and all the ancillary providers as well,” says Dr. Goldstein.
