The Beryl Institute Blog Archive

As part of its ongoing commitment to providing an exceptional patient and family service, Community Health Network (CHN) in Indianapolis, decided to turn to its employees for input on how it can continue to improve this aspect of its mission. As part of a recent survey to staff members at one of the system’s hospitals, CHN asked about potential barriers to improving patient experience.  This generated great energy among the staff with more than 300 staff members offering over 800 distinct responses regarding possible influences on the patient experience in their facility.  

From those responses ten top barriers were identified, including:

1.  Poor personal communication skills  

2.  Lack of time to spend with patients and families due to conflicting organizational priorities

3.  Managers and Administration not making Patient Experience a priority

4.  Lack of staffing

5.  Equipment and supply issues that both interrupt the ability to provide care and frustrate the patient

6.  Attitudes and mood of the staff that affect ability to relate to patient  

7.  Ineffective systems and processes

8.  Interdepartmental communication breakdowns

9.  Excessive “all staff” emails cut into patient care time

10.Breakdown in teamwork

One of the significant “ah-has” from the survey is that while many of the barriers are not surprising, they are clearly items that can (and should) be addressed and improved. While some are operational issues, such as staffing or equipment that may require longer decision cycles, the others get to the core of how staff at all levels engage with patients and one another. These provide potential opportunities for more immediate impact.  

Hospitals that want to pursue improvements in patient experience can learn from CHN’s process. Take the important first step to identify organizational changes that can be made quickly. They can also learn from the list itself, in recognizing it may be some of the very fundamental aspects of organizational life that impede our ability to best meet patients needs. In CHN’s case, how can communication skills be improved, interdepartmental communications reinforced or stronger teamwork developed?

Let me be clear, in sharing these examples I am not suggesting the solution is simply training.  Rather, success is realized through an unwavering commitment to make fundamental changes in your organization. These are not cumbersome and large shifts taking great time, effort or resources. They are focused and purposeful improvements that will go a long way to change the experience for patients and their families, as well as your employees.

This week The Beryl Institute releases the first in our expanded series of white papers on improving the patient experience.  The paper provides insights from three individuals who are leading efforts to transform how their organizations address the patient experience, one of which is CHN.   For all three organizations, the patient experience starts well before the patients enter the physical hospital building at their first contact with the hospital - be it online, on the phone, or in the parking lot. This reinforces the idea that first impressions are just the start of creating truly lasting impressions. Through their stories, each individual helps us see is that it is often a commitment to identifying opportunities and then taking steps to address the fundamentals that can have a significant impact.

The healthcare marketplace is increasingly focused on what it will take to improve the patient experience. The trick is determining what steps matter, where we can make positive change quickly and what actions may require more time and resources.  Right now, having a top patient experience score translates into local market bragging rights. Soon it will equate to bigger reimbursements from CMS. So can we create a formula for improving the patient experience? Remember, as the experience at CHN shows, improving the patient experience is an individual journey for each organization; one that requires clear priorities, unwavering commitment and a bias for action. Perhaps the real question is can you afford not to?

Jason Wolf

Executive Director - The Beryl Institute

There is no disputing the name Ritz-Carlton is synonymous with customer service.  Part of the credo of Ritz-Carlton is, “Where the genuine care and comfort of our guests is our highest mission.” And now more and more hospitals are adopting the Ritz-Carlton service excellence model.  This isn’t surprising given that hospitals will soon receive a portion of their Medicare reimbursement based on patient satisfaction scores. With this imminent reality, I wasn’t surprised when Henry Ford West Bloomfield, a new suburban Detroit hospital, chose a former Ritz-Carlton executive as its CEO, nor was I shocked to learn about the Concierge Care program at New Jersey-based Riverview Medical Center.  Through this service, Riverview patients can order a massage or manicure during their stay, make arrangements for pet care, take care of gift lists with gift selection, wrapping and shipping services, and order delicious meals from participating area restaurants.  These services dramatically reframe the traditional expectations of a hospital experience.

What did catch me by surprise is that some hotels are now purposefully shifting to act more like hospitals.  The Ritz-Carlton in Philadelphia has rolled out a new concierge service developed exclusively for discharged patients who aren’t ready to go home and don’t want to stray too far from the medical team that provided care.  The service appears ideal for patients who have lengthy but uncomplicated recovery times or lengthy treatment scenarios.  For patients, the hotel offers more pampering than if they had stayed at the hospital. For the hotels, the recovering guests present the opportunity for new revenue streams. A medical concierge at the hotel tends to each guests needs. The concierge does not perform medical procedures or administer drugs, but the concierge can provide wake-up calls for medical appointments, transportation to and from doctors' offices, special sleep arrangements, custom dietary options, prescription pickups, etc. Because the hotel is close to the hospital, medical teams can more easily provide necessary follow up care.  The hotel shuttle can even pick them up.  All the services are a la carte, added to a guest's final bill much as an in-room movie would be. Whether specific services are covered by health insurance is up to the guest's provider.

Philadelphia, with its abundance of internationally recognized hospitals, was a natural fit for the hotel chain's pilot program, said Michael Walsh, general manager of the city's Ritz-Carlton.  Hotel analysts say the medical-concierge idea is the latest competitive strategy for luxury hotels, which boast of having the best of everything.  If the medical-concierge program is successful, the Ritz-Carlton Hotel Co. says it plans to expand it nationally and abroad.

You may be thinking to yourself, “We don’t have a Ritz-Carlton next to our facility or even the internal bandwidth to offer concierge-like services.”  This shouldn’t limit you in this effort. Perhaps you can partner with other businesses in your community to provide special services for your patients while they are undergoing outpatient treatment or in the hospital.  For instance, are you near a bakery that will deliver get-well cookies, or a drycleaner who is willing to pick up patient clothing?  Could a local hotel shuttle pull double-duty as a hospital shuttle for outpatient visits or doctor’s appointments?   If a service could be viewed as a value-add for the patient or family member, consider how to make it work.  It will be sustainable if the concept benefits both the hospital and the local business, plus it will have you stand out for your commitment to service.

As someone whose organization is committed to helping hospitals provide the optimum customer experience to patients and families, I’m struck by the genius behind the Ritz-Carlton effort. This type of commitment to the patient experience before, during and after the delivery of care should be at the core of all we do in health care. It is a chance for you to become an extended business partner in the communities you serve and more importantly have your institution be the place patients choose not only for care, but for superior service.  Go ahead…surprise them!

Jason Wolf

Executive Director - The Beryl Institute

If you’ve spent time near urban downtown traffic intersections, you’ve likely seen these brave souls…. traffic cops.  Nowadays, of course, traffic police can be spotted near malls, busy school zones and large churches. They are indispensible.

As health care policy experts talk about health care reform, one of the central aims of reform is improving care coordination, and the overriding assumption is that hospitals will be the traffic cops.  Health care’s busiest intersection is the nexus where hospitals, insurers, other health care providers and payers mix together.  It’s a loud and busy place. In the future, physicians will no doubt play a role in care coordination, but hospitals will be deciding when patients need to be released, where they should go for care after discharge, and what the care continuum will look like.  This is all the more likely as an increasing number of physicians become employees of hospitals as part of growth initiatives or due to the fact that they are seeking some level of economic security.

Many health care experts are betting that Accountable Care Organizations will form across the country to manage care coordination.  That’s not necessarily the case everywhere when you consider that setting up an ACO is a complex proposition.

With or without ACOs, my instincts tell me that hospitals will be the central drivers in a new care coordination system.  To operate effectively, though, hospitals will need a more sophisticated system of communications to accomplish their work, meaning integrated voice, IT and patient records systems and channels.

We know the government has pledged to help hospitals upgrade their IT systems to advance use of electronic health records.   The government hasn’t pledged financial support for upgrading phone communications systems and triage networks, leaving that to each hospital to manage.  But this work isn’t merely a technological issue; it’s also an issue of customer relationship management.  How will hospitals maintain connections with patients, payers and other providers so that care is better coordinated?  The same way they do it now?  Let’s hope not.  I say this simply because we’ve seen only limited examples of successful and effective care coordination, primarily in markets that have sole providers in a tight geographical region--Geisinger Health System comes to mind.  The Medicare Advantage program also deploys care coordination teams for some, but not all, of its covered lives.

The real challenge for hospitals that will carry out the job of traffic cop will be setting up the care coordination teams, creating infrastructure to support them, and paying for this new and intense level of service.  Some health systems are large enough to manage this endeavor on their own having the needed staff resources on hand, but my guess is most hospitals are not prepared for the potential scope of this effort.   In terms of the financial implications for this effort, it’s anyone’s guess.

We know care coordination holds the promise of improved health outcomes for many patients, especially patients with chronic illnesses. We believe better care coordination will ultimately generate savings through reduced hospitalizations and readmissions and eliminating duplicative services. Maybe the savings will balance the expense. More often than not, the savings don’t fall to the hospitals, but to the payers.  My hope is that regulatory issues won’t prevent all the parties involved from sharing the savings with hospitals and ultimately the consumers of healthcare themselves.

One consistent theme in the discussions around health care reform is that hospitals are being asked to invest a great deal of their limited resources up front to help fix the system, with the hope and promise that they will reap a legitimate ROI later.  I sincerely hope this is the case.  No sane traffic cop would enter an intersection without a whistle, orange vest and white gloves.  We can’t expect hospitals to perform the vital activities that are linked with care coordination without providing them adequate resources and support.

Jason Wolf

Executive Director - The Beryl Institute

Mother’s Day is just around the corner, and AT&T estimates that nearly 123 million will call Mom that day--in percentage terms, 68 percent of people in the U.S. will call Mom to say hello that day.   Ask yourself, though, what makes Mom feel special?  Is it the one call on a day when everyone feels obligated to touch base with Mom, or all the calls in between?    The answer is obvious, and that rule might apply to patients, too.

More studies show that the key to preventing hospital readmissions is contacting patients within the first week following discharge.  That’s a great idea that needs to be more universally implemented.  However, in an era when patient satisfaction is becoming almost as important as preventing readmissions, contacting patients only after they’re discharged may seem like the bare minimum effort…like the call on Mother’s Day. 

Maintaining some sort of consistent connection with patients will likely be a key ingredient to improving the patient experience overall, since we know that the definition of “the patient experience” is expanding beyond the actual acute care stay or outpatient visit.    Health care providers that can build a connection with their patients and potential patients will fare better than those that don’t.  Prioritizing patient contacts means your organization will have to abide by spam laws and no-call rules, but it can be done….if you focus on capturing the information and permissions you need as patients engage your services early in the care process.

As I’ve stated before, I believe one of the major trends that will come from health care reform, now that it’s finally passed, is the development of accountable care organizations.  By their nature, ACOs will require some sort of frequent communication with patients between visits.   If promotional mail is filtered out, and email systems are clogged, the phone may be the best and most personal tool for hospitals that want to connect with and market to patients and potential patients.

For an acute care hospital with an active patient base of about 50,000--the base being defined as the number of individuals treated as inpatients or outpatients within the last 12 months--it’s actually possible to call all of them once each year, if you have a team of six callers working every day in eight-hour shifts.  During these calls, you could discuss their last stay, any new health issues, and recommend preventive or diagnostic screenings.   How realistic is this scenario?   For most hospitals, this approach would not be realistic, nor very useful in terms of helping patients manage their health, because not all of these patients would need or appreciate that sort of call.  However, there would be a tremendous ROI, both in improving satisfaction and increasing patient long-term loyalty. 

The key is to develop a patient contact strategy, determining which patient subset is appropriate to call and setting up the systems to support those patients’ needs, such as scheduling, etc.  One thing I don’t recommend when calling patients -- don’t be like the 3 percent of people who call collect on Mother’s Day!

Being stranded on the side of the road with an automobile emergency is one of life’s least popular little interruptions...and there’s very little that can change that perception.   However, a friend told me about his recent experience with a flat tire during rush hour that may have changed my mind, a little.  

He used the roadside assistance service linked to his cell phone plan and called for help.  Within the hour, a patient and skilled auto assistant came to his rescue.   In a short time, he was on his way again.   Several very striking things occurred during the hour or so my friend was stranded.  I related his experience to where health care needs to go. 

Within a few minutes of placing the call for help and getting confirmation that help would be sent, he got a return call updating him on the status of the roadside rescue driver.   A few minutes after that, he received another call inquiring about his ongoing safety.  Shortly after the tire was replaced and the roadside technician had left the scene, he received another call asking if he would take an automated survey on the dispatch center service and roadside technician service, with the option of speaking to a real person following completion of the survey if he wanted to provide additional feedback or had any questions.  

While my friend probably should have noted that his tire was worn and done a better job with car maintenance before starting out on the road, the roadside service did its best to get my friend up and running again, while keeping him informed and providing a conduit for additional communications.   The only thing the service didn’t do was put my friend in touch with the closest car mechanic for a more thorough examination of his car.  Maybe that’s a thought I should a pass along to the cell phone company.

In the not too distant future, I believe health care providers and/or insurance companies will need to develop this kind of intensive connection program with patients under their care.   This translates into communications before the inpatient visit and after discharge.  For non-urgent care, early connection with the patient could ensure that he or she gets more comprehensive treatment during the pending patient visit.   For example, while a patient may request an appointment regarding an arthritic shoulder, a quick over-the-phone health quiz might also uncover the need for an annual cholesterol check or colonoscopy, allowing the provider to make those arrangements during the upcoming visit.   In addition, contact after discharge is a key step to reducing hospital readmissions.

Every consumer is basically like my friend with the car….cruising down life’s highway, and perhaps not taking good care of themselves.  When an emergency occurs, they want to call someone who can help solve the immediate problem, but also help manage the situation.   If a cell phone auto rescue plan can provide that attention for $9.99 per month, shouldn’t hospitals and insurance companies look to model this type of customer service?  What are you doing to be only a phone call away?

Imagine a health care system where doctors have a financial incentive to limit unnecessary tests and ensure that patients take better care of themselves.  This system would actually aim to keep patients out of the hospital. 

This is the goal behind Accountable Care Organizations, or ACOs, the latest health care delivery model being touted by D.C. policy wonks and health care gurus.  The current version of the health care reform bill in the U.S. House of Representatives calls for a Medicare pilot project to see if ACOs can lower costs and improve care. 

What exactly is an ACO?  There is no exact answer, but they must include three components: primary care physicians, specialists, and at least one hospital, and the size of the hospital doesn’t matter. These three groups would share responsibility for the quality of care and the cost of care received by the ACO's patients. If the ACO achieves both quality and cost targets, it could receive a bonus; if it fails, its members could face lower Medicare payments. The incentive is to deliver coordinated, efficient care. 

Each ACO would be operated by a group of doctors and hospitals that would be paid by Medicare to care for all the health needs of at least 5,000 elderly or disabled people.

Under the existing fee-for-service system used by Medicare and most private insurers, doctors get paid more by providing more services, and hospitals make more by increasing admissions. With ACOs, doctors and hospitals would get paid based on their ability to hold down overall costs and meet quality standards. In effect, their pay would be based on improving care, not generating more of it.

If the ACOs fail to meet certain quality and cost savings targets, the providers in the ACO would receive lower payments from Medicare.  Conversely, the ACOs would also be rewarded for keeping patients happy and meeting national quality standards, such as making sure men get annual prostate exams and women get their annual mammograms.

In effect, ACOs are an attempt to build relationships between doctors and patients that mimic the closeness that many small town doctors enjoy with their patients.  It’s also an attempt to build integrated health systems like the Mayo Clinic where none exist. But Mayo took several decades to build.  The pilot ACO studies will attempt to see if one can be formed in a year or two.

Creating ACOs requires hospitals and doctors to work closely together and to share financial risk, as well as potential profits.  This means ACOs must break down some pretty serious political and cultural boundaries between hospitals and doctors.  Many doctors prize their independence and don’t want to be bossed around or be treated as employees.

Not all ACOs have to be the same. This could be especially true in rural areas.   The end result, though, is the same: creating an integrated health care organization that is responsible for cost and quality.

If hospitals and doctors are going to live up to this objective, they’re going to have to manage patient health in a more proactive manner.  This means becoming slightly more intrusive.  Imagine a time when the doctor or hospital representative becomes as intrusive as the telemarketer.  The only difference is that the telemarketing call probably raises your blood pressure, whereas the weekly ACO caller is interested in helping you lower it.    How many hospitals are set up to maintain this sort of contact level?  The ones that aren’t may not be ready for the ACO agenda.  Tell me what you are doing to proactively manage your patients’ health.

2010 is here; a new decade with new challenges. During the past decade, all sorts of new technology entered our lives. As your children played with the latest Wii, Xbox or PlayStation, and you downloaded the latest best seller to your Kindle, did you take the time to think about the implication of the latest technologies for your hospital?

How will patients, accustomed to using their phones for instant access to everything, change the customer service demands for healthcare providers? Will they expect to use text messages to get their room cleaned? Will they want a special app for food on demand?

A new report, Trends in Patient Service Strategies: Improving Customer Satisfaction with Technology, explores how healthcare organizations can leverage technology advancements to improve customer service.  While most hospitals already use relationship management systems and web-based scheduling and are dabbling with personal health records, patients are looking for e-mail and chat as well as registration kiosks and patient portals. This report details how technology can support and improve patient satisfaction.

I believe that in this new decade we will increasingly rely on technology to support our customer service initiatives. The emergence of new technology and the increasingly high expectations of patients will make support for technology a strategic necessity. While there may be challenges to adoption, I am convinced that hospitals who leverage technology will increase customer satisfaction.

How are you integrating technology into your customer service strategies? I'm anxious to hear from you. So text me, email me, tweet me or use whatever technology you prefer. I want to hear from you...my phone works pretty well too.

You can follow Paul on Facebook (facebook.com/paulspiegelman) and Twitter (@paulspiegelman).

A sweet grandmother called St. Joseph's Hospital and timidly asked, "Is it possible to speak to someone who can tell me how a patient is doing?"

The operator said, "I'll be glad to help, dear. What's the name and room number of the patient?"

The grandmother said in her weak, tremulous voice, “Norma Findlay, Room 302."

The operator replied, "Let me put you on hold while I check with the nurse's station for that room."

After a few minutes, the operator returned to the phone and said, "I have good news. Her nurse just told me that Norma is doing well. Her blood pressure is fine, her blood work just came back normal, and her physician, Dr. Cohen, has scheduled her to be discharged tomorrow."

The grandmother said, "Thank you. That's wonderful. I was so worried. God bless you for the good news."

The operator replied, "You're more than welcome. Is Norma your daughter?"

The grandmother said, "No, I'm Norma Findlay in Room 302. No one tells me anything."

--------------------------------------------------------------
Many of us can identify with Norma to some degree. Perhaps we’ve felt out of the loop and uninformed at some point in our own healthcare experiences. Perhaps it was a situation where we didn't feel like our doctor explained a condition in more detail, or when a nurse came to run tests we didn’t fully understand, or when the physician’s office location changed without telling us. 

As healthcare providers, it’s easy to get caught up in the behind-the-scenes work and our many daily tasks. We may not realize how our interactions or inactions might affect the patient experience.

I did spot one good thing in this story though. It sounds like the hospital was doing a good job making information available to family members, giving the organization the benefit of the doubt when it comes to HIPAA violation.

With patient satisfaction so important, stepping back and assessing how well all levels in your organization are doing with respect to communicating to patients is critical. As a healthcare organization committed to delivering the best patient experience, what steps are you taking to ensure that your patients are kept in the loop and do not feel like Norma?

I bet you've used Consumer Reports to help buy a used car, washing machine or hi-def TV.  But did you realize that you can now use Consumer Reports to shop for healthcare?  Hospital ratings data has now gone mainstream, not buried in obscure sites like cms.hhs.gov and leapfroggroup.org that many consumers are still unaware of.  

Consumer Reports is now providing hospital ratings for more than 3,400 U.S. hospitals using HCAHPS data.  Consumers can now find the famous "Recommended" checkmark for a hospital just like they would do for a Toyota.  You can track ratings on eight performance indicators regarding the patient experience, including nurse and physician communication, room cleanliness, discharge information, staff attentiveness, communication about medications, pain control and noise level.

Are we ready for consumers to see our true colors as they would for a car or computer?  Results show that we're not:

- 92% of the hospitals received the lowest ratings for staff communication about medications

- 82% of the hospitals received negative feedback for the way they give out discharge instructions

In short, the kimono is now open.  We are exposed to the consumer community and we should be.  I would appreciate your thoughts about how we make sure that our customers trust us enough to give us the Consumer Reports "Recommended" checkmark.

Are you tired of your friends showing off their latest iPhone applications?  Well, there is one iPhone program that will impact all of us in healthcare – Canopy Financial’s new iPhone application for consumer-directed health (CDH) plan enrollees. This new application allows iPhone and iPod Touch users to determine if they can use their spending accounts to pay for a procedure – and, more importantly, determine the typical cost of the procedure based on zip code.

According to Canopy’s CEO, this information will help consumers comparison shop for procedures and even negotiate prices with providers.  Contact information is included! The next target for this consumer-friendly pricing model? The Blackberry. The company’s goal is to eventually have this program available on all mobile phones.

I have long believed that price transparency and even price parity will be coming to healthcare.  And, I feel strongly that healthcare providers must focus on developing a compelling customer-focused value proposition that includes but also transcends price.

With consumers negotiating prices, it is more important than ever to connect with customers before they need a procedure.  Then price will become only a part of the value equation – with service and brand playing a key role.  Pricing is no longer the elephant in the room that no one will discuss.  What are you doing to promote your value to consumers?