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Dome - Q&A: Promoting the 'Always' Experience: A Conversation with Lisa Allen

Dome March 2015

Q&A: Promoting the 'Always' Experience: A Conversation with Lisa Allen

Date: February 27, 2015

Lisa Allen
Photo by Keith Weller

Lisa Allen is the chief patient experience officer for Johns Hopkins Medicine. Trained as a medical anthropologist, she works closely with leaders and frontline medical staff to improve patients’ experience, which is measured with the Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) inpatient survey and other CAHPS for outpatient surveys.

These surveys are mailed to a sampling of patients after discharge or a visit. The HCAHPS survey covers communication with doctors, communication with nurses, responsiveness of hospital staff, pain management, communication about medicines, discharge information, cleanliness of the hospital environment, quietness of the hospital environment and care transitions.

How do we know how patients feel about their hospital stay?

We use the HCAHPS survey, which was constructed based on responses from thousands of patients who were asked what was important to them. You won’t notice things like food, parking or room decor on it. So what is important to patients? To be treated courteously, to have their concerns and questions heard, to receive explanations in a way they can understand, and to have medications and discharge plans clearly communicated.

The survey asks questions such as: “During this hospital stay, how often did nurses treat you with courtesy and respect?” and “During this hospital stay, how often did doctors listen carefully to you?” Patients answer “never,” “sometimes,” “usually” or “always.”

The “always” experience is what we are striving for. It’s what our patients and their families deserve.

What are our scores like?

Our scores are good, but we can make them better. HCAHPS is moving from displaying survey results only in “always” percentages to employing a five-point “star” system, which is scheduled to launch on the Hospital Compare HCAHPS website in April. The Johns Hopkins Hospital will have four stars overall based on the data to be posted. The good news is that we are just a percentage point or two away from earning five stars.

The data tell us that when patients perceive that their care team is working together to care for them, they rate us more highly on the overall experience of care.

What can we do to improve our scores?

The only way the scores will improve is if we change the experience. Certainly working on teamwork is important, because we see how patients’ perceptions of teamwork affect their overall experience. It is everyone’s job to provide the best possible patient experience.

We are reinvigorating the new and improved Language of Caring approach to communication. This is a module-based program that teaches patient-centered communication. We have a strong commitment from leaders at all levels throughout the system to work through the modules over the next 12 months, and we are adapting it for use by physicians. Our goal is to provide compassionate care—to build trust, alleviate suffering, provide a healing environment and offer a sense of hope or comfort.  When people are in the hospital, they are anxious and scared, and they need to feel listened to and cared for. If they do not, they become more anxious and may become more demanding. When you help them feel connected, you can resolve problems earlier or stop them before they even start.

You say that patient safety and the patient’s experience are tightly interwoven. How so?

You can’t have an unsafe environment and positive experience. It’s all on a continuum: If you have a bad safety event, how likely is it that you’re going to have a positive patient experience?

Beyond that, patients whose experiences are good tend to be more engaged, and engaged patients and families can help prevent medication errors. An engaged patient is one who’s thinking: “I know this test result is supposed to come back today. I haven’t heard anything. I should ask about that.”

Talking to our patients about patient safety is a way to engage them and improve their experience: “I know someone just asked you to identify yourself, but it’s my job to keep you safe. I want to make sure it’s the right medication.” Letting people know why we do what we do engenders a sense of connectedness and helps patients feel that they are in partnership with their care providers.

—Interviewed by Christina DuVernay