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Optimizing the Patient Experience
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Optimizing the Patient Experience
Patients are a heterogeneous lot. Hailing from a diversity of backgrounds and geographies, they seek care at Johns Hopkins hospitals and outpatient clinics for numerous reasons. But in one respect they are identical: All share the expectation of receiving safe, high-quality care that is compassionate and responsive to their needs. Good clinical outcomes are of course important, but patients want to feel as safe and comfortable as possible while they are receiving care.
Adult patients’ assessments of their hospital care are measured by the Centers for Medicare and Medicaid Services’ Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) survey, with questions covering communication, care transitions, the hospital environment and more. Based on patients’ responses, a rating of one to five stars is calculated for the different categories, and an overall star rating determined. These results are publicly reported on hospitals’ websites as well as on the Hospital Compare website, the aim of which is helping individuals choose where to receive medical care. The latest overall rating for all hospitals in Johns Hopkins Health System is three stars. To see current results for all the hospitals, go to the Patient Safety and Quality page on the Johns Hopkins Medicine website. (For more about these surveys, see the sidebar “Measuring Patients’ Experience.”)
“Higher star ratings signal that we are delivering on patient expectations, while poorer ones indicate we are falling short,” says Lisa Allen, chief patient experience officer for Johns Hopkins Medicine. Disappointing patients has financial consequences. In Maryland, up to 2 percent of hospital revenue is determined by performance on quality measures, 50 percent of which is based on patient experience.
“Making the patient feel heard, attended to, and respected is important to making their experience a positive one,” she explains. “And that requires good communication skills. Our providers tend to think of themselves as good communicators, but our patients don’t always agree.”
To improve communication skills and meet patients’ expectations, hospitals in the system employ different models to improve communication, including the Language of Caring program, PEARLS, and the Connect-Partner-Reflect model. These help providers establish bonds with patients, engage them in shared decision-making and reinforce key messages about managing their health. Not only do engaged patients feel better about their experience, but research shows that they incur lower medical costs and have fewer admissions, says Allen.
All Johns Hopkins Medicine hospitals have multiple initiatives in place to improve patients’ experience of care. Here we look at what two hospitals in the system are doing. (And for a sense of how one individual can make a difference, see the sidebar "Meet Jesse Grant, Patient Experience Specialist.")
Focus on the Child and Make Things As Normal As Possible
“What is one thing that matters most to you today?” With this question, nurses at Johns Hopkins All Children’s Hospital seek to help young patients and their parents minimize distress and find comfort and hope. Homing in on one thing that will make a difference to a child can go a long way to easing a difficult time.
“The hospital works to make children’s days as normal as possible,” says Joel Roach, the hospital’s service excellence manager. “Fixing a toy or celebrating important events in a child’s life — these individualized, creative activities can make a big impact on our patients and their parents,” he says.
Improving care from the child’s perspective takes many forms, he says. Providers work to engage children and their families in decision-making, and teen patients are invited to join the Family Advisory Council or the Teen Advisory Council. Proactive Point of Care Rounding includes a high level of awareness and application of communication principles from the Language of Caring, such as providers’ positive intent and acknowledgment of the patient’s feelings. Metrics on aspects of the care experiences are gathered and shared, and special multidisciplinary patient experience workgroups are being formed to focus on strengthening specific areas, such as physician communication.
Johns Hopkins All Children’s Hospital has seen impressive gains in its scores on the Child Consumer Assessment of Healthcare Providers and Systems (Child CAHPS) survey as a result of these varied initiatives. In the first and second quarters of FY2017, the hospital attained scores in the 75th percentile or higher in five of 17 measures; in the third and fourth quarters of that year, it hit the 75th percentile or higher in all 17 out of 17.
“These gains are testament to the dedication and willingness of All Children’s staff to grow and change to best serve our child patients and make their hospital stay as comfortable and normal as possible,” Roach says.
Relationship-Based Care at Sibley Memorial Hospital
Delivering an optimal care experience for the patient is based on nurturing three relationships, says Patricia Haresign, patient experience nurse specialist for Sibley Memorial Hospital: care for the self, care for colleagues and care for the patient and family.
“We believe that we have to nurture ourselves to nurture others,” she says. “A lot has been written about the need to build resilience in staff, so we encourage microbursts of self-care to build resilience and cultivate compassion for patients.” Some units have developed tranquility rooms where staff can take a short break to pull up a brief mindfulness or positive affirmation app on their phones, or simply to sit quietly for a moment or two. The skilled nursing facility has an “Engaged 2 Excel” whiteboard where staff members write notes of appreciation to colleagues or name something that they are grateful for.
Mindfulness exercises are taught to help care providers relate to patients and respond to their needs. “When we are attuned, we are intentionally connecting to the patient and learning about him or her as a person, and this creates a caring bond that is mutually energizing and builds trust,” she says.
Problem areas received targeted attention. One unit, for instance, saw its score in one aspect of patient communication soar from below the 10th percentile to the 94th. “On subsequent leader rounding, patients remarked that the staff were always very busy yet were wonderfully cheerful and responsive,” Haresign says.