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The importance of patient voice in value-based purchasing

October 16th, 2012

by Jason A. Wolf

This October brings the reality in the United States that the Centers for Medicare & Medicaid Services is now determining reimbursements via its Value-Based Purchasing (VBP) program.

Whether its impact on your organization is big or small, this milestone in the measurement of patient perspective reignites what I believe to be a critical consideration for healthcare overall.

First, there is no better time to reassess your driving motivation for patient experience improvement. If the emergence of HCAHPS (Hospital Consumer Assessment of Healthcare Providers and Systems) or now VBP-driven reimbursement has been the reason for action, you may already be behind on this journey.

Patient experience is much more than a survey or the resulting dollars it impacts. All too often in healthcare we are moved by the latest policy, popular practice or trend. Patient experience, while it may feel like all of the above, is actually none of them.


Our motivation in this new world of consumer choice must be about the actions those who deliver or support care take every day. Consumer choice, quality and bottom-line impact collectively come together to reinforce that patient experience is much more than a survey. It is the ultimate outcome in healthcare today.

While acknowledging the impact of HCAHPS and VBP as the marriage of patient input and financial impact, there are much bolder choices to be made. The most important is that we must remember the power of the patient voice. (I must note here, as I do when I talk about patient experience as well, that in using the word "patient" I mean the broadest sense of patient "unit" encompassing the patient, family and support network).

The power of patient voice is found beyond the use of the HCAHPS survey or even internal satisfaction measures. Its essence is captured in the first component of the definition of patient experience itself, interaction. And it is through interaction itself that we have the greatest opportunity to impact patient experience (and I would suggest to those moved primarily by VBP, to impact the bottom line as well).

Engaging patient voice must be an intentional process, and the ability to create the "right" interactions is key. Some critical opportunities to consider include:

The real value of social media: Much has been written, including in Hospital Impact posts of late, highlighting the value of social media. The power of patient voice via social media is much the same as I have suggested in my previous post about making experience "theirs" versus "ours."

While you might use social media to extol your virtues as an organization, the real magic is in getting their thoughts. Not simply harvesting for input, but actively engaging in virtual conversations with patients and the community becomes a massive avenue to engage patient voice. This includes online chats and posted questions, responses, comments, etc. You can use social media as a tool for continuous dialogue that can and should inform your experience efforts.

An expanded opinion pool via an e-panel: Healthcare organizations are now finding ways to expand the use of patient and family advisory councils with a much more extensive and far-reaching "e-panel." Patients, families and community members are engaged through a number of interaction points with a healthcare organization, from their website or presence in the community such as a health fair, to an actual patient encounter, all through which someone can sign up for the panel. E-panels can be used to solicit input on major topics or segmented to get specific thoughts on issues the organization is looking to address. Not only do panels extend the patient and family input capacity, they too become a significant outreach mechanism in the community.

The intimacy and honesty of personal engagement: I am consistently amazed by how little healthcare organizations do to engage patients and families during their care. I do not suggest we inundate them with surveys or a litany of questions, but if there are things we want to determine during the time and patient or family members are with us, our greatest opportunity is to just ask. Actually engaging patients by asking gives them a sense you care, you are trying to get better and you value them beyond being only a body in the bed.

More importantly, beyond "formal" questions or input, how are you using the conversations caregivers and others have in rooms to gather data and address issues overall? One of the greatest sources of patient voice is in the daily interactions you have with them. Healthcare organizations need to build in means to capture and debrief on this information to discover trends, identify issues or acknowledge successes. Building in a system that drives casual data into a formal process of review can lead to powerful insights and significant improvements.

While these are just three of many ways to approach this, my hope is to spark your thinking about how you are working to engage the patient voice. The greatest opportunity we have in impacting and improving the patient experience is by knowing not only how we are doing, but also what really matters to patients and their families. It all starts with a brave willingness to ask.

Jason A. Wolf, Ph.D., is executive director of The Beryl Institute, where he specializes in organizational effectiveness, service excellence and high performance in healthcare. Follow Jason @jasonawolf and The Beryl Institute @berylinstitute on Twitter.


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