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The power of healthcare's 3-letter words

November 28th, 2012

by Jason A. Wolf

With the value-based purchasing (VBP) period now underway, the latest round of rules released for the Affordable Care Act (ACA), the reinforcement of electronic health records (EHR) under meaningful use and the accountable care organization (ACO) movement gaining traction, I realized we have become lost in a sea of three-letter words in healthcare, particularly in the United States.

And these words have, for many, taken on a similar feeling as their more established cousin, the four-letter word. These terms have become necessary evils to some and have even caused disdain for others. Most recently, requirements associated with these policies have created a backlash of commentary on the purpose of these regulations and their potential impact on healthcare overall.

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The most pertinent of these as we look at the expanding dialogue on patient experience is VBP, which actually ties reimbursements to performance in both quality (through core measures) and experience (through HCAHPS--the Hospital Consumer Assessment of Healthcare Providers and Systems survey).

I have not been shy in suggesting that VBP and/or the HCAHPS survey itself should not be the main motivator for action, but it is clear that these policies and their sister three-letter words have caused heightened awareness and even greater sense of activity across the U.S. healthcare system.

While we all recognize the actions and even the professional emotions these ideas have stirred, it also is fair to say we must move beyond the stage of complaints to serious recognition of how these ideas will affect the healthcare experience, specifically the patient and family experience. I offer three considerations as we look to have the greatest impact on patient experience in this new era of policy--choice, perception versus process and implications versus intricacies.

  • Choice: In discussing the patient experience with healthcare leaders above all else our actions are truly about choice. While some may argue "we have no choice" as a result of regulations, I would counter by asking is that the true reason to act or are we committed above all else to health, well-being and healing of all in our care? Choice is perhaps the most powerful tool at our disposal in addressing experience as it signifies leadership commitment to a vision, it exemplifies staff willingness to act, and it engages patients and families in their own care encounter. The implication of choice was explored in a recent Hospital Impact blog post.

  • Perceptions versus process: In healthcare, we have mastered the science of process, designing systems, structures and even buildings to support an effective process of delivering care. While not a negative, it poses significant challenges if this is the only point of focus. While we want to ensure a safe and efficient delivery mechanism, this is often designed with the deliverer in mind, not the perspective of the patient and family. At The Beryl Institute, we define patient experience as the sum of all interactions, shaped by an organization's culture, that influence patient perceptions across the continuum of care.

    At the heart of this statement is that for all we do in healthcare, we must be aware of and informed by the very perceptions of those for whom we care. In a recent blog post I offer that it is perception that will shape a healthcare organization's reputation, and ultimately influence the bottom line.

  • Implications versus intricacies: Regulations, such as those described by our three-letter words, often take on an air of inevitability and we tend dive into the weeds on the operational intricacies needed to get them "right." I think we would be better served by spending time working on the implications for why we should act. For example, in a recent study, a focus on experience measures were seen to be a better driver of reduced readmissions rates. If we spend all our time on getting the rules right we may actually overlook the path towards the best potential outcome for patients and families overall.

In the end, we must look beyond our thoughts or feelings about the three-letter words and recognize we have huge opportunities. When we take choice, perception and implications together we have a serious prescription for focused, intentional action that moves us beyond the compelling force of policy to one in which you can be clear you are doing the right thing.

For most, healthcare wasn't an industry we joined to drive efficiencies or find great wealth, though these are both potential results. Fundamentally, it was about the opportunity to make a difference in the lives of the patients and families we serve. That trumps policy every day.

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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