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What if patients designed experience surveys?

November 20th, 2013

by Jason A. Wolf

In a recent Hospital Impact post, I shared the experience I had during the birth of our son this spring. I stressed an important point that continues to emerge in the many conversations I have with caregivers, patients and family members--the how trumps the what in patient experience success.

With all that I believe to be central to the improvement of patient experience, I also have been increasingly aware of some gaps in the overall process itself and want to poke a bit at our accepted practices.

In conducting interviews for an upcoming paper exploring the measurement of patient experience, I thought of my first opportunity to receive (albeit indirectly) an HCAHPS (Hospital Consumer Assessment of Healthcare Providers and Systems) survey just weeks following our son's arrival. While I have addressed both the value and limitations of this survey, when helping my wife answer the questions I found many things I could not respond to.

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So why could I not respond? It was not for lack of knowledge, but because certain things were not asked. There was no way to address the hows I experienced--for example, the incredible kindness and support provided by the housekeeper who served as the most effective and caring navigator of a stay for an incredibly nervous and sleep-deprived new dad.

With that, I continue to pose the question: What if patients and/or family members designed the HCAHPS and experience surveys--what questions do you think they would ask?

The powerful implication of this inquiry is not only the questions people have and continue to suggest, but the realization of what many of us in healthcare overlook at times--that we too are patients, we too are family members, friends and loved ones--and there are things we wish to share.

Now, this is not an argument about validity, purpose, focus or intent of existing surveys, or a suggestion that questions generated in this way would be representative or statistically valid. We also must acknowledge that surveys such as HCAHPS are now mandated and take up both time and budget resources that could impede asking more. But perhaps that is my point, in striving for clear measures, is it possible we are potentially missing something important and significant in really improving experience overall?

As I ask about patients and/or family members designing the HCAHPS survey, I've seen some of the following themes emerge--and while some could argue some ideas already are represented in current surveys, the point here is not one of explaining away, but of listening.

Emerging themes include:

  • Effectiveness of the care overall: Were the outcomes those we discussed or what I expected, and, if not, was it clear why?
  • Clarity and explanation: Was time taken at all points in the care continuum to help me understand process, procedure, diagnosis or rationale, outcomes, required actions, personal commitments, etc.?
  • Understanding of my needs: Did someone take the time to clarify my needs and expectations and help me see which of them could or could not be met based on the situation?
  • Coordination and teamwork: While individual responsiveness or communication may have been positive, did my team work well together or convey confidence in their coordination or alignment around my care?
  • Respect of my uniqueness: Was I treated as an individual or rather just a part of a repeatable process?
  • Listening and inquiry: Did anyone take the time to truly listen to me beyond being "responsive"?
  • Highlights or impactful moments: What situation or individual provided a remarkable encounter and what did they do?

As noted above, this is not a critique of what we do, but rather recognition that we may be missing something. This is more than a nice exercise in including the voice of the patient. This is an effort to ensure the best in experience outcomes--that of quality, safety and service--in each and every healthcare encounter.

If we challenge ourselves as healthcare organizations to consider what we would like to be asked or take the bold step to ask our patients and their families what they would like to be asked, we may have all we need to know to move the needle up, and from one of simple quantity to the quality of the encounter overall.

So if it were you, what would you want to be asked? I invite you to join the conversation.

Jason A. Wolf, Ph.D., is president 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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