How Are You Improving The Patient Experience?

Patient Experience

By: Daniel Cook

Published: 6/19/2019

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Your facility's future success hinges on meeting growing expectations for high-quality, compassionate care.


The patient was saying all the right things, but something about the way she was acting seemed off. Turn on your observers, thought the receptionist. It's the motto of every staff member who works in the same-day surgery unit at the University of Chicago (Ill.) Medical Center. They're taught to notice a patient's nonverbal cues and demeanor, to listen to voice inflection and read body language.

That training helped the receptionist sense the patient's uneasiness. "You appear a bit nervous," she said. "Is there something I can help you with or is there something on your mind?"

The patient appeared grateful, relieved even, and revealed that she was apprehensive about the nerve block she was about to receive.

Ah, that's it.

The receptionist smiled, said she understood and immediately went back to alert the charge nurse of the patient's concern. The nurse came to the waiting room, sat with the patient and her husband, described in detail how they'd place the block and answered every question the couple had about the process.

"You could see the patient's shoulders relax and she smiled for the first time since arriving," recalls Sunitha K. Sastry, MPH, CPXP, director of the patient experience and engagement program at University of Chicago Medicine. "Her husband was leaning in and really tuned into what was going on."

The entire episode contained the essential elements — a take-charge mentality, empathy, compassion and clear communication — that contribute to a positive patient experience, which has never been more important in this era of value-based care.

Patients have access to incredible amounts of information about their procedures. They feel empowered to choose where they'll go for surgery: a competing facility across town, across state lines or across the border. They expect to be cared for with compassion. They expect their surgeries to go as planned and they demand excellent outcomes.

"In a consumer-driven market, which is what health care has become, you need to build a strong relationship with patients and their families," says Ms. Sastry. "That requires achieving excellence in every experience with every patient, every day. It's a tough nut to crack, but that should be the goal."

Setting the tone

You're with patients for a matter of hours on the day of surgery, so establishing a meaningful bond with them must begin with the first phone conversation. Yes, you must communicate and receive important clinical information during pre-op phone calls, but avoid ticking off a checklist of questions. "Make an effort to put a personal spin on the conversation," says Ms. Sastry. "Even something as simple as commenting on the weather or asking about weekend plans can spark a conversation."

Patients often receive the first impression of your facility when they're surfing the web to learn about the procedure they're about to undergo or the facility where they'll have surgery. Is your facility's website easy to navigate? Does it provide essential information for patients, including staff and physician profiles, and educational material about the procedures you offer?

LITTLE TOUCHES Even the smallest gesture can boost patient satisfaction scores.   |  Pamela Bevelhymer, RN, BSN, CNOR

Patients who can't function without their phones in today's digital world appreciate interacting with your staff through online portals, which let them complete pre-op histories at their convenience and provide them with access to educational materials. They're also likely to download apps that let you send automated updates, alerts and reminders throughout the episode of care, including guidance about preparing for surgery and tips about post-op rehab. On the day of surgery, communication apps let your staff keep family and friends updated about the progress of their loved one's surgery with real-time messages sent from the OR.

Of course, good ol' fashioned personal greetings still make quite an impression. "The seemingly simple things like introducing yourself, making eye contact and smiling, addressing patients by name and giving them your undivided attention make a big difference in how patients perceive your staff and facility," says Callie Craig, MS, BSN, RN, CNOR, systems director for patient experience and education at Integris Health in Oklahoma City, Okla. "Communicating with a positive, personal tone, even if it's for just a couple of minutes, makes patients feel like they chose a good place to have their surgery, that your staff is going to take great care of them."

An increasing number of patients have high-deductible insurance plans, which often require significant out-of-pocket payments. Money is a stress point for many people, and the anxiety of paying for procedures can increase a patient's already high stress level on the day of surgery. Make sure members of your business office research patients' insurance plans and touch base with patients well in advance of their procedures to discuss how much they'll owe when they arrive and the options to cover the costs, including applying for healthcare credit. Patients should focus only on getting through surgery, not on how they're going to pay for it.

Excellent outcomes

What about the tangible aspects of surgical care — opioid-sparring techniques to manage post-op pain, first-stick success during IV starts, active warming measures, and the use of antiemetics and alternative therapies to prevent PONV — that send patients home happy and healthy? They're all essential factors in achieving quality outcomes, to be sure, but they're only a segment of the overall surgical experience.

"We all do those things, don't we?" asks Stacey Decker, MS, BSN, RN, CPAN, vice president and chief nursing officer at Integris Lakeside Women's Hospital in Oklahoma City, Okla. She suggests you ensure your staff is doing them effectively. Accentuate the positive. For example, update your team on the number of normothermic core body temperatures measured in PACU instead of informing them at a staff meeting of how many patients they failed to properly warm over the past month.

"When you share leading metrics instead of lagging metrics," says Ms. Decker, "you provide information they can use to improve patient care."

Staff engagement

POWERFUL VOICE Take time to communicate with family members, who can influence how patients reflect on the care they received.   |  Pamela Bevelhymer, RN, BSN, CNOR

Ms. Sastry says improving the surgical experience for patients demands ensuring exceptional daily experiences occur for everyone in your facility. Notice she didn't say every patient.

"It's essential to establish a positive workplace culture for your medical staff, clinical team and nonclinical workers," says Ms. Sastry. "Engaged employees drive the engagement of patients."

Refocus your staff before every shift on the importance of providing patient-centered care, says Ms. Decker. "We huddle for 5 minutes to reemphasize patients' needs," she says. "We also ask staff about barriers they might face in making sure patients have an excellent experience." When you expect delays, constantly inform patients about their status. "Be transparent, check in with them regularly and make the down time as comfortable as possible," says Ms. Decker.

Of course, no matter how prepared your team is for a day of surgery, patients will be frustrated by some aspect of their care. That's why it's important to train staff on proper ways to communicate with dissatisfied patients, says Ms. Craig. A simple strategy: Paraphrase patients' concerns back to them: It sounds like you're very frustrated because of the wait times.

"It's a disarming gesture that validates a legitimate concern before you issue an apology, if one is warranted, for not meeting your facility's standard of care," says Ms. Craig. "Apologies sound trite if they're given before you take the time to understand the underlying reason for a patient's concern. Listening, truly listening, really makes a difference in how patients ultimately perceive problems and how you respond to them."

Stacy Coulter, program manager of the patient experience and engagement program at University of Chicago Medicine, suggests getting out from behind your desk to regularly ask patients and their family members — it's not just the patient's voice that's important — about the experience they've had in your facility. Addressing concerns on the spot will prevent small problems from becoming major issues you find out about on patient (dis)satisfaction surveys and online reviews, she says.

Human connections

Kindness. Understanding. Comforting. Those are the words the patient who was nervous about the nerve block ultimately used to describe the care she received.

"It's so important to acknowledge and share with staff the positive feedback you receive from patients," says Ms. Sastry. "That's ultimately why you do what you do."

Ms. Sastry acknowledges that compassion fatigue is a real concern, and it's difficult to make a connection with every patient in the outpatient setting, where time pressures are constant and case volume is key, but she continues to be inspired by patients who take the time to share how much they appreciate the kindness and compassion they received during their stay. Remember, too, that you're caring for people who are hurting and frightened of the unknown, who'd rather be somewhere else.

"We love to hear from patients who say we treated them as a person, not a procedure," says Ms. Coulter. "In surgery, it's not always about the wow factor. It's more important to alleviate patients' fears and make them feel as comfortable as possible." OSM

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