Houston Methodist

Jim Cook

Being a successful manager in a highperforming organization is not easy. You’re tasked with multiple important priorities related to the organization’s mission and rated on the ability to accomplish difficult tasks connected to this mission while using resources appropriately and efficiently. At Houston Methodist, we have a vision, mission and values which help us make the right decisions. These are not unique to Houston Methodist, but they are reinforced at all levels of our organization. These principles help us establish priorities and guide us in responding to concerns. Three of our priorities are always patient service, employee engagement, and financial stewardship. We have data and metrics to help us navigate these areas. I will focus on patient service to demonstrate some of the concepts related to managing this function using data.

Patient satisfaction is not a new topic, but it has evolved significantly since its introduction in the 1950s. The current incarnation is the patient experience, which is more comprehensive than the early measurement of patient satisfaction and quality. Patient experience seeks to encompass the entire continuum of the patient interaction with the organization and their feelings towards those interactions. This perception is critical to the success of healthcare organizations and has been studied extensively. The function has also been elevated at many organizations as evidenced by the hiring of Chief Experience Officers (CXOs) to oversee this function.

" The NPS is a single  metric used to gauge  customer loyalty based  on the ‘likelihood to  recommend’ question.  This is the essence of  patient experience  " 

Measuring and improving the Patient Experience is a lofty goal, but it does make sense because the patient’s perception shouldn’t be graded on a transactional basis but rather on the collective experience of all interactions. As you can imagine, there are many interactions in a total patient encounter and many ways to measure the patient’s experience of those encounters. Due to the complexity and sheer volume of this task, many organizations use a third party to measure patient satisfaction and patient experience. This has also been hard coded into value-based purchasing of healthcare through the Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS).

These, and other measurements, should be used as a starting point to assess patient experience. As a system director for an ancillary service (laboratory), HCAHPS doesn’t directly measure the services we offer. We have another series of questions from our Patient Experience vendor which gives us detail into our practice. The primary metric is the net promoter score (NPS). The NPS is a single metric used to gauge customer loyalty based on the ‘likelihood to recommend’ question. This is the essence of patient experience.

 Along with this overall measure, we have additional specific questions which separate interactions and contribute to the NPS. Looking at data on individual questions helps us identify gaps in expectations. The questions measure the patient’s experience, but don’t all contribute equally to the NPS. The significance is based on a correlation coefficient. For the outpatient laboratory, these questions, their correlation coefficients, and matrix are represented by this example:

sing the data from this example, effort should be made on improving patient wait times and throughput as the most effective use of resources to improve overall score. Standard process improvement methods and training can be used to improve low scores and reinforce high scores on highly correlated elements.

This is just a small example of the data available through our patient experience provider. We also use a patient tracking tool to measure wait times and throughput. Data available through this tool includes:

• Peak times

• Patient counts

• Activity counts

• Time between activities

• Average time in area

• Patient volumes by hour, day of the week

• Trends

This data is useful in managing the patient experience through the encounter and is very specific. All this data can be benchmarked, help establish goals, and be used to evaluate processes and personnel.

To improve the patient experience in outpatient areas, we should focus on the following:

1. Communication - Clear communication with patients is essential to ensure that they understand what is happening and what to expect. This includes explaining the procedure, providing instructions for preparation, and answering any questions the patient may have.

2. Comfort - Patients should be made as comfortable as possible during their visit. This includes providing comfortable seating, ensuring that the temperature is appropriate, and minimizing wait times.

3. Efficiency - Patients should be seen in a timely manner and not kept waiting unnecessarily. This includes streamlining processes and minimizing wait times.

4. Cleanliness - The area should be clean and well-maintained to ensure that patients feel safe and comfortable.

5. Staff training - Staff should be trained to provide excellent customer service and to handle difficult situations with empathy and professionalism.

So where does common sense fit into the equation? Common sense is practical judgement based on perception and experience. It is the use of knowledge and judgement rather than data. Common sense certainly has a role, especially in an experienced employee or manager. However, common sense can’t be assumed. That is where data is essential. The use of data allows for objective measurement and leads to quantifiable action. Effects of training and process enhancement can be measured and monitored. Common sense can go a long way, but data can go further.