Overall Satisfaction Scores Stuck for last 10 Years. 3 Key Premises

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1 Overall Satisfaction Scores Stuck for last 10 Years Source: Healthcare Advisory Board / Press Ganey 3 Key Premises We have reached the ceiling in how much we can improve patient perception scores by simply hardwiring universal service expectations. The most important variable in creating patient loyalty is not being taught or measured in service excellence. Culture is driven by management systems and priorities, not by workers or values. 1

2 Formula for Patient Perceived Quality Pt. Perception of QUALITY = 1 : 1 ratio = Patient Satisfaction What about unrealistic expectations? Innovation = Making Unusual Connections We deliver fun and happiness. Services Stage (Emotional) Goods Deliver Commodities Extract Make Tom Hanks Pine, Gilmore: The Experience Economy 2

3 We are in the same sector as Disney meeting a different emotional need. Disney: Meeting the emotional needs of a family to have fun together. Hospital: Meeting the emotional needs of a family together. A hospital without compassion is like Disney without fun. Typical Service Excellence Exercise What do you want when you go shopping? Friendly Courteous Problem solving Respectful Helpful Quick Competent Explain Things Our patients want these things also however 3

4 What are some significant differences between these two customers? We can standardize service and courtesy, but not compassion. Scripted and standardized (Valets) (Picking up on Cues) 4

5 Are we losing something important? Service industry terminology changes the meaning. H-CAHPS NEW OLD vs. Patient ( patiens one who suffers, pathos) vs. Doctor ( dokere one who teaches) vs. Nurses ( nutrire one who nurtures) vs. Healing, ( make whole body, mind, spirit) Pouring old grape juice into a new wine bottle doesn t make it wine. Service Excellence (Standardized Behavior) Patient Experience (Emotional Engagement) 5

6 If Disney Ran Your Hospital You Would... W. Edwards Deming on Things that Cannot Be Measured The most important figures one needs for management are unknown and unknowable What is the value, for instance, of the multiplying effect of a happy customer and the opposite effect from an unhappy customer? (Patient perceptions) Out of the Crisis, pg

7 Limitations of Satisfaction Surveys Delayed Response (Patients memory fades) Complexity of Care (Difficult to isolate where or when) Ceiling Effect (Clustering at the top makes it hard to distinguish adequate vs. superior service) Varying Expectations (Can t trust the Golden Rule) Hesitancy to Voice Concerns (Wish to be viewed as good patients and tell you what you want to hear less than 1 in 25 with a complaint will tell you). Healthcare Advisory Board, 2008 Measurement Outcomes Perceptions Clinical Financial 7

8 Why is it so hard to raise our scores? Meeting expectations = 0 Satisfied = 0 Satisfied patients have no story to tell (or blog to write). Research on satisfaction shows On a scale of 1 to 5, people who mark a 4 are times more likely to defect to the competition than those who mark a 5. Harvard Business Review, Nov-Dec, 1995 HCAHPS is a 4 point scale, getting more top box and blurring the difference between satisfaction and loyalty. 8

9 What Makes a Patient a Fan? Caring, Cared, Cares +32 Kind, kindness +24 Compassionate +15 Help, helpfulness +15 Comfort, comforting +13 Friendly +8 Professional +9 Attention, attentive +7 Concerned +6 Listens +4 Loving +3 Sweet +3 Respect +3 Quick +3 Polite +3 Patient +3 Understanding +2 Thoughtful +2 Knowledgeable +2 Smiling +2 Bedside manner +2 Empathy +2 Tender +1 Takes time +1 Sensitive Reassuring Selfless Gentle Nice Conscientious Committed Warm Upbeat Generous Softness Pleasant Supportive Cheerful Informative Competent Efficient Proficient Prompt Hardworking Courteous Hans Selye on Stress and the Immune System The Einstein of Medicine Father of Psychoneuroimmunology Stress hormones like cortisol and adrenalin cause shrunken immune tissue, the growth of tumors, and weakening of the body s ability to heal itself. Compassion can affect a patient s immune system. 9

10 Stress and Breast Cancer Life Expectancy Women with advanced breast cancer who have abnormal daytime levels of cortisol, a hormone released in response to stress, are significantly more likely to die sooner than patients with normal levels of the hormone. David Spiegel, MD Journal of the National Cancer Institute, June 2000 Stress and Breast Cancer Life Expectancy California Breast Cancer Research Symposium 9/9/2005 Sacramento, CA Linda J. Luecken, Ph.D 10

11 Latest Research Model on Breast Cancer Diagnosis Adaptive Coping Maladaptive Coping Decreased distress Increased distress Decreased cortisol, increased NK and T-cell activity Decreased spread, severity, Increased disease-free time and survival Compassion Oncology Unit Palliative Care Hospice Increased cortisol, decreased NK and T-cell activity Increased spread, severity, decreased disease-free time and survival Empathy The Jefferson Scale of Empathy (JSE) is a validated instrument developed in 2001 to measure empathy in the context of patient care. Clinical studies show strong relationship between empathy and better clinical outcomes in: Pain Management Cancer progression Diabetes control (A1c) Women s Health Psychotherapy Wound healing 11

12 Add an A to AIDET for an A-plus In Patient Perceptions First ASSESS emotional cues, and if they are afraid, sad, angry, anxious, or in pain Acknowledge their feelings with genuinely felt empathy. and THEN continue with your script. Compassion The healing blind spot in Lean Six Sigma Clinical Pathways Checklists Nursing Competencies Just Culture Service Excellence Standards HCAHPS 12