Measuring and improving the patient experience is vitally important. The Royal College of Physicians, for example, say patient experience should be valued as much as clinical effectiveness, and patient experience is one of Lord Darzi’s 3 quality criteria.
However, patient experience is highly subjective and that makes it difficult to measure.
As part of Monitor’s focus on incentivising better patient care through the payment system and other regulatory functions, we are speaking to leading providers and commissioners across the world about how they define, measure and improve patient experience.
Here are 5 things we learned from Dr John Bulger of Geisinger Health System, a leading not-for-profit insurer and healthcare provider based in the US.
1. Focus on what matters to patients. Patient experience can refer to many different aspects of care, but in Dr Bulger’s experience, some of the most important questions for patients are: did staff treat me with respect, was my pain minimised, was there good communication with me and my family, was it convenient. The next step, says Dr Bulger, is to move towards patient-reported outcome measures, rather than just measuring overall satisfaction. This means asking the patient, in the example of a hip replacement, how much joint pain they had before and then after, what was their quality of life before and after.
2. Ask patients. Geisinger uses an external company to send conventional survey forms out to patients who have been in its hospitals or clinics. It has also started using online surveys. The questions cover staff friendliness, waiting times, ease of booking appointments, interactions with doctors and nurses, food, cleanliness and so on.
3. Have dedicated staff. A part of Geisinger’s quality and safety division is already tasked with patient experience, and the organisation is in the process of hiring a chief patient experience officer, a role that is becoming increasingly common in US hospitals. Data analytics experts are also on hand to help organise the data and make it available to staff. For example, Dr Bulger says, a hospital nurse can log in and see how his or her floor is doing at any given time, and how patients have rated their experience. Encouraging transparency, where each floor can see how the other floors are doing, means Geisinger can try to understand why a certain group is doing better or worse than others and spread the learning.
4. Look for insights. Dr Bulger says he was surprised to find that doing 2 things together – which individually had only a minor impact – could make a big difference. For example, when Geisinger tried coupling hourly rounds by nurses with daily visits by the nurse manager, they discovered it significantly improved patient experience, whereas each measure on its own hadn’t had much effect.
5. Incentivise clinicians. Geisinger gives bonuses to doctors and nurses that are related to patient experience and survey results. The bonus works out to around 1 to 2% of their salary, not a huge percentage, but Dr Bulger says it gets staff’s attention and sparks debate about the best way to measure patient experience.
Dr Bela Prasad is pricing development lead at Monitor. She spoke to Dr John Bulger, chief quality officer at Geisinger. Further interviews are planned with other health leaders from around the world.
Better care, better payment 