Paul Roemer, Managing Partner, Healthcare IT Strategy
Recent discussions with hospital executives convince me that there remains more unknown about Patient Experience Management (PEM) than what is known.
I think it would be helpful to separate PEM into two parts:
- The business of healthcare (the process of running the hospital’s business)
- The healthcare business (the clinical processes)
Most of the current internal PEM programs focus on the clinical side and are targeted at discrete clinical processes within functions like ER and Radiology.
While implementing PEM in those areas will benefit the hospital and improve the patient experience, their overall impact will be minimal. The reason is that the total Patient Experience is comprised of literally dozens of functions and interactions. It is possible to improve one aspect of the experience and have it be relatively unnoticed by a single patient and totally unnoticed by all the patients who not require that service.
Here is a real example. One hospital ranked among the leaders for labor and delivery for its clinical offerings was rated poorly by those delivering at that facility. The good news is the hospital’s consultant solved the problem. The problem? The doctors and staff had all the choice parking spaces, and the expectant moms had to lumber across a rather large parking lot—why they needed a consultant to figure this out is not something I can explain. However, the experience of all the hospital’s other patients remained unchanged.
A recent Mckinsey study reported PEM is the first or second priority of hospital CEOs and COOs during the next 3-5 years. It also reported most have not done much about PEM because the C-Suite did not know which part of the organization “owned” the initiative.
There is no reason why the CIO cannot take ownership of PEM and deliver major improvements. How? First define which processes touch the most patients. Here are three:
- Admissions
- Billing
- Payment
In most instances, patients are not familiar enough with the clinical part of their visit to know what could be done better. If they have to wait twenty minutes for an MRI then they have to wait twenty minutes. After all, it is not like they had anything else to do during those twenty minutes—they are a captured audience.
However, if patients have to wait twenty minutes to be admitted, or have to make five calls to get someone to help them understand their bill, all of a sudden they start to equate their experience to the same negative experience they had the last time they waited for the cable repairman.
An argument can be made that much of PEM has to do with how effectively and efficiently a hospital operates its business processes. The two key benefits from improving PEM are:
- It decreases hospital costs without incurring a substantial investment
- It decreases patient churn
PEM is an opportunity for the information technology department to take charge of an important area. It is an area that does not require much clinical expertise in order to deliver results. It is all about improving patient-facing business processes. It offers an opportunity to deliver dramatic change.
When I approach opportunities like this, I never do so from the perspective of what would have to happen to make the number of patient billing complaints drop by 10 percent. I look at the problem from a perspective of how this issue would be handled in a perfect world, and try to build a solution to meet that.
In a perfect operating environment, the number of patient billing issues would be zero, not simply a reduction of the current number of issues. What would the process model have to look like to create zero billing issues?
A perfect operating environment would not be shaving five minutes off of the admissions process, it would be making the admissions process go away. What would the process model have to look like to enable that?
While the solution will not be as simple as reallocating parking spaces, it will not be nearly as difficult as implementing EHR, and the outcome will be much better.
flpoggio says
Paul, I fully agree with you about PEM and the CIO taking ownership. However I would quibble about billing and payment. First, this clearly has to be the purview of the CFO, and the billing and payment process is largely driven by major outside forces. Payors define the methodology, criteria, format, content and more. Medicaid is notorious for turning payments on and off, as the latest state budget crisis demands. I think the CIO can help here but only in a limited way.
In my experience, both as an industry ‘insider’ and as a recent patient not to mention my mother and mother-in-law, there is a critical area that is almost totally ignored that could easily be the purview of the CIO and he/she could make an enormous difference. That is patient flow and the hand-offs of care between departments, essentially care coordination. I beg to differ on your example about waiting 20 minutes for a procedure since ‘you have nothing else to do’. In my own case, I was left outside a Radiology department in a wheel chair waiting to be transported back to my room for over 20 minutes. Believe me I was more than aware of what was /was not happening and was getting angrier by the minute. And that was only one of many such instances during my ten day stay where an inter-department hand off failed. Of course, after discharge I sent a long letter to the CEO detailing the good and bad of my stay. The major observation that I shared with the CEO was that her employees were devoted, caring and working extremely hard to overcome a series of work flow system failures that greatly diminished their efforts and left a very unhappy ‘customer’. As I write this my mother-in-law is a patient (in a different hospital in another state) and is experiencing the very same issues. For example, why does it take all day to discharge a patient?? See: http://www.kelzongroup.com/20billion.html
It seems hospitals for years have focused on department efficiencies, how to make the lab more productive, nursing more patient oriented, admitting more streamlined. And many of these efforts have had success – but limited success. Fact is, until we really get into the inter-disciplinary coordination amongst departments we will realize at best only fifty percent of potential improvements, and still have a very high tendency to slide back to our inefficient ways.
Care coordination and patient flow are really the same as production management in commercial industry. In my experience I have yet to see any hospital really attack this area. I hear CIOs saying they know this is a problem and the solution is to implement a new HIS or EMR. In reality this always fails because the problem is not a data or information shortcoming, it is a work flow problem, it is an inter-department process problem, and no health care IT system I have ever seen begins to address this issue.
I have written about this many times in journals and blogs. For a more detailed description and suggestions on how to address this failure please check out: http://www.kelzongroup.com/IPOP.html
To me this should be the real core of your PEM concept. Thanks for bringing it up and keep plugging away.
Frank Poggio