What do patients want? University of Utah Health’s director of patient experience Mari Ransco reveals what ten years of system dedication and qualitative analysis of hundreds of thousands of patient voices have taught us.
Sara* started having a headache every day a year ago. On good days, it was a dull throbbing. On bad days, it felt like tightening screws into the sides of her head and a pounding hammer above her left eye. The pain never went away until she slept. She felt scared, and worried she would feel like this forever. Sara sought the expertise of Dr. Seniha Ozudogru, a headache specialist at U of U Health. Sara sees Dr. Ozudogru every few weeks. After a recent visit, she responded to a survey she received in her email:
“I would follow Dr. Ozudogru across the world to continue being her patient. I've never once met a doctor that treated their patients with so much respect, kindness, and compassion. Every single time I'm there, she asks about my family, my job, comments on changes to my hair - treats me like a human being. I do not believe that I will ever have another doctor as exceptional as Dr. Ozudogru. She is a treasure. This is the only neurological clinic I will ever recommend. Every single person here is phenomenal. From desk staff out front, to nurses assigned to take patients back, to Rob in insurance claims, to each specialized neurologist. They are all absolutely incredible.”
(Actual patient comment collected from Press Ganey medical practice survey February 2018)
*PATIENT CASE ADAPTED FROM “LIVING WITH CHRONIC HEADACHE: A PERSONAL MIGRANE STORY." HARVARD 2011.
WHAT IS PATIENT EXPERIENCE?
The 117-word comment in this case study is not actually unique. Every week, our organization receives an average of 2,500 patient comments. Most of them describe a journey – from anxiety, pain, and worry to respect, comfort, and often – hope.
A patient’s experience begins the moment they choose or are referred to our system. Their experience describes their care journey – from scheduling an appointment, seeing a specialist, an inpatient stay, filling their prescriptions, follow-up appointments – to whatever the outcome may be. Be it a simple cold or chronic condition, each step in the patients’ entire care experience matters.
WHAT MAKES AN EXPERIENCE EXCEPTIONAL?
In 2008, patient experience at U of U Health wasn’t so great. The system faced frequent patient complaints, including poor communication, long waits to schedule appointments, lack of care coordination, and unprofessionalism. This prompted then-Senior Vice President Dr. A. Lorris Betz to challenge every leader in the system to improve with the statement, “Medical care can only be great if the patient thinks it is.”
FINDING THE 5 ELEMENTS
To improve, we started listening to the voice of our patients – every single one.
In 2010, University of Utah took the lead as the first health system in the country to move from a paper survey to using an electronic survey of patients’ care experiences. Very quickly, we were inundated with incredibly descriptive feedback. Patients began sharing their stories – worries, joys, what happens when we (the health care system) mess up, what’s hard about a particular diagnosis, and what’s amazing about their particular care team, from support staff to physician.
NEEDLES IN A HAYSTACK
Every year we receive 240,000 surveys that generate over 130,000 individual patient comments. It was (and is) a firehose of information to digest. To make sense of this massive amount of information, we partnered with a natural language processing firm in 2013 to attempt to break down the complexity into a few, actionable insights. But after a year of analysis, the company could only tell us things we already knew – the proportion of positive or negative comments or the most frequently mentioned topic: wait time. That wasn’t good enough for U of U Health’s physicians, leaders, and staff who had already moved past simply classifying comments. What they wanted was insight – what, specifically, builds trust and loyalty with patients? How do we improve our patients relationship with our providers, teams and system? In other words, what makes a patient experience exceptional?
5 CONSISTENT THEMES
The system’s department of patient experience, a team of five individuals, undertook the challenge of answering this question using qualitative analysis. In 2014, the team pulled a sample of 10,000 comments from various care settings – inpatient, outpatient, primary care, specialty care, emergency care – and analyzed them by service line. Each comment was read, categorized, sent back to service line leadership as feedback, and then brought back to the group for discussion. Over time, five consistent themes emerged:
THE 5 ELEMENTS OF PATIENT EXPERIENCE
An exceptional patient experience reflects all five elements.
Patients want to be known, heard, and provided a plan that reflects and includes their values. Patients want the team to coordinate for them and be on the same page with each other. Patients want the team to be organized to meet their specific needs. When all five elements are present, patients describe their confidence and trust in the care team. Patients even describe their loyalty to the health care system.
Here is how the five elements sound when the patient has confidence in the physician and the team is organized to meet her needs:
Example of a 5 Element Comment:
(Actual patient comment from a surgery performed by vitreoretinal surgeon Dr. Mary Elizabeth Harnett. Collected from Press Ganey ambulatory surgery survey July 2018.)
HOW WE USE THE 5 ELEMENTS
To understand patient feedback. Answers to questions on Press Ganey surveys, the quantitative data, doesn’t provide much detail. It’s the stories that shed light on why a patient needed more explanation or how asking about the patient’s family makes them feel like a person, not a diagnosis.
Identify specific behaviors to care teams to start, stop, and continue. Delivering an exceptional experience often means becoming more consistent with specific behaviors. We use the five elements to help teams understand the high-impact behaviors that make a difference with patients.
Widen the perspective from one method of improvement. Typically, teams have focused on one area of improvement, such as efficiencies around wait time. Managing wait time is important, but its equally important to demonstrate consistent behaviors in the other four areas. The five elements helps broaden improvement opportunities beyond one path of improvement.
Every year, we receive 240,000 surveys that generate over 130,000 individual patient comments – and we read every single one. We listen for the five elements and communicate the patient voice directly with our care teams – approximately 350 people each week receive their patients’ comments. Each week for the last five years, we share the top 10 comments that feature the five elements with the entire system.
And as a result, University of Utah Health has become a national leader in delivering compassionate, coordinated, and expert care. Over the past 10 years, patient experience has become the cornerstone for initatives focused on quality and safety, patient-reported outcomes, and cost reduction.