Patient experience is one of the three pillars of quality in healthcare. If healthcare organisations are to improve the quality of care they provide, then efforts to improve their patients’ experience must be integral to any quality improvement plan.
Improved patient experience is not only linked to increased satisfaction; there is evidence that organisations which emphasise this have better outcomes in terms of patient safety and clinical effectiveness – the other two pillars of quality. Studies show that good patient experience is associated with a shorter efficient length of stay, lower readmission rates and a lower cost per patient.
Ins and outs
Often, one may hear the terms outpatient or inpatient used when referring to a type of diagnostic or therapeutic procedure. “Inpatient” or “IP” means that the procedure requires the patient to be admitted to the hospital, primarily so that he or she can be closely monitored during the procedure and afterwards, during recovery.
“Outpatient” or “OP” means that the procedure does not require hospital admission and may also be performed outside the premises of a hospital. Although one can predict that MOST of the patients’ dissatisfaction will happen at “OP”; yet fears occurring during “IP”, and the possibility for longer length of stay in hospitals and/or surgical interventions, makes it more impactful in terms of overall experience. And during “IP”, what happens to patients’ families and visitors’ experience form part of the overall experience.
Coming to hospital for elective surgery is undoubtedly a stressful time for many people. There is some evidence to show that patients with less anxiety before their surgery feel less pain postoperatively and their wounds may heal more quickly. When a poor service is provided, it costs more money and is linked to decreased satisfaction. Good surgery is not only a matter of technical ability but is also based on foundations of good decision-making. There is an old surgical adage that goes ‘choose well, cut well, get well’, to which should be added ‘prepare well’. A well-organised operating list, be it a day surgery list, an inpatient elective list or an emergency surgical list, will result in an increase in theatre efficiency and improved patient experience and safety. The principles should be based on meticulous planning, excellent communication and be centred on a multidisciplinary approach to patient care. What applies for managing a Surgical list also applies in other different touch points across the patient journey inside the hospital e.g. Clinic, Pharmacy, Laboratory, etc.
Go with the flow
Poor systems deliver poor results – for patients, staff and payers. A common assumption in the healthcare sector has been that more cost is required to improve patient flow and healthcare quality. However, it can be argued that increases in cost have not always resulted in proportionate improvements in access to or quality of care. The term “flow” describes the progressive movement of people, equipment and information through a sequence of processes. In healthcare, the term generally denotes the flow of patients between staff, departments and organizations along a pathway of care i.e. Patients’ interaction with hospital’ staff; systems and processes to create Moments of Truth (MOT) that result in the overall patient’ experience during his/her visit to hospital. The concept of using flow to improve care has received increasing traction within healthcare, especially in relation to reductions in patient waiting times for emergency and elective care. Awareness has been growing of the ideas, first tested in other industries, and results that organisations have generated by applying ow thinking to their organisations. Yet; ‘It’s about looking at it from the patient’s perspective – how do we remove the barriers and for the patient make it seem integrated? Because that’s where the quality and efficiency gains lie.’
The improvement approach falls into three key phases, which reflect the Plan, Do, Study (or Check), Adjust (PDSA) cycle of lean (sometimes referred to as PDCA).
- Understanding the system (Study and Adjust thinking) or “Diagnostics”
- Testing different solutions and implementing new processes (Planning and Doing) or “Maintenance and Innovations”
- Measuring for improvement (Study and Adjust thinking again) or “Continuous Improvement”
The discipline of clinical systems improvement focuses on processes within organisations, viewed from a patient perspective. It emphasises engagement of all stakeholders in understanding and improving an end-to-end process and uses time-series data to diagnose and measure the impact of improvements. Changes are tested using Deming’s quality improvement cycle of Plan, Do, Study (or Check) and Adjust (PDSA).
Lean methodology – the basis of the world-famous Toyota production model – aims to provide what the customer wants, quickly, efficiently and with as little ‘waste’ as possible. Its application to healthcare lies in streamlining and improving the quality of processes by minimising or eliminating waste (including unnecessary delays, re-work, inappropriate procedures and errors) and maximising what adds value to patients. Add to this the concept of “Kaizen” (“Continuous Improvement” in Japanese) and you have the basis of a strong change competence in any organisation.
The theory of constraints came from a simple concept similar to the idea that a chain is only as strong as its weakest link. It recognises that movement along a process, or chain of tasks, will only flow at the rate of the task that has the least capacity. The approach involves two key principles.
- Identifying the constraint (or bottleneck) in the process and getting the most out of that constraint. Since this rate-limiting step determines the system’s throughput, the entire value of the system is represented by what flows through this bottleneck.
- Recognising the impact of mismatches between the variations in demand and variations in capacity at the process constraint.
In summary, the healthcare industry still lags behind many other industries in terms of applying some best practice protocols and methodologies for improving the “Process Flow”, “Waste Removal”, “Improve Efficiency” and, by implication, “Positively Impact Customer Experience”. In fact, without a real focus on Customer/Patient Experience element – based around clear outcomes – these sound methodologies will under-deliver.