Summary: Patient satisfaction is a big deal in health care these days. I talked about the topic with Randi Redmond Oster, the head of Help Me Health and the multi award winning author of “Questioning Protocol,” which details her journey with her son, who has Crohn’s disease, and his multiple operations. “What I discovered was this: the process of health care could be improved,” Randi said. “I have an aerospace engineering background and that combination of the insight to safety, communication and keeping things working. Plus seeing the reality of what was happening in the hospital helped me, and propelled me to become an agent of change.” Here’s our interview, lightly edited for clarity.
Jeanne Pinder: So you told me that happy patients can to make money for hospitals. This seems like a great idea. Can you explain?
Randi Redmond Oster: Sure. So so the word happy is a little bit… What I like about the word happy is it states an emotion. And I think that we have to understand that part of delivering service excellence is meeting the emotional end-frame of what a customer, or in this case a patient, wants to achieve. Unlike going to Disney World, where you want to be delighted or wowed, in the hospital patients really do accept the fact that sometimes outcomes can be less than desirable.
What is important is that they are satisfied. So satisfaction does not necessarily mean that you have to be happy, but how they want to be treated is critical to reaching satisfaction.
So then the question is “how does it make more money for the hospitals?”
A couple of years ago the industry came up with this concept of value based purchasing. And there are over 3,000 hospitals right now involved in value based purchasing, which actually gives incentive plans for performance to health care providers.
Part of that value based purchasing: one of the incentive payments is — it’s over one and a half billion dollars in incentive payments — is tied directly to what is called HCAHPS (Hospital Consumer Assessment of Healthcare Providers and Systems), which is the patient satisfaction survey. And what we have observed last year in 2016: Almost a third of the hospitals are seeing negative reimbursements for poor performance. Happy patients, or in this case patients that meet the patient satisfaction goals: There is a direct correlation to the bottom line in health care now for meeting that number.
How to make patients satisfied
JP: So how can hospitals actually make patients happy or satisfied? Aren’t patients always stressed and upset when they’re in the hospital?
RRO: So so patients are stressed and upset. If you just think about probably your own experience or many people’s experience, there were things that make them stressed and upset that have nothing to do with their care, right?
How long they were waiting: think about in the emergency room. Or the fact that there were so many people that they were confused. Or they didn’t even understand what their medications were or how to take care of themselves when they finally got home.
All that actually adds to the stress of being upset and decreases people feeling happy — even though I think “happy” is the wrong word here. It decreases satisfaction.
And so what the HCAHPS program has done: It has defined in metrics 10 measures that will lead to satisfaction. I won’t go through all 10 of them, but some of them were pretty basic. “I understood what the doctor said.” “I understood what the nurse said to me.” “The room was clean.” “It wasn’t noisy.”
And so you don’t think about those attributes: having a clean room that wasn’t noisy, for example. “I understood what my caretakers were saying to me does reduce stress and does help reduce being upset.”
So those metrics have been put into place and are being measured, and then based on how people are performing or how the hospitals are doing, it affects how much money they’re paid.
How it actually works
JP: You work with hospitals and other providers to help them improve these measures. Can you give a specific example of this? How this work might benefit a hospital?
RRO: So what we’ve done is we have looked at in industry how do you design your product or service to make that emotional end frame that creates high satisfaction. What’s important there is to understand what you’re trying to achieve.
So for example at Disney World they want people to feel “wow!” and they want them to be delighted. And by knowing that that’s what that expectation is. You can redesign and re-engineer your processes to create that. So even in Disney World if you’re waiting on line for two hours — how many times have you started to see that they know how to keep the line moving, or they have a video going so you don’t feel like you’re waiting in line that that long.
And so what our work is: we’ve actually done the research to understand what is that emotional end frame, what is it that the patients want to feel as they’re going through that experience. And I will share with you: happy is not one of them.
They don’t expect to be happy, but they they do have very clear understanding of how the current process makes them feel them and what they how they want to feel.
And so what we do want our work is we reveal what I would call the secret sauce. Right. You know what that emotional end frame is. And then the second piece of that is: how do you train all of your employees, from the person who comes in and cleans the sink in the room to the doctor, to make sure that they’re all focused on on the same thing?
And that’s what we have discovered and what we know for best practices is this: an industry that creates that satisfaction gives people a positive experience. And that’s what really makes a difference in the patient’s life.
Changing the culture of health care
JP: Great. So your company, Help Me Health, transforms how health care thinks about and delivers patient experiences to achieve better outcomes and a bottom line. Tell me exactly how you go about doing that through your co-workers, and how do you work this magic.
RRO: So I’ve been very lucky that after my book “Questioning Protocol” came out, and I was on the circuit speaking about my book, one of the trailblazers in the United States on creating cultural change actually read my book and called me up and she said, “Randi, I’ve done this in other industries. We can change the culture of health care — leveraging the experiences from the stories from your book using proven processes.”
That’s Kathleen Cattrall, and then also we have Chris Janks, another business partner who’s also worked in organizing very large businesses. We have a team of people that we leverage that have worked in a myriad of industries … that I that I won’t say here because some of it is still confidential. They have changed the customer experience and the culture of how those organizations think about their companies. And so that team of leaders has come together to help me to take that best practice and transfer it to health care.
JP: Is there a place you would send us where we could experience something like this? Besides Disney?
RRO: There are there are two industries that Kathleen has on her bio that that I feel comfortable disclosing. The first one that she had tremendous success in was changing the cable industry through Time Warner Cable.
She always tells the story of how people hated their cable experience, and then they worked on what was it that met the customer satisfaction needs, and how do you create a workforce to deliver that.
The second one that she’s worked on extensively and was the VCA, the veterinarians. They have over 700 veterinary clinics for your animals. Many times people would say to me, “you know, my dog gets better service, and I know more about my dog’s care and understand it better than my own father’s.” Kathleen also was instrumental in that turnaround as well.
Learning by experience: A game board approach
JP: So can you give a little window how exactly you work this magic? You go to a hospital, and then what happens?
RRO: There are a couple of ways we do it.
At the end of the day, the most important thing is this: the ideas to create change have to come from the employees. So here’s what we don’t do: we don’t do training via PowerPoint.
We’re not up there saying you have to do this this and this and then here’s a list and you have to check off this list — because what we’re talking about is how do you create an experience that’s individualized to a person? And there isn’t a check-off list for everyone.
One methodology that we use is called the learning map. If you imagine a game board, like the game of “Life,” we design these game boards so that work groups in a hospital — everyone from the doctor the nurse to the person cleaning the room — is now working at that game board. It takes them through the patient journey.
It’s not a point in time — let’s say when the doctor is just talking to them, or the nurse is talking to them, or the transfer person is taking them from one room to another. They really get to see the patient journey and from that. The feedback has we’ve received in our beta test is “it’s a wow.” I’ll give a quick example.
We do one patient journey of the discharge process. It starts at 9 o’clock in the morning, and I’ll just tell you that in this case, my son’s, he gets out at 3 o’clock in the afternoon. There are about 12 different key things that happened during the day.
At the end of the day, everyone did their job right. The doctors did their job right. The nurses did their job right. My son was discharged from the hospital. But how do you think the patient felt during these different steps during the day?
We give red, yellow and green dots — red meaning they probably don’t feel so great about that interaction. Yellow, they were neutral. Green, they felt good.
‘We didn’t really think about it that way’
We’ve done this many times, and I will tell you that the 12, for the most part — they’re all red or yellow. That’s the shock for the teams — they said, “you know, we didn’t really think about it that way — sitting there on the edge of the bed for an hour waiting for the doctor was probably not the best thing.”
And the reason this is so important and it goes back to the HCAHPS scores is this: then the patient is asked, “How did you feel about your experience?” And we know through research that for people, that emotional component is much heavier than some of the rational thought. There was a study done at Harvard that actually goes through documents. And so then you get a low satisfaction score. It ties directly to your bottom line.
So what happens in this exercise is first there’s the “Aha!” that the experience wasn’t the greatest, but the second piece of it is how do we redesign or re-engineer the process so that it doesn’t happen again? And that’s why we don’t do PowerPoint presentations because you know a lot of these teams that are doing these exercises — they know the answers. They know what to do. They come up with the ideas of their own, and then the key is then for them to be able to implement it.
That’s another piece of what we do: In some cases the hospital CEO happened to be at the event, and that day he said, “we’re no longer doing it this way.” That’s the beauty. It’s fast. And people feel very engaged, which is another critical issue in health care. How do you engage your workforce? Our mission is to improve the patient experience. But I feel just as importantly that we also make sure that the people working in the system are engaged — and engaged means that they enjoy their job.
JP: What started you down the path toward this work?
RRO: The path definitely was my son’s experience — writing the book and then, in the past year, meeting these leaders who know how to re-engineer the processes.
My mission is to make sure the experience my son had in the hospital is obsolete within 10 years.
Engaging employees to do better
JP: You said you have research documenting this. Can you quote some numbers?
RRO: I talked a little bit about how our process increases engagement of employees. And this is how it goes directly. It’s tied to the bottom line. Press Ganey (the company that does the HCAHPS survey) has gone through one of their surveys. It was called “Every Voice Matters.”
It’s the bottom line on employee and physician engagement. They looked at how does a highly engaged workforce versus a low-engaged workforce impacts the value-based payment program — how much they get reimbursed. And the statistic is that hospitals scoring in the top 10 percent of employee engagement earned back 26 cents more per dollar than the hospitals that are at the bottom.
So when you start to look at that and you say, “Wow, just having increased engagement by your employees, you’re going to get back more per dollar.” It ties directly to your bottom line.
They also then looked at high engagement and low engagement, and they found that for a hospital scoring in the bottom 10 percent of employee engagement, they would have average readmission penalties three times as large as hospitals scoring in the top 10 percent. Readmissions is another key area: if your patients are readmitted within 30 days there are penalties for that as well.
So what our process is engaging the employees to come up with solutions to help with their relationships with their end user, and this has bottom line impact from the Press Ganey survey (see attached document) in terms of readmissions and of value-based payments.
JP: Thank you so much!
RRO: Thank you!