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Patient Experience Data Are Outcomes
From Press Ganey Associates, Inc., Wakefield, MA, and Harvard Medical School and Harvard School of Public Health, Boston, MA.
In fits and starts, but with increasing certainty, health care is changing its organizational focus from the activities of clinicians to meeting the needs of patients. That progress has been slowed and complicated, however, by lack of a performance framework that captures the extent to which patients’ needs are being met. In the absence of such data, “quality” has often been described in terms of the reliability of providers in complying with evidence-based guidelines.
Provider reliability is important, of course, but no substitute for the measurement and improvement of actual patient outcomes. After all, health care exists not to grade providers but to help patients. But clarity on that focus raises some important questions that we have not often discussed in the past.
What exactly are we trying to accomplish in health care? What is the goal? How can we tell how we are doing?
The answers cannot be found solely through measurement of “hard” clinical outcomes, such as death and disability. Yes, these are the most important focuses for improvement in health care, but we cannot deliver immortality, and we often can only delay complications of chronic disease. There is something else that our patients seek from health care, and it can only be measured by asking them directly.
Measuring "Peace of Mind"
That “something else” was described by one of my colleagues as “peace of mind that things are as good as they can be, given the cards that we have been dealt.” That may not be the most compact term in health policy, but I have yet to come up with something more concise— and it captures something immediately recognizable as important to anyone who has ever taken care of a patient with a serious disease, or spoken to that patient’s family. Of course, we should do our best to help patients live as long as possible, and of course we should optimize their health and relieve symptoms at every step of the way.
But there are other things that influence the degree of suffering that patients endure along that way, like hope, trust, anxiety, fear, and confusion. They are often considered part of the “art of medicine,” but I think we call them “art” because we are nervous about approaching them with discipline and rigor. In fact, these things can be measured, and managed—and the organizations that improve them are often rewarded with greater market share and professional pride.
Some of my clinician-colleagues do not immediately think of patients’ “peace of mind” as an important outcome, but when their family members or friends have medical problems, this issue immediately comes to the foreground. These clinicians do everything in their power to ensure that their special patients do not have to endure long delays or uncertainty about what is going to happen next, or reconcile conflicting advice, or wait for phone calls that will come…well, sometime soon. We know such experiences are part of what is often called the “disutility of care,” but when they happen to our intimates, we recognize it as something closer to torment.
The bad news is that the challenge of giving patients coordinated care gets harder every year, as medical progress introduces increasing complexity to health care. The good news is that we are in fact getting better at coordinating care every year, because we increasingly recognize the importance of the challenge, and are responding.
Data Collection Advances
One important first step in managing the coordination of care is measuring it. After all, only patients themselves can judge how adequately their needs have been met. And, until recently, the perspectives of patients could only be surmised, and clinicians were expected to improve their “bedside manners” on a case-by-case basis.
But that time has passed. Today, advances in health information systems and in communications technology allow data to be collected from patients at low costs; and for patients to be followed over time so that their outcomes can be measured, analyzed, and improved. Patients can be segmented into groups with similar shared needs, so that teams can be organized to meet those needs. Some of these needs are clearly clinical (eg, control of pain from diseases or treatments), while others are not directly related to patients’ medical problems but are instead driven by how well health care providers work together.
Evolution of the health care marketplace has made improvement of value for those patient segments a strategic imperative. Provider organizations have to meet the needs of patients if they are to maintain or increase their market share—and, not coincidentally, these organizations are discovering that measurement and improvement of patient experience is an important strategic priority.
In this context, innovations are rapidly being adopted in 4 areas:
- The data that are being collected—Data that reflect how well patients’ needs are being met (ie, actual outcomes) have taken center stage, while data on amenities (eg, food and parking) are increasingly peripheral.
- How the data are being collected—Paper and telephone surveys are been supplemented or replaced by electronic methods. Increasingly, health care organizations are seeking email or other electronic ways of communicating with their patients. The reliability of collecting data via older methods is increasingly problematic, and electronic data collection reach patients faster and more efficiently. On average, respondents to electronic surveys are slightly younger than respondents to paper surveys, but the goal of measuring patient experience is to drive improvement; thus, more data is essential (see below).
- How much data are collected—The clear trend is away from seeking data from small samples of patients to meet some regulatory requirement, and toward seeking data from large samples of patients (ideally, giving all patients a chance to provide information). Larger amounts of data are needed to analyze data at the levels where true accountability lies, and true improvement can occur, such as the individual clinician’s performance.
- How the data are being used—A growing number of organizations are taking bold steps to increase accountability for improving patient experience, up to and including public reporting at an individual physician level. Many organizations are placing a modest financial incentive on improvement, while others use internal peer pressure as their approach. For example, physicians may undergo performance reviews annually at which their patient experience data as well as other performance metrics are discussed. Or organizations may share data internally without blinding, so that clinicians’ colleagues can see the ratings and comments made by patients.
Some of the most dramatic improvements have been made by organizations that have adopted the approach pioneered by the University of Utah Health System, which began sharing all patient ratings and comments on the internet in December 2012. Although Utah’s physicians were of course leery of the risks involved, they have found that the vast majority of patient comments were in fact laudatory—patients want to believe that clinicians are doing a good job, and have a low threshold for praising them. And the small percentage of criticisms from patients have proved powerful drivers of improvement. As a result, Utah and other organizations who are pursuing the transparency approach have seen improvement in patient experience far beyond what one could ever expect using financial incentives.
Summary
In sum, measurement of patient experience is no longer focused upon amenities such as food and parking based on responses from a few hundred patients. Instead, the field is about capturing important outcomes from as many patients as possible, so that teams and individual clinicians can improve their actual patient care. The strategic imperative to measure and manage these outcomes has never been greater; it is the antidote to a major side effect of medical progress, which is the chaos that characterizes modern health care. By asking patients about how their care is really going, I am certain we will respond and improve.
Corresponding author: Thomas H. Lee, MD, [email protected]. Dr. Lee is Chief Medical Officer for Press Ganey Associates, Inc.
From Press Ganey Associates, Inc., Wakefield, MA, and Harvard Medical School and Harvard School of Public Health, Boston, MA.
In fits and starts, but with increasing certainty, health care is changing its organizational focus from the activities of clinicians to meeting the needs of patients. That progress has been slowed and complicated, however, by lack of a performance framework that captures the extent to which patients’ needs are being met. In the absence of such data, “quality” has often been described in terms of the reliability of providers in complying with evidence-based guidelines.
Provider reliability is important, of course, but no substitute for the measurement and improvement of actual patient outcomes. After all, health care exists not to grade providers but to help patients. But clarity on that focus raises some important questions that we have not often discussed in the past.
What exactly are we trying to accomplish in health care? What is the goal? How can we tell how we are doing?
The answers cannot be found solely through measurement of “hard” clinical outcomes, such as death and disability. Yes, these are the most important focuses for improvement in health care, but we cannot deliver immortality, and we often can only delay complications of chronic disease. There is something else that our patients seek from health care, and it can only be measured by asking them directly.
Measuring "Peace of Mind"
That “something else” was described by one of my colleagues as “peace of mind that things are as good as they can be, given the cards that we have been dealt.” That may not be the most compact term in health policy, but I have yet to come up with something more concise— and it captures something immediately recognizable as important to anyone who has ever taken care of a patient with a serious disease, or spoken to that patient’s family. Of course, we should do our best to help patients live as long as possible, and of course we should optimize their health and relieve symptoms at every step of the way.
But there are other things that influence the degree of suffering that patients endure along that way, like hope, trust, anxiety, fear, and confusion. They are often considered part of the “art of medicine,” but I think we call them “art” because we are nervous about approaching them with discipline and rigor. In fact, these things can be measured, and managed—and the organizations that improve them are often rewarded with greater market share and professional pride.
Some of my clinician-colleagues do not immediately think of patients’ “peace of mind” as an important outcome, but when their family members or friends have medical problems, this issue immediately comes to the foreground. These clinicians do everything in their power to ensure that their special patients do not have to endure long delays or uncertainty about what is going to happen next, or reconcile conflicting advice, or wait for phone calls that will come…well, sometime soon. We know such experiences are part of what is often called the “disutility of care,” but when they happen to our intimates, we recognize it as something closer to torment.
The bad news is that the challenge of giving patients coordinated care gets harder every year, as medical progress introduces increasing complexity to health care. The good news is that we are in fact getting better at coordinating care every year, because we increasingly recognize the importance of the challenge, and are responding.
Data Collection Advances
One important first step in managing the coordination of care is measuring it. After all, only patients themselves can judge how adequately their needs have been met. And, until recently, the perspectives of patients could only be surmised, and clinicians were expected to improve their “bedside manners” on a case-by-case basis.
But that time has passed. Today, advances in health information systems and in communications technology allow data to be collected from patients at low costs; and for patients to be followed over time so that their outcomes can be measured, analyzed, and improved. Patients can be segmented into groups with similar shared needs, so that teams can be organized to meet those needs. Some of these needs are clearly clinical (eg, control of pain from diseases or treatments), while others are not directly related to patients’ medical problems but are instead driven by how well health care providers work together.
Evolution of the health care marketplace has made improvement of value for those patient segments a strategic imperative. Provider organizations have to meet the needs of patients if they are to maintain or increase their market share—and, not coincidentally, these organizations are discovering that measurement and improvement of patient experience is an important strategic priority.
In this context, innovations are rapidly being adopted in 4 areas:
- The data that are being collected—Data that reflect how well patients’ needs are being met (ie, actual outcomes) have taken center stage, while data on amenities (eg, food and parking) are increasingly peripheral.
- How the data are being collected—Paper and telephone surveys are been supplemented or replaced by electronic methods. Increasingly, health care organizations are seeking email or other electronic ways of communicating with their patients. The reliability of collecting data via older methods is increasingly problematic, and electronic data collection reach patients faster and more efficiently. On average, respondents to electronic surveys are slightly younger than respondents to paper surveys, but the goal of measuring patient experience is to drive improvement; thus, more data is essential (see below).
- How much data are collected—The clear trend is away from seeking data from small samples of patients to meet some regulatory requirement, and toward seeking data from large samples of patients (ideally, giving all patients a chance to provide information). Larger amounts of data are needed to analyze data at the levels where true accountability lies, and true improvement can occur, such as the individual clinician’s performance.
- How the data are being used—A growing number of organizations are taking bold steps to increase accountability for improving patient experience, up to and including public reporting at an individual physician level. Many organizations are placing a modest financial incentive on improvement, while others use internal peer pressure as their approach. For example, physicians may undergo performance reviews annually at which their patient experience data as well as other performance metrics are discussed. Or organizations may share data internally without blinding, so that clinicians’ colleagues can see the ratings and comments made by patients.
Some of the most dramatic improvements have been made by organizations that have adopted the approach pioneered by the University of Utah Health System, which began sharing all patient ratings and comments on the internet in December 2012. Although Utah’s physicians were of course leery of the risks involved, they have found that the vast majority of patient comments were in fact laudatory—patients want to believe that clinicians are doing a good job, and have a low threshold for praising them. And the small percentage of criticisms from patients have proved powerful drivers of improvement. As a result, Utah and other organizations who are pursuing the transparency approach have seen improvement in patient experience far beyond what one could ever expect using financial incentives.
Summary
In sum, measurement of patient experience is no longer focused upon amenities such as food and parking based on responses from a few hundred patients. Instead, the field is about capturing important outcomes from as many patients as possible, so that teams and individual clinicians can improve their actual patient care. The strategic imperative to measure and manage these outcomes has never been greater; it is the antidote to a major side effect of medical progress, which is the chaos that characterizes modern health care. By asking patients about how their care is really going, I am certain we will respond and improve.
Corresponding author: Thomas H. Lee, MD, [email protected]. Dr. Lee is Chief Medical Officer for Press Ganey Associates, Inc.
From Press Ganey Associates, Inc., Wakefield, MA, and Harvard Medical School and Harvard School of Public Health, Boston, MA.
In fits and starts, but with increasing certainty, health care is changing its organizational focus from the activities of clinicians to meeting the needs of patients. That progress has been slowed and complicated, however, by lack of a performance framework that captures the extent to which patients’ needs are being met. In the absence of such data, “quality” has often been described in terms of the reliability of providers in complying with evidence-based guidelines.
Provider reliability is important, of course, but no substitute for the measurement and improvement of actual patient outcomes. After all, health care exists not to grade providers but to help patients. But clarity on that focus raises some important questions that we have not often discussed in the past.
What exactly are we trying to accomplish in health care? What is the goal? How can we tell how we are doing?
The answers cannot be found solely through measurement of “hard” clinical outcomes, such as death and disability. Yes, these are the most important focuses for improvement in health care, but we cannot deliver immortality, and we often can only delay complications of chronic disease. There is something else that our patients seek from health care, and it can only be measured by asking them directly.
Measuring "Peace of Mind"
That “something else” was described by one of my colleagues as “peace of mind that things are as good as they can be, given the cards that we have been dealt.” That may not be the most compact term in health policy, but I have yet to come up with something more concise— and it captures something immediately recognizable as important to anyone who has ever taken care of a patient with a serious disease, or spoken to that patient’s family. Of course, we should do our best to help patients live as long as possible, and of course we should optimize their health and relieve symptoms at every step of the way.
But there are other things that influence the degree of suffering that patients endure along that way, like hope, trust, anxiety, fear, and confusion. They are often considered part of the “art of medicine,” but I think we call them “art” because we are nervous about approaching them with discipline and rigor. In fact, these things can be measured, and managed—and the organizations that improve them are often rewarded with greater market share and professional pride.
Some of my clinician-colleagues do not immediately think of patients’ “peace of mind” as an important outcome, but when their family members or friends have medical problems, this issue immediately comes to the foreground. These clinicians do everything in their power to ensure that their special patients do not have to endure long delays or uncertainty about what is going to happen next, or reconcile conflicting advice, or wait for phone calls that will come…well, sometime soon. We know such experiences are part of what is often called the “disutility of care,” but when they happen to our intimates, we recognize it as something closer to torment.
The bad news is that the challenge of giving patients coordinated care gets harder every year, as medical progress introduces increasing complexity to health care. The good news is that we are in fact getting better at coordinating care every year, because we increasingly recognize the importance of the challenge, and are responding.
Data Collection Advances
One important first step in managing the coordination of care is measuring it. After all, only patients themselves can judge how adequately their needs have been met. And, until recently, the perspectives of patients could only be surmised, and clinicians were expected to improve their “bedside manners” on a case-by-case basis.
But that time has passed. Today, advances in health information systems and in communications technology allow data to be collected from patients at low costs; and for patients to be followed over time so that their outcomes can be measured, analyzed, and improved. Patients can be segmented into groups with similar shared needs, so that teams can be organized to meet those needs. Some of these needs are clearly clinical (eg, control of pain from diseases or treatments), while others are not directly related to patients’ medical problems but are instead driven by how well health care providers work together.
Evolution of the health care marketplace has made improvement of value for those patient segments a strategic imperative. Provider organizations have to meet the needs of patients if they are to maintain or increase their market share—and, not coincidentally, these organizations are discovering that measurement and improvement of patient experience is an important strategic priority.
In this context, innovations are rapidly being adopted in 4 areas:
- The data that are being collected—Data that reflect how well patients’ needs are being met (ie, actual outcomes) have taken center stage, while data on amenities (eg, food and parking) are increasingly peripheral.
- How the data are being collected—Paper and telephone surveys are been supplemented or replaced by electronic methods. Increasingly, health care organizations are seeking email or other electronic ways of communicating with their patients. The reliability of collecting data via older methods is increasingly problematic, and electronic data collection reach patients faster and more efficiently. On average, respondents to electronic surveys are slightly younger than respondents to paper surveys, but the goal of measuring patient experience is to drive improvement; thus, more data is essential (see below).
- How much data are collected—The clear trend is away from seeking data from small samples of patients to meet some regulatory requirement, and toward seeking data from large samples of patients (ideally, giving all patients a chance to provide information). Larger amounts of data are needed to analyze data at the levels where true accountability lies, and true improvement can occur, such as the individual clinician’s performance.
- How the data are being used—A growing number of organizations are taking bold steps to increase accountability for improving patient experience, up to and including public reporting at an individual physician level. Many organizations are placing a modest financial incentive on improvement, while others use internal peer pressure as their approach. For example, physicians may undergo performance reviews annually at which their patient experience data as well as other performance metrics are discussed. Or organizations may share data internally without blinding, so that clinicians’ colleagues can see the ratings and comments made by patients.
Some of the most dramatic improvements have been made by organizations that have adopted the approach pioneered by the University of Utah Health System, which began sharing all patient ratings and comments on the internet in December 2012. Although Utah’s physicians were of course leery of the risks involved, they have found that the vast majority of patient comments were in fact laudatory—patients want to believe that clinicians are doing a good job, and have a low threshold for praising them. And the small percentage of criticisms from patients have proved powerful drivers of improvement. As a result, Utah and other organizations who are pursuing the transparency approach have seen improvement in patient experience far beyond what one could ever expect using financial incentives.
Summary
In sum, measurement of patient experience is no longer focused upon amenities such as food and parking based on responses from a few hundred patients. Instead, the field is about capturing important outcomes from as many patients as possible, so that teams and individual clinicians can improve their actual patient care. The strategic imperative to measure and manage these outcomes has never been greater; it is the antidote to a major side effect of medical progress, which is the chaos that characterizes modern health care. By asking patients about how their care is really going, I am certain we will respond and improve.
Corresponding author: Thomas H. Lee, MD, [email protected]. Dr. Lee is Chief Medical Officer for Press Ganey Associates, Inc.