COVER STORY · POPULATION HEALTH MANAGEMENT “You would think four points lower in
a domain doesn't sound like much, but in the patient experience world, that's actually a huge decline” says Rick Evans, senior vice president and chief experience officer at NewYork-Presbyterian. “That was the equivalent of falling off a cliff. It was alarming to see, and only in the last couple months has it started to begin to tick back up.” Evans and other health system chief
Rick Evans
patient experience officers are working to repair the cultural damage caused by the pandemic that led to the declining survey scores. Part of that work involves doubling down on training and improving employee morale, which also declined sharply during the pandemic. It also requires a renewed focus on health equity, as well as discovering new ways to capture the patient’s voice and
involve patients and families more deeply in decision-making processes. Evans says this work is made somewhat
easier by the fact that patient experience has evolved into something like a disci- pline. A body of knowledge has developed around understanding patients’ percep- tions of their care, and the ability to collect that data has gotten better and broader, Evans says. The HCAHPS survey is imperfect
but being improved, Evans notes. “The standardization of those measures across the country was a great leap forward and really helps us to compare to each other,” he says. “That benchmarking ability is really critical in any kind of improvement work. Over the years, as we've identified issues that need improvement, a whole body of evidence-based best practices has emerged, so that if you're asking a nurse leader or practice manager to improve their patient experience ratings, now we've got tactics and tools that are evidence- based, that have been proven to work. It has gotten much more strategic, much more data-driven, much more evidence- based. I would say that there's almost a discipline now within healthcare around this kind of work.”
The VA Way At the U.S. Department of Veterans Affairs, a turnaround on patient expe- rience actually preceded the pandemic.
“Over the years, as we’ve identified issues that need improvement, a whole body of evidence-based best practices has emerged, so that if you’re asking a nurse leader or practice manager to improve their patient experience ratings, now we’ve got tactics and tools that are evidence-based, that have been proven to work.”
—Rick Evans, senior vice presi- dent and chief experience officer at NewYork-Presbyterian
Several years ago, the Veterans Health Administration partnered with the Veterans Experience Office (VEO) to create a standardized patient experi- ence for all veterans receiving care at all sites across the country. A 2017 Journal of the American Medical Association (JAMA) article noted that VA hospitals performed better than non-VA hospitals on several outcome measures but per- formed worse on certain
pat ient Jennifer Purdy
experience mea- sures and behav- ioral health. That article was one of the factors that led the VA to create the
“VA Way” effort to deliver an enhanced experience, says Jennifer Purdy, direc- tor for patient experience in the VA’s Veterans Experience Office. Purdy, a social worker who has
worked for the VA for 29 years, says it was important to set the expectation of what the customer experience should look like. “We have 400,000 employees and we take care of 9 million veterans, so if you think about the scope of it, we needed to define a group of behaviors and set expectations of customer experi- ence delivery, so that we could spread it across the system and be standardized so that there wasn't a lot of variation.” In order to be more responsive to
patients’ comments about their experi- ence, the Veteran Experience Office stood up what Purdy calls a near-real-time feedback system with a platform called Vsignals. When a veteran completes a
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medical appointment at the VA, within two weeks they are sent an e-mail asking how that experience went. They are asked a series of questions depending on what journey they're on — whether they have received outpatient services or have been discharged from a medical center or been to an emergency department. “We look at the moments that mat-
ter most to those patients in those journeys, and that's what we measure on Vsignals,” she says. “As soon as the veteran submits their response, it automatically populates our database. Our near-real-time survey gives us the opportunity to know what's going on right now, and gives us the opportunity to correct things more quickly.” The VEO has seen strong results
from the renewed effort on training and more nimble feedback mechanisms. For instance, veteran trust in the system has gradually improved from 47 percent to 79 percent over the last six years. “Of course, we want to continue to
improve, but I think back to when we started, the VA had come off a period when wait time issues arose in Phoenix, and there was a lot of media about the inability to get appointments, so there was a lot of distrust in the system,” Purdy explains. “When we were stand- ing up the Veterans Experience Office, we knew we had to rebuild the public trust of VA. The way we build trust is by meeting with veterans and know- ing what matters the most to them. Of course, they don't want to wait more than 20 minutes to get into their appointment. But oddly enough, when we talked to veterans, that wasn't one of the moments that stood out the most to them. What really mattered to them is: how do I get to my appointment and then once I'm in there, how do I have a trusting relation- ship with my provider? How do I know
“When we were standing up the Veterans Experience Office, we knew we had to rebuild the public trust of VA. The way we build trust is by meeting with veterans and knowing what matters the most to them.”
— Jennifer Purdy, director for patient experience in the VA’s Veterans Experience Office
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