Using the Voice of the Customer to Improve Performance
The pressure is on! In 2013 CMS will begin to pay hospitals less if
their HCAHPS scores are not meeting norms or improving. Hospital administrators
are scrambling to respond to these and other fiscal stresses.
Hospital leaders often put a great deal of pressure on department managers
and Patient Advocates to “raise the scores,” in an effort
to make people accountable. We believe in accountability too, but worry
that the emphasis on improving scores has two flaws. First, employees
will not be motivated by improving scores. The emphasis should be on
improving the patient’s experience. Improving
the experience is more inspirational, and if done well, will lead to
improved scores.
The second problem with directing people to improve scores is that they
often do not know how. Even though HCAHPS questions
ask about frequency, the patients’ perception may be linked less
to quantitative numbers of activities and more to whether their needs
or expectations were met.
There are many, many ways to improve the patient experience. Using the
voice of the customer to drive improvements is one of many approaches,
and it seems particularly relevant now, when reimbursement will soon
be at risk.
In this article, we will look at eight ways to hear the voice of the
customer. In any of these activities, the key is to really listen to
what our customers are telling us, trying hard not to filter the patient’s
voice with our own biases and beliefs. Good luck, and please feel free
to contact us if you would like more information.
Patient Complaints
This is a very rich source of information, because we are hearing the
patient’s story in his or her own words. Be sure a skilled communicator
is talking with patients, (not just emailing or letter-writing) and
asking enough questions so that the patient’s perspective can
be truly understood. The goal here is not just to meet CMS requirements
or create numeric reports; it is to understand at a very human, behavioral
level what created the problem for the patient. That knowledge can then
be used to create change.
Patient Survey Data
Yes, the data is helpful. Use the scores and norms you receive from
your survey vendor, and drill down to understand differences in units,
shifts and patient diagnoses. However, recognizing that the score for
male cardiac patients on 3 South is low may not be enough. For instance,
on the question about how often the nurse "treated you with courtesy
and respect," we need to know more before we can initiate targeted
improvements. What does "courtesy and respect" mean to these
patients? What behaviors do they need to experience to believe they
received courtesy and respect?
Use the survey data as a starting point to help you decide what you
need to investigate further. One way of doing a deeper dive is by using
mini focused surveys of patients either while in-house (be careful not
to violate CMS guidelines) or after the HCAHPS survey process is complete.
Patient Advocates and others in your facility may be able to design
the mini survey questions. If no one in-house has this skill, hire an
outside consultant to help.
Other ways to learn more about how patients interpret survey questions
and what they want and need are by Rounding, holding a Focus Group,
or creating an Advisory Council. All these ideas are addressed below.
Patient Survey Comments
Comments on surveys can be a gold mine, if they are extracted carefully.
It is important to read the comments for specific examples of what pleased
or displeased patients. If patients have indicated they are willing
to be contacted about their survey, someone can even follow up and ask
more questions about a comment.
The contents of comments should also be checked against patient complaint
data, because there may be consistency in the messages that can help
you plan improvements.
Rounds
It doesn’t matter who is making patient rounds, the information
gathered should be captured and used. Qualitative data is rich in information
that can be helpful. Even when a patient initially does not provide
specifics, we can ask for them. For instance, if a patient says that
everything is going well, a follow up question that can be asked would
mine for details – "That is great Mr. Jones. I would
love to give that feedback to the staff, if it is alright with you.
Can you give me an example or tell me what makes you feel that all is
good?"
Rounds are a time when you can ask the "mini survey" questions
referenced above in an attempt to better understand your patients’
perspective on specific variables in the survey. To stay within CMS
guidelines, such questions may not resemble those in the HCAHPS survey,
so they must be more general than if you pursue the same issue in a
Focus Group or a survey you send after HCAHPS.
Focus Group
A Focus Group can be created by inviting any type of customer you want.
Using our example above, you could invite male cardiac patients who
received care on 3 South.
During a Focus Group, a skilled facilitator will ask pre-planned open-ended
questions, and the participants will respond using their own words and
stories. One person’s comment may trigger a memory in another
person, adding to the richness of the data.
Keys to success with a Focus Group are that the planned questions are
few enough that there will be time, that there is someone who can take
notes on the responses, and that no one who might bias the comments
is present in the room.
Plan to offer some incentive, such as a good meal or gift certificate
or check, as the participants are giving you the gift of their time.
Patient Advisory Council
The purpose of the Council is to provide a place where you can hear
the voice of the customer. This is applicable when you want help understanding
the patient’s perspective about existing service and products
and or proposed new ones.
Advisory Councils usually meet regularly, and members serve a term that
can range from a year or two to longer. A charter document describing
the purpose and mode of operation should be created and adopted in the
beginning, so that the Council’s understanding of their role is
in sync with administration’s, and so that meetings are productive
for hospital employees and patients alike.
Although usually issues discussed are more global in nature, an Advisory
Council might well have some suggestions about what nurse "courtesy
and respect" look like, and that question could be put on the agenda
at a meeting.
Employees as Patients
Many employees become patients, at our own or another hospital. You
might want to develop a process to regularly get feedback from these
employees. You could hold Focus Groups, or use surveys to get their
feedback.
Two caveats: make sure employees do not feel their confidentiality has
been violated when you know about their hospitalization, and if they
were in your own hospital, make sure they feel safe giving honest feedback.
Informal Communication
The voice of the customer can also be heard informally. Examples include
conversations you overhear in the hallway, cafeteria or elevator, and
comments your own friends and family make about their experiences in
your hospital or another. Often casual acquaintances who know we work
in a hospital will tell stories that can be useful insights into the
mind of a patient.
Create a method that will allow all employees to easily and quickly
give this feedback to someone who will use it, along with other types
of patient input, to drive improvement.
If all of this seems overwhelming, realize you are probably already
partially doing some of these things, and simply need to better capture
and use patient input. If you need help implementing any of these ideas,
or just want additional information, please contact us; we would be
pleased to have a conversation with you.
Have you had success using the Voice of the Customer? If so, please
email us and tell us about
it. We would love to give additional ideas in a future newsletter. |
