improving service quality and patient satisfaction through it ... 22...er wait times represent a...

Improving Service Quality and Patient Satisfaction Through IT

Roger Kropf, PhD

New York University

© 2017 by Roger Kropf, PhD

www.rogerkropfphd.net

http://www.rogerkropfphd.net/

Uber-fication

“My expectations have been elevated -- I call it the Uber-fication everything. I expect to get what I want, when I want it, where I want it, and how I want it, all at the push of a button…most businesses are working toward meeting that expectation…But not healthcare organizations.”

Denise Lee Yohn, ”Healthcare Companies Should Design Patient Experiences Like Customer Experiences” Forbes, February 15, 2017https://www.forbes.com/sites/deniselyohn/2017/02/15/healthcare-companies-should-design-patient-experiences-like-customer-experiences/#39083a456038

https://www.forbes.com/sites/deniselyohn/2017/02/15/healthcare-companies-should-design-patient-experiences-like-customer-experiences/#39083a456038

Technologies

MRI entertainment systems

Wait time management

Voice-enabled communication

Objectives For Today

Learn how to assess the impact of technology on patient satisfaction.

Examine alternatives for using web-based, text-based and video communication to improve satisfaction.

Looking For A Home Run

Improve Satisfaction

AND Improve Clinical Quality

AND Reduce Expenses and/or Increase Revenue

MRI Entertainment System for Kids:A Home Run?

3D virtual reality entertainment system that provides multiple entertainment options

Googles and headsets isolate patient from MRI

Patient is able to communicate with technicians via headset and microphone

MRI Entertainment System

http://www.mrivideo.com/cinemavision.php

http://www.mrivideo.com/cinemavision.php

Entertainment System : Improved Child and Parent Satisfaction

Child avoids claustrophia

Isn’t frightened by noise

Enjoys content

Avoids fasting, preoperative assessment, needles (unless contrast was required), added preparation or recovery time, and a shorter wait time.

Parent avoids reaction to children’s fear and discomfort

https://www.youtube.com/watch?v=mz8sVSZVsPcd

https://www.youtube.com/watch?v=mz8sVSZVsPcd

Entertainment System : Improved Clinical Quality

Avoids imaging problems due to motion

Reduces sedation and potential adverse effects

“There was a reduction [in sedation] from 53 to 40% for age 3–10 years… and 16 to 8% for those older than 10 years.”

Hared, R. K., & Strain, J. D. (2001). “MRI-compatible

audio/visual system: impact on pediatric sedation” Pediatric

Radiology , 31, 247–250.

Effects of Sedation

“Of the Children, 239 (20.1%) experienced adverse events related to sedation, including inadequate sedation in 150 (13.2%) and decrease in oxygen saturation in 63 (5.5%). Five of these children experienced airway obstruction and two became apneic”

Malviya, S., Voepel-Lewis, T., & Tait, A. R. (1997). “Adverse events and risk factors associated with the sedation of children by nonanesthesiologists” The International Anesthesia Research Society , 85, 1207–1213.

Entertainment System: Reduces Expenses and/or Increases Revenue

Avoid lost revenue from aborted procedures

Avoid expense of treating patients with an adverse reaction to sedation

Avoid cost of repeated sedation and imaging because of inadequate sedation

“13.2% of sedation cases studied were considered inadequate

sedations and had to be repeated to acquire the needed

diagnostic images” (Malviya, Voepel-Lewis, & Tait, 1997)

Entertainment System : Reduces Expenses and/or Increases Revenue

Reduces personnel necessary for monitoring and additional time in the imaging department for induction and recovery of sedated patients.

Increases volume by becoming the “family friendly” provider

Increases volume of physician referrals due to reduced sedation

“In one year, the savings from not sedating 268 patients could pay for two A/V systems. This shows that reducing the need for sedation is cost-effective. Improvement in workflow should also occur by allowing more patients to be scanned per day without sedation.”

Lemaire, C., Moran, G. R., & Swan, H. (2009). “The impact of audio/visual systems on

pediatric sedation in magnetic resonance imaging” Journal of Magnetic Resonance

Imaging, 30, 649–655.

Savings Pays for Entertainment System

Why Improve the Patient Experience?

Payment reforms

HCAHPS and CGCAHPS Patient

Satisfaction Surveys

The Hospital Value-Based Purchasing Program

Hospital Compare www.medicare.gov/hospitalcompare

Competition

http://www.medicare.gov/hospitalcompare

How To Assess Satisfaction And The Impact of Technology

Quantitative methods

HCAHPS, CGCAHPS and other surveys

Qualitative methods

Focus groups and patient advisory committees

Short surveys sent via text*

Professional shopper

Journey Mapping

Online reviews (Healthgrades, Yelp)

* “Urgent care chain uses consumer feedback to boost performance” Health Data Management online (August 10, 2017)https://www.healthdatamanagement.com/news/urgent-care-chain-uses-consumer-feedback-to-boost-performance

https://www.healthdatamanagement.com/news/urgent-care-chain-uses-consumer-feedback-to-boost-performance

“online consumer review platforms such as Yelp can supplement information provided by more traditional patient-experience surveys…The content of Yelp narrative reviews mirrors many aspects of the HCAHPS survey but also reflects new areas of importance to patients and caregivers.”

“Yelp Reviews Of Hospital Care Can Supplement And Inform Traditional Surveys Of The Patient Experience Of Care” Health Affairs (April 2016) Vol. 35 no. 4, 697-705http://content.healthaffairs.org/content/35/4/697.abstract

Online Reviews

http://content.healthaffairs.org/content/35/4/697.abstract

Online Reviews

Identify areas to explore

Can be provider-sponsored or commercial (e.g., Yelp)

Shouldn’t be viewed as representative

Commercial firms or local staff can review and summarize “Reputation strategy helps Nicklaus Children’s respond to

complaints” Health Data Management (August 3, 2017) https://www.healthdatamanagement.com/news/reputation-strategy-helps-nicklaus-childrens-respond-to-complaints

https://www.healthdatamanagement.com/news/reputation-strategy-helps-nicklaus-childrens-respond-to-complaints

Journey Mapping

Description of what consumer does in searching for and using product initially and over time

Systematic process requiring dedicated staff and/or consultants

Adam Richardson, “Using Customer Journey Maps to Improve Customer

Experience” Harvard Business Review (November 15, 2010)

https://hbr.org/2010/11/using-customer-journey-maps-to


Journey Mapping - Questions

Actions: What is the customer doing at each stage? What actions are they taking to move themselves on to the next stage?

Motivations: Why is the customer motivated to keep going to the next stage? What emotions are they feeling? Why do they care?

Journey Mapping

Questions: What are the uncertainties, jargon, or other issues preventing the customer from moving to the next stage?

Barriers: What structural, process, cost, implementation, or other barriers stand in the way of moving on to the next stage?

Adam Richardson, “Using Customer Journey Maps to Improve Customer Experience”

Harvard Business Review (November 15, 2010)



CGCAHPS Quality Measures

Getting Timely Appointments, Care, and Information.

How Well Providers Communicate With Patients.

Providers' Use of Information to Coordinate Patient Care (New to the 3.0 version).

Helpful, Courteous, and Respectful Office Staff.

Patients' Rating of the Provider.

The CAHPS Clinician & Group Survey produces the following measures of patient experience

Agency for Healthcare Research and Quality

https://www.ahrq.gov/cahps/surveys-guidance/item-sets/PCMH/index.html

https://www.ahrq.gov/cahps/surveys-guidance/item-sets/PCMH/index.html

CGCAHPS Health Information Technology Item Set

Helpfulness of provider’s use of computers during a visit

Getting timely answers to medical questions by e-mail

Helpfulness of provider’s website in giving you information about your care and tests

Getting timely appointments through e-mail or a website (1 item only)

Quality Measures

Agency for Healthcare Research and Quality

https://www.ahrq.gov/cahps/surveys-guidance/item-sets/HIT/index.html

https://www.ahrq.gov/cahps/surveys-guidance/item-sets/HIT/index.html

Looking For A Home Run

Improve Satisfaction

AND Improve Clinical Quality

AND Reduce Expenses and/or Increase Revenue

Wait Time Management

Having to wait can decrease patient satisfaction regardless of service quality

Uncertainty magnifies the stress of waiting, while feedback in the form of expected wait times and explanations for delays improves the experience.

Wait Time Management

Expectations play a major role

Wait time should be actively managed rather than accepted

Technology can help

Wait Time Management:Pagers and Buzzers

Allows patients to walk around, but there are limited things to do

“Promptly” isn’t defined.

Uncertainty isn’t reduced and there is no feedback.

Leverage the internet or text-based communications?

Wait Time Management:Wait At Home Or Office

“WAHOO is NextCare Urgent Care’s Wait

At Home Or Office Service. Simply check

in by the method most convenient for you –

online, by phone, or in the clinic – and then

wait wherever you are most comfortable.

We’ll call you when your exam room is

ready.”

https://nextcare.com/faq/wahoo/

https://clockwise.md/hospitals/453/appointments/new

https://nextcare.com/faq/wahoo/https://clockwise.md/hospitals/453/appointments/new

Wait Time Management:HCA Text-Based System

HCA Midwest Health (a 10 emergency room enterprise) has a web based application, a mobile application and a text based application where patients can text a number with their zip code and it will text them back with the closest emergency room and its wait time.

http://hcamidwest.com/service/emergency-care


Wait Time Management:Managing Expectations

What is the “service promise”?

How is this perceived by the patient?

What are the dangers in making this promise and how can they be reduced?

Wait Time Management:HCA Midwest Health Service Promise

About our ER Wait Times

Our average ER wait times are approximate and provided for informational purposes only. If you are having a medical emergency, call 911.

The ER wait time represents the time it takes to see a qualified medical professional, defined as a Doctor of Medicine (MD), Doctor of Osteopathy (DO), Physician Assistant (PA) or Advanced Registered Nurse Practitioner (ARNP).

ER wait times represent a four-hour rolling average updated every 30 minutes, and is defined as the time of patient arrival until the time the patient is greeted by a qualified medical professional. Patients are triaged at arrival and are then seen by a qualified medical professional in priority order based on their presenting complaint and reason for visit.



Wait Time Management:A Home Run?

Improve Satisfaction?

Improve Clinical Quality?

Reduce Expenses and/or Increase Revenue?

Voice-Enabled Communication

Amazon Echo. Google Home

Voice-Enabled Communication

Amazon Echo and Google Home allow voice control and information retrieval

Will create new expectations about how information is retrieved and used

Patients with physical and mental limitations may obtain new capabilities that affect healthcare outcomes

HIPAA compliance remains an obstacle

Boston Children's Hospital KidsMD for Alexa

https://www.amazon.com/gp/product/B01E3F0AUC?ref=skillrw_dsk_pnps_dp_0

https://www.amazon.com/gp/product/B01E3F0AUC?ref=skillrw_dsk_pnps_dp_0

Beth Israel Deaconness Medical Center (Boston) Alexa Inpatient Pilot

Alexa, ask BIDMC

What’s my room number

Who’s on my care team or List my care team

What is my diet or What can I eat

Call a nurse or I need a nurse or Send in a nurse

Give me some inspiration or Inspire me

I need spiritual care or Request spiritual care

I need a social worker or Request social work

What's my care plan for today or What are my planned activities for

today

Ok, thanks or Stop or You can stop

John Halamka, “Early Experiences with Ambient Listening Devices (Alexa and Google

Home)” Life as a CIO Blog (3/29/17)

https://geekdoctor.blogspot.com/2017/03/early-experiences-with-ambient.html

https://geekdoctor.blogspot.com/2017/03/early-experiences-with-ambient.html

Amazon Echo for Dementia

“It has afforded me something that I have lost. Memory. I can ask Alexa anything and I get the answer instantly. And I can ask it what day it is twenty times a day and I will still get the same correct answer.”“’Alexa, remind me to take my medicine at 8:00am and 8:00pm everyday.’ Once you tell Alexa to do this, it will indeed remind you daily to take your medicine.”

Rick Phelps - diagnosed with Early Onset Alzheimer’s disease

Amazon Echo for Dementia – Technology for Seniors, Daily Caring

http://dailycaring.com/amazon-echo-for-dementia-technology-for-seniors/


Voice-Enabled Communication:Adults With Mobility Issues

“Older adults with mobility issues or health conditions like Parkinson’s can also benefit from an Echo. It gives them more control over their environment and more independence.

For example, a senior could easily turn on the light across the room or adjust the room’s temperature using only their voice. If they wanted to hear music or read a book, they could do it with another quick voice command.”

Amazon Echo for Dementia – Technology for Seniors, Daily Caring



Voice-Enabled Communication:A Home Run?

Improve Satisfaction?

Improve Clinical Quality?

Reduce Expenses and/or Increase Revenue?

Final Words

Patient satisfaction can be measured and managed

Technology can help

Acquisition is easier to justify if clinical quality is improved and expenses are reduced and/or revenue increased

Questions? Comments?

Roger Kropf, PhD

[email protected]
http://www.rogerkropfphd.net/mailto:[email protected]

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