Patient Experience: Why You Can’t Mandate Patient-Centeredness

I was reading some of the writings of Dr. Lucian Leape, the father of the patient safety movement. Twenty-two years ago, Dr. Leape warned us that the hospital industry needed to do better in the area of safety.

He demonstrated that we were riddled with unreliable processes, medical errors and unnecessary deaths and injuries. This message was not received all too favorably. Denial and skepticism were the reactions. Dr. Leape did not back down. Over time, as the data began to build, a tipping point was reached where the need for improvement was undeniable.

Now, health systems feature patient safety as a priority. Most health systems have a chief safety officer and teams of doctors, nurses and improvement specialists focusing on making care delivery more reliable. While there is still a lot of work to do in patient safety, the field is now recognized as a necessary area of focus, rather than the grumbling of a few zealots.

Like patient safety over 20 years ago, the patient experience movement is going through its own growing pains today. Almost 10 years in, patient experience is still not recognized by all health systems as a top priority. Less than five percent of hospitals achieved a 5-star rating on the federal HCAHPS patient satisfaction survey. It is estimated that at least half of physicians feel that patient experience adds no value to clinical care.

However, like safety, patient experience is beginning to be recognized as a must-have. More health system boards and CEOs are creating a chief experience officer position to drive patient experience across their health systems.

To support the experience work, teams of data analysts, hospitality experts, process improvement specialists and coaches are being assembled. In the meantime, the federal government is increasing its financial penalty of hospitals for low performance in patient experience.

A Family Advisory Council…

One best practice to help drive patient-centered care is the implementation of family advisory councils (FACs). A FAC is a group of patients and family members who meet with senior hospital leadership on a regular basis to give feedback on how to improve care delivery.

In addition, some hospitals have family members sit on various committees so that the voice of the patient is not lost when important decisions are made. FACs can be a powerful tool in the promotion of patient experience and patient-centered care. However, the success of the FAC depends on the hospital’s willingness to listen, act, and change.

When a FAC gives feedback about parking, dining, pain control, waiting, sleep interruption, communication and other topics that FACs typically bring up, the hospital must listen to this feedback. The hospital leadership must view these suggestions as for their highest priority and change internal processes to correct the issues. FACs are a golden opportunity to hear directly from the consumer and to serve patient needs. It is the voice of the customer.

Unfortunately, the FAC movement has not taken root everywhere. Some of the reasons for the failure are:

Not all hospitals have FACs
Not all FACs have the listening ear of the senior hospital leadership
Not all hospitals put a high priority on FAC feedback

Massachusetts Mandate

In 2008, in an effort to foster patient-centeredness and to facilitate the implementation of FACs, the State of Massachusetts passed a law mandating that all hospitals in the Bay State have a FAC.

While the intent of the legislation was in the right place, the law cannot guarantee that it will impact patient-centeredness in hospitals. You just can’t legislate that we treat our patients the right way.

The culture of the hospital, the health system, and the health industry must embrace patient-centeredness as a core tenet of what we do. Any hospital can get a group of patients together, collect feedback, and then do little with it. They obeyed the law.

Look at the list of the accomplishments of the local FAC. Are the projects they are working on driving transformative change across the organization or are they small projects with little impact? The FAC could be an amazing resource to drive patient-centered care if their feedback is taken seriously. Unfortunately, a mandate will not create culture change and buy-in.

The field of patient experience continues to climb the mountain of legitimacy just like patient safety did 25 years ago. Our industry needs to drive this because it is the right thing to do for patients, not because lawmakers tell us to listen to our customers.

Paul Rosen, MD