Case Studies offer an exclusive look into current healthcare efforts, presented as an opportunity to learn from others as well as a spark for further ideas on how we can work to improve the patient experience.
This Case Study was originally posted in March, 2018.
Engaged and Empowered Staff Fuel the Ambulatory Surgery Center Patient Experience
What was the challenge, opportunity or issue faced?
In 2016, when CMS announced new ways to measure patient experience, our goal was to get out in front of the new requirements by taking a close look at each aspect of our patients' experience and assess our readiness to meet those requirements with people, processes and tools. Our context for change was written in the measures from the OAS-CAHPS survey: quality of communication and care by both providers and office staff, and preparations for surgery, discharge and recovery.
First, we established that patient satisfaction is different than patient experience. While the quantitative scoring in our surveys was high (96-99% positive), the qualitative commentary showed that serious gaps existed in the experiences, and therefore the perceptions of our patients.
Making meaningful change required adopting a different perspective. Working with a patient experience consultant, we learned how to see the patient's journeys through their eyes: as someone who may never have been to the surgery center, who may have a low level of health literacy. What's the one thing that they most need?
The answer: give them clarity. At every point in the process. Tell them what's expected of them, what will happen to them, and when.
What did you do to address it?
This required a grassroots effort: first, to build understanding and awareness of all that patients experience and second, to help CRSC staff see their role in the context of that experience. Finally, we needed to enlist staff in designing the experience, rather than allowing it to happen by default.
We built a team of representatives from across the organization to help us understand the experience as it's delivered. Together, we created fictional personas: patients with specific conditions, limitations and expectations. We defined the phases of a typical experience, then detailed out the clerical and clinical interactions that they encounter: before, during and after their procedure. Because a conversation with a 24-year-old is very different than one with an 84-year-old, we studied the ways that every patient-facing person should accommodate these audiences, and how support staff impact those experiences as well.
We distilled a complex matrix into a system map that depicts interactions across the entire experience from the patient's view: what's the Message being shared, by which Member of the staff, in what Medium, and at what Moment in the process. Media include verbal, printed, digital interactions and how the facility itself supports the experience.
What outcomes were achieved?
Having visualized the experience in a System Map, we needed to find a way to lock it into the culture, to serve as a visual shorthand for patient experience: the Infinity Loop. We've incorporated it into a number of graphic approaches to serve as an internal shorthand for patient experience at CRSC.
On August 29, 2017, we launched this concept at an all-staff celebration. This was the starting point to improved internal conversations around PX, leading to increased staff engagement. Staff now have a tool to understand their role in the context of the broader patient experience giving us a platform to fulfill the original charge: giving patients and their families as much clarity as possible at each point in the process.
The primary measure of success is continued Medicare reimbursements tied to CMS standards. For staff, this will translate into profit sharing and compensation. But we believe the overall goal is that engaged, empowered staff will design ways to enable confident, stress-free patients who will, in turn, tell better stories about their experiences. This internal collaboration has become an integral, sustainable part of the CRSC culture.
Culture change is something that needs to be unlocked from within, not imposed from the outside. So multiple groups at CRSC have formed that meet at regular intervals:
- A self-selecting group of Patient Experience "Champions" (one representative from each internal department) have worked with our PX consultant to develop a strategic plan that lays out the expectation, accountability, benchmarks and procedures to communicate to staff. They serve as the conduit between their department and CRSC leadership and enlist staff to implement new initiatives within their own departments.
- An administrative oversight group works with the consultant as a coach for ongoing efforts.
- Process Improvement groups give all staff an opportunity to uncover challenges, then develop and test new ideas and tools to improve communication and staff experiences.
- Procedures for training and orienting new hires are being implemented.
- We've also created space (elective, not mandatory) for existing staff to observe and learn from other departments as part of their workday. By creating the structure for this "cross-pollination," we build awareness and appreciation for each team member's contribution and encourage sharing of issues and ideas.
About Copper Ridge Surgery Center
Opened in 2004, the Copper Ridge Surgery Center (CRSC) is a free-standing, joint-venture Ambulatory Surgery Center (ASC) owned by the ASC Partnership, LLC (a group of physicians located in Traverse City, MI) and Munson Medical Center. CRSC is an 8 OR, 4 Procedure Room facility that safely serves more than 21,000 patients annually. This makes it one of the highest-volume multi-specialty ASCs in the country and the highest-volume multi-specialty ASC in the state of Michigan.