Health care systems are acutely aware of the imperative to enhance the patient experience and ensure patient engagement. Partnering with patients, reducing wait times, delivering effective care, reducing pain and suffering, and providing safe, high-reliability care are key issues that have become a priority for health care leaders.
Metrics to capture the patient experience have been evolving. There are multiple surveys to query patients and receive comments, from the federal government’s series of CAHPS surveys to the assessments developed by health care consultancies. In addition, start-up patient experience and reputation management companies are mining hospital and physician reviews posted on social media. Other companies are applying natural language processing to gain a deeper understanding of the qualitative data generated by patient comments.
These tools all rely on large datasets. They are invaluable for understanding the big picture of the overall patient experience. Percentiles and trending are not sufficient, however. As a supplement to these datasets, there are additional tools in the patient experience measurement toolkit that rely on “n of 1” observations to gain a deep understanding of what the patient is going through in trying to navigate the care system.
Anthony DiGioia, MD, and his team at the Patient and Family Centered Care Innovation Center of UPMC have developed a methodology to capture health care through the patient’s eyes. The core activity is following a patient and observing what happens as he or she goes through an entire care experience. Dr. DiGioia developed the methodology in his orthopedic practice by focusing on the care experience of a hip replacement, examining the entire process from arrival at the hospital to discharge and post-operative rehab.
Numerous opportunities for improvement emerged. For example, some post-op hip replacement patients were waiting to be picked up from the hospital in the rain. The team also discovered a way to minimize the need for blood transfusion during surgery. Other provider groups have used the shadowing methodology to improve. A trauma team implemented the use of iPads to help keep parents and children digitally connected after suffering a motor vehicle accident, as they were taken to adult and pediatric hospitals separately. Another team shadowed the pediatric blood draw experience and redesigned it to reduce anxiety and fear.
In their book, Demand: Creating What People Love Before They Know They Want It, Adrian Slywotzky and Karl Weber describe the technique of hassle mapping. The premise is that each service experience has the potential to create frustrations, inconveniences, disappointments, and complications for consumers. Slywotzky points to the example of Reed Hastings. Hastings was able to improve upon the hassles created for customers at Blockbuster Video in the late 1990s, including: two trips to the store to pick up and return a video, parking, wasting time in the store, a limited selection, and frequent late fees. The use of emerging technology with the purpose of solving these hassles resulted in Netflix.
Like patient shadowing, a hassle map can be used to uncover all of the difficulties and inconveniences that a patient encounters along the way. Consider how the hassle map can be applied to the various care experiences in the health system: making an outpatient appointment, an ER visit, the surgical experience, and hospitalization, to name a few areas ripe for improvement. This construct offers unlimited possibilities to uncover the frustrations encountered by patients and their families.
An empathy map is another tool that can shed light on what patients are feeling as they move through the care experience. Empathy mapping originated in design thinking, and is used to display people’s various emotions as they navigate any experience. An empathy map may uncover emotions ranging from fear, anxiety, surprise, delight, confusion, anger, reassurance, comfort, and peace of mind all within one experience. The map can show not only positive and negative emotions, but each emotion can also be graded for intensity. There are many applications to health care experiences. As one shadows a patient, one can observe the patient’s body language, facial expressions, and response, and ask how the patient is feeling at different points during the care experience. A window into the patient’s emotions can be a strong motivator to redesign care experiences in order to change negative emotional experiences to positive ones.
Most patient experience work today depends on collecting and analyzing large volumes of survey data. Reliance on survey data and comments alone is insufficient, however. Caregivers must look beyond spreadsheets and use other tools that focus on individuals. These collective “n of 1” observations can then become key drivers to redesign entire care experiences for all patients.
This blog post originally appeared in NEJM Catalyst on September 21, 2016.