Patient Engagement

Handcrafting the Patient Experience

Article · September 11, 2019

With over 6 million listings in 100,000 cities worldwide, Airbnb has redefined the hotel and hospitality industry. A key component of the company’s success is its dedication to “handcrafting” the guest experience. Handcrafted experiences are designed with an intentional, in-depth focus on individuals, informed by placing oneself in another’s shoes. They create delight for users through unexpected end-to-end experiences.

We believe Airbnb’s model offers lessons for guiding health care innovation in patient satisfaction.

There’s no doubt that health care has begun to pay more attention to patient experience metrics, such as those captured by the national Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) survey. These metrics are increasingly transparent and publicly available. The Centers for Medicare and Medicaid Services now withhold a percentage of Medicare payments to providers based on patient experience scores. Adding to this consumerization of health care, today’s savvy patients text their doctors, post online reviews, and shop around using tools like Medicare’s Hospital Compare website to compare hospital star ratings across outcomes, quality, and patient experience.

People rarely go to the doctor or hospital looking for a delightful experience. But there are creative steps we in health care can take to insert convenience or surprise into their encounters that make patients and families think, “Wow, that was great.” Or even, “This was a tough experience, but I know my doctor or health care entity is trying a little bit harder for me.”

Handcrafting in health care means meeting patients where they are. It means understanding who your patients are, how they live, whom they lean on for support, and how involved they want to be in their care. As patients consume health care in new ways, we need to start thinking outside the box, reaching people where they are, diving deep into their stories, and using that information to drive high-quality care.

According to a recent NEJM Catalyst Insights Report, 96% of providers surveyed believe that health care can learn from consumer-facing industries such as hospitality and technology to improve patient experience and engagement.

What can health care draw from Airbnb’s success and approach? We’ve teased out three guideposts for redefining the health care experience and have conducted our own research and exercises to capture what patients really want.

1: Institutions must place themselves deep within the world of their patients.

Understanding the patient perspective by living through their end-to-end experiences will expose drivers of high and low patient satisfaction. Investigating the mental and physical journeys that patients take to access health care can provide insights into important pain points and frustrations, as well as surprises and delights. Did they have to rush through an appointment to pay a parking meter or pick up a child from school? How far does a follow-up phone call from the doctor’s office go in ensuring someone is doing all right after a hospital discharge?

From early on, Airbnb’s founders embedded themselves in the experience of customers who provide and use its lodging to understand the journey from both perspectives. For example, cofounders Brian Chesky and Joe Gebbia went to hosts’ homes to photograph them for the website and, while there, asked for feedback about renting through Airbnb. Those visits helped them develop resources for supporting future hosts. On the travelers’ side, Airbnb guests rank their stays on a 5-star scale. To create truly delightful experiences, Chesky and Gebbia began asking guests to describe an imaginary 10-star stay. They knew that being perfect (or 5-star) does not mean being delightful (10-star), so they imagined the playful space of what is beyond perfect. This work has informed the creation of Airbnb “superhosts,” who keep stocked refrigerators, offer keys to their cars, or make local dinner reservations in hopes of surprising guests and promoting their listing rank.

We conducted our own beyond-perfect exercise within the Emergency Department (ED) at Penn Presbyterian Medical Center at the University of Pennsylvania, an urban, academic ED and Level 1 trauma center. We approached 35 patients receiving care and asked them, “Amid this chaos, how could we make this better?” When asked to describe a 5-star experience, patients provided expected responses, such as better communication or decreased waiting times. But encouraging them to imagine a 10-star experience inspired creativity. People came up with great ideas. Patients imagined an ED outfitted with a lending library, yoga and acupuncture services, small refrigerators, personal video streaming stations, and in-room charging stations for electronic devices. Patients also suggested a more welcoming, home-like space (“The room is too plain and depressing) or help with travel arrangements (“I would love to have a ride home so I don’t need to bug someone else”). While most focused on creature comforts, one patient suggested having the ED physician contact the patient’s primary care physician “to have a conversation bridging the gap of communication.”

2: Capturing passionate, organic feedback is essential for fully appreciating the patient perspective.

Commonly used patient satisfaction surveys, such as HCAHPS and Press Ganey, provide patients with scripted questions, with little room for rich narrative. To improve care, we must stop using overly structured formats and allow for what Reid Hoffman, cofounder of LinkedIn, describes as passionate feedback. This type of organic feedback conveys the stories and moments of care that are critically important to patients and that spark word of mouth. Let’s create space for patients to paint a portrait of their current experience from which we can learn and produce change.

As an example of passionate feedback, a family member of a deceased neurosurgery patient posted an online comment along the lines of, “Thank you to our neurosurgical team for going above and beyond to make Mom really comfortable as she was going through this critical illness. You took us through this journey. . . . We wouldn’t be where we are without you.”

Patients are already accustomed to giving passionate feedback. They are increasingly using online comment-driven platforms, such as Yelp and Google, to share ratings, reviews, and open narratives around their health care experiences. Patients even post real-time reviews and photos from their waiting rooms or treatment rooms. In a recent study that several of us conducted, we analyzed nearly 101,000 Yelp reviews from EDs and urgent care centers to better understand what patients value in these acute care settings.

Health care leaders must exercise judgment in parsing this kind of feedback, as passionate patients may provide meaningful themes central to broader populations along with less-representative, fringe perspectives. The outlier ideas may still be helpful, but they should be assessed by studying a larger volume of patient feedback.

3: Health systems should develop pilot programs that build unique patient-centered delight in order to identify scalable interventions.

Airbnb leaders quickly realized that memorable travel was based on meaningful experiences unique to the destination, rather than just the hotel. They began investing in “magical trips” and created Airbnb Experiences, which offer a range of activities including restaurant reservations and concert tickets that can be booked along with lodging. At first, these and other Airbnb services — like photographing host homes — were executed manually and inefficiently by staff and interns until they could be automated. This go-slow strategy increases the odds of getting the important details right.

In health care, the essence of this handcrafted approach is not in the exact, and likely unrealistic, details of a 10-star experience. The process of allowing patients to envision “wow” scenarios identifies themes to address and rapidly test actionable changes.

For example, we conducted a pilot exercise at our Penn Family Medicine practice in downtown Philadelphia to better understand their needs. One part of our approach included posting a phone number that patients can use to text HELP at any point during their visit. A practice manager or another staff member immediately calls back and asks, “What can I do to help you?” Despite concerns about being flooded with texts, we typically receive only one a day.

What we’ve learned is that patients understand why they may be waiting, but they want to know the context, and for how long, to plan their day. They may be worried about getting a parking ticket or missing a bus to work. Creating delight in that practice might include adding $5 electronically to a parking meter, covering a patient’s Uber or Lyft ride to work, or simply providing a cold glass of water or an apple. Delight looks different to different people.

Before this intervention, patients might have given the practice low satisfaction ratings for many reasons. Now, they see the poster on the wall, have an immediate way of getting in touch with someone, and may leave the encounter thinking, “This practice cares, wants to improve, and help.”

Pilot programs of handcrafted ideas can mature and be designed for efficient scalability. Conducting rapid-cycle testing with focused interventions on small patient groups can provide key insights into how larger programs may succeed or stumble in real-world use. Leaders can use this learning to build and adapt larger-scale rollouts of patient-centered experiences.

It’s important to remember that creating delight differs from creating institutional change around traditional metrics like hospital length of stay or readmission rate. Handcrafted experiences demand different mind-sets and approaches. They likely will start small and need to be adapted to varying clinical environments and regions. Handcrafting requires an intense and dynamic approach and the ability to pivot quickly as insights crystallize. Creating institutional change, on the other hand, often involves more structure and less variability.

Large health care systems may struggle to adopt the concepts behind handcrafted experiences, as they may require investing in nontraditional approaches to addressing health and health care. To fundamentally change the patient experience, leaders must remain open and nimble. Embrace and test ideas that are driven by the voices of patients and their caregivers, even if they seem unconventional. These ideas may lead to happier (and healthier) patients.

Responding to the Consumerization of Health Care

The intentional and methodologically rigorous process of capturing patient feedback to inform operational change has started to gain momentum nationally. For example, organizations like the Agency for Healthcare Research and Quality (AHRQ) and the Patient-Centered Outcomes Research Institute (PCORI) are beginning to push the idea of learning health systems, which continually gather, analyze, and apply evidence and care experiences to guide improvement. This approach has the same spirit at the heart of handcrafting — that is, reaching out to patients in real time to inform care delivery.

The consumerization of health care is changing patients’ choices and expectations. Health care must look to other industries like Airbnb, Amazon, and Uber for lessons and techniques to build and improve the patient experience.

True innovators looking to provide exceptional health care experiences will lead the way by adapting models from other arenas. Learning from end-to-end patient stories, aiming for the 10-star visit, gathering passionate feedback, and building delight are approaches by which health care can reimagine and redefine the patient experience.

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