Experiences -vs- Journeys In Healthcare – Bill Bunting – Medium

I had several interesting conversations yesterday morning with industry pundits. And they all focused on what healthcare does wrong. But then, I saw someone pose a valid point and a question on Twitter with regards to patient/consumer experience: “Plenty of bad stories. What about positive stories?”

I’ve thought about this for hours on end now. It’s now tomorrow afternoon.

Positive experiences?

And after racking my brain, I sought updated definitions of patient experience, as opposed to ones that I was brought up in this industry on. They’ve evolved as the industry has evolved by way of, in most cases, a bunch of regurgitated nonsense we “think” matters to patients.

The Agency for Healthcare Research and Quality (AHRQ) undoubtedly has the most comprehensive definition. Quite frankly though, by their standards, I’m not sure any of us have ever had a positive patient experience. Average at best by those guideline — they’re brutal.

But I think that depends on how you define “experience.”

In some back and forth banter with Andy DeLaO, this was the result:

An experience can be a singular event. For the same reason, you could have multiple experiences of the same event. Think in terms of lab draw or annual physical. Does that one event equate to overall patient happiness? No. Especially for chronic patients.

But yet, everyone still uses the word experience. It’s just another buzzword in an already buzzword laden industry. Because experiences are singular events. Which raises a valid question: are we even using the right word? Regardless, The Beryl Institute probably has the best definition as it relates to an experience:

“The sum of all interactions, shaped by an organization’s culture, that influence patient’s perceptions across the continuum of care.”

But the Beryl definition makes a fundamental mistake — “it’s not patient experience they define, it’s the patient journey.”

Patients don’t think in terms of experiences.

They think in terms of their journey, because they just don’t have one experience, they have multiple stops along the way. Healthcare consumers may think in terms of experiences, but not patients. Which is probably why we refer to it as an “experience” instead of a “journey.” Consumers out number patients. Consumers aren’t patients.

“Everyone else calls it an experience.” So, then again, “we are using the wrong term, the wrong measure, and the wrong focus.” Perhaps we need two measures: patient journey and consumer experience.

With that in mind, could I myself even post a positive story to tell?

Positive “consumer” experience? Sure. Maybe.

Positive “patient” journey? H*ll no. And I’ve been a patient a while.

I’m still racking my brain.

I not going to lie, I even went back to the word “experience” and ran a Google search: “Patient Experience Success Stories” because I know “Patient Journey Stories” probably just don’t exist.

A few stories on culture shift.

A few results for new technologies that might improve it.

Even effectively a how-to guide for how to tell your story — we’re our own best advocates.

So, do we just not ask?

Bad patient and consumer stories you can find a dime a dozen, especially with regards to singular experiences.

Do we really just not ask — other than asking both patients and consumers to take a quick survey following their encounter? Am I just searching for all the wrong things?

So, I thought back to earlier in my career within an academic medical hospital. Did we really not ask? Were we solely focused on HCAHPS scores? Did we really focus on highlighting only those “outcomes” that were good? Did we ignore the journey overall, good or bad? And is every other hospital system doing practically the same thing?

Holy crap.

Was it more of a “this ‘experience’ score says X so we need to correct Y” instead of actually talking to the patients so we could learn from their journey and then change, let alone correcting bad consumer experiences?

Sadly, yes, I believe so.

We collected “satisfaction” data and figured out ways to increase our scores where we performed poorly. We didn’t tell the greater story of our departments, or our employees, or even our patients with regards to their journey. We simply told the outcome.

“Satisfaction…wtf is that? Press Ganey only measures their bank account. I don’t just want to be satisfied, I want to be delighted.”

It was the outcome, not the journey, that we wrote about. It was the outcome, not the journey, that we educated from. It was the outcome, not the journey, that drove our culture.

All we cared about were singular experiences.

We simply focused on the outcome — the success stories of cancer treatment, or bypass surgery, or transplants, or heartstring NICU stories that pulled at your heartstrings. And even then, we focused on a few good outcomes, instead of the overall journey and the outcome, which encompass both good and bad experiences across the continuum.

Why? Well, I’m not real sure in retrospect.

Actually, wait, I am sure.

Because singular experiences sell in healthcare, not journeys. And [good] singular experiences are what shareholders, and community leaders, and donors, and referring specialists want to see. They only care about the outcome, not how we got there — even for those of us who are on a greater journey throughout the system.

It’s good for business.

Which explains a lot — the business of healthcare drives the encounter, end-to-end. And we don’t place much stock in the journey (or even much the experience for that matter) as long as the outcome is halfway decent and we didn’t lose our @ss getting the patient or consumer there.

Next in line, please. Relationships don’t matter.

Coverage in the media is much the same. We cover advances in medicine that lead to either potential or actual patient outcomes because it sells. Just like we often cover how drug prices affect patients or consumers. We don’t much care about the journey that leads you down either of those paths. We only care about singular events that make us look good.

Outcomes may be halfway decent overall throughout the industry, but the truth is, the state of patient “experience” is bad. I’d suspect that the state of the patient “journey” is even worse, but no one has studied that — at least not that I can find.

Prophet did a research study once that found that “an alarming 81% of consumers are unsatisfied with their healthcare experience, and the happiest consumers are those who interact with the system the least.”

Now, I have a problem with the word consumer here, but if you replaced “consumers” with “patients” in the first sentence to delineate the difference between the two healthcare users, it would make perfect sense.

Could you imagine how abysmal percentages would be if we actually measured patient journeys?

Regardless, whether it’s a journey or an experience, the fact is this: the more you use it, the more you see. The less you use it, the less you see.

It’s sort of like eating at your favorite restaurant. Rarely do you encounter a bad meal or a bad waiter. But if you walked in the kitchen and saw your food being prepared, or looked behind the stove or the dishwasher, or combed through the various places uncooked food is served — you’d likely be grossed out.

Healthcare is really no different.

Patients have known this for years, likely decades, as they have meandered along their journey from one end of the care continuum to the next. But consumers are just beginning to notice.

And they’re noticing the gap between perception and reality.

The difference is, consumers aren’t afraid to speak out and make a change when it comes to their use of the healthcare system. Patients, on the other hand, are often held captive to the system, shackled by their disease or the state of health that they are in at any given moment. Patients don’t particularly have a choice.

As Prophet notes: “Providers underestimate the degree to which the patient experience fails to meet consumer expectations. This skewed perspective is creating a lack of urgency among providers to fix the problem. While providers are aware of patient dissatisfaction, they have many competing initiatives, making it difficult to prioritize.”

And that’s just with respect to experiences and satisfaction, not journeys.

In other words, we’re not focusing on the elements that matter the most to patients and consumers, and by-and-large, we’re not really doing anything to fix the disconnect because we’re not involving the right stakeholders to design processes and technologies that work.

We’re just applying band aids to hold back the water in the dam. We’re not shifting our corporate culture or culture of caring to do better — to deliver the basic tenants of the Hippocratic Oath.

Which is why we have seen progressive leaders leave their posts at hospitals and tech companies alike to help be the change — to drive conversations that shift culture, and interactions, and perceptions all across the continuum of care. Even if that means taking a massive pay cut for the greater good.

But we still have a long way to go, which explains why the American College of Healthcare Executives found previously that “despite the best intentions to deliver a better patient experience, providers struggle to make it a priority among competing initiatives. For example, 75% of providers say patient experience is critical to the future success of their organizations. Meanwhile, on the list of hospital CEOs’ top concerns, patient satisfaction does not make the top five.”

I bet hospital CEO’s don’t even recognize the difference between an experience and a journey, let alone care about it.

Regardless, there’s infighting at the top, and as a result, patients and consumers continue to fall victim.

And if we can’t deliver on and cater to the needs of patients today, how are we going to tomorrow when operations become far more complex in the era of consolidation and merger?

We’ve already seen what happens in that scenario with hospitals — as the rate of consolidation increases, patient satisfaction decreases.

We’re too worried about acquiring competitors, and bulk buying, and building shiny new facilities to see that none of that really matters to patients at the end of the day.

They want to trust. They want transparency. They want more time. And they want clean transitions. And until we can enable a more cohesive approach to patient care throughout their journey, they’re always going to have lackluster results — especially when they already don’t confidence in us.

And the time is now for power to shift to both patients and consumers, just like it has in other industries.

It’s their turn to be in the driver’s seat.

It’s healthcare’s turn to let them be.

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