Dramatic Improvement in Patient Satisfaction · Dramatic Improvement in Patient Satisfaction: ... engagement Achieve employee buy-in, ... The newly discovered role of the sub-conscious

www.beyondphilosophy.com

Dramatic Improvement in

Patient Satisfaction: A Case Study from Memorial

Hermann Hospital System

Qaalfa Dibeehi, Chief Operating and Consulting Officer,

Beyond Philosophy

Rhonda Dishongh, Director of Customer Experience Design,

Memorial Hermann

www.beyondphilosophy.com 2Beyond Philosophy © All rights reserved. 2001-2011

The Beyond Philosophy Perspective

Customer Experience

is all we do!

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Europe & Asia

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Is now available

Focus on the emotional side of

Customer Experience

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Beyond Philosophy © All rights reserved. 2001-2011


Learning Objectives

• How to set the stage for

implementing a patient

experience program

• What it takes to achieve

outstanding patient

satisfaction results

• What works and what

doesn’t from a hospital that

has done it successfully

• the key elements of a

successful program

4Beyond Philosophy © All rights reserved. 2001-2011


The hyper competitive market in Houston…

With over 100 hospitals and medical centres and 19,500 hospital beds,

Houston has one of the best and largest medical communities in the world.


The Texas Medical Center

• comprises 49 member institutions

• receives 160,000 daily visitors

• over 6 million annual patient visits

Home of field leading:

• MD Anderson Cancer Center – the

world’s leading cancer hospital

• Debakey Heart and Vascular Center

• Texas Heart Institute


Memorial Hermann is big and complex11 hospitals, a vast network of affiliated physicians and

numerous specialty programs and services. Facilities include:


Memorial Hermann

• Memorial Hermann-Texas Medical Center, the teaching

hospital for The University of Texas Medical School at

Houston and home of the nation’s busiest Level I trauma

center

• 8 suburban hospitals

• 3 premier Heart & Vascular Institutes

• TIRR Memorial Hermann, one of the nation’s top rehabilitation

and research hospitals

• Children’s Memorial Hermann Hospital

• the Memorial Hermann Sports Medicine Institute

• the Mischer Neuroscience Institute

• 8 comprehensive Cancer Centers

• 21 Imaging Centers

• 8 Breast Care Centers

• 10 surgery centers

• 25 sports medicine and rehabilitation centers

• 19 diagnostic laboratories

• PaRC, a substance abuse treatment center

• the Life Flight® air ambulance program

• the city’s only burn treatment center


The Situation

Problem

• To maintain sustainable and profitable growth,

MHHS needs to attract the small but insured

portion of the population with a focus on

cancer patients

• 31% of the population in Houston are uninsured

• Only 20% would qualify for governmental

assistance and have their expenses reimbursed

by the government.

Solution

• MHHS recognised that loyalty is built in large

part on great patient satisfaction.

• MHHS began on a mission to improve its

patient experience in 2005.

• As a starting point it piloted revamping its 1)

Cancer and 2) Heart & Lung service lines via

the Beyond Philosophy approach

• After learning the approach, it has gone on to

customize it based on their own experience.


Confident Quality Care

Comfort, Ease and Access

Personalised,

Collaborative

Genuine,

Attentive


Person treatment

Illness treatment

Long Term

HEALTHOUTCOME

LONGETIVITY

Undifferentiated

Differentiated

EMOTIONAL

ENGAGEMENT

Extract

commodities

Stage

experiences

Make

goods

Deliver

services

Adapted from: Welcome to the Experience Economy, Pine & Gilmore, HBR, July-August 1998

Treating the obvious

symptoms

The Evolution of the Patient Experience and Healthcare

Treating the

disease

Treating the

patient

Managing

wellbeing

HCAHPS

Short Term



The Original Beyond Philosophy Approach


Customer

MirrorPyramid

Emotional

Signature

Moment

Mapping

To assess end-to-

end experience

form customer

point of view

To help gain buy-

in and align the

various

departments to

the CE

To assess and

improve the

customer

emotional

engagement

To reshape

experiences from

a CE perspective

Understand the end-to-end

patient experience from the

patient’s (customer) point of

view

Reshape the experience

from a patient experience

perspective with a specific

focus on emotional

engagement

Achieve employee buy-in,

educate them on what

being patient-centered

means and how it

translates into practice


Customer Mirror: Walking the Experience

Suspicion Pre-RegisterVisit Doctor Follow Up All ClearCheck-ups BillingFinancial

CounsellingTreatment Travel & Park DiagnosisTest (s)


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http://images.google.co.uk/imgres?imgurl=http://www.wnba.com/media/comets/breast_cancer_sign.jpg&imgrefurl=http://www.wnba.com/comets/community/Cooper_Gets_Mammogram-195599-222.html&h=200&w=150&sz=8&hl=en&start=15&tbnid=wh6Fa-KwEuK0JM:&tbnh=104&tbnw=78&prev=/images?q=memorial+hermann+cancer&gbv=2&svnum=10&hl=en

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http://images.google.co.uk/imgres?imgurl=http://www.k-state.edu/parasitology/chemotherapy.jpg&imgrefurl=http://www.k-state.edu/parasitology/cancer.html&h=1392&w=2009&sz=323&hl=en&start=6&tbnid=8rfFpT_IIRoqwM:&tbnh=104&tbnw=150&prev=/images?q=chemotherapy&gbv=2&svnum=10&hl=en

http://images.google.co.uk/imgres?imgurl=http://www.lrcc.on.ca/general/tour/chemotherapy.jpg&imgrefurl=http://www.lrcc.on.ca/general/tour-chemotherapy.xml&h=268&w=400&sz=22&hl=en&start=9&tbnid=KjB2wZaQHqTXxM:&tbnh=83&tbnw=124&prev=/images?q=chemotherapy&gbv=2&svnum=10&hl=en

http://images.google.co.uk/imgres?imgurl=http://www.stegh.on.ca/C9/Chemotherapy/nurse_patient_2.jpg&imgrefurl=http://www.stegh.on.ca/C9/Chemotherapy/default.aspx&h=441&w=633&sz=280&hl=en&start=68&tbnid=H8jHDp89-JK8aM:&tbnh=95&tbnw=137&prev=/images?q=chemotherapy&start=60&gbv=2&ndsp=20&svnum=10&hl=en&sa=N

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http://images.google.co.uk/imgres?imgurl=http://www.pellahealth.org/patients_visitors/images/hospital_bill.gif&imgrefurl=http://www.pellahealth.org/patients_visitors/billing_info.php&h=407&w=322&sz=33&hl=en&start=1&tbnid=iqtvgnQsiKEapM:&tbnh=125&tbnw=99&prev=/images?q=hospital+bill&gbv=2&svnum=10&hl=en

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Net Promoter Barometer

Suspicion Pre-RegisterVisit Doctor Follow Up All ClearCheck-ups BillingFinancial

CounsellingTreatment Travel & Park DiagnosisTest (s)

0

10

9

8

7

6

5

4

2

3

1

Promoter: 8%

Passive: 50%

Detractor: 42%

Experience NPS = -34%

How

lik

ely

wo

uld

I r

eco

mm

en

d th

is a

sp

ect o

f th

e e

xp

erie

nce

Clinical Aspects of the Experience: Average Score = 7.1 Non-clinical Aspects of the Experience: Average Score = 3.0

Detractor Range

Promoter Range

Passive Range



Pyramid: over 50 employees from the 8 functional divisions

outlined ways to make the intended customer experience manifest



Moment Mapping Experience Design Construction Site

• Custom designed experiential standing workshop – multiple exercises (Main

board, Emotional barometer, Red Dot/ Green Dot, Expectations, etc.)

• The tour - Bringing the construction site to the employees, not the other way

around (spreads the word, generates interest and excitement)

• It should look a bit rough like a construction site – sends subtle message that

they are building the experience (overcomes organisational formality, motivates honest

feedback)

Set Up In Progress



We conducted focus groups to gather further items from customers and

validate the “construction site” research

Customers say that

“emotional well

Being” is responsible

for almost a third of

their long term

clinical outcome.

Likewise,

customers state

that 33% of a

hospital’s service

should be focused

on “emotional well

being”



Patient Satisfaction Matrix


Clinical

outcome

Emotional Outcome

Satisfaction at risk! Satisfied

Dissatisfied Satisfied

Customer Comment:

“It was hell I would not

wish for anybody to go

though it”

Recommendation:

“just get the best

doctor”

Customer Comment: “I

was surprised and this

was life reaffirming. It

has made me a better

person.”

Recommendation: “If

possible, go to my

hospital”

Customer Comment:

“Not the best care”

Recommendation:

“don’t go there”

Customer Comment:

“They did all they

could for me.”

Recommendation:

“They are wonderful,

they do all they can

and more.”

+

-

+-

They may forget what you said, they may forget what you have

done…but they will never forget how you made them feel....


Pilot Planning - The approved opportunities were then

placed in the regular project calendar



The New Experience



Initial Success (within 6 months post project)


17%

23%

Before BP After BP

MHHS Market Share:

Cancer + Heart & Lung Service Lines

40 days

5 days

Before BP After BP

Efficiency:

Cancer Diagnosis to Treatment

18%26%

Before BP Q1 After BP

43%

Q2 After BP

MHHS Patient Satisfaction:

Low Performing Hospital

Before BP Q1 After BP Q2 After BP

MHHS Patient Satisfaction:

High Performing Hospital

81%92% 91%

Patient satisfaction increased from 42nd to

99th percentile on average!


Some Key Insights that Made a Big Difference

Strategic Insight Difference it Made•Customers say that “emotional well Being” is responsible for almost a third of their long term clinical outcome. •Likewise, customers state that 33% of a hospital’s service should be focused on “emotional well being”

• Gave the program and the hospitals the ammunition to argue that the patient experience is crucial to clinical outcomes not just satisfaction scores.

• It’s the shift from Patient Experience work as “nice to have” to “must have”.

• While the cancer is a big negative, the cancer service experience does not have to be.

• Patients know how to tell the difference

• Overcame the general resistance of thinking about delivering a “Positive" or “life changing” experience.

• MHHS now treats the experience as opportunity rather than necessary evil

• While the clinical care provided is top notch, patients tend to judge the cancer service on the basis of non-clinical “moments of contact”

• Brought home the fact that patient judgement and expectation is not the same as physician opinion.

• Ex.: developing Cancer Business office, patient defined scheduling of financial counselling, traffic advisory planning service

• A 1% improvement in the “key” emotions could be worth millions to MHHS.

• A initial focus on the Attention emotions would provide the biggest “bang for the buck”.

• The opportunities which focused on the Attention emotions were prioritised.

• This gave the patient experience program a tangible focus in it’s initial stages.

The care provided by lower skilled “support clinicians” (eg, phlebotomists, etc) was being overlooked but patients pay a great deal of care to these because they feel they have a better ability to judge these

• One of the items opportunities out of the MM was the creation of the & Deadly sins of care. These are basics of “support care” that MHHS would focus on getting right. As one sin is cleared, it would be replaced by the next biggest sin and so on.



Patient Satisfaction directly relates to revenues now


4 out of the 7 components and 57% of the questions in HCAHPS are related to

the “Person management” side of the experience


Replicated Success (Memorial Hermann Northeast Hospital)

• In 2005/ 2006 Northeast Hospital was not a part of MHHS when Beyond Philosophy

was engaged there

• In 2007, it had a terrible track record

• 33 straight years of being unprofitable

• 5% Patient Satisfaction

• Memorial Hermann assumed management of it in 2007 and applied the Beyond

Philosophy customer experience approach that it had been optimising



Replicated Success (Memorial Hermann Northeast Hospital)

• In 2005/ 2006 Northeast Hospital was not a part of MHHS when Beyond Philosophy was engaged there

• In 2007, it had a terrible track record

• 33 straight years of being unprofitable

• 5% Patient Satisfaction

• Memorial Hermann assumed management of it in 2007 and applied the Beyond Philosophy customer experience approach that it had been optimising

• Immediately, MH Northeast began to show the effect of the approach

• Bested plan to break even in 2015 by becoming profitable by $18million in 2011!

• Patient satisfaction improved to 65% up from 5% when MHHS acquired it


MH Northeast

Patient Satisfaction

Press Ganey measures patient care for more than 10,000 health care facilities.

Patient Satisfaction

Average Improvement

National Texas HoustonMH

Northeast

1.0% 0.8%1.6%

7.5%

Press Ganey Top Improver Award 2010


Want to improve your Patient Satisfaction?


Hospital

organisation PatientsStaff

What do Patients experience?

What do we WANT Patients to experience?

How does the Environment support

PE?

How do we keep the culture alive?

CE Ecosystem

Understand the actual Patient Experience (PE)

Redesign the Patient Experience

Asses the internal capacity to deliver great

PE

Transfer the knowledge


We invite you to continue the

conversation and ask questions

Thank You

Atlanta Office: +1 678 638 6162

London Office: +44 (0)207 917 1717

[email protected]

QaalfaDibeehi

uk.linkedin.com/pub/qaalfa-dibeehi/0/81/371

Documents

Dramatic Improvement in Patient Satisfaction · Dramatic Improvement in Patient Satisfaction: ... engagement Achieve employee buy-in, ... The newly discovered role of the sub-conscious