What is old is new again… or is it?
In 1995 a benchmark study related to timely administration of antibiotics in pneumonia patients ignited the energy around fixing the problem of delay by making the processes patient-centric. We didn’t have the understanding of patient and customer experience or the software programs to help identify and solve a problem through project management. However, collectively we had the desire to improve the “experience” not just for the patient but for all of the stake holders involved. We knew we had to re-design our processes around antibiotic administration but it was much larger than a simply isolated process.
No man is an island
We were all interconnected in a systems approach in this process redesign. Through this thinking, we began to unravel the patient experience regarding the admission process. We did a journey map without realizing that is what we did. We started to dissect the process a patient underwent by mapping all the points of contact from the initial encounter at the hospital through the admission process and ultimately to the point the patient was safely in bed on an inpatient unit. We identified the barriers, the discontent, the redundancy and waste as we focused our thinking around how to improve the process by placing the patient in the center.
Shooting for the BHAG!
In the mid-nineties, my colleagues and I at Muhlenberg Regional Medical Center in Plainfield, NJ identified that admission processes, whether through the Emergency or the Admitting department, were complex, redundant, difficult and frustrating. We didn’t think big enough when identifying the problem or in our process improvement approach. We didn’t understand that we should shoot for the Big Hairy Audacious Goals (BHAG)! We thought lofty goals of efficiency, efficacy and satisfaction were nirvana, but we were short-sighted. We didn’t go far enough!
True, the processes were cumbersome and clinical outcomes impacted by the delay of care, but we could fix that by throwing more resources such as space and staff at it.That would be a Band-Aid, not a fix, and certainly not a transformational improvement. What was needed and done was to design the front-end processes around the patient, bringing staff and services to the patient and not the other way around. It wasn’t about what was perceived as easiest for staff, but what would eliminate steps, time and increase throughput. Without calling it journey mapping, we outlined all the touch points a patient had in being admitted to the hospital. We eliminated some steps and combined others while limiting the number of caregivers the patient encountered through cross training staff.
Satisfaction vs. transformative experiences
Our patient satisfaction scores went up and turn around and admission times decreased. Our patients may have given us a high mark on satisfaction, but what about the overall experience? Would an efficient admission process even under the premise that if you start out on the right foot the rest of the journey would be impacted positively build loyalty? Would the patient and/or family want to return to our hospital or at the very least be likely to recommend our hospital to family and friends? Did we transform the way we delivered care?
After we published several articles on redesigning admission processes and patted ourselves on the back as being pioneers in this thinking, in reality there was nothing transformative in what we did. We came up with a better mousetrap that others sought to implement but the story stopped there and yet the story wasn’t over.
Listening to the patients… or VOP
We hit on without realizing it at the time that what we set out to do was to improve the experience of the patient, staff and physicians, and ultimately improve the quality of care. Although we involved the patient in our decision making, I cannot say we engaged the patient in a meaningful way. We didn’t have the knowledge at the time that an engaged consumer would be able to influence care delivery in a more substantive way or that what was needed was to build loyalty. A critical success factor for transforming care delivery is listening to the voice of the customer (VOC), and interjecting their requirements and expectations into all you do in providing that care.
We need to build on those early efforts and apply them in today’s landscape of consumerism, cross generational influences and a tech- savvy population. We need to engage the patient in a much more sophisticated way. The patient should and must be our partner in care, not just the receiver of care.