Deirdre Mylod, PhD, Executive Director, Institute for Innovation
When patients provide feedback about care quality, they bring a complex mix of needs, expectations and evaluations to the equation. Some believe that a healthier person brings with them higher expectations of speed, convenience and amenities from their healthcare experience. The assumption is that healthier patients are more critical because their relative good health affords them the opportunity to compare their experience to other types of service environments.
Evidence shows, however, that healthier patients are more likely to offer positive evaluations of care. Following are key insights on this topic from the Institute Findings Library.
Better Self-Report of Health Status = Higher Patient Experience Scores
Not surprisingly, maternity patients are most likely to report excellent (44.1%) or very good (41.7%) health. Medical patients most likely to report fair (28.1) or poor (9.3%) health, with fewer reporting excellent (7.2%) or very good (19.4%) health. Surgical patients fall in between with a fairly large group reporting excellent (12.5%) or very good (34.4) and few (<5%) reporting poor health.
Within each Inpatient service line (maternity, medical and surgical), patients who self-report as being in excellent health are the most likely to recommend the hospital. As health status worsens, evaluations also decline. Similarly, patients with poorer health status are consistently less likely to rate their hospital as a 9 or a 10.
In the Medical Practice setting, it is most common for patients to evaluate their own health as either very good (33.3%) or good (34.3%).
As in the Inpatient setting, similar patterns occur: patients in poorer health are less likely to recommend their care provider to others; they are also less likely to evaluate their provider as a 9 or a 10.
Patient experience indicators give us insight into which elements of care are consistently meeting patient needs and where unmet needs still remain. It is intuitive that patients with more complex health issues may be less likely to have their needs met. Our health care system has become increasingly specialized in order to treat the sickest of patients from a technical perspective; however we may not be addressing the needs of our patients along the way.
When looking within the inpatient setting at the medical and surgical populations, we find that the attributes of care least influenced by patients’ health status relate to courtesy, amenities and perception of skill. In contrast, the elements of care that are most impacted by health status include discharge preparation, pain control, responsiveness to concerns, emotional support and involvement in decision making. Sicker patients have greater needs related to their care.
By understanding the different needs of sicker patients, providers can more appropriately respond and support them during their care. In addition to sophisticated clinical quality, these patients need support to navigate the stress of their health issues, control over decisions that matter and education to engage in their own self-care.
Deirdre Mylod, Executive Director, Institute for Innovation
The Institute for Innovation now offers a growing set of findings that use national data to provide insight into the complexity of the patient experience. The first set of findings includes an interactive library that allows site visitors to dig into patient-level risk factors that are associated with how patients view care.
Three topics are available, including:
• Coordination of care - patient perception of teamwork
• Shared Decision Making- patient perception of being involved in decisions
• Drivers of Variation- patient overall ratings and likelihood to recommend
Findings are available for Inpatient and Medical Practice populations. After selecting the topic of interest and setting, you can choose different categories of patient-level factors such as patient demographics, social determinants of health, care processes or attributes of care. Each category provides a graphic display of charts and findings from a national data set. When you find a slide or set of results that you want to share, you can print them right from the tool. There’s a lot to explore!
To get you as excited as I am about the powerful insights in these findings, I’d like to highlight one insight about maternity patients that can be gleaned from these results. Traditionally we think of maternity patients as offering relatively positive evaluations of their inpatient experience, and the national data does show that their ratings are more favorable than the medically treated group.
However, when we consider the impact of the health of patients, we find that the higher scores for the maternity group are likely a function of the fact that they are healthier than other patients in the hospital. They are far more likely to report that their own health is Excellent or Very Good. But when self-report of health is controlled for, maternity patients are actually less likely to rate their hospital stay as a 9 or a 10 as their medically treated peers with similar health status.
These findings represent the first phase of analysis for the Institute work and offer descriptive patterns that help to better understand how needs are being met for different groups of patients. We’ll be building on these results in 2015 by adding national results that describe the impact of organization characteristics. The patterns in these patient-focused findings remind us that health care is complex, and our response to patients must be complex and informed by evidence. By better understanding how patients groups with similar needs experience care, we’ll be positioned to redesign process to better meet those needs. Doing so will bring greater value to the patient - and greater focus to our mission to reduce patient suffering.
In late August our Founding Executive Council met as part of its quarterly update and brainstorming session. I am always energized and excited by the conversation and ideas that are shared. We discussed the extension of the suffering framework
to include clinicians and caregivers and what it might mean to more actively work toward spreading empathy, trust…and even hope. This meeting was particularly significant because it represented the first anniversary of the formal work of the Founding Executive Council
. It was just last year in August 2013 that the group first came together for discussion, though many of the members had been contributing their thoughts and suggestions that shaped the Institute for Innovation in the months prior.
Looking back on the past year, much has been accomplished. And of course, the work also shows us how much more there still is to do. The Founding Executive Council went through a consensus process in 2013 to identify the four prioritized projects
that have become the Institute’s focus. And coming this Fall, the first results from those projects will become publicly available on our website. We look forward to sharing these findings with the industry, and most importantly to hearing feedback and sparking conversation.
I’m inspired by a quote from Thict Naht Hahn, who said “If you have a great aspiration, it’s because you have seen suffering, have awakened to the presence of suffering and want to put an end to it.” Our work is grounded in the premise that patients suffer and that our goals must include treating medical illness within the larger context of holistically reducing patient suffering. The acknowledgement of patients’ wider experiences has inspired our work and led us to lofty aspirations. We’re excited to watch the journey unfold and to have you along with us.
Deirdre Mylod, PhD, Executive Director, Institute for Innovation
The Institute for Innovation has been hard at work over the last several months. These are exciting times with tremendous engagement and enthusiasm for how we can better understand what patients need.
In November, the Founding Executive Council
convened in person and spent three hours in a working session. Together, the Council worked to define vision statements for each of the four prioritized research projects
, and discussed the concepts around reducing patient suffering and better addressing patients’ needs. That conversation continues to dynamically evolve over our quarterly meetings. Subject Matter Expert work groups
have been formed for each of the projects and regular meetings are underway. Initially, the groups brainstormed many possible research questions to address under each topic and then engaged in a formal consensus process to prioritize the specific areas of focus. These groups are now reviewing and reacting to the findings resulting from the first phases of our analytic work.
Last week I had the opportunity to visit the Mayo Clinic to learn more about their innovations in healthcare delivery and their efforts to create optimally-functioning teams. The strength of their culture was readily apparent as we met with key researchers and leaders throughout the organization. I was struck by the fact that literally every single person I met with spontaneously invoked the Mayo core value that “the needs of the patient come first.”
Efforts to reduce patient suffering require that we first seek to understand patients’ needs and keep those needs top of mind. Imagine my delight to see an exhibit of the historic Mayo headline, “Dr. Mayo Dedicates New Clinic to Relief of Human Suffering in Cornerstone Ceremony
During the dedication of this building, Charles H. Mayo, M.D., said: “Intelligence with knowledge enables wisdom to extend the highest service. Such service has made necessary this building, which we now dedicate to the relief of suffering humanity through diagnosis, treatment, and cure of disease, and the healing of wounds.” A compelling reminder that reducing suffering has always been at the forefront of great care.
I’m looking forward to attending the Cleveland Clinic’s fifth annual Empathy in Innovation Summit
next month. I’ve participated in this event each year since its inception and always come away inspired by the merging of strategy, tactics and shared purpose. Their work to promote empathy is a necessary piece of the puzzle to acknowledge and take action to reduce patient suffering. I hope to see you there. Image courtesy of Mayo Clinic and Rochester (Minn.) Post Bulletin