Getty Images/iStockphoto
Supporting the Provider Experience to Build a Good Patient Experience
Cultivating staff safety and a high-reliability culture are provider experience steppingstones that allow clinicians to execute patient experience best practices.
Does a better patient experience start with a better staff and provider experience?
If you ask Deirdre Mylod, PhD, the senior vice president of Research and Analytics at Press Ganey, it has to.
Indeed, there is a key behavioral and workflow approach to achieving a good patient experience. Optimal patient-provider communication, best practices for patient safety, and care coordination across departments and providers are proven to support a better healthcare experience.
But the highest performing hospitals and health systems implement those best practices first by taking a step back and ensuring their staff are set up to deliver on those behaviors.
That much became apparent in this year’s Press Ganey Human Experience Awards, a series of awards that recognize hospitals and health plans that rank in the top 5 percent for human experience, that can do so for a number of consecutive years, and that can hit on a number of quality metrics indicating nursing excellence.
In analyzing this year’s awardees, Mylod noted that it’s not just the provider behaviors and best practices that indicate good patient experience, although those are important. It’s also the way providers and staff members are set up for success and supported in executing those best practices that make all the difference.
“Organizations have the tendency to want to jump to the behavioral best practice, but what they really need to do is to first prioritize safety for patients and for staff,” Mylod said in a phone call with PatientEngagementHIT.
“Staff don't feel as safe as they used to in terms of assault and incivility. So, you have to prioritize safety for patients and for staff,” Mylod advised. “And that means communicating that you're prioritizing that, and also leveraging those high-reliability behaviors so that can trickle out. And then understanding that the workforce well-being is a requirement to deliver on everything you're trying to do.”
Akin to Maslow’s hierarchy of needs, Mylod said hospitals and health systems need to focus first on promoting a culture of staff safety, fundamentally physiological safety. Priorities can then move along to psychological safety, such as making staff members feel respected and listened to.
Supporting a culture of safety
If promoting the patient experience were a set of Russian nesting dolls, a culture of safety is the outermost layer, Mylod indicated. Staff members need to know that they are both physical and professionally safe when working in the hospital before organization leadership can begin to focus on patient experience and practice improvement.
That physical safety element is not something to be taken for granted, especially with the past several years being hallmarked by an increase in healthcare workplace violence. According to 2022 figures from the American Hospital Association (AHA), 44 percent of nurses have reported experiencing physical violence and 68 percent reported experiencing verbal abuse in the healthcare setting during the pandemic.
Reassuring staff of their physical safety starts with communication, Mylod said. Hospital and health system leadership need to make a point to outline their staff safety measures to create a sense of physical safety.
In terms of psychological safety, or professional safety, leadership needs to open up communication channels with providers.
“Physicians also really need to feel aligned to their leadership,” Mylod explained. “So, giving physicians the opportunity to meet with their physician leadership and to see how their physician leadership is contributing to the overall organization's direction is key.”
In doing so, leadership communicates to clinicians and other staff members that they are being listened to, that they are being respected, and that this is a place where they have the opportunity to grow professionally.
“Staff are the experts, and they're the ones providing care. If they don't feel listened to, they can't be their best selves,” Mylod said. “As a broader strategy, you should listen to staff, whether it's about what we're doing for safety, or quality, or their well-being, or what we're doing for patients, and you integrate that all together.”
The culture of not only patient safety, but also staff safety, makes it easier for leadership to move to the next layer and introduce practice improvement plans and new best practices for providers.
“Nest the behaviors you want in the culture in a way that says, ‘we're keeping you and patients safe; we care about you,’” Mylod recommended. “And this is part of what you want, is to work at a place that provides high quality care. Therefore, we're going to engage in these best practice behaviors.”
Creating a high-reliability culture
Part in parcel with a culture of safety is a culture of reliability, which targets the element of teamwork that is necessary to support the patient experience best practices.
High-reliability culture refers to “organizations that operate in complex, high-hazard domains for extended periods without serious accidents or catastrophic failures,” according to the Patient Safety Network under the Agency for Healthcare Research and Quality (AHRQ).
“The principles of high reliability go beyond standardization; high reliability is better described as a condition of persistent mindfulness within an organization,” according to PSNet. “High reliability organizations cultivate resilience by relentlessly prioritizing safety over other performance pressures.”
A high-reliability culture is not possible without a culture of staff safety, Mylod said, but once that safety has been established, it becomes easier for staff members to speak up when something is not quite right, like when an adverse safety event is afoot. Organizations looking to establish a high-reliability culture need to flatten hierarchies and stress that it’s a process failure, not a personnel failure, when safety events do occur.
“That high-reliability culture, that's what organizations need to have to really transform across all areas,” Mylod stated. “Because that's not just how you make safety better; that's how you make patient experience better, too.”
Nurturing the organizational culture of staff safety and high reliability then sets up hospitals and health systems to excel in the key best practices for a good patient experience.
Creating a good patient experience
Much has been made of the best practices for a good patient experience, from the food hospitals serve to the cleanliness of the rooms to the way providers communicate with families and patients. These best practices are the last piece of the human experience puzzle.
Mylod stressed the communication and patient-provider relationship aspect of the healthcare experience. Hourly patient rounding, for example, is important to getting good scores.
“In the inpatient setting, organizations really need to be doing some type of hourly rounding, where nurses on a regular basis proactively go into the patient room,” she said. “Patients are not just waiting to have to push the call button.”
The warm hand-off when new care teams begin their shifts, likewise, needs to be more personal. Traditionally, nurses and other care team members might share notes in the staff room. Mylod said hospitals that excel in the patient experience have started to hold this warm hand-off in the patient exam room, which helps integrate the patient as a member of the care team.
In turn, patients have the opportunity to correct a mistake or a misunderstanding and generally feel more reassured about the care they are receiving.
By reconsidering where, when, and how providers communicate with patients, they are better able to fill where gaps in patient understanding may have once occurred.
Ultimately, creating a good patient experience means giving providers the tools and circumstances to actually do so, Mylod said. By creating a culture of patient and staff safety, plus high reliability and accountability, providers will be empowered to execute on the patient experience best practices that can result in higher scores.
