A patient feedback management system that works
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A patient feedback management system that works

Why is patient experience important for a hospital?

A few years back, I was diagnosed with gallstones. My doctor advised me to get them surgically removed. A day before undergoing the surgery, I was admitted into a private room in a hospital. The housekeeping staff came to clean it every few hours. The nurses were extremely efficient in conducting the pre-op procedures and shared all details with clarity. Further, the on-call doctors and nurses were constantly trying to make me feel comfortable by striking a conversation. The food that was served did not taste bad either.

Post-surgery, my doctor visited me and asked how I was feeling. Of course, I was in a lot of pain but he tried his best to cheer me up by cracking jokes. For the next two days that I was in the hospital, I was well taken care of and had a pleasant experience. On the day of discharge, I was eagerly waiting to go back home and recover from the pain in a cozy and familiar environment. However, generating all reports, clearing dues, getting a wheelchair, and booking an ambulance took FOUR hours! Imagine the anxiety that I was undergoing. Now, I dread returning to that hospital. I also suggest all my friends and family to avoid visiting that hospital as much as possible.

Although the team of healthcare and non-healthcare staff members ensured that I received quality care, I had a terrible experience during discharge.

Blake Morgan, Customer Experience Futurist, Author, and Speaker, recently shared another unpleasant incident on similar lines.

Blake Morgan - patient feedback management

Source: LinkedIn

When a patient visits a hospital, the least that he expects is adequate care. Recall the times when you and your family were bereft of such care. Having worked closely with healthcare brands, I have now understood the importance of creating delightful experiences in this industry. All organizations must do the needful to ensure a positive patient experience for speedy recovery.

When we asked Mr. John Punnoose, an independent Director and Mentor for hospitals and health systems about the importance of patient experience, he rightly explained,

After all, he (a patient) is going through a traumatic time; he has not come into the system for fun or for leisure. Thus, the (healthcare) system must ensure that anything and everything revolves around ensuring that the customer/consumer/patient is fully at the core of the entire process of care giving…

Bonus read: To find out what suggestion Mr. Punnoose has for improving the experience of every patient, click here.

I believe that apart from being imperative, it is also the “morally” right thing to do.

How does patient experience impact the business?

If you consider the business perspective, every hospital today wishes to be the leader in the healthcare industry. But, when a patient has a poor experience, he would never return to that hospital. Additionally, he would share his experience within his circle. Without a doubt, word-of-mouth is the most powerful driver of growth for businesses, especially in healthcare.

When I shared my experience with friends and family, most of them decided not to visit that hospital. Consider this – ten other patients who might have had a poor experience would also have shared their harrowing stories within their social circle. Unfortunately, due to this network effect, the hospital squandered business opportunities from at least a hundred patients.

The word about poor patient experience spreads like wildfire, especially since the advent of social media. The impact that such events have on the business is catastrophic. On the flip side, benefits from patients sharing their positive experiences are manifold. Hospitals that understand this have already started working on enhancing the patient experience.

How is patient experience important for accreditation?

Accreditation is a method of certifying a particular organization, establishing its competence, authority, and expertise in its industry. Today, accreditation has become important in the healthcare industry all over the world.

Joint Commission International Accreditation (JCI), National Accreditation Board for Hospitals & Healthcare Providers (NABH), and Accreditation Commission for Health Care International (ACHC) are a few of the accreditation bodies. NABH is the accreditation body in India.

Currently, India has 526 accredited and 680 applicant hospitals and healthcare organizations. The NABH council assesses hospitals based on five patient-centered standards: Access, Assessment and Continuity of Care (AAC), Care of Patients (COP), Management of Medication (MOM), Patient Rights and Education (PRE), and Hospital Infection Control (HIC). If you observe closely, all these standards are directly or indirectly related to patients having a remarkable experience at the hospital. Thus, for receiving and sustaining an accreditation, excellent patient experience is a must.

In an interview, Ms. Poornima Raja, Head of Operations at Continental Hospitals, says,

We being a JCI and an NABH accredited facility, patient’s safety, trust, and well-being are among our top priorities…

Bonus: To learn how Continental Hospitals plans to become one of the global leaders in integrated healthcare, watch the video here.

Patient experience and care are the most critical factors for accreditation.

Since I started working with Omoto, a patient feedback management solution, I have encountered a few hospitals that are unaware of the importance of patient experience and some others that are struggling with setting the right processes for better patient experience management. Although many hospitals have embarked on the journey of patient-centricity, I believe there is still a long way to go. I am writing this article with the purpose of helping organizations understand the gaps and develop systems that create patient delight.

What is the current state of patient experience management in hospitals?

What are hospitals currently doing in order to ensure good patient experience?

In India, a few healthcare companies still believe that only doctors and nurses are responsible for and can create a good patient experience. However, it is important to note that the medical staff can provide quality ‘healthcare’ but might neglect the ‘care’.

To address this, some hospitals have hired more staff who are specialized in empathizing and building relationships with patients and their attendants. Mr. Rajarshi Sen, Manager of Operations & Strategic Initiatives at Kamineni Hospital, shared with us that his team spends most of their time in striking conversations with patients, asking them about their family members, vocations, and other aspects of their life. He believes that showing empathy and talking to patients helps in improving the patient experience.

Bonus: Listen to Mr. Rajarshi Sen talk about the current state of customer experience in the healthcare industry. Click here.

Some organizations have started listening to customers and personalizing the patient care. Mr. Rohit MA, Co-founder and Managing Director of Cloudnine – India’s leading chain of maternity hospitals – explains why they have deliberately designed the architecture of their hospitals in a way that a pharmacy isn’t the first thing patients see when they enter the facility.

In his own words,

When we were setting up Cloudnine, based on several personal experiences, international benchmarking, and through focused group study, people said they hated these (“+” and “24*7”) signs. They were probably right. So, none of the Cloudnine units have a pharmacy as the first thing that customers walking in would see. Instead, they can see a coffee shop, a well-appointed baby shop, a photo studio where pregnant ladies or new mothers with their new-born babies and families go to get their pictures clicked…

Bonus read: To know why Mr. Rohit MA says that customer centricity must be an intrinsic principle for any business, click here.

I have noticed that one of the biggest challenges that hospitals face is understanding patient expectations. Leading healthcare organizations have overcome this by capturing the voice of the customer in the form of feedback.

There are many hospitals that are collecting patient feedback but are unable to utilize it effectively. A few of them are using feedback merely to generate reports and calculate metrics. The rest of them, who are using it efficiently, are able to draw actionable insights and enhance the patient experience.

How are hospitals collecting patient feedback?

Before writing this article, we conducted a primary on-field research on Indian hospitals to understand how they manage patient feedback. We captured information about how they collect, collate, and analyze patient feedback. The infographic below summarizes our research.

infographic_1 patient feedback management

Bonus: Download the complete infographic here.

Despite living in a digital era, it is shocking to see that over 70% of Indian hospitals still use paper-based forms to collect feedback from patients, whereas merely 44% use digital media!

One in every six hospitals that use digital tabs to collect patient feedback is collating responses manually. Furthermore, over half the hospitals in India use a spreadsheet for data analysis.

How do hospitals derive actionable insights from the collected feedback?

Collecting feedback is just the first step towards better patient experience; the most crucial step is taking action on the feedback received. But how can hospitals understand what strategies would help them in improving the experience? When we asked this questions to various hospitals during our research, we observed a commonality in their responses.

Most of the hospitals told us that they generally observe a pattern in the feedback. This helps them uncover the areas/departments that they must focus on in order to improve the experience. Based on the kind of negative reviews that they receive, they are able to derive a few actionable insights.

Let’s consider this example – five in ten patients of a hospital complain about the taste of the food served, two complain about the behavior of the staff, and the rest share concerns about cleanliness, the response time of the staff, and lack of seating area. From the feedback, the hospital management team infers that they need to focus majorly on the food department and the employees’ soft skills. They derive two actionable insights: to change the food service partner and provide soft skills training to the staff.

What are the flaws in the current state of patient feedback management?

The infographic below depicts the effort spent in generating MIS reports from the collected patient feedback and the turnaround time for taking action on the same.

infographic_2 patient feedback management - px

Bonus: Download the complete infographic here.

Listening to and acting on customers’ grievances are extremely important in an industry as sensitive as healthcare. The benefits of acting on patient feedback are multifold. It helps in improving the quality of healthcare, growing the business financially, and bringing invaluable suggestions to the hospital.

However, I have noticed that the current patient feedback management system is flawed. The most critical flaws that every hospital must immediately take corrective actions on are:

1. High turnaround time

While around 96% of hospitals are taking action on feedback, most of them take almost a month to address patients’ concerns.

During our research, we found out that it takes ~2x more time to collate feedback collected on paper than that collected on a tablet device. This is the reason that 70% of hospitals that use paper forms to collect feedback have a turnaround time of over ten hours.

When a patient shares his feedback, he expects the hospital to act on it at the earliest. If the hospital takes long to revert to the patient, he loses trust in the hospital. He might also spread bad word about the hospital, deterring others from visiting. Due to this delay, the hospital loses business.

On the other hand, if the hospital acts on the feedback quickly, the patient not only feels delighted but also spreads positive word about the experience that he had in the hospital.

2. High amount of effort spent in feedback collation 

For every forty working hours a week, a hospital employee spends over ten hours in generating reports manually based on the patient feedback collected. This is 25% of his productive time! Hence, an appalling five person-days of effort are spent each month in preparing reports manually!

This takes away the time that the staff could have otherwise spent on meaningful tasks, such as resolving patient concerns, that could have positively impacted the business. On the other hand, automating the feedback collation process allows staff to engage directly with patients to improve patient satisfaction.

3. Error-prone report generation and analysis process

One in every five hospitals that use paper-based feedback forms has confirmed that it has 1-5% errors in the reported data because of human intervention.

Reports generated from the patient feedback play a crucial role in making business decisions, such as hiring more personnel or investing in better tools and medical equipment. If the reports are erroneous, these decisions are hugely impacted. For instance, suppose 80% of the patients complained about the shortage of staff in the radiology department. But, due to errors in manual collation, only 30% of this data was reported. In such a scenario, the hospital management would not consider recruiting more staff for the department, a circumstance that will continue to hamper the patient experience.

4. Skewed patient satisfaction scores
At the end of a meal, when a restaurant asks for my feedback rating on their services, often I respond with a 4-star rating. I am yet to have a 5-star experience. But, this rating could be misleading. The restaurant has no way to gauge what went wrong and what it did right.

Similarly, the scores can be skewed when a patient rates an experience in a hospital visit. Rajarshi Sen also touches upon this issue in his talk:

Quantitatively, you will notice that the patient has probably marked you as 4 on 5 at several of the parameters. But when you speak with them, they might tell you something like, ‘we liked the treatment,’ or ‘we liked the food but I wish that somebody came and cleaned my room a little bit more often.’ Somebody might say, ‘we loved everything but the food was a little bit spicy but everything else was okay.’

At times, the hospital staff collects feedback only from happy patients. While feedback from these patients ensures good patient satisfaction scores, it takes away any opportunity for the organization to improve the experience for its unhappy patients. Because of skewed scores, the hospital would not be able to make the right decisions to enhance patient experience.

How to overcome flaws in the current patient feedback management system?

1. Establish the right workflow

Sometimes, negative feedback goes unnoticed or unresolved. However, if a hospital designs its issue management workflow in such a way that all issues pass through various levels of employees – customer service agents, managers, and heads of the department – before closure, none of them could remain unresolved.

Omoto’s issue management workflow helps organizations achieve just that.

Omoto new issue management flow - patient feedback management

Click on the image to enlarge.

As soon as a negative feedback is recorded in the system, the Central Issue Management Team (CIMT) gets notified. CIMT then contacts the patient and tries to resolve the issue. If resolved, the team requests a Reviewer from the Quality team to close the issue. However, the issue gets escalated to the concerned department if CIMT is unable to resolve it. Various levels of employees in the department then attempt to resolve the issue. If they succeed, they request the Reviewer to close the issue. Otherwise, the issue then gets escalated to a senior management personnel in the Overdue section. This employee either tries to resolve the issue or stores it for future. In case this employee is unable to solve the issue, it finally is considered an Unresolved issue. All the unresolved issues are then shared with the stakeholders in the hospital in order to seek a solution.

One interesting feature is that only employees of the levels Reviewer, Overdue, and Unresolved can close any issue, whether resolved or unresolved. If they are not content with the kind of resolution provided to the patients, they have the authority to reopen these issues and reassign to employees who had provided the resolution.

This workflow design ensures that no patients remain dissatisfied. Even if their issues cannot be acted upon immediately, they are not forgotten by the management team of the hospital.

Imagine having an issue management workflow that is designed to take care of all patients who visit the hospital and create a delightful experience for them – this will guarantee an enhanced patient experience!

2. Take action on patient feedback

Collecting feedback without taking any corrective or remedial action on it is futile. Once feedback is collected, it must be worked upon and organizations must close the loop on patient feedback. This means taking corrective action and, further, apprising the patient of the same.

In a healthcare business, it becomes more important to close the loop on feedback because this an industry where word-of-mouth plays a substantial role. Even if a patient has not had a good experience at the hospital, if the hospital reaches out proactively, apologizes for the bad experience, and assures that a set of corrective actions have been taken to correct the wrong, the patient would be less upset than before.

3. Ask the right questions

Hospitals must collect patient feedback with the purpose of improving the experience by deriving insights from it, and not just for the sake of reporting metrics to the senior management. So, it becomes critical to ask the right questions to the patients.

Another pointer that hospitals must focus on is to keep the questionnaire relevant and short. If the questions are irrelevant, the hospital would not be able to derive enough actionable insights to improve the experience. Additionally, a lengthy feedback form might worsen a patient’s experience with the hospital. He might feel agitated and irritated while answering a long list of questions, especially when he is recovering from poor health. Further, the response rates for lengthy forms are substantially low.

Below is a sample questionnaire that hospitals could use as a template for in-patients and out-patients.

In-Patient Feedback Form:

IPD sample questionnaire patient feedback management

Out-Patient Feedback Form:

OPD sample questionnaire patient feedback management

Bonus: To learn more about Patient Satisfaction Index questionnaire, download the eBook here.

4. Use technology for patient feedback management

Technology has penetrated into all walks of life. Today, facilities like telemedicine and mHealth have disrupted the traditional healthcare processes. Affordable and quality healthcare is now available to those who did not have access to it earlier.

Just as technology has improved the scenario of healthcare across the world, it can be used in making the current patient feedback management system more efficient and flawless.

Seven out of ten hospitals that use tablet devices to collect feedback have a turnaround time of fewer than 3 hours on closing the loop with the respondent. This means that they have an advantage over others in enhancing the patient’s experience even before the patient leave the premise. However, for more than 70% of hospitals that are collecting feedback on paper, it takes over ten hours for a negative review to even get noticed. Clearly, an investment in an automated patient feedback management solution is worth its while.

With an automated patient feedback management system like Omoto, managing and acting on the patient feedback becomes efficient and easy. Omoto’s inbuilt workflow management system automatically sends a real-time trigger to the relevant department to take corrective action as soon as a negative feedback is received. If nothing gets done, Omoto automatically escalates the feedback to higher levels and notifies the respective Heads of Department. Employees can also report the remedial action that they take on feedback. This allows the hospital management to track and monitor every feedback to its closure.

Using Omoto, many hospitals in India have been able to reduce the manpower in collecting and collating patient feedback by 1 person-months and improve the turnaround time by 90% in certain cases. Because of the automation of patient feedback management, the staff is now able to spend more time in resolving patient grievances rather than working on mundane tasks such as entering patient feedback data manually. This has not only had a profound impact on the patient experience but also empowered the employees because of their direct involvement in improving the patient experience.

A simple system such as this, coupled with a robust strategy to improve patient experience, can start showing results within two to three months of rollout.

How to enhance the patient experience further?

1. Map the patient’s journey

To deliver an exceptional experience to patients, it’s important to understand them. Mapping the patient’s journey helps organizations to do so. A patient’s journey map helps in summing up what is said, seen, heard, and felt by patients from the moment of interest to the end of their relationship with the brand.

Organizations can map their patients’ journey by following the steps below.

  • Firstly, define a persona – a fictional character that encompasses certain needs, goals, and a behavioral pattern.
  • Secondly, define the stages in which patients do business with the organization or complete a transaction.
  • Thirdly, define the questions that the persona might have at each stage, based on the needs, goals, and behavior.
  • Fourthly, define the tools that the persona would use during each stage so that the organization can provide better support.
  • Finally, identify the stakeholders that play a role in each stage of the journey in order to understand the impact they could have on the persona’s experience.

We have designed sample journey maps for in-patients and out-patients of a hospital. Any hospital can use these journey maps as templates to map the journey of their patients.

In-patient:

We have considered Mr. Kumar as a persona for an in-patient environment. He is an attendant to the patient, his son, who is suffering from suspected dengue. Mr. Kumar has to get his son admitted to the hospital for treatment.

His goal is a speedy recovery for his ailing son. For this, he would like to meet a good doctor, avail genuine treatment, get fair billing, and be able to achieve insurance coverage. Ultimately, his overall expectation is to be able to get early recovery and discharge from the hospital.

IP patient journey map patient feedback management

Out-patient:

Let’s look at another patient’s journey through the out-patient, Ms. Sharma. She is a working professional who is suffering from cold and fever.

Her goal is to meet an experienced doctor who can diagnose her ailment, provide proper medication, and enable a speedy recovery so that she can resume work and return to normal life at the earliest.

OP patient journey map patient feedback management
Bonus: To learn more about Patient Journey Mapping, download the eBook here.

Having worked closely with many healthcare organizations, I have realized that it is crucial for a hospital to walk in its patients’ shoes and anticipate what the patients might be going through while availing its services. With patient journey mapping, the hospital is able to visualize and understand critical points of failure where corrective action needs to be taken in order to improve patient experience.

2. Train the team effectively

When in a hospital, patients need to seek the assistance of the staff members. For instance, a patient might need help for visiting multiple departments, arranging for a wheelchair, contacting the on-call doctor, or even looking for a restroom. If the staff is unresponsive towards these queries, the patient’s experience is less than satisfactory.

Firstly, hospitals must hire the right employees. Additionally, they must frequently provide the staff with relevant training to make them empathetic, caring, and highly approachable. The management must also design KPIs for the patient-facing staff around patient satisfaction indices.

Quite often, employees in healthcare do not communicate with patients during the feedback process. A small investment in coaching the frontline staff on how to communicate with a patient could go a long way. Let me share examples of how two different organizations collect patient feedback:

In the first hospital, a Patient Relations Executive (PRE) hands over a tab-based feedback form to the patient after the discharge intimation is received. Along with handing over the tab, the PRE informs the patient and his attendant about the delightful news that the patient has fully recovered and can go home now! The PRE requests the attendant to clear the bills and meet the doctor for post-recovery care. Subsequently, the PRE moves on to attend the next patient.

On the other hand, in the second hospital, the PRE hands over the tab-based feedback form and sincerely requests the patient/attendant to fill in the feedback form. The PRE says “We would be very thankful if you could let us know how well we took care of you. Please be completely transparent in your feedback. Do not hesitate to mention anything you might not have liked in our service. This will ensure that other patients are benefited too. Your feedback is extremely valuable to us. Please do take three mins to complete the same. We read through every feedback and constantly work towards delivering a great patient experience.” After this, the PRE also shares the delightful news about the patient’s discharge and clearly explains the next steps of billing and clearance. Subsequently, the PRE moves on to attend the next patient.

The PRE in the second hospital makes the patient feel motivated to give an honest feedback.

3. Encourage the management to engage with patients

Patient-centricity is not applicable solely to patient-facing employees – doctors, nurses, lab technicians, and receptionists. Patient centricity must become the organisation’s culture. Senior leaders must also remain accessible by making frequent visits to patients in the hospital, engaging with the patients and their family, monitoring their progress, and keeping an eye on the behavior of caretakers towards them. Top management members must spend at least an hour or two every week talking to patients who have had a negative experience, in order to understand their needs better.

This way, the staff sees and hears the leaders expressing a genuine sense of urgency, commitment, and passion towards patient experience. Additionally, it portrays that every patient is cared for and their patronage is considered valuable.

What challenges to expect in your journey to creating patient delight?

1. Getting senior management buy-in

One of the major challenges that organizations face in embarking on the journey of creating better patient experience is to get the senior management team on board with the planned strategies and initiatives. Without leadership buy-in, the initiative is bound to either become a department level exercise – to which most other departments won’t put in their hundred percent – or become a one-off, good-to-have project that everybody thinks is important but doesn’t have the time to work on.

There is no sure-shot way of convincing the management. However, most industry leaders suggest that it is important to present a business case that shows how improving patient experience will have a positive impact on the hospital’s brand value. Some starting points to help in building such a business case are:

  • What is the cost of an unhappy patient sharing his/her unhappiness on social media or news media?
  • Where do you stand in patient satisfaction amongst your competitors?
  • What is the value of positive word of mouth from happy patients?
  • What is the overhead of servicing unhappy patients compared to happy patients?

Collecting hard data around these questions and building a hypothesis on the results that can be achieved by improving the patient experience would be helpful in getting leadership buy-in.

2. Instilling a patient-centric culture in employees

As the front-runners of delivering patient delight, it is inevitable for all employees to have a patient-centric mindset in everything they do. It is crucial for senior management to convey a strong message that the team has to constantly deliver exceptional patient experience. Sensitizing the team about the fact that patient feedback is meant to help them achieve this goal is also critical.

Building a patient-centric culture requires that employees empathise with the patients. Showing employees how their work impacts the patient experience is a good way to develop empathy. Training the patient facing employees to not just listen to what patients say but also watch for their body language and pick on the non-verbal communication will definitely help further improve patient experience.

3. Biting more than you can chew

When hospitals learn about the benefits of delivering outstanding patient experience, some hospitals might go all-in and try to implement every proven strategy to improve patient experience. While I appreciate the enthusiasm, it might not be the best way to start. The quality, not the quantity, of these processes would have a positive impact on the experience.

First, organizations must instill patient-centricity in their culture. All efforts, strategies, and investments would go in vain if a patient-centric vision is missing in the organization.

The next step is to setup a robust and automated patient feedback management system. Such a system would bring transparency in data and show the real picture to hospital management, therefore driving more effective decision making process.

Finally, the most important step is to act on feedback efficiently by setting up an automated process to close the loop on patient feedback.

What results to expect with the implementation of everything mentioned above?

By automating the entire patient feedback collection, collation, and analysis process with the help of Omoto, healthcare organizations have benefitted in the following ways:

  • Reduced the manpower required in collecting, collating, analyzing, and reporting patient feedback by 75%
  • Cut down the turnaround time on patient feedback by 90%
  • Enhanced patient satisfaction by 70%

Because of reduced effort in managing patient feedback, the staff is now able to spend more time talking to patients and acting on issues shared by them. With a low turnaround time, patients’ trust in the brand has increased. The accuracy of reports generated from the patient feedback has helped organizations in making informed business decisions.

These factors have clearly improved the patient experience as hospitals have been able to enhance their patient satisfaction rating by 70%.

Continental Hospitals, one our clients, has set an example in the healthcare industry by becoming one of the leading brands in delivering quality care and top-notch patient experience. The video below describes how they use the voice of the customer in the course of this journey.

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