Diane E. Meier, MD, FACP, FAAHPM
Director, Center to Advance Palliative Care
Co-Director, Patty and Jay Baker National Palliative Care Center
Icahn School of Medicine at Mount Sinai
Christy Dempsey, MSN, MBA, CNOR, CENP, FAAN
Chief Nursing Officer, Press Ganey Associates
This blog post is part of a five-part series, in which Diane E. Meier, MD, interviews the inspiring keynote speakers of CAPC National Seminar 2018.
In this post, Dr. Meier is joined by Christy Dempsey, chief nursing officer of Press Ganey Associates – an organization whose mission is to “support health care providers in understanding and improving the entire patient experience.” Christy is author of The Antidote to Suffering: How Compassionate Connected Care Can Improve Safety, Quality, and Experience, through which she explains that reducing the suffering of patients and caregivers is essential to improving health care delivery. This interview provides a sneak peek into Christy’s keynote, titled ‘Assessing and Reducing Suffering Using Measures of Patient Experience’.
Dr. Diane E. Meier (DEM): Thank you, Christy, for agreeing to give a plenary at our upcoming CAPC Seminar and for participating in this interview. I’d like to begin by talking about ‘patient experience’ and ‘patient satisfaction’. Everyone has heard these terms so many times, that they risk becoming meaningless—what do they mean to you?
Christy Dempsey (CD): When you think about ‘patient satisfaction’, your mind may automatically go to the superficial: making patients happy and being nice. ‘Patient experience’ is the totality of the experience. The clinical, operational, cultural, and behavioral—everything that happens to, about, and with the person who happens to be a patient.
The way we think about the patient experience has been top of mind for Press Ganey from the start in 1985; the understanding that health care professionals need to know how they’re perceived by patients in order to make improvements. Now, the federal government, via the Centers for Medicare & Medicaid Services (CMS), uses data from the Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) as part of a hospital’s value-based purchasing score, creating a monetary component. Focusing on the patient experience should not be contingent upon the score, percentile, or money attached to it. These things come when you focus on what’s right for the patient.
Focusing on the patient experience should not be contingent upon the score, percentile, or money attached to it. These things come when you focus on what’s right for the patient.
DEM: I would argue that the patient experience is the ultimate metric, because in theory, the whole health care system exists to serve the needs of patients. In the end, a patient’s assessment of whether their needs were met is the gold standard for quality.
CD: Exactly. And while financial metrics are always top of mind for a board of a health care organization, these metrics are driven by patient experience. This is because patient experience is not patient satisfaction; it’s the totality is everything you do.
DEM: Some colleagues have said that patient experience is as simple as having TVs in the waiting room, or offering access to parking, vs. focusing on quality of care. Your data shows that patient experience is highly correlated with quality outcomes. Can you tell us about this study?
CD: Of course. Our goal was to identify the key drivers behind a patient’s likeliness to recommend an organization, which is a key factor of patient loyalty. With access to various data points, we discovered that likeliness to recommend was dependent on teamwork, followed by nurse courtesy, and room cleanliness. Each of these factors made patients feel safe in care.
“If you work well together as a team to take care of me, I feel safe.”
“If you’re talking to and listening to me, and involving me in my care, you’re courteous. I feel safe.”
“If my room is clean, my perception is that the entire organization is clean, and I’m not going to get an infection. I feel safe.”
Ultimately this demonstrates that patient experience is not about being nice or making people happy—it is about making people feel safe in your care. Patients need to know that you know who they are and what’s important to them, in order to build trust. Without that, they won’t be compliant, or report a good experience. There is no light between clinical quality, patient safety, and the patient experience. It’s all the same thing.
There is no light between clinical quality, patient safety, and the patient experience. It’s all the same thing.
DEM: That’s a really critical point, and reminds me of an analysis published in Harvard Business Review, where the strongest independent predictor of thirty-day readmissions was communication. This exemplifies how something that may dismissed as ‘unimportant’ is clearly linked to what happens to patients in our system, during and after hospitalization.
CD: Right. We have to think about the health care providers who are taking care of patients across the continuum; those who are asked to be empathic and compassionate, but may never have experienced what it’s like to be on the receiving end of care. Without this, they may confuse the patient experience with the idea of just “being nice.”
DEM: That’s a critical misconception that needs to be cleared up. Continuing forward, are health care systems paying attention to data on patient experience, and do they think it’s actionable? What interventions or approaches have exemplar health systems taken to try to move the needle on patient experience?
CD: Since reimbursement is tied to patient experience, all health care systems are paying attention to some degree. However, some look at scores or the percentile rank, using the data like a hammer and setting unreasonable goals. This ends up demoralizing those taking caring of patients, as the focus is on the data and reimbursement, rather than the patients. That’s not why we went to school—we went to school to take care of people.
More organizations are making changes for the positive, creating a cultural shift with a systems approach. Some have developed chief experience officer roles, robust patient-family advisory councils, and have even put patients on committees. There’s a greater degree of transparency, as information about clinicians is available for patients to see on the internet; with accountability in play, there is a behavioral change on the provider side, and patients can find a perfect match for their care. At the end of the day, it’s important to understand that this is not about patient satisfaction or a score. It’s about changing in the way you take care of people—those in beds, and the people taking care of them.
At the end of the day, it’s important to understand that this is not about patient satisfaction or a score. It’s about changing in the way you take care of people.
DEM: Speaking of that, I heard Vivian Lee speak about the University of Utah, an early adopter in adding physician scores and comments to their public website, now happening across many leading health systems.
CD: Transparency is important, but it shouldn’t be a ratings game. It’s a match game for the patient, who can find their provider of choice by understanding how they provide care. It’s not one size fits all, and transparency is a way to match to the right provider.
DEM: That circles back to the ends of medicine; to serve the priorities and goals of our patients who come to us with trust and vulnerability. If you don’t ask them, you can’t know.
I’d like to talk about your journey as a nurse. Is there a connection between your training, professionalism, and your current national leadership role? There are many things that someone with a nursing degree can do to help humanity and be a positive act in the world. How did you find your highest and best use?
CD: After high school, I was offered a full scholarship to journalism school. Due to timing, and a relationship that I wanted to pursue (my now husband!), I decided to stay local, which also meant taking my career in a different direction. Nursing school seemed like a good choice for me, as I saw others in that role (including my mother), and knew there were many things that I could do with the degree. At the end of the day, it was a great decision, one that I have never regretted.
I’ve worked in many areas of the hospital; I started as a burn technician, moved to the Neurotrauma ICU, then to the recovery room, management (both perioperative and emergency services), and then administration. While in administration, my hospital became a charter member of the Patient Flow Collaborative through the Institute for Healthcare Improvement (IHI), which led me to hearing Eugene Litvik speak about separating scheduled and unscheduled volume in the operating room. Thinking this could help our hospital, I called my surgeons, who trusted me enough to try it (and it worked!). Our work got the attention of Eugene and other principals at IHI, leading to future work together.
I left the hospital in 2007 to lead the consulting part of a company that Eugene co-founded, which was later acquired by Press Ganey. After continuing with my role for a few years, the CEO of Press Ganey approached me, stressing the importance of nurses in patient experience, and spoke of the need for the organization to recognize the field. That’s when the chief nursing officer (CNO) role was developed for me; it’s been an amazing journey.
Did you enjoy this interview? Listen to Christy Dempsey’s keynote, ‘Assessing and Reducing Suffering Using Measures of Patient Experience’, at CAPC National Seminar 2018, November 8-10 in Orlando. Learn more and register.