Patient Experience: A Critical Indicator of

Healthcare Performance

PAMELA H. GULER, FACHE

S u m m a r y • Patient experience has become a critical differentiator for health-
care organizations, and it will only grow in importance as transparency and consum-
erism dominate the healthcare landscape. Creating and sustaining a consistently
exceptional experience that promotes patient engagement and the best outcomes
is far more than just “satisfying” patients, going well beyond amenities that
may be provided.
Perception of care experience is often shaped by methods we use to address the
biopsychosocial needs of patients. Building relationships and communicating well with
our patients and families are primary approaches. In a complex healthcare situation,
patients may not fully understand or remember the highly clinical nature of treat-
ment. However, they always remember how we made them feel, how we communi-
cated with them as a team, and what interactions they experienced while in our care.
Patients who are fully informed and feel connected to their caregivers are
often less anxious than those who are disengaged. Informed and engaged patients
are enabled to participate in their healthcare. Organizations that focus on develop-
ing an accountable culture—one that inspires caregivers to communicate in a way

F E A T U R E
that connects to patients’ mind, body, and spirit while leveraging standard, evidence-
based patient experience practices—find that patients’ perception of care, or “the
patient experience,” is vastly improved.
Adventist Health System has embarked on a journey to patient experience ex-
cellence with a commitment to whole-person care and standard patient experience
practice across the system. Recognized with several national awards, we continue
to strengthen our approach toward bringing all of our campuses and patient set-
tings to sustained high-level performance. We have found that a combination of
strong, accountable leadership; a focus on employee culture; engagement of phy-
sicians; standardized patient experience practices and education; and meaningful
use of patient feedback are top contributors to excellence in patient experience.

Pamela H. Guler, FACHE, LSSMBB, CPXP, is vice president and chief patient experience officer at
Adventist Health System, headquartered in Altamonte Springs, Florida.
The author declares no conflicts of interest.
© 2017 Foundation of the American College of Healthcare Executives
DOI: 10.1097/HAP.0000000000000003

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© 2017 Foundation of the American College of Healthcare Executives

 W hat is the patient experience? If you
ask anyone in healthcare this question
today, you will likely hear a variety of an-
integrated care includes medical practice
offices, urgent care centers, home health
and hospice agencies, and skilled nursing
swers. Some may say it is patient satisfaction facilities.
or qualify it as whether we are nice to pa- As a system, Adventist Health System
tients and families. Others may refer directly has been on a journey of patient experience
to how experience is measured via tools improvement for the past six years. Exhibit 1
such as the Consumer Assessment of shows the level of improvement we have
Healthcare Providers and Systems (CAHPS) achieved by showing monthly progress from
surveys of the Centers for Medicare & 2009 through July 2016 according to the
Medicaid Services (CMS). Still others may Hospital CAHPS (HCAHPS) survey mea-
offer a comprehensive view of the patient sure overall rating. The solid line notes
experience, such as The Beryl Institute’s Adventist Health System’s progress in the
(2016) definition: “the “top-box” score (the percentage of patients
A standard approach to sum of all interactions, responding with a score of 9 or 10 to the
evidence-based practices is shaped by an organiza- question “Rate the hospital on a scale of
tion’s culture, that influ- 0–10”). The dashed line represents the 50th
imperative to a successful ence patient perceptions
percentile for the Press Ganey national
patient experience. across the continuum of benchmark database (a comparative to
care.” Regardless of how approximately 1,800 other hospitals), and
we define the patient experience, this topic the dotted line represents the 75th per-
has been, and will continue to be, a critical centile. Clearly, our pace of change has
indicator of future viability for healthcare been dramatic. As we reach higher scores,
organizations. Consumers expect clinical the challenge to improve becomes even
excellence in their care; how we treat our more daunting, so we have refined our
patients, communicate with them, engage strategies over time to achieve the desired
them, know them, and partner with them performance.
throughout their lifetime, addressing their
whole health journey, becomes a differenti- Adventist Health System’s Definition
ator as well. of Patient Experience
How do Adventist Health System’s caregivers
Patient Experience at define the patient experience? That is an
Adventist Health System interesting cultural question. A key driver of
Adventist Health System is a faith-based our commitment to our patient experience
healthcare organization headquartered in efforts is our ability to energize and sustain a
Altamonte Springs, Florida. Our more culture in which our caregivers continually
than 78,000 employees maintain a tradi- connect to the “why”—our mission, vision,
tion of whole-person health by caring for and values—behind everything we do. In 2012,
the physical, emotional, and spiritual needs as we further formalized our efforts around
of every patient. With 46 hospital campuses the patient experience, we asked our em-
and more than 8,300 licensed beds in ten ployees how they define this term. More
states, we serve more than 4.7 million pa- than 90 definitions were submitted from
tients annually. Our full continuum of across the system, and 600 attendees at

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Exhibit 1 Adventist Health System: Overall Hospital Rating Compared with National Benchmarks

Source: Press Ganey. Reprinted with permission.

our annual Patient Experience Summit that Critical Factors in Improving

year voted on the “winning” definition: Patient Experience
“treating the patient as you would the person At Adventist Health System, four critical
whom you love the most.” factors serve as a framework for approaching
This simple and meaningful definition, and sustaining a high level of performance
submitted by a bedside nurse, has resonated in patient experience.
throughout the system for the past four years.
While defining the patient experience may Critical Factor 1: Make Culture a

F E A T U R E
seem like a simple step in a cultural journey, Top Priority
developing a definition of this important An organization might expect to jump im-
work from the inside was important to us. mediately into the practices or “tactics” of
And the fact that it came from a bedside care- patient experience interactions, such as
giver rendered the definition all the more hourly rounding, when first addressing the
important. critical factors that produce the best results.
Today, we complement this definition While this approach is tempting (and in-
with the concept of whole-person health and deed, these practices are covered later in
delivering a consistent patient experience the article), the most important area of focus
with uncommon compassion across our to master first is the employee culture. En-
entire system. Consistency is key: We have gaged employees who are committed to the
found that delivering a standard approach organization’s mission and dedicated to
to evidence-based best practices, built on a the why are the number one leverage point
cultural framework of engaged caregivers for driving exceptional experience for pa-
committed to our mission, is imperative to tients and families. Hiring employees with
a successful patient experience. a service- and teamwork-oriented attitude to

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© 2017 Foundation of the American College of Healthcare Executives

 accompany their clinical skill is essential to meetings via Skype for each patient setting
building a culture of sustained excellence in (e.g., inpatient, emergency department,
patient experience. ambulatory), through which hundreds of
Constantly “re-recruiting” high per- participants continue to learn from each other
formers, growing solid performers, and and from our Office of Clinical Effectiveness
coaching up those who need additional regarding best practices.
growth are equally critical aspects. Strategies Every summit and meeting includes a
for reducing turnover and stabilizing the patient story that demonstrates the importance
workforce are key as well. Establishing and of promoting a strong patient experience.
actualizing these activities takes strong, The sharing of meaningful patient experience
engaged leaders at all levels of the organi- stories is one of the most powerful methods
zation. Leadership development that en- of connecting to the why with employees
riches leaders with the skills they need to and physicians. Since 2013, we have aimed
engage, grow, coach, and lead their teams is to “connect head and heart” through various
a significant compo- innovative methods, such as the following:
Communication from the nent of the work we
senior-most levels of the must do. All of these • A story portal was developed for our
system’s intranet and marketed
organization about patient building blocks of a
culture that supports throughout the organization as a place to
experience is a priority. patient experience submit stories—hundreds of them over
excellence demonstrate the importance of the years—that illustrate meaningful
alignment between patient experience and patient experience interactions.
strategic human resources. • Every meeting related to patient
experience opens with a story, usually
Approaches to Growing a Committed Culture shared by the caregiver who was a part of
What are some methods for growing a that story.
culture committed to patient experience • Patient experience stories are shared by
excellence? Fundamental to our current and our CEO as “mission moments” through
his regular newsletter, Newsline, to all
continued success is an intentional focus on
employees.
education and networking throughout the
• Story sharing is encouraged in unit-level
health system as they relate to patient expe-
department meetings.
rience improvement and excellence. Our
• Our system celebrates these stories
system hosts the annual Patient Experience through an annual award for “caring
Summit in Orlando, which has grown to 700 with uncommon compassion.” Criteria
attendees from all ten states in which Adventist for the award over the years have ranged
Health System operates, with national key- from the campus submitting the most
note speakers and sharing of internal best stories to the portal (in 2014) to how story
practices. Networking and celebrating prog- sharing is leveraged at each campus to
ress are major components of this summit, connect to the why (2015) to the campus
including a spirited awards luncheon hosted with the most powerful story (2016). One
by our CEO. of our 2016 Uncommon Compassion
We springboard from the yearly summit Award–recognized stories was an
by conducting monthly online strategy extremely powerful message about the

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 care provided to Pulse nightclub shooting should all own patient experience, and the
victims in Orlando by our caregivers. ultimate ownership sits with the CEO. If the
CEO stresses patient experience as a priority,
Often, patients are engaged to share
the entire organization follows. With that
their stories, creating an even deeper oppor-
support as a foundation, others in the organi-
tunity for our caregivers to connect to the
zation, such as CNOs and chief patient expe-
heart and to recognize the importance of the rience officers (CXOs), are better enabled
patient experience. In fact, a Pulse victim to drive change and sustained improvement.
and patient at one of our campuses opened
the Patient Experience Summit in fall 2016, Critical Factor 2: Engage Physicians
sharing thoughts from that difficult time Many physicians are naturally empathetic
and relating how our caregivers had become with patients, demonstrating strong com-
family until relatives could arrive. We also munication and listening skills. Others may
recognize the importance of sharing stories have challenges in this area and need assis-
that may not be selected as “best” so that we tance to improve. A national research study
may learn from them as well. published in 2009 noted that 75 percent of
Capturing direct comments and accounts patients admitted to the hospital were un-
from patients and families is another critical able to name a single doctor assigned to
component to delivering the best patient their care (Arora et al. 2009). Another
experience. Adventist Health System cap- well-reported historical study noted that the
tures both positive and constructive feedback average physician interrupts a patient after
through surveys and follow-up phone calls to approximately 18 seconds during the opening
patients. Our surveys are designed to allow description of the patient’s principal con-
for written comments, and our survey part- cern (Beckman and Frankel 1984). Subse-
ner’s online tools allow us to pull and ana- quent studies have supported these
lyze these comments. Our chief nursing findings, including more recent research
officers (CNOs) lead meetings at their cam- that lowered the number to 12 seconds in

F E A T U R E
puses where patient comments are reviewed the case of residents (Rhoades et al. 2001).
for trends and discussed for successes and To provide the best experience and care, we
opportunities. Managers share comments in must take the time to listen to our patients.
their unit meetings, and senior leaders pro- We know that engaging physicians in the
vide patient feedback to physicians. Sharing patient experience journey is imperative to
comments provides an opportunity to rec- success. We must go beyond that acknowl-
ognize employees and physicians for excel- edgment, however, and providing a method
lent service to our patients and families, as for physicians to enhance skills in relation-
reward and recognition are critical to sus- ship building and empathy with patients is a
taining excellence in this area. known best practice.
Above all else, communication from the One key strategy is to develop and internal-
senior-most levels of the organization about ize a physician–patient relationship–based
the importance of patient experience is a communication course taught by physicians
priority. Senior leadership should also to their colleagues. Other organizations have
support the efforts and resources that are internalized education programs of this na-
required to improve patient experience. We ture with success, and Adventist Health

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© 2017 Foundation of the American College of Healthcare Executives

 System is now on this path as well, setting answering “always” rather than “usually.”
our education program in place, training our One effective approach with physicians is
physicians as facilitators of an evidence- to “humanize” the data by sharing how
based curriculum, and in turn leveraging many more patients would have needed to
these facilitators to train their colleagues in answer “always” to move the resulting score
these important skills. to the 75th percentile.
In addition to communication skills, an- On the patient side, an excellent strategy
other important, yet simple, practice is sit- for improving patients’ perception of com-
ting when talking with a patient. Research munication with their doctor is the practice
indicates that the patient’s perception of of physician–nurse dyad rounding. This
time spent with the physician increases practice, when implemented effectively,
if the physician sits, and the patient also vastly improves teamwork and communica-
feels the physician is more compassionate tion between caregivers, reduces follow-up
(Ketelsen, Cook, and Kennedy 2014). Yet, phone calls to the doctor from the nurse, and
sitting is often a chal- enables the nurse to better care for the needs
Engaging physicians in lenge, at least in the in- of the patient appropriately and efficiently.
understanding patient patient or emergency Engaging physicians in this practice, or in
experience feedback and department setting: the more advanced practice of multidisci-
Physicians are in a plinary rounding at the bedside, provides a
data is important. hurry, they do not think strong framework for exceptional patient
of sitting, or a chair is not available. Some experience and care.
of our campuses have hung designated “for
your doctor” folding chairs on the walls of Critical Factor 3: Standardize Patient
patient rooms so that the physician always Experience Practices
has a chair to use. Whatever action is needed, A few years ago, this section might have
making sure that your physicians can sit, been titled “Best Practices for Patient Ex-
and encouraging them to do so, is a high- perience,” but over time, Adventist Health
impact strategy. System’s overall mind-set has shifted from
Engaging physicians in understanding a recommended-best-practice approach to
patient experience feedback and data is also a standard “this is how we care for our pa-
important to the improvement journey. We tients” methodology. Recalling that consis-
stratify our patient experience survey feed- tency is a key attribute of excelling at patient
back to the physician level to allow our doc- experience, as a system of 46 campuses we
tors to gain insights into their patients’ have achieved strong improvement in our
perception of care. Patients hold physicians patient experience journey over the years,
in high regard. We find that raw scores from with national recognition. That said, we still
experience surveys tend to be higher for encounter some variation in performance
questions related to physicians, with a nar- across campuses. The current stage of our
row or compressed range for movement to journey is to standardize as a unified system
improved percentile performance. In fact, we around specific practices with one consis-
often find that movement for a physician in tent method for teaching, validating, and
HCAHPS scores from the 50th to the 75th holding ourselves accountable to those
percentile requires only a few more patients practices. We know from networking and

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benchmarking with other top-performing or- communicate in a consistent manner while
ganizations, as well as from our own internal caring for their patients is key.
results, that engaged employees who imple- We connect with our caregivers regu-
ment these practices well and with inten- larly on the why behind hourly rounding.
tionality drive top-decile performance. First and foremost, hourly rounding is about
What are those standards for patient safety for our patients. Studies have shown
experience? They may vary slightly by patient direct correlations between hourly round-
setting, but some examples are the following: ing and reduced falls and pressure ulcers.
Hourly rounding also reduces the use of call
• Executive leadership rounding on
lights and allows the nurse to proactively
employees and patients
manage the plan of care. Every caregiver un-
• Direct leader rounding on employees
derstands these incredibly powerful reasons
• Nurse leader rounding on patients
for this very intentional practice.
• Hourly rounding on patients by staff
We also stress the relationship building
Once our campuses have entrenched between staff and patients that must occur
these standards into their practice, we insti- during conversations, with a focus on em-
tute standards related to bedside handoff, pathy and listening skills. One of our edu-
follow-up phone calls, and nurse–physician cation methods teaches our busy nurses
dyad rounding. We deliberately avoided try- how a strong connection can be made in just
ing to “boil the ocean”—implementing all 90 seconds. Another method teaches
the standards at once. nurses to ask the patient about the most im-
A detailed description of each of these portant thing (MIT) that they can do for him
practices can be found throughout the lite- today. The nurse writes the response on
rature, including the HCAHPS Handbook the communication board in the patient’s
(Ketelsen, Cook, and Kennedy 2014), so they room so that all employees and physicians
are not elaborated on here. However, the topic who interact with the patient are aware of
of hourly rounding merits additional com- it. For the patient, the MIT often is not

F E A T U R E
mentary, primarily considering how Adventist clinical and may be a personal factor. Any ac-
Health System has leveraged paients’ percep- tivity we can undertake to enhance our rela-
tion of this rounding to drive improvement. tionship with those in our care is essential to
the patient experience.
Hourly Rounding
We have found that hourly rounding, when Critical Factor 4: Commit to Meaningful
conducted purposefully, drives improvement Use of Data
of patient experience results in the inpatient The impact of hourly rounding on patient
setting. What does purposefully mean to us? experience has been researched and proven
We use the acronym COLA, for “care out through national studies (Meade, Bursell,
loud always,” with our caregivers, encouraging and Ketelsen 2006), but no amount of read-
them to narrate their care with a patient or ing about others’ successes equates to see-
family as they address the “five Ps” of hourly ing hourly rounding—and your employees’
rounds: pain, potty, position, periphery, and connection to the why—with your own eyes.
parting. We know that our caregivers are Adventist Health System’s survey measure-
in the room hourly, so ensuring that they ment tools are described later in detail, but

Pamela H. Guler, FACHE  23

© 2017 Foundation of the American College of Healthcare Executives

 one feature of these tools is highlighted percentage of patients who answered
here: the additional questions we can ask “always” or chose the most positive response
the patient. to a given HCAHPS question) for each
For our inpatients, we use a format that HCAHPS composite domain. Patients who
includes both HCAHPS and additional answer yes to the hourly rounding question
questions. One of those questions simply have a dramatically higher perception of their
asks the patient, “Did a staff member care experience as reflected in HCAHPS.
visit you hourly during the day?” With For example, patients who answer yes to the
this feedback from our patients, we can hourly rounding question score nurse com-
easily share with our employees the munication “always” 86.9 percent of the
vast difference in HCAHPS results be- time, while patients who answer no to the
tween patients who answered yes to the hourly rounding question score nurse com-
hourly rounding question and those who munication “always” only 59.3 percent of the
answered no. time. Now, following the bull’s-eye cross-
A sample reporting graphic that we use walk for these scores by noting where the
to share this impact, from board level to top-box dot falls on the graphic, nurse com-
frontline staff, is shown in Exhibit 2. The dots munication ranks at 95th percentile for pa-
and triangles on the bull’s-eye reflect national tients who answered yes to the hourly
percentile levels for the top-box scores (the rounding question versus 1st percentile for

Exhibit 2 Impact of Hourly Rounding on HCAHPS Perception of Care

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those who answered no. Nurse communi- provides regular ranking charts that show
cation has often been called the “rising tide” how all of our campuses are performing.
measure—when this metric improves, all This approach serves several purposes,
others follow. So leveraging strategies which include promoting networking to
that greatly impact nurse communication, learn from others and celebrating or rais-
such as hourly rounding, is all the more ing awareness of where we stand compared
important. with others. We encourage individual cam-
Through this bull’s-eye graphic, our teams puses to report similarly, sharing how their
get the message at a single glance that this individual units are performing compared
standard process has a strong, positive im- with others, making this method applica-
pact on patient experience when executed ble to both large systems and individual
well. In fact, with much time now spent ob- campuses.
serving hourly rounds at our campuses and How frequently should survey results be
reviewing their bull’s-eyes, we can even get a reviewed? Depending on sample size, pulling
sense of how purposeful the rounds are at survey results weekly or even daily can lead
the campuses by noting how close the ligh- us to unnecessarily react, negatively or posi-
ter dots (or patients who said yes to hourly tively, to changes. Having a large enough
rounds) are to the center of the bull’s-eye. In sample size is critical before assuming re-
other words, it shows how impactful and sults represent the patient population with
important rounding and communication are full validity. Our survey partner provides ex-
to the patient experience. cellent tools that allow our frontline leaders
We use data meaningfully to drive change to report on their own results in addition to
in other ways. Our goal in all that we do is the standard reports we provide. Teaching
to be at or above the top quartile in perfor- leaders about sample size helps ensure that
mance for patient experience, with the ulti- they pull results for the right time frame and
mate goal of being top decile, compared with validate the data to help them better inter-
the rest of the nation. We also have process pret results and drive sustainable change.

F E A T U R E
goals in place. For example, for our hourly Every survey administered, along with the
rounding question, our goal is for 90 percent voice of that patient, matters. At the same
of our patients to respond yes, indicating a time, we must keep data validity in mind
cultural entrenchment of the process. All before making broad statements about
of these goals roll into a process called the our performance.
clinical close. Much like a financial close,
this process involves an executive review Measuring the Patient Experience
of performance each month across the sys- So far, the data and reports described re-
tem, with campuses reporting on a regular flect the survey process we use at Adventist
basis to the senior-most executives in the Health System. We partner with Press
organization. Ganey for all types of acute care surveys—
As a large system, we also leverage data those for inpatients (HCAHPS), emergency
in meaningful ways through a spirit of department patients who are not admitted to
competition. We all strive to provide the very the hospital, and outpatients and ambulatory
best experience for our patients and fami- surgery patients (OAS CAHPS)—as well as
lies. As a system-level department, my team for surveys for our medical practice setting.

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© 2017 Foundation of the American College of Healthcare Executives

 We partner with other vendors for our home Finally, in our consumer-driven mar-
health and hospice CAHPS surveys. We mail ketplace, we look outside our typical means
paper surveys in every instance, and we sup- of feedback capture to social media and
plement the emergency department and other ways to analyze the voice of our cus-
medical practice surveys with an e-mail tomers. New software will enable us to
version. Our survey tools allow us to cap- further analyze these inputs.
ture patient comments, which as men-
tioned earlier is a key to improvement. We Our Patient Experience
also implement the new CAHPS tools as Organization
they are released from CMS in early-adopter We are often asked about the makeup of our
fashion so that we have the time to assess system headquarters–based patient experi-
our performance with them and strive to ence team and how we leverage patient ex-
excel in the feedback provided by patients as perience leaders in the field. At the
part of our mission. corporate level, patient experience is a part
But survey tools are of Adventist Health System’s Office of
We must think proactively not our only method Clinical Effectiveness, facilitating alignment
about resource of measuring patient with nursing and physicians. Of equal im-
requirements to handle experience. As noted portance are strategic alignments with hu-
earlier, one patient man resources and other areas, such as
what is coming
experience standard brand and marketing, communications, and
in the future. relates to nurse leader information technology (IT). The system
rounding on patients (every patient, every patient experience leadership team is com-
day). Twenty-five of our campuses have posed of a CXO, a system director, and a
adopted a tablet computer–based tool called system manager overseeing both patient
MyRounding to track these rounds, log and consumer experience efforts. The di-
and resolve any issues, capture trends, and rector oversees a clinical team of project
note recognition of employees for sharing. managers and consultants who focus on
These bedside rounds, and the ability to various patient settings and areas (inpatient,
capture and organize feedback from them emergency department, ambulatory, post-
easily, are helpful in improving the over- acute, and physician strategies). The man-
all experience for our patients and families. ager oversees a team of analytics, survey
Regular reports are provided to our CNOs compliance, and process improvement
showing round completion, trends, and strategists. The team leads patient experi-
open issues, affording an opportunity for ence projects and consulting across the
discussion and accountability with the team. continuum of care while also managing all
Another powerful method of capturing CAHPS and other survey efforts, compli-
patient feedback is through our follow-up ance, and reporting for all patient settings,
phone call process. This system has evolved removing the need for our campuses to
over the years, and a number of our cam- handle these duties. We leverage and in-
puses are moving to a regional call center fluence a network of patient experience
approach to make these calls efficient and leaders throughout the system, with most
consistent, thus meeting the needs of our campuses having at least one leader. Those
patients and families in additional ways. roles typically report to the campus CNO

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and are critically important to the imple- We must also consider whether our
mentation of strategies. measurement tools can capture experience
perception and reality at each touch point
Patient Experience and the Changing and allow us to make adjustments as neces-
Healthcare Landscape sary. As our healthcare world transforms
Much of this article so far has featured ex- around us, we are finding a strong need to
amples of patient experience practices adapt quickly to broaden our consumerism
within the four walls of the acute care set- focus as well as our emphasis on population
ting. However, we also have expanded our health strategies.
focus on the patient experience across the The changing healthcare landscape also
care continuum. As mentioned earlier, Ad- brings expanded attention to other patient
ventist Health System places a heavy em- settings for the government-mandated
phasis on whole-person health. Our internal CAHPS surveys. As each new survey be-
research has shown that for every inpatient comes available—first voluntary, then
admission, 20 or more interactions with our mandatory—our organization must evolve
patients take place in other settings. As CXO, and ensure that we are complying with all re-
my role and that of my team have expanded quirements. Often, we are already surveying
across the continuum over the past few years a given patient setting with a vendor survey
to include comprehensive coverage of both product, but each new CAHPS survey brings
patient and consumer experience. a tighter focus on compliance and eligibility
With a focus on whole-person health, our that requires increased attention and resources.
faith-based system embodies a set of eight The CAHPS surveys are excellent tools that
principles as we care for patients, families, enable us to best capture patients’ percep-
and communities. These biblically founded tions of care, and we must think proactively
principles are represented as CREATION about resource requirements to handle what
health—choice, rest, environment, activity, is coming in the future as each new tool
trust, interpersonal relationships, outlook, is added.

F E A T U R E
and nutrition. These principles are entrenched Transparency of data and pay for perfor-
in our interactions with patients in a way mance are the final, vitally important consid-
that enriches the patient experience. erations in the changing healthcare land-
We see our interactions with all con- scape. With consumerism as an ever-present
sumers as taking place across five themes: factor surrounding healthcare outcomes—
engage me, know me, hold my hand, make including patients’ perception of care—we
it easy, and give me the best care. With em- must sustain improved performance.
phasis on these themes, the work that we do
becomes much more than a focus on sur- Sharing Best Practices with Other
vey results—we systematically review each Organizations
touch point for consumers and patients and One of the most exciting aspects of our work
the experience provided. In terms of the IT in the patient experience realm is the growth
environment, our patient portals and cus- of expertise and networking available across
tomer relationship management methods the United States. Many organizations now
help us remain viable in the current and have a CXO or similar role dedicated to the
future marketplace. patient experience. Benchmarking and

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 networking with each other occur through a We have also adopted a common language
number of vendor and nonvendor partner– across the system for interpreting and re-
sponsored forums. We constantly network porting patient survey results. A robust, con-
with other large organizations via our Press sistent reporting approach is key to fully
Ganey partnership as well as through orga- understanding how we are performing. With
nizations such as The Beryl Institute. We Lean Six Sigma experts on staff in our pa-
recently adopted a practice for executive tient experience department, a level of data
leadership rounding that started at UCLA rigor has been introduced that brings added
Health, at the University of California Los structure to our understanding of perfor-
Angeles, and was replicated at the Cleveland mance. Our clinical close process is also
Clinic. This practice is just one example entrenched in our culture as a top priority
of the many lessons learned from others for senior-level executives. The process keeps
and implemented in our own organization. patient experience at the top of mind for all.
In turn, we have shared our practices re- Finally, we are creating patient and fam-
lated to storytelling and other culture- ily advisory councils (PFACs) throughout our
building efforts, as well as methods for system—a high priority for 2017. A number
developing patient experience standards of campuses already have their own coun-
and reporting. cils, and a system-level council is now being
formed. The patients’ voice is crucial to all
Change Initiatives Undertaken in of our experience efforts, and PFACs help
Patient Experience ensure that those voices are heard and en-
As described, our patient experience work gaged in our journey.
over the past six years has included the es-
tablishment of standards, education, and Conclusion and Lessons
culture-building efforts. Standards are in Learned
place for core service skills that apply to all Delivering an exceptional patient experience
employees, including service recovery. is both a clinical and a business imperative in
Additional standards for how we interact today’s healthcare environment. Consistently
with patients are in place for different pa- doing so is not easy work; it requires lead-
tient settings (e.g., inpatient, emergency ership diligence, engaged employees and
department, ambulatory) that go beyond core
physicians, standard practices, and a strong
service skills. We have developed tools that
culture committed to always placing the pa-
are employed with patients every day with the
tient and family at the center of the conver-
primary goal of engaging them in their care,
sation. Adventist Health System has learned
communicating with them completely, and
many lessons along our journey, and I offer
preparing them to care for themselves with an
the following as our top ten:
eye toward whole-person health. An example
of such a tool is our inpatient My Care Folder, 1. Always keep the patient at the center
which is provided at admission and follows of the discussion. Think of what is best
the patient through his stay and departure for the patient.
from the hospital. We have similar stan- 2. We all own the patient experience, and
dardized tools across our system to establish the ultimate owner is the top of the
a unified and consistent experience. organization. If the CEO conveys the

28  frontiers of health services management 33:3

© 2017 Foundation of the American College of Healthcare Executives

 importance of patient experience, future, and map strategies that will
others will consider it important. ensure success.
3. Culture, standard practices, or data alone
will not solve the patient experience References
issue. All must be leveraged and aligned Arora, V., S. Gangireddy, A. Mehrotra, R.
to drive and sustain change. Ginde, M. Tormey, and D. Meltzer. 2009.
4. Employee engagement should be the “Ability of Hospitalized Patients to
first priority. Use the power of storytelling Identify Their In-Hospital Physicians.”
Archives of Internal Medicine 169 (2):
to connect to the why. Reward and
199–201.
recognize, and build a positive culture Beckman, H., and R. Frankel. 1984. “The
related to patient experience. Effect of Physician Behavior on the
5. Consistency and high reliability are key. Collection of Data.” Annals of Internal
Establish evidence-based standard Medicine 101 (5): 692–96.
practices and a consistent method Beryl Institute. 2016. “Defining Patient
for teaching and validating them. Experience.” Accessed September 23.
www.theberylinstitute.org/?page=
6. Don’t try to boil the ocean with patient
DefiningPatientExp.
experience strategies. Focus on Ketelsen, L., K. Cook, and B. Kennedy.
entrenching the standards carrying 2014. The HCAHPS Handbook 2: Tactics
the largest impact first. to Improve Quality and the Patient
7. Maintain focus. It is not easy to sustain Experience. Gulf Breeze, FL: Firestarter
top performance. Publishing.
8. Collect, analyze, and apply meaningful Meade, C. M., A. L. Bursell, and L. Ketelsen.
data to drive change. 2006. “Effects of Nursing Rounds on
Patients’ Call Light Use, Satisfaction, and
9. Patient experience is extremely
Safety.” American Journal of Nursing
important across the continuum of 106 (9): 58–70.
care. Look outside of your four walls Rhoades, D. R., K. F. McFarland, W. H. Finch,
with strong focus as well. and A. O. Johnson. 2001. “Speaking and
10. Understand consumerism, transparency, Interruptions During Primary Care Office

F E A T U R E
and the healthcare climate of the Visits.” Family Medicine 33 (7): 528–32.

Pamela H. Guler, FACHE  29

© 2017 Foundation of the American College of Healthcare Executives

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permission.