Improving Care and Service by Capturing Patients’ Voices

COUNTLESS PAPERS have touted the importance of returning to a patient first care approach that prioritizes effectiveness, efficiency and value-based care. But, what does having a patient-centered care approach mean when viewed through the lens of an industry beholden to data-driven metrics and often-hindered siloed processes and technologies?

Patient-centered care is a patient-first focus. It means putting oneself in the patients’ shoes and viewing care from their viewpoint. One important way of doing this is by capturing patient voices in their own words and using their perceptions of care to help improve delivery. When patients’ perceptions are measured by more than the numerical rating scales, their substantive feedback can provide opportunities for care improvements.

What Are Patient Voices?

Patient voices are firsthand accounts of patients’ experiences and can include any number of variables such as how easy the appointment process was, their perceptions of the clinic or office, how well they were kept informed about their health, the support received when making important decisions and how well they understood provider instructions after returning home. All of these experiences and perceptions can provide valuable information that elucidates where improvements in the care journey may be needed and do so by eliminating unconscious bias.

But, patient voices are subjective and influenced by numerous social determinants of health. Patients’ perspective can also be affected by how vulnerable they feel, data literacy, communication styles and language. In one example, after an oncologist shared with a patient a detailed and lengthy diagnosis, he learned that the patient had heard nothing beyond the word “cancer.” For him, this revelation informed how he would deliver information in the future. Allowing a few minutes for patients to absorb what they have heard is equally important to the information they hear.¹

So, how can healthcare organizations actively listen, prioritize and involve patients in their healthcare decisions, while soliciting feedback that can turn their experiences into meaningful and useful change?

Patient-Centered Approach to Care

The question of how to most effectively and meaningfully capture patient voices that support clinical decision-making can be a challenge. After all, patients are already sharing their experiences on social media and ratings websites, but soliciting feedback through validated open-ended questions that are balanced, complete and meaningful has the potential to significantly increase the number and quality of comments at point of care.¹ These narrative surveys provide a starting point to return to a patient-centered approach to care.

For more than two decades, the Consumer Assessment of Healthcare Providers and Systems initiative has developed surveys that help providers understand the patient experience. Supported by the Assessment for Healthcare Research and Quality (AHRQ) and downloadable from the AHRQ website, these surveys can be adjusted and administered in a variety of formats that eliminate the “one-size-fits-all” approach.²

As more patient data is gathered, stakeholders must devote time and attention to building an infrastructure that enables measurement tools for continuous improvement across multiple stakeholders. In fact, Congress mandated outpatient surveys for ambulatory care as part of reimbursement payments, and a growing number of hospitals and clinics have added senior level staff who oversee patient experiences to ensure satisfaction.³

With buy-in from the top, transparency in communication identifies patterns of mistakes and where improvements can be made while removing barriers to change.

Patient-Reported Outcomes

Patients should be at the center of every discussion, so capturing patient-reported outcomes (PROs) in patients’ own voices is an important standardized assessment. How well patients understand their own health, factors that influence their health, desires and expectations for health outcomes, how well they comply with treatment protocols, and whether they feel they are getting the care they are seeking are all factored into PROs. Soliciting this information can help to inform clinical and qualityof-care outcomes and improve patient satisfaction. It also ensures patients’ voices are central to care delivery.

But scaling PRO assessments so they influence higher quality care at a lower cost across an organization can be challenging. In part, the rigorousness of information collected, the diversity of that information and how best to leverage the information are three persistent challenges. For example, depression, a common measure in health assessments, may be viewed and treated differently depending on the context of where the information was collected. Preventive care, specialty care and interventional care each view depression as an important measure of health, but treatments differ across the spectrum of care.⁴ Patient workflows and reporting requirements must be addressed in each case.

Because patients may not always be able to make reliable attributions of their experiences, learning from patient feedback requires interpretive skills and analysis of patterns in patient narratives.³ Data in the healthcare industry is growing exponentially, so capturing and distilling all of that data is as big a challenge as understanding how to respond to data trends that inform necessary improvements. Machine learning is one option that supports aggregation of patient responses; however, the costs may be prohibitive.

Quality Across the Spectrum

PROs can be collected through mailed surveys, electronic health records, survey apps and other means to ensure useful capturing and scoring of data that supports downstream quality improvements.

As the healthcare industry strives for continual improvement, vigilance in quality of care across the economic spectrum must be included. That includes capturing patient voices in ways that meet patients where they are, not necessarily where it may be most convenient for data capture. Surveys sent through the mail in patients’ native languages with return postage paid is one way to encourage responsiveness without relying on technology that may not be available to them.

A Commitment to Improvement

Gathering patient voices and turning those narratives into meaningful data has the potential to improve patient and provider learning experiences, as well as actionability where changes could lead to both improved quality of care and overall patient health.

But the commitment to most effectively gather and use this data takes top-down directed time and resources. Providers should take care when speaking with patients directly about their experiences, as well as when developing or choosing patient surveys so the data gathered is meaningful and complete. Then, they should look for response trends, both positive and negative, that can influence future decisions in care delivery. Patient voices are strong indicators of organizational health, and those voices should be heard.