A colleague of mine I’ll call Mary is fighting Stage IIIC ovarian cancer. Recently, Mary came down with a bad stomach infection. She reached an on-call physician, who told her to go to the ER, where she would be admitted to the hospital.
When Mary arrived at the ER, she found 50 patients waiting to be seen. She took her place in the queue. Eventually, she was screened by ER staff, who directed her to wait to be evaluated by a physician, despite the fact that the on-call physician had already determined to admit her to the hospital.
Almost three hours after arrival at the ER, Mary still hadn’t been seen by a physician, much less admitted. She reached the on-call physician and asked if the process could be accelerated. The physician promised to try. Finally, four hours after arriving at the ER for what should have been essentially a routine transaction, Mary was admitted to her room.
The Importance of Coordination
Patients experience healthcare not as discrete encounters, or as a linear progression along a continuum, but as a complex system of interdependent structures, processes, behaviors, and outcomes. As healthcare systems grow larger, encompass more facilities, and cover a greater span of the care continuum, complexity increases and coordination gets harder.
The emerging value-based payment system is increasing the importance of coordination while changing its nature. Coordination now requires not just seamless execution of individual episodes of care, but continuous coordination in order to maintain health over time, avoid unnecessary hospitalization, and ensure effective transitions from one care setting to another.
In addition, consumers have higher expectations for service delivery, driven both by their greater financial responsibility for healthcare costs and by sky-high levels of service from companies such as Amazon and Nordstrom.
Some nontraditional healthcare competitors are making care coordination a core component of their value proposition, touting the use of dedicated care navigators and ready access to providers by phone, email, and text.
To remain relevant, legacy healthcare organizations must get coordination right.
Another Example
Mary had scheduled the lab tests that were required for her chemo treatment in conjunction with placement of the chest port so that she didn’t need a separate appointment for the tests. She coordinated this arrangement with her oncology team, alerted her chemo team, and notified the facility where the port procedure would be done. In addition, she reiterated the need for lab tests during each of four calls she received confirming her port procedure.
When she arrived for the port procedure, she reminded the nurse about the tests that were needed for the next day’s chemo. The nurse checked the medical record and said that she did not have any orders for lab tests.
My colleague asked the nurse to contact the chemo team. The nurse reached someone who confirmed the need for tests, but told the nurse that one of the tests was not necessary.
After the port procedure, my colleague called the location where the chemo would take place, and the person on the phone confirmed that they had all the tests needed. However, the next morning the chemo facility called to say that the omitted test was, in fact, necessary. After devoting so much time and energy to avoid having to schedule tests the morning before chemo, my colleague still had to arrive early to have the omitted test done.
“Chemo or No Chemo, I’m Happy to Help”
After hearing about these experiences, I arranged for Mary to speak with a senior executive at the hospital. Mary returned from the meeting energized.
Mary began her discussion with the executive by emphasizing that the hospital staff consistently tried to help her and to do the right thing. Then she told her story—about the wait in the ER and the miscommunication over lab tests, along with the challenges of reaching the right person by phone, confusion over having multiple contacts, and difficulty absorbing the overwhelming amount of information provided. Mary offered suggestions for improvement in each of these areas.
The executive listened carefully and took extensive notes throughout. He discussed each situation seriously and knowledgably. In some cases, the problems were a surprise; in others they were known. In some cases, the executive promised to investigate; in others, he noted that improvements were underway. He was frank about the time involved in making changes in a complex and growing organization. Throughout, he was grateful for the information, unstinting in his attention, and concerned about my colleague’s health.
“He really is one of the good ones,” Mary reported. “I’d like to do more. Chemo or no chemo, I’m happy to help.”
Transforming the Patient Experience
I was quite moved by this story.
Illness in general and cancer specifically can be frightening, exhausting, and disheartening. Just getting through each day can be a major struggle. For Mary, the opportunity to transform her personal struggle into help for others in similar circumstances was a form of renewal.
On many days, the pace and complexity of running a hospital can be overwhelming. Emails must be answered, meetings can’t be missed, and the pile of documents needing review grows. In this case, the hospital executive saw an opportunity to step off the daily treadmill and get to the core of the hospital’s mission: helping patients.
In an era of consumerism, delivering an excellent patient experience day-in and day-out is essential for success. Improving that experience must start with an understanding of the patient’s perspective. Getting that perspective requires active listening—seeking out patients’ insights informally and in regular, structured conversations. Then, the learnings must be translated into constant and consequential improvements in the factors that mean the most to patients.
As Mary’s story illustrates, listening to patients can bring truly remarkable benefits. It can highlight process problems that the hospital hadn’t recognized. It can create urgency, energy, and enthusiasm for improvement. It can build patient loyalty. It can create a more collaborative relationship between patients and the hospital. Also, by showing patients that their insights are valued, listening can give patients a renewed sense of purpose and worth at an otherwise distressing time in their lives.
Listening is helping.
Your comments are welcome. Ken Kaufman can be reached at kkaufman@kaufmanhall.com.
Ken Kaufman’s book Fast and Furious: Observations on Healthcare’s Transformation is available at kaufmanhall.com/fastandfurious.
