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A Matter of Patients

– By Matt Skoufalos –

For many years, patient satisfaction in the health care business turned on fundamental questions like whether your medical condition was resolved, or whether you were seen in a timely fashion. In 2020, the concept has become more complicated and is tied more substantially to financial outcomes for health care practitioners and the institutions for which they work.

As the health care industry undertakes a shift toward providing concierge-level care on par with commercial consumer experiences – the better to improve the patient satisfaction scores that affect their reimbursement rates – imaging departments at hospitals and specialists at freestanding clinics are evaluating the entirety of their operations to best meet these elevated expectations. How facilities and equipment are designed, managed and maintained all play as much a part as how staff are trained, supported and incentivized to carry these priorities through.

Corey Gaarde, associate vice president and senior technology specialist at design firm Hoefer Wysocki of Leawood, Kansas, said that design trends in health care are urging consideration of the cumulative patient experience “outside the four walls” of the buildings they visit.

“It starts at home and doesn’t stop until the patient gets back home,” Gaarde said.

Gaarde said the challenge he lays at clients’ feet is “to think of that digital front door” that exists as soon as their patients begin to access information about their facilities. Trying to get institutions that are focused on delivering vital medical services to equally value customer service requires a shift in thinking. He urges them to aim for a level of concierge care comparable to that found in enterprise-class hospitality businesses.

To get there, Gaarde asks clients to consider the experience from the patient perspective, and looks for ways to leverage common, consumer-grade technology to do so. It can start with things like GPS-led, pedestrian wayfinding and navigation through a large hospital campus, or sending an attendant to meet patients and family members at the front door and help guide them through a potentially complex, busy environment.

Once onsite, “the idea is to make it a much more pleasant experience,” from giving patients and family members control over the environment, from lighting to entertainment, to the thermostat; even where blankets and pillows are kept, Gaarde said. These slight touches particularly can have an impact on patient satisfaction in facilities where finance prohibits making more extensive, wholesale upgrades, but “the comfort of an environment is more modifiable,” he said.

“There are 50-60 different technologies that help define a hospital environment,” Gaarde said. “We try to take a comprehensive look at the whole environment, and see what people are doing. There are a significant amount of opportunities from a design perspective to enhance patient care.”

“Even using traditional, real-time locating solutions has shown marked impact on throughput and the ability to manage tracking staff, patients and equipment to expedite procedure times and wait times, so it’s less on the patients themselves,” he said.

Gaarde also pointed to technology that has given hospitals the ability to inject simplified surveys into the in-room patient experience, the better to correct problems as they arise and before people are discharged.

“There is this drive to make it a much more comfortable level of reporting, and really making sure that caregivers are walking in and explaining to patients, ‘We want to know if you’re comfortable,’” Gaarde said. “If they’re not getting the results, they can interact digitally. Unit managers and quality teams can look at that data real-time as the patient is in-house and figure out what’s going on.”

Within the imaging space, Gaarde points to environmental changes that consumer technologies like digital displays can deliver in leveraging the aesthetics of a room to de-stress a patient. By presenting an aquarium, a scene from nature, or even just dimming the lighting, digital displays can help set a scene that improves conditions in the room. For patients stuck in a procedure-level room for long periods of time, the ability for caregivers to update family members on their condition in real time also might be possible to deliver over video display.

“There is a definite push to be more proactive than reactive, especially while family members are in house, and technology is more able to support that,” Gaarde said. “Balance the population that still wants that high-touch [environment], but make it a much quicker, more streamlined process. From a standardization perspective, evaluating technologies that work in imaging that affect the actual equipment is important, but standardized care, standardized communication, cost, communication and support are, too.”

As the Centers for Medicare and Medicaid Services (CMS) continues to focus on institutional customer satisfaction surveys, the agency is also “evaluating changes to traditional responses,” Gaarde said, which means that organizations must find leaders who will champion such environmental improvements from a reimbursement perspective. He urges institutions, “don’t be afraid of doing the business case analysis” for making upgrades because they might discover that they can inexpensively tweak what they already have in-house and still reap dividends.

“There’s a fear that organizations need to do the whole thing,” Gaarde said. “It may not be too expensive if you understand what you’re trying to accomplish from the patient and caregiver experience level, and still have the maximum ROI. Sometimes just painting will enhance the perspective.”

“[Begin] a cycle of evaluating what you have in house, and what can be done to improve processes and technologies: quick wins that can come out of small improvements,” he said.

Ken Luke, CEO of Allegiance Imaging and Radiology of Atlanta, Georgia, also believes in placing technological solutions at the forefront of the patient experience in the imaging world. There’s plenty of devices, equipment and software focused on increasing patient safety and improving the speed at which exams are conducted, interpreted, and the results communicated to their ordering physicians. What’s just as important to delivering a high-quality experience, he said, is the empathy and care you show the patient from the first phone call through the study itself.

“An imaging center has a lot of moving parts, even with the technology, so taking care of each patient really well is a very important part of that,” Luke said. “Patients want something that’s fast and convenient to them, and accessible, because they think they might have a problem. It’s important to treat that patient with kid gloves, so the type of person we hire, we want to have empathy and be sympathetic to patients who may have issues.”

Luke codified that approach in an internal customer service program called “The Allegiance Pledge.” It formalizes handling of the patient within the imaging center, and defines how each staffer is to treat the patient, from administrative staff to technologists and center managers. He said that program has helped establish standards of care “to get everyone on the same page.”

“Answering the phone, how we meet and greet the patient, how we schedule – there’s a standard for that, and it’s part of the culture for the company, not just another procedural manual that you have to follow,” Luke said. “That’s what differentiates most companies from each other: what the culture is.”

When hiring employees who would align themselves with the Allegiance Pledge, Luke said he looks for staffers with “people-people” personalities and who are trainable and teachable in the skills required to do the job. Finding those who have both sets of skills can be more difficult, “but they’re out there, and it makes a difference in how the patient’s treated overall,” he said. Often described in management speak as “high-tech, high-touch” personalities, Luke said those kinds of employees do “really what anyone in medicine should be doing today.”

“It’s a lot of common sense; the golden rule,” he said. “I think it’s about what kind of personality and approach you use. Start with a consulting approach and look at it from the bottom up. You’ve got to spend some time, interview people, and find out how they do things, what’s working well and not. Sometimes it’s little things that need to be fixed, a tool that people need.”

“At the top or the bottom, it should be the same,” Luke said. “A business has to make money, but it also should serve the customers really well. If you do, they’re going to tell others through word of mouth, and you get more return business and more referrals from those physicians. So it all balances out. The profits follow if you’re running a good company from the front end. You’ve got to make sure that you’re managing well both processes as well as people.”

Writing a pledge is one thing; instilling company culture that reflects its values is another. Luke said the success of any such aspirational goals is based on whatever management structure upholds them; whether the culture starts at the top. If it can filter down to center managers, they can keep an eye on how the rest of the personnel are following through with it, he said.

“Those center managers are really the key to how each center performs or doesn’t perform, and they’re only as good as their personnel,” Luke said. “Make it easy for the managers to do this.”

Subsequently, he advises that customer service outreach personnel follow up with referring offices to ensure that they’re satisfied with their results as much as are their patients.

“If patients are happy, it’s a confirmation that we’re doing a good job,” Luke said. “If they’re unhappy, then it means something went wrong. The best way is to admit that mistake versus sweeping it under the rug. Physician offices want that; they expect that. They’re entrusting their patient with us.”

This kind of follow-up and attention to detail at every stage of the patient experience is especially critical for outpatient imaging centers, he said. Patients who have choices – and who are encouraged by their insurers to patronize the lowest-cost options for their care – will only come back to a center that provides a high quality of service. Hospitals don’t have the same burden once a patient is admitted, which is why Luke stresses the importance of managing relationships with patients and providers.

“Outpatient imaging is providing services, and they have to do it in a way to justify the referral source, who will like you well enough to give you repeat business,” he said.

To David Widmann, president and CEO of Konica Minolta Healthcare Americas Inc., the best way to improve the patient experience involves

working toward technological solutions that speed clinical decision-making. By providing significant, patient-specific information inexpensively, using proven, legacy technologies, Widmann believes that there’s a window of opportunity to drive meaningful change.

“The Affordable Care Act advanced a number of concepts that have put the patient, quality and meaningful use at the center of care, and all those things are moving the needle,” he said. “We’ve centered ourselves around precision medicine in a unique way: imaging, genetics and research.”

“We really do think the power of digitalization can come together to change how information is used at the point of care, and realize the concept of personalized medicine by connecting radiomics and genomics together,” he said. “It offers quicker, better, long-term patient satisfaction. It triages everything back together.”

With the understanding that high-end imaging technologies may not be readily available in every outpatient clinic, Konica Minolta Healthcare is focusing on increasing the reliability and efficacy of volume modalities like X-ray and ultrasound to quickly treat more patients and keep them out of the hospital unless it’s absolutely necessary for them to be there.

“We want to give the clinician the ability to gather initial insight that helps validate that decision process, and be very precise to patient needs,” Widmann said. “We don’t try to take a gold-standard modality and replicate it. But we do think that since an X-ray is done 100% of the time before an MRI and a CT, the better information we can get from that, the better the patient gets an outcome faster.”

Operating from the standpoint that these primary imaging technologies are actually really good enough in a lot of instances, Widmann thinks they can be pushed to deliver more information faster, and with more personalized results for patients. He used an example from his own circumstances to illustrate the point.

After having taken a fall from a ladder in which he struck his knee on a step, Widmann was trying to push through the pain, thinking it was just a bruise. When an ultrasound showed that he’d fractured his patella, he made an appointment with an orthopedist. There, an X-ray confirmed the fracture, and the ultrasound, which had shown his ligaments were fine, saved him the time and expense of an MRI study. This all happened while he was traveling and out of network.

“My experience was quite good using basic technology,” Widmann said. “An MRI would have been good – it’s the gold standard – but I didn’t need it.”

X-ray and ultrasound technologies are value-driven solutions that encourage efficiency simply because so many are conducted for a first look. But by applying digitization to these legacy technologies, Konica Minolta is able to offer practitioners the ability to extrapolate X-ray studies into moving images, and adding ultrasound tools to guide non-interventional therapies. The result is that patients can receive screenings that match their risk protocols, not the average risk protocols. By changing the direction of preventative diagnostics unique to that patient, he or she no longer has to go through the angst of not knowing what’s wrong.

“Our goal is to enable a clinician to deliver a better decision sooner,” Widmann said. “Once you embrace that thought, you start to look at the process of use, and the outcomes that come not just from the equipment but from the entire experience.”

“If an X-ray can provide more information toward clinical outcomes and be simple and just in-and-out for the patient, then it achieves two goals right out of the gate,” he said. “We can also use the data for analytics to make the user of the equipment more efficient to reduce the need for retakes.”

“The most fascinating part is really how the radiologists are recognizing how it can benefit them by reducing the amount of time it takes for them to commit to this high-volume approach,” Widmann said. “If they can add additional insight to X-ray and ultrasound, they can spend more time on the tough cases that go to MRI and CT.”

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