By, MBA, MSN, ACM, AND , LMSW, CMAC, ACM
Patient satisfaction and the prevention of readmissions are continuously discussed as quality metrics for hospital success. With an increased focus on these and other metrics to continually improve patient care, hospital systems work to improve the patient experience from pre-admission to post-admission. The question is…have these changes improved the patient experience? Are we working together as an efficient team, or have we created redundancy and repetitive processes that may decrease patient satisfaction? Are we putting the patient at the center of care, or are we getting in our way and creating duplicative workflows that are frustrating to the patient?
THE PRE-ADMISSION PROCESS
Let us begin our conversation with a patient who is being scheduled from their surgeon’s office for inpatient surgery. During the preoperative phase, the patient will receive phone calls from pre-admissions to ask questions regarding insurance, emergency contacts and demographic information. The patient has also given this information to the surgeon’s office. Because most electronic medical records (EMR) in the outpatient setting do not connect with the hospital EMR, patients will need to repeat this information several times. Patients can also expect a call from the business office to discuss copayment, preauthorization and initial payments. The patient will also be contacted by the pre-admissions nursing team to complete pre-surgical care and evaluation either via phone or in person and may need to come into the hospital a day or two prior to complete lab work, X-rays, and a COVID screening. At this time, the patient will also meet with the admissions counselor to complete their conditions of admission and update contact information and any other remaining paperwork.
For scheduled surgeries, some hospitals and surgeons require the patient and their coach or caregiver to attend a pre-operative class at the hospital a few days to a few weeks prior to surgery. This is an additional touchpoint for the patient and family to interact with the hospital team but also an additional step from the processes above. This time with the patient will be used to discuss expectations during their admission and the role of therapy, case management and physical prep required prior to the day of admission.
Now we take a big breath and think, wow, the patient is exhausted before they are even admitted! How many times have we reached out to them, and how many of those could be combined to improve efficiencies? Next, the patient is admitted and hopefully surgery goes well, and we transition into the discharge process.
POST-OPERATIVE FOLLOW-UP AFTER DISCHARGE
When a patient discharges from the hospital, they are still in a state of recovery, expected to continue care at the next setting or at home as they adjust to new medications and continue to heal. They are likely overwhelmed and exhausted from their stay in the hospital. As we well know, once a patient is discharged from the hospital, the patient’s journey does not end.
Follow-up phone calls occur from several different departments after discharge including the discharging nursing unit, the case management department to ensure that the patient was able to make their follow-up appointment or fill medications, as well as the surgeon’s office for a follow-up appointment. If the patient is discharged with home health, they will receive additional phone calls to discuss arrangements for home visits, and, depending on what services they require, physical therapy, IV infusion or nursing may reach out to them to arrange services in their home. If the patient is enrolled in an ACO/VBP arrangement, regardless of their knowledge in that arrangement, they may also receive a call from the outpatient care management team. Payers have also been known to have care managers providing this service and will likely reach out to the patient post-discharge.
HOW CAN WE IMPROVE AND STREAMLINE PROCESSES?
Communicate and work together! Hospitals are under intense pressure to perform well in patient satisfaction scores and additional quality measures across the continuum, as well as decrease readmissions and ensure medication compliance. It is no surprise that hospitals and health systems are working every angle possible to provide the best care. Somewhere along the way, we have lost the ability to be efficient.
If we put the patient at the center of the care delivery process and understand their journey through the continuum, rather than think of our silo and the information we need, we can change the construct of how the experience occurs.
Evaluate your process and determine what you need to adjust by considering a centralized access management strategy and a centralized transition of care strategy. In any scenario, Melanie Meyer, PhD, highlights three requirements for success in her case study on the patient journey (2019).
- "A visible health goal
- "Transparent, shared decision making
- "A closed loop communication process"
Below are steps to consider as a starting point to correct processes:
- Map the patient through the care continuum.
- Determine what information is needed and what technology data sharing can be leveraged to avoid duplicating the process for the patient.
- Utilize a scheduling system for the patient, so that each care team member obtains that information needed to their expertise, but the process is coordinated collaboratively for the patient.
- Practice the process from the patient’s perspective to identify gaps and brainstorm solutions for coordination.
- Co-locate access point services for the patient to enhance services: e.g., rather than the patient going all over the hospital, could individual staff go to the patient in a clinic process, where the patient stays in one location and all team members from registration, lab, PT, nursing, care management, etc., round on the patient during that time?
In evaluating your transition of care strategy, speak with your post-acute and value-based arrangement partners (payers, ACOs) to coordinate a primary contact for the patient that is outpatient based with triage information sent back to the hospital setting should support need to be escalated. Regarding post-discharge follow-up calls, eliminate multiple calls and centralize the function to a call center that has access to the medical record and care plans needed for successful transition.
The hospital and healthcare system should not be a treasure that the patient achieves after numerous obstacles and tests. The patient experience and success are nested in their trust that the health system can deliver on its offerings. This requires a reach across silos to create an organized and transparent experience for the patient with clear guidelines for how the patient can receive help from the experts along the way.
Meyer, M. A. Mapping the Patient Journey Across the Continuum: Lessons Learned from One Patient’s Experience. Journal of Patient Experience 2019, VOL 6(2) 103-107.