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Un-complicating Healthcare IT

Using Lean To Improve Patient Experience: The View From The Waiting Room

Jun 25, 2015 9:07:00 AM Posted by Jim Tufts | Leadership Solutions Team Lead

The View From The Waiting Room: Using Lean To Improve Patient ExperienceDrive Patient Experience Instead of Just Evaluating It

Like most of the rest of the world, community hospitals are increasingly focused on measuring customer (or, in our case, patient) satisfaction. But while measuring satisfaction is really important, too many community hospitals approach patient satisfaction in a way that may inflate their satisfaction numbers, and then they take well-intentioned but misdirected steps to improve their numbers. With a lean approach firmly in mind, however, community hospitals can dramatically improve their patients’ experiences.

One of the first problems is that patient satisfaction surveys get mailed out to patients days or even weeks later after their visit. Even if the patient had a terrible experience, they’re likely feeling better, they’re at home and not in the hospital, and they’ve gotten some distance from the things that might have shaped a negative experience. All of these factors can significantly affect the results of a patient satisfaction survey and not give you an accurate picture of what you need to work on.

Patient satisfaction surveys are compromised by a number of other issues as well: Do patients understand what department(s) they’re rating? Will you get a response rate that yields meaningful results? Will patients who do respond tell you the whole truth in a way that helps you really understand what’s going on?

Remember: what you are really after is to thoroughly understand and take care of your patients’ needs. There has to be a better way not just to evaluate the patient experience but to actually drive real patient satisfaction.

That’s where Lean comes in.

Don’t Cover Dissatisfaction With Coffee And Magazines

Some have truly learned how to make everything they do focused on the patient. To get to the point of truly focusing on the patient, a community hospital culture that empowers staff to adjust to the very human side of the patient is necessary. Lean thinking is the best method of creating that culture. Even if just one person begins to focus on the patient experience with Lean thinking in mind, delivery of care will be made more efficient and drive patient satisfaction up.

As a Lean Coach, I’ve seen that most hospitals I’ve worked with have one or more “Patient Satisfaction Committee(s).” I’ve heard a lot of very logical ideas that came from them. Who couldn’t use a cup of coffee or fresh magazines while you’re waiting? However, my disappointment has been always the unwillingness to watch and see what happens to patients when they come through the door. It takes time to train yourself to walk a mile in your patient’s shoes. A good place to start might be the waiting room experience.

The worst situation I’ve seen was in a community hospital, where a nursing home resident was setting a few feet inside the door waiting unaccompanied for a ride back to a long term care facility. There was a repeated cold blast of winter air coming in the front door that probably wasn’t doing their health any favors. And it lasted for over an hour. When I asked a registration person about her, I was told not to worry; there was someone on the way. While a patient might be slightly more comfortable with that cup of coffee and a good magazine, neither addresses the real issue: that she’s sitting unattended, by a cold door, for a very long time. Which is easier, improving your processes so providing good care doesn’t require a patient to wait, or working on ideas to mask the negative experience?

Becoming a Learner Of The Patient Experience

The most direct description I have of healthcare patient satisfaction is that “staff everywhere does a great job of caring for patients.” Most of the time, I would even describe it as fantastic. I’ve witnessed people go through great personal sacrifice to give rides, get special meals for hospice patients, and show a gifted level of compassion I wasn’t aware was possible. I’ve seen the kindest things done for sleeping patients or their families. The biggest problem I see, however, is that the personal sacrificing is not consistent. Not every staff member seems to show the same level of care and it can even vary by types of patients. For many, it only seems to apply when the patient is in front of them. When they are out of site, it is a whole different story.

  • Follow up phone calls? Why do those when I have other patients to care for?
  • Call lights answered? Maybe someone else has time.
  • A full waiting room is a problem? That just means we’re busy.

To put it in simple terms, most patients get lost if their needs are not obvious. Sometimes they aren’t the type of person who feels comfortable asking a stranger for something or they’re just plain independent (a nice way of saying it). If a patient doesn’t communicate what they need in that few brief minutes while someone’s with them, there are often unmet needs. Isn’t that where the patient satisfaction rubber meets the road?

To even begin to unwrap or understand patient satisfaction, we first have to understand the patient.

  • You have to study them.
  • Observe them.
  • Notice their individuality in order to empathize.
  • Ask a patient what their satisfaction level is while they’re in the hospital, not after they leave.

If you really want to impact the satisfaction ranking, you have to get beyond a superficial evaluation of patient satisfaction. The processes involved in care have to be built to deliver what they need, when they need it. But most importantly, they also have to be processes designed by looking inside the human being in front of you. Again, that’s where Lean comes in.

Creating Value For The Patient = Patient Satisfaction

I was coaching a team at a community hospital through eliminating waste in a pre-surgery process, where we dug into the detail of pre-surgery steps with an eye on what happens to the patient in every phase. Interviews were conducted to understand their chief concerns during the day of their surgery and subsequent hospital stay. One respondent stunned us when asked what her number one concern was. Her one word answer was, “Ginger.” Her dog. What would happen to her beloved pet while she was in the hospital? As an elderly person with no family in the area, this was at the top of her list. It took one very skilled nurse asking the questions to draw this out. One who had practiced putting people at ease enough to get them to express what was going on. It takes a second level of creative skill to take care of unique situations like this and get to the heart of what a patient needs. Some people have learned how to put the care in caregiver.

When a staff member finds their unique way to connect with patients, it is a thing of beauty. Patients respond when a clinician or staff member steps outside of him or herself and puts themselves in the patients’ shoes. If a culture is built around the patient, this behavior becomes the norm.

If given the proper consideration and application, Lean is one of the greatest catalysts there is to improve patient satisfaction. It is all about creating value for the patient. The primary purpose of most Lean activity and focus is to laser in on what the patient needs in every step of their healing journey. That’s where true patient satisfaction is born.

Learn Lean To Improve Patient Satisfaction

Do you want a new approach to taking on the challenge of improving patient satisfaction? Look at every patient encounter through a “Lean Lens”. This helps you zero in on value to the patient. Steps to help you focus:

  • Learn how to apply the A3 method to frame your efforts
  • Learn what waste vs. value is for your patient
  • Learn to visualize what is happening to your patient through the construction of a Value Stream Map

The use of the word “learn” in each statement is intentional. To get at the heart of patient satisfaction, you have to learn as much as you can about your patients. In the process, you will discover what’s truly important to them. Using Lean methods to uncover the layers of patient complexity that influences your satisfaction scores is a proven approach. A new approach will yield new results.

What Lean Healthcare Really Is And How To Get Started In Your Hospital


Jim Tufts | Leadership Solutions Team Lead

Jim, along with the Leadership Solutions team, leads, guides healthcare providers, in user education, consulting, process improvement, disaster recovery planning, strategic IT planning and more. Jim is the author of the whitepaper, “Guide to the HIPAA Security Rule,” and is often found in healthcare association meetings, national conferences, or in a healthcare board room educating on protecting electronic patient health information.