Defining Patient Experience: (noun), see Snowplow

The temperature showing on the car’s digital display in the garage was thirty-two degrees.  Two minutes after exiting the garage the temperature displayed was zero.  The weatherperson on NPR stated the actual temperature was minus four with a wind-chill of minus seventeen.  NPR also reported that the lowest attainable temperature is somewhere around minus four hundred and sixty degrees, a point at which molecules no longer move—apparently it is the movement of molecules which create heat.

Zero or minus four, I was still some four hundred and fifty-six degrees away from absolute zero, so at least I had that going for me.  The sound made by my car’s contracting metal and glass was that of too-thin ice cracking on a frozen lake.  Regardless of which temperature reading was accurate, the takeaway was that it was cold.

It bugs me when things are named something but the name is either inappropriate or gives the impression of being something it is not.  Snowplow is one of those things.  A plow is something that tills the earth, turns it inside out.  What was on top is now on the bottom and vice-versa.  A snowplow does not do that to snow, it pushes the snow away.  I’m thinking it should be relabeled as a snow bulldozer. 

The car’s thermometer was programmed to display degrees from zero to some upper, unknown limit.  It was not programmed to display negative numbers.  On most days, if I told the person next to me the outside temperature, I would be reporting accurate information.  I would not be guilty of only reporting a generalization of the temperature, something like ‘it’s really cold.’

We do that with how we measure and report patient experience.  We do it with precision, precision gleaned from data we purchase.  We state with certainty that our patient experience is 7.23 on a scale from one to ten.  That is like saying it is fifty-nine degrees on a similar scale.

The number loses value unless one has something with which to compare it.  Yesterday morning it was fifty-nine, and twenty four hours later it was minus four.  Where we live fifty-nine is an anomaly for January, but then again, so is minus four.  But if your measurement tool stops at zero it is fair to say that the tool is flawed.

In the same way that there are temperatures that my car was not measuring, there are patient experiences that HCHAPs is not measuring.  In fact, there are significantly more experiences that are not being measured.

We measure, report, and design our experience improvement efforts on:

  • thirty percent of inpatients
  • zero percent of inpatient experiences before they enter the hospital and after they leave it
  • zero percent of outpatients
  • zero percent of prospective patients, visitors, and family members

So, if you are reporting how your organization is doing regarding patient experience, how valid is it to stand before the operating committee or the board and report that your organization scored a 7.23?  The only value of that number comes from where it places your hospital on the continuum of the scores of all of the other hospitals.  It tells you whether your hospital will be penalized.

This is worth restating.  Your score is only a measure of whether your organization will be penalized.  It also helps you understand how far away your hospital is from either getting out of the penalty box or from falling into it.

Your score is not a measure of patient experience.  In order to report patient experience you would have to measure all of the components of patient experience, something hospitals are not doing.  In order to measure someone’s experience you would have to ask them and observe them having those experiences.  What was your experience the last time you called to schedule an appointment?  Were you able to get help about filing a claim by using your iPad?

Patient Experience.  Using the current vernacular of the term, if I looked it up in the dictionary I would expect to see the following:

Patient Experience: (noun), see Snowplow

A remarkable experience for every person every time on every device.

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