What is Total Quality of Encounter–TQE?

Better to remain silent and be thought a fool than to speak out and remove all doubt—Abraham Lincoln.

I have the right to remain silent, but at times I seem to lack the ability—Ron White.

Today I am opting to follow Ron’s path, shall we see where it leads us?

I just finished reading the two pieces in the patient experience field that many would feel to be the loadstars on the topic.  One is from on online media publication; the other comes from what many would consider to be the ‘go-to’ consulting firm in the space.

I reread both pieces looking for the part where they tell hospitals how to increase patient satisfaction. I concluded that reading them a third time would not get me what I hoped.  Chances are that if your organization is trying to improve the patient experience someone in it has read at least one of the pieces.

So, shall we toss some metaphorical tomatoes at the monitor?

Every right minded patient knows that their visit to the hospital will at various times have things done for them that will be painful, humbling, humiliating, embarrassing, and frightening.  Patients have the expectation that their clinical experience will be all of these things. Patients may be smarter than we give them credit for being. 

Like it or not, they know their time in the hospital will not be fun.  Patients know they will encounter these feelings regardless of which hospital they choose.  What I mean by that is that patients are not going to say ‘This is the last time I am going to Our Lady of Perpetual Blunders because it really hurt when they replaced my hip.  When I get my other hip replaced I am going to go Joe’s Feel-Good Hospital.

Patients believe that the hospital’s highly trained medical staff does its very best to provide outstanding care.

The flaw in most patient experience efforts can be tied in part to the fact that patient experience and patient satisfaction need not be the same.  Maybe they are more like twin sons from different mothers.  Is it possible that how patients feel or rate their experience has to do with clinical things, and how they rate their overall satisfaction has to do with the hundreds of other points of contact they had with the hospital?

If that is the case, we are trying to solve a problem containing two unknowns; patient experience and patient satisfaction—something mathematicians will tell you is difficult to accomplish.

Let us use the label TQE to represent the Total Quality of the Encounter.

TQE = Patient Experience + Patient Satisfaction

Patient Experience reflects how the patient feels the hospital performed clinically and Patient Satisfaction reflects how the patient feels the hospital performed regarding nonclinical events.

One part of the TQE equation includes world-class, 2.0 processes.  The other part of the equation may more closely resemble 0.2 processes, processes at which even your cable television operator executes better.

To Improve TQE one must improve the experience and the satisfaction.  Neither single type of improvement meets the test of being both necessary and sufficient.

And here is the kicker.  The patient experience is a summary of different processes for each patient. No two patients undergo the exact same clinical processes.  So improving a given clinical process does not raise all boats, does not improve the hospital’s overall patient experience rating.  Clinical processes have the following characteristics; they are discrete, they relate just to healthcare, and they are not able to be automated.  They are what I call barely repeatable processes, BRPs.

On the other hand, there are dozens of processes, dozens of points of contact that every patient encounters.  Improving one does raise all boats, does improve the hospital’s overall patient satisfaction rating.  Nonclinical  processes have the following characteristics; they affect all or almost all of the patients, they do not relate just to healthcare, and many can be automated.  These are what I call easily repeatable processes, ERPs.

If I wanted to make a big impact on how patients rated the Total Quality of their Encounter, TQE, I would take a hard look at the ERPs.

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