Improving the Experience of Care: “The Secret”

Robert Frost’s poem "The Secret Sits" is two simple lines of poetry, a couplet:

"We dance round in a ring and suppose,
But the Secret sits in the middle and knows."

The meaning is left up to the reader. In healthcare, the "Secret" is the person at the center of care. The patient, their family, and their caregivers. They sit in the middle and they know, they just don’t have effective ways of sharing what they know or want, and healthcare is not very good at listening and responding accordingly.

During a recent conversation with a client hospital executive, she shared some findings that shine a light on this disconnect between what patients want and what leaders think patients want.

When she asked her leadership peers to list the priorities to improve the experience of care, they said:

  • New facilities
  • Quiet-time to ensure rest
  • Private rooms
  • Food on demand
  • Interactive bedside computers
  • Eliminate visiting hour restrictions

When the patients of her organization were asked to list the priorities they sought in order to improve the experience of care they receive, they responded:

  • Treat me with more respect
  • Communicate better between each other
  • Listen to my needs / requests / concerns
  • Be more happy
  • Show more empathy

Are you surprised?

The reasons behind this disconnect run deep. For many hospitals, clinics, and doctors’ offices the methodology for capturing the voice of the patient (the data) is broken, the tools are clumsy, and what leaders are doing with the data is not resonating, not effecting change, and not very sophisticated.

If I ran a restaurant in a like manner, it would go something like:

You’re served a cold tasteless entrée, on the menu as a ‘hot delicious special’. You have no opportunity to share your feedback with your server; they’re too busy with other patrons, appear far from approachable, and don’t ask you whether this is what you thought you ordered. When you do muster the courage to say something you’re told that you’ll receive a survey in the mail, and you can provide your feedback there.

Several weeks later the survey arrives in your mail box. You try and remember the meal you’re being asked about and reality kicks in; you’re likely remembering one or two experiences blended together, or you’re still so upset about the meal that you just let the restaurant have it…

The restaurant owner and manager receive the survey, identify the waiter and ask him or her to improve their service…

Without weaving this analogy further, you get the idea, oh and by the way, my restaurant would quickly go out of business if this was how I responded/reacted to such service failures.

The signal, response and desired change feel like they are all disconnected. This is how many hospitals currently "measure" the experience of care, this is the data they use to reward and recognize, and this is the data that they use to "drive change".

What’s missing is an effective system for better capture of operations data. We need practices that capture feedback as close to real time as possible and that use this information to inform operations. The data should be used to inform where training and education is needed to close the gap between the current state and desired state.

Are you listening to "the secret" or dancing around the ring?

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