Embedding "the voice of the patient" is an aspiration many healthcare organizations hold, yet one that most find challenging to operationalize.
Some, like Massachusetts-based Cambridge Health Alliance, engage patient advocates in quality improvement committees.
The global pharmaceutical giant Merck built partnerships with patient-oriented websites like PatientsLikeMe and Smart Patients to better understand patients’ experiences with disease and treatment.
And many healthcare delivery organizations partner with survey research firms to capture measures of patient satisfaction.
However, a challenge with each of these approaches is that patient perspectives are filtered through the medium in which they are delivered.
Patient voices on committees or patient-oriented websites often bias towards patients with particularly striking experiences or who are invested in achieving a particular outcome. While these outlier voices are important, they may not always be representative of the broader patient-base served.
Survey research can be very revealing, but it is often highly filtered when it is presented more broadly and can fail to provide necessary texture to drive decision-making.
How can healthcare organizations ensure that authentic patient voices permeate decision-making and strategy? How can they build genuine connections between their leaders and the patients they serve? Importantly, how can they truly gain a competitive advantage from insights achieved through engaging patients?
As leader of the CareMore Health System, an integrated health plan and delivery system, I have struggled with these issue as we have grown from 2 clinical care centers in Southern California in 2006 to 55 in 8 states in 2017.
The patient voice has been an important part of the "CareMore story" since its founding, however, we have only recently taken steps to formally operationalize it within our culture.
Over the past 2 years, we have implemented 5 approaches to make the patient voice real within our organization:
Make Senior Leadership Accessible to All Patients
My predecessor as CareMore's president, Leeba Lessin, communicated regularly with CareMore patients. She established relationships with patients through her deep ties to the community in which CareMore was founded; her decade long tenure as an organizational leader; and her commitment to staying connected with patients who experienced our service. She often spoke of the feedback she received from patients in meetings--and the patient voice often informed her decision-making.
Being relatively new to CareMore in 2016--and without pre-existing ties to our patients and the communities we serve--one of my first actions as CareMore's leader was to share my (actual) email address and office phone number in a letter to all of our 100,000 health plan members--and to regularly include this information in all of my subsequent written communications with our patients.
This direct line to patients helped surface key operational challenges we faced as organization. As an example, one of our patients “KJ” voiced a complaint about having requested her laboratory results, but not having received a call-back.
That message triggered further inquiry and the realization that we needed better processes to track and manage in-bound requests from our patients that we have since implemented.
One might expect that we would be overwhelmed by patient contact, however, patients were highly respectful of only emailing or calling me to express very strong positive or negative opinions, or engaging when they genuinely needed help problem-solving an issue.
This approach has also helped to identify true sources of delight for our patients--usually an outstanding employee who had gone above-and-beyond for a member.
As an example, I recently received a message from San Jose, CA patient “RP” who wanted to recognize his dietician, Nicole: "She is just great. She is patient and endeavors to answer any question put to her. If she does not know the answer she will say so but always offers to find out and call you back." This type of direct feedback enabled the organization to recognize Nicole for her great work.
Last fall, we had significantly lower than projected dis-enrollment rates from our health plans, which could be due in part to our greater personal connection with our patients.
Proactively Engage Patients in Informal Settings
Patients may experience difficulty sharing candid feedback about the organization in clinical settings where they receive care.
They worry that sharing feedback may generate resentment and backlash on the part of staff. As a result, they often remain silent in clinical settings when they have ideas on how to improve quality or service.
We have implemented monthly "member luncheons" at a local restaurant where a randomly selected group of patients can share their ideas and perspectives on how to improve care.
These luncheons feature a rotation of CareMore leaders who are present to hear ideas and feedback about patient care.
At these luncheons, patients are invited to share 1) a personal introduction and the length of their relationship with CareMore; 2) their positive experiences with our organization; and 3) how we can serve them better.
These luncheons expose CareMore leadership to the real challenges patients face in accessing care and give us a real-time opportunity to problem-solve. Ideas shared at these luncheons can feed into quality improvement ideas and methodologies.
At one luncheon, several members discussed their concerns regarding the quality of dental services from some of our contracted dental providers in the community.
This discussion prompted us to re-examine our dental care strategy and launch a new dentistry model integrating dental and chronic disease care in our Montebello, California-based care center that aims to address many of the problems that were surfaced. We have also made changes to our dental network in all markets and focused it on a smaller number of higher quality dentists.
At another luncheon, a member described problems she faced affording her prescribed medicines. Members of our CareMore pharmacy team worked with her and her physician to ensure she had had a regimen in place that she could afford.
Require Non-Patient Facing Organizational Leaders to Connect with Patients Regularly
To ensure that all of CareMore's senior leaders remain connected to our patients/members, we implemented a new requirement that all staff at the "Director" level and above connect monthly with randomly selected patients by outbound phone calls, outside the context of that patient receiving care.
Leaders have been given scripts that aim to identify sources of satisfaction and dissatisfaction among our patients and were also given instructions on how to proceed to resolve and address the issues that were raised.
Patients have responded with feedback like "CareMore saved my life." One operations leader remarked that feedback like this "helps me feel connected to the mission of the company."
One finance leader remarked that he “ordinarily wouldn't feel comfortable doing something like this, but I really enjoyed it because I felt like I could really help someone."
Most patients who have received calls have been satisfied with the organization, but some were unsure about how to solve specific problems, e.g., getting a new walker, or obtaining a smaller oxygen tank. One Las Vegas member voiced displeasure with some of our health plan co-pay structures that we are now using to re-evaluate our benefit-design in that market.
Patient feedback is helping us to shape communications, as well as giving us an opportunity to solve specific issues as they arise.
Additionally, CareMore recently launched its Togetherness Program that involves regular telephonic outreach to 1400 CareMore members who have self-identified as being lonely or socially isolated. We have solicited volunteers from all our employees, and over 160 employees—more than 10 percent of our workforce—have volunteered to adopt a member as part of the program. These calls are another medium through which a broad group of associates is listening for says to better serve our patients.
Explicitly Use Patient Input to Drive Program Design
Perhaps the most powerful way to reinforce the voice of the patient is to explicitly drive patient input into program design.
One example of how we have done this has been the redesign of our transportation services.
Throughout most of its 25-year history, CareMore has provided transportation for patients to their medical appointments.
It has been both one of our greatest sources of distinction and disappointment, as patients appreciate the service, but are frequently critical of the wait times for return transportation from medical appointments to their home.
On-time within the non-emergency medical transportation industry is within one-hour of when a ride has been requested.
As we learned from our patients, this timeframe can feel like an eternity of waiting following a long medical appointment.
We drove this feedback into a first-of-its-kind partnership with the ride-sharing company Lyft to use ride-sharing to more rapidly transport patients to and from their medical appointments.
The implementation of this program was not without its own challenges--and we worked with patients to understand their issues transitioning from traditional transportation companies to ride-sharing services. We implemented senior-sensitivity training for area Lyft drivers--and were able to maintain high levels of satisfaction and meaningfully reduce wait times for our patients.
There are few more powerful ways to express a commitment to the patient than using their feedback to design and implement new programs.
Tell Patient Stories Often
CareMore leaders are very deliberate about sharing any stories of patient impact within the markets we serve, as well as company-wide.
Associates at all levels value hearing how their work is translating into better care for patients.
Anytime CareMore leaders receive a patient story by mail or email, we are very deliberate about clearing it of patient identifiable information to ensure patient privacy and then including it in the company newsletter or forwarding it with a message to the all employees list-serve.
In addition, leaders frequently begin or end company meetings by talking about patient feedback or sharing a positive or negative patient story.
There is an almost insatiable appetite for connection to the voice of the patient.
Conclusion
The voice of the patient is critical for 1) surfacing opportunities to improve care and service; 2) keeping leaders engaged with how services are affecting patients and the front lines of care delivery; and 3) informing future strategic direction.
As competition in healthcare becomes more intense, organizations that truly embrace the patient voice will win.
At least that’s the bet we’ve made at CareMore.
