It’s an endless debate – do happy, engaged staff deliver better patient care? Or, does effective, safe care result in happier, more engaged staff?
In a time of enormous financial pressure and staffing shortfalls, there has never been a more important time to debate this critical question.
Cemplicity has been working with healthcare providers for many years, observing the link between staff engagement and patient experiences. At a global level, patient experience ratings have been declining since Covid. Staff shortages and workplace pressures signal to me that a stretched workforce cannot meet patient needs effectively and safely. And, it’s not just about the patients. Care workers who are working in teams with roles not filled have caught the short straw and most will be well aware of the corners they are cutting, just to meet the basic healthcare needs of their patients.
It isn’t enjoyable for staff or patients, nor is it safe.
The link between patient experiences and staff engagement
In an interesting programme we run with a private hospital group of 17 hospitals, there is a direct correlation between each hospital’s patient experience rating and their staff engagement scores. That is, the hospital with the highest patient experience rating has the most engaged staff. The hospital with the lowest patient ratings has the lowest staff engagements scores.
My experience running several businesses has made me a true believer in the importance of creating a positive culture and ensuring team members enjoy coming to work. If our Customer Service executive answers the phone with a smile on his face, it shines through to the caller and helps set the tone for a constructive and helpful outcome. When something goes wrong and we are dealing with an emergency, being able to rely on your team mates to drop everything and help find a resolution is essential. At Cemplicity, our emergencies are followed up with ‘introspectives’ – team huddles that explore why something happened and how we avoid it in the future. These only succeed with a no-blame culture and having a bit of spare, quiet time.
Our clients enjoy working with us, even though things don’t always go to plan.
So many of the hospitals we work with are exceptional at creating these positive work environments. However, others are feeling intense pressure and cannot afford or find the staff to fill empty roles, placing pressure on the remaining teams.
How can digital patient experience and outcome programmes help improve workplace culture and staff engagement when we are faced with these hard issues?
Making the Most of Precious Resources – Less is More
One way to help improve staff culture and engagement is to help them do less. And thus do the important things better and perhaps even do more for patients. Monitoring patient outcomes allows services to adapt to better meet patient needs, which in turn also impacts their experience of care.
In one Cemplicity programme, we are running a combined Patient-Reported Outcome (ePRO) and PREMs across multiple providers of Musculoskeletal (MSK) service. In this work, we systematically gather data on the impact of treatment on different patient cohorts. Why is this important? Because it demonstrates what treatment works as well as what treatment is not leading to improvements in pain and function. This is allowing our clients to reduce some treatments, to look for alternatives and to continue confidently with effective pathways. Another interesting facet is the ability to monitor if shorter periods of active treatment can achieve the same outcomes as longer periods. This reduces the load on clinicians and frees up some time, without impacting patient outcomes.
In another example, Cemplicity is building a statistical analysis technique into our reporting, that allows us to highlight which facets of care are most important to patients, and how well you are performing in these areas. With the simple insight this analysis provides, each team can focus on the most important things, that if improved, will make the biggest difference to their patients.
Both these examples highlight the opportunity to stop doing things that don’t work or that are less important, so that staff can concentrate on the things that work well or that patients tell us are important to them.
And speaking of doing less, to free up staff, don’t forget the streamlined, automated approach that is the hallmark of modern PREMs and PROMs programmes. When you implement a Cemplicity programme, what can you stop doing or do less of? Many of our clients have legacy paper surveying, they may have staff phoning patients after they get home, they may have requirements under accreditation programmes (e.g. JCL) that can be met without extra work. Our programmes may help your clinicians meet their requirements for Continuing Professional Development.
Creating a Positive Culture
Unfortunately, we still meet some healthcare providers who think patient feedback is primarily about complaints! Globally, 8 out of 10 pieces of patient experience feedback we gather is positive. A heartfelt thank you for compassionate care. (Most of the remaining feedback are sensible ideas that can be easily addressed.)
How can you make sure this positive feedback gets back to staff? This is an incredible tool for culture change starting with how your PREMs programme is positioned in your organisation through to the ongoing celebration and promotion of positive feedback.
Tips and tricks that the Cemplicity team designs into our client programmes includes:
- Ensuring the senior client executive takes an active leadership role when the programme is first announced to the staff. It is essential this is viewed as a positive initiative and not a stick to find and beat out bad performance.
- Copywriting in the survey to encourage patients to name staff who went the extra mile, so these people can be thanked.
- Linking positive comments to the organisation website.
- Ensuring regular staff meetings draw positive comments into team discussions.
Overall, our philosophy is to highlight, learn from and emulate high performance.
Easy Wins
One of the most satisfying aspects of asking patients for feedback soon after their healthcare experience are the easy wins. Our programmes impact at a strategic level but at the same time, we need front line staff acting on all the small suggestions that come through.
The role for the Executive leader is to ensure staff members know that they have permission to act and to ensure someone has the time to monitor that things are changing. There are 100s of examples of small suggestions that can be fixed without a lot of time and money, that then helps future patients and reduces interruptions and demands on busy care teams. e.g.
- A patient who experienced a lot of pain having his 2l urine drainage bag replaced on a ward, was given 4l bags in the outpatient clinic and asked why these bags could not be used in the hospital as well.
- People had great difficulty on discharge getting to the car park due to the lack of wheelchairs.
- An elderly woman was left sitting by her bed without adequate clothing for several hours. She could not get back into bed without help, could not reach her call button and no one came to help her. (Incidentally, she gave a high overall experience rating showing how important it is to read comments as well as use ratings.)
These are excellent examples for continuous improvement that will improve patient experiences as well as reduce interruptions for staff and costly, time-consuming complaints and rework.
Automation and Real-Time reporting – a boon for patient experiences and clinician efficiency
One of the fascinating parts of Cemplicity’s work is the link between our outcome work and patient experiences. We all understand the importance of partnership with patients and involving them in decisions about their care. Some of the outcome instruments are designed specifically to enhance shared decision making and to elevate the patient goals for treatment into planning. Traditionally, Patient Experience leaders might not consider the relevance of Patient-Reported Outcome measures (PROMs) to patients’ experiences of care but there is one tool in particular that we feel can have an important role in optimising experiences. This is called the Patient Specific Functional Scale (PSFS), most commonly used in MSK service, but deeply relevant for all patients starting a care journey.
PSFS asks patients to state their main goals for seeking treatment. What does a good outcome look like to each patient that walks through the door? For some it might be to experience no pain. For others it may be about getting back to work quickly or being able to lift a grandchild for a hug.
By automating PSFS and others like this, we reduce the time that staff need to spend with patients when they come into a clinic – more time can be spent on care planning and treatment and less time on administration. We can also give patients more time to consider their goals, rather than use up the precious time in front of the clinician.
In one of our programmes, this approach has enabled clinicians to schedule 1.9 more appointments a day. And, because the patient survey response is reported back in real time, it is available as needed for the first consultation and treatment planning. This is a great example of how streamlining and removing inefficiencies for care teams can also improve patient experiences and outcomes. Overall, a tool like PSFS can help services plan a patient’s journey so that when it’s all over, the patient’s needs have been closely met and the likelihood of an excellent experience of care is high.
Thinking more directly about PREMs, Cemplicity advocate for enabling every single patient through a hospital to provide feedback after treatment. Historically, programmes were designed for paper or phone-based surveying. This led to strict sampling protocols because the costs of postage, paper, data entry and reporting was high. It also meant that patients were not given opportunities to tell their stories or provide open comments. These were too hard to data enter or analyse. And, rarely were surveys available in different languages.
At Cemplicity, we believe inviting every single patient to give feedback is part of their care journey, displaying the health provider’s commitment to partnership. We encourage offering patients the choice of language and ensure there are plenty of opportunities for patients to tell their stories.
Some clients express concern about the volume of feedback this approach leads to. They fear that we’ll place more burden on staff rather than alleviate it.
However, in a well-designed programme, not only do we take administrative burden off staff, we are able to seamlessly surface the compliments and strengths of different teams – those critical ‘thank yous’ that are missed in the usual hubbub of a busy hospital and that are so important if staff are to enjoy coming to work.
Nothing Happens without Leadership
Wrapping this up, the difference between an average programme and a great programme, one that directly impacts staff culture and patient experiences, is leadership.
Our strongest client leaders support our work by creating the culture where success is celebrated and resource is available to systematically act on the small wins.
A high impact PREMs programme is achieved when it is introduced as a positive tool for change. The metrics need to form part of the regular organisational scorecard, with a particular focus on high performance. Every team should be incorporating patient feedback in their day-to-day jobs and team meetings.
Cemplicity actively supports our clients to achieve this throughout the life of your programme but we really shine when the senior executives actively sponsor our work and understand the direct connection between culture and experiences.