4 Tips for Deciding Your Patient Experience Survey Themes

How do you decide what to ask in your Patient Experience survey, when it could be anything and everything?

Here are a few things to keep in mind:

  1. Your patients have physical, emotional and personal needs and often rely on support from caregivers. Capture enough of your patients’ need areas and don’t forget to measure caregiver thoughts.
  2. Your purpose or how you’re going to use your measurement outcomes. Ensure that you are able to relate outcomes to your KPIs.
  3. If you’re thinking about benchmarking, keep your questions aligned with best practice and make sure your sample is representative of the patient demographics that come through your door.
  4. If you want richer insights into patient experience or stories to alert or encourage staff, then identify what patients feel are the most important aspects in their experience of your healthcare setting, and seek specific information around that.

We looked at outcomes from a 2009 research report by The Kings Fund around patient ratings of aspects of inpatient care, and, a recent 2015 report by Deloitte that looked at the patient experience link to profitability. Here are our observations:


The Picker Institute (Europe) also identified that, how nurses and doctors interact with patients was a key determinant of overall satisfaction with care; and in particular, how coordinated their efforts were and whether they treated patients with dignity and respect.

Here are *14 key patient experience themes that healthcare settings use in their surveys, in a quest to measure the ‘right’ things:

Communication with doctors and nurses Confidence and trust in health professionals
Compassion and empathy Involvement in treatment decisions
Responsiveness of hospital staff Coordination and Integration
Emotional support – relieving fear and anxiety Being treated with dignity and respect
Involvement of family and friends Pain management
Cleanliness Quietness
Discharge processes Post-discharge

So start here. Start right. And you’ll be well on your way to getting impactful outcomes.



*based on HCAHPS (US), Picker (Europe) and NHS (UK) domains

Core Domains for Measuring Inpatient Experience of Care 2009 – The Picker Institute Europe

Patient Engagement and Their experience: The Virtual Touchpoint, 2012 – Tower Group Whitepaper

The Value of Patient Experience 2016 – Deloitte Report

The Point of Care Measures of patients’ experience in hospital: purpose, methods and uses, The Kings Fund 2009

‘E-Framing the Patient Journey’

Based on a True journey.

A friend, on holiday in Christchurch, broke her toe. Luckily, it was her fourth toe. Unluckily, her companions were one high-maintenance 4 year old and two suitcases. It was, bluntly, crap timing. Hobbling about, she headed to a clinic.

After a long wait, the nurse was brisk. Her toe was examined and it was explained to her that she would only get an x-ray if the doctor deemed it necessary. It was also explained that the reason for this is that the treatment would be the same whether or not the toe was fractured.

Waiting room number 2.

The doctor greeted her but faltered at her name. No, she didn’t have one of those long unpronounceable Indian names; it was just misspelled on the system.

The doctor laughed and shook his head, apologizing for his frontline team.  ‘Sorry. Kiwis can’t spell. My wife is a Kiwi, she’s terrible at it.’

‘I know!’ my friend agreed, quipping, ‘Spelling is the only time I feel like I don’t fit in as a Kiwi!’ Laughter and chatter ensued.

He got down to business, examined her toe, and ordered an x-ray. He reiterated what the nurse said about the treatment being the same either way.

Waiting room number 3.

It took 3 tries before the radiographer could locate the injury, and identified as being on the distal end (top part) of the fourth toe.

Waiting room number 4.

Fracture confirmed, the doctor asked about her activities over the next few days, whether she wanted her toe braced or strapped up for more comfort, and offered her crutches. Instructed to raise her feet while sitting and take painkillers when necessary, she thanked the doctor and left the clinic.

Let’s look at this patient journey through the lens of our 6E Framework:

This was a simple journey, yet one that could be measured.

There were parts of the Experience that were long and potentially frustrating (waiting times) and parts that had alignment and clarity e.g. the initial nurse assessment, the first consultation and differential diagnosis by the doctor, the confirmatory radiological investigation and then the final diagnosis and management plan by the doctor.

There would have been Emotions associated with waiting times and administrative mistakes (data entry errors), but there was humour and there was reassurance. The doctor displayed Energy in his engagement – he conveyed empathy with the patient, and communicated the treatment plan well, he knew his purpose and seemed personally satisfied with his work.

There was sufficient time spent in Execution (radiographer’s persistence with protocol and multi-disciplinary assessment (alignment of nurse’s communication with the doctor’s treatment).

My friend walked away from the clinic, satisfied. She felt like an individual. She connected, in a human way, with the doctor. She could see the team (nurse, doctor, radiographer) all working toward her diagnosis. As a result of their excellence, she wasn’t very frustrated with the four (!) waiting times, her misspelled name nor the pain she came in with.

In this case, as in many others, Excellence was defined by the patient, not simply by the providers.

In fact, I don’t think she cared to remember any lack in the clinic’s systems.

To her, the patient experience trumped the patient process. Herein lies the potential for Evolution in the patient journey.

To find out more about the 6 E framework for improving the Patient Experience, feel free to drop me a line.


It’s Not What You Think About Them. It’s How They Feel About You.

Walk into a healthcare boardroom and you’ll find C-suite managers poring over hard data reports, analytics that tell them that, mostly, all patients are happy with them, all KPIs have been achieved. Shimmy up to the nurse manager on duty, and you’ll find out that she’s weary but yay, three patients have been discharged (including the one with the demanding hubby), so it’s all good. Take the lift down to reception, and they’ll tell you different tales of woe and wonder. Why don’t these stories always align? After all, there is a myriad of measurement taking place – statistical data, patient surveys, focus groups, patient emails, improved processes and tools….

Creating a true, holistic picture of the patient experience is challenging. The disparate pieces of research that take place in a healthcare setting don’t always fit together or come together. Staff are listening to differing views, reading contradictory reports and acting on different outcomes and priorities. Indeed, in a 2015 patient experience survey of 1561 respondents from healthcare settings in over 21 countries, less than half had actually formally defined patient experience for their organisation (Beryl Institute).

Our 6E Framework aims to improve patient experience by offering healthcare settings a step-by-step guide on how to produce this true holistic picture. It not only gets you thinking about mapping the patient journey and uniting the disparate pieces of data that is collected throughout your setting on this ‘journey’ (EXPERIENCE), but it ensures the encapsulation of ‘patient stories’ and patient feelings (EMOTIONS) to build one clear purpose for all staff to follow (ENERGY) in improving the patient journey. It helps you develop an accurate strategic plan and implement solutions (EXECUTION) and ensures you measure and repeat your successes (EXCELLENCE). Ultimately, the framework develops your organisational capability in patient experience (EVOLUTION).

The Hertfordshire Partnership University NHS Foundation Trust and Leeds Community Healthcare NHS Trust are examples of healthcare organisations that benefited from sound advice with improving their patient experience:

  • Response rates quadrupled, covering more age, gender and ethnicity groups.
  • Solid mapping and measurement of patient journey elements allowed for immediate implementable strategies – many as simple as the need to disseminate more information or provide further explanation to patients – to address concerns and issues.
  • When the patient experience measurement was repeated within the same year, the level of patient satisfaction had significantly increased – doubled and tripled in some cases!
  • In the Hertfordshire case, in some wards, 100% respondents felt listened to (up from 54%).

Patient Journeys. Emotions. A Team Living Its Purpose.

For some, these are soft, soppy, intangible metrics to measure. But for those in the industry of caring, there’s no denying its culture-changing results at the front-line.

Election Policies Need to Put Patients First

The Australian Federal Elections are drawing near. The Conservatives and the Labour Party are once again pitching their wares – fighting it out on who has the best health policy. Amongst the spouted sales spiel and all its nation-centric statistical data, the patient’s (what the policies are/should be ultimately all about) voice is lost.

A recently released book on ‘Patient-Provider Communication’ (Blackstone, Beukelman and Yorkston, April 2015), noted ‘that patients, health care providers, policy makers, and researchers live in nearly parallel universes with differing incentives, access to data and information, accountability expectations, and time frames for action’. What this alludes to is the potential for differing visions in patient healthcare, experiences and communications – resulting in a potentially disparate state of affairs.

What if patient experiences were given a larger focus in the formation of national health policies? How much more refined would policies be? Undoubtedly, communication between patients and their clinicians/hospital management will have more prominence in local and national policies. And from high-level policy to on-the-ground realities, issues like how to better communicate with the patient over things like a treatment or healthcare plan would get the attention it so rightfully deserves.

In my recent trip to the Beryl Institute Conference in Dallas, I had the good fortune of meeting with Dr. Tom Scaletta and Julie Danker – who lead patient experience initiatives at the Edward-Elmhurst Hospital – and found out how they manage patient communications. Regarded as one of the leaders in this space with their G.R.E.A.T. coaching techniques, they imparted practical insight into communication and engagement techniques that can help patients and clinicians.

Here are some key takeaways from them:

  • Contact patients the day after ED discharge – it keeps them safe and satisfied
  • Engage patients digitally – it reduces cost and increases reach
  • Automate work processes – it allows charge nurses and case managers to efficiently intervene at the right points in the workflow process
  • Build in an automated response mechanism/module into your systems – it allows for the acknowledgement of compliments and resolution of complaints by ED leaders
  • Measure, measure, measure – use statistically-valid metrics and patient comments to drive provider performance. We can always keep improving.

If you want to know more, watch the video below from our Patient Experience Channel (or check out www.eehealth.org/great)

The day “patient-centred care” became a reality in Australia

Energesse, one of Australia’s leading healthcare IT consultancies, will be unveiling the first  patient feedback technology to measure patient emotions.  The MES Experience platform has transformed the NHS, and Energesse is bringing the technology to the exhibition after trialling it with one of Australia’s largest hospital districts for the past 18 months.

Dr Avnesh Ratnanesan from Energesse, together with the director of MES from London, Nick Goodman, will be showcasing the technology on stage in the Healthcare Innovation Zone at 3.40pm on 15th March.

The MES Experience technology is a multichannel platform for collecting patient experience and satisfaction data at point-of-care, and reports meaningful analytics for managers. This technology has the potential to truly enable patient-centred care in Australia by producing quantitative data on the emotional aspects of patient opinion in real-time. For the first time, health services will be able to monitor and adjust patient care according to the current situation.

If you are attending the conference, please do come and witness the debut of MES Experience software platform on stage in the Exhibition Centre. Free passes to the Expo can be obtained here, if you have not registered on any events yet.  Thanks and we look forward to seeing you on the 15th!


Executive Guide: 16 Insights Executives Miss in their Customer Data

As both the corporate and healthcare worlds get increasingly consumed with data and analytics, there are many preventable mistakes and lost opportunities that executives experience when determining everyday decisions about their customers or patients. A common scenario is when managers make ‘improvements’ to a product or service, only to find later that their new changes resulted in financial losses, and they don’t really understand WHY.

Often this is due to a lack of developing a deep understanding of customer insights from their own data or research. Commonly, what executives BELIEVE they know about their customers or patients, is largely at a superficial level. In fact, they often ‘don’t know what they don’t know’, and conscious or subconsciously refuse to acknowledge their lack of awareness of customer behaviour. Immature data management leads to a vicious cycle of poor executive decision making.Immature customer data management leads to poor business

The proof of ineffective management decisions lies in the results such as poor customer or patient engagement, low sales volume or high numbers of patient complaints. Mostly these executives also only act when its too late, because they are not fully aware of the ‘preventative’ solutions available to them.

The real tragedy is that customer data is often readily available within an organisation’s own databases and data centers. However, many executives simply don’t know where their data is kept, who to get it from and how to connect the pieces strategically to solve everyday problems. The common excuses are:

16 insights bubbles

Failure to utilise data effectively often translates into poor return on investment on staff time, budgets and resources. On an individual level, executives are penalised, reprimanded or even fired for underperforming and making costly mistakes that they should have picked up on. On an organisational level, it also leads to inability to solve problems or transform outdated business and care models – the lag indicator is when the Chief Financial Officer starts complaining about an unhealthy bottom line.

In our busy worlds, we are inundated with multiple channels of data and information from customer feedback, patient surveys, focus groups, social media posts, emails, website forms, call centers, mobile chat, etc. Many executives don’t know how to effectively make sense of all these valuable data sources particularly with the quantity, speed and variety at which data is coming at us.

In these more demanding environments where customer and patient expectations are greater than ever, what’s often missing is the ability to translate all the data ‘noise’ into meaningful insights and wisdom that changes executive decisions, actions and improve results. It’s often tricky to see the ‘wood from the trees’, particularly when an executive has been in a role for over a year.

Here are 16 of the common mistakes we’ve seen executives, even experienced senior managers, make over and over again. Can you relate to any of them?


Data Gathering

1.  We’ve found that most organisations vastly underutilise their existing data. Reasons for this can be lack of technical expertise, lack of awareness of available insights tools and methodologies or lack of time and money. Conversely, many executives spend excessive amounts of time and money implementing poorly researched projects or solutions, which could be greatly enhanced by utilising data and insights currently available.

2.  There is often confusion that more volume of data = better insights. Whilst this can be the case, deep insights come from a combined analysis of quantitative and qualitative data focused on the solving a specific problem. In the current era of ‘big data’, higher volumes provide greater accuracy and new insights, but they can also cause more confusion if the right filters are not applied.

3.  For those that are more data-savvy, there is a heavy reliance on ‘hard’ quantitative data to measure performance. However, in our interviews with leading CEO’s, many are starting to understand that measuring ‘soft’ KPI data measures like culture, compassion, staff attitude and customer frustration provide much better lead indicators to problems like patient complaints, high staff turnover and poor customer retention.

Data Analysis

4. Once datasets and data sources have been aggregated and are easy to access, some executives think “its now time for the data to tell us what to do!” That’s an incorrect way to think about data; its far more effective to think “What are our major business problems or current priorities that we can now use this data to help solve”. This initial approach may then uncover unexpected trends.

5. Actually speaking to customers and patients also = data! Stories and text verbatim from face-to-face meetings, observations, and long answers in surveys are goldmines for WHY problems keep recurring. Whilst such anecdotal data shouldn’t be generalised, it also shouldn’t be ignored completely. These case studies are often the key insights to innovation and improving products and services

6. Executives often do not dig deep into the emotional analysis and root cause of customer frustrations and delights; they often deal with problems at a superficial level and implement quick, superficial solutions. As we move into an era of better understanding of human behaviour, deep emotional analysis of customer and patient experience is fundamental to transforming processes and systems.

7. Once data is organised, they should be used to inform an organisation’s measures of success and how incentives are allocated. However, it’s important to understand which data points are most appropriate for a measure, and that they are collected in a consistent fashion over time.

8. Some executives often extrapolate general industry behavioural data to its own customers – and implement solutions because “everybody else in the industry is doing it”. Customer segments can behave very differently e.g. Gen Y purchasers of health insurance have significantly different expectations to Baby Boomers. A mass-approach loyalty program may only be partially effective, without deep customer understanding.

9. It’s important to integrate perspectives (datasets) from multiple stakeholders to make the best decisions. Relying on purely on senior management instinct or front line staff feedback, may not give you accurate picture of what your customers/ patients think and feel (and vice versa).

10. When it comes to gathering qualitative data (from surveys, etc), many executives either ask the wrong questions or ask the right questions in the wrong way. The emphasis is often on closed questions or Likert scale responses, which are simple to analyse, rather than open questions with rich experiential information from customer narrative or verbatim patient responses.

Data Management

11. Understanding security requirements for how data should be collected, shared and stored is a speciality in itself and most executives do not understand these aspects at all. Many do not really want to either. This is often the realm of the IT and Legal departments and even then it is a highly specialised space requiring specific knowledge of the organisation’s data security protocols. When in doubt – delegate (or outsource) to trusted experts, especially with regard to data security and compliance.

12. Privacy is a related issue – it is important to understand the privacy policy for your organisation. However, privacy can often also be used as an excuse for not sharing information on customers with third parties. This can ultimately lead to resistance to progress, especially when executives are trying to improve a whole customer journey. When deciding on which data to share, it is best to think about what is the ‘highest good’ for customers/patients or no. 1 objective of the organisation. With that principle in mind, one can determine how to best filter, cut and use the data to serve that purpose, within ethical business boundaries.

Actioning Data-Driven Decisions

13. When it comes to decision-making, the process of prioritising solutions to a problem can often be based on subjective insights expressed in a management meeting (e.g. loudest voice, length of tenure, organisational politics, who plays golf with the boss, etc). These decisions may ignore objective feedback from key stakeholders such as customers. This often hurts organisations when they have to look back and try to rationalise why things were done, without any evidence to back the decision.

14. Human beings are obsessed with predicting the future, and things are no different with data. Predictive analysis of data is helping many organisations make big strategic decisions such as ‘which new market do we do diversify into’ as well as tactical decisions such as ‘how to best deploy a new machine asset in our diagnostics area’. However, organisations need to build up to this capability and it is no sense having predictive capabilities if basic operations and customer service are not performing well. Basic operational performance is influenced by how culturally accustomed staff are at using data in their decision-making. This is a capability that can be nurtured over time.

15. Remember, that having valuable insights from your data is are critical starting points in a change journey, and one that need to fundamentally improve in the healthcare industry. Nonetheless, there is no substitute for courageous leadership and sound judgement that comes from experience, and knowing when to ‘believe’ there is adequate data and insights at hand to make a timely decision, and when to look for more information before making one. This is where it is important to be guided by a big picture, holistic view of the organisation and account for other problems or strategic priorities that can influence a final decision.

16. To keep up with the pace of change, health organisations need their data collection, analysis, and decision-making processes to be systemised in order to be effective over the long term. Obtaining useful insights from data is a better start, but having skilled, trained people to take the right actions is absolutely critical.

If you are experiencing challenges with data or would like to have a conversation with us about your business priorities, please contact us. I’d be happy to answer your questions or explore how we may be able to help you use your data to solve your healthcare or business issue.

Health Insurance customer retention – Constructive feedback from our readers

Since the release of our Health Insurance Customer Experience White Paper, we’ve had thought-provoking engagement from health insurance providers, aggregators and customers. These insights uncovered more ‘devil in the detail’ to complement the comprehensive knowledge base in the White Paper.

In terms of observations with customer retention, several funds have had to introduce policies with exclusions, sub-limits and changes to the limits due in order to lower prices and make them more affordable. However, when customers find out later that these changes did not meet their initial expectations and then leave, these products can then become commercially unsustainable and unprofitable over time. This leads insurers to implement more restrictive changes which can further reinforce the ongoing vicious cycle of poorer customer retention.

Customer retention can also be linked to staff retention, particularly on the front line. In Australia, one of the reasons for this is because new staff are recruited into call centre’s particularly during the peak periods of March and June. This is where policy sales increase due to annual price rises and the end of financial year respectively (so tax benefits can be claimed). These new sales staff may not be as well trained on product knowledge or company procedures compared to the usual staff and may provide information that is inaccurate or incomplete.

During this period, the quality of interaction and customer understanding from the call centre may decline and policy sales that occur may be due to aggressive marketing strategies. This is exacerbated by incentives and pressure on front-line sales staff to meet sales targets during a short period of time. It can therefore result in sales of health insurance products that don’t necessarily meet the needs of customers.

There have also been observations on aggregator funds that sell health insurance products on behalf of health insurance funds. To differentiate themselves, these aggregators aim to spend a significant amount of time with customers to understand their real needs and position policies that better suit their needs out of a broader selection. However, they too can sometimes be influenced by policies with the best incentives.

A key issue can occur once a customer has signed up with the aggregator, and their details then have to be handed over to the health insurance fund. This follow up process may occasionally be disjointed. It can result in the customer’s ‘old’ fund continuing to deduct monthly payments while the new fund (that the customer has just switched to) has also begun to deduct payments. Many of these handovers can be messy and as a result cause a lot of customer dissatisfaction and complaints because it relies on coordination between entirely different organisations.

In some cases, this coordination may be seamless, but in others there are competitive reasons why this coordination may be challenging for the customer. This is when the old funds ‘win-back’ teams are not alerted to contact the customer and try and win back the customer that’s looking to change. Although there are regulations to prevent any inappropriate actions from occurring, however there are nuances that allow funds to utilize a variety of different tactics when it comes to trying to retain that customer.

Ultimately, behavior that ends up frustrating customers will cost either the aggregator or the health fund in the short, medium, or long-term, by departure of that customer. Insurers should decide what is in the best interest of the customers when making these decisions before creating solutions or changes to the process.

If you’d like to learn more on ways to empower consumers and improve experience in the health journey, join us in Melbourne for a  breakfast event called Building a Sustainable, Patient-Centred Healthcare System on Oct 30, 2015, 7.30 AM to 10.30 AM (AEST).  Download the brochure here.  Our breakfast event in Sydney was a great success, so if you happen to be in Melbourne, please join us if you are available, and feel free to pass on this invitation to your colleagues in healthcare. Click here to REGISTER

Many thanks to our readers who contributed their knowledge to this article – but who did not wish to be acknowledged – you know who you are!

In your experience, what have you observed in terms of the process of switching health insurance policies?