A step by step guide on how to holistically improve patient experience, adaptable for any healthcare setting. This training is presented by Dr Avnesh Ratnanesan, who is a thought-leader and expert on practical methods for improving patient experience and consumer engagement in the health setting.

1. Dr Avnesh Ratnanesan CEO @energesse
The ‘6 E’ Framework
“A step-by-step guide to improving
patient experience for PX champions”

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ABOUT ENERGESSE

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LEARNING OBJECTIVES
By the end of this course, participants will be able to (at an introductory level):
E1-2: Experience, Emotions
1. Define what is the patient experience (by providers, and by patients)
2. Understand methods for measuring patient experience, including:
• Knowing where to start on how to focus on the patient
• survey processes and logistics of surveying – multichannel, internal & external surveys
• obtaining appropriate breadth of consumer input/feedback (including marginalized
populations e.g. rural, regional, indigenous and ethnic minority patients
• How to get clinicians and staff buy-in to measure
3. Help clinicians, staff, partners, health department policies and the ‘system’ become more
responsive to patient expectations

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LEARNING OBJECTIVES
E3-4: Energy, Execution
1. Have a clear change process to lead a transformation of patient experience – high level strategies and
practical tactics
2. Get buy-in to use the data to change actions and results
3. Make a difference to patients with limited resources (time, budgets and staffing)
4. Understand how to change attitudes, behaviours and value empathy and compassion
5. Identify how PX management helps improve the safety, quality and integrated care
6. Recognise the need for transparency, and how to achieve more transparency internally
7. Learn specific, innovative communication techniques engaging patients and family members (e.g. extracting
medical information or communicating technical details such as why they are having tests, procedures)
E5-6: Excellence, Evolution
1. Learn how to redefine success, obtain it and maintain results
2. Case studies of how other organisations have achieved better experience and health outcomes or other
benefits
3. Identify resources for patient experience research and practical tools and techniques that can be used
immediately
4. Identify where healthcare information is publically available for consumers

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WHAT WE WILL NOT COVER TODAY:
1. Learn how to help patients engage and invest in their own health
2. How to improve specific healthcare processes e.g. appointment setting, discharge
planning, etc.
3. How to implement a statewide strategy for improving the patient experience

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THERE IS A PRIZE!

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EVOLUTION OF
HEALTHCARE -
THE TRIPLE AIMS
1. Don Berwick et al Health Affairs 2008 Triple Aim

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WHAT IS PX ?
The sum of all interactions, shaped by an organization's culture,
that influence patient perceptions across the continuum of care.”
-Beryl Institute

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Patient
Satisfaction
Customer
Service
Net Promoter
Score
Consumer
Engagement
Feedback &
Complaints
SurveysQualitative
Research
Quantitative
Research
Patient
Stories

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PX AS DEFINED BY PATIENTS?

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PX AS DEFINED BY PATIENTS?
“The Patient Experience is an experience unique to that individual.
We do not have to judge the experience.
But we can be instrumental in shaping it”

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CONSUMER HEALTH PREFERENCES:
WHAT DO THEY WANT (IN GENERAL TERMS)?
Ref: Ian Worden, MMD, MHI, Better patient engagement

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AUSTRALIAN CHALLENGES WITH PX SURVEYS &
CONSUMER ENGAGEMENT
1. Patient Surveys paper based or via telephone
2. Use multiple disparate survey databases, tools, etc.
3. Insights patchy, uncoordinated and lack strategic intelligence
4. State survey results take from 3 to 18 months to be received
5. Cumbersome reports or none from Ward to Board
6. Minimal engagement from ethnic minorities
7. Front line staff disengaged in the survey – outsourced research
8. Quantitative data shows where problem is, but not WHY – difficult fixing issues

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AUSTRALIAN CHALLENGES WITH PX & CONSUMER
ENGAGEMENT
Everything else described in the Learning Objectives!

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THE ‘6 E’ FRAMEWORK
From Patient Experience to Healthcare Evolution
Patient Organisation
Patient Experience/Outcome Goal
E6. Evolution
E5. Excellence
E4. Execution
E3. Energy
E2. Emotions
E1. Experiences

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E.1 = EXPERIENCES

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WHERE DO YOU START?
Hospital Emergency Surgery Hospital InpatientHome
1. Identify the specific patient population(s), ward (s), healthcare facility or
community where you need or want to improve the experience
2. Define and Map their patient journey

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MAP THE WHOLE JOURNEY FOR BETTER SOLUTIONS
Hospital Emergency Surgery Hospital Inpatient
General Practice
& Allied HealthRehabilitation Medication
Outpatient careHome
Workplace Wellness
Supplements
Health Insurance Claim

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Queen Eleanor Hospital has a new PX Leader!
INTERACTIVE EXERCISE

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1. Methods for collecting data on the experience customers need and want across
the journey.
• Patient and Consumer Surveys e.g. NPS verbatim comments
• Focus groups
• 1-on-1 conversations with front line employees and management
• Call Centre Voice Recordings
• Customer E-mails – Complaints, Compliments and Comments
• Online conversations and ratings e.g. BHI, Patient Opinion, NIB Whitecoat
2. Understand the why from your qualitative data – get the real reason specific
expectations were unmet
CAPTURE DATA ON THE EXPERIENCE(S)

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PATIENT EXPERIENCE SURVEYS
• Who to survey - patients, patient’s family, nurses, doctors, front-line staff,
management
• How to design a PX survey:
• start with the outcomes you want from the survey,
• base questions on patient journey touchpoints,
• use HCHAPS/Picker Institute as a guide,
• engage an expert/consultant to review survey design, methodology, questions, results
• What tools can I use to deliver the survey:
• Resources as per above,
• Survey Monkey,
• Multi-channel survey platforms /mediums e.g. MES Experience

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PATIENT EXPERIENCE SURVEYS
• What questions should you ask?
• Determine the outcomes you want from the survey outputs
• Don’t just ask patients to rate on a few domains, ask about feelings,
• Ask about what actually happened to them during their care,
• Ensure open questions for qual info (can be far more useful than quant) e.g. what mattered
most to you during this experience
• How frequent should it be done?
• Depends on setting
• Measure what you can manage
• E.g. busy hospital wards - Daily gathering of feedback (realtime ideal)
• E.g. Community - Focus groups once or twice a year

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CAPTURE FEEDBACK VIA MULTI-CHANNEL APPROACH
Online
Text Message (SMS)
Email
Kiosk and Tablet
Automated Telephone Surveys
Postcards and Drop-boxes

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CUSTOMISE SURVEYS TO SPECIFIC NEEDS

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CAPTURE THE EXPERIENCE

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FREE TEXT COMMENTS – UNDERSTAND WHY

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MES EXPERIENCE – REAL TIME FEEDBACK

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PATIENT EXPERIENCE RESEARCH – FREE RESOURCE
Research on challenges and future
opportunities to manage patient experience in
NHS Hospitals (UK)
Free Download:
www.energesse.com

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E.2 = EMOTIONS

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Patient
expectation
Organisation’s
expectation
Product/Service
expectation
Growing
Patient
Experience
Gap

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E2. EMOTIONS
Experience < Expectation = Frustration/Anger = Satisfaction Deficit
Experience > Expectation = Excitement/Delight = Satisfaction Profit

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Detractors Promoters
PX : IT’S NOT WHAT YOU THINK ABOUT THEM,
IT’S HOW THEY FEEL ABOUT YOU
e.g. Family & Friends Test (FFT)/ Net Promoter Score (NPS)
Frustration & Anger Delight & Excitement

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SENTIMENT ANALYSIS OF DIGITAL FREE TEXT DATA

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MEASURE STAFF COMMUNICATION AND COMPASSION

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E.3 = ENERGY

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ENERGY =
Leadership
Employee Engagement & Culture
Attitude & Motivation
Wellbeing
Empathy & Compassion
Meaning & Purpose
Love & Joy
Authenticity
Ref: Covey SR & Link G Smart Trust, 2012 Free Press. Sisodia R et al, Firms of Endearment, Sisodia et al 2007 Prentice Hall.

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E3. ENERGY - IMPROVING STAFF EXPERIENCE & CULTURE
1. Don Berwick et al Health Affairs 2008 Triple Aim and
2. Bodenheimer et al Annals of Family Medicine 2014

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IKIGAI = Purpose
IMPROVING STAFF CULTURE
and MINIMISE BURNOUT
Reconnect Clinicians, Staff and
Managers with their Purpose

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DISCOVER YOUR PURPOSE (IKIGAI)
Where work and life is most fulfilled and performance improves
Answer 4 questions and find the intersection:
1. What do you love doing?
2. What does the world need? (problem to solve for patients, consumers,
stakeholders)
3. What can you get paid for? (Is it financially sustainable so you can maximise
your impact)
4. What are you good at? (True Strengths)

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Download Purpose Toolkit – FREE RESOURCE
www.energesse.com/coaching/

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 Strategy for Organisational Change – Kotter’s 8 Step Model
 PX Capability Audit
 Prioritising which problems to focus on?
 How to generate solutions for them? (Ideation)
General solutions to improve patient experience
Specific solutions to improve patient experience
 Methods to implement solutions – Lean, Six Sigma, PDSA
 Technique for communicating with Patients – G.R.E.A.T.
E4. EXECUTION

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Ref: Edward Elmshurst Health, Chicago.
https://www.eehealth.org/great
PATIENT COMMUNICATION – G.R.E.A.T.

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E4. EXECUTION
INTERACTIVE EXERCISE
The survey results are in – what now?

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Methods to get engagement (buy-in) from clinicians and staff to take action
 Clearly communicate ‘What’s In It For Me’ (WIIFM) from their perspective, not
yours .e.g. Save time, save money, improve care, job satisfaction, fulfilment and
higher purpose (ikigai)
 Get buy in from the start, even before you start the surveys and implement
improvements. Bring them on the journey
 Appoint a PX leader for every team
 Ensure they get outcomes daily or weekly at their unit meetings
 Disseminate the right reports to the right stakeholders at the right time
 Get staff to brainstorm solutions to their challenges
 Celebrate small wins regularly, not just big ones
E4. EXECUTION

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REAL-TIME FEEDBACK:
TRANSPARENCY to FRONT LINE
ACTION
Actionable immediately by front line
staff and ward-specific updates

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E5. EXCELLENCE - How do you monitor excellent results?
• Pick specific questions e.g. FFT or NPS as a overall benchmark
• But excellence starts at smallest unit level or by specific issue or by specific
disease state or patient population
• Measure the most important score for your target patient population – ASK
THEM what this is
e.g. Pain Scores for Chronic Pain or Cancer patients
e.g. Waiting Times for Emergency Departments
e.g. Bed Occupancy rate for private health facilities/hospitals

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E5. EXCELLENCE
CASE STUDY
EVIDENCE OF
OUTCOMES
Hertfordshire
Partnership University
NHS Foundation Trust
Service Question
July-
Sept
2015
Action Taken
Oct-Dec
2015
Change
Albany Lodge
If you came here from another
service, were you kept informed
throughout the process
22%
At all staff meetings the team now
discuss how the Trust can improve the
transfer process so patients are better
informed
54% + 32%
Astley Court
Do the activities you do help
towards your recovery?
69%
More activities were organised including
external trips
88% + 19%
Aston Ward Do you feel listened to? 57%
1:1 time was put aside for service users
to express all their thoughts and feelings
100% + 43%
Hampden House
Has your mental health
medication and any side effects
been explained to you?
73%
Staff time was put aside to explain and
provide more information on medication
in 1:1 and group sessions
83% + 10%
RAID (Lister)
Do you know how to mental
health support out of hours?
90%
Service Users provided with mental
health helpline cards with relevant
contact details
100% + 10%
Holly Lodge
Has your mental health
medication and any side effects
been explained to you?
50%
Staff time was put aside to explain and
provide more information on medication
in 1:1 and group sessions
73% + 23%
Holly Lodge
Do you know how to get advice
and support out of hours?
68%
Detailed information is now routinely
given out on how to access support and
advice services
87% + 19%
Owl Ward
Has your mental health
medication and any side effects
been explained to you?
48%
Doctors are asked to explain medication
and side effects during their ward rounds
67% + 19%
Owl Ward Do you feel listened to? 44%
Named nurses are now allocated to
speak with service users twice a week
63% + 19%
Robin Ward
Have you been offered regular
physical activities?
47%
The ward ordered a table tennis table
and a Wii games console to promote
physical exercise on the ward
83% + 36%
Robin Ward Do you feel listened to? 53%
Nurses now ensure they have 1:1
sessions with each patient throughout
the day
100% + 47%

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E5. EXCELLENCE – REPORTING
• The MOST important benchmark is to benchmark against your own patient
population over time and show improvement
• Incorporate PX scores into overall quality and safety reporting
• Report from Ward to Board – note different report formats often required
because different stakeholders group needs different insights to make
decisions.
• Tell a clear story
• Combine data with patient and staff stories or testimonials to illustrate your point
• Remember to use the positive data to motivate as well, don’t just focus on the negative!

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 Deloitte researched Hospital Consumer
Assessment of Healthcare Providers and Systems
(HCAHPS) scores and performance measures
such as net and operating margins and return on
assets (ROA)
 Hospitals with higher Patient satisfaction scores also
demonstrated higher profitability - Becker Hospital
Review Report. Investment in Patient Experience
improves Finances, Marketing and Clinical
Measures
FINANCIAL EXCELLENCE

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“When our Patient Experience measures improved,
so did our Quality and Safety measures ”
- Sir Robert Naylor, former CEO, UCLH NHS Trust, Sustainable Health
Transformation 2014
E5. EXCELLENCE – QUALITY AND SAFETY

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CASE STUDY – CLEVELAND CLINIC
 The Cleveland Clinic has long had a reputation for medical excellence and for holding down costs. But in 2009, the CEO,
examined its performance relative to that of other hospitals and admitted to himself that inpatients did not think much of
their experience at its flagship medical center or its eight community hospitals—and decided something had to be done.
Over the next three years the Clinic transformed itself.
 Made improving the patient experience a strategic priority. got everyone in the enterprise—including physicians who
thought that only medical outcomes mattered—to recognize that patient dissatisfaction was a significant issue and that all
employees, even administrators and janitors, were “caregivers” who should play a role in fixing it.
 By conducting surveys and studies and soliciting patients’ input, the Clinic developed a deep understanding of patients’
needs.
 They had to change mind-sets, develop and implement processes, create metrics, and monitor performance so that the
organization could continually improve.
 Staff communicated intensively with prospective patients to set realistic expectations for what their time in the hospital
would be like.
 These steps were not rocket science, but they changed the organization very quickly. fears expressed by some physicians
that the initiative might conflict with efforts to maintain high quality and safety standards and to further reduce costs turned
out to be unfounded. During the transformation the Clinic rose dramatically in the University Health System Consortium’s
rankings of 97 academic medical centers on quality and safety. Its efficiency in delivering care improved as well.
Ref: https://hbr.org/2013/05/health-cares-service-fanatics

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E.6 = EVOLUTION

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E.6 = EVOLUTION
 Defined as sustained improvement in 3 repeat measures:
• Individual level,
• Ward level,
• Department level,
• Hospital/health facility level
• Community/population level e.g. Australia’s Health 2016
Ref: Australia’s Health 2016. Australian Institute of Health and Welfare. http://www.aihw.gov.au/australias-health/2016/

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CASE STUDY – BAYSTATE HEALTH
• Western Masuchusettes, 400 physicians, 10000 employees
• Baystate Breast and Wellness Center embarked on Patient Experience Redesign – ‘no one was
excited so we changed the conversation’
• Leadership held 2 day retreat with reps from each patient touchpoint – HR, PI, Mktg. Shared
input. They planned improvements in people,comms, process and physical settings
• Asked patients – ‘When you consider this experience, what mattered most to you?’
• Allowed them to ‘identify their graffiti’
• Psat went from 60-70% to 84 -100%, MD referrals – 15%to 70%, Consumer confidence – 50% to
70%, Revenues went up by 35%
• Ongoing marketing –physician partnership: Planned, facilitated mandatory PX retreats, planned
strategy, weekly update meetings
Ref: http://www.slideshare.net/bharatis/case-study-of-patient-experience-design-marketing-management-baystate-breast-wellness-center

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NEXT STEPS – HOW CAN ENERGESSE HELP YOU?
1. Design, develop or execute your survey
2. Conduct a PX Capability Audit of your organisation – identify gaps, capability strengths and
opportunities for improvement
3. Design your PX Strategy and help you implement your plan
4. Raise internal awareness, engagement and motivation – Keynote Speaking
5. Educate your management and front line staff – Training Workshops
6. Generate and implement solutions to improve patient experience e.g. process or system
improvements - Workshops
7. Coach physicians – reduce burnout
8. Train and Coach PX Leaders: 1-on-1 or groups
9. Provide real-time Patient Surveys and feedback platform – MES Experience

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PATIENT
EXPERIENCE
AUSTRALIA
CONNECT
DISCUSS
ASK
SHARE

58. Patient Experience Solutions . Research & Surveys . Keynote Speaker .
Consulting. Training. Coaching .
Contact: avnesh@energesse.com
02 8091 0918

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RESOURCES
Experience
1. Berwick at al 2008 Healthcare Triple Aims Health Aff May 2008 vol. 27 no. 3759-769
http://content.healthaffairs.org/content/27/3/759.full
2. Making Sense and Making Use of Patient Experience Data http://www.energesse.com/patient-experience-white-paper/
3. Patient Experience Channel – Brief Educational Videos http://www.energesse.com/patient-experience-channel/
4. Real-time feedback Patient Survey Platform – MES Experience http://www.energesse.com/patient-experience/
Emotions
1. Emotional Analysis with PanSensic technology http://www.energesse.com/customeranalytics/
Energy
1. Covey SR & Link G Smart Trust, 2012 Free Press.
2. Sisodia R et al, Firms of Endearment, Sisodia et al 2007 Prentice Hall.
3. Bodenheimer at al 2014. From Triple to Quadruple Aim. Annals of Family Medicine
http://www.annfammed.org/content/12/6/573.full
4. Purpose Toolkit for clinicians and staff – free download http://www.energesse.com/coaching
Execution
1. Leading Change: Why Transformation Efforts Fail:
http://www.gsbcolorado.org/uploads/general/PreSessionReadingLeadingChange-John_Kotter.pdf
2. G.R.E.A.T. Patient Communication Method Edward Elmshurst Health, Chicago. https://www.eehealth.org/great

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RESOURCES
Excellence
1. Deloitte Center for Health Solutions 2015 Survey of US Healthcare Consumers
https://www2.deloitte.com/content/dam/Deloitte/us/Documents/life-sciences-health-care/us-dchs-the-value-of-patient-
experience.pdf
2. Comparator sites – Transparency theme
• Bureau of Health Information http://www.bhi.nsw.gov.au/BHI_reports#292477
• Whitecoat www.whitecoat.com.au
• Patient Opinion www.patientopinion.org.au
3. Cleveland Clinic Case Study Ref: https://hbr.org/2013/05/health-cares-service-fanatics
Evolution
1. Australia’s Health Report Ref: Australia’s Health 2016. Australian Institute of Health and Welfare.
http://www.aihw.gov.au/australias-health/2016/
2. Baystate Health Case Study Ref: http://www.slideshare.net/bharatis/case-study-of-patient-experience-design-marketing-
management-baystate-breast-wellness-center
3. Patient Experience Australia Linkedin Group

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FUTURE TRENDS IN AUSTRALIAN HEALTHCARE