The emergency room is a stressful and unplanned way to begin a patient journey, and the Ruth and Harry Roman Emergency Department at Cedars Sinai in Los Angeles is one of the nation's busiest.

THE PROBLEM

Staff wanted their patients to feel supported and heard, so instead of relying solely on post-discharge/post-transfer insights, they committed to collecting real-time feedback to better understand patient needs and quickly implement changes to improve the patient experience.

Consumer Assessment of Healthcare Providers and Systems (CAHPS) only paints a partial picture, said Claude Stang, executive director of emergency services at Cedars Sinai.

"Because the regulatory assessment is sent to patients weeks after a hospital visit, scores can be misleading if applied too broadly," he observed. "Patients have numerous interactions throughout a hospital visit. As a result, the nuanced minute-by-minute experiences often are lost when only looking at big-picture data."

PROPOSAL

"Knowing how busy the ED can be, we didn't have time to integrate a complex platform that conflicted with our existing workflow," he continued. "Fortunately, working with our vendor, Feedtrail, our customer success manager streamlined onboarding and made recommendations so new processes didn't interrupt our staff or our patients."

Staff implemented bimonthly rotating initiatives to dig into specific aspects of the ED patient experience – such as care communication, cleanliness and wait experience – to ensure they exceed patient expectations and receive the care they have come to expect from Cedars Sinai.

"If you partner with someone on improving the patient experience, make sure they have a dedicated point person to support your team and flag anomalies that need to be immediately addressed."

Claude Stang, Cedars Sinai

"The project design included members from ED, physician leaders, nursing leaders and the patient-experience team," Stang spelled out. "Prior to deciding on new initiatives, we meet internally to understand what nurse managers and leadership are seeing and hearing on the floor and comb through feedback received to ensure alignment on the next priority.

"The surveys have allowed us to create a direct dialogue with patients about their experience," he added. "Harnessing the voice of the patient, we have been able to enact immediate service recovery, such as offering a patient further explanation on wait times. We've been able to change processes, including one-on-one caregiver conversations at discharge and air fresheners in busy waiting rooms, and provide staff feedback with positive patient comments or specific areas of improvement."

As trends emerge or current events change, staff are able to quickly modify questions. For example, at the start of COVID, staff were able to ask how safe patients felt in the ED waiting room and their understanding of Cedars Sinai safety precautions to see if changes in process, communication or signage needed to be made.

"We also were able to ask patients which safety protocols made them feel most secure while waiting to be seen, which resulted in us efficiently deploying the appropriate safeguards, such as additional hand sanitizer stations and a socially distanced waiting area," Stang noted.

MEETING THE CHALLENGE

Using text messages to share short, relevant surveys at key points during a patient visit has helped patients feel more in control of their experiences.

"We're able to review, share and manage that feedback in the moment and address trends the same day," Stang explained. "The feedback compiled from different initiatives across the ED has allowed us to design intimate systems around the patient, such as one-on-one conversations with caregivers before patients leave, and has empowered staff by confirming the best practices patients appreciate the most.

"We found 'interactions with staff while waiting' had the biggest impact on how patients rated their ED waiting experience – with staff friendliness and the quality of their explanations heavily impacting a positive experience," he added.

Sharing these trends and successes internally has helped every employee understand the importance of their interactions, feel responsible for service recovery and become empowered to be an advocate for patients, he reported.

"We've been able to engage staff and physicians by sharing positive comments and compliments, often on the same day they saw the patient, rather than weeks or months later when they've forgotten who the patient was," Stang said. "It is extremely important during times of stress and fatigue, as we have seen throughout this pandemic, to make sure everyone has their 'cup filled' periodically to keep them focused, energized and positive.

"We also learned from patients that they were frustrated with the intake flow of the emergency room and didn't understand our process for treating those who needed the most immediate attention," he added. "By serving up a welcome text, they were given an overview of what to expect and a steady diet of updates – they could opt in or out."

This had a calming effect, making patients feel like there was a plan in place and that the waiting room wasn't ad hoc or unorganized, he said.

The invaluable patient feedback from work in the emergency department proved staff had designed a better way to engage with and learn from patients without disrupting their care experience or requiring additional work from the care team. This gave the leadership team the confidence to expand the rollout of tailored, in-the-moment patient surveys in departments and rounding processes across the health system.

RESULTS

Feedtrail provides instant qualitative and quantitative feedback for the Cedars Sinai team to absorb on a regular basis.

Over a period of six months, staff have been able to increase their Net Promoter Score by +1.5, receiving responses from patients that they "would recommend" Cedars Sinai to a friend or family member. That's a positive trend staff will continue to monitor as they expand Feedtrail's availability to other departments.

"Since the beginning of our partnership, we have been able to increase the response rate of surveys and patient information requests, a sign that engagement is welcomed if delivered through the right medium," Stang observed. "Additionally, we are seeing a steady increase in positive responses, although we do find that any negative feedback is critical to enhancing the environment for care we are creating.

"Limiting the blind spots we previously had is probably the most successful outcome to date for Cedars Sinai," he continued. "Our team now has significantly more visibility into the specific experiences our patients are having across the numerous touchpoints in the ED."

ADVICE FOR OTHERS

Adding another tool may feel counterintuitive, but adding the right tool can allow hospitals to improve without feeling inundated by yet another dataset, Stang advised.

"By finding the right tool that provides the right data, hospital leadership can integrate real-time patient experience surveys into their systems and use the patient-provided insight to make on-the-spot decisions," he said.

"You don't know what you don't know," he continued. "It's simple, but relevant to working in a health system that moves at 100 miles per hour all of the time. If you partner with someone on improving the patient experience, make sure they have a dedicated point person to support your team and flag anomalies that need to be immediately addressed."

The emergency department is an intimidating place for patients and caregivers, so it is critical that the environment is comforting and sensitive to a wide range of needs, he added.

"We learned how to better tailor our care based on patient preferences and continue to gain valuable insights about how our resources can be allocated during peak periods of usage," he concluded. "Healthcare provider organizations can benefit from patient feedback platforms in many ways, including improving ratings and online reviews that build trust and credibility for the organization."

Twitter: @SiwickiHealthIT
Email the writer: bsiwicki@himss.org
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