Patient Experience: A Root Cause Analysis

Patient Experience Performance Outcomes have taken center stage in the quest to achieve the Triple Aim of Safe, Affordable, and more Value Driven Healthcare Delivery Systems. This movement has accelerated in recent years due to advancements in technologies and analytics used to measure and coordinate clinical outcome data, as well as the growing trend toward placing more financial and behavioral responsibility on patients and families. In addition, PE has become an important measurement for determining revenue under Pay-for-Value reimbursement programs enacted by Government and Private Payers. Concurrently, financial incentives are increasingly used to transform Primary Care and Specialty Practices into Patient Centered Medical Homes (PCMH) where Team-Based Care is guided by the values and engagement of patients served.

While the Clinician and Group Consumer Assessment of Healthcare Providers and Systems survey (CG-CAHPS) has been found to be valid and reliable for measuring Patient Experience in non-acute settings, the most vexing problem expressed by practices is how to use the survey and PCMH data to improve PE outcomes and revenue. Hence, understanding the root cause of poor PE can help care teams align PCMH and CG-CAHPS data sets to develop data-guided PE strategies.

As a result of poor PE outcomes throughout healthcare, four Landmark Studies by the Institute of Medicine created an awareness and sense of urgency to reform healthcare as noted below:

Using an Ishikawa Fish Bone Diagram can help care teams better understand the contributing factors for poor Patient Experience and Clinical Outcomes based on the Institute of Medicine studies and incorporate them in PE strategies.

With an understanding of the strategic focus of each study, care teams can begin aligning the principles of Patient Centered Medical Home Transformation and predictors of healthcare consumer behavior. In the following illustration, the Cox Interaction Model of Client Health Behavior is used to create predictive modeling of PE outcomes.

Along with applying Patient Centered Medical Home Principles, Care Teams can use the Root Cause Analysis process to design data-guided active learning modules to improve comprehension and application of organizational behaviors that create positive Patient Experience Outcomes.

James P. Young, Jr., PhD

Dr. Young has over 35 years in healthcare consulting and is a Certified Professional in Healthcare Quality and Patient Centered Medical Home Content Expert. He also serves as an awarding-winning Assistant Professor, Healthcare and Business Administration and is Associate Department Chair, Human Resource Management and Marketing, Davenport University.

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