I love to do this exercise with healthcare professionals because it gets them back to the essence of the patient experience and reminds them that this is the state of mind of many of their customers. These emotions and needs are at the core of the patient experience. As healthcare providers, you need to keep this in mind as you care for them and as you prepare them to leave.
Identifying and addressing these feelings and needs are among the most important aspects of patient care. And just because someone is being wheeled over the hospital threshold as a discharged patient doesn’t mean that those needs stop. A carefully timed and purposeful discharge call can go a long way in helping the patient feel reassured and confident about healing and care.
Think Back Exercise
Think back to a time when you were ill. It could be as simple as a bad cold or as complicated as a surgery or recovering from an injury. How did you feel? List all the feelings that come to mind.
What did you need? Again, think of that time when you were ill. What did you need?
Reason #2—Improve clinical outcomes and reduce readmissions
Another key reason hospitals implement PD calls is to improve clinical outcomes. You want to make sure that patients understood their discharge instructions and what to do next. PD calls help to validate patient comprehension and follow through of the instructions. They also give the opportunity to reinforce teaching.
When people are in a hospital, they often become very compliant because they feel vulnerable and out of their comfort zone. In fact, many people become highly compliant just to get through the ordeal and out of the hospital. But, once patients get back home in their familiar environment, a false sense of security often takes over. In such cases, and especially if patients are feeling better, they become convinced that things aren’t so bad, and they can resume normal activity.
Once a patient is feeling better, the less motivated he is to follow up on the discharge instructions, including medications and physician appointments. Or, if there’s been rehab or some other follow-up care needed, he may rationalize that it isn't really necessary. After all, the patient feels fine now.
This mindset, or false sense of security, is one of the most important reasons for making a PD call. First, the call continues the great care that you gave while the patient was in the hospital. Second, it reminds the patient that just because he is home and, perhaps, feeling better, it doesn’t mean he should ignore the treatment plan. This type of reminder improves clinical outcomes.
Improving clinical outcomes has additional implications in today’s reimbursement environment. Readmissions are costly to payers and disruptive to patients. But now, readmissions of a specific diagnosis-related group (DRG) have financial ramifications. The CMS have begun monitoring specific patient cohorts, which are currently being tracked on the CMS Hospital Compare site. The first three DRGs listed under evaluation for readmission rate include heart attack, heart failure, and pneumonia. The CMS will use a severity-adjusted methodology to calculate what is deemed an excessive readmission rate for each organization evaluated. Then, based on the calculation for excess readmissions, each organization could be penalized a portion of its reimbursement in the event of excess readmissions.
I won’t pretend to be an expert on the reimbursement aspect of either the readmission rates or Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS), and I highly recommend that you familiarize yourself with the CMS calculations and regulations. Keep in mind that these maximum penalties are going to continue to grow over time—up to 2 percent in fiscal year 2014 and 3 percent in fiscal year 2015—and they’re going to continue to add more patient groups to those that are already being tracked for avoidable readmissions. In the future, additional DRGs that could be added include COPD, bypasses, angioplasties, and other vascular procedures.
Reason #3—Deliver service recovery
The third essential reason many hospitals conduct PD calls is to implement service recovery measures. It’s been established that inpatients are a captive audience. While they have options for which organization to visit in their time of need, and they are certainly more educated about expectations in this electronic age, the majority of inpatients are only seeking care out of necessity. Furthermore, they come through a hospital’s doors in a heightened emotional state and are filtering their perception of service through a subjective lens. Quality is in the eye of the beholder.
Despite good intentions in your customer service delivery, some service issues are inevitable. Issues may vary in scope and size, but they are guaranteed to influence a patient’s experience and how she views your responsiveness to her needs. In a hospital setting where patients and their families interact with dozens of your team members across multiple departments and shifts, you may not even realize what messages are being sent to them or how they are received, let alone when something goes wrong.
Although many organizations try to find service recovery opportunities during rounds, some patients report being hesitant to vocalize concerns due to fear of retribution from the staff. Whether real or perceived, patients may not want to discuss service issues until they are no longer in your care.
If a patient is satisfied with his experience, it is likely he will tell two to three of his friends and family members about it, leading to positive brand reinforcement and the increased likelihood for loyalty and referrals. However, if that patient feels you did not handle a service issue in an appropriate or timely fashion (maybe it wasn’t addressed at all), it is almost guaranteed the patient will tell beyond two or three people about it. At that point, without even realizing there was a problem, you stand to jeopardize future business with the patient again and everyone he shared his bad review with. And consider the negative potential of online social networking media, spreading news like wildfire.
Placing PD calls provides an opportunity to identify and address such service issues swiftly and effectively. Within that first 24 – 72 hours after heading home, the experience is still fresh in a patient’s mind. By calling patients proactively, you demonstrate having their best interest in mind and wanting to gain information that will not only help you repair your relationship with them but also make changes before problems become widespread.
The bottom line is it really all comes down to trust. You think you’re in the healthcare delivery business—you deliver medical services, make people better, and send them home. But it’s important to remember that you’re really in the business of trust. When people enter your hospital for care, they are placing their trust in you. That is the sacred bond you enter into with your patients. And you can never forget how sacred and fragile patient trust is. PD calls give you an opportunity to solidify a trusting relationship.
Everybody Wins
Many healthcare organizations have mission statements that speak to care, compassion, service, and quality. Part of living your mission or promise comes down to how you manage the entire patient relationship, including after discharge. People’s needs and vulnerabilities don’t stop as they are wheeled over the threshold or drive away from your campus. In their minds, they are your patients. It’s important to foster that relationship.
Regardless of the main reason you start a PD call program, hospitals have found that they benefit across all areas. Patients often appreciate being asked for their opinion. It makes them feel valued and appreciated. Whether their feedback is positive or negative, patients appreciate being asked. The very act of asking is good public relations and can cement a positive, lasting impression.
PD calls impact clinical outcomes by addressing medication