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Patient satisfaction made simple

April 1, 2011
by Dennis Grantham, Editor-in-Chief
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Foundations Recovery Network finds that treatment patients seek the simple things-relationships, trust and fun.
Some years ago, upon his appointment as CEO of a psychiatric hospital, Rob Waggener's first act of leadership was to get himself admitted for a week. He wanted to understand the patient experience.

So, in 2008, when Foundations Recovery Network (FRN, Nashville, Tenn.) committed to improving “customer experience management” as a means of improving satisfaction, outcomes, revenues, and referrals, it was no surprise that Waggener, who now serves as FRN's CEO, was on board.

Foundations recovery network corporate staff (l-r) includes carol arrowwood (chief hr officer), lee pepper (chief marketing officer), ceo rob waggener, and coo richard rodgers.
Foundations Recovery Network corporate staff (l-r) includes Carol Arrowwood (Chief HR Officer), Lee Pepper (Chief Marketing Officer), CEO Rob Waggener, and COO Richard Rodgers.

This time, however, research was conducted by a college-age intern who-as a patient at every FRN facility-completed what FRN executives now call “Ted's Excellent Adventure.”

Through eye-opening “moments of magic and misery” (see Figure 1), the intern captured the customer experience and convinced FRN execs that changes were needed. At the same time, execs studied the details of customer experience management as explained in Fred Lee's book, “If Disney ran your hospital.”

FRN's leaders saw the value of improving the customer experience, says Waggener. At that point, “we moved from thinking about what patients want to actually finding out.”

The customer's view of treatment

Another driving force behind FRN's effort was to better address the motivation level of customers (patients) at the beginning of treatment. Noting that FRN's treatment approach utilizes the “five stages of change” model (SAMHSA, TIP 35), Waggener says few patients arrive in the “action” phase. That, he says, “is the phase where they accept that they have a problem and are motivated to change.” This phase is considered the key to effective, patient-driven treatment.

Instead, he says that “the vast majority arrive in earlier phases-the ‘precontemplation’ or ‘contemplation’ phases-when they're just beginning to consider that they may have a problem. They're showing up because they want to get the family off their back.”

To get the treatment process started, “we've got to meet them where they are and tap into the limited amount of motivation they've got,” says Waggener. That means making the treatment experience as attractive as possible-from the first call to post-discharge follow-up-because “people who don't want to be in treatment will complain about everything. They just want out.”

Research defines the challenge

To better tap into, then define, these powerful elements of customer expectation and experience, FRN leaders hired Diane Schmalensee-a former Malcolm Baldridge Quality Award examiner-to outline FRN's quality-improvement effort, starting with research. Ultimately, the research encompassed some 30 “customer” focus groups including program alumni, current patients, families, and referral sources, as well as some 70 percent of FRN staff from every location.

The research also:

  • identified five major phases of the treatment process (pre-admission, admission, clinical treatment, daily experiences, and pre- and post-discharge);

  • identified the most significant or important expectations in each phase and how they are experienced, satisfied, or struggled with, by the patients;

  • identified which FRN employee function(s) were involved in fulfilling the expectation; and

  • suggested procedures that could be used to ensure expectation fulfillment.

Teams convert research to process

Next, FRN execs joined with facility directors and their staffs to develop cross-functional and cross-locational teams. These teams would compare the suggested procedures to actual (and varied) work processes at each location, then hammer out “ideal” work processes-customized to specific employee functions-so that each functional process could be standardized at each site.

Before and after PCC initiative

The team process resulted in development of:

  • a large “Policies and Procedures” manual containing the broad collection of internal processes;

  • a series of small function-specific (physician, nurse, counselor, etc.) Process Manuals focused on delivery of the customer experience in each role, and;

  • a series of customer/family/referral questionnaires that would be completed at intervals from admission through post-discharge to measure overall impacts on the customer experience relative to objectives.

Drivers of patient satisfaction

Pilot testing

In the fall of 2009, the entire customer experience management process-renamed the “Patient Centered Care” initiative-was then piloted at FRN's The Canyon in Malibu, Calif.