This document discusses factors that contribute to positive patient experiences in the hospital setting. It summarizes a report by the Institute for Healthcare Improvement that identified five primary drivers of excellent patient care and experience: leadership, staff commitment, respectful partnerships with patients, reliable care processes, and evidence-based practices. The report found that improving patient experience requires an integrated, system-wide approach rather than isolated initiatives. It also emphasizes the importance of understanding the patient perspective by observing their journey through the healthcare system.

1. What makes a positive
patient experience?
IHI explores how to improve a patient’s
time in the hospital
Hospitals have been working toward better patient
satisfaction for years. Now, with patient experience
survey results posted publicly and a new national value-
based purchasing system in place, it’s more important
than ever to understand what positively and negatively
affects a patient’s time spent in the hospital.
“Culture of safety and culture of a great patient
experience are very, very closely tied together,” says
­Barbara Balik, RN, EdD, senior faculty at the Insti-
tute for Healthcare Improvement (IHI), principal at
Common Fire Healthcare Consulting, and coauthor of
the report Achieving an Exceptional Patient and Family
Experience of Inpatient Hospital Care. “If leaders are seeing
those as two separate activities, they’re going to waste a
lot of time and energy.”
Balik and the report’s team of authors found that
there are five primary drivers of excellent patient care
and experience (see “IHI patient and family experience
driver diagram” on p. 4 for more information):
➤➤ Leadership
➤➤ Staff hearts and minds
➤➤ Respectful partnership
➤➤ Reliable care
➤➤ Evidence-based care
These drivers reinforce the idea that there is no silver
bullet to achieve a better patient experience, says Balik.
“I think our
original hope
was we’d find a
small bundle of
things, kind of
like a ventilator-­
associated pneu-
monia bundle,
and we’d get this
great patient expe-
rience,” Balik says.
“But what we learned from the exemplar hospitals is
when we really pressed them about what they did spe-
cifically for patient experience, they could not separate
that out from what they do for quality and safety.”
The team found that “random acts of goodness” alone
will not create a positive patient experience.
“It’s not just rounding, after-discharge phone calls,
scripting for nurses—those are great tools and tactics, but
if it doesn’t fit together as part of an integrated system,
you’re not going to make or sustain the headway you
want,” Balik adds.
The study’s authors conducted an in-depth research
review, studied exemplar organizations, and interviewed
experts in the field to discover the primary and second-
ary drivers of exceptional patient and family experi-
ence, as defined by whether patients would be likely
to recommend a hospital (measured by the HCAHPS
“It’s not just rounding,
after-discharge phone calls,
scripting for nurses—those
are great tools and tactics,
but if it doesn’t fit together
as part of an integrated
system, you’re not going
to make or sustain the
headway you want.”
—Barbara Balik, RN, EdD
IN THIS ISSUE
p. 6 NQC sets tone of accountability
Highlights from the National Quality
Colloquium’s opening session.
p. 8 Infection control videos go viral
Exploring the new fad of creating videos for better staff IC practices.
p. 10 Does cookbook medicine take away the joy?
Columnist Catherine Hinz, MHA, discusses how standardization of care
protocols doesn’t have to take away the joys of caregiving.
p. 11 Staff Trainer
Test staff members’ knowledge of The Joint Commission’s National
Patient Safety Goals.
October 2011 Vol. 12, No. 10

2. Page 2 Patient Safety Monitor Journal October 2011
© 2011 HCPro, Inc. For permission to reproduce part or all of this newsletter for external distribution or use in educational packets, contact the Copyright Clearance Center at www.copyright.com or 978/750-8400.
“willingness to recommend” dimension). The IHI report
is designed for “hospitals to use this framework to design
their efforts to improve the patient and family experi-
ence—testing and implementing changes, weaving them
into the fabric of daily work for everyone, and achieving
outstanding results,” according to the report.
Leadership support
Like all good quality improvement initiatives, leader-
ship support is vital for a positive patient experience,
says Balik. With patient satisfaction tied to value-based
purchasing for fiscal year 2013 (see “Payment and
patient experience” on p. 5), leadership may want to
look closely at what actions a hospital takes to improve
experience..
“It’s part of our growing accountability as healthcare
leaders,” says Balik. “I think in the past, perhaps execu-
tives didn’t realize how big a role they played in patient
experience, and it’s more explicit now.”
But with more evidence showing that a positive
­patient experience is linked with whether a hospital
operates efficiently, respectfully, and with good commu-
nication, that notion that leadership involvement isn’t
vital should change.
Professional teamwork and efficient systems
Respectful listening, communication, and teamwork
are essential to a good patient experience, says Balik.
“If nurses can’t partner well together, they certainly
can’t with patient involvement,” she says. “Patients
need to feel like there’s a whole team of people working
together with them, not just isolated people who come
and go.
“If we’re not respectful to one another, patients pick
up on that,” adds Balik. “That’s fundamental.”
Also important to a patient’s perception of care are
hospital systems and protocol. If they’re not effective,
the patient will notice.
“If staff don’t have effective systems, they’re not going
to be able to create a great experience with patients and
families,” says Balik. “Unreliable systems for staff are
unreliable for patients and a waste of resources.”
Ineffective systems mean frontline staff have less time
to spend with patients—a commodity many patients
highly value. If systems are inefficient, communication
will also likely suffer.
David M. Benjamin, PhD
Adjunct Assistant Professor
Department of Pharmacology
Experimental Therapeutics
Tufts University School of Medicine
Boston, MA
Steven W. Bryant
Vice President and Managing Director
Accreditation Services
The Greeley Company
Danvers, MA
Sue Dill Calloway, RN, JD
Director of Hospital Risk Management
OHIC Insurance Company
Columbus, OH
Wendy Fisher, RN
Patient Education Coordinator
A.O. Fox Memorial Hospital
Oneonta, NY
Patricia Gilroy, MSN, MBA
Clinical Patient Safety Coordinator
Alfred I. duPont Hospital for Children
Wilmington, DE
Gayla J. Jackson, RN, BSN
Nurse Manager
Mount Auburn Hospital
Cambridge, MA
William N. Kelly, PharmD
Professor
Mercer University School of Pharmacy
Atlanta, GA
Sherry Mazer, FACHE, CPHQ
Regulatory Officer
Temple University Health System
Philadelphia, PA
Tim O’Kelly
Risk Manager
Deaconess Hospital
Oklahoma City, OK
Patricia Pejakovich, RN, BSN,
MPA, CPHQ, CSHA
Senior Consultant
The Greeley Company
Danvers, MA
Kenneth R. Rohde
Senior Consultant
The Greeley Company
Danvers, MA
Mary J. Voutt-Goos, RN, BSN, CCRN
Director Patient Safety Initiatives
Henry Ford Health System
Detroit, MI
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Systems must also support patient engagement. En-
gagement makes the difference between doing some-
thing to the patient, for the patient, or with the patient,
says Balik. “I really advocate that as a baseline we need
to be doing with the patient.” For example, Balik says a
hospital could allow visitors at any time, with the only
restrictions placed by the patient regarding who can visit
and when.
What happens if there’s a problem with this patient-
centered allowance? Balik says it’s up to the hospital—
not the staff—to have a policies that support patients
and staff. For example, if security is a concern, there
should be a name badge system, a visitor census, and
more security if necessary. If patient visitors are causing
a disturbance late at night, there should be a policy in
place for such a scenario, with expectations for visitors
set ahead of time.
Teaching patient experience from
the beginning
One of the drivers, “staff hearts and minds,” may
seem like something a hospital can’t really change or
affect. But in fact, it’s a driver that can be controlled
through hiring and training.
“A number of organizations, many outside of
healthcare, do what we call ‘hire for values’ and then
train for specific skills. Human resources must be
involved in the patient experience, as they must hire
individuals whose ideals align with the hospital’s,” says
Balik.
Balik warns, however, that if you hire for values, you
should ensure that the hospital actually displays those
values in everyday care.
“You can’t recruit people for values and then throw
them into an environment that negates everything that
you’ve recruited them for,” she says. You should show
potential candidates what the values look like in action.
Understanding the patient journey
To understand patient experience, go to the source:
the patients.
“What I really recommend and what I’ve been teaching
is how to observe and follow a patient across the experience
of care,” says Balik. She admits that it can be hard to follow
a patient throughout his or her entire stay, but even fol-
lowing a patient from the ED to the inpatient unit, or from
preop to the operating room, can be a learning experience.
“Having staff who work in those areas actually follow
a patient through the experience, taking notes, taking
photos for learning, are the best sources of discovery and
the best way to identify where we need to improve,” she
says, adding that the process can be part of a mock Joint
Commission regulatory patient tracer and thus make use
of activities that already occur in your ­hospital. n
Editor’s note: To view the report, visit www.IHI.org.
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4. Page 4 Patient Safety Monitor Journal October 2011
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IHI patient and family experience driver diagram
Source: Balik, B., Conway, J., Zipperer, L., Watson, J. Achieving an Exceptional Patient and Family Experience of Inpatient
Hospital Care. IHI Innovation Series white paper. Cambridge, MA: Institute for Healthcare Improvement (IHI), 2011.

5. October 2011 Patient Safety Monitor Journal Page 5
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Payment and patient experience
Understanding the payment point system
In spring 2011, CMS issued a final rule for value-based
purchasing (VBP), for which more than 3,000 hospitals are
eligible. The move creates the first ever national pay-for-per-
formance system.
“It helps set the framework to fundamentally change
how hospitals are paid for their services to Medicare ben-
eficiaries,” said Jean Moody Williams, group director for
the quality improvement group for the Office of Clinical
Standards and Quality in a July 27, 2011 CMS Open Door
Forum. “It’s moving from ‘How much did you do?’ to ‘How
well did you do?’ And more importantly, ‘How well did the
patient do?’”
Seventy percent of the VBP will be based on 12 clinical
process measures; the other 30% is based on eight patient
experience of care dimensions on the Hospital Consumer As-
sessment for Healthcare Providers and Systems (HCAHPS) pa-
tient survey, including:
➤➤ Nurse communication
➤➤ Doctor communication
➤➤ Hospital staff responsiveness
➤➤ Pain management
➤➤ Medicine communication
➤➤ Hospital cleanliness and quietness
➤➤ Discharge information
➤➤ Overall hospital rating
The score is based on both achievement—one hospi-
tal’s performance during the performance period (July 2011
through March 31, 2012) for fiscal year 2013 compared to all
other hospitals during that period—and improvement, which
is one hospital’s performance during the performance period
compared to its own performance during the baseline period
(July 2009 through June 2010).
For HCAHPS measures, hospitals have an opportunity to
receive achievement or improvement points, plus consisten-
cy points. For each of the eight HCAHPS dimensions, hos-
pitals will be rewarded either achievement or improvement
points, whichever score is greater. Scores are determined for
all dimensions and totaled (the highest possible score is 80,
or 10 points for each dimension). This total is referred to as a
hospital’s “base points.” In addition to base points, the hos-
pital also has an opportunity to earn consistency points.
Consistency ponts are based on the lowest-scoring di-
mension (LSD).The LSD is compared to the 50th percentile
of all hospitals in the baseline ­performance period; this is
called the achievement threshold. The jackpot is an LSD that
hits or surpasses the achievement threshold (i.e., all eight di-
mensions perform above the threshold)—this earns a hospi-
tal 20 consistency points.
At the other end of the spectrum, if an LSD is below the
worst-performing hospital, otherwise known as the “floor”
rate, that hospital earns 0 points.
If a hospital’s LSD lies between the floor and the achieve-
ment threshold, the hospital will be awarded somewhere be-
tween 0 and 20 points, based on a formula that takes into
account the LSD score relative to its distance from the floor.
The purpose of consistency points is to “encourage
higher performance across all HCAHPS dimensions and promote
­wider systems changes within hospitals to improve quality by
offering hospitals additional incentives,” according to CMS.
A hospital’s base points and consistency points added to-
gether form its patient experience of care score—i.e., 30% of
its total VBP score. In subsequent years, CMS plans to add ad-
ditional ­domains and measures to provide a broader snapshot
of quality ­improvement and efficiency of care delivery.
Editor’s note: For more information on VBP scoring, visit
www.cms.gov/Hospital-Value-Based-Purchasing.
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