[MUSIC] We're going to be talking today about satisfaction, experience, engagement, and patient and family centered care. And today, it's really about definitions. So we're going to define and distinguish, what is patient and family centered care? What is patient satisfaction? What's the patient experience? And how does that differ from patient and family engagement? So at Johns Hopkins Hospital, we have six strategic priorities throughout the health system. The one that I'm going to be focusing on is patient- and family-centered care. So it's important to note that this is part of a strategic plan. So what does our strategic plan mean? Well, for patient and family centered care, it means we will promote a culture that embraces, expects, and rewards the delivery of patient and family centered care. We'll partner with the patients, their loved ones, and others to eliminate preventable harms, optimize patient outcomes and experience, and reduce waste in the health care delivery. And finally, we'll engage patients and families in shared organizational and clinical decision making. When we started with this strategic plan, what we needed to do as a next step was really to put in some definitions. And that's what I'm going to be talking about. So what is patient and family centered care? Well, this was work that was done by Gerdes and others early on. And so what does that mean? It means that we have respect for patients' values, their preferences and expressed needs. Coordination and integration of care, information, communication, and education, physical comfort, emotional support, and finally, involvement of family and friends. And in other lessons, you're going to learn about how we measure these different metrics. So there are many definitions for patient experience. As a matter of fact, in a review by Wolf et al in 2004, there were already 18 definitions for patient experience. It's encompassed in patient and family centered care, but experience is different. What we needed to do was determine which one would resonate with us and our organization. We pulled together a team of leaders from throughout Johns Hopkins Health Systems, and we brought it to our patients and our families. And how we ended up defining it really was through finding a definition that was put out there by Integrated Loyalty Systems. And we ended up modifying it for our own use. What we said was, at Johns Hopkins Medicine, the patient experience is based partly on patients' and family's high expectations of what is about to happen and their cumulative evaluation of their journey through our system. So how do we look at this? We look at it through both the opportunities we have to delight or disappoint based on clinical and emotional interactions. And with this one, I think it's very important. People will often push back and will say, isn't it the clinical issue that's the most important? And I will tell you that in my long years of doing this work, that sometimes you have a unfortunate clinical outcome. But if it's emotionally handled well, patients and families are satisfied with their experience. Other times, you may have a very good clinical outcome. But if the emotional interaction isn't there, they can be very disappointed or actually harmed by the experience. And finally, it has to do with our interactions with our people, our processes, and our physical setting. This is important because oftentimes, we have good people, but poor processes that will frustrate our employees and our patients. These need to be worked on as well. And then what kind of a physical setting are our patients in and our employees? There is a difference between satisfaction and experience. People used to always talk about patient satisfaction. And this was really around subjective kinds of concepts. How good was your food, very good to very poor? How good was the parking? How warm was your room? And it really can vary greatly by country and culture. We've been moving away from patient satisfaction to really talk about experience. And patient experience is meant to elicit factual data, and it can be easier to interpret and to do something about. So questions like, how often were your room and bathroom kept clean, from always to never? So if the bathroom, if they're saying usually or sometimes, we have something that we can do with it. We can go in and see what's going on with that cleaning. Why does communication matter? Well, as I mentioned earlier, negative patient experiences are harms, just like iatrogenic infections are harms. Patients care about how their doctors and other staff make them feel, and about how they care for them. Effective communication supports safe, high quality, team-based patient care. So we say that caring is integral to curing. Let me give a quick example. If you were to have medication errors, sometimes what we find is that communication didn't happen with the patient. The patient could have told you that they had a problem with that medication. So again, it's important, and it creates an environment of safety. In the United States, we use standardized surveys that measure experience. These surveys were really developed based on what was important to patients, the voice of the patient. Also, it reflects our inpatient, our medical practice, our outpatient surgery surveys. So we have many different surveys looking at different types of care that we provide in our health system. And finally, the focus, as I mentioned, in the United States, healthcare is moving towards measuring experience rather than satisfaction. The conversation is really shifting. It's shifting from what's the matter with you, which is more of a disease-based orientation, to what matters to you. So now that's called a new framework of Patient and Family Engaged Care. And Frampton et al published this document about what engaged care looks like. And it's really care that's planned, delivered, managed, and continuously improved in active partnership with patients and their families to ensure integration of their health and health care goals, preferences, and values. And those are the things that we're starting to measure as we look at the patient experience and engaged care.
