Reinventing the Patient Experience at the Department of Veterans Affairs
Chief of PX Michael Renfrow on the VA's new approach to EX, CX and PX
As one of only two federal agencies that has improved on its CX metrics in the past year, (the General Services Administration is the other) the Department of Veterans Affairs has rolled out a series of initiatives aimed at improving the patient experience for veterans throughout its 144 healthcare systems. Each system covers a designated geographic area, known as a “catchment” which is delineated according to the veteran population, similar to the way school districts are determined.
We caught up with Michael Renfrow, chief of patient experience consultation at the US Department of Veterans Affairs, ahead of his speaking session at the CCW Executive Exchange in March. Here’s what we had to say about the patient experience.
A new patient experience designed to make veterans feel welcome
A 2017 study showed that VA hospitals in the US deliver higher-quality care than non-VA medical centers in terms of lower mortality rates and lower rates of repeat hospitalizations, but score lower in patient satisfaction. At the beginning of the year, the Veterans Experience Office launched a series of patient experience initiatives aimed at creating a more welcoming atmosphere for veterans at VA-operated hospitals and clinics across numerous touchpoints.
WeCare Rounding: Medical center leaders and administrators make “rounds” speaking directly with staff and visitors about the services they received. Renfrow spends most of his time on the road, conducting 250 site visits per year. He leads a team of 14 PX coaches and consultants that are responsible for implementing PX solution across 147 VA medical centers.
“The WeCare model also is a way for us to standardize some of the communication,” said Renfrow. “In every encounter you can explain your role, connect, actively listen, respond and express gratitude. It’s scripting in a really loose framework format; it’s not robotic.”
Red Coat Ambassadors: Volunteers wearing red coats are stationed at the entrances to welcome visitors and direct them to their destination.
Own the Moment: A CX workshop administered to over 60,000 VA staff members to help guide veterans through their service experience by teaching staff on active listening and expressing gratitude.
Green Glove initiative: Encourages staff to ensure their facility is welcoming, clean and safe by picking up litter.
Making the patient experience into an agency-wide priority
The Veterans Health Administration is the largest integrated healthcare system in the US, operating 1,255 healthcare facilities serving over 9 million enrolled veterans.
Given the scale and complexity of the VHA, implementing change isn’t easy. In February, the VA hosted its first patient experience symposium in an attempt to convene agency-wide staff around the mission of PX. The organizers initially budgeted for 450-500 attendees, but Renfrow said they had to turn away “hundreds” of staff members because they didn’t have the space, capacity and budget for such an overwhelming response.
Inspired by the high level of interest coalescing around PX, Renfrow and his team created a training program called PX University for staff across the VA to gain from some of the learnings, ideas and techniques discussed at the symposium. While the rationale and techniques for PX are relatively straightforward, the difficulty for professionals in any industry is implementing change at the office once the conference, seminar or other inspiring event is over.
“It does us no good just to give them a bunch of tools and talk about techniques and tactics for three days if we don’t give them some leadership tools as well,” said Renfrow.
The PX University training program aims to impart lasting leadership lessons in assertive and transformational leadership training, while also educating participants on data awareness and change management so they can cascade their learnings throughout their respective organizations formally or informally.
Evaluating success and failure in the patient experience
For compliance purposes, national healthcare systems use a standardized survey known as the Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS), which evaluates healthcare providers on 27 questions evaluating the quality of care administered by doctors and nurses -- such as whether they treated the patient with courtesy and respect, explained their health condition in a way the patient could understand.
However, any hospital or clinic that relies solely on HCAHPS feedback is missing out on mountains of voice of customer input, and neglecting the “softer” aspects of the patient experience such as ease of communication, parking and onsite services. For this reason, VA hospitals launched their own real-time feedback survey for non-inpatients, administered 48 hours after any healthcare encounter. The survey is much shorter, consisting of just five questions.
“Interestingly, what we found was that about 70 percent of the comments we get back are actually compliments, which is really nice,” said Renfrow. “We use that to drive employee engagement. A significant portion of veterans leave a positive comment that identify a nurse or doctor by name.”
Renfrow says he pays special attention to the “but” comments, where a patient may have said something like, “this was great, but…” which points to an experience gap.
“Those ‘but’ comments are where there’s an opportunity to do a lot of service recovery and make the experience right for the patient.”
The biggest patient experience challenges facing the VA
Renfrow says the biggest challenge within the Department of Veterans Affairs is communication -- but it’s not because of data silos across a large organization. It’s much simpler than that. When surveyed, doctors and nurses affirmed almost unanimously that they take patient preferences into consideration, but they don’t actually ask the patient whether they need more information on their health condition, whether they’d prefer their medication in pill or liquid form, or what type of follow-up they’d like after discharge.
Healthcare being a sensitive field, it’s imperative that doctors and nurses create a climate where patients feel that they can ask questions and be forthcoming about their health concerns without feeling embarrassed. It means making important distinctions in communication styles, such as the difference between saying “You understand what I’m saying, right?” versus “Do you have any questions about what I just said?”
The former wording pushes the patient to say yes by default, while the latter invites them to ask questions.
Renfrow says he and his team have found it useful to train staff on scripted communications -- not robotic lines but general guidelines around phrasing --- to foster more open-ended patient-doctor conversations.
“Communication is the biggest challenge and I always tell physicians ‘You’re not asking the wrong questions; it’s about reshaping that communication in a positive way.’”