Changing How Health Care Is Taught

Monday, December 8, 2014

Graduate course focuses exclusively on patient experience

By Mark Donahue

If you’ve ever been in an emergency room late at night, you’ve seen the demands put on staff to provide care, often to people in critical need. Sometimes that means a long wait, a crowded room and a bit of stress.

For many patients, this may seem like a given, but to a growing movement of health care professionals, it also represents one of the best opportunities to examine — and improve — the “patient experience.”

This fall, a group of students enrolled in the Master’s in Health Systems Management program at Rush University took part in the first graduate-level course exclusively focused on patient experience to be offered at a U.S. medical center as part of the core requirements.

Their studies took them to a familiar place to view the workings of the “front door” of a hospital — the busy Rush University Medical Center Emergency Department (ED) — where health care begins for so many — and where it is most tested.

And it was there that something quickly became apparent to the students: What we think of when we think of an emergency room experience is not set in stone.

New lines of communication

Imagine yourself again in the midst of that late-night visit. Ten or 15 minutes have passed, and maybe your chair is beginning to feel uncomfortable. Then someone from the hospital approaches, a friendly face, and lets you know the reason for the wait and how much longer till a doctor will see you or your loved one.

Or perhaps you look up and notice next to one of the televisions a large video board with your name on it, an estimated wait time and information on the doctor you are about to see.

These were among the ideas generated by the students when they visited the Rush ED. The department already has an ongoing effort to improve its patient experience and decrease the “door-to-discharge time,” said Mila Sobinsky, a department administrator.

The students were invited by Dino Rumoro, DO, MPH, chairperson of the Department of Emergency Medicine, to add their own insight, and it became a centerpiece of the new course. 

“We wanted to unify the course around a central experience for the students,” said Francis Fullam, assistant professor in Rush University’s College of Health Sciences and course co-director. “And rather than having them jump to all these different settings, we had them return to the same setting so they could see the interconnections.”

Some of the students suggested methods that have already been in use in the Rush ED for more than a year, such as medical scribes — trained medical information transcribers who help document patient visits, freeing physicians for more face-to-face interaction.

Through real-world observation and access to patient feedback and survey data, the students even tackled the architecture of the ED and how it might affect operations, suggesting separate waiting rooms for adults and children and their families.

Everything is in play when evaluating patient experience, said Mary Malone, lecturer in the College of Health Sciences and co-director of the new course. It can begin as early as research on a hospital website and continue on through to discharge.

Patient metrics on the rise

Over the past three decades, patient experience data, once little more than an afterthought, have moved closer to the mainstream of health care, said Malone, who is also a 1985 graduate of Rush University’s Health Systems Management program.

Championed by a growing number of nonprofit organizations, even the government has gotten involved, requiring all hospitals to administer the Hospital Consumer Assessment of Healthcare Providers and Systems survey, known as HCAHPS. It applies to all adult inpatients, excluding psychiatric patients.

HCAHPS scores are tied to federal funding and are published on the Medicare website for the public to review. Rush makes sure all its medical workers are aware of results for their area of focus, said Fullam. Doctors at Rush are able to see their own patient satisfaction scores on the hospital’s electronic health records system, as well as those of their colleagues. 

“We have the highest instance of patients willing to recommend our hospital in the city of Chicago and among the highest in the nation, but that’s not good enough,” said Fullam. “Rush is trying to say, ‘We’re glad we have achieved this level of appreciation and acknowledgment from our patients, but there’s more we can do.’”

Preparing the next generation

Rush is already training attending physicians, residents, nurses and other staff on the patient experience concept and metrics — the effort in the ED being just one example. But the Rush University program goes further by educating future health care leaders who will play a pivotal part in spreading the message.

Rebecca Goudarzi, an HSM student, said the new course has sparked her interest in the patient experience, and she believes it could become a focus for her after graduation. “I think it’s really important to establish early in people’s careers to think about being patient-centered,” Goudarzi said. “For me, it was a new way of seeing things and to consider views of the patient that I had never thought of before.”

Students in the class are also conducting academic research to bring their voice to a wider audience. An article co-written by Fadi Hachem, a recent HSM graduate and patient experience manager at Midwest Orthopedics at Rush, was published in The Patient Experience Journal in November. The article focused on listening to patients in a systematic way to help reduce the national problem of readmissions.

One course cannot provide all the answers, said Malone. But the real value is in being unafraid to bring the patient-first mindset to any setting in health care, no matter how seemingly unchangeable.

The course is now part of the HSM program’s required curriculum, and Malone and Fullam hope to one day bring it beyond the College of Health Sciences to Rush’s three other colleges, Rush Medical College, the College of Nursing and the Graduate College.

Sharing these concepts across disciplines helps play a part in building a common language around patient experience that can be used all over the world, said Fullam.

“My goal is that from early in their careers, the students view health care through the lens of patients and families — that they will never ‘un-see’ the importance of the patient experience,” said Malone. “That, to me, changes this generation of health care professionals.”