Listening has always been a critical component to medicine. Increasingly the healthcare world is seeing the value in listening to patients’ stories and helping these narratives drive hospital transformation.
“Patient stories provide rich, qualitative data, and context to the critical texture, which is how are we doing in delivering great patient care and a great patient experience,” Lee Chen Ee, group director of organizational transformation at Singapore Health Services, said at Cleveland Clinic’s Patient Experience Summit.
While patient stories can be vital for future engagement strategies, gathering these stories can be labor intensive. This challenge, coupled with the fact each patient has a highly individualized experience, can led to difficulties putting the lessons learned from patient stories into practice.
“It is important for us to hear from enough patients because from a methodological perspective, one of the challenges is that patient stories sample size tends to be small because it is very time intensive to collect stories. So, the question is whether it is representative,” she said. “The same experience viewed from one patient’s lens is very often just one side of the story and sometimes may not be entirely accurate. So, we need to get enough stories for the purpose of validation.”
But patient stories have influenced Singapore Health System’s practice in the past. Lee gave the example of an individual she met while doing patient interviews, who she called, Alice.
“Alice was hungry and pale when I saw her,” Lee said. “It was 3 p.m. She said she hadn’t eaten since early. She was fasting for a test. She didn’t know what test it was or what time it was going to be. She said she thought the nurse mentioned but she couldn’t remember. I said, ‘Why don’t you just ask the nurse again?’ and she sheepishly said, ‘You know they are all so busy I feel bad to ask.’ And it was true I looked around and the nurses were totally harassed rushing from one task to another.”
Lee then thought about her child’s experience in the hospital where the nurse had the time-consuming job of sitting with her daughter and recording everything she ate and any outputs. Meanwhile as a caregiver she could have recorded this data, she said.
“Nurses are spending a lot of time on a lot of mundane tasks. In turn, it compromises time for direct patient care and patient experience,” Lee said. “This incited us to action, to partner with our nurses to create a bedside inpatient app. It allows inpatients or their family to enter a patient’s intake and output monitoring in cases where doctors require that. Because it is integrated with their EMR the data flows directly into medical records. And for Alice she can see her daily schedule including scans, surgeries daily test results, treatment plans, request for family help and much more.”
That wasn’t the only story that prompted Singapore Health Services to innovate. A couple who would be soon expecting a baby told Lee the story of trying to figure out the financial costs but ran into long phone calls without any answers.
“We created an app so [patients could] do financial counseling themselves so they didn’t have to wait in line at the hospital,” she said. “They could see what they could claim at different sources, what their estimated bill was and even their authorized use of the government healthcare savings account for the hospitalization.”
At the same presentation Dr. Albert Chan, chief patient experience officer at Sutter Health, discussed how his organization used patient stories to prompt system wide changes. Inspired by a patient with lung cancer who was able to see specialists early, Chan began to discuss how the system could become more effective for patients.
“We have this problem that we have tremendous demand and yet sometimes slots go unused,” Chan said. “So, we said let’s do a simple text reminder to remind people of their appointments. So we put a reminder system in place and we reduced no shows by between 9% and 19% depending on the location.”
This tool had a domino effect, leading to faster care for others.
“By making it simple for patients to tell us if they were coming or not, we were able to harvest data about cancelations, and when people canceled appointments we can use that in real time to offer that canceled appointment to someone else on a digital waitlist,” he said. “So, patients on our digital waitlist are seeing their primary care doctors 15 days earlier and specialist care 23 days early.”
While taking the time for busy hospital staff to listen is not always easy, patients have a special insight into the needs of the hospital.
“Patient stories tell us what problems to solve. They help us innovate. And they also help us to improve and iterate our innovations,” Lee said.