Has The Patient Triad of Experience, Engagement & Satisfaction Become An Afterthought?

September 2017

A precursor to each and every hospital and ambulatory practice countrywide utilizing an Electronic Health Record (EHR) is an EHR implementation.  Historically, implementations have been known to double as a springboard for an opportunity to optimize or improve on both existing clinical workflows and financial processes.  Each EHR module being implemented has their own corresponding team which are comprised of exclusively the organization’s staff and oftentimes healthcare IT consultants.  Throughout the implementation process, whether it be at beginning phases in which the current state assessment is being performed, during the build and testing phase, or on the day of Go-Live, the organization’s staff who double as individual team members each take great care and consideration as to the organizational impact of each and every decision made.  The C-suite is directly concerned with the financial implications and the impact on the organization’s leadership, who are directly concerned with the impact on department managers, who are directly concerned with the impact on that department’s staff…and so on and so forth.

Part of proper pre-implementation leg work ensures that the necessary staff members are involved in both the implementation process and appropriate individual teams so that the above mentioned organizational hierarchy can function optimally.  When this happens, all of the necessary employees are “at the table,” so to speak, and are able to provide invaluable insight as to decisions being made during the implementation process that will inevitably have a rippling effect on the organization as a whole.  When thinking about the proverbial table of consideration, it begs the question: is the nucleolus of this equation, being the patient, adequately represented at the table?  Think about it this way, “the patient” really should viewed as a member of each and every individual team, because without them there would be no workflows to optimize or no financial benefit to gain.  In fact, without them there would be no need for an EHR to implement.  However, since it is not realistic or appropriate to literally have a patient sitting at the table while organizational decisions are made or workflows are being assessed, realistically they have to serve in this capacity as an absentee team member.  With this being the case, does the patient as an absentee member of each and every implementation team have the ability to directly provide their invaluable input, suggestions, or critique the same way a department manager would?  Asking this question is not casting a shadow of a doubt on the fact that clinicians and other staff members act with the best interest of the patient in mind during the implementation process.  This consideration is universally accepted as part of the job responsibilities of all employees in the healthcare field.  More particularly, what is being questioned here is if there is a structured approach in place that allows for analysis and knowledge sharing for an absentee team member (the patient in this instance) that is just as effective as an individual who is physically present during a meeting in which decisions are being made? 

The patient experience, patient engagement, and patient satisfaction is what I like to refer to as the Patient Triad.  Are each of these three patient-centered areas that make up the Patient Triad being given the same analysis and consideration as the clinical and financial areas during each and every EHR implementation countrywide?  Many industry professionals may venture a guess that the answer to that question is no, but maybe there is a logical reason as to why this still is the case.  The approach to analyzing and optimizing the Patient Triad is much different than the somewhat standardized approach to analyzing the traditional clinical or financial areas.  An example of this can be found in a well-known consumer satisfaction statistic which has shown that for every 1 customer that bothers to complain, there are 26 other dissatisfied customers who remain silent1 .  If the patient, who is the consumer in this instance, is not “at the table” to voice 1) their dissatisfaction and 2) the reason(s) for that dissatisfaction, how can an organization begin to be expected to rectify a problem they are not aware is even occurring?  In this instance, without the proper approach and structure in place, it would be impossible for an organization to use an EHR implementation as a springboard for optimization of workflows in this area.  The components of the Patient Triad are unique to each and every healthcare institution based on the unique circumstances of the institution itself and the specific needs of that particular patient community.  Therefore, the components focused on when tackling the prospect of optimizing the unique Patient Triad considerations in fifty different hospitals across the country will often be different each and every time, whereas the approach to standardized clinical best practices such as monitoring/documenting vital signs in fifty different hospitals in fifty different states will be relatively similar.  

The bookends or anchors of the Patient Triad can be found in two modules/areas in which their name inevitably gives them away: Patient Access and the Patient Portal.  These are two areas in which the patient’s voice is unequivocally one of the most important on the individual implementation teams.  When the Patient Triad is not analyzed concurrently during an EHR implementation with the same care and consideration as the other areas/workflows, especially in the “bookend modules,” the approach will inevitably become a reactionary one.  When any aspect of a workflow is left to be developed or truly evaluated until after the system goes live, it is hard not to fall into the all too common knee jerk reaction type of resolution method. This will without fail create both an ineffective and unmanageable methodology for any organization, especially when dealing with these less straightforward areas that are grounded in the patient’s discretionary evaluation or assessment.

Thinking about the prospect of tackling this area in an attempt to truly make a longstanding difference can be overwhelming, especially when the prospect of an EHR implementation is on the immediate horizon.  However, do not let the vastness or uncertainty of what lies ahead serve as a detractor from undertaking it.  When beginning down this road, it is important to keep three things in mind:

1.  Dedicated Point Person: In the same way every module or area has a team lead designated to leading the charge in analyzing and implementing, the same should be true for the Patient Triad.  This holds true for not only EHR implementations, but also during post-live optimization phases.  This responsibility should not be added onto an individual’s already full plate of work, rather it should be adequately planned for during both the resource allocation and budgetary discussions.   It will be the responsibility of the individual chosen to have a working knowledge of all of the different areas of an organization, as the factors that make up the Patient Triad may vary greatly from department to department within one organization.  In addition, they also must be able to assess and plan for the intangible factors that come into play when dealing with general consumer satisfaction.

2.  Stay Well Versed & Vocalize: The old adage that “knowledge is power” absolutely still rings true and giving the Patient Triad a voice is half the battle.  When starting the journey of assessing these areas, a review of relevant industry statistics is a must.  Part of proactively and effectively tackling this area involves a) an honest evaluation of an organization’s current state and b) becoming familiar with the research other organizations, institutions, and/or agencies have completed and published.  This will ensure that an individual institution is truly informed on the goings on both inside and outside of the walls of their organization.  Once a knowledge base has been gained, open and honest communication of that information is paramount.  Information sharing is key in laying the groundwork for large scale change if needed.  In order for people to be open to change, they need to understand the “why” behind it.

3.  Dig Into the Cultural Considerations: Just as every town, county, state, and geographical area around the United States has a culture that is unique to them, so does each patient community for every hospital or practice out there.  Take a deep dive into what makes a particular patient community unique, and leverage workflows that make sense even if they occasionally require a bit more manual work for staff.  An example of this can be seen in an organization or practice that primarily treats a patient population who largely shy away from or are unable to utilize electronic means of technology to communicate.  If the majority of the patient community have little to no access to either a computer or smart phone, low computer aptitude scores or a general cultural resistance to communicating electronically, then the approach to garnering concrete feedback must be adjusted accordingly.  Do not abandon reaching out to patients via surveys, for example, simply because it does not make sense to do so electronically.  Rather try and implement an approach that the patient community is more comfortable with, even if it requires the occasional manual entry of results by staff.

With each and every conversation or article written surrounding how to improve the Patient Triad, we as both industry professionals and patients become agents for change in an area that can impact a person in their greatest time of need. 

About The Author:  Brittany Frazza has served as highly qualified consultant for HealthNET Systems Consulting, Inc. and is currently in charge of Marketing and Strategic Innovation for HealthNET.  She has a Masters in the Science of Jurisprudence in Health Law from Seton Hall University School of Law and 5 years of experience in Healthcare IT.


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Technical Assistance Research Programs (as cited in A Complaint Is a Gift - Using Customer Feedback as a Strategic Tool, Janelle Barlow and Claus Moller, Berrett-Koehler Publishers, 1996)