How operational friction impacts employee experience, and how to fix it

Consider this scenario: Dr. Garcia works hard to establish trust with each patient she treats, beginning with their first appointment. She’s an empathetic listener who can explain complex diagnoses and treatments in simple, easy-to-understand terms. She’s a top-notch physician who truly cares. But some things are outside her control.

Too often, she finds herself trying to overcome friction that occurred in other areas. Her patients encounter multiple bumps in the road just getting there. Repeatedly being put on hold, then getting disconnected before making an appointment. Inadequate signage from the lobby to the right office. Spending way too much time in the waiting room. When doctor and patient finally meet, their interaction is hampered by an underlying tension and mistrust that’s difficult to overcome.

Operational friction places burden on both patient and caregiver. Through shortcomings of the system and processes, the patient experiences undue friction on the front end, and that friction is absorbed by the doctor and healthcare employees. It’s frustrating for all involved.

Vicious and virtuous cycles

When operational friction happens, somebody—whether it’s the clinic administrator, member of the care team, or the physician, or other healthcare employees—must try to solve that problem for that patient. This creates extra work that interferes with their ability to do their job properly, layering onto the stress. This impacts resilience (initially as a decrease in decompression, but over time as a decrease in activation), which hurts engagement. Reduced workforce engagement is related to lower levels of patient experience. Poor patient experience further impacts clinician resilience and employee experience. It can turn into a vicious cycle, repeating itself with increasingly bad results.

What we need in healthcare is a virtuous cycle. Think about a time when a patient’s healthcare experience went something like this: They easily made an appointment without struggling with wait times, they had a great interaction with their clinician, and the follow-up was timely and thorough. Unfortunately, the virtuous cycle is rare in our business, but it’s what we should aspire to. Other industries are delivering experiences like this, and, as a result, expectations have been raised for healthcare to be more efficient with less friction.

Patients can be very forgiving—we don’t have to get every single thing right for a patient to have a net positive experience. But we must get better at getting the little things right. Often, we’ll get the “hard” things right: making a complex diagnosis, or connecting social determinants of health to a patient’s challenges and addressing them head-on. But when we fail to get less complicated pieces right—like scheduling an appointment—that makes it hard for the patient to get back onto a virtuous cycle of complete trust and loyalty.

2 layers of frustration for patients and for healthcare employees

In previous blog posts in this series, my colleagues Rachel Biblow and Dr. Tejal Gandhi discuss other negative impacts of operational friction: Rachel on the patient experience and patient loyalty, Tejal on patient and workforce safety. The third leg is the employee experience—particularly the physician/caregiver experience. It’s all connected, of course, but each of us has our own role to play in trying to minimize the problem of operational friction to improve experiences across the entire continuum of care.

While Dr. Garcia is a fictional character created to illustrate the snowball effect of operational friction, the details of that example will seem familiar to many healthcare employees today. Clinicians aren’t the only ones who suffer the secondhand effects of operational friction; it affects everyone in the workforce as it reverberates outward. There are two layers of frustration. The first can erode a patient’s trust in the clinical workers and healthcare organization. The second can accelerate employee burnout—and cause healthcare employees to lose trust in the organization they work for. In other words, operational friction that creates a loss of trust for patients also compounds the challenges that healthcare employees are already experiencing.

Members of the healthcare workforce have their own set of “operational frictions” in addition to those they’re absorbing from patients. They may lack adequate resources to deliver the level of care they want to provide. They may feel pressure from external barriers like government regulations, policymaking bodies, and medical licensing boards. There may be internal conflicts with colleagues, managers, or executive leadership.

Physicians can also experience moral injury when they know what needs to happen for a patient to improve, but are unable to make it happen because of operational challenges. In addition to the previously mentioned frictions (scheduling, signage, wait times, etc.), there are many others, including social determinants of health, inequities in care, government regulations, and insurance company restrictions.

5 strategies to reduce operational friction in healthcare

During my 25 years in healthcare, I've witnessed plenty of operational friction. As a primary care physician, it was devastating to learn my 85-year-old patient with chest burning and difficulty swallowing waited months to be seen because of difficulty scheduling an appointment. In my current role as Chief Clinical Officer at Press Ganey, I have a front-row seat, thanks to our extensive data and analytical insights, to just how disruptive operational frictions can be for patients and healthcare employees. Based on these insights, here are five strategies for confronting and overcoming operational friction—and avoiding it in the future.

1. Start small, and go big. In order to deliver high-quality healthcare, we need reliable people and reliable processes. That requires investing in both people and processes.
   Starting small means listening to the front line and breaking things down to the most granular level—like the small group of people in a clinic who are caring for a patient. This group must connect as a team; otherwise, it’s easy to get into an us-vs.-them mentality or the “blame game,” neither of which enables us to achieve the vision we’ve aspired to bring into reality. Organizations must survey, engage, and enable front-line workers to speak up and speak out.
   From there, clinic leaders and managers must feel empowered to share their collective challenges with the person they report to. That way they can get the resources and support they need for themselves and the front line.
2. Remember we’re all on the same team. Instead of “wearing the jerseys” of individual departments, we should be wearing the organizational jersey. Excellent (compassionate, connected, and expert) patient care requires coordination and communication between all involved. For example, a patient who needs a knee replacement has an entire care team overseeing their journey, including their primary care provider, orthopedist, physical therapist, anesthesiologist, nurses, and more. Operational frictions and organizational silos often get in the way of a care team’s ability to focus on the patient’s journey. But working across professions is what we all must do if we are to create a continuous patient experience that doesn’t lose information—and create frustration—along the way. I envision a future where our success is contingent on giving smaller teams more autonomy to do their best, while connecting them with one another so they work together instead of in silos.
3. Fix the systems and processes. Clinicians and nurses often feel like patient experience data is weaponized against them when things don’t go well. Front-line workers may feel they alone are being held accountable when a patient's experience is less than ideal. In reality, their effectiveness might have been hampered by inefficient workflows, insufficient staffing or scheduling, outdated processes or policies, and other factors. Asking doctors and nurses to be compassionate, connected, and caring while not fixing the operational frictions that are hampering them can lead to even more burnout among healthcare workers.
   When organizational leaders use patient experience data to motivate their healthcare employees to become better at compassionate connected care, they must also have plans for fixing the systems and the processes that are causing frustrations and limiting effectiveness in the first place. That might mean a realignment of scheduling, a policy change, or a process improvement.
4. Coach, train, listen, and learn. Coaching and training are essential as we strive to create virtuous cycles that will enable us to deliver the best care possible, as well as friction-free experiences. Whether it's communicating with patients, showing compassion, or learning how to listen better, there's nothing more critical than empowering ourselves and others to be lifelong learners. And the best way to learn is to tune in to the data, share the data, and act on the data to drive positive, sustainable change.
5. Act on your data. Data can reveal volumes about our patients, our organizations, our employees, and the crucial intersections between them.
   The same goes for different segments in the workforce. For example, our data shows that the millennial workforce wants something different than those who are older. We know that female physicians are having a very different experience than male physicians. And we know that minority groups in healthcare are having a very different employee experience when it comes to inclusivity. We need to break down the segments of the employee experience, use the data, and solve for those different segments’ needs. I'm hopeful that, as organizations use their data, they can more effectively reveal, prioritize, and solve those needs.

To learn more about how operational friction impacts healthcare organizations, as well as the strategies that can help eliminate friction for employees and patients, download our e-book: “The hidden costs of operational friction.”