Bringing the equity lens to patient experience
Healthcare is a calling. And so is patient experience. Have you felt that calling lately?
Maybe you’ve sensed that we need to rethink our definition of “experience.” That the silos we’ve traditionally bucketed experiences in need to be broken—that we need a more cohesive way to come together and deliver high-quality healthcare for every patient in our charge. If you’ve sensed this too, you’re not alone.
As healthcare has changed, so has the concept of patient experience. We have to take a more holistic, end-to-end view of “experience” to deliver on the promise of healthcare that’s safe, high quality, equitable, and truly human-centric, for everyone.
But different people experience care differently. Race and ethnicity, sex and gender identity, age, and other factors can significantly influence the experience at different points of their journey. For those of us working in healthcare, our own preconceptions, unfortunately, may be preventing us from seeing, hearing, and absorbing information we need—information about the patient experience, and how it intersects with the employee experience, too. We must confront our history, challenge our thinking, and disrupt our cultures—so we can listen and connect at a human level. We must recognize that diversity, equity, and inclusion (DEI) are essential components of what we are called to do. That’s how we create hope in our communities.
Those of us who serve as experience leaders, whatever our job descriptions say, must do the courageous work of actually leading experience. And we have to make sure everyone across the board has a high-quality experience at every interaction with your hospital or healthcare organization. That’s no easy charge—as Christy Moore will readily tell you.
Moore is Manager, Patient Experience Analytics, at Michigan-based Bronson Healthcare—and someone I am privileged to call a friend and colleague. As background: Bronson is the largest employer—and leading healthcare system—in southwest Michigan, with 8,800 employees, 1,500+ medical staff members, 68 patient care sites, and 796 licensed inpatient beds. For over a decade, Bronson has partnered with Press Ganey on several initiatives, including the urgent and critically important work of measuring patient experience through an equity lens.
Moore recently shared an inside look at this collaboration, and beyond that, how Bronson is focusing PX conversations and insights around driving equity.
Building a patient experience strategy on top of Bronson’s commitment to equity
Several years ago, Bronson Healthcare embedded a “commitment to equity” into its plan for excellence. The plan for excellence is a one-page document that lets employees know what’s important to the organization and guides their daily work. When Moore started in her patient experience role, she sought to understand what Bronson could learn beyond traditional CAHPS reporting. Specifically: Whose experience with Bronson was less than ideal? And what was causing the disconnect between those having positive experiences, and those whose experiences were lacking? Was it based on age, sex, gender identity, race, ethnicity, or something else entirely?
“Talking about race is hard. Acknowledging that systemic racism is impacting patients’ experiences is even harder. We all have blind spots and unconscious biases.”Christy Moore
Manager, Patient Experience Analytics, Bronson Healthcare
But issues with the integrity of the demographic data clouded the picture. Bronson, which collects race, ethnicity, and language (REaL) data in its electronic medical record (EMR) system, discovered in 2017 that nearly 15% of patients didn’t answer all demographic questions. What’s more, among those who did, there was a 20% error rate in how they self-identified vs. how the EMR identified them.
Bronson learned that across every care setting—from the emergency department to medical practices to inpatient surgery—its PX scores showed large differences between white patients’ and Black patients’ responses. Representation also was lacking: In 2022, Black patients made up about 10% of system encounters, but less than 4% of survey responses.
These numbers added up to a major challenge for Bronson’s service council (a patient-centered experience committee made up of executives and physician leaders). “Talking about race is hard,” Moore says. “Acknowledging that systemic racism is impacting patients’ experiences is even harder. We all have blind spots and unconscious biases.”
Asking patients the right questions to uncover a system’s unconscious bias
When Bronson Healthcare leveraged Press Ganey technology to reimagine its survey tool, it was an eye-opening experience. As Bronson’s team members soon learned, unconscious biases can have undue influence, even on the survey questions themselves. In its efforts to hear directly from patients why individuals had a worse experience than others, Bronson Healthcare added a question to all 88 of its patient experience surveys: How well did staff respect your needs based on race and ethnicity?
The intent was simple: Moore simply wanted to ask if patients felt they were treated with dignity and respect. If they answered yes, they could proceed to the next question. And if not, she wanted to know more. But the answers to this question were lacking—or “inflammatory and polarizing,” as Moore puts it. So back to the drawing board she went.
In the next iteration, Moore first asked if patients felt they were treated with dignity and respect, then proceeded from there. The team used branching logic technology: Patients who answered yes were directed to the next question, while those who did not feel treated with dignity and respect were guided to a different set of questions so the Bronson team could determine why.
Bronson selected 10 potential reasons that patients might feel disrespected. These were incorporated into the revised survey so patients could choose the most appropriate one(s).
When the new survey went live, 99% of respondents said they felt treated with respect and dignity. But that wasn’t good enough. How about that 1%—a total of 2,553 patients—who did not feel that way? “That’s unacceptable,” Moore says. “Our organization is meant to care for them, yet they left and did not feel respect and dignity. Every patient, every time, should feel respect and dignity.”
Unexpected answers to complicated questions
Bronson’s leaders were surprised to learn that the top two reasons people gave for not feeling respected were age and disability—outpacing race, sexual orientation, gender identity, and religion. Meanwhile, body size—which wasn’t on the list—showed up in a significant number of comments. Elsewhere, historically marginalized patients, like individuals of color and members of the LGBTQ+ community, felt less respected than straight, white patients.
The redesigned survey proved revelatory—and vital to Bronson Healthcare’s ongoing work to reimagine care. Since its launch, the accuracy of Bronson’s demographic data has improved to more than 90%, and other changes are in the works. For now, Bronson’s strategy for improvement is focused on building awareness, with extensive training and education around diversity, equity, and inclusion (DEI). Access to care remains a central issue. Logistics and reporting—two new considerations for this health system—have posed a challenge. But Bronson is busy laying the groundwork for its move into the action phase, hopefully this year.
4 immediate actions for building equity into patient experience
While this work is hard, it’s more important than ever to keep humans at the heart of compassionate, connected care. As a starting point, Moore recommends the following actions to reimagine care through an equity lens.
- Look at your data differently. Are you looking through the right lens, or is your view skewed by unconscious bias? Are any of the survey questions, design, or methodology unintentionally leading?
- Get curious. Ask yourself: What else do I want to know more about? Dig into the subject, read the survey comments, and learn from what your patients are telling you.
- Lean on a group of advisors. Change doesn’t happen in a vacuum. It takes a group with varied perspectives to have the kinds of conversations that drive change. The work team that reimagined Bronson’s patient survey comprised operational leaders, IT, and patients.
- Share comments. Patients’ candid responses humanize survey data and build empathy. So share, share, share—and learn, learn, learn.
“We have such a valuable tool that, I think, is sometimes underutilized in healthcare organizations. Now we know what our patients are feeling.”Christy Moore
Manager, Patient Experience Analytics, Bronson Healthcare
At the end of the day, we can’t do this work alone. It’s important to forge partnerships to further our collective efforts to improve the Human Experience of healthcare, and deliver that experience with more compassion, and more empathy, than ever.
Press Ganey remains committed to helping healthcare organizations disrupt static cultures, challenge status-quo thinking, and reimagine care through an equity lens. Reach out to a member of our patient experience team to learn how, together, we can build a brighter future for healthcare, for everyone.