Roundtable Talk





How can we improve the patient experience in Middle East hospitals?





Methodist International Dubai and Middle East Health magazine jointly hosted and sponsored a roundtable discussion at the Ritz Carlton DIFC, Dubai on 22 October 2012. The objective of this event was to discuss the importance of patient-centred care in the region as well as best practices for creating and maintaining a unique and highly successful ‘Patient Experience’. Thirteen healthcare leaders from different areas of the healthcare industry including healthcare regulatory agencies, hospitals, and technology related companies participated in the discussion. Following are some of the highlights of the session.

Dr Sarper Tanli, Vice President of Methodist International, welcomed the guest of honour Cathy Easter, President and CEO of Methodist International in Houston, Texas. He pointed out that Cathy believes that a comfortable environment should be formed where all patients feel special and unique, and that this philosophy stands at the core of the international patient services for Methodist.

The Presentation

Cathy Easter opened the roundtable discussion with a 15-minute slide show about Patient Experience and the importance of having patient-centred care.

In summary, she said: “I would love to see the Texas Medical Center move towards not just being the largest, certainly in volume, but becoming one of the best in creating patient experiences. We see a lot of international patients from all over the world.

“The Methodist Hospital is well recognised and has won many accolades. If I had to pick one from the list, it would have to be that we are one of the best companies to work for. We engage our employees and educate them on why the patient experience is important. We help them understand how our patients view us and what we do, and stress that every interaction our patients have with us – nurse, housekeeping, guest relations, doctor – impacts the patient’s overall opinion of our organisation. We let our employees know that they’re part of something more important than just coming to work and doing a job. Ultimately, positive results can only occur when every employee is personally responsible and active in driving safety, quality and the patient experience.

“At Methodist, we want all our patients to feel special and unique. A personalised healthcare experience fosters these feelings by addressing physical, emotional and spiritual needs. Our commitment to our patients remains our priority. As essential shared objectives that we carry out every day, the Methodist ICARE (Integrity, Compassion, Accountability, Respect, and Excellence) values are fundamental to the Methodist experience. In conjunction with an emphasis on service and safety, Methodist values are essential to creating a personalised patient experience. Every patient and guest deserves to be treated with our highest standards of care and hospitality.”

The Discussion

The roundtable discussion was moderated by Dr Sarper Tanli who used leading questions to direct a relatively informal and freeflowing discussion among the panellists.

Dr Sarper Tanli

As regional experts what does patient experience mean to you? From the things you see in your organisation what are the elements in terms of standards or techniques that you wish to implement to try and improve the patient experience?

Thomas Murray

I have noticed that the concept of time here is more valuable than in the United States. This is particularly evident in our call centre. In the United States we would allow maybe 10 rings, but here the caller will hang up after five. We bring employees in from across the world to work here and we have to inform them that they cannot wait. We train them on the expectations of timeliness and speed of response to our patients.

Dr Hassan Al Rayes

When you talk about patient experience, you really have to individualise it and try to suit everyone’s needs based on their own background or expectations. That’s what we have to work with.

Dr Amir Adolf

In response to what Mr Murray was saying about the patient experience – being hyper active doesn’t necessarily mean that they are actually communicating to or with the patient. I think if we can slow the patients down to allow for a better connection with them, we can explain the realities of the care in front of them. When we actually inform the patients, we start to win them over.

Greg White

In hospitals, I like the fact that someone knows me personally or greets me by my name. It’s great that some organisations are doing this. But when I am at a hospital I am also concerned about the quality of care and that my family member is receiving the correct treatment, for example.

Cathy Easter

I think that you raise a really excellent point. People know if their food is hot and they know that they have been treated respectfully, but they don’t always know if the treatment is perfect. But if you are paying attention to every guest all the time and say hello, make him feel good, that attention to detail certainly can alleviate other fears. You don’t really know if your surgical incision was absolutely the best incision it could have been. But a lot of times the attention to other non-clinical details, we believe can set the right patient-experience culture, not just for care givers but also for non-clinical caregivers as well.

Ala Atari

Customer service is not the same around the world and it has to be personalised based on where you are located. What works in the United States, doesn’t always work in Saudi or other parts of the world. To write a book about customer service, it will not be a general international book because we really have to customise everything to where we are.

Thomas Murray

I would go along with that. Our patients resent the nurses taking time away from them to document. Some people don’t mind it, but I noticed many of the folks especially one’s that come from little farther away from Dubai, are saying wait a minute, are you worried about me or are you worried about the screen there? Maybe we need to do a better job at explaining some of these things. It is that interface, like you said Cathy, that creates a problem and it is a significant one here. In America people like to see the technology being put into play. They can see the value of it, but it is not so here.

Greg White

We have had a lot of backlash over the years from introducing technology into what used to be doctor-patient experience, nurse-patient experience, etc. We have seen a huge growth in technologies, like iPads, voice-recognition software, etc, which have increased the speed of delivery and convenience, but we do still see people saying: “We really don’t want you doing that. I want you to discuss and interact with me.”

Going back to the patient experience, I think the bar is being raised. We are still humans, we want care and we want the best quality care. The way it’s delivered and the way that it’s experienced is different from one place to another, but I think that one thing is universal and that is the level of demand is going up. I do think that organisations like Methodist are on a bell curve. However, we’re at the upper end of that bell curve where our concern for quality is demonstrated. A lot of organisations are not that driven by that.

Dr Sarper Tanli

We talk about individualised health plans and other things and obviously when we are outside Dubai, the expectations of the population are different because of the varying demographics and profiles. In terms of the standards and techniques, it was wonderfully noted earlier that adapting is a technique.

What are the challenges that you see in terms of adapting and putting these standards and techniques in place?

Dr Naeema Aziz

We are definitely focused on patient experience. But what I have noticed in this region is that patient education is lacking. That is a very big factor in introducing any new technology, anything that is going to help us to provide the best customer service to them. It goes both ways, the patient has to be cooperative and I think that insurance companies can play a big role in that because patient education is the ideal.

Randy Edwards

I think technology will enhance the educational experience that we can provide patients. It will allow us to not have to gather that white board information every time, like your name, address, zip code, etc. but to help coordinate, standardise and provide some of their medical records. Why wait 3 days for the report, when they can get it within a few minutes or a couple of hours. There has to be a balance between how much new technology, or new elements of it, are introduced to healthcare. The practice of healthcare is really an old practice that we are trying to enhance in order to adapt it to a fast-paced world.

Lina Shadid

Being a patient, I think that education of the providers is much more important than putting the EMR [Electronic Medical Record] system in place or installing the best IT tools, because they don’t know how to use it effectively and it ends up looking bad for the patient.

Greg White

At our hospital, we ask for

 experience, you can look at technology as a benefit when an organisation like Methodist has this desire. I think the impetus is to create a better personal experience with better outcomes and better personalised health with more attention to detail. It goes back to the organisation and at its core has to be clear the reason why we are going do this and why it matters – and then you start filling in the blanks.

Ala Atari

At our hospital, we ask for our customer’s feedback in the form of electronic media and phone calls. I also visit patients while they are being treated at the hospital and ask for their feedback in person regarding complaints, food, temperature etc. I noticed that less than 1% of the complaints were about patient’s not receiving good customer service. In fact, the patients literally had to think about the complaint they wanted to bring up. I think we overdo it and ask for so much feedback about customer service that patients are sort of being forced to just complain. Dr Amir Adolf I think Methodist has invested in the structure and process as well as the environment of care, outcomes of which affect the patient. There are other systems I think we should pay close attention to. In fact, if we invest our time (not necessarily money) early on and upfront, technology should be inserted naturally to the process and not forced on providers. I appreciate what Shadid was saying earlier about how we can really educate doctors. Doctors love to be educated and love to be informed, but when you force unnatural events into the natural experience of encountering a patient, they question why they should do it.

Fida Ghantous

Any kind of engagement that we have – either here, the United States or Europe – has always been that you put yourself in the patient’s shoes. You start looking at your processes, where do I customise my interactions with the patients and how do I drive that experience to increase the touch points with my patient care at the end of the day. And on the enabling technologies I completely agree. You can’t really force feed it, it has be something that not only facilitates the change but actually makes a system.

Technology to enhance the patent experience

Dr Sarper Tanli

If you look at the journey from the patient’s point of view, how can we re-engineer the processes? How we can implement elements of technology? I am not only talking about e-health, but interactive media, other things that really have a touch point with the patients … how can we do that better?

Randy Edwards

I think it is more about the process. The tools are great, but I think it is the process. Compared to the experience I’ve had in the United States, [the experience I had at the Dubai Mall Medical Center] is a 100% better than in the United States. The way they shared information, the way they treated you, it really isn’t technology per se. The technology was there, but it was the way they approached the patient. So again technology is great, but it is the process that will take care of it. So I think it goes back to organisational values and support.

Cathy Easter

You have to accommodate people where they are and I think that’s where technology can be your gift because you really can schedule a lot of the things. They can schedule their own appointment, although not every time if it’s an emergency or other things. But if it is outpatients, there are lots of ways we could utilise the technology in a way that it is actually a gift to the patient and not intimidating. Not as much in the direct care-giving experience, but a whole lot more to support the patient experience. In some of the outpatient areas we make sure that we have magazines or an iPod loaded with music that they said were their musical preferences. It would surprise them and again give them some level of comfort that you care about some of these little touches.

Dr Hassan Al Rayes


In many of these innovations and processes what I see is that we have two issues. We have the medical and we have the patient care part. Traditionally people tend to concentrate more on medical – so in designing these structures, the doctors and nurses are doing everything. It is very rare that we have patients participating in that process. You ask the question how can we do this better? How can I make sure this medication is safe? You can only look at it from the perspective of the physician, or perhaps the nurse giving the medication. I can see why we can get further away from a patient-centred experience. Perhaps we need to have more patient input.

Dr Joseph Naoum


One point that we have to consider, especially about what Dr Al Rayes said, is to know what a patient wants. We really need to ask the patient, and often times we just need to give them choices. Patients don’t want more technology; patients want a hello, a clean environment, good care, outcomes and so forth.

Hospital design and the patient experience

Dr Sarper Tanli

What is the role of design in the environment… the environment that we create for our patients? How does it affect the patient’s experience?

Randy Edwards


I think the big change you have seen in the last 10 years is a big push towards [design] being much more about the patient and towards having an exceptional patient experience. Getting away from institutional [style] and bringing in more hospitality and a healthy environment where you have a lot more open space. The patient experience really starts from the time they pull into the complex.

Dr Joseph Naoum

In general, hospitals have been moving towards getting the family involved not just by having rooms with areas for families to sit and then spend the night with the patient, but also outside gathering places for the family or areas where the family can have internet access.

Dr Hassan Al Rayes

Randy, you mentioned that patients want large rooms. How would you then integrate or get what patients really want into the decisions and the processes you have? Are there patient committees or surveys? How do you know what patients really want?

Randy Edwards


Well some of the main processes that we have had, where we have the had the opportunity to go talk with patients through the user groups was part of it, but we also, if you look at lot of the user groups that are practicing, understand the culture fairly well, understand what the demands are from the family and the religion that supports them. It is a combination of the user groups and the patients. Historically it’s mainly been through the user groups which would be your surgeons and your department heads.

Fida Ghantous

There is a disconnect between a lean design that is usually copied from somewhere else or adapted from somewhere else and the actual operations that are on the ground in the hospital today in a location like Dubai, Riyadh or Doha. So when you put these two together you end up with inefficient patient transport, you end up with a number of staff that is ridiculous because hospitals are always bigger. This is a pandemic we have in the region, where it has to be bigger and it has to be nicer than the next one.

Randy Edwards

I think that the biggest challenge has been with work in KSA. They demand efficiency. Because their standard rooms are historically smaller, we talk about increasing room spaces. A lot of this analysis has to be put in to the design process. It needs to be demonstrated to them, because if you don’t demonstrate it they won’t pay for it.

Dr Joseph Naoum


I think an important element of the environment when you build a 50-bed hospital, is that it has to be simple. People can go in and out without any problem, but when we build a 200-bed hospital (specialty or multi-specialty hospital), it becomes hard to navigate. It is not going to be simple especially for someone who is visiting for the first time. Some options we can provide to the patients are valet parking and have someone to greet them at the door to help guide them to the right place instead of trying to figure it out themselves.

Cathy Easter


Patient flow is a huge issue. This is an area where IT really can help your patient experience. I think that you can take it too far. We visited a hospital in Colorado and their onstage-offstage process was so segregated that I didn’t feel like anyone was there. I felt it was merely too separate, we didn’t see any employees and felt like we were isolated.

I think that these are really important issues in this region and other places where your nurse satisfaction is not going to be extremely high if they walk 10km a day just to get supplies and other things that they need. What ends up happening, however beautiful that design is, they will stockpile their stuff and it is not going to look good. This can lead to a negative patient experience. I think this idea of bigger and bigger can at times really create unintended consequences and can negatively impact your employee experience.

Dr Sarper Tanli

How do you get your employees to engage with patients to really enhance the patient experience? How can you improve communication and have a more sustainable patient experience that grows over the years?

Ala Atari

In the US, we used to take people who are smart and send them to school and invest two to three years and in return they would work and give back to the company. But here we simply cannot do that as people would just disappear after all the investment you have put into them.

Dr Amir Adolf

One thing you can have is an employee contract and within that contract you can specify the drivers and have limitations for your investment. People will sign up for these things when you offer it, but I see that there is a lack of interest in high prolonged education for physicians and nurses and allied health professionals.

Dr Rashid Al Abri

The experience in Oman is that we enrolled the nurses and the doctors in communication skills courses. Based on the scores they received, they would be awarded with the certificate of appreciation from the Director General or at the end of the year we give them some sort of reward.

Dr Joseph Naoum

I think the tone is really set from the top down. The management, the administration and the board needs to really set the attitude and the plan to move forward. Like you said there are contractual agreements, there is loyalty building, and there are incentives.

Dr Amir Adolf

I know we are limiting the discussion really to patient experience, but in fact we are seeing a new kind of consumer today in healthcare. IBM just finished a study a few years ago from CEO’s around the world and one of the things that came out of that study from the healthcare side was the rise of something that is now called a pro-sumer. These are producers and they are also consumers. They are hybrids that are empowered by information, technology and knowledge not seen before in our encounters. So when you add those pieces together what you are basically saying is that the environment of engagement between us as a healthcare system and the educational system of a country have got to rapidly advance what is available, when is it available and how it is available.

Dr Naeema Aziz


We have to keep another very important point in mind. This region is not used to paying for their healthcare costs. For example in Oman 80% of the healthcare system is public. If you try to convert that system into private can you imagine how many would like to pay? Saudi tried to come up with mandatory insurance, but with a government fund. The model here should be different because for centuries people have not paid for their healthcare.

Dr Sarper Tanli


What elements from the processes – from design to IT to education – should we implement to improve the patient experience in this region?

Dr Amir Adolf


Dell has reintroduced a very simplistic model. Arab hospitality is well known around the world, they do it very well in hotels and it can be duplicated here at the entry points of all the hospitals. We are working with that model in all of the Sohar facilities.

Randy Edwards

Going back to a tailored Patient Centre experience for the region is important and that needs to be addressed. You have to enhance the experience of the employees. Patients need to be happy and the best way to assess whether they are happy is to ask them. But then hospitals need to provide that environment and that care. Again it has to be tailored to the region and it has to be tailored to each particular hospital, because each hospital is different from the other due to the patient population.

Conclusion

Dr Sarper Tanli thanked all attendees for sharing their views on patient experience and concluded the roundtable by saying: “We have come up with a couple of ideas on how to connect with patients, and how to understand the expectations of the patients for each community. We focused on customer service, local nuances and how much technology you need. We talked about how to use technology more as background information to improve patient care. We also talked about the close family expectations and their experiences in terms of developing communication skills and training for staff and how we can engage them overall.”

Date of upload: 22nd Jan 2013

 

                                  
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