World Class PX Pulse

World Class PX Pulse

An important new patient experience audit process

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mins

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March 23, 2024
By
Assoc. Prof Dr. Maxwell Winchester, Keith Yates, Pam Poranan (Prae)

Assoc. Prof Dr. Maxwell Winchester
Keith Yates
Pam Poranan (Prae)

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The value of patient experience to the healthcare industry is immeasurable, yet health care facilities are often left in the dark when it comes to its effective measurement and consequent improvement.

In recent years, countries such as Britain and the United States have attempted to assess patient experience within health and hospital services on a broad scale.

However, the generic and quantitative nature of these assessments have resulted in hospitals and healthcare facilities being presented with unactionable data in terms of their own specific contexts.

To address this issue, YATES+ has launched the World Class Patient Experience (PX) Pulse: an exclusive measurement tool that helps health care facilities achieve world class patient experience.

The World Class PX Pulse is an auditing system that uses healthcare/hospitality professionals to identify what matters most to patients, offering health care facilities actionable data and the opportunity to focus on areas that need improvement.

 

Read more about the World Class PX Pulse here

Lounge experiences are commonly a guest’s first impression of an airline or airport, yet studies reflect significant guest dissatisfaction with lounge standards globally.

The APEX World Class Lounge by YATES+ award,  has been engineered to identify key elements of the airport lounge experience that matter most to guests.

By triangulating objective measures of lounge service quality alongside qualitative feedback, the APEX World Class Lounge Audit creates a well-rounded review of elements needing to be addressed in alignment with world class standards.

The APEX World Class Lounge by YATES+ award gives recognition to airport lounges of exceptional guest experience on a global level.

 

To learn more, continue reading here.

What’s a Rich Text element?

The rich text element allows you to create and format headings, paragraphs, blockquotes, images, and video all in one place instead of having to add and format them individually. Just double-click and easily create content.

Static and dynamic content editing

A rich text element can be used with static or dynamic content. For static content, just drop it into any page and begin editing. For dynamic content, add a rich text field to any collection and then connect a rich text element to that field in the settings panel. Voila!

How to customize formatting for each rich text

Headings, paragraphs, blockquotes, figures, images, and figure captions can all be styled after a class is added to the rich text element using the "When inside of" nested selector system.

Patient experience (PX) has been of interest in health care for many years, with the National Health Service (NHS) commencing its national patient satisfaction survey in 2001 and the USA introducing the Hospital Consumer Assessment of Healthcare Provider and Systems survey (CAHPS) soon after (Ahmed, Burt & Roland, 2014).  The US CAHPS Clinician & Group Survey launched in 2010, however was ceased a few years later (AHRQ, 2024).

Data on its own will not improve patient experience, there has to actionable information available and there needs to be a commitment to take action (Ahmed, Burt & Roland, 2014).

In fact, Coulter et al (2014) raised concern that despite the NHS implementing a thorough programme of PX measurement in 2013, there was no system in place to ensure the data improved performance.  This concern was confirmed in a study of all 153 NHS trusts which showed the results of the NHS patient satisfaction studies in various constructs did not lead to improvements in performance (Locock et al, 2020).  Below is the summary of patient experience dimensions included in different studies.  

The standard ‘customer satisfaction (CX)  measurement systems’ in healthcare or to be precise  - ‘patient experience (PX) measurements’ do not provide actionable feedback on what or how things need to be improved, which has been highlighted as most desirable by healthcare facility managers(Barry et al, 2015; Coulter et al 2014). PX measures also do not provide the much-needed ability to benchmark against other health care providers (Barry et al, 2016). Patients are not experts on health care service delivery (Ahmed et al, 2014; Barry et al, 2016), many have different expectations, which biases the results (Ahmet et al 2014)and most will have few comparison points to make a judgement on patient experiences.

Customer Experience (CX)/Patient Experience (PX) measures also assume that measuring customer attitudes of service provision is a valid measure of the service provision on offer(rather than actually measuring the service provision) (Sharp, Page &Dawes, 2000).

Objective measures of service quality by industry professionals are rare in practice, with the exception of mystery shopping, which is considered a marketing research-based variant of participant observation (Sharp, Page & Dawes, 2000). Across industries, mystery shopping has been demonstrated to be reliable and valid as a measure of customer experience(Dawes, Sharp & Adelaide, 2000) and the dimensions that emerge from mystery shopping generally resemble SERVQUAL dimensions. More specifically, simulated patient studies, known as ‘pseudo-patients’ (Lazarus, 2009) have demonstrated robustness over other patient satisfaction measures that include reduced recall bias, social desirability bias and elimination of bias from demographic factors (Campbell et al, 2013; Goodrich & Lazenby, 2022) and should be part of a health facility’s PX improvement programme (Lazarus, 2009).  

Mystery shopping more broadly has been used extensively in health care scenarios (Jacob et al, 2018) and has been demonstrated in one clinical setting to increase net margins by over 14 percent within 18 months of implementation (O’Neill et al, 2012) and in others, it contributed to significant improvements in PX, along with improvements in employee satisfaction and engagement (Garantino et al, 2013; Daouk-Öyry, 2018).

As much as positive impact of simulated patient studies created, there are still gaps in this measurement tool.

Firstly, mystery shopping is normally conducted using a tailor-made script or focus point based on existing standard of the medical facilities (e.g. Jacob et al, 2018). This leads to difficulties to benchmark regionally, nationally or globally. The absence of the opportunity to benchmark with the best in its category, leaves little room for the hospitals to improve to the best practice standard.

Second, most of mystery shopper providers do not offer actionable feedback by industry processionals, as they are “tick a box” exercises. Detailed qualitative feedback is required to aid the healthcare facilities improve their PX (Barryet al, 2015; Coulter et al 2014).

Lastly, it is questionable as to what is being measured. Most data collected on patient satisfaction including simulated patient studies are KPI-based. Based on the practice of mystery shopping in healthcare, measuring KPIs is important. It is still not a measurement of the experience of the patient (Barry et al, 2015).

To address these issues, the World Class PX Pulse is being launched in 2024. It is a first of its kind, measuring tool focusing on what matters to the patient categorised in 6 constructs. This will offer a patient experience auditing system that uses healthcare/hospitality professionals to rate the key aspects of patient experience, but more importantly provide detailed, actionable, qualitative feedback to participating health care facilities, focussing on the areas that require improvement. This is critical as it has been identified as a needed addition to PX measurement in health care settings (Barry et al, 2016). It is this qualitative feedback, alongside the recommendations from world class experience experts that is key to offer actionable strategic advice to health care facilities.  The PX Pulse consultant will use the data to provide specific areas of improvement to the executive team by benchmarking against other participating healthcare facilities. This will allow them to focus on the actionable recommended actions that will directly improve patient experience.

To take this further and to learn how the lounge audit is processed.
References:

¹ Cholkongka, N. (2019). Identification of service quality competency framework for the lounge attendants: a case of a privately-owned airline in Thailand. ABAC Journal 39(4) , 123-150.

² Nghiêm-Phú, B. (2017). An analysis of airline/airport lounge service using data gathered from airlinequality.com. Asia Pacfic Journal of Advanced Business and Social Studies, 4(1), 127-134

³ YATES+ have taken the decision to include sustainability and keeping guests safe as these are notable in the strategic plan of many airline, airport and lounge operators and have received a lot of attention in the wider media. A number of studies highlight the importance of cleanliness of lounges and lavatories which is an important part of the perception of “keeping me safe”.  The following studies also support the addition of “sustainability” as important in lounge and airport experiences:
• Abdel-Gayed, A. H., Hassan, T. H., Abdou, A. H., Abdelmoaty, M. A., Saleh, M. I., & Salem, A. E. (2023). Travelers’ Subjective Well-Being as an Environmental Practice: Do Airport Buildings’ Eco-Design, Brand Engagement, and Brand Experience Matter?. International Journal of Environmental Research and Public Health, 20(2), 938.
• Han, H., Lho, L. H., & Kim, H. C. (2019). Airport green environment and its influence on visitors’ psychological health and behaviors. Sustainability, 11(24), 7018

⁴ Cholkongka, N. (2019). Identification of service quality competency framework for the lounge attendants: a case of a privately-owned airline in Thailand. ABAC Journal, 39(4), 123-150.

⁵ Chua, B. L., Lee, S., Kim, H. C., & Han, H. (2017). Investigating the key drivers of traveler loyalty in the airport lounge setting. Asia Pacific Journal of Tourism Research, 22(6), 651-665.

⁶ Curkan, S. C., & Özkan, E. (2021). The effect of airline lounge services on the selection of airline. Journal of multidisciplinary academic tourism, 6(1), 17-26.

⁷ Han, S., Ham, S. S., Yang, I., & Baek, S. (2012). Passengers’ perceptions of airline lounges: Importance of attributes that determine usage and service quality measurement. Tourism Management, 33(5), 1103-1111.

⁸ Aditya Julio, S. E. Proposed service quality improvement using servqual method and importance performance analysis (ipa) of sultan executive lounge in sm badaruddin ii airport. Second International Conference on Theory and Practice (ICTP-2016), 28th and 29th, October, Melbourne, Australia
ISBN: 9780 9943 65613

⁹ Kim, Y. J., Ban, H. J., Kim, D. H., & Kim, H. S. (2020). Understanding customer experience of airline lounge using text mining of online review. Culinary Science & Hospitality Research, 26(2), 36-44.

¹⁰ Farris, P.W., Bendle, N., Pfeifer, P.E. & Reibstein, D.  (2010).  Marketing Metrics: The Definitive Guide to Measuring Marketing Performance.  Pearson: London

¹¹ Sharp, B., Page, N. and Dawes, J., 2000. A new approach to customer satisfaction, service quality and relationship quality research. Australian & NZ Marketing Academy Conference Proceedings, Griffith University.

¹²  See:
• Fisher, N. I., & Kordupleski, R. E. (2019). Good and bad market research: A critical review of Net Promoter Score. Applied Stochastic Models in Business and Industry, 35(1), 138-151.
• Keiningham, T. L., Cooil, B., Andreassen, T. W., & Aksoy, L. (2007). A longitudinal examination of net promoter and firm revenue growth. Journal of Marketing, 71(3), 39-51.);
• Kristensen, K., & Eskildsen, J. (2014). Is the NPS a trustworthy performance measure?. The TQM Journal, 26(2), 202-214.
• Mecredy, P., Wright, M. J., & Feetham, P. (2018). Are promoters valuable customers? An application of the net promoter scale to predict future customer spend. Australasian Marketing Journal, 26(1), 3-9.
• Romaniuk, J., Nguyen, C., & East, R. (2011). The accuracy of self-reported probabilities of giving recommendations. International Journal of Market Research, 53(4), 507-521.
• Pingitore, G., Morgan, N. A., Rego, L. L., Gigliotti, A., & Meyers, J. (2007). The Single-Question Trap. Marketing Research, 19(2).
• Sharp, B. (2006), “Net promoter score fails the test”, Marketing Research, Vol. 20No. 4, pp. 28-30.
Also see [https://customergauge.com/blog/airline-customer-experience-net-promoter-score] to see that according to this source Airlines such as Aeroflot, United Airlines and Thomas Cook score significantly higher than award winning airlines such as Singapore Airlines. Not surprisingly, this leads to industry experts to questioning the validity of the NPS.

¹³  Sharp, B., Page, N. and Dawes, J., 2000. A new approach to customer satisfaction, service quality and relationship quality research. Australian & NZ Marketing Academy Conference Proceedings, Griffith University.

¹⁴  Dawes, J., Sharp, B., & Adelaide, N. T. (2000). The reliability and validity of objective measures of customer service: Mystery Shopping. Australian Journal of Market Research, 8(1), 29-46.

¹⁵ Lowndes, M., & Dawes, J. (2001). Do distinct SERVQUAL dimensions emerge from mystery shopping data? A test of convergent validity. Canadian Journal of Program Evaluation, 16(2), 41-53.

¹⁶  Halvorsrud, R., Kvale, K., & Følstad, A. (2016). Improving service quality through customer journey analysis. Journal of service theory and practice, 26(6), 840-867.

The World Class PXPulse should not be seen as a replacement for patient satisfaction measures and Patient Retention Index (PRI).

Instead, it provides a complementary measure of patient experience that triangulates these other two measures and in addition, provides detailed qualitative feedback to the executive team for future improvements of patient experience.  We note LaVela and Gallan’s (2014) observation: “It is important to examine data collectively from multiple sources and evaluation approaches; in many cases using several different data collection approaches to produce a more informative, rounded picture is preferred (e.g., triangulation)” (p.31).  The PX Pulse will complete this triangulation for health care providers to complement patient satisfaction measures and PRI.

 

For more information about World Class PX Pulse, please email WorldClassPX@yatesandpartners.com

References:

Agency for Healthcare Research and Quality (2023). [available: https://www.ahrq.gov/cahps/helpful-resources/index.html]. Accessed 19th February 2024.

Ahmed, F., Burt, J., & Roland, M. (2014). Measuring patient experience: concepts and methods. The Patient-Patient-Centered Outcomes Research, 7, 235-241.

Barry, H. E., Campbell, J. L., Asprey, A., & Richards, S. H. (2016). The use of patient experience survey data by out-of-hours primary care services: a qualitative interview study. BMJ Quality & Safety, 25(11), 851-859.

Campbell, J. L., Carter, M., Davey, A., Roberts, M. J., Elliott, M. N., & Roland, M. (2013). Accessing primary care: a simulated patient study. British Journal of General Practice, 63(608), e171-e176.

Coulter, A., Fitzpatrick, R., & Cornwell, J. (2009). Measures of patients' experience in hospital: purpose, methods and uses (pp. 7-9). London: King's Fund.

Coulter, A., Locock, L., Ziebland, S., & Calabrese, J. (2014). Collecting data on patient experience is not enough: they must be used to improve care. BMJ, 348.

Dawes, J., Sharp, B., & Adelaide, N. T. (2000). The reliability and validity of objective measures of customer service: Mystery shopping. Australian Journal of Market Research, 8(1), 29-46.

Daouk-Öyry, L., Alameddine, M., Hassan, N., Laham, L. & Soubra, M. (2018). The catalytic role of Mystery Patient tools in shaping patient experience: A method to facilitate value co-creation using action research. PLoS ONE, 13(10): 1-17 e0205262.
https://doi.org/10.1371/journal.pone.0205262

Granatino, R., Verkamp, J., & Stephen Parker, R. (2013). The use of secret shopping as a method of increasing engagement in the healthcare industry: A case study. International Journal of Healthcare Management, 6(2), 114-121.

Goodrich, G. W., & Lazenby, J. M. (2023). Elements of patient satisfaction: An integrative review. Nursing Open, 10(3), 1258-1269.

Jacob, S., Schiffino, N., & Biard, B. (2018). The mystery shopper: a tool to measure public service delivery?. International Review of Administrative Sciences, 84(1), 164-184.

Jenkinson, C., Coulter, A., Bruster, S., Richards, N., & Chandola, T. (2002). Patients’ experiences and satisfaction with health care: results of a questionnaire study of specific aspects of care. Quality and safety in health care, 11(4), 335-339.

Johansson, P., Oleni, M., & Fridlund, B. (2002). Patient satisfaction with nursing care in the context of health care: a literature study. Scandinavian journal of caring sciences, 16(4), 337-344.

LaVela, S. L., & Gallan, A. (2014). Evaluation and measurement of patient experience. Patient Experience Journal, 1(1), 28-36.

Lazarus, A. (2009). Improving psychiatric services through mystery shopping. Psychiatric services, 60 7, 972-3 .

Lee, W. I., & Lin, C. H. (2011). Consumer hierarchical value map modeling in the healthcare service industry. African Journal of Business Management, 5(3), 722.

Locock, L., Graham, C., King, J., Parkin, S., Chisholm, A., Montgomery, C., ... & Ziebland, S. (2020). Understanding how front-line staff use patient experience data for service improvement: an exploratory case study evaluation. Health Services and Delivery Research, 8(13).

Lowndes, M., & Dawes, J. (2001). Do distinct SERVQUAL dimensions emerge from mystery shopping data? A test of convergent validity. Canadian Journal of Program Evaluation, 16(2), 41-53.

O'Neill, S., Calderon, S., Casella, J., Wood, E., Carvelli-Sheehan, J., & Zeidel, M. L. (2012). Improving outpatient access and patient experiences in academic ambulatory care. Academic Medicine, 87(2), 194-199.

Sharp, B., Page, N. and Dawes, J., 2000. A new approach to customer satisfaction, service quality and relationship quality research. Australian & NZ Marketing Academy Conference Proceedings, Griffith University.

By
Assoc. Prof Dr. Maxwell Winchester, Keith Yates, Pam Poranan (Prae)

Related Article

World Class PX Pulse

In this Article

World Class PX Pulse

An important new patient experience audit process

The value of patient experience to the healthcare industry is immeasurable, yet health care facilities are often left in the dark when it comes to its effective measurement and consequent improvement.

In recent years, countries such as Britain and the United States have attempted to assess patient experience within health and hospital services on a broad scale.

However, the generic and quantitative nature of these assessments have resulted in hospitals and healthcare facilities being presented with unactionable data in terms of their own specific contexts.

To address this issue, YATES+ has launched the World Class Patient Experience (PX) Pulse: an exclusive measurement tool that helps health care facilities achieve world class patient experience.

The World Class PX Pulse is an auditing system that uses healthcare/hospitality professionals to identify what matters most to patients, offering health care facilities actionable data and the opportunity to focus on areas that need improvement.

 

Read more about the World Class PX Pulse here

Lounge experiences are commonly a guest’s first impression of an airline or airport, yet studies reflect significant guest dissatisfaction with lounge standards globally.

The APEX World Class Lounge by YATES+ award,  has been engineered to identify key elements of the airport lounge experience that matter most to guests.

By triangulating objective measures of lounge service quality alongside qualitative feedback, the APEX World Class Lounge Audit creates a well-rounded review of elements needing to be addressed in alignment with world class standards.

The APEX World Class Lounge by YATES+ award gives recognition to airport lounges of exceptional guest experience on a global level.

 

To learn more, continue reading here.

Caring for patients is at the heart of healthcare, yet the patient experience does not always reflect this intent.

Drawing on a decade of experience as a patient experience leader in the Middle East, Pam Poranan shares her expertise in elevating the patient experience.

She reflects on the common practice of combating patient dissatisfaction with staff training and reveals why this is often ineffective.

Her crucial insight into hospital operations and organisational culture highlights a deep understanding of how to transform the patient experience from the inside.

 

Access the full article here.

What’s a Rich Text element?

The rich text element allows you to create and format headings, paragraphs, blockquotes, images, and video all in one place instead of having to add and format them individually. Just double-click and easily create content.

Static and dynamic content editing

A rich text element can be used with static or dynamic content. For static content, just drop it into any page and begin editing. For dynamic content, add a rich text field to any collection and then connect a rich text element to that field in the settings panel. Voila!

How to customize formatting for each rich text

Headings, paragraphs, blockquotes, figures, images, and figure captions can all be styled after a class is added to the rich text element using the "When inside of" nested selector system.

5

min

mins

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In this Article

Patient experience (PX) has been of interest in health care for many years, with the National Health Service (NHS) commencing its national patient satisfaction survey in 2001 and the USA introducing the Hospital Consumer Assessment of Healthcare Provider and Systems survey (CAHPS) soon after (Ahmed, Burt & Roland, 2014).  The US CAHPS Clinician & Group Survey launched in 2010, however was ceased a few years later (AHRQ, 2024).

Data on its own will not improve patient experience, there has to actionable information available and there needs to be a commitment to take action (Ahmed, Burt & Roland, 2014).

In fact, Coulter et al (2014) raised concern that despite the NHS implementing a thorough programme of PX measurement in 2013, there was no system in place to ensure the data improved performance.  This concern was confirmed in a study of all 153 NHS trusts which showed the results of the NHS patient satisfaction studies in various constructs did not lead to improvements in performance (Locock et al, 2020).  Below is the summary of patient experience dimensions included in different studies.  

The standard ‘customer satisfaction (CX)  measurement systems’ in healthcare or to be precise  - ‘patient experience (PX) measurements’ do not provide actionable feedback on what or how things need to be improved, which has been highlighted as most desirable by healthcare facility managers(Barry et al, 2015; Coulter et al 2014). PX measures also do not provide the much-needed ability to benchmark against other health care providers (Barry et al, 2016). Patients are not experts on health care service delivery (Ahmed et al, 2014; Barry et al, 2016), many have different expectations, which biases the results (Ahmet et al 2014)and most will have few comparison points to make a judgement on patient experiences.

Customer Experience (CX)/Patient Experience (PX) measures also assume that measuring customer attitudes of service provision is a valid measure of the service provision on offer(rather than actually measuring the service provision) (Sharp, Page &Dawes, 2000).

Objective measures of service quality by industry professionals are rare in practice, with the exception of mystery shopping, which is considered a marketing research-based variant of participant observation (Sharp, Page & Dawes, 2000). Across industries, mystery shopping has been demonstrated to be reliable and valid as a measure of customer experience(Dawes, Sharp & Adelaide, 2000) and the dimensions that emerge from mystery shopping generally resemble SERVQUAL dimensions. More specifically, simulated patient studies, known as ‘pseudo-patients’ (Lazarus, 2009) have demonstrated robustness over other patient satisfaction measures that include reduced recall bias, social desirability bias and elimination of bias from demographic factors (Campbell et al, 2013; Goodrich & Lazenby, 2022) and should be part of a health facility’s PX improvement programme (Lazarus, 2009).  

Mystery shopping more broadly has been used extensively in health care scenarios (Jacob et al, 2018) and has been demonstrated in one clinical setting to increase net margins by over 14 percent within 18 months of implementation (O’Neill et al, 2012) and in others, it contributed to significant improvements in PX, along with improvements in employee satisfaction and engagement (Garantino et al, 2013; Daouk-Öyry, 2018).

Text Link
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But what qualities of an airline or independent lounge are important to guests? The research on important dimensions used in assessing lounge quality across key industry and academic studies are presented in the table below:

As much as positive impact of simulated patient studies created, there are still gaps in this measurement tool.

Firstly, mystery shopping is normally conducted using a tailor-made script or focus point based on existing standard of the medical facilities (e.g. Jacob et al, 2018). This leads to difficulties to benchmark regionally, nationally or globally. The absence of the opportunity to benchmark with the best in its category, leaves little room for the hospitals to improve to the best practice standard.

Second, most of mystery shopper providers do not offer actionable feedback by industry processionals, as they are “tick a box” exercises. Detailed qualitative feedback is required to aid the healthcare facilities improve their PX (Barryet al, 2015; Coulter et al 2014).

Lastly, it is questionable as to what is being measured. Most data collected on patient satisfaction including simulated patient studies are KPI-based. Based on the practice of mystery shopping in healthcare, measuring KPIs is important. It is still not a measurement of the experience of the patient (Barry et al, 2015).

To address these issues, the World Class PX Pulse is being launched in 2024. It is a first of its kind, measuring tool focusing on what matters to the patient categorised in 6 constructs. This will offer a patient experience auditing system that uses healthcare/hospitality professionals to rate the key aspects of patient experience, but more importantly provide detailed, actionable, qualitative feedback to participating health care facilities, focussing on the areas that require improvement. This is critical as it has been identified as a needed addition to PX measurement in health care settings (Barry et al, 2016). It is this qualitative feedback, alongside the recommendations from world class experience experts that is key to offer actionable strategic advice to health care facilities.  The PX Pulse consultant will use the data to provide specific areas of improvement to the executive team by benchmarking against other participating healthcare facilities. This will allow them to focus on the actionable recommended actions that will directly improve patient experience.

To take this further and to learn how the lounge audit is processed.
References:

¹ Cholkongka, N. (2019). Identification of service quality competency framework for the lounge attendants: a case of a privately-owned airline in Thailand. ABAC Journal 39(4) , 123-150.

² Nghiêm-Phú, B. (2017). An analysis of airline/airport lounge service using data gathered from airlinequality.com. Asia Pacfic Journal of Advanced Business and Social Studies, 4(1), 127-134

³ YATES+ have taken the decision to include sustainability and keeping guests safe as these are notable in the strategic plan of many airline, airport and lounge operators and have received a lot of attention in the wider media. A number of studies highlight the importance of cleanliness of lounges and lavatories which is an important part of the perception of “keeping me safe”.  The following studies also support the addition of “sustainability” as important in lounge and airport experiences:
• Abdel-Gayed, A. H., Hassan, T. H., Abdou, A. H., Abdelmoaty, M. A., Saleh, M. I., & Salem, A. E. (2023). Travelers’ Subjective Well-Being as an Environmental Practice: Do Airport Buildings’ Eco-Design, Brand Engagement, and Brand Experience Matter?. International Journal of Environmental Research and Public Health, 20(2), 938.
• Han, H., Lho, L. H., & Kim, H. C. (2019). Airport green environment and its influence on visitors’ psychological health and behaviors. Sustainability, 11(24), 7018

⁴ Cholkongka, N. (2019). Identification of service quality competency framework for the lounge attendants: a case of a privately-owned airline in Thailand. ABAC Journal, 39(4), 123-150.

⁵ Chua, B. L., Lee, S., Kim, H. C., & Han, H. (2017). Investigating the key drivers of traveler loyalty in the airport lounge setting. Asia Pacific Journal of Tourism Research, 22(6), 651-665.

⁶ Curkan, S. C., & Özkan, E. (2021). The effect of airline lounge services on the selection of airline. Journal of multidisciplinary academic tourism, 6(1), 17-26.

⁷ Han, S., Ham, S. S., Yang, I., & Baek, S. (2012). Passengers’ perceptions of airline lounges: Importance of attributes that determine usage and service quality measurement. Tourism Management, 33(5), 1103-1111.

⁸ Aditya Julio, S. E. Proposed service quality improvement using servqual method and importance performance analysis (ipa) of sultan executive lounge in sm badaruddin ii airport. Second International Conference on Theory and Practice (ICTP-2016), 28th and 29th, October, Melbourne, Australia
ISBN: 9780 9943 65613

⁹ Kim, Y. J., Ban, H. J., Kim, D. H., & Kim, H. S. (2020). Understanding customer experience of airline lounge using text mining of online review. Culinary Science & Hospitality Research, 26(2), 36-44.

¹⁰ Farris, P.W., Bendle, N., Pfeifer, P.E. & Reibstein, D.  (2010).  Marketing Metrics: The Definitive Guide to Measuring Marketing Performance.  Pearson: London

¹¹ Sharp, B., Page, N. and Dawes, J., 2000. A new approach to customer satisfaction, service quality and relationship quality research. Australian & NZ Marketing Academy Conference Proceedings, Griffith University.

¹²  See:
• Fisher, N. I., & Kordupleski, R. E. (2019). Good and bad market research: A critical review of Net Promoter Score. Applied Stochastic Models in Business and Industry, 35(1), 138-151.
• Keiningham, T. L., Cooil, B., Andreassen, T. W., & Aksoy, L. (2007). A longitudinal examination of net promoter and firm revenue growth. Journal of Marketing, 71(3), 39-51.);
• Kristensen, K., & Eskildsen, J. (2014). Is the NPS a trustworthy performance measure?. The TQM Journal, 26(2), 202-214.
• Mecredy, P., Wright, M. J., & Feetham, P. (2018). Are promoters valuable customers? An application of the net promoter scale to predict future customer spend. Australasian Marketing Journal, 26(1), 3-9.
• Romaniuk, J., Nguyen, C., & East, R. (2011). The accuracy of self-reported probabilities of giving recommendations. International Journal of Market Research, 53(4), 507-521.
• Pingitore, G., Morgan, N. A., Rego, L. L., Gigliotti, A., & Meyers, J. (2007). The Single-Question Trap. Marketing Research, 19(2).
• Sharp, B. (2006), “Net promoter score fails the test”, Marketing Research, Vol. 20No. 4, pp. 28-30.
Also see [https://customergauge.com/blog/airline-customer-experience-net-promoter-score] to see that according to this source Airlines such as Aeroflot, United Airlines and Thomas Cook score significantly higher than award winning airlines such as Singapore Airlines. Not surprisingly, this leads to industry experts to questioning the validity of the NPS.

¹³  Sharp, B., Page, N. and Dawes, J., 2000. A new approach to customer satisfaction, service quality and relationship quality research. Australian & NZ Marketing Academy Conference Proceedings, Griffith University.

¹⁴  Dawes, J., Sharp, B., & Adelaide, N. T. (2000). The reliability and validity of objective measures of customer service: Mystery Shopping. Australian Journal of Market Research, 8(1), 29-46.

¹⁵ Lowndes, M., & Dawes, J. (2001). Do distinct SERVQUAL dimensions emerge from mystery shopping data? A test of convergent validity. Canadian Journal of Program Evaluation, 16(2), 41-53.

¹⁶  Halvorsrud, R., Kvale, K., & Følstad, A. (2016). Improving service quality through customer journey analysis. Journal of service theory and practice, 26(6), 840-867.

First, is the leadership's commitment to a transformation. 


The leadership must support the wholistic change based on the understanding that each part of the patient journey can impact one another, meaning we must consider the entire healthcare journey7.  The C-suite of an organisation must publicly support the required transformation, giving all staff a sense of purpose that brings them together, working towards a common goal8.

Secondly, address the root causes of patient complaints and close those gaps as much as possible.

Patient complaints could be the result of a lack of standards or processes, unclear roles and responsibilities, lack of management commitment, overworked or insufficient number of staff9,overall lack of skills, or absence of willingness to excel.  If your organisation is facing multiple root causes, prioritise by choosing a top few, and work from there.

Lastly, the transformation implementation 
must centre around the ‘enhanced experience’.

Stakeholders must be consulted in the creation of the new service process that impacts the experience. Once agreed upon, this will be used as a core model in the training. Staff performance, recognition programme and KPIs must also be linked to the measurement of the enhanced experience.

During my time as a Patient Engagement Director, I worked closely with the leadership and different teams across the hospital operations to enhance patients’ and visitors’ experience following the same logic.

In the last year of the COVID-19 pandemic, our patient feedback fluctuated and showed a downward trend on all data collection tools.

The two main root causes were unclear service processes due to frequent changes and updates during the pandemic and staff were experiencing burnout and demotivation.

To tackle these, we established the notion of enhanced service processes throughout the patient journey. These were designed to deliver a patient experience that strengthened our hospital brand. The enhanced processes were designed through consultation with different departments involved in the patient journey. Added to this, we established a clear commitment by the leadership team to the new processes. The processes were then published in the service manual and shared with our staff.

This helped our staff to understand and visualise what an ‘excellent’ patient experience looked like. At each touchpoint on the patient journey, all staff were clear on what was expected from them in terms of their behaviours; 'what and how' to be with the patients. Teams across departments, such as receptionists and registration teams, had clarity on how they would work together at each touch point.

We then developed a tailor-made training programme with two main purposes; to uplift the spirit of the team and to learn and practise the new behaviours defined in the new service processes.

We invited frontline roles including receptionists, registration staff, and security team members, to join the programme.

To strengthen the trained behaviour, we launched our performance observation programme that measured the new service behaviours. Line managers met individually with their team once a month to coach and provide feedback based on the observation criteria.

We also had recognition initiatives on weekly and monthly bases, celebrating those who demonstrated new behaviours. We created 
an annual patient engagement expo, which highlighted the importance of patient experience and the key service behaviours for all employees.

Within eight months of the first launch of the transformation workshops, our patient review scores improved an average of 20% across various data collection tools, including Google reviews and Press Ganey surveys.

As a leader of the transformation, the result of the change was more than the numbers and scores. I witnessed the change at 
the individual level involved in the transformation processes. Staff showed up at work with high energy, and they were keen to help our patients and visitors. There was strong engagement between teams. Each took ownership of patient satisfaction and wanted to do their best to make their patients feel valued, respected, and personally attended to. The feedback received from handwritten comment forms showed a significant increase in patient compliments and these compliments often mentioned staff names!

If you are interested in enhancing patient experience at your facility, I am confident that these three steps will take you in the right direction.
‍Happy to connect and learn more about your patient experience story. Reach me via LinkedIn at https://www.linkedin.com/in/pamporanan/

Pam Poranan is Co-CEO at Yates and Partners Ltd

Associate Prof. Dr Maxwell Winchester is at Victoria University, Melbourne

and a member of the YATES+ Advisory Board
References:

1. Gaudet, T. (2022). Cultural transformation to a whole health system: lessons learned. Global Advances in Health and Medicine, 11, 2164957X221091452.

2. See:

- Kee, J. W., Khoo, H. S., Lim, I., & Koh, M. Y. (2018). Communication skills in patient-doctor interactions: learning from patient complaints. Health professions education, 4(2), 97-106.

- Sonis, J. D., Aaronson, E. L., Lee, R. Y., Philpotts, L. L., & White, B. A. (2018). Emergency department patient experience: a systematic review of the literature. Journal of patient experience, 5(2), 101-106.

3. See:

- Liu, J. J., Rotteau, L., Bell, C. M., & Shojania, K. G. (2019). Putting out fires: a qualitative study exploring the use of patient complaints to drive improvement at three academic hospitals. BMJ quality & 
safety, 28(11), 894-900.

- Baldwin, K. M., & Spears, M. J. (2019). Improving the patient experience and decreasing patient anxiety with nursing bedside report. Clinical nurse specialist, 33(2), 82-89.

4. See:

- Sonis, J. D., Aaronson, E. L., Lee, R. Y., Philpotts, L. L., & White, B. A. (2018). Emergency department patient experience: a systematic review of the literature. Journal of patient experience, 5(2), 101-106.

- Liu, J. J., Rotteau, L., Bell, C. M., & Shojania, K. G. (2019). Putting out fires: a qualitative study exploring the use of patient complaints to drive improvement at three academic hospitals. BMJ quality & 
safety, 28(11), 894-900.

5. Liu, J. J., Rotteau, L., Bell, C. M., & Shojania, K. G. (2019). Putting out fires: a qualitative study exploring the use of patient complaints to drive improvement at three academic hospitals. BMJ quality & 
safety, 28(11), 894-900.

6. Haverfield, M. C., Victor, R., Flores, B., Altamirano, J., Fassiotto, M., Kline, M., & Weimer-Elder, B. (2022). Qualitatively exploring the impact of a relationship-centered communication skills training program 
in improving patient perceptions of care. PEC innovation, 1, 100069.

7. See:

- Mahdavi, M., Doshmangir, L., & Jaafaripooyan, E. (2021). Rethinking health services operations to embrace patient experience of healthcare journey. The International Journal of Health Planning and 
Management, 36(6), 2020-2029.

- Gualandi, R., Masella, C., Viglione, D., & Tartaglini, D. (2019). Exploring the hospital patient journey: What does the patient experience?. PloS one, 14(12), e0224899.

- Ocloo, J., Goodrich, J., Tanaka, H., Birchall-Searle, J., Dawson, D., & Farr, M. (2020). The importance of power, context and agency in improving patient experience through a patient and family centred care approach. Health Research Policy and Systems, 18, 1-16.

8. Mannion, R., & Davies, H. (2018). Understanding organisational culture for healthcare quality improvement. Bmj, 363.

9. See:

- Fortin, A. H. (2002). Communication skills to improve patient satisfaction and quality of care. Ethnicity & disease, 12(4), 58-61.

- Pearce, M., Wilkins, V., & Chaulk, D. (2021). Using patient complaints to drive healthcare improvement: a narrative overview. Hospital Practice, 49(sup1), 393-398.

- Hong, K. J., & Cho, S. H. (2021, April). Associations between nurse staffing levels, patient experience, and hospital rating. In Healthcare (Vol. 9, No. 4, p. 387). MDPI.

The World Class PXPulse should not be seen as a replacement for patient satisfaction measures and Patient Retention Index (PRI).

Instead, it provides a complementary measure of patient experience that triangulates these other two measures and in addition, provides detailed qualitative feedback to the executive team for future improvements of patient experience.  We note LaVela and Gallan’s (2014) observation: “It is important to examine data collectively from multiple sources and evaluation approaches; in many cases using several different data collection approaches to produce a more informative, rounded picture is preferred (e.g., triangulation)” (p.31).  The PX Pulse will complete this triangulation for health care providers to complement patient satisfaction measures and PRI.

 

For more information about World Class PX Pulse, please email WorldClassPX@yatesandpartners.com

References:

Agency for Healthcare Research and Quality (2023). [available: https://www.ahrq.gov/cahps/helpful-resources/index.html]. Accessed 19th February 2024.

Ahmed, F., Burt, J., & Roland, M. (2014). Measuring patient experience: concepts and methods. The Patient-Patient-Centered Outcomes Research, 7, 235-241.

Barry, H. E., Campbell, J. L., Asprey, A., & Richards, S. H. (2016). The use of patient experience survey data by out-of-hours primary care services: a qualitative interview study. BMJ Quality & Safety, 25(11), 851-859.

Campbell, J. L., Carter, M., Davey, A., Roberts, M. J., Elliott, M. N., & Roland, M. (2013). Accessing primary care: a simulated patient study. British Journal of General Practice, 63(608), e171-e176.

Coulter, A., Fitzpatrick, R., & Cornwell, J. (2009). Measures of patients' experience in hospital: purpose, methods and uses (pp. 7-9). London: King's Fund.

Coulter, A., Locock, L., Ziebland, S., & Calabrese, J. (2014). Collecting data on patient experience is not enough: they must be used to improve care. BMJ, 348.

Dawes, J., Sharp, B., & Adelaide, N. T. (2000). The reliability and validity of objective measures of customer service: Mystery shopping. Australian Journal of Market Research, 8(1), 29-46.

Daouk-Öyry, L., Alameddine, M., Hassan, N., Laham, L. & Soubra, M. (2018). The catalytic role of Mystery Patient tools in shaping patient experience: A method to facilitate value co-creation using action research. PLoS ONE, 13(10): 1-17 e0205262.
https://doi.org/10.1371/journal.pone.0205262

Granatino, R., Verkamp, J., & Stephen Parker, R. (2013). The use of secret shopping as a method of increasing engagement in the healthcare industry: A case study. International Journal of Healthcare Management, 6(2), 114-121.

Goodrich, G. W., & Lazenby, J. M. (2023). Elements of patient satisfaction: An integrative review. Nursing Open, 10(3), 1258-1269.

Jacob, S., Schiffino, N., & Biard, B. (2018). The mystery shopper: a tool to measure public service delivery?. International Review of Administrative Sciences, 84(1), 164-184.

Jenkinson, C., Coulter, A., Bruster, S., Richards, N., & Chandola, T. (2002). Patients’ experiences and satisfaction with health care: results of a questionnaire study of specific aspects of care. Quality and safety in health care, 11(4), 335-339.

Johansson, P., Oleni, M., & Fridlund, B. (2002). Patient satisfaction with nursing care in the context of health care: a literature study. Scandinavian journal of caring sciences, 16(4), 337-344.

LaVela, S. L., & Gallan, A. (2014). Evaluation and measurement of patient experience. Patient Experience Journal, 1(1), 28-36.

Lazarus, A. (2009). Improving psychiatric services through mystery shopping. Psychiatric services, 60 7, 972-3 .

Lee, W. I., & Lin, C. H. (2011). Consumer hierarchical value map modeling in the healthcare service industry. African Journal of Business Management, 5(3), 722.

Locock, L., Graham, C., King, J., Parkin, S., Chisholm, A., Montgomery, C., ... & Ziebland, S. (2020). Understanding how front-line staff use patient experience data for service improvement: an exploratory case study evaluation. Health Services and Delivery Research, 8(13).

Lowndes, M., & Dawes, J. (2001). Do distinct SERVQUAL dimensions emerge from mystery shopping data? A test of convergent validity. Canadian Journal of Program Evaluation, 16(2), 41-53.

O'Neill, S., Calderon, S., Casella, J., Wood, E., Carvelli-Sheehan, J., & Zeidel, M. L. (2012). Improving outpatient access and patient experiences in academic ambulatory care. Academic Medicine, 87(2), 194-199.

Sharp, B., Page, N. and Dawes, J., 2000. A new approach to customer satisfaction, service quality and relationship quality research. Australian & NZ Marketing Academy Conference Proceedings, Griffith University.

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Assoc. Prof Dr. Maxwell Winchester, Keith Yates, Pam Poranan (Prae)