Continuity of care is the process by which patients and their physician-led care teams cooperatively manage health issues over time.
The patient experience is a critical element of continuity of care because of the role it plays in cementing the provider-patient relationship. It determines many critical elements of patient care, This includes whether the patient adheres to the treatment plan, keeps appointments, takes medications, or engages in self-management.
An experience that leaves the patient feeling truly cared for and confident in their ability to improve their own health nurtures trust and a cooperative relationship with the provider.
These experiences are an important part of the pathway to effective care. Indeed, the benefits of positive patient experiences go beyond patient health and engagement to generate referrals and improved financial outcomes for the practice.
Five-star patient experiences
During 2016, we completed a study of over 1,000 online patient reviews of care providers from doctors’ offices to urgent care. The stories and narratives written by patients—combined with the numerical ratings of their experience demonstrate the power of the provider-patient relationship to invigorate continuity of care.
The goal of our study was to understand the drivers of a patient’s intention to return to the practice. It also shed light on their willingness to refer the care provider to others.
We looked at patients who indicated in their reviews that: “I will tell my friends and family to seek care here—and will return in the future.”
What we discovered has significant implications both for patients and care providers. Specifically, we found that patients who provide a 5-star rating (on Google, Healthgrades, Yelp, or Facebook) were 10 times more likely to say they will return and refer.
The patient’s own words
In the patient’s own words, a 5-star patient experience has certain qualities:
- “I sincerely believe that if it had not been for Dr. X’s and her team’s thoroughness and communication, we would still be here scratching our heads and racking up the medical bills.”
- “I’m used to long waits for medical appointments (even after you “held your place in line” for a certain appointment time) but they are almost always on time. They sent my prescription to my pharmacy right away so I was able to get my medication quickly. I will definitely remember this location!”
- “I appreciate how quickly I got to see a doctor and his promptness and care in diagnosing and treating me. He also gave me a detailed ‘action plan’ showing me the drugs I was being prescribed and everything they did at the clinic, including my vitals. I don’t think I’ve gotten that from other clinics before.”
These narratives—and the hundreds of 5-star reviews they represent—show how specific behaviors by care providers and support staff directly engage patients in their own care and treatment. The theme that runs through the 5-star reviews is care and compassion, and a proactive approach to meeting the medical and psychological needs of the patient. The key to a caring and compassionate patient experience is having the right people in place and bringing out the best in them through effective procedures.
Hiring the right people
The practice team is the most critical input to the patient experience. And, of course, the team starts with who you hire. Each position makes a unique contribution—from providing care and treatment to ensuring timely communication and follow-through.
To hire people who can consistently deliver your vision for care, you must first define the behaviors and processes that are needed to deliver the type of patient experience you hope to offer. Articulating care paths—or intended patient experiences for specific conditions—clarify and emphasize the tasks, processes, and behaviors your team needs to consistently deliver and the necessary qualities you should consider in the hiring process.
With a clear vision for what you want patients to experience, you can begin to consider the qualities (e.g., abilities, values, skills, and personality traits) needed in each role. Then, you can change how you evaluate candidates to better measure these qualities. This may mean adding structured interview questions, adding or changing hiring assessments, or changing how you evaluate applications and resumes.
By building hiring processes with the vision of a great patient experience in mind, we have helped our customers reduce turnover by over 50% and increase supervisor ratings of care providers for compassion, care, and accountability.
Healthcare leaders have found targeted care and service initiatives to be effective in improving continuity of care and patient outcomes. For example, to reduce readmissions within 30 days of an initial hospital stay, healthcare systems review charts and data to determine the patients most likely to return.
This group receives consistent communication and visits from home health aides to ensure medications are taken, follow-up clinical visits are attended, and they have access to the resources they need to recover.
Being prompt and finding ways to reduce door-to-door times, while simultaneously demonstrating care and compassion, can go a long way to build trust and patient loyalty. However, when coupled with empirically supported techniques to understand a patient’s background and motivations, your efforts can help you reach even greater patient outcomes.
Motivational interviewing, for example, involves understanding and then sparking a patient’s unique internal motivators to inspire continued care and self-management. This technique starts with an empathetic approach to a patient’s condition.
It determines where they are in the process of behavior change (e.g., pre-contemplation through action), and then strives to move them to the next stage (e.g., from contemplation to action). Sustaining motivation can not only keep patients engaged in their own self-management, but also increase their likelihood of continuing to seek care.
In sum, a vision for care can guide your practice’s goals and policies for everything from reducing door-to-door time to improving engagement in preventative health initiatives. Your vision tells your team what patients should experience—specifically, what they should, think, feel, and do after receiving care. This gives your practice a clear destination for care and a roadmap for achieving it.
Success will follow
As Patagonia founder, Yvon Chouinard, famously said,
“Profit is what happens when you do everything else right.”
Meaningful improvements in health outcomes and the functioning of our healthcare system can only happen if you do everything right, starting with the quality of the people you hire.
What is ‘continuity of care’? Journal of Health Services Research and Policy. October 2006.
Reducing hospital readmissions: lessons from top performing hospitals. The Commonwealth Fund. August 2011.