Earlier this year I was asked why my physician organization’s goal for the “Communication with Doctors” section of the HCAHPS survey isn’t a top box score of 100%. My explanation was that setting a goal of absolute perfection for a subjective assessment of communication between doctors and patients would likely be counterproductive, producing apathy rather than engagement on the part of physicians (if you’re a fan of setting SMART goals, you’ll know that ‘A’ stands for attainable).
I later realized that although my answer may have been indicative of some short term managerial savvy, I failed to understand the challenge that my questioner was issuing. This realization struck me - nearly six months later - while reading a compelling piece from the New England Journal of Medicine entitled “The Word That Shall Not Be Spoken,” written by Dr. Thomas Lee, Chief Medical Officer of Press Ganey.
In it, Dr. Lee asks whether the relief of suffering is a reasonable expectation of the patient experience mission and explores why physicians traditionally shun the notion that they are responsible for “relieving suffering.” He writes that, “Relief of suffering may be a task too vast to seem real for most people — something on the order of achieving ‘world peace'.”
Despite this perception, Dr. Lee concludes that the relief of suffering is a valid overarching vision, noting that “good organizations have ambitious goals.” He also acknowledges the enormity of this profound goal and shares the critical message that lies within it, “Collectively, we should not shy away from work that can never be completed.”
As 2013 comes to a close, I’d like to commend the increasing numbers of physicians and physician organizations that have committed to improving the patient experience despite innumerable challenges and imperfect means of measuring success (read more in the Beryl Institute's white paper, "Voices of Physician Practices and Medical Groups: Exploring the State of Patient Experience").
We must continue these great efforts not because the patients receive surveys or because we’ve been offered performance incentives, but because our calling obliges us to promote, as Dr. Thomas Lee says, the relief of suffering. HCAHPS scores are short-term goals. The relief of suffering is the vision. Spend 5 minutes talking about your latest HCAHPS scores. Spend your career learning how to better relieve suffering.
And recognize that quality in healthcare will never be “complete”. Those who make great strides in patient experience improvement will be those who don’t shy away from the work despite this reality. Much of the challenge - and the beauty - of the work we do to improve the patient experience is that it is unending. While this may sound ominous, I find it reassuring for two reasons. First, it implies that it’s never too late to begin focusing on patient experience improvement. And second, it is indicative of the richness of the patient experience and the many incredible ways that we can positively impact it.
In retrospect, I believe the person who asked me why our organization wasn’t targeting 100% HCAHPS top box scores was making a deeper inquiry about our vision. They wanted to know that our doctors understand this is a career-long pursuit and that they won't shy away from the unending work of improving the patient experience. Now I understand the question. And I promise, we won’t.