Welcome back, everyone, and hopefully you found the last session helpful. And now I think we're going to really dive into the final session, which will discuss creating a culture of quality in the GI unit. Jenny Nguyen will start us off with a talk on measuring and maximizing patient satisfaction. And so I'll turn it over to Jenny. Thank you so much. I really appreciate it. All right, guys, I'm excited to help bring home towards the end of the conference. It's been a pleasure and I've learned so much so far. So my second talk is going to be about measuring and maximizing patient satisfaction. And this is a topic that I find so near and dear to my heart. I think we all got into the health care to really, you know, help make a difference for patients. And so I always tie everything back to patients. There's nothing for me to disclose for this talk. Sorry. Today, I'm going to outline we're going to review patient experience and patient satisfaction, ways to measure patient experience, methods to improve patient experience and DEI considerations in the endoscopy unit. So start with a definition. What is patient experience? One definition is that it encompasses the entire range of interactions that patients have with the health care system. So let's think about the patients that come in for their endoscopy procedure. Their experience begins well before the time that they set foot in the endoscopy unit for their actual procedure. Right? It can be quite complex. For the patients, were they seen in the GI medicine clinic and then they got all of their instructions right then? Were they scheduled right then? Did somebody see their PCP and they were referred? And if so, how long did it take them to get contacted for their colonoscopy? Was the instructions and the letter easy to understand and follow? Do they have any challenges getting their prep? And all of these factors influence a patient's experience before they ever even get to us. So why is patient experience important? Patient experience helps us understand, are we delivering care that is patient-centered care? Are they at the center of what we do? Are we delivering care that is meeting the very diverse population in which we all serve that is respectful and responsive to what they need? All of our patients have very unique preferences, needs, values, beliefs, right? And so we have to ensure that we're being very consistent and have hardwired process for efficiency, but also are unique to meet the needs of those that we serve. So what is patient satisfaction? I just want to highlight the patient experience and patient satisfaction are different entities. They're not the same, yet they are very closely related. So patient experience is what happens to patients as they interact with the healthcare system, right? What is the conversations with them? What are their interactions? What are they experiencing day-to-day leading up to their visit and then for their actual visit is the entire healthcare system interactions. And then patient satisfaction, it is the measurement of which somebody is extent, or sorry, the measurement or the extent of how content somebody is with the care in which they received, right? So two patients can have the exact same experience, but yield very different satisfactions. I'll give an example to illustrate this. Two patients come into your very busy endoscopy unit for screening colonoscopy, let's say for 11 a.m. procedure time. The first patient, it's her first colonoscopy and she expects her procedure to start at 11 as that was communicated and planned for her. The second patient has been to many procedural departments and knows that delays can happen from time to time. So the second patient does not expect to start at 11, but rather maybe more by 12 or 12.30. Both patients are called back to start at 11.30. So the first patient is not satisfied, actually dissatisfied. Her experience is not a pleasant one as her expectations were not met. The second patient is thrilled. Even though she's slightly delayed, it exceeded her expectations. So this is just one example of how two patients, same healthcare system, same experiences, but very different satisfaction outcomes. So the next topic is why does patient experience matter? You know, it matters for a lot of reasons, but you know, a phrase that I say to my team all the time is every moment matters when it comes to patients, right? Patients are, you know, looking at verbal and nonverbal body language. You know, are we, you know, extending a hand to somebody look lost, you know, in the hallway and we're just saying, how can I help you, right? Wayfinding can be challenging for patients. So every moment matters and every moment is an opportunity for us that are comfortable with the healthcare system to help influence patients, right? But it matters for efficiency, right? So if you think about, you know, the workflow and the experience of patients leading up, you know, to coming to the endoscopy unit for scheduling, right? Was it an efficient workflow? Was it an efficient experience for them? Meaning, you know, did they understand their instructions? Was it easy to follow? Were their questions answered? Because if they have positive experiences and all questions are answered and it's a smooth process for them, it's going to be more efficient for us the day up because they're going to show up and they wouldn't have eaten, they're, you know, they're going to follow their bowel prep, they're going to be clean, right? If they maybe don't have, you know, very positive experiences leading up to it, then that could lead to inefficient, you know, inefficiencies leading up to it. The same goes for, you know, day of an endoscopy unit, right? If you have a patient who's not happy, is disgruntled, you know, and they need some service recovery, maybe the charge nurse, you know, can't help turn bays or can't pull subsequent patients because they're having to give some, you know, unplanned time to patients to give some service recovery. Maybe the endoscopist or anesthesia attending or CRNA is having to spend more time with the patients than we typically do, you know, to help them feel better and ensure that they're going to get the best care that they deserve, right? Efficiency matters because if you have good positive, you know, patient experience and you have efficient days, then it's going to lead to better patient outcomes and better clinical outcomes for the patients, right? Patients that have positive experiences and they have trust in the care they're receiving, they're going to be more compliant with their medication regimen with subsequent procedures that have to happen. If patients do not have good experiences, then that could lead to them not having good behaviors or compliant with the regimen, thus not having subsequent procedures scheduled. And it matters because patient experience either helps build a brand and reputation of your unit, you know, the endoscopist specifically or the organization you work for in a positive light or maybe a negative light, right? I like to use this analogy with my staff. It's kind of like a Yelp review, right? If you're going to go out to a restaurant or try somewhere new, you're going to ask the community in which you're around. Maybe it's your colleagues, your friends, your family, your neighbors. You're going to say, tell me about this place. I was thinking about going here, right? It's no different than patients when they're going, especially if it's their first time, either for a colonoscopy or going to a health system. They're going to ask their community, tell me about this organization, about this provider, about this procedure, right? So patient experience matters because if somebody has positive experiences, they're going to share that. They have negative experiences, that's also shared. So there's two types of measurements for patient experience. There's formal and informal. The first that we're going to review is formal measurements. So I took a picture of our OAS caps and I included it here just for a visual reference. So many of you are probably familiar that hospitals, both hospital-based and ASVs, you get patient surveys that are sent to patients. And if you've ever been a patient, you know that these can be pretty lengthy and it asks a plethora of questions about physicians, nurses, the cleanliness of the facility, the care that you've received. And one category is the willingness to recommend. So these scorecards are published for the community to see. And a lot of this for hospitals are value-based or reimbursement. You're scored on your willingness to recommend. You want patients to recommend your facility. And they do that by having positive experiences. This is actually one of my favorite things that we do at a unit level, is we meet every month for a patient experience committee. And it's interdisciplinary. We have a GI attending, we have anesthesia staff, myself, endoscopy, some of my endoscopy procedure, procedure nurse, prep and recovery nurse, the manager of schedulers and coordinators. And we meet monthly to look not only trends and opportunities of all of these categories and the overall willingness to recommend score, but also, you know, there's open dialogue fields and these surveys and patients are very willing to give feedback, both positive things that went really well and maybe opportunities, things that can be looked at and dissected a little bit. And so I personally love doing that because, again, it's what we do is for the patients and about the patients. And what better way than to dissect and review the information that is already given to you and readily available. So let's do a little audience poll. I want to know, does your current endoscopy unit have a patient experience committee that meets routinely to review and discuss the patient experience data? Yes, no, or are you just not sure? Oh, perfect. So it's almost, it's almost evenly split like, you know, I, but prior coming to endoscopy, I've been in my unit for four years as the nurse manager. I was on an inpatient GI unit for almost 10 years and in various roles. And my inpatient unit, we did not have a dedicated patient experience committee, rather the nurse manager at that time would just present the willingness to recommend to us. And I didn't at that point really see the value in it when I also in tandem with that worked as an endoscopy nurse for about three years as an independent endoscopy unit. And we did have a patient experience. And so I think having those two experiences, when I became the nurse manager of my current unit of endoscopy, I really saw the value in having a patient experience committee, as I really think, you know, it brings information to you, it really connects back to purpose to the patients, a lot of what we do. And so it's really interesting to see that it's about half and half for this group. Alright, so the other type of measurement was the informal measurements. So unlike the formal measurements or the formal measurements, the OAS caps, it is automatically produced and it's readily available. The informal measurements, to me, are just as valuable as measurements in regards to getting information on patient experience. So these are things that I have done in my couple of years of being with endoscopy is I do waiting room observations, right? There's a lot that we can learn and see if we take a step back, right? I think we're all very busy in the hustle bustle of very efficient at what we do, right? But we get very numb almost to our workflows and our tasks, because we're so efficient at what we do in our various jobs. So you know, when I do these waiting room observations, they are not announced, I take my computer so I can look at our schedule, and I kind of hunker down in the corner for a couple of hours at a time. And from this, I can see, are we communicating to the patients if they're delayed? Are we doing the warm greetings, meaning when we go to the waiting room to pull our patients back for procedures, are we walking up to them? Are we making eye contact? What is our engagement with our patients? Is the EVS coming through to do high touch point cleaning of the waiting room, right? You can see a lot just by the body language of the patients and the environment of which your patients are waiting. I, you know, elicit feedback from my staff and providers, right? You know, as the nurse manager of having, you know, a staff of 90 and three different endoscopy units, you know, I also very self-aware, there's a lot that probably transpires that I'm just not aware of, right? I'm not in the rooms, I'm not in there all the time. So I want feedback from my staff and providers. I want to know what's going really well, and why is that going well, and what can we share with that with the other team to make things more efficient, right, for our patients? What is not going well, right? And then how do we approve upon that? And then my hospital has a patient, a patient and, oh my gosh, I'm sorry, a patient family lays on staff, and I collaborate with them, right? You know, so it's very important for me to look at the eyes, you know, for what our patients get. For example, you know, when we got, we have, you know, we've had several renditions of our letters that we give to our patients, right? So I work with this group and I say, will you please review this? Is this easy for you to follow? You know, I will pull them and say, no, this is the path of how we physically get from the parking garage to the unit. Does these signs make sense, right? Again, we're used to those workflows and those paths because we do it every day. So I think really collaborating and getting these informal measurements and feedback from others is pivotal to understanding our patient's experience. So the three C's is something that I live by. It is collaborate, connect, and correct. So for collaboration, you know, to me, it's not just about my endoscopy team. One of my roles is to collaborate with all those that help support us. You know, one of the things I say all the time is there are pillars that help support endoscopy. It's not just our procedurals and our staff and our providers, but it is our schedulers and our coordinators that give the patients to us in a very efficient manner. It is our central supply to ensure that we have everything we need despite all of the, you know, challenges that we've seen with supply. It is our biomed for our equipment. It is our registration staff and valet, et cetera, right? And to me, it's so important for me to collaborate with all of these disciplines to ensure that I have a very healthy relationship with them and a connection with them. You know, I do GEMBA walks where I walk through with our central supply leadership once a week to work on supplies. I do a GEMBA walk with our EVS leadership once a week to really, you know, collaborate and work with them. Connecting with patients is pivotal for, you know, improving patient experience. So, you know, how do we connect with patients in such a busy department? You know, can we round on patients, you know, when the opportunity affords? You know, something I do is I send thank you cards, you know, to my patients, you know, at the end of their, with their discharge. In the back, it is a verb, which is thank you for choosing MUSC endoscopy. I hope you had the best experience. But if you didn't, please call me. And it has my number and my email, right? And I think another way connecting with patients is through those four more measurements. When you get your patient survey, your OAS caps, some patients will leave their data, you know, will leave their information. And if they did not have a positive experience, I still connect with them. Even though their experience with us has ended, I still will contact them and try to help make their experience one a little bit better after the fact. And then correct. So, through the collaboration and through the connection, you know, really looking at trends and opportunities, what can be corrected to improve? You know, and following these three Cs is a continual workflow that have to be looked at, you know, on a continuum in regards to improving patient experience. So, some creative initiatives that I've implemented that I want to share with the group today is we did something called a comfort campaign. And this was a couple of years ago. And this was something that yielded from our patient survey. In the category of comfort, we were not scoring very well. And in the open dialogue, patients were commenting that comfort was not something that was yielded as an important for them. So, this was very simple. We just, you know, collaborated with the teams from registration staff. They just used the word comfort. And when they checked the endoscopy patients in, they would say, thank you so much for choosing us. We're going to make sure you're very comfortable today throughout your stay. And the prep, the nurses would say, let me get you a warm blanket to help you get more comfortable. Likewise, the GI techs in the room would say, I'm going to help you get positioned to make sure you're comfortable throughout your procedure. Right? So, it was just the comfort. That now has been adopted as a best practice throughout perioperative MUSC. Within a couple of months, we saw our comfort scores increase exponentially. So, it was wildly successful. I've gotten music therapy, you know, in our waiting area a couple of times. There's volunteers, student volunteers at the hospital. And it's just string, you know, strings or something very light and not intrusive at all, but just playing very softly and lightly in the corner of our waiting room. We've added a status communication board in our waiting area. So, that way the caregiver or driver of our patients can see, you know, the status of where they're at within, you know, their stay of endoscopy. The signage update I talked about a little bit. This came from partnering with the patient family liaison group. You know, does the signage make sense in our department? You know, we're a very large complex health care system that's, you know, widespread across the campus. So, is it easy for patients to follow signs and get to us? Wayfinding was a challenge. The thank you cards that we send, you know, at the discharges, thanking them for the care in which they received. And like I said, partnering with that patient family group is beneficial because it gives feedback from us at a different lens than what were just our day-to-day workflow. So, the last topic in, you know, in this discussion that I have today is DEI considerations. You know, I think we could all agree the world is such a more diverse place today than it was, and that's one of the most beautiful things about us. But I think with that, you know, that makes DEI, you know, such a critical component in health care, right, for optimizing patient experience. You know, there's so many, you know, different things that we have to consider to ensure that we're meeting the very diverse population in which we serve for a positive experience, right? We all know that there's, you know, there's language barriers, right? We serve a different population. We have an older generation and younger generation. We have patients that are very tech savvy that can navigate their electronic, you know, MyChart systems very well. We have patients, maybe, that wouldn't, would have challenges with that, right? So, are we delivering care and communicating in a way that meets the needs of all the patients in which we serve? And then, you know, lastly, I think it's important, you know, the study highlighted that, you know, having, you know, endoscopists, you know, team members, you know, a diverse population is important because patients come in and they're wanting different, you know, different genders. You know, I can say as an nurse manager, people will contact me sometimes, not to ask about the skill of the endoscopist, but to say, you know, I'm really nervous to come in. I'm very anxious to come in. I'm scared. I'm really comfortable. Do you have a young female endoscopist? Do you have a male endoscopist that's, you know, older? I've had, you know, staff call me or community call me to say, you know, I'm a transgender male. Do you have an endoscopist that, you know, has a large following for, you know, for my population, you know? And so I'm just seeing more and more of these things come, you know, come up. And so it's so important for the lens, you know, to look to provide care through the lens of DEI to ensure that we're meeting what everybody needs, right? And I think if we have an environment of multi-gender endoscopists, of team, and we make patients feel comfortable, then it's going to improve the clinical outcomes. It's going to improve the compliance of the patients in which we serve. So in summary, I say patient experience matters, and it's closely tied to their satisfaction. Every interaction shapes a patient's experience. To understand your patient experience data and to collaborate, connect, and correct is pivotal. Conduct your informal measurements as this contributes to comprehensive insight on one's experience. And DEI is a party in the eyes of a patient. Thank you guys so much.

patient satisfaction

patient experience

GI unit

healthcare system

patient outcomes