Assessing healthcare performance during rapid change

“How are we doing?”

In every C-suite and board meeting, that question is top of mind as organizations confront the challenges flowing from the COVID-19 pandemic and other crises of the past two years. Many organizations, including Press Ganey, compare current performance data to the same time period from 2019, disregarding 2020 as a year too anomalous to provide a benchmark. These comparisons are sometimes used for incentive programs, but their most important use is determining whether the organization is “on track” with its longer-term strategic plans.

However, organizations are finding that comparisons of current performance with 2019 have an “apples and oranges” problem—i.e., healthcare today is almost a different business from just a few years ago. The permanence of changes in the environment in which leaders must lead, and managers must manage, is sinking in. The decade that lies ahead requires new management practices and data strategies.

Signs say the old "business as usual" is never coming back

The volume of electronic messages from patients to their physicians rose approximately 150% in the first weeks after the COVID-19 pandemic began and has yet to decrease. This increase in messaging from patients was slowly building over the past decade and identified as a cause of physician burnout. But during the imposed periods of isolation during 2020, patients of all ages discovered how to use patient portals and reach their healthcare providers in other ways as well.

Patients got used to using the internet 24/7 to get things done, including their healthcare needs. Many medical practices are just now beginning the work of conducting healthcare performance reviews and redesigning processes to accommodate this change (and some have not). But this example is just one of many that reflect permanent change in how patients are interacting with healthcare and using the internet to research their physicians, tests, and treatments. (86% of patients now search their physician reviews online before visiting.)

Telemedicine visits shot up, decreased, and have since plateaued at roughly 11% of visits. Press Ganey's healthcare performance review data has shown from the start that patients give similar high ratings to their clinicians during in-person or telemedicine visits, but they give lower ratings to telemedicine’s logistics (e.g., the ease of logging on). Over the past six months, there is clear improvement in how easy patients are finding telemedicine to use at many institutions—but not all. Clearly, some organizations are working at improving how telemedicine works for clinicians and patients, and others are not.

Workforce turnover in the entire country is at alarming levels—4.2 million Americans quit their jobs in October, resulting in a decline of about 205,000 from September and landing the month a record high. These data points are actually evidence of the robustness of the economy, with people often leaving 
because they’re finding jobs they want more. While it’s certainly good news for the job seeker, it poses obvious challenges for healthcare organizations that need to retain good people in order to build good teams. 

Press Ganey's healthcare performance review data showing that nearly 30% of nurses are actively considering quitting (with even higher rates among millennials) made national news. Another concerning trend is that employees at the lower end of the healthcare pay scale are leaving for jobs at supermarkets and fast-food chains. Healthcare organizations still retain many people because of pride in their missions, but organizations cannot count on this factor alone.

The murder of George Floyd in May 2020 led to a surge in concern about a centuries-old problem in diversity, equity, and inclusion—and, appropriately, that concern continues to build and understanding of its importance is only deepening. Press Ganey recently published healthcare performance data showing that employee perceptions of inclusiveness are strongly related to their likelihood of staying—a powerful trend that impacts every job type.

Organizations are redesigning for a new normal

Around the country, we’re seeing organizations recognize the change in the environment and redesign the methods in which they work. Some of the most telling redesigns that we want to highlight:

Hardwiring nimbleness: During times of rapid change, many organizations are realizing that they can’t make big decisions annually at budget time. Texas Health Resources, for example, has moved to quarterly goal setting and modified its budget management to allow for quarterly adjustments.

Restructuring care redesign accountability: The movement toward service lines has gone into a higher gear at many organizations as leaders have realized that they must not only be nimble, but they must also be effective in implementing care redesigns. As one chief medical officer stated, “Once we realized that COVID was not just going to last a few months, but was probably going on for years, we understood that we couldn’t have 32 different hospitals figuring out on their own how to redesign orthopedic care. And we couldn’t have medical directors who might only know a little about orthopedics telling orthopedists what they needed to do. We needed to move to an orthopedic service line that really meant something, and the same for other major areas.”

Prioritizing workforce wellness and culture: To recruit and retain excellent employees, organizations are taking a wide array of steps including rethinking roles (especially nursing), focusing on making real progress on diversity, equity, and inclusiveness, building effective teams, and developing special programs for some segments (e.g., support for women physicians). Our impression is that all these steps are good steps, and there is no single magic bullet. The chief human resources officer has become a truly critical member of the C-suite team.

Developing a data strategy appropriate for the challenges: To be nimble and effective, organizations need data. For example, in the past, many organizations measured workforce engagement once a year at most. Some organizations were reluctant to measure at all during the stressful early months of the COVID pandemic. Once organizations realized that the pandemic and related stress were not ending, they have moved to frequent pulse surveying of subsets of the workforce to guide interventions.

The lessons learned during this time of change are among the most telling of our careers. One of those lessons is that our overarching goal in healthcare—to reduce the suffering of patients—remains the same, even when everything else is changing. Another is that to reduce suffering during such a period, organizations must not take the trust of patients and their employees for granted—their leaders must work thoughtfully and relentlessly to deserve and build it. We realize now that “excellence” as an organizational goal is not a destination so much as a direction. There are always going to be disruptions that change the context of our work—e.g., climate change, the next COVID and the quandaries that will flow from the medical advances just over the horizon. Assessing healthcare performance and improving through times of change have become core functions for healthcare organizations. We look forward to partnering with you in this work.

Speak with one of our experts to learn more about how your organization can use design to improve patient experience.