In my previous post, I talked about the formula E = mc2, that is, to achieve excellence (E) we need the commitment of workers (c), trust in the institutional project of the governing bodies and health officials (c from confide) and the appropriate methodological development (m). I would like to delve into the methodology and in particular on the importance of the patient experience when deploying improvement projects and consider it as a priority in the strategic development of our institutions.
The public health system methodically evaluates patient satisfaction which allows us to obtain global information regarding users’ perception. However, we abuse studies that are too general and in which the evaluation differs excessively when it comes to the time dedicated to healthcare. These and other methodological limitations make it difficult to draw conclusions and the possibility of using the information related to the patient's experience as a source of identifying opportunities for improvement is also an element that limited by cultural aspects. To expand on these aspects, it’s interesting to read the articles "The Patient Experience and Health Outcomes" Matthew P et al  and "Collecting data on patient experience is not enough: they must be used to Improve care" A Coulter et al .
Last December I attended a conference organized by the Hospital Clínic of Barcelona, in collaboration with CatSalut and Red de Investigación de Servicios de Salud en Enfermedades Crónicas (REDISSEC), coordinated by Joan Escarrabill (responsible for the Program of Chronic Care, Hospital Clínic of Barcelona) with participation of professionals from various institutions. I found it very interesting that the conference was planned to incorporate the patient experience in organizational design and process redesign, starting from a first analysis of processes and their critical points with professionals, then continuing with working in focus groups of patients, families and caregivers, moderated by an external expert and without the presence of professionals. Focus groups generate opportunities for improvement and can also serve as a basis for the identification of key questions to incorporate into a population survey to assess a specific procedure. Various examples have been brought forward along these lines: patients treated with bariatric surgery for morbid obesity, patients using home respiratory therapies and patients enrolled in a program of subcutaneous insulin infusion to treat diabetes difficult to control. In this latter case, it’s noteworthy that different proposals for improving the devices’ design has been made and already sent to the manufacturers.
We begin to find institutions that consider the patient's experience as a priority in their strategic development. A very prominent example is the Cleveland Clinic. "Patients were coming to us for the clinical excellence, but they did not like us very much" explains Delos Cosgrove, CEO of Cleveland Clinic, so he created the Office of Patient Experience with a team of 112 people and an annual budget of 9.2 million dollars. The office has led various actions:
- Involving 43 thousand employees, in groups of 8-10 people including doctors, nurses and administrative staff, in a case analysis exercise to reflect on how to act on putting the patient first.
- Implementing the "hourly rounds" – an initiative that consists in nurses visiting hospitalised patients every hour and asking them 5 questions: Do you need something? Do you have any pain? Do you want to change position? Do you need me to bring you any personal belongings? Do you need the toilet?
- Developing videos to raise workers’ awareness and communicate strategic priority within the training sessions. Jordi Varela presented one of those videos in a post dedicated to the involvement of doctors and here’s another one also very interesting.
When it came to patients’ satisfaction assessments, Cleveland Clinic has gone from mediocre results to occupy one of the top positions in the ranking of American hospitals and their measures have also contributed to improving the quality, safety and efficiency. The article "Health Care's Service Fanatics" published in Harvard Business Review  in May 2013, details on the transformation strategy.
Asking patients’ opinions and knowing their experiences with different approaches ought to enrich the strategic, organizational and process design. A few years ago, health executives and managers were designing alone; many, not all, moved on to plan by relying on the opinion of professionals; now it’s time to incorporate robustly and in a complementary way, the patient experience. In parallel, we must ensure that we all do our job while taking into account the context and needs of the patient.
 Matthew P. Manary,M.S.E., William Boulding, Ph.D., Richard Stalein, Ph.D, and Seth W.Glickman, M.D., M.B.A. The patient Experience and Health Outcomes. NEJM 2013;368:201-3.
 Coulter A, Locock L, Ziebland S, Calabrese J. Collecting data on patient is not enough: they must be used to improve care. BMJ 2014;348:g2225 doi:10.1136/mmj.g2225.