When it comes to measuring the patient experience, EMS falls short

By Jay Fitch, Ph.D.

How can we know if we're improving EMS if we don't ask the patients and the communities we serve"

The IHI Triple Aim has become a widely accepted framework for improvement efforts in health care and one of its three parts is the patient experience. I'm surprised for a number of reasons that the State of EMS report found that the majority of agencies are not truly measuring patient satisfaction.

Risk management
The top reason I'm surprised is that improving the patient experience is basic risk management. Research and common sense both tell us that patients who are less satisfied with their providers will be more likely to complain and possibly to file lawsuits.

Especially in EMS, where the public's expectations of what actual medical care we can provide are often low, our attitude and the way we communicate with a patient might be the most important aspect of the care we provide. We could do everything technically right and save a life, but treat the patient's family with disrespect and we'll receive a complaint.

Another paramedic can literally get everything wrong, but if that medic smiles and provides comfort, he or she may well receive commendations.

Patient care
We also need to understand that the patient experience is part of patient care. We can't separate technical and clinical skills from communication and empathy. They are equal components of providing prehospital medical care.

It was discouraging to see that nearly half of the Fitch/EMS1 Cohort agencies only track complaints or don't really measure patient satisfaction at all, and that only a quarter of the agencies use a third party to measure patient experience.

Tracking only complaints leads to a punitive view of improving the patient experience, looking only for the worst examples and often chastising the caregivers involved. Truly measuring patient satisfaction and trying to improve it often involves seeking out the good examples.

I once heard of an agency that noticed one practitioner consistently received great feedback from patients. Instead of focusing on punishing the bad apples, the organization's leaders focused on what that one paramedic did differently and how they could replicate those actions throughout the agency.

Reimbursement
Perhaps measuring the patient experience has yet to catch on in EMS because people fail to see the financial incentive. Unlike hospitals, whose reimbursement levels could be impacted by patients' responses to the Hospital Consumer Assessment of Healthcare Providers and System survey, EMS providers do not see an obvious tie between economics and patient satisfaction.

In fact, leaders might perceive an economic disincentive. There is a small cost to measuring patient satisfaction using an outside vendor, which is the best way to ensure an objective response that can help your organization improve.

Some agencies may have started measuring the patient experience only because they expect the Centers for Medicare and Medicaid Services to expand use of patient satisfaction measures from hospital reimbursement to other areas, like ambulance transport. But predicting the precise future of health care reimbursement remains a murky proposition, and many agencies would rather wait and see.

Regardless of future financial incentives, EMS leaders should recognize that in some ways, measuring the patient experience is the best way to measure the performance of an EMS system. Many agencies rely on operational measures such as response time to assess their system, but we have come to realize that response time is only clinically important for a small number of critical conditions. On the clinical side, the most common measures are cardiac arrest survival or intubation success rates — metrics that examine important processes and outcomes, but look at only a tiny fraction of total calls.

Measuring patient and family satisfaction is a way to look at performance of the entire system on every call. Patients, families and bystanders will judge the overall experience with EMS from the time they dial 911 until they are in a bed in the emergency department and talking to hospital staff.

How we demonstrate not just clinical care, but people care — through our interactions, our ability to explain what's happening, our efforts to provide comfort — is just as important as our IV success rates or whether we obtained two sets of vitals.

How we act on each call, especially in the first and the last few minutes, can make a lasting impression on our patients and probably a difference in how they feel about their caregivers. Calling 911 is usually an anxiety-filled event, and when we take people from their homes to a strange and stressful environment like the emergency department, wheeling them in on their back, feet first — well, it can be a terrifying experience.

Whether or not the patient experience impacts an agency financially or not shouldn't be the only motivator for asking patients for feedback and measuring satisfaction. At the end of the day, alleviating patients' fears, reducing their anxiety and displaying compassion should be part of our core mission. And if we're not actively measuring whether we're achieving that mission, we're probably not going to know when we fall short — or how to do it better.

About the author
Jay Fitch, Ph.D., is the founding partner and president of the public safety consulting firm Fitch & Associates. In addition to consulting, Dr. Fitch frequently speaks at conferences and serves as the program chair for the Pinnacle Leadership Forum. Contact Jay directly at jfitch@emprize.net.

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