by Barbara S. Long, APR

If you want to see things through someone else’s eyes, you’ve got to put yourself in that person’s shoes. This old advice, when applied in a health care setting, is helping some hospitals find out what patients really think and feel about their health care experience. Hospitals are using the knowledge to tweak services and facilities to improve satisfaction and drive more business.

It’s called “experience mapping,” and the concept is not new. According to John McKeever, senior vice president at Gelb Consulting in Houston, Web site developers were the first to apply the concept to determine online users’ experience as they moved from page to page. What did users like? Where did they have problems? It’s a simple qualitative research approach that Gelb has repackaged with in-depth customer interviews about expectations and experiences.

Experience mapping is different from process mapping and typical patient satisfaction research. It helps organizations understand the customer experience at each step in the process from beginning to end. “Experience mapping helps develop a strong customer-centric focus. It’s not process mapping, which is operational. It is a strategic shift in focus from operations to customer. It explains the emotions behind the actions,” McKeever says. It is most valuable when customer relationships are complex and involve multiple “touch points” or points of contact – perfect for hospitals.

Although a new idea in the health care industry, hospitals are starting to see the value in truly understanding the patient experience. This is particularly important when service improvement is an issue, before a new facility is designed, when branding needs an overhaul, or whenever new information technology strategies are being considered. Information from the research may benefit the entire organization, but marketing departments are the ones taking the lead from a strategic planning position.

Marketing takes the lead
The University of Texas M.D. Anderson Cancer Center in Houston was one of the first to try experience mapping. According to Alicia Jansen, executive director of marketing, it was an opportunity for the marketing department to add value to the organization and carve a niche for itself by truly understanding the voice of the customer.

“Health care CEOs and presidents are looking for help in meeting goals strategically and tactically. This is a way for marketing to help meet those goals and improve customer satisfaction in a little more innovative way,” Jansen says.

The organization started last year with pilot projects in genitourinary (GU) and pediatrics. Jansen chose these departments because each had specific needs where marketing could help and staff was open to the process. For GU services, administration had set a business goal to increase volume by 6 percent. Pediatrics was already growing, but the organization wanted to change its name, which opened the door for rebranding. Jansen felt both projects could benefit from a thorough understanding of patient expectations and needs.

Froedtert & the Medical College of Wisconsin in Milwaukee also started two pilot projects last year. According to Caryn Esten, manager of planning and strategic support, one project helped with the design and planning of a new cancer facility before the architects were even hired. “We wanted to investigate how cancer patients and family members want to receive care and then build in what people want,” she says.

The second project will rename the emergency department upon completion of a total facility upgrade. Froedtert sees experience-mapping research as a way to do both projects “right” from the start. Improving the patient experience is also a strategic goal set by leadership. “We feel that service excellence is something we can do to improve our standing over our competitors,” Esten says.

Walking in the patient’s shoes
Once a project is selected, the research and compilation of results takes two or three months. Hospitals typically start with a small team of internal stakeholders who are responsible for delivering care in the project area. This group works with the researchers to draft the first experience map, which serves as a guide for patient and physician interviews.

According to McKeever of Gelb Consulting, this step begins a customer-centric dialogue that allows team members to orient themselves to the process and establish expectations. Most important, it creates a sense of ownership among the stakeholders and a willingness to commit to making the changes necessary for improvement.

The team, with input from marketing, determines the type of patients and physicians selected for in-depth qualitative interviews. M.D. Anderson chose a cross-section of patients from the GU clinic to represent a range of patient demographics and cancer types, including kidney, bladder, and prostate. For pediatric research, they wanted to hear from parents of children younger than age 14, as well as those 14 and older, segmented by certain diseases.

Interviews can be conducted one-on-one, in small groups, or by a Web-enabled telephone process. Researchers at Froedtert used patient intercepts for the emergency department research. “Gelb [employees] literally camped out in the emergency department waiting room for a week. For patients that were admitted, they went with them through the process and followed them to their room. Then they followed up with patients after discharge,” Esten says. Patients were asked questions about the current process. What didn’t they understand? Where were they confused? What would have made it better?

In one-on-one and small group interviews, experience mapping helps patients recall their specific interactions with the organization. Patients are asked about the first time the hospital “touched” their life. Then they are asked to recall specific experiences two to three months later.

Research also can be more general. For example, research for Froedtert’s cancer center project focused more on what patients, staff, and the service-line leader would expect to find in a “next generation” facility. Researchers probed everything, including medical care, facilities, parking, food, scheduling, access to providers, and creature comforts.

The process of gathering information individually or in small group settings can yield volumes of results. Twenty experience-mapping interviews can generate more than 100 pages of verbatim transcripts and more than 20 hours of audiotapes. Cost of the research depends on the type and number of interviews. M.D. Anderson says it prefers the one-on-one interviews and budgets $30,000 per project, which includes 50 to 60 patient and 20 to 30 staff member interviews.

Seeing through the patient’s eyes
Sometimes the research validates what a hospital already knows. In some cases, it identifies challenges the hospital did not know existed.

Froedtert learned it would have a big challenge in its efforts to reposition its emergency department. “The ED is in the old county hospital in the city’s center. People in the intercepts said they had an aversion to coming based on [its] history of being where gunshot victims and stabbing cases were taken. The experience mapping helped the issue to surface. Now we know how strongly people feel about it. We’ll really need to make a difference through branding for the new facility to succeed,” Esten says.

M.D. Anderson found it had not done a good job “personalizing” its services. “Some patients chose M.D. Anderson because of our reputation, but they didn’t feel the organization was humanized. They felt we needed to put a ‘face’ on M.D. Anderson,” Jansen explains.

In pediatrics, interviews revealed that one of the most important “touch points” for parents in choosing a hospital was talking with the child’s physician, yet referring physicians didn’t know much about M.D. Anderson. “We learned we needed to push more information to the referring physician community,” says Jansen.

Once patients entered the M.D. Anderson system, other operational issues surfaced. “We give patients everything they need to know on the first visit,” Jansen says. “We were overwhelming the first-time patient with information.”

Improving the experience
The final step in an experience-mapping project is to review the results with staff and develop a plan to operationalize changes. Typically, this step involves a group of 30 to 40 participants to brainstorm ways to improve the patient experience and to prioritize ideas.

The process includes those staff members who will be involved in making and implementing day-to-day changes. “The ideas for how to help patients are their own. It’s not a top-down process,” Froedtert’s Esten says. “Oftentimes, activities are not costly. For example, people who enter the ED expect to wait. However, they are troubled by not knowing how long they will have to wait, or what is going on. Simple things, like telling a patient how long to expect to wait, don’t take five minutes of the staff member’s time. But it’s easy to overlook when [employees are] busy. The experience mapping validates the need to take the time.”

The process also allows staff to focus on what changes would be nice to have and what changes would have the most impact. “If we are trying to create the ‘ideal’ patient experience, we have to weigh the benefit and the costs,” Esten says. “It’s the ultimate reality check. Are there enough resources, staff, and facilities to make it [worthwhile]? What can we do to get close [to an ideal experience]?”

Although construction of the new Froedtert cancer facility will not be complete until early 2008, one product of experience-mapping research will be finished before the facility opens. “Since cancer patients are more active online seeking information for their own care, we are using the experience map to create what patients want in online services,” says Esten.

Froedtert plans to create an interactive cancer portal where patients can access private areas of the Web site to get a customized welcome packet or in-depth information for their cancer diagnosis. “The private portal will recognize the patient [and] their type of cancer and add appropriate content,” Esten says. “We can launch it a full year before the physical experience is ready.”

M.D. Anderson is putting its research to work in new branding campaigns. “We’ve developed ads for our prostate team, using our staff and physician bios and pictures, to put a face on our services. We focused on our team approach, our customized care, and our patients’ opinions of care,” Jansen says. The organization is also offering family physicians a free “second consult” with an M.D. Anderson pediatric oncologist in an effort to build stronger relationships with community physicians.

The information overload required more coordination. To help direct information to patients more appropriately, the marketing department created an interactive DVD, which can be accessed at lobby kiosks. It covers all the areas a patient needs to know to navigate the system. Different modules of the DVD help patients with general information. A “Places to Go” section guides them to the cafeteria, gift shop, and vending machines. In “People to Know,” patients can find out whom to contact for test results or to change an appointment. They can even print instructions to take with them.

The DVD helps patients educate themselves and learn the system when they are ready. Staff members call it a godsend. They are now able to focus more energy on medical treatment and less time reviewing general information with patients.

Jansen points out that experience mapping offers auxiliary benefits. “It helped marketing form stronger strategic partnerships with the GU and pediatric staff,” she says. “We are providing them with quarterly updates and plan to go back and get their feedback after one year to strengthen the partnership and fine-tune the changes we made.”

Improving the bottom line
It’s still too early to estimate a return on investment from the experience-mapping projects at Froedtert and M.D. Anderson. However, both organizations are convinced that it works and have included additional projects in next year’s budget.

In fact, M.D. Anderson plans to undertake five projects in 2007. “Experience mapping [overseen by the marketing department] is showing that it can drive business and improve customer service. Our GU business goal was to increase services by 6 percent. We exceeded that by double and increased operational efficiency,” Jansen says. “Once other departments see the benefit, they want to get in on it.”

Barbara Long, APR, is president of E-savvy Communications in Jefferson City, MO. The firm specializes in strategic Web-based communications for small to medium-size health care providers. You can reach her at esavvy@blongesavvy.com.