Anyone who’s ridden on the London Underground is familiar with the term but it cannot be lost on healthcare as well.
Most patient satisfaction metrics focus on specific incidents during the patient stay. Admissions, Nurse/staff responsiveness, sanitation, empathy, and food are but a few.
Experience tells me that the most difficult to track, and perhaps the most important are the handoffs whether within a provider or even more important, between them. As a result of mergers and acquisitions, the term “between” can be even more challenging within the same large enterprise than if there were handoffs between providers with different ownership.
Some of the biggest gaps can occur in situations where complicated “corporate” cultures and brands are being merged and blind spots occur during transition points in patient care.
Healthcare leaders need to mind these gaps in much the same way they would mind standards in such areas as surgery, emergency department, rehabilitation, housekeeping, etc.
As a healthcare professional, you know very well where these handoffs can fail in your organization.
Here are some of the ones that come to mind from my discussions with patients and families as well as clinicians.
Gap #1: Lab Results & X-rays
Rarely do these tests occur strictly for the use of the departments supplying the service. They are mostly related to an order placed by another clinician or physician. In a world of instantaneous communications, the transferring of this data comes up as one of the most common bottlenecks in patient and family satisfaction.
Think of the number of times you hear patients say, “I can’t understand why my doc hasn’t received or read my test results yet!" Anxiety and worry ensue.
I’m not so naïve to be saying that providers don’t realize that this handoff challenge happens or that they’re not making efforts to fix it whether with technology or workflow improvement. The fact is that it is a chronic problem despite the method used to fix it.
Gap #2: Patient Medical Records
Volumes have been written about the challenges of patients and clinicians getting the records they need, despite the illusion that high-priced EHR platforms have this data at your fingertips.
The challenge is compounded in a number of ways.
One is the age-old technology principle of interoperability or the seamless flow of data across disparate platforms. Given that some providers can have three or four EMR/EHRs that need to reliably and safely talk to each other the gaps can increase dramatically. Plus in an age of mergers and acquisitions, the ability to determine what the primary platform will be and how the others will migrate away from their previous platform is not for the faint at heart.
Add to that corporate culture. I teach in my digital transformation classes that interoperability is largely NOT a technology issue. Various divisions become VERY protective of their data, and despite being "one big happy family" the truth is that sharing is an acquired skill that must come from the top.
A “need to know” culture is one of the greatest gaps that healthcare organizations can create. This should not be confused with HIPAA violations or secure patient data. Gaps in interoperability happen in even the most compliant organizations.
Gap #3: Migration to Outpatient
The gap widens dramatically the further the patient gets from the brick-and-mortar facility. While the on-premises systems can be far from perfect, moving into a more virtual care environment has its challenges with handoffs.
Provider portals are historically not patient-centric despite the much-hyped digital front door. The inability to easily navigate these portals to find critical dosage updates, test results, appointments, and one’s historical patient data creates frustration and a decline in patient satisfaction.
Add to this the other gap, or perhaps chasm, is that satisfaction studies tend to end once the patient is discharged. Ironically as care moves from the hospital to the home the need for feedback INCREASES when there is little to no ability to communicate with the patient on a face-to-face basis.
It’s impossible to have a handoff when there is no one to handoff to at the next stage in the care continuum!
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