March 26, 2021

Improving Patient Experience in Your ED with Dr. Justin Schrager

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About the Episode:

The emergency department often represents the patient’s initial experience with a health system. However, these visits frequently bring stress, uncertainty, and poor satisfaction for the patient. Our guest, Justin Schrager, discusses the challenges ER providers face when trying to create a positive patient experience and a technology solution that can help improve the patient experience and drive patient loyalty in the ED.

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About the Podcast:

The Engaging Healthcare Podcast by Stericycle Communication Solutions features conversations focused on the challenges, trends, innovations, and hot topics of the healthcare industry. Hear industry experts share their approaches to transforming healthcare and give fresh perspectives on the future of value-based care.

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Mark Angus: “Welcome to the Engaging Healthcare podcast presented by Stericycle Communication Solutions. I'm your host, Mark Angus, we’ll be providing you with insightful commentary on the healthcare industry's challenges, trends and hot topics. To learn more about how we help modernize patient engagement and maximize patient outcomes, head over to StericycleCommunications.Com. If you've ever gone to the emergency department, chances are, this is your first encounter with the hospital. Identifying how to improve patient experience in the emergency department can be difficult. Today's guest, Dr.  Justin Schrager, Co-founder and Chief Medical Officer of Vital, as well as practicing emergency physician with Emory Healthcare in Atlanta, Georgia, is here with valuable insight about how to bring a consumer like experience to the E.D. Justin, welcome. Let's talk about patient experiences in the ER are they better or worse than their inpatient counterparts?”

Dr. Justin Schrager:  “Of course. So the emergency department traditionally has had more of a challenge in terms of patient experience than other care venues. In fact, the emergency department typically has about maybe 20-ish points, lower patient experience scores than the rest of the hospital for at least for hospitalized patients and none that has external validity. I mean, if you ask anyone about what their last experience was like in the E.R., it's a scary day. They're usually having an emergency that is either life or limb threatening or they have a lot of diagnostic uncertainty or they're there with a family member, and they don't really know what's going on. And so there's sort of a time, urgency related to the patient experience, too. There are very difficult barriers to setting expectations in the emergency department, specifically because of the way that we as E.R. doctors and nurses take care of patients. But based on how it's not first in, first out, it's based on how sick people are. And so it's difficult to give people estimates about what they're waiting on, how long it's going to take, and in general its just kind of a high stress, high stakes environment, which in and of itself leads to more stressful experience. There's a sort of bleed out effect of just kind of the hectic nature of the emergency department that makes providing an excellent, let's say, customer experience or patient experience much more challenging from the outset.”

Mark Angus: “And that leads me to my next point Justin. So what are the challenges E.R. providers and staff face in trying to provide a positive patient experience?”

Dr. Justin Schrager: “So in the emergency department, patient experience is intimately tied to wait times and length of stay. So we know that we know the longer people wait, the worse experience they're going to have. And that makes sense, right? If you wait a really long time for your table at a restaurant, you're going to sit down and already be kind of upset.”

Mark Angus: “Very true.”

Dr. Justin Schrager: “So setting expectations during that long wait time is traditionally difficult. Next to impossible, because it's difficult to predict what kind of patients are going to come through the door in an ambulance while you have waiting room patients come and sit. It's hard to look someone in the face and say, you're going to be out here for an hour. I guarantee we'll get you back. If you could set that kind of expectation, people are kind of OK with it as long as they know what they're getting into. It's kind of like getting on a ride at Disneyland where they put a sign up at the front. Right that says it will be an hour and 15 minutes like, OK, well, I'm going to bring my kids on this ride. It's going to be an hour and 15 minutes. I'm going to get some snacks. I'm just going to think of something fun to do while they wait. Right while the emergency department. There's no there's no way to do that in terms of expectation setting. So from the outset, it's difficult. And then what I will also say is that E.R. providers, nurses, staff members have a very different, they have a very different focus than customer experience or patient experience. They are not that is not their prime directive. And in many emergency medicine circles, the patient experience scores companies that do the surveys are sort of like four letter words. Right and so the idea is that if you're an old school E.R. person, you should focus on your main job, which is keeping people alive and your secondary job is operational flow, keeping people moving and making sure that everything is running efficiently. And a very distant third or fourth would be making sure people are happy and comfortable while you do these lifesaving things. So it comes from a different era, right? A different era where emergency departments were not as crowded, and the wait times were not as long. And you can get away with that kind of like operational mentality. So that those are the things that people have to deal with. And then also say that our nurses specifically are actually really good at providing a nice experience for patients. It just so happens that it's a difficult time in the patient's life right now with appendicitis, they're uncomfortable, they're in pain like there are sometimes when there's just not that much you can do for somebody to make them feel more comfortable, whereas people that are more stable, but they're pain controlled and that kind of thing. They're more they're more looking for like those simpler customer service things, like a little more attention or a pillow or water or things like that. So the barriers to kind of making people's experience more comfortable, a little higher. And then, of course, the last sort of the first thing to go when the area gets busier is are those extra touches. Is that like popping in the room to be like, hey, you know, we're still waiting on your CT scan, i'm sorry, like we had a really sick person come in with the stroke that bumped you out the line, you know, that kind of thing. Those little extra touches that you would expect from excellent service are harder to do during, especially during the COVID era when you have to put on a full gown and it takes longer to just pop into a room. And then above and beyond all of that, traditionally, we have interacted our people have interacted with family members as much as with the patients. Usually you have family members there in the room. Right so when I'm there with an older patient and their daughter, I talk to both of them in different ways. And then I try to get my teaching and explanations through in different ways, different mechanisms. I keep the family member just as happy as the patient. Sometimes give them coffee, water, whatever it is, because I know how long, how far it will give me in terms of how I can help the patient, especially later on. So that's obviously kind of off the table right now during COVID as well. So there are lots of barriers that kind of get in the way of providing what I would consider as a consumer of healthcare as well, an excellent experience.”

Mark Angus: “And you made some really good points there. I mean, there's a lot happening and their world, the E.R. providers world and what they're going to be focusing on. Can they can be focusing on saving lives, like you said. So what can technology solutions help in this regard? What technology solutions are that can help improve the experience and create patient loyalty?”

Dr. Justin Schrager: “So, you know, there are a number of there are a number of companies that do patient engagement and patient experience within the world of software, and there are some companies have been around 10, 15, 20 years. And then there are new startups and other companies, such as the InQuicker Navigator that does this type of thing. So what I will say is that the companies all function from the background of trying to do standard things to improve people's experience that would be improving communication, expectation setting, education about diseases, education about just general processes that might be unfamiliar to patients. And where they succeed and fail is in what proportion or percentage of the patients they're able to reach on a daily basis, like how many people are using it. And the other part is how much they're asking the staff to do so, like I said, E.R. people are very busy and there are always very busy. You can never find someone in the emergency department who's not busy. And if you ask them to do one more thing, it's going to force them to give up doing something else. So for every question an E.R. staff member answers for a patient, where is the vending machine. What's the address here or what's the phone number of those kind of things that distract them from one other small task that they're currently doing. So at least with InQuicker Navigator, which is what we're talking about today, so far, functions sort of outside the realm of clinical input. So if you really want to be successful in the modern healthcare, patient engagement, patient experience, platform world, snd truly provide an excellent experience that's additive during the E.R. stay, you have to not subtract from the clinical work that's going on in the background. You don't want to be forcing the staff to be constantly holding the patient's hand through the solution or helping them log in or doing 10 other things. So it's my general opinion of it is that it should do that. And it should use modern software design principles, artificial intelligence, predictive analytics, smart wait times, same stuff that all consumers expect in their current software platforms is something that you should strive to use in the healthcare setting, meaning nobody would use Google Maps, if I just told you how far it was from your home to work. Use it because you can see about how long it's going to take you to get there. And see the traffic on the way. You can see sort of estimates of you personally like it's personalized to you about how long it's going to take you to get there. So those are things that I think software solutions that do patient engagement should strive to do, should be less burdensome to the staff more helpful to patients, and then to include modern design principles, which are, frankly, foreign within the healthcare software landscape.”

Mark Angus: “Justin, thank you. This has been a really interesting interview, but before you go, I'd like to just get your further thoughts on the future of patient navigation tools and how they will impact future experience.”

Dr. Justin Schrager: “Of course, so I think that healthcare is moving towards sort of what I spoke about before, which is using modern software to engage with patients, and we're at a juncture in the healthcare world of trying to decide how we're going to do it. Are we going to force our staff members to do one more thing, constantly doing updates on patients, that kind of thing, in addition to their normal work, which I think is probably a safety issue, knowing how busy my staff is in the E.R., or are we going to do what other companies have done, which is meet people where they are, which is on their phones and give them what they expect, which they see in every other service industry, whether it's from Domino's Pizza to Jiffy Lube to Google Maps, whatever it is, the Delta Airlines app, they're all nice applications that they do things that are predicting, you know, delays, things like that, setting expectation, doing educational and educational teaching that is appropriate for the educational level and linguistic barriers that the patients have. I think that's the direction that healthcare is going. Certainly that's the way that we've designed InQuicker Navigator to do it. Now, the other thing is that the healthcare landscape is shifting, right? So less people are going to the hospital, more people are doing telemedicine, more people are staying home. The hospital systems have done a better job of keeping sick people in their homes for longer and not having to stay in the hospital itself, which is very costly to the insurers and to Medicare and whatnot. And so I think that the more we can do to engage with patients on devices that are portable that they already are using all day long and to allow them to communicate back and forth with the providers when important and to be able to self serve information to themselves when less important, is going to be advantageous to everyone within the healthcare setting. It will be a safer way of doing healthcare. It will be faster, will be more pleasant for our patients, and it will enable us to reach multiple users simultaneously. Everyone from a family member at home to the patient sitting in the room can use the same types of information at the same time. So we're actually kind of at a neat juncture in the way that software such as InQuicker Navigator works with the existing sort of like electronic healthcare, sort of older, I guess, if you want to call it electronic healthcare platforms that have not traditionally been able to offer those things, frankly, because of the way they're designed.”

Mark Angus: “Thank you, Justin, that was a really insightful talk with you today, I appreciate you sharing all your thoughts about patient experience as an E.R., and also some of the latest patient navigation tools that we're going to be seeing impacting the future experience. Thank you for your time.”

Dr. Justin Schrager:  “Thank you.”

Mark Angus: “Thanks for listening to the engaging healthcare podcast presented by Stericycle Communication Solutions. Continue the conversation by following us on Twitter and LinkedIn. If you enjoyed the podcast, be sure to subscribe. Until next time.”

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