Curbside Consult with Dr. Jayne 3/7/22

As a CMIO, I spend a great deal of my time thinking about patient experience. Telehealth is a major focus for my organization, and in the name of patient experience, we worry about dozens of details:

• Are the colors on the website pleasing?
• Can patients easily figure out that we offer telehealth, and what hours?
• How patient-friendly is the registration process for the patient portal?
• Have we optimized the pre-visit check-in process?
• Are we asking enough questions to gather the information the physicians want, but not so much information that patients are frustrated by the questions?
• Is the connection to the telehealth platform seamless?
• Are there risks for a poor-quality visit?
• Are the post-visit instructions clear and delivered to the patient quickly?
• Is the communication back to the rest of the care team timely?

This week I had to put my patient hat on again, and it was an experience that made me wish that healthcare executives spent half the time thinking about the in-person patient experience that I’ve spent thinking about telehealth over the last six months. The opportunities for improvement spanned the spectrum of people, process, and technology.

For background: my visit was for a radiology procedure at a large academic medical center and had been scheduled six months ago. I transferred care there last year after some medical misadventures elsewhere and didn’t know exactly what to expect.

The first miss on their part was the fact that they don’t use the capabilities of their EHR and patient portal to manage basic pre-registration and appointment confirmation tasks. Instead, I had to start playing phone tag with the registration team four days prior to the procedure. I missed their first call because I was working, and then they called again before I even had a chance to listen to the voice mail. I couldn’t answer that call either, and then when I did have time to call back, I was routed through a complicated phone tree before I finally reached a human who was able to verify my insurance and demographics. I asked about arrival instructions since I hadn’t been there for this particular procedure before, and all they could tell me was to stop and ask at the information desk because the person on the phone couldn’t see what specific procedure I was scheduled for.

Two days prior to the visit, I got another call, this time with the pre-visit instructions I had been looking for earlier in the week. Because I use Google Assistant to screen calls from unfamiliar phone numbers, I could see the beginnings of the transcript and picked up. Fortunately, it was a long looping recording that I was able to listen to a second time to make sure I had all the information. It did give more information about the arrival process, including parking information and some additional details about where to arrive at the hospital. I’m not sure how the call would have worked out had I not picked up, though, since it would have rolled to voice mail partway through the recording and likely would have been cut off.

On the day of the visit, I left in plenty of time because I knew traffic would be dicey. It wasn’t as bad as I thought, but I needed every second of extra time because there was hardly any available patient parking at 8 a.m. I made it to the registration area 30 minutes before my appointment as recommended, then had to sit for another 20 because the registrars were on break.

In the mean time, I got to observe challenges other patients were facing. One gentleman was there for laboratory testing but didn’t know the name of his physician, so the staffer couldn’t figure out his orders. Apparently they can’t be looked up by patient, only by ordering physician. The patient knew the orders were from the urology department, but the staffer said they couldn’t do anything until he could give the physician’s name. The patient had to call upstairs to the office and find out what clinician’s name the orders were under, and then they could take care of him. It seemed a little ridiculous to me, but I don’t pretend to understand how their systems are set up.

Once the registrars were back from break  — which continued an extra 3-4 minutes while they watched TikTok in the waiting room right in front of me — I was called back. There must not be an indicator as to whether patients completed the pre-registration process by phone, because I was asked if I did it, and despite saying yes, I was asked all the same questions again. They asked me to sign several consents on a signature pad without offering a readable copy of the consent. Seriously, is it even a valid consent if the patient was never given the document to read? I think it’s unlikely.

The registrar handed back a blue ticket with my insurance card and photo ID, but didn’t explain what it was. I quickly figured out that it was for parking validation, but first-time patients might appreciate some explanation. I was sent on my way with a complicated set of instructions for finding my next destination deep in the radiology department.

There I was met by another receptionist who handed me two paper forms to fill out. Neither had been generated from the EHR, so they didn’t have any of my demographics or historical information. I had to fill out all the basics again, including name, DOB, address, medications, allergies, name of my PCP, name of the referring physician, and more. All of these things could have been handled through the patient portal they day before and placed into the system for the team to review had they not already existed in the EHR. At a minimum they could have printed a pre-populated form for the patient to just update in person rather than having to start from scratch.

When I turned in my clipboard, I got chastised by the registrar for not having a visitor sticker on. I had one when I initially arrived, but I guess it fell off after moving through multiple different stations and putting my tote on and off my shoulder repeatedly.

Once I made it into the actual MRI suite, I was taken to a set of lockers and verbally given a complex set of instructions on how to use the lockers, which had recently been made keyless. I was given gowns to change into, but no scrub pants like I was used to at my previous radiology department. The tech told me they quit using pants for cost reasons, and now they just give people two gowns. Having pants definitely makes for a more pleasant patient experience, so I asked about bringing my own next time. I was told that is not allowed.

After changing, I had to find my way to the IV station, where they reviewed my allergies. The screen still showed an allergy that had been retired almost a year ago during testing by an allergist at the same academic medical center, and which I had requested be removed via the patient portal as well. The nurse updated the screen (hopefully for the last time), got the IV going, and took me to an internal waiting room.

At some point in the pandemic, every other chair in that waiting room had been taped off by placing a banner around the arms to block the seat. The banners said something about social distancing, but I didn’t retain the message because I was too busy being floored by the amount of dust and dirt that had accumulated on the unoccupied chairs. We’re talking mini-tumbleweed dust bunnies here. I know people haven’t been sitting in the chairs, but I am guessing that no one has been wiping off any of the other chairs either, because I can’t imagine a worker who was tasked with wiping chairs ignoring something that looked like that. I would have taken a picture if my phone hadn’t been impounded in the locker.

I was finally taken back for my study,. After getting situated for the MRI, I had to specifically ask for a blanket to cover my bare and freezing legs. I wonder how many patients know to ask for that.

The MRI was not entirely uneventful, but I’ll leave that story for my closest friends over cocktails. After I finally made it out of the machine, the staff confirmed that I wasn’t having any other tests or procedures that day, so they could remove my IV. Good thing I wasn’t still dizzy and feeling crummy from the test because there were no chairs in the room. I had to bend over and rest my arm on a counter for the tech to pull the IV. Had I been an elderly patient or someone with a tendency to faint with procedures like that, things could certainly have gotten bad very quickly.

After that, I had to find my way back to the locker room area, where an older patient was struggling with the lockers because she couldn’t remember how to get it to unlock. There weren’t any posted instructions, so I coached her through it before retrieving my own clothes. I changed quickly because at this point, I just wanted to get out of there.

The staff had said there was no checkout process and I was free to go, but the signage didn’t clearly tell me how to get back to the initial waiting area. I made a wrong turn and wound up in a back corridor, where they were transporting an intubated patient in a hospital bed. I quickly turned around for privacy reasons and headed back into the maze of corridors, finally making it through the waiting area to the main hallway.

Upon turning left to exit, I ran into the same transport team in the main corridor wheeling the intubated patient (whose gown was hanging half off) through the main atrium, where I’m pretty sure there aren’t supposed to be patients in hospital beds. Maybe there was a broken elevator or maybe something else was going on, but I felt bad for the gentleman’s lack of privacy as well as the other patients and visitors who probably have never seen a gravely ill intubated patient and might have found it shocking. If that’s indeed how hospitalized patients are transported to MRI, then shame on the architects for their design.

After dealing with my parking ticket (the magical blue card covered only $1.50 of my fee) I was even more eager to just get out of there. There was a line at the elevator, so I took the open staircase in the elevator atrium. When a parking garage has closed-off stairs, I expect them to be a little grubby and usually poorly lit, but these steps in the open atrium were dirtier than any big-city subway station I’ve ever visited. There was trash on the ground, used masks, and enough road salt granules to make the stair treads somewhat slippery. It made me wonder when someone from hospital administration last used those stairs and what they thought about it. It also made me wonder what the big-time donors whose names are on the building would think.

Overall, I would give my patient experience no more than 3 out of 10. If I encountered the level of dirtiness I saw at the hospital at a restaurant, I’d walk out the door. As healthcare consumers, however, we are expected to tolerate it.

If you are a hospital or health system executive, I urge you to walk the proverbial mile in your patients’ shoes, in-person as well as virtually. Fix the little things like wayfinding signage and locker instructions. Offer blankets rather than waiting for patients to ask. Let patients bring their own scrub pants for MRIs if you’re not going to provide them. And for the love of all things, use the expensive EHR to the best of its capabilities rather than continuing decades-old processes. You can bet I’ll be sharing my experience fully when the patient survey arrives.

If you’re an administrator, have you walked in the patient’s shoes, and were you shocked by what you saw? Leave a comment or email me.

Email Dr. Jayne.