There are more than 100,000 perceptions of Carl R. Darnall Army Medical Center--some good, some not so good--but each unique. And it is exactly those perceptions that are driving changes to improve the patient experience for CRDAMC's beneficiaries.

"Patient experience is about a patient's perceptions of the care they received during their visit and encompasses every touch point from start to finish," said Tracie Duckett-Stephens, chief of CRDAMC's revitalized patient-experience department.

It only ends, she said, when the patient quits talking about his or her experiences to friends and family. That could be days, months or even years, and whether those conversations praise or criticize, it is all about reputation.

That's why Duckett-Stephens and her team of patient advocates preach customer service to everyone from janitor to doctor.

"We know coming to the doctor or a hospital stay is not anyone's idea of fun, which is why we want our beneficiaries to know we care and are listening," she said.

To demonstrate that care and concern, Duckett-Stephens said, the hospital continuously trains employees and department supervisors in customer service, as well as exploring new initiatives to enhance the patient experience.

One of those initiatives is CRDAMC's Patient Family Advisory Council, a new solution-based working group with its members composed of staff members and assorted beneficiaries. It is chaired by the commander and co-chaired by a retiree.

"Who better to tell us what is going on and what improvements we can make than the people who are experiencing the services we rendered?" said the patient-experience chief.
CRDAMC also welcomes patient feedback from various surveys to drive cultural change.

Patient feedback
To statistically measure outpatient experiences, the Military Health System has implemented a new survey that now standardizes customer-service measurements throughout the military. JOES, short for Joint Outpatient Experience Survey, replaces the Army Provider-Level Satisfaction Survey (APLSS).

The survey is mailed randomly to outpatients and takes about five minutes to complete, said Duckett-Stephens. Responses also are confidential.
"We really do take feedback seriously," said Duckett-Stephens, although the preferred method to resolve complaints is through Interactive Customer Evaluations (ICE). "ICE is unique because it is more real-time, and there is immediate feedback."

Another plus with ICE, she said is quicker resolution.

"If you tell us what you do not like in ICE, we have a chance to immediately resolve it or at least start investigating it to research a resolution," she said, adding that another unique element to ICE is that it is customer-driven, which also provides CRDAMC employees an avenue to submit complaints and compliments.

Although feedback is critical to continual improvement, Duckett-Stephens said educating employees to accept feedback as a gift and not as a punishment is one of the barriers in enhancing customer service and employee relations.

"Employees automatically get defensive when a patient advocate approaches them," she said," but it really is not to get anyone in trouble. We use it as a lesson-learned and see how we can improve."
The best kind of feedback? Face-to-face communications.

"You can have all the surveys in the world, but good old-fashioned face-to-face communications is best to find out about how our beneficiaries feel about the services they received," she said, adding that leadership is doing just that as they go to room to room to visit patients to discuss their inpatient experiences.

Consistency is key
One of the biggest roadblocks to patient perceptions is inconsistent communications, said Duckett-Stephens.

"One of our biggest challenges is to make sure pertinent information gets to all areas and to all people that it affects," she said, adding that it is not something easily done since there are 92 buildings within the CRDAMC footprint. "Consistency is the key so anytime the patient comes in, they should be receiving the same messaging."

This, she said, weighs heavily on the patient experience, which is why customer-service training is critical to those who have a direct hand in patient care.

"We have scenario-based training to help our employees deal with challenging patient situations," said Duckett-Stephens, adding that multiple levels of training give supervisors the tools they need to support their frontline staff, especially helping them deal with escalating situations. "We like for clinics and departments to actually own that whole patient-experience process to include resolving issues at the lowest level possible."

Patient experience also encompasses other things like the nemesis of all intangibles: wait times.

"Our goal is little to no wait time, but sometimes the doctor has an emergency and wait times do exceed expectations," she said, adding that Army Medicine's wait-time goal is 10 minutes. "While we cannot do anything about unexpected situations, what we can do is communicate to the patient the reason for the delay."

Besides improving patient-staff communications, technology is contributing to improved patient experiences via digital messaging. Nearly 100 overhead monitors are located throughout the hospital and its clinics that display digital slides that convey command messaging and programs affecting beneficiaries. The programmed messaging ensures all of CRDAMC's 100,000 plus beneficiaries are continually informed about everything from prescription refill procedures and hospital programs to health tips ranging from quitting smoking and weight management.

Patients in 'driver's seat'
"We always are looking for different ways to show our beneficiaries that we care," said Duckett-Stephens. "We also would love to have patient-experience ambassadors throughout CRDAMC and its outlying clinics. This person would be a champion for patient rights and know how to deal with situations on the spot."

The bottom line, however, is family: treating people like you want to be treated.

"Our beneficiaries have a choice in healthcare, and I want CRDAMC to be that choice," she said. "That means you trust us."

Editor's note: As Carl R. Darnall Army Medical Center (CRDAMC) nears its first-year anniversary, the Fort Hood hospital is launching a pre--celebratory patient-appreciation week February 13-17. Throughout the week, CRDAMC is hosting various events ranging from live Facebook feeds from various departments to "java chats" with the commander. The week-long event is designed to demonstrate CRDAMC's appreciation for the privilege of serving its 100,000 plus beneficiaries, as well as thank them for choosing CRDAMC. Since the new hospital's 2016 opening, it has incorporated numerous customer-service improvements based on beneficiary feedback, as well as implemented new programs designed to improve the patient experience. This story is part one of a two-part series on the "patient experience." Read part two here:https://www.army.mil/article/182668/)