Beyond Patient Experience: The New Frontier of Well-being for All

The terms “experience,” “burnout,” and “well-being” are part of a lexicon with a long history of evolution (see timeline below). This body of work provides an invaluable foundation for those committed to understanding these terms and concepts to advance their improvement work.

• In 1992, the Institute for Patient and Family-Centered Care established PFCC with core concepts of dignity and respect, information sharing, participation, and collaboration.
• In 2001, the Institute of Medicine coined Patient and Family Engagement as: “Providing care that is respectful of, and responsive to, individual patient preferences, needs, and values; and ensuring that patient values guide all clinical decisions.”
• In 2007, The Beryl Institute defined patient experience as “The sum of all interactions, shaped by an organization’s culture, that influence patient perceptions across the continuum of care.”
• In 2008, the Institute for Healthcare Improvement introduced the Triple Aim to improve the experience of care, the health of populations, and reduce the cost of care.
• In 2010, the Triple Aim was used in developing the Patient Protection and Affordable Care Act (ACA).
• In 2014, research from The Beryl Institute posited that experience reflects events that happen independently and collectively across the continuum of care, focuses on individualized care and tailoring services to meet patient needs and engage them as partners in their care, and is strongly tied to patients’ expectations.
• In 2014, the concept of Quadruple Aim was coined, adding the need to account for the well-being of healthcare providers to the Triple Aim.
• In 2017, the Institute for Healthcare Improvement’s Framework for Improving Joy in Work included steps to improve joy in work and workforce well-being, a framework for ensuring a joyful, engaged workforce, key change ideas, and measurement and assessment tools.
• In 2017, the National Academy of Medicine’s Clinician Well-Being Collaborative was convened to raise the visibility of clinician anxiety, burnout, depression, stress, and suicide, improve baseline understanding of challenges to clinician well-being, and advance evidence-based, multidisciplinary solutions to improve patient care by caring for the caregiver.
• In 2021, The Beryl Institute introduced human experience in healthcare as a natural evolution to include the experiences of patients and families, members of the healthcare workforce, and the communities they serve.

Patient Pharmacy Experience

In the context of patient experience, which consists of all interactions across the continuum of care, pharmacy and medications significantly influence patient experience. Pharmacists are often given the moniker of “the most accessible healthcare provider” given the frequent visits to the pharmacy, the ability to consult with pharmacists in person or by telephone without needing an appointment, and extended service hours (e.g., 24/7). Additionally, taking medications is a once or multiple times daily event for many patients. A considerable breadth of interactions also contributes to the pharmacy experience, including aspects like the route of administration, costs, side effects, refill requests, prior authorizations, prescription deliveries, and patient education. The breadth of medication use also spans the continuum of care, including inpatient facilities, clinics, retail pharmacies, infusion centers, skilled nursing facilities, procedures, imaging, and home care. Therefore, optimizing medication-related interactions is crucial for enhancing the overall patient experience.

Pharmacy Digital Front Door

The “Digital Front Door” concept is a virtual entry point to healthcare services, integrating various digital technologies that facilitate interactions between patients and their healthcare teams throughout the service continuum. Patients can easily find and research available services, schedule appointments, receive treatment through telehealth or virtual care, access their electronic health records, pay bills, and communicate with their physicians and other healthcare team members. This digital front-door approach empowers patients to take control of their healthcare while allowing healthcare team members to use their time more effectively.

Pharmacy services have multiple digital touch points, including prescription refill requests and reminders, medication adherence applications, updates on the status of prior authorizations, marketing of services (such as vaccinations and specialty pharmacies), delivery kiosks, and more. Thus, assessing how pharmacy services fit into the organizational digital front-door strategy is essential.

Workforce Pharmacy Experience (External to Pharmacy Workforce)

Another important stakeholder group is the workforce external to pharmacy (e.g., nurses, physicians, respiratory therapists). This workforce’s pharmacy experience significantly influences overall well-being and joy of work. Organizations must intentionally optimize the pharmacy experience for the workforce external to the pharmacy. For example, in the aggregate, seemingly minor issues, when they are single occurrences (e.g., finding medications, prior authorizations, order entry, refill requests), are a major factor influencing an individual’s work experience, either positively or negatively. Pharmacy must lead efforts to improve the workforce pharmacy experience as part of a broader initiative to enhance overall workforce well-being. Examples include but are not limited to improving the usability and efficiency of medication order entry, finding and fixing root causes of missing medications and delivery delays, and clearly communicating the status of prior authorizations. Efforts to improve workforce well-being and joy in work must include the workforce pharmacy experience.

Joy in Pharmacy

The experience of the pharmacy workforce (pharmacists, pharmacy technicians) has many opportunities for improvement. Pharmacy staff play a critical role in safeguarding medication use and have developed a culture of being rewarded for catching potential or actual medication errors. Unfortunately, this culture often leads to working to address burnout in terms of deficits (i.e., what is wrong or what needs to be improved). One principle of the IHI Framework for Joy in Work is that joy in work is not the absence of burnout and flips the script to focus on strengths (i.e., what is working or our advantages). Pharmacists and pharmacy technicians examine how systems contribute to error beyond the individual as part of medication safety training. Another fundamental principle of the Joy in Work Framework is that joy in work is not solely about individual burnout or resilience but is also a product of the organization as a system. Fostering joy in work is foundational to employee engagement and satisfaction and achieving the Triple Aim. However, improving joy at work can be daunting, given the pervasiveness and degree of lack of joy in work, as well as the skepticism of the workforce. The IHI Framework for Joy in Work provides practical tools and proven methods to drive improvement. The new year offers an opportunity to assess, reflect, and resolve to prioritize joy in work.

Calls to Action

1. Take steps to improve the pharmacy experience for patients and the healthcare team.
2. Implement the IHI Joy in Work framework by asking employees what matters in their daily work, identifying impediments to joy in work, committing to a systems approach to making joy in work a shared responsibility at all levels of the organization, and using improvement science to test interventions to improve joy in work in your organization.
3. Assess how your organization’s digital front door integrates pharmacy services.

Looking for more information or assistance for your organization? Reach out to Visante today!

Subject Matter Experts: Dave Hager and Phil Brummond