Guest Column: Achieve case management service excellence
Achieve case management service excellence
Using a Moment of Truth Analysis
By Patrice Spath, RHIT
Brown-Spath & Associates
Forest Grove, OR
A Moment of Truth Analysis can help case managers better understand the level of service they provide to patients and families. A case management moment of truth is an occasion when the patient experiences some interaction with case managers and forms a judgment about the quality of the services. For example, a moment of truth occurs when the case manager walks into the patient’s room. The case manager’s behaviors and body language in the first few seconds set the stage in the patient’s mind for a good or bad interaction. The patient may notice whether the case manager makes immediate eye contact or enters looking down at a notebook.
Of course, good service is always important, but at moments of truth it’s crucial. Unfortunately, the effectiveness of case management interventions may do little to make up for shortcomings in the quality of customer service. Research suggests that patients have a hard time separating clinical expertise from service expectations. Patients often define "care" in terms of service. Among the quality measures patients identify as important are respect for their values and preferences, adequacy of communication, and sharing of information.
Moment of Truth Analysis is a technique that involves mapping out all of the contacts, or "moments of truth," that a patient and their family have with case managers and analyzing the quality of these contacts. In this way, processes and procedures that need improvement can be found. The purpose of analyzing case management moments of truth is twofold: to create a patient service mindset in the department and to identify some priorities for improvement.
Invite all case managers to participate in the analysis. The moment-of-truth worksheet in Figure 1 can be used to guide discussions. Create a list of the contacts that patients and their families have with case managers. For example, what contact do patients have before they come to the hospital? When they are first admitted? And so on. These contacts are potential moments of truth. List these moments in the first column (e.g., case manager first introduces herself or himself to the patient). It may be convenient to break moments of truth into critical contacts, such as:
- initial contact;
- assessment;
- care planning;
- ongoing support;
- problem solving;
- facilitate transition of care at discharge.
Once the critical contacts have been listed, determine what the desired situation would be through the patient’s eyes. Ask, if you were the patient or the patient’s family, what would you like at this moment? Answers to this question are recorded in Column 2. For example, at the initial contact, the patient would like the case manager to give the impression that he or she is relaxed and ready to listen, not harried and just wanting to move things along. Be sure that the desired situations are stated in observable or measurable terms as seen through the patient’s eyes. For example, "friendly case manager" is too vague. Say instead, "case manager does not seem rushed or impatient." And although "home medical equipment request form completed accurately" is measurable, it is not what patients would most likely report as the desired situation. Rather, "patient/home caregiver educated in use of home medical equipment" captures the patient’s experience of hospital-to-home transition services. If available, patient satisfaction or focus group survey results can be useful during this step of the analysis.
After determining what patients/families would like at each of the critical contacts, discuss how case managers are now doing at meeting these expectations. Are case managers actually providing this level of service at the moments of truth? You may not have objective data that answer this question, but that’s OK. Ask the case managers to give a "best guess" grade (A to F) to each moment of truth based on what the situation is now and what it should be from the patient’s eyes. After completing this exercise, you’ll find that some moments are magnificent — patients probably get more than they expect. You also may find some critical contacts that could be moments of misery — when patients get less than they expect. A partially completed sample Moment of Truth worksheet is illustrated in Figure 2.
The next step is to take action to turn the potential moments of misery into magnificent moments. If you want a different level of case manager service, you will have to change something. But rather than trying to fix all the problems at once, priorities must be set. It is important to involve case managers in the priority-setting process just as it was in the Moment of Truth Analysis. Ask everyone to rank or vote on topics for improvement. You might even consider involving a few patients you know will be constructive in providing input. Consider the following questions when setting priorities:
- In what areas is our performance far from what is considered ideal by patients and their families?
- What improvements do we think patients/ families will notice most?
- Where do we think we can be successful in making change?
Some moments of truth are more vital than others and, consequently, the quality of case management customer experiences at those points will impact on satisfaction more heavily than others. A Moments of Truth Analysis can help you sort out the most important interactions with patients and their families and view those interactions from a different perspective. Start by mapping out critical contacts. Write down all the events through which patients come in contact with case managers and experience care coordination services. Then determine what matters most to patients and families and evaluate how well you are meeting their needs on these key points. By systematically evaluating what patients want at the moments of truth, case managers can use such information to redesign and improve services. Service improvement is a never-ending task. Each round of improvement builds momentum toward a mindset of service excellence.
A Moment of Truth Analysis can help case managers better understand the level of service they provide to patients and families. A case management moment of truth is an occasion when the patient experiences some interaction with case managers and forms a judgment about the quality of the services.Subscribe Now for Access
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