In this XM Discussion, we’ll be talking about how healthcare organizations can improve patient experiences by focusing on building patient trust. Trust is absolutely foundational to all relationships, whether that’s the relationships we have with other people, relationships we have with the organizations we interact with, or those we work for. 

Our trust levels are going to affect whether and how we decide to engage with other people or institutions. When we have high levels of trust in someone/something, we are more likely to do things like interact with them voluntarily, forgive them if they make a mistake, and listen to their advice and recommendations. For us in the Experience Management space, that means building trust with our customers or employees is absolutely critical for their long-term loyalty. 

While we have seen trust become an increasing area of focus across every single industry (which is one of the reasons that we named 2024 the Year of Trust) perhaps nowhere is it more important than in the healthcare industry.

To help us examine how you can build trust with patients, we are joined by Nicole Richendollar, Vice President of Advisory and Managed Services at our partner Walker, who has been a Patient Experience Officer for a large health system, so is deeply familiar with patient experience from both a practitioner and a consultant perspective. 

An edited transcript follows.

–

Isabelle Zdatny: Welcome Nicole.

Nicole Richendollar: Hi. Thank you for having me.

Isabelle Zdatny: So before we dive into the discussion, could you give us a little bit of background about yourself and the role you play at Walker?

Nicole Richendollar: Sure. So as you mentioned, my name’s Nicole Richendollar. I am a nurse by background. I worked in an organization in healthcare for over 12 years in leadership, and oversaw patient experience and Experience Management.

I’ve been at Walker for almost two years, where I help healthcare organizations and adjacent healthcare clients to improve the overall experience they provide to their patients, their families, and caregivers, as well as employee experience. We see what process improvements we can put in place along with the technology to help support listening to the patients and their families and our employees.

The State of Patient Experience

Isabelle Zdatny: So let’s start with a little bit of scene setting. Broadly speaking, how do you characterize the current state of patient experience? How does it compare to maybe what you’re seeing around customer experience in other industries?

Nicole Richendollar: Yeah, great question. In healthcare specifically, and I would say in all industries, experience is still a strong factor in the way that we are trying to provide care for our patients. The Beryl Institute put out an article in which they looked at all the different ways that experience, quality, and the different things that are important to our patients in today’s world. Experience, as well as the quality of care being provided, is one of the top things that patients are looking for in healthcare moving forward – they want to make sure that they can receive the best quality of care.

Compared to other industries, patients have higher expectations of healthcare. They’re going to get their care, put their trust in you, and want to make sure that they’re getting the best care possible in those recommendations. So compared to government, banking, and retail, the research and the background shows that people expect more out of healthcare, rightfully so, because they’re putting their lives in your hands and they want to make sure that you’re doing what you should be doing for them.

Isabelle Zdatny: That makes a lot of sense. The stakes are much higher in healthcare than say other places like retail or fast food where it’s still important, but there’s a little bit less hinging on the outcomes there.

Patient Experience Needs to Center on Voice of the Patient

Isabelle Zdatny: I’m curious, what are some of those common activities or focus areas that you’re seeing in these healthcare organizations? Are patient experience teams focusing more on activities in the realm of analytics and insights? Do you see them taking on areas like human-centered design, change management, or strategy and transformation? Where do you see them spending most of their efforts today?

Nicole Richendollar: I think honestly it’s a combination of everything, because you can’t really do one without the other. The analytics capture information and make sure that you’re listening to our patients, and knowing what they need is going to help drive your strategy and process improvements and ultimately the change management that you’re going to put in place when you’re trying to develop patient experiences in general.

On design thinking, making sure you have that patient’s voice at the center of that design is important. Because from a healthcare institution’s perspective, if you’re designing a process, you want to make sure it’s going to meet that patient’s needs. We want it to work for the healthcare organization, but putting the patient in the center of that is really essential, too.

Why Invest in Tracking Patient Trust? 

Isabelle Zdatny: I opened this conversation by talking a little bit about the importance of trust overall in Experience Management. You talked a bit about the importance of trust in patient experiences, but why from your perspective, is this an area that organizations should specifically invest in tracking and improving?

Nicole Richendollar: Great question. I think trust has always been an important thing that our patients and our healthcare organizations should really have been looking at. It hasn’t historically been measured because it wasn’t one of the criteria that needed to be measured, but it’s always been a factor that comes into play for healthcare organizations. 

So thinking about it like a personal experience, going to an emergency room or going to the doctors or some type of facility, if you don’t know anything about them or have any type of history about them going in, are you going to trust what the doctors are saying to you if you have absolutely no knowledge of what type of facility this is?

If you want to develop better relationships with the patients and with their family members, developing that trust is an important factor for that relationship to be successful.

Isabelle Zdatny: Yeah, actually in our most recent ROI of customer experience report, we found that 90% of customers who are highly satisfied with their experience said that they would trust a hospital or medical clinic, which is higher than it is any of the other 20 industries we surveyed. It’s important everywhere. But it’s interesting that in our data we’re also reinforcing that there’s a particularly strong connection with trust amongst healthcare providers.

Measuring Trust and Other KPIs

Isabelle Zdatny: Which makes me also curious, you were saying trust wasn’t historically asked, and a lot of healthcare providers today use NPS (Net Promoter Score) as a core relationship metric. As you think about tracking and measuring trust, how does that relate to existing metrics that providers are using? Is it worth tracking trust? What are some of those practices you’ve seen organizations use around it?

Nicole Richendollar: The majority of the healthcare organizations that I work with have started measuring trust. So it is becoming more of a standard that people do measure it, because we know how important it is to our patients and to the healthcare organizations to have that trust. 

When you’re looking at the data, typically trust is one of the leading indicators and highly correlated to likelihood to recommend, which most healthcare organizations, as you mentioned, use as their key performance indicator.

So when you’re trying to identify what you need to be working on, having trust show up continuously as the top driver of that should really be eye-opening – that something you haven’t measured is something you need to be focusing on. 

I definitely recommend that people who aren’t measuring it should start taking a look if they’re not. And regardless of if you’re measuring it or not, you need to be focusing on trust and how you’re building that trust with the patients.

The Drivers of Patient Trust

Isabelle Zdatny: So we’ve looked at the why, let’s now look at the how. 

What are the elements of the patient experience that typically drive trust? What are those key moments or interactions or journeys that are going to have a disproportionate impact on a patient’s likelihood to trust a program?

Nicole Richendollar: There’s so many key moments that impact the trust that you build. It’s going to be different depending on which patient journey you’re looking at. If you’re looking at a patient’s experience in an outpatient medical doctor’s setting, it’s going to look different than if you have a patient experience in the emergency room, or just an outpatient clinic. 

Regardless of the situation, though, communication is one of the main ways to start building trust. When patients do trust their healthcare providers, they’re more likely to communicate openly and honestly about their symptoms, their concerns, and their preferences. Not only are you going to have better patient satisfaction from that, but you’re also going to get better diagnoses and better treatments and better quality outcomes.

Adherence to treatment plans changes, as well. If you really know and trust your provider, you’re likely to continue to take those medications, go to your follow-up appointments, and get those extra exams that you need because you do trust that they have your best interest and wellbeing in mind when they’re trying to provide you care. You’re also more likely to become a partner with your provider when determining what your care plan should be.

If you do build those trusting relationships with patients, they’re likely going to come back to you for more medical care as well as recommend their friends to you too, as that’s shown through the data.

Isabelle Zdatny: A number of the things you recommended have struck me as similar to the strategies that we recommend to other organizations to build trust with their customers. Things like acting consistently, doing what you say you’re going to do, being transparent, communicating clearly, demonstrating care. 

There are these universal approaches that everyone can take to build that trusting relationship, whether it’s patient experience, customer experience, even with the people in your life. So much of it really just comes down to consistently demonstrating competence, benevolence, and integrity.

How Healthcare Providers can Improve Patient Trust

Isabelle Zdatny: This brings me to my next question here, which is: what are some of those specific recommendations that you would offer to healthcare providers who are looking to improve patient trust?

Nicole Richendollar: Again, it’s going to depend on the patient journey and the situation that you’re looking at. First and foremost, I would say identify what constitutes trust for your patients. What does trust look like for them? That can be simply asking them: what is trust to you? How do you look at trust when you’re looking at your healthcare experience, creating different focus groups, measuring trust if you’re not measuring it. 

Again, I might look at the patient journey and start identifying the expected process for your patient journey and how you can better collaborate, communicate, interact with your patients, develop those relationships and make sure that they adhere to their treatment plans. 

I want to be clear that it’s not just the times that you’re interacting with patients face-to-face or on the phone, but it’s also how you’re interacting with them through your mobile apps. What’s happening prior to the patient coming to your doctor’s appointments? Or afterwards with billing, following up on their appointments, their medications, etcetera. What does that look like? 

So it’s not just while they’re physically in your presence, but the beginning to end stage of the patient journey throughout their whole entire experience.

Isabelle Zdatny: I love that focus on journeys, because a lot of organizations are starting to build out those journey maps, that feels like a very tangible way to start improving trust. What are those key moments of truth? What are those steps people take before interacting with your organization? Afterwards? And how do you make sure that you are building trust during every single one of those key moments? 

Nicole Richendollar: The other thing I would suggest, if you’re not already doing this, is read your patient comments. Patient comments and the qualitative feedback can be very insightful and show you where that lack of trust is at. And maybe that would identify a starting point, too. 

Isabelle Zdatny: With trust, there’s definitely an element of expectation. Have you seen healthcare organizations set patient expectations through things like brand values or vision and give patients a sense of what they can expect during an experience with a healthcare provider? Which providers can then use to meet or exceed those expectations at every point along the way and build trust that way?

Nicole Richendollar: So I think anytime you’re interacting and connecting any type of experience, trying to link that back to your brand values can be important. Tactically, I’ve seen healthcare organizations make videos of what the journey should look like or what to expect when coming in to see your doctor and give them a visual representation.

I’ve also seen providers put out different checklists prior to coming to appointments to say, this is what you should be expecting, or this is what you should be prepared to talk about during your time. They might give some pre-questions that they could be asking their provider or things to come up with to determine their diagnosis, their medications, and treatments, and everything like that too. Connecting that to the brand values is important, but also being able to give that technical visualization to patients too, to say, this is what you should be expecting coming into the healthcare organization.

Isabelle Zdatny: Yeah. People don’t like uncertainty. It increases anxiety, and I feel like nowhere is that more true than in our – at least in the United States – incredibly complicated healthcare system. The more you can, let people know exactly what to expect every step of the way and that’ll help reduce their uncertainty. 

Nicole Richendollar: It does start from the time that someone steps foot on the campus. Where do you park? Where do you go to enter the hospital? How do you first show up as a healthcare organization to patients, even through social media and your online brand reputation?

Isabelle Zdatny: Do you see any organizations building like peer-to-peer groups or building that trust one-on-one with nurses or with doctors, and bring that more human element in as well?

Nicole Richendollar: There’s a lot of things that I’ve seen healthcare organizations do specifically around community involvement. We know that there’s different demographics within the communities, and certain populations have higher levels of trust with healthcare organizations versus other populations and demographics. There are different outreach groups and people that will go to where people of these demographic groups live to start developing those relationships with them, do some additional onsite care, and give people in these communities focus time with medical providers to let them know that it’s not as scary and that you can trust them in these situations. 

The community outreach I’ve seen has been really, really impactful in helping to develop that trust, as well as a presence outside of the healthcare organization. You’re not just, you know, someone behind a computer screen at the hospital or at a doctor’s office.

Isabelle Zdatny:  Yeah, you’re not just there when things are going wrong. 

I’m wondering, do you know which communities are less likely to trust healthcare organizations and how you can go about specifically growing trust with those groups?

Nicole Richendollar: Off the top of my head, underrepresented populations of people typically have less trust in healthcare organizations. They’re also less likely to complete surveys, so you’re not accurately capturing data from those different demographic groups. So it’s important to do a different type of outreach within those communities.

People in rural communities are also less likely to seek medical care because it’s not as easy to access healthcare organizations. And so it’s not necessarily that they don’t have as much trust, it’s just not as easy for them to get in there. And so their likelihood to continue to receive treatments and follow up with their doctors is lower compared to people who have greater access to healthcare organizations. 

Isabelle Zdatny: That makes a lot of sense. 

Something you keep talking about that is making me think is that this isn’t just quantitatively tracking and understanding trust. Trust is a more complicated human, maybe “squishier” concept. And so having those qualitative interviews, talking with patients in your target audiences feels like a really important piece of understanding trust for your organization specifically and how you can go about growing it with those different groups.

So just to highlight, we’re talking about tracking it as a metric, from what you’re saying, it seems like qualitative research is also a really important element here.

Nicole Richendollar: And I would say that it’s not only that you have to go out and do those types of interviews with different populations, but you’re capturing qualitative information through your online platforms. People are leaving comments online. You’re also capturing it through different avenues such as complaints and grievances in the hospital, and your EHR (Electronic Health Records) has a lot of valuable information that you can use and pull from to see about how patients are continuing to either come to the healthcare organization for care or what does that experience look like for them based on their complaints, their chief complaints and diagnosis, and what are they seeking when they’re coming to the healthcare organization. So there’s a lot of different ways that you can look at trust outside of just the experience data.

Isabelle Zdatny: Not just solicited, survey-based feedback.

Nicole Richendollar: Exactly. 

Successful Providers build Trust through Multiple Avenues

Isabelle Zdatny: Do you have any favorite examples of healthcare providers you’ve worked with who have improved patient trust? Any success stories you’d like to highlight?

Nicole Richendollar: I’ve worked with organizations that really overhauled their brand based on some of the feedback that they’ve received from their community on how they are perceived by different members. And it was a lack of trust that was showing up there. They not only renewed their brand, but they went through and did a lot of work to help develop trust within their communities to get patients and their family members to start trusting them. 

They did a lot of outreach and created that consistency where they show up the same way. Some retrained the staff members who were caring for the patients and the members, as well as all of the people behind the scenes so that they were providing better experiences to help support the clinical staff. 

These successful healthcare organizations took a microscope to some of their internal processes and looked at whether they were falling short and started improving little by little. It obviously was not fixed in a month, it was not fixed in a year, it took a long time to do, but they definitely evolved their patient experience.

Isabelle Zdatny: So it sounds like these successful organizations focused on outreach, showing up consistently, and training their staff and your employees on how to build that trust. 

Were there any particular training activities or qualities in an employee that they found would build that trust better than others? Any specific advice here on how to train your staff to build trust with patients?

Nicole Richendollar: Service recovery is a huge component of training, because we know as humans we’re going to fall short of expectations. We’re not going to be able to meet everyone’s goals and expectations a hundred percent of the time, realistically. You have to be prepared to show up in those instances where you can’t meet those patient expectations, or those family expectations for the loved ones who can’t communicate.

And so how does your staff show up and provide that service recovery in the moment? Do they have to escalate to a manager right away and get someone else higher involved? How do you take accountability? Saying, “I’m sorry that you’re having this experience,” or something like it can go a really long way for patients and acknowledge that they’re having to deal with a situation that isn’t great.

Isabelle Zdatny: Not all experiences are always going to go as perfectly as you want them to be, especially in a healthcare setting. 

And that’s another one of the strategies that we recommend to all organizations: take accountability when something does go wrong. There’s times where, when you do that really effectively, it builds trust more than if they hadn’t had that kind of poor experience in the first place. 

Key Lessons for XM Professionals

Isabelle Zdatny: So to bring us home, I have one final question that we always like asking our guests. What are some of the key lessons you and your clients have learned that you would like to share with other patient experience professionals who are looking to understand and improve trust within their organization?

Nicole Richendollar: Healthcare institutions notoriously take forever to implement any new processes. So I would say start somewhere. And it’s okay if it’s not perfect a hundred percent of the time, but just at least showing up and starting something is a good first step.

And if you’re not measuring trust, maybe you should start looking at measuring it. Talk to your community members and try to identify where the breakdowns of trust are currently. Look at one of your patient journeys and see how those experiences measure up versus expectations.

Isabelle Zdatny: I love those. Experimentation is something we recommend all the time. It often proves not just correlation, but causation if you improve the experience in a certain way and it demonstrably improves outcomes. Build off your early wins and go from there rather than trying to move the entire organization all at once, which is pretty impossible to do.

Nicole Richendollar: Yeah. Don’t boil the ocean, start somewhere. 

Isabelle Zdatny: Yes! It’s a cliche for a reason. 

On that note, let me say a huge thank you to Nicole for joining us! 

Check out links to some of the resources we mentioned in this discussion as well as the link to Nicole’s LinkedIn profile.