Ambulatory Care Gold Standard Patient Experience - Capital Health

Ambulatory Care 

Gold Standard 

Patient Experience 

“Working together for your health”

Contents 

CONTENTS .................................................................................................................................................................2 

INTRODUCTION .......................................................................................................................................................3 

AMBULATORY CARE INTEGRATION PROJECT JOURNEY .............................................................................................3 

PROJECT OBJECTIVES ..........................................................................................................................................3 

PROJECT SCOPE ......................................................................................................................................................4 

AMBULATORY CARE PROCESS ...................................................................................................................................4 

PROJECT APPROACH.............................................................................................................................................4 

THE JOURNEY.............................................................................................................................................................4 

THE CONCEPTUAL MODEL OVERVIEW ..........................................................................................................5 

AMBULATORY CARE - GOLD STANDARD PATIENT EXPERIENCE FRAMEWORK CONCEPTUAL MODEL .......................6 

VISION.........................................................................................................................................................................7 

AMBULATORY CARE - GOLD STANDARD PATIENT EXPERIENCE VISION ....................................................................7 

PRINCIPLES, STANDARDS AND ENABLERS.....................................................................................................7 

THE AMBULATORY CARE - GOLD STANDARD PATIENT EXPERIENCE FRAMEWORK...................................................7 

PRINCIPLE #1 ............................................................................................................................................................9 

I CAN EASILY ACCESS AND SCHEDULE MY CARE AND NAVIGATE THROUGH THE CAPITAL HEALTH SYSTEM. .............9 

PRINCIPLE # 2 .........................................................................................................................................................12 

MY PROVIDERS SHARE ONE SOURCE OF INFORMATION ABOUT ME AND COORDINATE MY PLAN OF CARE..................12 

PRINCIPLE #3 ..........................................................................................................................................................14 

I HAVE CHOICES IN MY HEALTH CARE AND MY DECISIONS ARE RESPECTED. .............................................................14 

PRINCIPLE #4 ..........................................................................................................................................................16 

I KNOW WHAT TO EXPECT AND HAVE INFORMATION AND ASSISTANCE AS I NEED IT.................................................16 

PRINCIPLE #5 ..........................................................................................................................................................19 

EVERYONE SHARES OWNERSHIP FOR DELIVERING MY GOLD STANDARD EXPERIENCE. ............................................19 

PRINCIPLE #6 ..........................................................................................................................................................21 

I FEEL COMFORTABLE AND SECURE IN A CARING ENVIRONMENT..............................................................................21 

A VISIT TO CAPITAL HEALTH: 2015 ................................................................................................................23 

ACCESS AND SCHEDULING .......................................................................................................................................23 

ARRIVAL AND REGISTRATION ..................................................................................................................................24 

IN ROOM...................................................................................................................................................................24 

DISCHARGE ..............................................................................................................................................................25 

Page 2 of 25

Introduction 

In the fall of 2006, Capital Health launched one of its top strategic initiatives, the Ambulatory 

Care Integration Project. The overall goal of this project is to improve the patient experience at 

Capital Health. Capital Health is already known for outstanding quality of care and breadth of 

services. The challenge is to be known for offering the Gold Standard patient experience as 

well. As depicted below, there are two primary streams of work -- the Ambulatory Care - Gold 

Standard Patient Experience and EMR/Scheduler. 

Ambulatory Care Integration Project Journey 

Integrated Clinical Services Enabled by Advanced Clinical Tools 



Principle(s) Principle(s) Principle(s) Principle(s) Principle(s) 

Standards Standards Standards Standards Standards 

Enablers (Key Operating Points) 

People 

Process 

Environment 

Technology 

Ambulatory Care – Gold Standard 

Patient Experience Project 

Clinical Redesign and Transformation 

Scheduler / EMR 

Technology Implementation 

Project Objectives 

The objective of the Ambulatory Care – Gold Standard Patient Experience Project is to develop 

a framework to enable Capital Health and their physicians, clinicians and staff to consistently 

deliver the ideal patient care experience to all of their patients in ambulatory settings. 

The Ambulatory Care – Gold Standard Patient Experience is expected to: 

• Enable high quality patient outcomes 

• Enable cost effective use of resources 

• Enable a high standard relative to patient safety 

• Deliver an environment which provides high patient and family/caregiver satisfaction 

• Be scalable to the regional level to facilitate effective management of patients across the 

continuum of care 

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Project Scope 

The Ambulatory Care Process as defined for this project is illustrated below: 

Ambulatory Care Process 

Access and 

Scheduling 

Registration 

and Check-in 

In Room 

Discharge 

The Ambulatory Care Process is comprised of four phases and the related People, Process, 

Environment and Technology elements: 

Access and Scheduling: Includes the request for a referral; locating the appropriate physician 

for referral; scheduling an appointment; locating the site/clinic; accessing the provider and/or 

information related to the healthcare process; way finding at the site; parking 

Registration and Check in: Includes logging the patient into the Admission and Billing system; 

logging the patient as arrived at the specific clinic; waiting room processes; waiting room area 

In Room: Includes exam room preparation; rooming processes; patient interactions with care 

givers; patient preparation for visit. Does not include clinical guidelines or clinical treatment 

planning. 

Discharge: Includes instructing patient and their designees related to follow up; distribution of 

consultative reports; follow up appointment/ diagnostic scheduling 

The entire health continuum including acute inpatient care, community care and primary care 

and the interplay with ambulatory care were taken into consideration with the design of the 

framework. An example of the interplay between ambulatory care and the healthcare 

continuum is the communication back to the primary care physician post consultation. 

Project Approach 

The Journey 

A Coordinating Committee was formed to develop the Gold Standard Framework. Members 

included physicians and management, and all sites were represented. As depicted in the 

following graphic, the Framework was developed in a six-step process from October 11, 2006 to 

January 2, 2007. 

Page 4 of 25

Ambulatory 

Care 


Step 2 Step 3 

Step 4 

External Scan 

Best Practices – Healthcare 

Best Practices – Other Industries 

Patient Feedback 

In-clinic Patient Surveys 

Deep 

Dive 

Draft 

Gold 

Standard 

Review draft 


with Coordinating 

Committee and 

Selected 

Representatives 

Refine 

principles based 

on review with 

front line focus 

groups 

Summit 

Step 5 Step 6 

Develop 

Standards 

and 

Enablers 

Review 

and 

Approval 

Step 1 

Internal Scan 

Staff Interviews and Focus Groups 

Executive Level Interviews 

Physician Interviews 

Clinic Observations 

Structured 

Brainstorming 

Validation 

Session 

The Conceptual Model Overview 

The Ambulatory Care - Gold Standard Patient Experience Framework consists of principles, 

supporting principles, standards, and enablers. Together, they support the delivery of the 

Ambulatory Care – Gold Standard Patient Experience to Capital Health patients. 

The conceptual model for the Ambulatory Care - Gold Standard Patient Experience is based 

upon a pyramid format. As illustrated below, enablers support the standards and the principles, 

which in turn support the vision of the Ambulatory Care - Gold Standard Patient Experience. 

Page 5 of 25

Ambulatory Care - Gold Standard Patient Experience Framework 

Conceptual Model 






People 

Process 

Environment 

Technology 

Vision: 

Principles: 

Standards: 

Enablers: 

A description of what we 

want the Ambulatory 

Care patient experience 

to be 

A set of fundamental, 

comprehensive, and 

required criteria 

How achievement of the 

principle will be 

measured 

How the principles will 

be achieved 

To create the Ambulatory Care - Gold Standard Patient Experience Framework, a consistent set 

of definitions for each component of the framework was established. These critical elements 

are described below. 

• Principles define the set of fundamental, comprehensive, and required criteria for achieving 

the Ambulatory Care - Gold Standard Patient Experience vision. Each principle has a subset of 

supporting principles that provide the additional detail necessary to operationalize the 

overarching principle. 

• Each principle has a set of standards to measure the successful implementation of the 

overarching and supporting principles. These standards have been quantified and categorized 

into short-term, mid-term and Ambulatory Care - Gold Standard Patient Experience goals. The 

time frame for each goal will initiate at the end of implementation of the related enabler. Shortterm 

goals are those that are expected to be met within 6 months. Mid-term goals are 

expected to be accomplished within 6 to 12 months. The standards will be implemented 

system-wide to allow for cross comparison and measurement of the system components 

against the Ambulatory Care - Gold Standard Patient Experience. 

In order to help achieve these principles, a sample set of enablers has been selected as a 

result of research of customer service best practices, both internal and external to the 

healthcare industry. Enablers are the toolkit of operating points that support achievement of the 

principles. The enablers have been categorized into one of 4 areas: 

• People: Those enablers that encompass development of or changes to existing job 

descriptions, new roles, and behaviours. For example: development of a greeter role (an 

individual who is responsible for greeting all patients as they enter the facility) would be 

considered a people enabler. This type of enabler will most likely be paired with one of the 

other 3 enablers as implementation of a process, environment, or technology enabler may 

change current roles. 

• Process: Those enablers that encompass development of new processes and/or policies or 

changes to existing processes and/or policies. Process enablers can be implemented with or 

Page 6 of 25

without Environment and Technology enablers but will most likely have an accompanying 

People enabler. 

• Environment: Those enablers that encompass changes to the environment. These include 

policies related to image strategies, ambiance, design palette, assignment of exam rooms, 

layout of physical space, wayfinding, parking facilities and related policies. These enablers 

may be paired with any of the three other enablers or may be solely implemented. 

• Technology: Those enablers that encompass the implementation of technology. These 

include implementation of an automated scheduling system, EMR, new parking meters, 

registration kiosks, electronic directories, and other communication or information systems. 

The implementation of enablers will be system-wide or site-wide. For example, policy changes 

may be made on a system-wide basis to maintain a consistent Capital Health image. Other 

enablers will be selected and implemented specific to the needs of the specific clinic and/or site. 

Summarized below is the outcome of applying this conceptual framework to the development of 

the Ambulatory Care Gold Standard Patinet Expereince. 

Vision 

Ambulatory Care - Gold Standard Patient Experience Vision 

The vision for the Ambulatory Care - Gold Standard Patient Experience must be a powerful 

statement of what Capital Health wants the Ambulatory Care Gold standard to be. Grounded by 

Capital Health’s mission and values, the Coordinating Committee and Project Team developed 

the draft vision. While the language still needs to be refined, the Coordinating Committee, with 

input from over 100 people, recommends the following vision statement: 

“Working together for your health” 

Principles, Standards and Enablers 

The Ambulatory Care - Gold Standard Patient Experience 

Framework 

At its core, all Ambulatory Care - Gold Standard Patient Experience principles and supporting 

principles will support the mission, vision, and values of Capital Health. The Ambulatory Care - 

Gold Standard Patient Experience framework is built on the following assumptions which are 

based upon the patients’ basic expectations related to their ambulatory patient care experience. 

The framework assumes that all ambulatory patient care experiences will enable and provide for 

the patient, at a minimum: 

• Safety as dictated by all provincial, federal regulatory requirements and industry best practices 

• Quality of Care based on evidenced-based research and industry best practices 

• Clinical Education and Research 

• Shared Responsibility – Patient/Provider 

• Respect 

• Confidentiality and Privacy as dictated by all provincial and federal regulatory requirements 

To have the strongest impact and maintain the focus on the patient, the overarching principles 

are written from the patient’s perspective. It is assumed that responsibility for the success of the 

Ambulatory Care - Gold Standard Patient Experience framework is shared between patients 

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and their health care teams. Therefore, both patients and health care teams are responsible for 

being respectful, setting expectations, and honouring agreements. 

The Ambulatory Care - Gold Standard Patient Experience framework follows. Each of the 6 

overarching principles has been organized in the following format. 






People 

Process 

Environment 

Technology 

Page 8 of 25

Principle #1 

I can easily access and schedule my care and navigate through the 

Capital Health System. 

Supporting Principles 

• Patients have choices in scheduling their appointments and are able to self schedule 

• Appointments are coordinated across multiple providers to support seamless, patient-centred 

care 

• Access processes are predictable, consistent, logical, and timely (e.g. referral, scheduling, and 

registration) 

• There is adequate parking and parking fees are consistent 

• The facilities are designed for optimal wayfinding, sequential and easy movement 

• Clinic operations support patient flow and access 

• Patients have the appropriate modes of transportation readily available intra- and inter-site 

Standards Short-term Goal Mid-term Goal Gold Standard 

• No show rate • 20% decrease in no • 50% decrease in no •


• There are published 

wait time standards 

for routine and 

urgent appointments 

in all clinical areas 

• Wait time in waiting 

room 

• Referring physician 

satisfaction 

• Overbooked 

appointments 

• Wait time standards 

are met 50% of the 

time 

• 50% of patients 

indicate they are 

“very satisfied” with 

appointment access 

(patient survey) 

• Patient wait time is 

decreased by 50% 

• 50% increase in 

physicians who are 


the referral process 

• Decrease 

overbooked 

appointments by 

50% 

• Wait time standards 

are met 75% of the 

time 






• Patient wait is no 

longer than 20 

minutes post 

scheduled 

appointment time 

• 80% of referring 

physicians are “very 

satisfied” with the 

referral process 

• Maximum of 25% 

double booked 

appointments 

• < 24 hours for urgent 

care 

• < 30 days for routine/ 

preventive care·0 

days for primary care 

for third next 

available 

appointment (IHI)· 

• 2 days for specialty 

care for third next 

available 

appointment (IHI) 






• Patient wait is no 

longer than 10 

minutes post 

scheduled 


• Automated referral 

process 

• Rate of double 

booked 

appointments 

matches patient no 

show rate 

Sample Enabler Description Sample Source 

Patient Navigator 

(Appointments) 

Staff member dedicated to assisting 

patients with making follow up and 

referral appointments during the 

treatment process 

Bumrungrad International, 

Bangkok, Thailand 

Mayo Clinic, Jacksonville, FL 

People 

Patient Way 

Finder 

(Directions) 

Staff member dedicated to assisting 

patients with directions to and within 

facilities 

Out of industry: 

Red Coats: NWA 

Transporters 

Staff dedicated to transporting patients 

within the facility; able to be utilized for 

inpatient and outpatient visits 

US hospitals 

Process 

Scheduling 

guidelines 

Standardized 

referral forms 

Guidelines that indicate visit length, 

instructions to be provided to patients 

and other exams or tests to be 

scheduled 

Standardized referral forms indicating 

reason for referral which supports 

Jackson Memorial Hospital, 

Miami, FL 

UC Davis Medical Center, 

Sacramento, CA 

Page 10 of 25


Technology 

Environment 

Reduced or 

complimentary 

parking 

Staffing 

assignments 

Exam Room 

assignments 

Porter hotline 

Electronic 

Scheduling 

System 

Patient web 

portals 

Registration 

kiosks 

Smart cards with 

photo ID 

Map kiosks 

Designated 

parking 

Offsite parking 

with shuttle 

service 

Wheelchair 

stations 

Valet parking 

diagnostic results 

Reduced parking fees or complimentary 

parking for patients 

Each physician is provided with the 

minimum number of support staff as 

defined by best practices 

Physicians are assigned a minimum 

number of exam/procedure rooms 

Red phones at primary entrances 

available for patients who direct dial into 

a centralized porter dispatch system 

A centralized database listing providers 

by specialty, credentials, schedule and 

available appointment slots 

Patient portals for web-based 

scheduling where patients can select top 

3 preferred appointment slots and are 

then provided a scheduled appointment 

within 24 hours 

Kiosks that patients can use to self 

register for appointments 

Identification cards with a smart chip 

that holds patient demographic 

information 

Kiosks that will provide maps from a 

patient’s current location to his/her 

appointment/desired location 

Specific parking locations that are 

designated for patients and physicians 

Expanded parking locations for patients 

and staff that are accessible by a 

courtesy shuttle 

Wheelchairs are available at entrance 

points with a nominal deposit or 

identification card 

Fee-for-service or minimal cost parking 

available for patients at main entrances 

of facilities 

Beaumont Hospital, Royal 

Oak, MI 

Veteran’s Administration, 

US Code of Federal 

Regulations 

Veteran’s Administration, US 

Code of Federal Regulations 

Presbyterian Healthcare, 

Albuquerque, NM 

Kaiser Permanente, USA 





Mayo Clinic, Jacksonville FL 

St. Luke’s, Houston TX 

Baptist Health South Florida, 

USA 




USA 

UAB Medical Center, 

Birmingham, AL 



Detroit Medical Center, 

Detroit, MI 

University of Chicago 

Hospitals, Chicago, IL 

Out of industry example 

Retail Malls, USA 

Disney World Resorts, USA 

Henry Ford Hospital, Detroit, 

MI 

Memorial Hermann, Houston, 

TX 

Room status A board or mechanism that indicates the Northwestern Memorial 

Page 11 of 25


indicators (i.e. 

occupied signs) 

Walk ways 

Signage 

room is vacant or occupied or indicates 

that lab tests are needed 

The facilities have sufficient and clear 

pedestrian walk ways 

Facility signs and placards for patient 

wayfinding 

Health System, Chicago IL 

Map Directory Map directory at each entrance Northwest Healthcare, 

Minnesota, USA 

Principle # 2 

My providers share one source of information about me and 

coordinate my plan of care. 


• Patients are not asked to repeat information unless there are clinical reasons to do so 

• There is a single source of information for each patient 

• Each patient seen and treated at Capital Health has an integrated Capital Health record 

• Information in the medical record is accessible by the patient’s care team 

• Each patient has a clear plan of care and one provider has primary responsibility for managing 

the plan 


• Standardized records • 50% of patients have 

an integrated 

medical record 

• Report availability 

• Chart location 

• Chart accessibility 

• Reports are available 

within 48 hours of 

the referral 

appointment 

• 50% of all medical 

records are logged 

into a centralized 

chart tracking system 


records are available 

in clinic 24 hours 

prior to appointment 


have a common 

problem list, single 

medication list, and 

an integrated plan of 

care 

• All reports are 

available 

electronically within 

24 hours of the 

appointment 


records are logged 

into a centralized 

chart tracking system 

• 100% of the 

consolidated medical 

records are available 

24 hours prior to 

appointment 


have a common 

problem list, single 

medication list, and 

an integrated plan of 

care 

• All reports are 

available and 

accessible through 

the patient’s EMR 

within the same day 

of the appointment 

• EMR eliminates need 

for chart tracking 

system 

• All clinicians have 

24/7 access to an 

EMR 

Page 12 of 25


Information 

validation 

A policy that outlines which pieces of 

information need to be validated and the 

frequency of patient demographic data 

updates 

Provincial and Federal 

regulations 

Policy that all 

patients seen at 

Capital Health 

are registered 

and have a 

medical record 

created for them 

A policy which states that all patients 

seen/treated at Capital Health facilities 

are registered in the patient database 

and a medical record is created for each 

patient 

JCAHO 

Training 

Appropriate training for staff related to 

inputting, accessing, and archiving 

patient data into the central patient data 

repository/system 



Process 


chart 

organization 


forms 

All charts have standard sections, are 

organized consistently and use 

standardized forms (e.g., demographics, 

problem list, medication list, allergy list, 

history, physical, care plan, progress 

notes, diagnostic results) 

Standardized forms for problem list, care 

plan, medication list, demographics, 

history and physical (H&P content may 

vary by specialty) 

Mayo Clinic, Rochester MN 


Standard 

reporting format 

Standardized consultative report formats 


Multidisciplinary 

rounds 

A structured forum where multiple 

disciplines are brought together to 

determine the treatment plan for a single 

patient 

Comprehensive Cancer 

Center, Tulane University 

Hospital, Louisiana USA 


Single problem 

list 

A list which details the patient’s 

complaints and conditions 


Sacramento CA 


Single 

medication 

record 

A record that captures all medications 

prescribed to a patient and denotes 

amount prescribed, prescribing clinician, 

and expiration date 


Sacramento CA 


Page 13 of 25


Single shared 

patient database 

system 

Enterprise master patient index contains 

standardized demographic data for each 

patient registered at Capital Health 

facilities 




Technology 

Centralized 

electronic chart 

tracking system 

and bar coding 

system 

Computers 

A tracking system in a localized area 

which tracks the location of patient 

charts throughout the system; charts 

would be coded out of central storage, 

coded into destination and traceable by 

bar code 

Computers in every patient care area to 

facilitate point of care documentation 

and access to information 



Mayo Clinic, Rochester, MN 




Provider access 

All providers have access to NetCare or 

EMR to access diagnostic and 

consultative results 

Capital Health, Edmonton, AB 




EMR 

An electronic medical record which is 

accessible by patients and all providers 

as appropriate 




Principle #3 

I have choices in my health care and my decisions are respected. 


• Patients’ input is solicited and is incorporated into the plan of care as appropriate 

• Patients’ rights are honoured and each patient acknowledges and understands his/her 

responsibilities 

• Patients and/or their designees are provided with necessary information, including expected or 

potential outcomes, to make informed decisions about all aspects of their care 


• Receipt of Patient 

Rights and 

Responsibilities upon 

first time registration 

• Documented patient 

education 


receive Patient 

Rights and 

Responsibilities 

included in the 

materials provided 

upon first time 

registration 

• 50% of patients have 

a learning 

assessment, 

documenting the 

preferred language 



Rights and 





registration 


have a learning 

assessment 





Rights and 





registration 


have a learning 

assessment 



Page 14 of 25


• Patients are satisfied 

with their level of 

participation in their 

health care 

and mode of 

communication, 

reading capability, 

and level of 

understanding 

documented in their 

plan of care 




their level of 


health care (patient 

survey) 

and mode of 



and level of 

understanding 


plan of care 







survey) 

and mode of 



and level of 

understanding 


plan of care 

(JCAHO) 







survey) 


Medical 

Translators 

Medical translators are available on site 

in most commonly spoken languages for 

80% of the patient population 

Language hotline is available for times 

when translator is not available on site 

or for less common languages 

Northwestern Memorial 

Hospital, Chicago, IL 

People 

Hotel Dieu Grace Hospital, 

Windsor, Ontario 

Mayo Clinic, USA 

Patient Educator 

Patient educator assigned to each clinic 

to develop materials and processes to 

elevate patient education at Capital 

Health facilities 

Johns Hopkins Medicine, 

Maryland USA 

Patient 

preference 

Policy to record patient preferences 

regarding language and location into a 

database to assist with scheduling and 

coordinating translators as needed 

Bumrungrad International 

Hospital, Bangkok, Thailand 

Process 

Patient input and 

care plan “sign 

off” 

Patient Rights 

and 


Policy to record patient sign off on care 

plan to indicate the patient has been 

made aware of their care plan and has 

had an opportunity, as appropriate, to 

contribute to the care plan 

Policy that all patients are given and 

acknowledge receipt of Patient Rights 

and Responsibilities, which details their 

rights and responsibilities regarding 

treatment and service at Capital Health 


Oak, MI (inpatient discharge 

records) 

US Hospitals 

Staff training 

All staff receive training related to 

Patient Rights and Responsibilities, 

specifying service and treatment 

guidelines and expectations 

US Hospitals 

Education 

materials and 

Materials prepared in clear, easy to 

understand language and are available 

Bumrungrad Hospital, 

Page 15 of 25


templates 

in most common languages spoken by 

80% of the population 


Templates (written and verbal scripts) 

that providers can use to communicate 

to patients the procedures, research, 

benefits, risks and alternative services 

available related to their care plan 

Process 

Visit summary 

Primary Care 

Policy 

A standardized form for all Capital 

Health providers to record a summation 

of each patient visit (key findings, next 

steps, next appointment to be 

scheduled, and number or email to use 

if patient questions) 

A system policy that indicates all 

patients will select a primary care 

clinician when accessing Capital Health 

services 


Fannin Pediatrics, Houston, 

TX 


Technology 

Provider 

Directory 

Patient web 

portal 

A web-based directory which lists 

providers by specialty, credentials, and 

availability that would be accessible for 

patients to research potential providers 

A web-based portal designed to 

provided patients with access to 

personal clinical information 

Patients are able to access their health 

record, input personal information and 

view information on topics of interest 

(e.g., diabetes, weight management) 

Blue Cross Blue Shield, USA 


United Health Insurance 

Patient data: Group Health 

Cooperative, Seattle WA 

Patient topics of interest: 

Henry Ford Hospital, Detroit, 

MI 

Principle #4 

I know what to expect and have information and assistance as I need 

it. 


• Patients and/or their designees receive pertinent information about their care and next steps 

throughout the visit 

• Patients have a single point of contact per service or clinic utilized for questions about their 

care and services 

• Patients are given information about wait times and options are actively explored 

• Processes and forms are standardized and consistently implemented system-wide 

• Communication happens in the language and method of the patient’s choice 

• Information about the care team is available to each patient 

• Educational materials are available in a format that is understandable to the patient 

Page 16 of 25


• Initial visit packet 

• Appointment 

reminders 

• Point of contact per 

service or clinic 

utilized 

• Patient satisfaction 

with level of 

information and 

assistance provided 

• 50% of new patients 

receive initial visit 

packet prior to visit 


receive appointment 

reminders 

• 50% of patients are 

given a point of 

contact per service 

or clinic utilized for 

questions, etc. 




the level of 

information they 

receive 




the helpfulness of 

staff 

• 100% of new 

patients receive 

initial visit packet 

prior to visit 



reminders 









the level of 


receive 





staff 

• 100% of new 

patients receive 

initial visit packet 

prior to visit 



reminders 









the level of 


receive 





staff 


People 

Patient Navigator 

/ Concierge 

A patient navigator or concierge position 

to assist patients with scheduling 

appointments, registration, and other 

processes 


Bumrungrad International 

Hospital, Bangkok, Thailand 

Wait time policy 

Policy that indicates all patients who 

wait greater than 10 minutes are 

personally addressed by a staff member 

Disney World Resorts 

Sarasota Memorial Hospital, 

Florida 

Process 

Customer 

service policy 

Policy that indicates that all patients are 

offered an amenity for extended wait 

time beyond their scheduled 


Oakwood Healthcare, 

Dearborn, MI 

Swedish Medical Center, 

Issaquah, WA (offers movie 

tickets to ED patients who do 

not see a physician within 30 

minutes 


Auto service, US (10 minute 

oil change or it’s free) 

NWA and Continental will 

offer care packages for 

customers who are delayed 

for some flights (include a 

meal voucher, 5 minute 

phone card and a coupon to 

Page 17 of 25


be used for next visit) 

Initial visit packet 

All new patients are provided with an 

initial visit packet with helpful information 

such as parking locations, physician 

office location, and any pre-appointment 

instructions 

Brigham and Women’s 

Hospital, Boston, MA 

Uniforms and 

name tags 

Uniforms that would aid patients to 

identify staff roles (e.g., way finders 

wear green jackets or transporters wear 

vests) 


Name tags that include credentials 

Intake 

forms/process 

Standardized patient intake form and 

process that would be utilized systemwide 

(demographic information 

collected, registration process) 


Appointment 

reminders 

Provide patients with an appointment 

reminder prior to the scheduled 

appointment in their preferred method 

(e.g., phone, email, letter) 


Oak, MI 

Learning 

assessment 

A learning assessment to determine the 

patient’s preferred learning style and 

language preference to guide providers 

in communicating clinical information to 

the patient 

JCAHO 

Process 

Translator 

scheduling 

Customer 

service 

guidelines 

A scheduling procedure that ensures 

translators, if needed, are scheduled in 

advance of the patient’s visit 

Develop consistent system-wide 

customer service guidelines and 

expectations for staff and clinicians 

Cleveland Clinic, Cleveland, 

OH 




USA 

Disney World Resorts 

Patient education 

materials 

Patient education materials are available 

in multiple languages, formats and 

venues (e.g., handouts in clinic, web, 

patient information kiosks) 

Johns Hopkins, Baltimore, 

MD 

Single point of 

contact 

Patients given an 800 number as a 

single point of access for all questions 

and concerns 


Oakwood Healthcare, 

Dearborn, MI (also online 

real time chats) 

Techn 

ology 

EMR 

Electronic medical record that is 

accessible by patients and appropriate 

clinicians system-wide 




Page 18 of 25


Staff information 

Pictures and brief resumes of care team 

are in the facilities and on a web portal 

for patient access 

United Health, USA 

Blue Cross/Blue Shield, USA 

Environment 

Status board 

An appointment information status board 

to indicate approximate wait time or 

clinic delays (e.g., the emergency room 

wait time is 2 hours or physician 

appointments are delayed by 15 

minutes) 


Airlines 

Disney 

Principle #5 

Everyone shares ownership for delivering my Gold Standard 

experience. 


• Employees are empowered to address patient concerns and problems 

• Performance expectations for each role are established based on Ambulatory Care - Gold 

Standard Patient Experience principles 

• Processes are continually reviewed and improved 


• Patients are satisfied 

with customer 

service levels from 

all staff and 

physicians 

• Employees and the 

care team are trained 

in customer service 

skills 

• Balanced Score 

Card 1 

• Quality and 

Performance 

Improvement 

Actions 2 



customer service 

experience 

• 50% decrease in 


complaints 

• 75% of employees 

and the care team 

have documented 

completion of 


training 

• 75% of score card 

measures are on 

track 

• Performance 

improvement plans 

are in place for all 

identified issues 




experience 



complaints 



meet “gold standard” 

expectations of 

customer service on 

their annual review 



track 




identified issues and 

track positive 

progress 


“very satisfied” 



complaints 



meet “gold standard” 

expectations of 

customer service on 

their annual review 



track 




identified issues and 

track positive 

progress 

Page 19 of 25

1. Balanced Score Card: A management tool that provides feedback around both the internal business processes and external 

outcomes in order to continuously improve strategic performance and results. 

2. Quality and Performance Improvement Actions: Actions that review current quality and performance metric identify issues and 

determine a course of action. Includes not only clinical quality but also service quality. 


People 

Management 

Engineering 

A department dedicated to assessing 

issues that impact facility efficiency and 

is responsible for collecting, collating, 

and distributing report cards 

University of Chicago 

Hospitals, Chicago, IL 


Miami, FL 

Customer Service 

Training 

Customer service training provided to all 

staff on an annual basis 

Out of industry: Disney, 

Nordstrom 

Problem resolution 

guidelines 

A resource tool to assist staff in 

resolving patient concerns and provides 

a menu of available options to resolve 

patient’s issues 


USA 

Out of industry: Nordstrom 

Chain of 

command 

A clear chain of command that is 

communicated to staff as resources to 

contact, as necessary, when assisting 

patients 


USA 


(Radiology Department) 

Miami, FL 

Employee 

evaluation 

Incorporate customer and patient 

service in the employee evaluation 

process 


USA 

Process 

Report Card 

A set of management metrics that 

tracks organizational process and 

improvement efforts and acts as a 

dashboard of the organization’s overall 

operations 

US Hospitals 

Performance 

Maintenance 

Committee 

Develop a staff composed committee 

that is dedicated to maintaining 

organizational performance 


Miami, FL 

Performance 

improvement tools 

Performance improvement tools (e.g., 

chart audits, secret patient) to assist 

management in improving organizational 

efficiency, staff compliance, and 



Miami, FL 

Monthly performance dashboard report 

that measures performance against 

standards 

Page 20 of 25


Technology 

Satisfaction 

survey 

Web-based patient, staff and physician 

satisfaction surveys 


Miami, FL 



Principle #6 

I feel comfortable and secure in a caring environment. 


• The facilities promote the healing goals of the patient/care team relationship 

• The facilities support efficient operations, while minimizing wait times 

• Public spaces are comfortable and can accommodate various accessibility and personal needs 

• The workplace environment for the care team is efficient, flexible, and empowering 

• Clinical areas are well equipped and allow patient choice of modesty and privacy 


• Patient satisfaction 

• Care team 

satisfaction 

• Environmental score 

cards 

• Choice 3 

• Social support 4 

• Positive distractions 

to suit a variety of 

sensibilities 5 

• Access to nature 6 

• 50% of group 

surveyed are “very 

satisfied” with clinical 

experience 

• 

• Clinics exceed 

expectations on 50% 

of all environmental 

metrics 

• 50% of facilities have 

implemented patient 

choice guidelines 

• 50% of facilities 

provide space for 

social support 

guidelines 


incorporate positive 

distraction guidelines 


incorporate access 

to nature guidelines 




experience 




metrics 







guidelines 





incorporate access to 

nature guidelines 




experience 




metrics 







guidelines 





incorporate access to 

nature guidelines 

Page 21 of 25


• Lack of 

environmental 

stressors 7 


incorporate 

environmental stress 

reduction 

recommendations 

within the clinical 

setting 


incorporate 


reduction 



setting 


incorporate 


reduction 



setting 

3. Choice standard includes choice in the areas of privacy, information, communication, schedule and control. 

4. Social support can be defined as space for family members, connectivity, collaboration, community, and human interaction. 

5. Positive distractions to suit a variety of sensibilities: intellectual, spiritual, physical, and environmental. Colour palettes are welldesigned 

to enhance the goals of the experience. 

6. Access to nature includes natural light, views of nature and natural materials and patterns. 

7. Lack of environmental stressors includes noise, glare, poor air quality, workplace distractions, and poor ergonomics. 


Process 

Exam room ratio 

Environmental 

assessment 

Optimal exam rooms to clinicians ratio 

(3 exam rooms to every 1 clinician) 

Quarterly environmental assessment to 

assure operations are running efficiently 

and in accordance with Gold Standard 

VHA 

US 

Technology 

Patient pagers 

Provide patients with on-site pagers to 

notify them when an exam room is 

available or the clinician is available for 

consultation 


USA 


(Urology Clinic), Miami, FL 

Privacy curtains 

Privacy curtains configured to provide 

the patient a private area within the 

exam room to change clothing 

Memorial Hermann, 

Obstetrical and Fertility 

Clinic, Houston, TX 

Robes and 

gowns 

Patient size appropriate natural fabric 

gowns and robes 

Trillium Health Centre, ON 

Environment 

Consultation 

rooms 

Colour palette 

Private rooms available for clinician 

meetings with patients and their 

family/advocates designees to discuss 

clinical information and treatment 

options 

Colour palettes are well-designed to 

enhance the goals of the experience. 


Oak, MI 


Franciscan Health Services, 

Tacoma, WA 

Seating 

Provide additional seating capacity that 

accommodates various personal 

needs for the social support members 

within the clinical environment, 

specifically the exam rooms 


Seattle, WA 

Views of nature 

Incorporate views of nature and natural 

materials within the interior spaces 

St. Charles Medical Center, 

Bend, OR 

Page 22 of 25


Work stations 

Acoustics 

Flexible, ergonomic work areas allowing 

choice of focused individual work or 

teaming activities 

Acoustically-absorptive surfaces to 

reduce ambient noise level 

St. Charles Medical Center, 

Redmond, OR 


Issaquah, WA 

A Visit to Capital Health: 2015 

Using the principles, standards, and enablers developed through this process, one can envision 

what the patient experience would resemble at the Capital Health of the future. A Ambulatory 

Care - Gold Standard Patient Experience patient experience is depicted below through the 

various steps of the ambulatory process. 

Access and Scheduling 

Page 23 of 25

Arrival and Registration 

In Room 

Page 24 of 25

Discharge 

Page 25 of 25

Ambulatory Care Gold Standard Patient Experience - Capital Health

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