Posted By Diane M. Rogers, BA, ACC, CPXP,
Tuesday, May 16, 2017
Updated: Thursday, May 11, 2017
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Daunting – that’s the word that described how I felt each time I thought about taking the Certified Patient Experience Professional (aka CPXP) exam. It seemed like such a daunting feat, and yet I truly believed it was something I should do – professionally and personally.
Professionally, taking and (hopefully) passing the CPXP exam, there were countless reasons why I thought it was something I should pursue – most predominantly credibility.
Personally, it was overcoming that constant battle in my head that I fight – the fear of failure. You’d think that as an adult, having lived more than half a century that I would be more comfortable with accepting my best self. But alas, finding triumph in simply having the courage to try alludes me.
Still, this was something that I couldn’t let go. I kept ‘playing the tape forward’ and could feel the disappointment in myself if I chose not to take the exam. But, ‘playing a different tape forward’ I could feel what it was like when I passed – when I called myself a CPXP. There was something empowering, bold and confident in that image that quieted the fear-filled voice in my head just a bit. Still, I wasn’t ready to apply.
I accessed all of the available information on the PXI website. I participated in the CPXP Prep Webinar. I purchased the CPXP Workbook – all in an endeavor to overcome that fear. But still, I didn’t apply.
My fear of failure is a loud, discouraging deterrent to growth and adventure, putting all of what matters on the end result. And this notion of ‘it’s all about the end’ is in such conflict of what I believe and have experienced, as one of my own mantras in life is – “It’s never about the end, it’s always about the middle”. So, I had to find a way forward – to appreciate the middle, and to celebrate the courage I had in choosing trying.
And so, I called Peggy, my Beryl Institute Faculty colleague, in the hopes that I could find support and a study buddy to bolster my confidence.
“Hey Peggy”, I said.
“Are you planning on taking the CPXP exam?” I asked.
“I hadn’t really thought about it”, she replied.
Seriously?!? Not thought about it?!? I haven’t stopped thinking about it! Now what?
“Well”, I said, quietly stepping into that space of vulnerability,
“I think I want to take it, and wanted to know if you would take it with me … I’m afraid I won’t pass”. (Even as I write these words, I am hearing the ridiculousness of this fear and the stifling nature of its implications.)
And almost immediately, I was calmed, comforted, and catapulted into the ‘middle’.
“Sure, what the heck”, Peggy responded.
Peggy and I set up our first prep call 3 months before the exam. It was clear from that first meeting that we had very different study patterns. I was very structured. I outlined a prep approach where we used the CPXP Workbook as our guide. I assigned focus areas with specified completion timeframes. I set up weekly teleconferences for us to review content. I made sure we had available all of the resource recommendations. And, within each structured step I took, Peggy was right there - encouraging me, supporting me, and patiently tolerating my prescriptive approach.
We met weekly, reviewing each knowledge domain, often surprising myself by how much I knew. And over time I began to relax. I began to trust myself, my knowledge, my experience, my understanding of the material. The more comfortable I got with the process of preparing and the material, the more confident I got in taking (and passing) the exam.
Soon our study sessions grew more into developing situational exercises and less into memorizing content. I began to appreciate Peggy’s brilliance and curiosity in asking – ‘I wonder how they would write an exam question for that’? I could feel Peggy’s confidence – it was contagious. I often thought, ‘If she can do it, so can I’!
And as you might expect, this ‘Sure, what the heck’ CPXP prep adventure grew into an remarkable friendship – one filled with respect, laughter and appreciation for each other and the strengths we share individually and collectively.
In October, 2016 I took the CPXP exam… and passed. And as I ‘play the tape backward’, reflecting on the choice I had in front of me, I am grateful for choosing to jump into the middle. The middle was filled with growth, courage, focus, support, encouragement, strengths, friendships and confidence. The middle helped remind me of my best self. And the middle helped to develop me into an even better patient experience professional.
“It’s never about the end – it’s always about the middle”.
P.S. With heartfelt appreciation, thank you Peggy.
P.S.S. For those of you considering any step forward into a new space of experience – Go for it! Trust yourself, your strengths, and those core qualities within you that make you your magnificent, best self!
Diane works with and supports The Beryl Institute as a faculty member, facilitating virtual classroom sessions, topic calls and workshops. She is also Founder and President of Contagious Change, LLC, assisting healthcare organizations to achieve new potentials. Specializing in improving the healthcare experience, she works with clients to tailor programs and improvement initiatives. She is a certified professional coach, and developer of The hArt of Medicine®, a program designed to engage the clinician in creating therapeutic relationships and improving their communication and empathy skills through a unique experiential learning approach. Diane believes that ‘everyone has the capacity to change a world’. Whether the world is the physical space that we occupy or a moment in an individual's life; we all have the ability to create a positive energy that brings about an amazing change.
To learn more about the upcoming CPXP Prep Course on June 20th in Chicago, click here.
Certified Patient Experience Professional
Posted By Andrew S. Gallan, PhD,
Monday, May 15, 2017
Updated: Thursday, May 11, 2017
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In 2016, Advocate Health Care, the largest health system in the Chicagoland area, integrated into its performance measures a Net Promoter-like score, which they call a Patient Loyalty Score (PLS). Net Promoter Score (NPS) is a valuable metric, and it has been adopted by many companies in almost every industry. NPS is a simple, easy to use, and easily calculated metric that is intuitively associated with business health by assessing a respondent’s likelihood to recommend an organization to a friend or colleague. Health care organizations are beginning to see its value, and are exploring how it is best calculated and used.
For Advocate Health Care, PLS is constructed using data from CAHPS and vendor surveys, and utilizes the likelihood to recommend question. Only a top-box score is defined as a promoter, and varying bottom scores are defined as representing a detractor. That is, for a five-point scale (ED vendor survey) the bottom three responses are categorized as detractors; for a four-point scale (HCAHPS) the bottom two are detractors; and, for a three point scale (CG-CAHPS) only the bottom score is a detractor.
Some issues with the measure include the referent (CG-CAHPS asks about likelihood to recommend the provider’s office, ED refers to the department, and HCAHPS asks about the hospital), and the limited scale width (the original NPS scale is 11 points). However, for me, having a patient-provided measure outweighs the issues, and I commend the organization for holding people accountable for patient perceptions of care. The strength of this metric is to create system-wide responsibility for a patient-provided measure, thereby ensuring that the patient’s voice is heard.
Like most organizations, Advocate Health Care is interested in earning increased rates of positive word-of-mouth recommendations. As a result, I recently engaged with Advocate as an Academic-in-Residence. In this role, championed by EVP & COO Bill Santulli, SVP & CNO Susan K. Campbell, and VP Information and Technology Innovation Tina Esposito, I performed analytics to identify drivers of PLS. The two important research questions that drove this project were:
- Which variables are the most important drivers of PLS?
- What can we learn from patient comments about potential drivers of PLS?
In order to investigate these questions, I was provided with almost two years of HCAHPS, CG-CAHPS, and ED survey data and patient comments. Top line results included the following:
Inpatient (HCAHPS): Nurses and personal issues (privacy, pain, and emotional issues) had by far the most impact on patients. Positive comments centered on comfort, communication, and care. Negative comments focused on food.
Outpatient (CG-CAHPS): The face-to-face interaction between a patient and physician is the “moment of truth,” and as such is what the patient apparently will use to evaluate the entire experience. Positive comments centered on comfort and communication. Negative comments focused on waiting and rude treatment.
Emergency Department (Vendor Data): When patients are in the ED, taking care of personal issues will have the greatest impact on PLS. These issues include keeping patients informed about delays, caring about patients as people, pain control, and providing information about caring for yourself at home. Positive comments centered on comfort, communication, and care. Negative comments focused on feeling vulnerable and afraid in a busy and foreign environment.
As a result of this project, Advocate Health Care is now embarking on disseminating the results, integrating insights into daily practice, and evaluating additional questions that emerged from the analysis. I’d be interested in hearing more about what your organization thinks about NPS, how you use it, and what you have learned as a result!
 NPS was first proposed by Fredrick F. Reichheld, (2003), "The One Number You Need to Grow," Harvard Business Review, 81 (December), 46-54. For more on advantages and issues utilizing NPS in health care, see https://thepatientoutcomesblog.com/2012/11/12/net-promoter-score-in-health-care/
Andrew S. Gallan PhD is an assistant professor at DePaul University in Chicago, a member of the Editorial Review Board of Patient Experience Journal, and principal of Dignity in Action, Inc., a PX analytics and advisory company (www.dignityinactioninc.com). Andrew can be contacted via email: firstname.lastname@example.org.
net promoter score
patient loyalty score
Posted By Justin Bright, M.D.,
Friday, May 12, 2017
Updated: Monday, May 8, 2017
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I have never in my life met a physician who woke up in the morning hoping that his patients hated him. I don’t know of any doctors who want their patients to have a terrible experience in their hospital, emergency department, or clinic. Yet, every time I am at a patient experience conference, the physicians there are seen as unicorns because they are actively engaged in improving patient experience. The question I hear most often from others involved in service excellence is, “how do we get more doctors to act like you?”
A question I ponder often is, if physicians care about the well-being of their patients so much, why are we having such a hard time getting physician buy-in on patient experience initiatives? If the physicians are already halfway there because they inherently deeply about the well-being of their patients, then why is this so hard!?!?!
I think it’s time that we as patient experience professionals engage in some serious introspection about how we are messaging the importance of patient experience to our physicians. What are your goals as a patient experience leader? What are the directives being handed down to you by hospital leadership? Do you want satisfied patients? Or do you want compassionate, empathetic and streamlined care? Are you leading every discussion about patient experience with stats, survey scores and percentiles? Does your health system make the physicians feel like they are terrible at providing a consistent and excellent experience to their patients without acknowledging just how incredibly complex it can be to actually do so? Are you celebrating the physicians who are doing well?
My suggestion is, you need to drop the term “satisfaction” from your vocabulary. That is not what any of us are trying to achieve. “Satisfaction” or mention of survey data makes doctors go insane. There is no partnership there. No inspiration. No buy-in. Just an adversarial relationship that makes physicians feel like leadership just doesn’t get it. Instead, focus on “experience.” Focus on communication. Inspire physicians with stories – using positive reinforcement to recognize the times when a patient’s experience was incredible. Physicians believe in a duty to their patients. The experience a patient has is the only 100% frequency event in our health systems. Care that does not involve compassion, empathy, and communication is not care at all. In my dream scenario, we are never mentioning satisfaction or scores to our doctors. Yes, the surveys need to continue, but should be monitored in the background by service excellence departments. If we engage our doctors, my hope is the rest will take care of itself.
My fear is that as patient experience continues to evolve, and as the pendulum continues to swing more towards “Patients First,” “All For You,” and other similar mantras, that we will fail to acknowledge just how difficult this endeavor is for our physicians. Sometimes it feels as if everyone is trying to push the patient experience boulder to the top of the mountain, but everyone is pushing in a different direction. If there were a simple solution, we’d all be doing it already. The key to organizational change is for you as a leader to have a clear goal, clearly delineate a path for your physicians to follow, and then you continue to drive them down that path in order to achieve sustainability. As we continue to look at ways to improve the consistency of physician communication and compassion, I also urge patient experience professionals to look within – how consistent and compassionate is your messaging to your physicians?
Justin Bright, M.D. is the Patient Experience Champion at Henry Ford Hospital in the Department of Emergency Medicine.
Posted By Rebecca Ruckno,
Friday, April 21, 2017
Updated: Friday, April 14, 2017
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We have all been there right? What hat should I wear at work today? The pretty hat? The thinking cap? Or maybe the hard hat? The role of the patient advocate can sometimes be confusing. We all agree that we need to support the initiatives of our hospitals while also supporting our patients and families. How can we keep ourselves whole?
Over the past year and a half, the advocates have been working with a new initiative; Proven Experience. If the patient perceives that their experience was less than satisfactory, they can request their co-pays to be waived or refunded. Proven Experience is a promise of providing the best patient experience for every patient every time. When doing the investigation on the issue brought forth by the patient we often hear “all care was appropriate”. But what does “care” mean? To the medical team, care may mean that all medical protocol was followed and the outcome matched the protocol. To the patient, care may mean more than the “medical” care. It’s about how they were treated as a person. Did they receive all the information required to make an informed decision? Did we respect the patient and follow our C.I.CARE initiative? Often it is the compassion and the communication that our patients tell us that we are lacking. The team discusses the request with the patient and arrive at a mutual conclusion ending with the refund of the out of pocket expense. Because the perception of the outcome may differ, we may choose we wear our hard hats!
Since the roll out of the refund program we have almost doubled the issues we handle monthly resulting in adding additional staff. The relationships between the advocates and the various departments that they interact with have become stronger. Particularly, the departments of Finance, internal audits, service lines and legal. This is due mainly to our development of a more collaborative agreement with a win/win for our patients. We are looking to improve telephone wait times, appointment wait times, smooth transitions and bills that are understandable. Kindness and compassion are integral in the journey to recovery for our patients. The patients are bringing their experiences to the team hoping to make it better the next time. Perhaps we have always taken care of these issues before but now the refund has new meaning. Research in the future will show us if customer loyalty is obtained because of improving the experience.
The frustration has been in the reliance of other areas to help us determine what the refund will look like. Information needs to be gathered from the patient, the teams and finance. Billing of insurances, waiting for information from various departments can delay the final response to the patient.
When we do have time to catch our breath we need to look at the repetitive issues, develop a strategy and truly fix the challenges. Data needs to be reviewed and solutions must be developed. We have a variety of hats to choose from every day. Often times we may need to change our hat to meet the needs of our patients while also meeting our own needs. Thinking caps are required.
Becky Ruckno is the Director, Patient Liaisons and Interpretive Services with Geisinger Health System.
Posted By Katie Owens,
Monday, April 17, 2017
Updated: Wednesday, April 12, 2017
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What is culture? Culture can consist of many different elements in healthcare. From the way things are done in the organization. The shared relationships among people which dictate how they behave. To a set of shared beliefs and values. Each belief (while uniquely described by many) universally acknowledges that culture is an important part of the fabric of their organization.
Despite the fact that many people have conviction that organizational culture will either enable an organization’s success or serve as a barrier to achieving outcomes, sometimes broaching the subject of Culture can cause leaders or front line team members to shy away. Culture can feel messy, hard and inconvenient. We may be proud of some aspects of our culture but disappointed in others. Our team sought to find evidence outside of anecdote and theory to help leaders understand the role culture plays in creating excellence. That query led us to conduct our recent study demonstrated that culture does impact outcomes. The two big learnings we had conducting our study published in the Journal of Healthcare Leadership is that:
First, high performing cultures are more likely to do better than low performing cultures on key balanced scorecard metrics: Employee and Physician Engagement, Patient Experience, Value-Based Purchasing and Turnover. These cultures did not outperform by a small margin but a margin of magnitude and statistical significance (see Video on Culture Imperative). In other words, our team found that culture is not “nice to have” but critical to create demonstrable outcomes.
Second, engaging your employees in your culture is the most powerful step to create positive results. Your workforce is the lifeblood of your organizational culture: their engagement, relationships with leadership and each other and commitment to your mission. We found four key levers that are more likely to support achievement of outcomes:
- The extent to which patients are treated as valued customers.
- You find that your values are very similar to the values of this organization.
- You feel that being a member of this organization is very rewarding.
- You are proud to be a part of this organization.
There is no question healthcare leaders, staff and physicians are perservering day in and day out to provide the very best care to patients despite a myriad of challenges. Our teams are craving cultures that give them a sense of purpose and joy. As we work to create a “new normal” that equips our organization to provide person-centered excellence across the continuum of care, our findings indicate that leaders should pay attention to culture and actively steer workforce engagement to create employee pride, a focus on the customer and shared values.
Katie Owens, MHA is Vice President of HealthStream Engagement Institute, a HealthStream Company. Katie is a highly regarded thought leader in the healthcare industry who is a national speaker, executive coach and facilitator of leadership. Katie is founder of Lumen, a monthly podcast dedicated to shining a light on the bright spots where excellence happens in healthcare. KatieOwens.org
improving patient experience
Posted By Brooke Billingsley,
Friday, March 17, 2017
Updated: Wednesday, March 15, 2017
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Patients spend little time thinking about the nurse’s list of tasks to complete. They aren’t aware of the excellent job their nurse did charting their care, how staff made sure safety precautions were adhered to or what it took to provide a meal on time.
Patients are functioning on an entirely different level. They are focusing on what they can control – which is very little – and how external forces are making it easier or harder to achieve their goals of getting better and getting out of the hospital. What registers with patients is ‘touch’ – those memorable moments in which staff made a genuine effort to connect with patients.
A positive transformation occurs in a patient’s perception of their care when touch is added to a task. That is certainly true with the Bedside Shift Report.
The BSSR is often misunderstood because it is seen as time consuming, does require effort, and for some, is uncomfortable. But the BSSR must be seen from the patient’s perspective to be fully appreciated. The benefits and value to the patient far outweigh the arguments against.
Consider what the patient sees when a fully functioning Bedside Shift Report is conducted:
- The BSSR allows patients to hear and physically experience how committed the organization is to their care and illustrates how unique and important their case is.
- Patients are very conscious of how staff interacts with one another through conversations and body language. The BSSR presents an opportunity to show unity and camaraderie, which patients ultimately associate with good care.
- Staff has the opportunity to give patients the assurance that they will receive the same great care from the new nurse as the previous nurse. It also increases the chance for mutual praise and promotion of the rest of the team.
- Because the Bedside Shift Report is not a patient expectation (they are not likely to say, “Hey, I think I should be in on that get together in the hallway,”) the act itself is (novel) and memorable lending itself to increased satisfaction.
- The BSSR demonstrates that time spent with the patient has value, which in turn shows respect for patients and their participation.
- Adding some personality to the process completes the recipe for a guaranteed touch opportunity.
There are a few additional things you should consider in making the transition to a Bedside Shift Report a successful one.
- Have a plan to determine what would be most beneficial for the patient to know and work out the details of the information exchange.
- Practice until it feels comfortable. In time this should become second nature.
- Communicate in a way that is most understandable to the patient.
- If the patient is not able to participate, include family if they are present.
And finally, when you formally conclude your time with your patients, the BSSR shows that you care enough to say good-bye adding touch to a required task.
Brooke Billingsley is the CEO at Task To Touch™ e-Learning & Perception Strategies, Inc. a healthcare perception research company. Brooke is a speaker, consultant and author.
bedside shift report
improving patient experience
Posted By Dr. Avnesh Ratnanesan,
Friday, March 10, 2017
Updated: Tuesday, March 7, 2017
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Empathy in healthcare is both a traditional concept as it is a new-age buzzword. That’s because it has never lost its importance as a legitimate element of a patient’s healing process.
Simply defined, empathy is the capacity to walk in the shoes of another. Essentially, the ability to understand, appreciate and relate to someone else’s emotions. There is more chatter in the industry now about defining, teaching, learning and measuring empathy in healthcare than there has ever been.
Making emotions a visible part of your (formal or informal) measurement validates the feelings of patients which in turn, 3promotes patient satisfaction, enhances the quality and quantity of clinical data, improves adherence and generates a more therapeutic patient-physician relationship.
Ultimately, it all links back to the Net Promoter Score (NPS) or the Friends and Family Test (FFT). A key HCAHPS question, the NPS or FFT asks the patient point-blank if they would recommend the hospital to family and friends.
There’s your ROI.
EMOTIONS AND NPS
Human emotions are core to every patient experience. At every stage of the patient journey, there is a feeling, sentiment or attitude that will, collectively, define the experience for the patient at the end of their engagement with a healthcare setting.
Hospitals are often obsessed with benchmarking against other hospitals in term of their respective performance indicators, however there is a need to first benchmark against the EXPECTATIONS of your own patient population:
- If the experience < expectations, then you have a satisfaction deficit which leads to frustration and anger
- If the experience > expectations, then you have a satisfaction profit which leads to delight and excitement
Frustration and anger are detractors to the patient experience. If these emotions are experienced, then you can be sure that the patient is on their way to relay their negative experiences to others or not return, or both! Feelings of delight and excitement on the other hand naturally motivate patients to ‘promote’ your healthcare setting to others.
Measuring emotions is key part of our 6E Framework, a step-by-step guide to producing a true holistic picture of patient experience. Its measurement impacts the full spectrum of this framework:
Understanding the real patient EXPERIENCE through EMOTIONAL data ENERGISES staff in their purpose and EXECUTION of solutions. Successes are repeated to produce EXCELLENCE in delivery and organizational capability in patient experience EVOLVES.
How do you draw these emotions out of a patient so you can understand, measure and respond appropriately? Some state it boldly, some 3hide their emotions through seemingly rational questions or casually drop a comment about their emotions, to test the waters on how it would be received in the healthcare setting. Pick up on these clues, don’t ignore it or change the topic.
For the uncertain and non-forthcoming patient, surveys are a great way to get emotional data. One would imagine that a survey asking about their emotions would not only surprise them but send a clear message that there is a space in that setting to talk about emotions, that a culture exists that encourages and supports emotions.
INTELLIGENCE FROM EMOTIONAL DATA
When the clinician and non-clinician are able to recognize the emotions around a patient, it allows them to be more authentic and honest in the support given to the person (not patient).
Clinicians are able to view the person’s emotions within a more accurate context and address it in specific ways: 2
- Learning: Where the patient is fearful because of a lack of information, there is an opportunity for staff to help educate the patient to reduce his fear
- Empowerment: Where the patient feels helpless in the face of his health, there is an opportunity for staff to develop the patient’s sense of power over the situation through education, tools and technology
- Self-discipline: Where the patient is frustrated over their personal management of their health, there is an opportunity for staff to help the patient develop discipline through motivation, tools and technology
- Feelings of control: Where the patient is overwhelmed with the amount of information around their diagnosis, there is an opportunity for staff to ensure that the communication of information is at a pace and volume that the patient is comfortable with and to involve the patient’s family members or friends in managing overwhelm.
When an organization can undertake the above in a systematic way, an ‘energy’ or a vibe starts to infiltrate through the ranks. Clinicians and non-clinicians start to discover or re-discover the meaning in their roles and the organization becomes more congruent with its purpose.
What’s the vibe like where you are?
1. Empathy and Emotional Intelligence: What is it Really About?’, International Journal of Caring Sciences, Volume 1 Issue 3, Alexander Technological Education Institute of Thessaloniki, Greece http://internationaljournalofcaringsciences.org/docs/Vol1_Issue3_03_Ioannidou.pdf
2. Adapted/Inspired from information from a Chapter Abstract from Patient Emotions and Patient Education Technology: http://www.sciencedirect.com/science/article/pii/B9780128017371000020
3. “Let me see if I have this right...”: Words That Help Build Empathy, Coulehan JL, Platt FW, Egener B, Frankel R, Lin CT, Lown B, et al. (2001).
Dr. Avi Ratnanesan is a medical doctor with broad healthcare sector experience including hospitals, biotech, pharmaceuticals and the wellness industry. He is a leading expert who coaches and consults to senior executives, entrepreneurs, practitioners, organizations and governments.
Posted By Sarah Fay, MBA,
Friday, March 10, 2017
Updated: Friday, March 10, 2017
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We can all agree that in order to have a well-rounded view of patient experience, we cannot look solely at the information that comes back to us in our patient experience surveys – they are just one piece of a larger puzzle that make up an organization’s culture. And culture is what drives the experience…for everyone. I believe that we must look at data from several vantage points. Some of these, include:
- patient experience surveys
- employee engagement surveys
- physician engagement surveys
- information gathered during executive and leader rounding
- patient stories
- key human resource metrics
- feedback from our patient and family advisory councils
- quality and safety data.
If we leave one vantage point out, we risk losing the complete picture. And this picture must include patient relations data as well.
I oversee patient experience for Southwest General Health Center, a long-standing 354-bed community hospital in Middleburg Heights, Ohio. Last year, we merged our patient relations department with our patient experience department. Unifying these departments has not only helped me in my work – it has benefited our patients too.
The richness of the data collected by our patient representative is invaluable to developing and executing our patient experience strategy. By combining our patient relations data with our patient experience data, we have a well-rounded view of our patients’ perceptions. Trending our patient relations data is key to this.
- Trends helps us determine where we need to focus our efforts. The trends in concerns and complaints bring to light an area that we have an opportunity in, while the trends in compliments bring to light an area we can celebrate. When we combine these trends with our patient experience survey data, we are better able to prioritize our strategies, programs and celebrations.
- Trends help us pinpoint areas that need additional support. When we combine these trends with our patient experience survey data, I am able to hone in on areas, departments, units or individuals that may need specific training or one-on-one coaching. It also tells me where we need to focus our process improvement efforts. The trends in compliments show me areas, department, units or individuals that I can rely on to champion the cause. Those people can then help train and coach others.
- Trends help us conclude if the initiatives we have put in place on the front-end are working. Combining the patient experience survey data with the trends of both compliments and complaints, tells me if our programs and initiatives are having the intended outcomes.
Our partnership extends beyond the data too. Our patient representative has a very unique skillset – one that I hope to transfer to the bedside through a robust service recovery program at Southwest General. With her distinctive skillset, she can help develop a program, train our staff and teach them how to embrace the skills necessary to handle concerns and complaints right at the bedside. This will shift her into a more proactive role and I believe that is the wave of the future.
Sarah Fay, MBA, is the Director of Guest Experience at Southwest General Health Center in Middleburg Heights, Ohio. She may be reached at email@example.com.
Posted By Jeremy Blanchard, MD, MMM, CPE, FACP, FCCP and FACPE,
Wednesday, February 1, 2017
Updated: Wednesday, February 1, 2017
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“I was on the inside looking outside. The millions of faces, but still I’m alone… I hope we’ll be here when they’re through with us.”
When I hear Foreigner sing “Long, Long Way from Home,” I am reminded of conversations I have had with my colleagues, physicians and advanced practice clinicians (APCs). The world of medicine is so dynamic and different from when I started medical school in 1987. Many of these changes are good and have great intent, but many of the ramifications threaten core value attributes of our different generations of healthcare providers: autonomy, sacred relationships with patients, complex problem solving and the joy of practicing medicine. In these conversations the providers relate not having a voice, feeling like healthcare is changing without their input, and not for the better. They feel alone and not valued.
Being a caregiver seldom, if ever, starts from the perspective of practicing medicine as a business opportunity. It starts from a place of the desire to do good. As we enter medical school bright eyed, empathic and energized, what happens to us? Or at least how is our showing of empathy and building relationships threatened or compromised?
This blog is my call for action. A call for us, leaders in healthcare and patient experience, to develop a strategy to address the following question. How can we help our physicians and APCs, seasoned and new, from multiple different generations, feel valued and recapture or sustain their joy of practice? It is paramount, because the provider being empathetic, engaged and joyful is pivotal to our family and friends’ quality of care and how they feel when receiving that care (1, 2).
“I've learned that people will forget what you said, people will forget what you did, but people will never forget how you made them feel.”
- Maya Angelou
The reality of our present American healthcare model in regard to providers is reflected in these powerful statistics.
- 54% of doctors show signs of burnout and only 40% of doctors are satisfied with their work life balance.(3)
- For every 1 hour physicians provide direct patient care, nearly 2 additional hours are spent in activities associated with the Electronic Health Record.(4)
- In one study 52% of medical students suffered from burnout; of those burned out, 35% admitted to unprofessional conduct related to patient care.(5)
- 14% of Internal Medicine Residents rate life “as bad as it can be” or “somewhat bad.”(6)
- 38% of Internal Medicine Residents had personal debts greater than $100,000 dollars (2008 monies).(6)
- 6.3% of participating surgeons had suicidal ideations in the past 12 months.(7)
Physician burnout is real and threatening our whole healthcare system - the quality, safety and compassion of the delivery of healthcare.(8) Burnout is not just among older physicians or surgeons; it is across the whole spectrum of healthcare. In Maslach’s Burnout Inventory Manual, he states, “Burnout is a syndrome of emotional exhaustion, loss of meaning in work, feelings of ineffectiveness and a tendency to view people as objects rather than as human beings.”(9)
When considering this subject there is a complementary way of looking at it that I find valuable. In each of the above statistical bullet points there are multiple challenges accumulating to depersonalize and overwhelm the provider. But what if we were to focus on how we support these courageous and valuable members of the healthcare team? Instead of focusing on burnout, reposition ourselves and focus on developing resilience, investing in our providers to help them find their joy, recapture their personal and cultural value. The following are conversation topics I believe we need to discuss now to answer this call to action. Here are statements to serve as an agenda for generative conversations and next steps to action.
- Interventions for burnout need to be as multi-factorial as the causes. The etiologies of burnout for my generation of providers, compared to the millennial provider, may have the same or different root causes. Recognizing the differences in generations allows for more impactful and valuable interventions.
- Costs in healthcare live in silos with their relationships unrecognized or declared. A key to making this a prioritized conversation is identifying the price tag to this epidemic. The cost shifts this conversation from the doctor’s and APC’s problem to the CFO’s and CEO’s problem.
- We need senior leadership in health care to recognize and quantify the hidden opportunities of investing in our providers. Data shows doctors who have sustained empathy and joy provide safer care and a better patient experience. In population health models this translates to increased revenue.
- It is proposed with future physician shortages, APCs will have a greater impact on care delivery, healthcare revenue and patient experience; that “future” is now. We need to create systems that recognize the APC as a unique member of the healthcare team.
- With the changes taking place in healthcare we need to assure the new paradigm of excellent care outcomes (the quadruple aim) - enhancing patient experience, improving population health, reducing costs and improving the work life balance of those who provide care.(10)
- A happy physician or APC costs the institution much less in legal fees, mistakes, nurse turnover, etc. How do we help our medical culture apply the resources to address major causes of burnout and to support the development of resiliency programs?
- Essential to a successful navigation of our healthcare future is identifying communication as an advanced healthcare competency. It deserves the same attention as the mastery of procedural skills, knowledge base and work flow.
The time is now and the “who” is us. If we do not begin to have these conversations and change the perspective of healthcare, our “default” future is one of: not enough healthcare providers, increased healthcare costs and a loss of the “sacred” relationship between the noble men and women who care for patients. This conversation is focused on physicians, but applies to all who touch a patient’s life. Won’t you join me?
- Lucian Leape Institute. Through the Eyes of the Workforce: Creating Joy, Meaning and Safer Health Care. Lucian Leape Institute of the National Patient Safety Foundation 2013.
- Beach M, Sugarman J, et al. Do Patients Treated with Dignity Report Higher Satisfaction, Adherence, and Receipt of Preventive Care? Annals of Family Medicine 2005; 3:331-8.
- Shanafelt T, Hasan O, et al. Changes in Burnout and Satisfaction with Work-Life Balance in Physicians and the General US Working Population Between 2011 and 2014. Mayo Clinic Proceedings 2015; 90(12):1600-1613.
- Sinsky C, et al. Allocation of Physician Time in Ambulatory Practice: A Time and Motion Study in 4 Specialties. Annals of Internal Medicine 2016; 165(11):753-760.
- Dyrbye L, Massie F, et al. Relationship Between Burnout and Professional Conduct and Attitudes Among US Medical Students. Journal of the American Medical Association 2010; 304(11):1173-1180.
- West C, et al. Quality of Life, Burnout, Educational Debt, and Medical Knowledge Among Internal Medicine Residents. Journal of American Medical Association 2011; 306(9):952-960.
- Shanafelt T, Balch C, et al. Suicidal Ideation Among American Surgeons. Archives of Surgery 2011; 146(1):54-62.
- Shanafelt T, Balch C, et al. Burnout and Medical Errors Among American Surgeons. Annals of Surgery 2010; 251(6):995-1000.
- Maslach C, et al. Maslach Burnout Inventory Manual, 1996.
- Bodenheimer T and Sinsky C, From Triple to Quadruple Aim: Care of the Patient Requires Care of the Provider. The Annals of Family Medicine 2014; 12(6):573-576.
Jeremy R. Blanchard, MD, MMM, CPE, is a Chief Medical Officer at Language of Caring. Grounded in healthcare realities and aspiring to partner with others committed to healthcare transformation, Dr. Blanchard is an expert in ensuring physician development, commitment and wholehearted engagement. A dynamic speaker, skilled facilitator and coach, he provides tailored programs for medical staff, coaches individual physicians, and partners with physician leaders to assess needs and implement physician engagement strategies.
Posted By Julie A. Snow,
Wednesday, February 1, 2017
Updated: Tuesday, January 17, 2017
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As a patient, it can be uncomfortable and overwhelming to stay in a lonely hospital room with a seemingly neverending stream of unfamiliar faces coming and going throughout all hours of the day and night.
Hospitals can do a lot to improve the patient experience. One simple, yet surprisingly effective way to do so is by simply taking the time to introduce the patient to his or her care team professionals. This one act can improve a patient’s familiarity with their care team members, enhance their awareness of what to expect from each member and increase their confidence in the care that is being provided. When these things happen, the doctors, nurses and other hospital staff can also feel more connected with and more committed to providing the best care possible.
With both patients and providers quickly establishing a relationship with each other, patient satisfaction with their overall hospital experience can improve drastically while hospital staff feels more fulfilled in their work. It becomes a win-win situation.
Improve Patient Familiarity with Care Team Members
A team-based approach to patient care is widely used by hospitals. This is to ensure the best care possible for each patient. When the team is optimized by being composed of staff members who are working to the highest level of their expertise and abilities, the following can be accomplished:
- Patients gain enhanced access to a team of experienced professionals
- Patients are more satisfied with their stay
- Care will see improved levels of quality, reliability, and safety
- Hospital costs will reduce
If there is a downside to using a whole team of rotating professionals, it’s that the patient may not be given much of a chance to establish a relationship with each team member. This delays or reduces the chance for trust to be built. However, by keeping patients regularly updated on not only the name of their care provider but also their photo, title, and qualifications, it is easier to build a higher level of trust in a shorter amount of time.
Increase Patient Trust and Confidence
So what happens when patients are more familiar with the background, qualifications and certifications of each team member who is responsible for their care? Patients feel more comfortable in the hospital environment and even the confidence in themselves and their ability to heal is increased.
With this newfound trust and confidence, patients can become more empowered to voice their concerns, ask questions regarding their care plan or prescriptions and accept the advice of experts. After a patient leaves the hospital, they will be more likely to follow their doctor’s instructions and seek needed follow-up care.
A New Way for Introductions
A nurse can write his or her name on a whiteboard hung up on a patient’s wall, but now there is a better, more engaging way to make introductions. Hospitals are introducing their patients to care team members via an in-room television or even a digital whiteboard displayed on a personal tablet. This method has proven effective since the updates happen automatically, in real time, and patients are familiar with the format.
Easy access to information and enhancing patient awareness both play a big part in the encouragement of patients to open a consistent dialog with their care provider. A simple conversation can make all the difference in the health and wellness of a patient.
Patients are determined, more than ever before, to be fully engaged and educated in their own health care. By giving them the opportunity to be proactive when interacting with their care team, you are also giving them the opportunity to be more fully satisfied with their overall hospital experience.
Julie A. Snow is a health researcher and writer who has worked together with Sonifi Health to improve patient experience. When she isn’t working or mothering, you’ll usually find her in an Ashtanga Yoga arm balance or eating (sometimes both at the same time).