Posted By Gen Guanci,
Thursday, January 4, 2018
Updated: Thursday, January 4, 2018
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Those in health care know all too well that the patient experience is a top pain point for executives and therefore a top organizational priority. There is also no shortage of initiatives, programs and activities that focus on improving that experience. Committees and task forces are formed with participation from leaders across the entire organization. Education and action plans are developed and rolled out. Patient experience scores are closely watched for the anticipated improvement. Then, reality often sets it: There is no—or only minimal—improvement. How can that be? And what can be done about it?
What if you were to take the traditional approach to improving the patient experience—the approach where initiatives, programs and activities are developed by those outside the point of care and rolled out to those who must operationalize them—and flip it? Shared governance is a leadership model that does exactly that. In a shared governance culture, staff members are empowered to make decisions that meet a set of articulated expectations shared by leadership. Shared governance has proven to be a highly successful partner in crafting strategies that yield sustained improvements. Shared governance is built on a set of four overarching principles:
Staff and leaders work together to improve practice and achieve the best outcomes.
Everyone contributes within the scope of her or his role as part of the team to achieve desired outcomes.
Staff and leaders share ownership for the outcomes of work and are answerable to colleagues, the institution, and the community served.
Participants accept that success is largely dependent on how well they do their jobs.
Using shared governance, groups of staff members (councils) are charged with the development of the specifics of the plan to address the opportunities for improvement. Let’s take the desire to have purposeful rounding be a standard of care. While the desired outcome is purposeful rounding, it would be up to the individual councils, groups, departments, or units to determine how this could be best operationalized in their area. Here are some examples of what could happen when the people closest to the work in each department are empowered to make decisions about how to make rounding purposeful for their specific patient populations.
The Maternal-Child department determines that rounds will be done hourly between 6:00 a.m. and 11:00 p.m., then every two hours between 11:00 p.m. and 6:00 a.m. They have made this decision to meet the needs of their patients to have a period of uninterrupted sleep.
The Surgical unit decides rounds will be a shared responsibility between the RN and the Clinical Assistants (CA). RNs round on the even hours and CAs on the odd hours. For the same reasons as the Maternal-Child department, they too decide hourly rounding hourly will be done between 6:00 a.m. and 11:00 p.m., then every two hours between 11:00 p.m. and 6:00 a.m.
The Patient Experience council, made up of a mix of staff members from across the organization (i.e., environmental services, clinical, nutritional services, etc.) work together to develop a meaningful rounding experience for patients and staff members that includes addressing the best practices in rounding conversations.
The expectation for each of the above groups was to craft a meaningful rounding experience that worked for the patient as well as the specifics of the individual units/departments. The plans, developed by staff members, are supported by colleagues as peer developed and rolled out the plans. Peers create the accountability with each other, and this in turn lessens the need for leadership to “manage” the plan. It also moves organizations from “us” and “them” to “we.”
There is an ancient Chinese proverb that states “An owner in the business will not fight against it.” Using shared governance to craft a plan for sustainable improvement creates ownership at all levels of the organization.
Gen Guanci is a consultant with Creative Health Care Management where she works with organizations as they build a culture of excellence. Her work with Magnet® and Magnet® aspiring organizations focuses on improving the patient experience, work environment, clinical practice, and patient outcomes. Her expertise in shared governance has enable her to empower staff to generate outcomes that exceed national benchmarks.
Posted By Sven Gierlinger,
Thursday, November 9, 2017
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It happened to me - first came a tingling in my fingers and toes; and within days, I was paralyzed. A husband and father of two young children at the start of a new assignment with The Ritz-Carlton Hotel Company - I was diagnosed with Guillain-Barré syndrome, a rare condition in which a rapid-onset muscle weakness caused by the immune system attacks and temporarily damages the peripheral nervous system. Suddenly, and for 90 days and nights, I was 100% dependent on my doctors, nurses and therapists.
Believe it or not, I’m actually grateful for this experience, as it showed me that as a patient, you are challenged to heal in many ways – physically, mentally, and emotionally. My experience in these moments helped me understand the power of embedding both service and empathy into the clinical processes that truly can make or break a patient or family experience. Every moment counts.
My years at The Ritz-Carlton opened my perspective to what guests really want – and it’s much more than crystal chandeliers, marble floors and fancy ocean views. The Ritz-Carlton takes culture very seriously and believes it should be fully ingrained in all its employees, even by memorization. This credo provided the gold standards of service that were the focus of my everyday work, and until this day I can recite each word.
The Ritz-Carlton Credo: The Ritz-Carlton is a place where the genuine care and comfort of our guests is our highest mission. We pledge to provide the finest personal service and facilities for our guests who will always enjoy a warm, relaxed, yet refined ambience. The Ritz-Carlton experience enlivens the senses, instills well-being, and fulfills even the unexpressed wishes and needs of our guests.
Based on my own professional and personal healthcare experiences, and as the Chief Experience Officer at Northwell Health, I knew I had to look at the experience through a very different lens. We have seen that the hospitality industry has established a precedent of best practices that can directly correlate to the healthcare industry. Let’s take the crossover themes from this credo for example: providing genuine care and comfort, personalization, a warm yet refined environment, and delivering on unexpressed wishes. I often wondered what this same credo would look like if ‘Ritz-Carlton’ was replaced with ‘Healthcare’, and if ‘guests’ were replaced with ‘patients’.
Let’s read the credo again…
The Healthcare Credo: Healthcare is a place where the genuine care and comfort of our patients is our highest mission. We pledge to provide the finest personal service and facilities for our patients who will always enjoy a warm, relaxed, yet refined ambience. The Healthcare experience enlivens the senses, instills well-being, and fulfills even the unexpressed wishes and needs of our patients.
Now, isn’t this what we all want and deserve from our own healthcare experience? It’s not only about first impressions; it’s about lasting impressions and creating that consistency in the patient experience. As experience leaders, it is imperative we understand how to enliven all the senses – what patients see, hear, touch, taste and feel. This understanding can greatly affect the patient experience, as well as the overall healing process.
At the end of the day, I think we can all agree that healthcare is about helping people through their most vulnerable time, and there is no greater honor. So, I challenge each of you to think about healthcare differently. Reflect on this healthcare credo and ask how you can translate these concepts into practice to truly make every moment matter.
Sven Gierlinger serves as the VP, Chief Experience Officer at Northwell Health. With a focus on providing exceptional customer service and delivering the highest quality care, Mr. Gierlinger is responsible for building an engaging, innovative and collaborative culture that drives organizational growth and customer loyalty through the patient/customer experience. He is also an Executive Board Member for the Beryl Institute and a member of the Institute for Innovation, Founding Executive Council. Northwell Health, headquartered in New Hyde Park, New York, is the largest healthcare provider and private employer in New York State. The system serves over 8 million patients in metro New York and the surrounding areas with its 22 hospitals and more than 550 outpatient practices.
Posted By Martijn Hartjes,
Monday, October 30, 2017
Updated: Monday, October 30, 2017
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One of the major transformations occurring in healthcare today is the shift toward seeing the patient as a consumer. Similar to other industries that are driven by customer service, health systems are recognizing the impact the patient experience has on consumer loyalty, institutional reputation and topline financial results. The business case is clear. And rather than being an industry push, patient experience now has a meaningful pull – 82% of health systems recognize patient experience as a top priority, and 89% of consumers reported that their experience is extremely important, according to The Beryl Institute’s recent research, The State of Patient Experience 2017: A Return to Purpose.
The lesser understood story about patient experience is its potential to improve patient engagement, staff engagement and even clinical value for patients. In my field of diagnostic imaging, the patient experience has been shown to be a critical component to getting the image right the first time. In MR imaging, the biggest impediment to a diagnostic quality scan is patient movement. When patients move – due to stress or discomfort – imaging quality is likely to be compromised. That can mean repeat scans and delayed time to treatment for patients. It can also mean frustration for staff and radiologists and consternation for radiology administrators who need to do more with less.
Staff Engagement is Key to Patient Experience
A patient’s care experience is directly dependent on the engagement of their caregiver. Staff involvement plays an essential role in how the patient views their exam and subsequent treatment as cited in the Institute’s report that 68% of health systems recognize that highly engaged employees are key to the patient experience. When it comes to a magnetic resonance imaging (MRI) exam, there is a human-to-human interaction that no machine can replace, and technologists are on the front lines of guiding patients and their families through this often stressful situation.
However, if the staff finds themselves overworked, stressed or burdened with reporting tasks or technical complexity, it is the patient who will ultimately be at risk. Having technology that supports a positive patient experience by making the technologist’s job easier can create a stronger patient-staff dynamic.
Reducing Patient Stress to Improve Imaging Outcomes
As consumers of healthcare, today’s patients are making decisions on where to receive treatment based on their expectations of service and preferences. We are seeing patients choose imaging locations that provide a less stressful situation over those that are far more convenient. Based on our experience, we know patients travel hundreds of miles to experience a more comfortable scanner experience with open scanners, rather than going to a more convenient location with smaller, closed scanners.
In addition to impacting their facility choices, patient stress in MR exams inflicts a high clinical, operational and financial toll, leading to reduced workflow and patient dissatisfaction. When patients feel apprehensive, they are more likely to move and distort the exam. Such motion complications cause 1 in 5 MRI exams to require a rescan, which can cost an institution an estimated $592 per hour, and a $115K loss per scanner every year. In this way, patient comfort is fundamental to guaranteeing high-quality diagnostic images.
One way to reduce patient stress is to humanize the experience by providing consistent communication throughout the process and create an interactive atmosphere from start to finish. Communicating the smallest details, like how the scanner table will move or how long the scan may take, will help set expectations and dramatically reduce patient anxiety. It’s not just the patient that needs empathy and comfort but the patient’s family as well. The Beryl Institute’s research confirms that the majority (80%) of respondents believed patient experience efforts have a positive impact on reducing patient and family anxiety to a great extent.
Letting Patient Experience Lead the Way
Across the industry, patient experience efforts are becoming an integral part of the fabric of care delivery and are being recognized as drivers for measurable outcomes. In the imaging field in particular, real insights from real patients are increasingly important to understanding their needs. By focusing on the people behind the images and by creating a calming, supportive environment, technology vendors and clinicians across the continuum of care can join forces to improving imaging outcomes and clinical value for patients.
Martijn Hartjes is an experienced healthcare executive with a professional track record in multiple disciplines of the medical device industry. Currently, he serves as senior director, head of global MR product marketing at Philips. In this role, he is responsible for the global MRI marketing function, leading product management, clinical portfolio management and product marketing.
Posted By Grace Cordovano PhD,
Wednesday, August 23, 2017
Updated: Wednesday, August 23, 2017
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A patient was recently discharged from an exceptional hospital after a 2-day stay. During those 2 days, he saw endless doctors, attendings, residents, fellows, interns, nurses, nurse practitioners, nursing students, TV and phone service staff, physical therapists, social workers, case managers, housekeeping staff, spiritual chaplains, food and beverage staff, transport staff and discharge planners. Forgive me if I’ve missed anyone. All of these hospital employees play an essential role in a patient’s care at the hospital. There was just one person missing: someone from the medical records department. It’s time to change the lens we are using to view the importance of medical records to patient success and health.
No one visited the patient to discuss the importance of having a copy of his medical records post-discharge and maintaining a personal medical history file. No one verified authorization for the release of medical records. No one asked what medical records the patient needed upon discharge. No one confirmed what doctors needed a copy of the patient’s medical records: like his primary care doctor, his cardiologist or his neurologist. There wasn’t a single person that walked through the revolving door of the patient’s room that mentioned anything that resembled “medical records”. As a private patient advocate, this is no surprise. I’ve accompanied clients to my fair share of hospitals, medical facilities and cancer centers. I’ve yet to see a medical records representative visit with a patient during their time at the hospital. Electronic Health Records (EHR) are not the answer as they weren’t designed with the patient as the priority. Patient portals, if a facility has them, aren’t effectively adopted or utilized and have many shortcomings.
Here’s what should be happening at hospitals. A medical records representative should visit patients in the hospital with a smart tablet. The representative should discuss a patient’s care goals and discuss care coordination with respect to medical records. Medical record authorizations should be pulled up on the smart tablet and patients should be able to electronically authorize releases from their bed. At minimum, the medical records representative should verify the contact information of doctors that should be receiving a copy of medical records for follow-up. All doctors who regularly treat the patient need to have a copy of the medical records for seamless communication, coordination of care, and patient success post-discharge. At discharge, patients should at least receive a copy of every test performed during their stay at the hospital. There is absolutely no reason any patient should be discharged without a basic copy of their records. None. Release authorizations and strategic planning of the use of records for patient success need to be done at the bedside while the patient is in the hospital. Medical record acquisition needs to become an active part of the discharge process, not a hunt thereafter. Let’s stop this insanity of needing to walk to the medical records office, usually in the basement of a different building than where the patient’s room is, to fill out a form or print one online and mail or fax it. We need to bring the medical records department to the patient’s room while they are in the hospital’s care: a simple change with potential for profound, patient-centric results.
Grace Cordovano PhD, founder of Enlightening Results, is dedicated to fostering private, personalized patient advocacy services, specializing in the cancer space. She is a firm believer in the continuous advancement and improvement of patient experiences through the infusion of empathic design and thinking into current healthcare paradigms. Follow her on Twitter @GraceCordovano.
Posted By Liz Salmi,
Wednesday, July 19, 2017
Updated: Wednesday, July 19, 2017
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After dating me for only 18 months, my now husband became my health care partner. I was 29. He was 31.
In mid-2008, I suffered a massive seizure, landed in the ER, and a scan revealed I had a mass in my brain. Brett suddenly found himself in love with a 29-year-old gal with brain cancer.
After my first hospitalization, Brett jumped into caregiver mode. If I needed clothes for the hospital, Brett packed the bag. When a nurse missed one last stitch in my scalp, Brett finished the job with tweezers. When I needed help coordinating a complex regimen of medications, Brett designed a color-coded spreadsheet that matched my giant pillbox organized by days of the week and times in the day.
Meanwhile, I jumped on the Internet to research treatment options on PubMed, joined Facebook Groups and Twitter communities for people with brain tumors, and started blogging about my experience for family and friends.
There is no right way to respond to illness. My way was to respond with curiosity. I cared about understanding the how and why of my diagnosis and the what of my treatment. Brett’s way was to respond with unconditional love and support. And he cared about taking care of me.
But there is one thing we both needed and continue to need to be active and engaged participants in my care: access to the details of my ongoing care plan—information that is a part of my medical record and embedded in my doctor’s notes.
Brett and I didn’t even know notes were a thing until earlier this year when a change in health insurance forced me to uproot my care from one health system to another. While in the process of collecting my medical records I stumbled across a large PDF document that revealed an insider’s view of my last eight years of living with brain cancer—my notes.
Doctor’s notes (or visit notes, progress notes, clinical notes) are the most important information in our record. This information is readily available to doctors and other members of the health care team to remind them about a patient’s condition and plan for care.
I received great care from my previous health system, but like 96 percent of Americans, my clinical notes were not shared through the online patient portal. This made me wonder… why hide my notes?
I want this to change—for me, for my husband, and for every patient facing a health challenge or working to stay well.
OpenNotes is a national movement encouraging doctors, nurses, and other health professionals to share the notes they write with the patients they care for using secure, patient portals, with the ultimate goal of improving the quality and safety of care. Shared notes enhance the patient experience by improving communication and trust, and reading notes helps to empower patients to make more informed decisions.
Access to notes can help caregivers like Brett, too. In a 2016 study*, patients and care partners with access to open notes stated that they had better agreement about treatment plans and more productive discussions about their care, and patients were more confident in their ability to manage their health and felt better prepared for office visits. Even better, care partners reported improved communication with patients’ providers at follow-up.
In less than five years, the OpenNotes movement has grown access to notes from 20,000 to over 15 million people. That number is impressive, but it represents just 4 percent of the U.S. population.
When I, the patient, don’t have access to notes, neither does Brett—the person most invested in my care. I spend about two hours each year with my health care team, and over 5,000 waking hours in self-care or “Brett-care.” Access to my notes could help us remember what we need to do between now and the next appointment with my doctor.
So what’s the hold up? Why don’t more people have access to their full medical record and clinical notes?
Doctors and health systems claim people will not understand their notes, or be afraid of what is written in them. This makes no sense to me. I am already looking for information about my diagnosis on the Internet—shouldn’t my first search be based on information in my own medical record?
My husband and I are the most invested people in my care, and the notes are about me. Any information about my health and health care is important to us, and we want to know about it. We can handle it.
* Wolff J, Darer JD, Berger A, et al. Inviting patients and care partners to read doctor’s notes: OpenNotes and shared access to electronic medical records. J Am Med Inform Assoc (2017) 24 (e1): e166-e172.
Liz Salmi is the Senior Multimedia Communications Manager for OpenNotes. OpenNotes is a foundation-funded national movement advocating for clinicians to share their visit notes with patients via patient portals. She is also a patient who does not have access to her notes.
To hear more from Liz and about OpenNotes, join us August 29th for the upcoming webinar, The Power of Knowing. You will learn more about the OpenNotes movement and how your health system can participate, and hear from a doctor and a patient about their personal experiences with notes and transparency.
Posted By Marcus Engel,
Monday, July 17, 2017
Updated: Monday, July 17, 2017
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I can’t remember the impact, but I remember the headlights. Then, the pain. The all-encompassing horrors of broken jaws, crushed facial bones and desperate attempts to breathe. I remember the metallic taste of blood mixed with gasoline. Then…the blackness. But, how could I know that darkness was permanent? How could I know that I was now blind?
I can’t remember the medics, the crike, the ambulance speeding to Barnes Hospital, but I remember my clothing being cut off. And, I remember Jennifer.
Throughout that wretched night in the ER, Jennifer held my hand and never left my side. Her presence and her words, “Marcus, I’m here…” were the only things she could have done to help…and they were exactly what I needed.
Throughout the hospitalization and recovery, rehab and 20 years of life, I knew nothing else of Jennifer. Her story is in my memoir and “I’m Here: Compassionate Communication in Patient Care.” But, beyond that night? I knew nothing. No last name, not her position in the ER. Nothing.
Two years after the trauma, as a 19 year old, I found myself in Morristown, New Jersey, training with my first Seeing Eye dog, a black lab named Dasher. Some people measure life in years. I measure life in dogs. Dasher was by my side for seven years. When he retired at age nine, I thought my heart would break. I’d lost my sight, so I thought I knew what loss was…but I was wrong.
Life goes on. We all know that. Dasher’s retirement ushered in another black lab, Carson, who was with me for another seven years. Then came Garrett; a yellow lab who, if you’ve heard me keynote since 2010, you’ll probably remember.
Soon after I picked up Garrett’s harness for the first time, we moved to New York City where I began my Narrative Medicine Master’s program at Columbia University. As I continued keynoting around the country, Garrett was by my side for countless flights, hotel rooms, hospitals and conference centers.
Then, Barnes-Jewish Hospital, the facility that saved my life, invited me to speak. As always, I told the story of “I’m Here” and Jennifer. Afterward, a member of the patient experience team approached and said words I’ll never forget: “Marcus, we have a surprise for you… we found Jennifer.”
Shock. Disbelief. Confusion. I was nothing short of a blubbering mess as I, for the first time in 20 years, held her hands again. Finally, I got to say thank you.
Weeks later, Jenny and I were interviewed by the St. Louis Post-Dispatch.
The journalist asked lots of questions, including, “How long have you had Garrett? How long do Seeing Eye dogs work? Where will Garrett go when he retires?”
Seeing Eye dogs work, on average, seven to nine years. Provided Garrett stayed healthy, we would be together around four more years.
“Will you keep Garrett when he retires?” she asked.
“No, I’ll then get another dog and need to focus all my bonding on the new pup. That’s not fair to Garrett, so I’ll find someone who wants to adopt him.”
Jenny practically jumped out of her seat declaring, “I want him!”
“Absolutely, I would love to have him!”
“Done,” I said. “I can’t imagine better hands.”
Last December. I laid on the floor of a hotel room, thanked Garrett over and over for being mine, for keeping me safe and for his unconditional love. Tears fell onto his velvet ears. Then, a knock at the door.
I hugged Jenny, fell to my knees and held Garrett one last time.
As Garrett and Jenny walked out, all I could think of was love. Love. Compassion. Presence. That’s what I received from Jennifer on the worst night of my life…and that’s what Garrett gave throughout his working life. It is a model of what all truly excellent patient experiences are comprised.
Marcus Engel, M.S., CSP, CPXP is a Certified Speaking Professional & author whose messages provide insight and strategies for excellent patient care. As a college freshman, Marcus Engel was blinded and nearly killed after being struck by a drunk driver. Through two years of rehab, over 350 hours of reconstructive facial surgery and adaptation through a multitude of life changes, Marcus witnessed the good, the bad and the profound in patient care. Marcus and his wife, Marvelyne, are the co-founders of the I’m Here Movement, a 501(c)3, which is changing the culture of care with two simple words.
To hear more from Marcus, join us August 15th for the upcoming webinar, Presence: Compassionate Communication Through Everyday Mindfulness or September 15th for our Regional Roundtable event in Ontario.
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 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 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.