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The Practice of Experience: A Relentless Pursuit of the Truth

Posted By Tifffany Christensen, Wednesday, September 5, 2018

As a CF/lung transplant patient turned Patient/Family Advisor (PFA), I have been on the frontlines of the evolution of Patient Experience strategies since 2005. I fell in love with PFACs and have been thrilled to see the ways in which we partner with patients and families grow more sophisticated over time. Today, we have patients and families working directly in clinical quality improvement, sitting at the board level and rounding on patients actively receiving care. It’s both inspiring to see the changes and frustrating to see how far we have to go to achieve genuine partnerships across the continuum of care.

After working as a patient advocate, I became a specialist in Patient and Family Engagement (PFE) “best practices.” Working with healthcare organizations to improve bedside engagement and community engagement proved challenging for multiple reasons. I hunkered down on the best practices, sought out additional strategies and remained steadfast in the belief that the right strategy would improve engagement and, ultimately, experience.

One day, I was on an oncology unit trying to determine how well the clinicians communicated with their patients.  I was rounding from room to room, asking patients questions. To me, the questions were both simple and very important to my understanding of the patient experience:

  • “When your doctor came in this morning, did you understand everything he told you?”
  • "After morning rounds, were you left with any questions that didn’t get answered?”
  • “When you call for a nurse, how quickly do they typically come to your room?” 

These were simple questions directed at what we care about in improving experience: clear/respectful communication and a timely response to needs. I thought I was doing a great job with my questions but the answers I kept getting were not what I expected, wanted or needed. Instead of telling me about the communication and timeliness of responding to call bells, patients were telling me about the pain in their side that was worrisome. Spouses told me long stories about getting the patient to the ED before being admitted. Universally, my questions were not being answered at all, no matter how many times I asked them or how I was able to rephrase. I wasn’t getting what I came for, but I was seeing what I had become.

In healthcare, there is a need to focus on improvement and standardization. I began to wonder, “Is it possible that I have ‘systematized’ my work in Experience to such a degree that it has become a series of strategies rather than an exploration of the ACTUAL experience?” The answer, for me, was ‘yes.’ My next question; “Am I working on strategies without a clear understanding of what matters most to those living the actual experience?” Again, the answer, for me, was ‘yes.’ I had become so deeply invested in “moving the needle” around improving the patient experience that I was no longer looking at the experience at all. Or, at the very least, I was only allowing myself to see a small sliver of it. It was an embarrassing and deeply important realization. This was a reminder that patients are living the experience of illness and injury—not the operationalizing of PFE best practices—and this internal focus is immediate and unrelenting. For me, this was the beginning of a new way of seeing “the experience of Experience.”

Today, I use Human-Centered Design and Experience Based Co-Design strategies to ensure I am able to uncover the “lived experience” of those providing and receiving medical care. In doing so, I am humbled to have the chance to witness the pain points caused by systems, cultures and perceptions. I am able to quiet my own agenda so those living in the ACTUAL experience have the opportunity to reveal what matters most. I have learned that change happens when an experience can be seen with the 360 degree view: patient, family, professional AND objective observer. Working in this way means I am no longer trying to “push the river,” but, rather, riding its natural flow long enough to gain true insights, understand the priorities and identify the Experience Aim. 

“Ethnographic research” or, what we often call “shadowing,” is not revolutionary in itself. What was revolutionary for me was what shadowing taught me about how much I had lost sight of caring about and capturing actual experiences. As this work evolves, so too does our toolbox of ways to improve. What I know now is that, in the face of so many exciting tactics, we must not allow ourselves to forget about the value of eyes and ears on the frontlines of care. The only way to true partnership (and sustainable improvement) is through a relentless pursuit of the truth using a variety of strategies.

Experience is not only an outcome.

Experience is a practice of returning over and over again to the source (patient, families, clinicians and staff) in order to understand how healthcare is being received and delivered.

Only then can we design meaningful improvements.

 

Tiffany Christensen
Vice President, Experience Innovation
The Beryl Institute

 

Tags:  design  improvement  partnership  staff  strategy  transplant 

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Introducing a Framework for Experience in Healthcare

Posted By Jason A. Wolf, PhD, CPXP, Wednesday, August 22, 2018
Updated: Wednesday, August 22, 2018

From the Roots of Community

In just a few weeks, The Beryl Institute will reach its eighth anniversary as a membership community and a growing global community of practice. On our journey we have been dedicated to building a network of committed professionals, practitioners, innovators, patients and family members and partners. That network, through its commitment to sharing wildly, has helped shape a framework for what represents the human experience in healthcare and clarify eight strategic lenses through which organizations can engage all voices in ensuing the best in experience for all.

This growing body of knowledge and collective understanding established through research and experience and the content it has produced called for a means to better codify, digest and access the information that will support everyone on this shared experience journey. The idea was a simple one, to establish a framework through which we could individually, organizationally and collectively understand where we are, identify the opportunities we have and then connect to the resources and solutions that will help us continue on the road to experience excellence.

Through conversations with a broad range of community members over the last year, this idea evolved from an experience landscape that could be used to define the work, to an experience framework, represented by an integrated set of lenses that influence experience. It offers an actionable means to engage deeper in experience improvement and excellence. 

Why an Experience Framework

An experience framework helps us in three critical ways. The first, it provides clarity in the strategic areas of focus – the strategic lenses – through which any experience endeavor should be framed. If we ascribe to the view of experience as the integration of all we do from quality, safety and service to the range of factors that influence the healthcare experience, then a means to identify these ideas and a structure to frame them helps us in expanding our strategic view of experience and leads to more comprehensive action overall. 

The second, it provides a means to identify where you are excelling or may have opportunities to address. By engaging in experience efforts through a set of strategic lenses you can both understand the areas in which action has led to outcomes and identify areas in which further work is needed. This framing also helps, as noted above, in ensuring a comprehensive set of actions focused on the experience effort overall.

The third reflects a practical application of the framework, as it offers a means by which knowledge, resources and solutions can be aligned. You will see that all content now available via The Beryl Institute aligns with one or more of the eight lenses (and is searchable based on these lenses as well). You will also find our events, such as Patient Experience Conference, will evolve into active learning programs centered around these lenses and we will be working with our vendor partners to align their solutions to the lenses they address as well. 

We invite and encourage others to consider this framework as a means to identify and align content and knowledge and share broadly as a result. Through this common framework we can create more efficient connection of needs to knowledge, strategies to resources and opportunities to solutions and expand our collective global dialogue through a common structure for focus and action.

The Experience Framework

With that recognized opportunity and an understanding of the roots and motivation for this endeavor I’d like to introduce you to the eight strategic lenses of the experience framework. In framing this introduction, it is important to stress that through the community input that shaped the framework we underline that all voices are critical and matter in the experience conversation. In addition, this framework reaches well beyond the clinical experience of patients to the full extent of the human experience in healthcare. The framework as such represents the range of perspectives and honors the breadth of those perspectives in its considerations while having some intentionality in helping to align and support the broader strategic and operational items that impact experience endeavors. It also recognizes that no two individual experiences can or will ever be the same and so this is not intended as a one size fits all solution, but rather as introduced, it is a strategic framework to enable that level of individualization to be even more effective. In having a means to align efforts at a macro level, we are well served to drive specific efforts and address specific needs to the level we must in any effective healthcare endeavor. 

The framework (Figure 1) is built on eight strategic lenses all of which address some aspect of what impacts and influences experience. Each of the eight lenses is also accompanied by a statement of “why”, rather than a definition. Our intention was not to create a static model of commonly accepted definitions, but rather to introduce eight active lenses and the considerations for why they require our focus in any experience effort. The eight lenses and their why statements follow: 

  • Culture & Leadership: The foundation of any successful experience effort is set on who an organization is, its purpose and values, and how it is led.
  • Infrastructure  & Governance: Effective experience efforts require both the right structures and processes by which to operate and communicate and the formal guidance in place to ensure sustained strategic focus.
  • Patient, Family & Community Engagement: Central to any experience effort are the voices of, contributions from and partnerships with those receiving care and the community served.
  • Staff  &  Provider  Engagement: Caring for those delivering and supporting the delivery of care and reaffirming a connection to meaning and purpose is fundamental to the successful realization of a positive experience.
  • Environment & Hospitality: The space in which a healthcare experience is delivered and the practices implemented to ensure a positive, comfortable and compassionate encounter must be part of every effort.
  • Innovation & Technology:  As a focus on experience expands, it requires new ways of thinking and doing and the technologies and tools to ensure efficiencies, expand capacities and extend boundaries of care.
  • Policy & Measurement:  Experience is driven and influenced by external factors and systemic and financial realities and requires accepted and understood metrics to effectively measure outcomes and drive action.
  • Quality & Clinical Excellence: Experience encompasses all an individual encounters and the expectations they have for safe, quality, reliable, and effective care focused on positively impacting health and well-being.

 

                              Figure 1. The Beryl Institute Experience Framework

 

A Move to Action

With the introduction of the experience framework, I want to reinforce the active nature of this work. We already have research efforts underway to further validate the framework and its application in certain care settings as well as will soon be releasing a report and follow-up research on influence factors of experience related to the strategic lenses.

The release of this framework is not simply a call for action and a hope for a response, but rather this is a move to action in itself. When we align as a community around what is fundamental to experience success and support one another in both what is needed to succeed and in helping others to understand what this work truly encompasses, then we can truly call ourselves a movement. The experience journey we have been on as a community has led us to this point where we can stand together in providing a formal frame to understand our opportunities and guide our actions. It is now up to each of us to determine how we will apply these ideas to support our own efforts, to positively impact those we care for and the communities we serve and how we can all continue to contribute to this global conversation on experience that is fundamentally changing healthcare for the better. Thank you to you all for your partnership and collaboration on this journey. 

 

Jason A. Wolf, PhD, CPXP
President
The Beryl Institute

Tags:  engagement  experience efforts  framework  lens  strategic 

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When Work Has Meaning

Posted By Deanna Frings, Tuesday, July 10, 2018
Updated: Friday, July 6, 2018

The title of this blog is not original to me but was a headline on the cover of the July-August 2018 issue of Harvard Business Review (HBR) referencing an article, Creating A Purpose-Driven Organization. It seems everywhere I turn, there is another book, article or referenced research on the neuroscience of purpose as a driving force that gives our lives meaning. And let me be clear, I love that there is currently an abundance of discussion on purpose and meaning. 

 

I have worked in healthcare my entire career from being on the front line as a respiratory therapist, leading teams in multiple leadership capacities to my current role as Vice President of Learning and Professional Development of The Beryl Institute. From my experience, conversations on meaning and purpose are not uncommon in the field of healthcare. I don’t know, maybe it’s because those of us who work in healthcare can easily connect that what we do really matters? We save lives. But how is this knowledge being lived out in our day to day practice as leaders in healthcare. Are we creating cultures that facilitate a discovery of purpose for ourselves and our employees? 

 

Organizations are focused on employee engagement and acknowledge its critical role in their experience efforts as reported in our, State of Patient Experience 2017: A Return to Purpose. And, it’s not surprising given the 2017 Gallup State of American Workplace report, that only 33% of employees are engaged in their work and workplace and only 21% of employees strongly agree their performance is managed in a way that motivates them to do outstanding work. 

These startling figures are not a new phenomenon. Previous Gallup Reports have shown much of the same. So, while we acknowledge the importance of an engaged workforce, the data suggests we continue to struggle, despite all the focus on improving it. 

I often speak on the critical role of leaders in achieving experience excellence and I would suggest that leadership is the critical link in transforming organizational cultures and creating engaged environments where individuals can reach their full potential. During these speaking engagements and workshops, I love taking people through a journey of discovery of purpose and meaning and I have witnessed the immediate and powerful impact it has. I hear a higher level of excitement in their voices, a clarity in vision and a drive in their commitment as they share their stories with each other. 

The conversation continues as we take the critical next step and determine actions we, as leaders, can take to not only share our purpose but invite employees to do the same. It’s one way to connect people to purpose. Simply stated in the HBR article, leaders most important role is to connect people to purpose.

Acting on a higher purpose can often motivate us to learn and develop our skills so we can excel in our performance contributing to what’s meaningful to us. It’s one reason I’m excited about Patient Experience 101(PX 101), a new educational resource releasing next week from The Beryl Institute. PX 101 is a comprehensive community-inspired and developed resource to build patient experience knowledge and skill for all employees across an organization by taking individuals through a discovery of purpose. It’s one of several new opportunities we’re launching this year in an effort to support global patient experience efforts based on the needs of our community. 

PX 101 offers the tools and activities you need to engage in deeper and authentic conversations on what patient experience is, what it means to your employees and how they positively impact experience excellence. It invites them to share their own accounts of how they make a positive difference resulting in a stronger sense of purpose and meaning to the work they do every day. 

 

When we find meaning and purpose in our work, the sky’s the limit to how high we can soar and how much we can contribute to our individual and organization’s success.  

As leaders in healthcare striving for excellence in experience, how do you connect people to purpose?


Deanna Frings, MS Ed, CPXP
Vice President, Learning and Professional Development
The Beryl Institute

Tags:  choice  compassion  culture  employee engagement  healthcare  improving patient experience  leadership  Patient Experience  personal experience  perspective  purpose 

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Radical Support After Adverse Events

Posted By Tiffany Christensen, CPXP, Thursday, June 7, 2018

Recently, I had the honor of speaking at Yale New Haven Health’s 2018 Inaugural Quality, Safety and Experience Conference. One of my favorite parts about presenting at conferences is the opportunity to attend and learn from the other presenters. This event was no different and it was a great day.

One of the most powerful sessions of the day involved two physicians discussing their experiences of harm and error. The focus of the conversation was not clinical and did not dwell on the details of the case—in fact, the patients discussed were clinically fine after an adverse event. Additionally, there was even some gray area about whether or not the physicians involved could have done anything differently to avoid the adverse event. This was not a conversation about clinical safety but, rather, emotional safety among colleagues.

Despite there being significant differences between the clinical elements of their experiences, the two physicians onstage shared many similarities in their experiences after the adverse event. They both considered leaving medicine; one physician confessed she wondered if she should make a career change to home renovation. Both struggled to sleep at night and both replayed the event over and over in their mind, seeking an answer to what could have been done differently. Perhaps most important, both physicians are haunted by the event to this day even though many years have gone by.

What I carried away from both of the stories shared that day was the deep sense of isolation both physicians experienced. When sharing their grief and trauma with collogues, they found they were met with responses that had good intentions but fell flat. “You did the best you could,” and “But the patient is alright, isn’t she?” didn’t sooth the deep, unrelenting self-doubt that had manifested within these dedicated doctors. The experience had not only caused them to question their worth as professionals but their worth as human beings. It seemed they had no safe place to turn. These two physicians made it clear that when mistakes happen the primary need for support goes to the patient and family. That does not mean, however, that support for the provider is not also needed.

Listening to these heart-wrenching stories, my mind went to an article I had read years ago. The article, “How the Babemba Tribe Forgives,” tells the story of a tribe in South Africa. In this community, when a person makes a mistake or does something irresponsible, everyone in the community drops what they are doing and circles around. For hours and sometimes days, the members of the tribe shower this individual with details of their good deeds, positive traits and strengths. Once they are satisfied that they have shared all of the good stories about the individual, the circle breaks and a celebration begins. I see this approach as “radical support” and is far from the standard way that most healthcare professionals receive support after a traumatic experience.

We live in a culture that often expects perfection of our healthcare professionals and, when a mistake is made, we don’t always have tools or skills to effectively support the person as they process and grieve. I can’t help but wonder, if the colleagues of these physicians had been given tools in order to react and provide support more effectively, might the physician wondering if she should move into home renovation see things differently? If, instead of replying with statements that invalidated the physician’s deep sense of insecurity, what would have happened if the response was to validate all of the physician’s strengths and good qualities as a person and a professional? What if the root of pain the professional is experiencing comes from an unconscious need for forgiveness and we offered that to them?

Assuming the “radical support” approach of the Babemba Tribe is philosophically intriguing, it may be challenging to imagine how it may translate into current systems and processes. For some teams, supporting a team member who is struggling with an adverse event may be a more informal conversation among leaders, staff and providers behind closed doors. Other organizations may benefit from a more formal approach that builds a new program or, ideally, integrates into an existing framework.

One potential framework that many organizations already use is Schwartz Rounds. Looking at The Beryl Institute White Paper, Schwartz Rounds: Supporting the Emotional Needs of Staff: The Impact of Schwartz Rounds on Caregiver and Patient Experience, it strikes me that both the spirit and the format would easily lend itself to a few adjustments in order to include “radical support.” A few highlights from this whitepaper quickly illustrate why one might connect the two:

  • The Schwartz Rounds program, now taking place in more than 425 healthcare organizations throughout the U.S., Canada, Australia, New Zealand and more than 150 sites throughout the U.K. and Ireland, offers healthcare providers a regularly scheduled time during their fast-paced work lives to openly and honestly discuss the social and emotional issues they face in caring for patients and families.
  • One of the primary goals of Schwartz Rounds Decreased is to reduce feelings of stress and isolation while fostering more openness to giving and receiving support.
  • One Schwartz Rounds participant articulated, “The ability to find a safe venue for expressing our unrest was, to me, the most attractive feature of the Rounds.” Another participant stated, “The emotions we feel, the stress we feel, does need to be ventilated someplace…”

The Beryl Institute has an unwavering commitment to the human experience in healthcare and, it is evident, humans working in this challenging field need more avenues to hear how much they are valued. Perhaps the Babemba Tribe approach is one worth adapting to the complex world of healthcare; whether through Schwartz Rounds or another framework already hardwired into the organization. No matter what, we must find ways to address isolation and provide better support to those facing questions of their own worth after an adverse event.

 

Tiffany Christensen, CPXP
Vice President, Experience Innovation
The Beryl Institute

Tags:  emotional safety  employee engagement  human experience  patient experience community  professional support 

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More than a Hashtag: We are #PXTogether

Posted By Stacy Palmer, Thursday, May 3, 2018
Updated: Thursday, May 3, 2018

Last month over 1,100 participants from around the world gathered in Chicago for the largest Patient Experience Conference to date. It was an incredible week offering opportunities for sharing and connection with our community. We learned together, cried together, laughed together and even danced together. 

This year’s opening video and message focused around the idea of #PXTogether. You may have even seen photos on social media of people proudly wearing t-shirts with that hashtag. But what does it really mean and why is #PXTogether so significant in this movement? 

Being part of The Beryl Institute team for the past seven years, I’ve had the opportunity to watch this field evolve through the power of community. I remember celebrating the first official member of the Institute on September 14, 2010, and we’ve continued to celebrate each time our now more than 14,000 members made that decision to join the patient experience movement. We celebrate because membership shows they share a commitment to this work and see value in accessing content and resources to improve the experiences of their patients, families and teams. But we also celebrate because their involvement means our community can learn from them as well. Each new thought, idea, process or question shared expands the library of resources and offers new insights and opportunity to others. That is the power of #PXTogether.

So, how can we ensure it’s more than a hashtag? I challenge you with a few suggestions to reinforce your commitment to this work and to the patient experience community.

  • Share your experiences. As we continue to support the global patient experience movement and in the spirit of #PXTogether, the Institute is expanding efforts to gather and build a library of case studies on the value and impact of patient experience from settings across the continuum of care and from locations around the world. We’re looking for case studies that identify critical opportunities or address specific problems, are focused on practical and replicable steps and provide some measure of outcome and/or impact as a result. Submit a case study so other community members can learn from your efforts.  
  • Recognize the successes of your team and/or those who inspire youAt the Institute, we understand the effort it takes to change cultures, implement new strategies and build true partnerships with patients and families. In order to recognize those efforts, we will be honoring and celebrating innovation among advisors, healthcare professionals and teams through our new PX Innovation Awards program. Consider nominating yourself, your team, organization, Patient/Family Advisor or others you see doing incredible work to further the movement.
  • Celebrate healthcare staff impacting patient experience everyday. Last week was the fifth annual PX Week. Inspired by members of the Institute community, PX Week provides a focused time for organizations to celebrate accomplishments, reenergize efforts and honor the people who impact patient experience from nurses and physicians, to support staff and executive professionals, to patients, families and communities served. The official PX Week always starts on the fourth Monday of April, but if you missed it this year, we encourage you to find a week that works with your organization’s calendar and priorities. Celebrating PX Week, whenever you choose to do it, reinforces to your staff that patient experience is a priority and their efforts are appreciated. The Institute has created a list of resources to assist you with planning a recognition program with suggestions for events you can implement and offers a list of audiences you should remember during your celebration.
  • Spend time with those who share your passion.The true spirit of #PXTogether can perhaps be seen best when those committed to improving patient experience gather to network, share and inspire one another. Save the dates and plan to attend future Patient Experience Conferences, and, even before then, join us at one or more of our new PX Pop-up events. Dates and locations will be announced soon for these regional lunch meetings hosted by member organizations.

Representing the idea of connection and sharing that has been essential to the Institute’s growth, the power of community remains strong and #PXTogether reinforces the great opportunities still ahead.

As this year’s opening conference video shared: 
Together, we are growing a global movement. We are impacting countess lives. We are ensuring an unwavering commitment to the human experience. #PXTogether

Stacy Palmer, CPXP
Senior Vice President
The Beryl Institute

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Opposing Natures: Honoring the Properties of Water

Posted By Tiffany Christensen, Wednesday, April 4, 2018
Updated: Tuesday, April 3, 2018

Patient activation is a behavioral concept… It is defined as 'an individual's knowledge, skill, and confidence for managing their health and health care'.
(Hibbard et al 2005).

We know from all of the literature on patient activation that there is a way to both understand and measure a patients’ readiness to manage their health and their healthcare. We also know that there are techniques, such as motivational interviewing, that can assist in moving a patient from lower activation to a higher activation. In so doing, patients and families gain knowledge skills and confidence. As a person working in the field of patient experience, I find activation work to be both inspiring and essential in operationalizing engagement. As a patient, I have experienced activation is a moving target.

Recently, I was reacquainted with my personal activation scale when I found myself feeling puny shortly before a big trip to Thailand. I had never been to Thailand, I was meeting my best friend there and I was using all of my airline miles to have the trip of a lifetime. It goes without saying that I really wanted to go so when I began feeling sick my first thought was “Noooooo! I can’t let this stop me from going!” Like a good CF/Lung Transplant patient, I called my team and set up an appointment to be seen with the hope that I would get the “ok” from my team to go on my big trip. I arrived with my personal SBAR form all filled out, questions at the ready and feeling very high on the activation scale.

The flu swab was negative, WBC was normal, chest X-Ray looked good and I was not spiking fevers. After a great conversation with my transplant medicine doctor, we decided it would be okay to go on the trip as long as my symptoms did not get worse over the next few days. That was the news I hoped to hear!

A few days later, I was on my way to Thailand via a very long series of stops: Raleigh to JFK to Moscow to China to Thailand. Confident I had a simple virus, I boarded my first plane feeling very comfortable with traveling the long distance. By the time I got to JFK, things began to change and by the time I was ready to board the plane to Moscow, I knew I was too sick to travel. After making the tough decision to turn around and getting my flight home arranged, I began my descent into illness.

In the interest of the reader, I want to begin by saying I was fine and I am fine. Eventually, it was determined through a bronchoscopy that I did have the flu. Just the flu. Especially this season, few people seemed to be able to avoid this virus and, just by how common it is, it seems silly to say that it brought me to my knees; especially in light of my past medical history. But it did.

Fever, fatigue, coughing…the normal flu stuff. At some point in the illness process I lost my voice entirely which was far more debilitating than I would have imagined it to be. As a CF/ Lung Transplant patient, I was hyper-focused on my symptoms and my internal life was one of balancing logic (“this is just the flu”) with diligence (“you can’t let this get away from you”). I had faith in my team and hoped each day that I would feel better but, day after day, I felt worse and worse. Worry began to creep in and clouded my mind. My once clear, organized approach to dealing with this illness challenge began to slip away. My level of activation seemed to be melting away along with my sense of well-being.

It was approximately one week after my initial symptoms that I had a night of restless sleep peppered with visions of ventilators. It was as if I could feel the life draining out of my body and I thought to myself, “Oh, I can see how people die from the flu.” I couldn’t help but wonder if I was experiencing anxiety or a premonition. My canceled trip to Thailand was no longer something I gave a second thought—my goal had shifted from wanting to go on that trip to wanting to make it through this alive.

The following morning, I carried the weight of my ventilator dreams with me as I went to have a bronchoscopy. At the hospital, I felt what has become a very common dichotomy for me: my very personal (often unspoken) illness experience butting up against the day-to-day work of those caring for me.

Because of my history working in a hospital, I both recognize and respect the “why and how” of daily operations. During the years I worked as a patient advocate in an academic medical center, my days were dictated by structure. The structure of the CMS policies I was required to follow, the structure of prioritizing the calls, letters and pages I received each day and the structure of daily work flow for the clinical providers surrounding me. Checklists, protocols and routines were everywhere. Assuming the role of sick patient, however, I was reminded that the experience of being a patient is often the antithesis of a structured, day-to-day norm. In fact, showing up for healthcare is quite opposite from a “normal” day. Likewise, being activated wasn’t something I had achieved and could check off of a to-list; it was something that I had to work to maintain.

The walk from the car to the front door was difficult; I was too weak to walk without holding on to my friend. After checking in, I had to get labs, CT and go to clinic. All of these were in very different parts of the hospital and the walk to each area seemed to be miles and miles. In each waiting room, I longed to lie down but there were only hard, upright chairs. I wore a mask and, since I lost my voice, nobody could hear me or see my mouth move. Person after person seemed both surprised and shocked to discover I was unable to communicate verbally. To all of the people I presented to, my case was not remarkable nor was it dire. Objectively, they were correct. That didn’t change the fact that I was still weighed down by my night of ICU visions and getting from “A” to “B” seemed to take all of the strength I could muster. It seems strange to me now that all of those emotional twists and turns had gone largely undetected by those around me; both my medical team and my family.

After the bronchoscopy, I was given strong antibiotics and slowly began to recover. My healing was as palpable as my descent into illness. I could feel my body changing every day and, some days, I was filled with a sense of euphoria because of my improving health. The tides had shifted and my internal life was one of hope and gratitude. Increasing physical strength buoyed my ability manage my life again. My challenging internal journey was winding down and I was returning to my “activated” self.  My sites were now set on going back to work and rescheduling that trip to Thailand.

If we want to "engage" patients, we must never lose sight of the fact that we are functioning in two different worlds: one that demands predictable outcomes and one that, by its own nature, can never be truly be made submissive to our will. As many times as I have lived through illness and healing, I am always amazed at how quickly I forget the reality of what it is to experience it. To try and operationalize the patient experience is like trying to contain water. It can be done, certainly, but to dishonor the unpredictable nature of illness/healing is like trying to deny the properties of water.

As we continue to hammer out ways to be better partners in the road of illness and healing, it’s natural for people on both sides of the bed to feel frustration. It’s also imperative that we keep in mind that this frustration does not result from one person being right or one person being wrong. Both are simply behaving exactly as the nature of their respective experiences dictate: the healthcare professional is functioning from logic, structure and science and the patient is immersed in the ever-changing tides of an illness/healing dynamic.

Activation levels are not a constant, no matter who the patient happens to be or how extensive their medical history. Knowledge, skills and confidence rise and fall like water lapping against the shore. If we begin all of our interactions with that awareness, we can put aside some intrinsic, (often) unconscious frustrations that derail us from partnership and effective communication. It is then we can truly meet people where they are and come together as a team.

 

Tiffany Christensen
Vice President, Experience Innovation
The Beryl Institute

Tags:  communication  flu  healthcare team  partnership  patient engagement  personal experience  recovery  story  team  together  transplant 

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Increasing the Value of The Beryl Institute Membership

Posted By Denise R. Weathers, Thursday, March 8, 2018
Updated: Thursday, March 8, 2018

For years, The Beryl Institute has offered the community a growing library of resources to support you in leading a positive patient experience effort for your organization. Over the past year, the Institute has experienced some major accomplishments highlighted in our 2017 Year In Review. As we continue the commitment to improving the human experience by offering value-added resources and services, the need for our members become ever so important. The question has become – how can The Beryl Institute best serve its members and the patient experience community?

Through our Annual Member Experience Survey distributed in December 2017, you helped us address this question by providing your much-deserved feedback. To highlight a few observations, we asked what you thought of the services that are being offered by the Institute. Similar to previous survey results, the top six most-valued and accessed member benefits are Publications, such as White Papers and Research Reports, Webinars, E- Newsletters (PX Monthly and PX Newslink), Learning Bites, PX Connect, the latest member benefit and the PX Conference.

Although the above-mentioned resources were rated as the most-valued resources, the one word that was consistent throughout the survey feedback and placed an even wider smile on our faces was “Community.” Relationships are considered by many to be the most important and satisfying aspect of life, and your partnership with The Beryl Institute provides you with a diverse global community of physicians, nurses, patient experience leaders, patient and family advisors, consultants, etc., in various healthcare settings, coming together to support one common goal…to improve the patient and human experience in healthcare. Community matters in patient experience and we must ensure it does for the power of the collection of voices in our movement and in the work, it calls us to do every day.

Community speaks to the heart of who we are and to the resources and opportunities we develop for you to engage in for learning, the collection and dissemination of ideas and the connection among peers such as your ability to connect in the recent addition of the online member community, PX Connect, and by attending the 2018 PX Conference, coming up next month April 16-18 at the Hyatt Regency Chicago.

The Power of community has also been elevated with the recent emergence of the PX Policy Forum and the newly formed Nurse Executive Council. To further increase the value of your membership, the Institute has or is taking steps to improve your member experience by providing:

 

Enhanced offerings for professional development and learning exploring how the Institute can elevate the partner organizations and speakers who present at its professional development learning areas such as webinars, PX Conference, Regional Roundtables and PX Grand Rounds; engaging and leveraging discussions in the online patient experience member community, PX Connect, to develop untapped content and resources; and, organizing content collaboration targets for specific areas we recognize may have some gaps such as Ambulatory Care, Physician Office Setting and Long-Term Care, to name a few.

 

 Increased member benefit awareness with enhanced communications highlighting targeted member benefits such as: Career Center, expanded volunteer opportunities and PX Connect, and include Patient Experience Continuing Education (PXE) credit offerings through most of the professional development and learning programs, pending approval.

 

Innovation, research and global presence by adding an Experience Innovation position to expand the Institute’s global landscape of groundbreaking advancements in the PX evolution.


It is our commitment to be that organization…that patient experience community that identifies and address your needs more effectively and one that provides an optimal suite of patient experience resources, products and services at the most affordable investment and value.

The Beryl Institute staff are here to serve you. We hope the continued focus on improving the resources, products and services display our commitment and our drive to showcase and support you and your organization on your patient experience journey.

Do you have ideas on how we could continue to increase the value of The Beryl Institute membership? Email me at denise.weathers@theberylinstitute.org with your ideas and suggestions.

 

Denise R. Weathers
Vice President, Membership
The Beryl Institute

Tags:  commitment  Community  community of practice  member benefit  member survey  member value  px connect 

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You Had Me at Hello: The Importance of the First Greeting in the Patient Experience

Posted By Terri Ipsen, CPXP, Thursday, February 1, 2018
Updated: Monday, January 22, 2018

The greeting. Such a small thing, but a wide lens to what a patient’s experience might be like during a visit to the doctor. At The Beryl Institute, our definition of experience includes “the sum of all interactions”; so getting this first step right – greeting the patient – is critical to influencing the patient’s perception and expectations about the care they will receive.

As Hurricane Irma was blasting through my home state of Florida, I was experiencing a physical “natural disaster" of my own: a herniated disc in my back that had trapped the nerve in my left leg, leaving me almost incapacitated. Getting immediate treatment for the pain from my regular doctor was impossible, as the storm had forced her to evacuate. To delay finding relief from my excruciating pain was not an option, so with the help of a friend, I was fortunate to get an emergency appointment with a spine specialist in another town. And this is where my story about first greetings begins.

The long 45-minute drive to the specialist was horrendous; my daughter was my driver as I laid flat in the back seat. Upon arrival, I shuffled into the medical office. Grimacing, I slowly approached the reception desk.  Before my name could even pass my lips, harsh words came flying at me from the other side of the glass window.

Do you have an appointment?” I thought to myself: Seriously? That is the most important question to ask me at this moment? I hobble through your front door, contorted with pain, and you are concerned about whether I have an appointment? The person on the other side of the window clearly was not focused on me, the patient, but rather the disruption that an unexpected patient would have on her day. No expression of empathy or compassion was displayed as she shoved a clipboard of papers into my hands. No assistance in finding a comfortable chair ever came. 

The poor welcoming carried over into the remainder of my visit: a 45-minute wait in reception and another 30 minutes in the exam room. There was no communication from the staff during either of these wait times – missed touch points that could have had major impact on my perception of care.

My experience in that medical office reinforces that there is still a lot of work to do in returning humanness to healthcare. The good news is that there are practices that do get it right, and this is where my story continues. The following week I visited a surgery center for a spinal injection. The greeting I received there was so different from my experience at the doctor’s office. Still in pain, I shuffled up to the front door. There, three nurses rushed outside and greeted me. One took my hand and acknowledged the pain in my eyes, “Looks like you need some help here. Let’s get you a wheelchair. We’re going to take good care of you.”  I felt I had arrived in heaven.

The receptionist was equally compassionate. Instead of giving me a clipboard of papers to fill out on my own, she left her desk and sat next to me in my wheelchair. She asked me the questions and completed the paperwork on my behalf. This provider got it right. The surgery center had built a culture of excellence based on empathy and compassion which was evident at every touch point of my visit. Imagine how healthcare could be changed if all providers embraced such a philosophy!

Frontline staff speaks volumes to the culture of healthcare organizations. A greeting that includes a smile and a courteous acknowledgement of a patient’s needs sets the scene for a good experience and, more importantly, customer loyalty. It made all the difference for me. Thank you, surgery center, for a great patient experience. You, indeed, had me at hello.

 

Terri Ipsen, CPXP
Executive Assistant
The Beryl Institute

Tags:  communication  compassion  empathy  first impressions  organizational culture  patient experience 

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With Healthcare at the Edge of Uncertainty, Human Experience Matters More than Ever

Posted By Jason A. Wolf, PhD, CPXP, Thursday, January 4, 2018

Happy New Year and I hope the first few days of January find you rested and ready for an exciting year ahead. I also recognize that 2018 brings continued uncertainty for healthcare and shifting pressures on our healthcare systems globally. This potential friction of calm and chaos is the boundary on which I believe we will find ourselves in healthcare for some time to come. And it is on this very active boundary where I believe we can and will thrive.

In the last year, we saw great strides in our efforts to elevate the patient experience conversation. Patient experience gatherings dotted the globe covering continents, inspiring national systems to refocus their intention, and encouraging new thinking and renewed purpose. Evidence continued to mount on the value of a broader commitment to experience and healthcare overall showed increasing commitment to a focus on experience as a central and integrated component of all we do. The State of Patient Experience 2017 revealed increasing investments, expanding scope and a realization that experience efforts are a clear path to achieving desired outcomes.

We were also guided by the powerful stories of those experiencing care. I was particularly inspired by the thoughtful call for compassion raised as we closed the year by Dr. Rana Awdish from Henry Ford and Tiffany Christensen, our new VP of Experience Innovation at The Beryl Institute at the IHI National Forum. Rana reinforced “We really can't presume to know the answer, we must ask generous questions to really know what matters to our patients,” while Tiffany challenged us to reconsider our perspective, asking, “What would happen if we admired our patients rather than pitied them?” and reminded us, “There is room for compassion on both ends of the bed.”

This idea of the need to connect, of a “both/and” versus an “either/or” in many ways is in direct conflict with much of the political and cultural climate in which we find ourselves today, where extremes are elevated and common ground eroded. This too represents that very boundary on which I believe we can thrive. It is through this expanded perspective on what actually matters that we realize we are talking about something much bigger – we are moving to a focus on the human experience at the heart of healthcare.

As I have reflected on this “evolution” in our journey, what I believe we have been doing is driving back to the very purpose on which healthcare was initially grounded. Before there were systems and structures, methods and machines, there was one human being engaging with another, one committed to help and one in need. It required both to participate, it took both to succeed…and it still does.

Jeff Bezos, founder and CEO of Amazon recently said that while he frequently gets the question: 'What's going to change in the next 10 years?' he almost never gets the question: 'What's not going to change in the next 10 years?'. His point being the second question is actually the more important of the two. It is those things that remain stable on which we can build and through which we can find our greatest success.

While we cannot predict how policy will change and in what ways or what new constraints or challenges we will face at the boundary of calm and chaos, we do know that each of us in the business of human beings caring for human beings will continue to have choices. While they are not necessary choices in what illness or disease may befall you, you do have the choice of how you believe you deserve to be treated, in what ways you want to be treated and therefore ultimately where you will choose to be cared for. You have choices in how you will care for others, in what you will do to understand what matters to them and to you and ultimately choices in how you will care for yourself as someone committed to helping others.

That is the essence of human experience. That is the essence of healthcare. Where we go from here depends on that idea. We can use the uncertainty of the moment or the lack of clarity or variability of what lies ahead as a distraction, or even an excuse, or we can focus on what matters at our core. In our efforts to focus forward, I offer four considerations:

1.     Intention and clarity matter.

The growing number of organizations defining what experience is for their organization reinforces that a clear intention and shared commitment to that purpose is central to any opportunity to drive excellence in healthcare.

2.     Consistency is the antidote to uncertainty.

When the ground feels unstable we must find places of strength on which to support ourselves. Being consistent in efforts to elevate and expand experience excellence is a central way to remain focused on purpose, ensure positive outcomes and manage through uncertainty.

3.     Shared understanding/ownership will change how we work.

The opportunity now presents itself to move beyond engaging people at the personal level, to activating them as co-owners in their care. This is more than a focus on centeredness, which represents a one-way relationship, to a dynamic sense of shared awareness and understanding in which all engaged contribute to outcomes.

4.     Listen to understand ALL the voices that comprise the healthcare ecosystem.

There must also be a commitment to listening at the broadest levels in healthcare to understand what drives people’s choices, what motivates their actions and why this work is important overall. In acknowledging that each voice in the process is critical we also reinforce the value and purpose that had people choose healthcare as a place to work and elevate those receiving care (as Tiffany challenged us) from passive participants to individuals we should admire.

As we move into 2018 we will push this idea further, learning from each of you, honoring the voices of all engaged in healthcare, truly clarifying what matters to those impacted by what healthcare chooses to do and ultimately reinforcing that in each of those choices we each make tiny ripples that touch thousands and thousands of lives around our globe. That is the opportunity for us as we look to the year ahead and beyond, to thrive at the boundary on which we find ourselves and use the energy that this dynamic tension creates to spur us on. In doing so, with our eyes forward and our hearts grounded in the human experience, we can continue to change healthcare for the better for one another and for all it serves.

 

Jason A. Wolf, PhD, CPXP
President
The Beryl Institute

Tags:  clarity  compassionate care  consistency  healthcare policy  healthcare uncertainty  human experience  patient experience  perspective 

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Do You See What I See?

Posted By Tiffany Christensen, Monday, December 4, 2017
Updated: Monday, December 4, 2017

As a person who lives with cystic fibrosis and has had 2 double lung transplants, I have experienced many stages of illness. I have understood from a very young age that having this illness is something people feel badly about and sometimes even wonder why “bad things happen to good people.”

But what if we have it wrong? What if illness isn’t the worst-case scenario? What if instead of looking at me with pity, I should be looking at you with pity because you don’t see what I see?

In my lifelong career as a patient, I have had people respond to me in all kinds of ways. The reactions were more pronounced as I grew sicker and they reached their peak during the time I wore oxygen. When I was wearing oxygen, some people would stare, some people would look away and others would approach me and say things that often caught me off guard. One man in Target said, “You shouldn’t have smoked so much.” One woman in Macy’s said, “I’ll pray for you.” My cousin asked, “Why would God do this to you?” Almost all of the people I encountered said—with their eyes— “You poor thing, I’m so glad I’m not you.”

While the intentions were almost always good and the reactions easily explained as a reflection of each person’s internal relationship with life, death and uncertainty, none of them ever hit the mark.  Nobody I came across ever reflected back to me what my perception of myself happened to be.

I felt physically weak, yes, but everything else about me felt strong. I felt connected to the universe, I felt a strong understanding of my purpose in this world and I felt lucky to have the lessons of illness laid before my feet day after day. The very last thing I wanted was pity. If anything, I would have liked admiration.

Imagine for a moment a patient laying in a hospital bed. They are curled up slightly around themselves, pale in the face and not very interested in interaction. Imagine walking in to see that patient. What might you think? What words come to mind? Vulnerable? Sad? Weak?

Now imagine walking into that same room with a very different lens. If you could see into that person’s mind, what do you think you would find there? Simply because they are not talking does not mean they aren’t thinking. Just because they aren’t emoting does not mean they aren’t feeling. So why are they so quiet? What are they doing?

They are enduring. They are bracing themselves against pain or discomfort. This takes energy and concentration. This takes a great deal of STRENGTH.

What if, like a marathon runner grimacing as they finish their final miles, we looked at the patient curled up in the bed and did not see weakness but, instead, saw determination and grit? What if we encouraged them, like we would do on the sidelines watching athletes riding their bikes in an Iron Man, telling them “You’re doing great! I know it’s hard but you’re amazing!” What if we stopped pitying people who are sick and saw them as people we could learn great lessons from? How would this change the way we deliver our healthcare?

Being sick is often an isolating experience. Not only because of the physical symptoms that limit our ability to live an active life, but because of the perception of weakness others project onto us. As I shared earlier in this post, during the time that I wore oxygen, I had a lot of comments from friends, family and strangers about my appearance of health. What I almost never received were questions. I longed for questions rather than statements. Here are just a few that I would have liked to hear:

  • “I know you have bad days and better days. On a scale of 1 to 10, what’s today?”
  • “Is there something I could do right now to make your life a little easier?”
  • “I want to support you and I’ve never experienced anything like what you are going through. Can you help me understand what life is like for you?”
  • “You know I love you and I worry about you, but I’m feeling strong today. Is there anything you want to talk about that you’ve been keeping inside because you were afraid it would be too hard for me to talk about?”

And then there is this one statement I longed to hear:

  • “Caring for you while you go through this illness is really hard. Sometimes I get sad, angry…you name it. But, I want you to know, I wouldn’t trade it for the world. Having you is worth every second of this struggle.”

The internal world of sick people isn’t always going to match mine so this is by no means a prescription. At the same time, nothing bad can come from seeing patients differently. If you see them as strong, perhaps they will gain more strength. If you ask them questions, they may not always want to talk about it in that moment, but they know where to go when they do.

Illness forces us to focus on what matters in this life. Let those who live with it be our teachers while we admire them as they take on their personal marathon. I hope you can begin to see what I see and watch how it shapes the way we deliver care.

 

Tiffany Christensen
Vice President, Experience Innovation
The Beryl Institute

Planning to attend the IHI National Forum later this month? Join Tiffany Christensen’s Keynote session with Dr. Rana Awdish, MD, lead by IHI President Derek Feeley, as the two women touch on how they are using their patient experiences to improve healthcare. You can also join Tiffany during Sunday’s Learning Lab, the CEO Summit and her “meet the author” luncheon. 

Tags:  communication  impact  improving patient experience  perception  purpose  relational healthcare 

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