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The Beryl Institute Patient Experience Blog
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Patient Experience – A Delicate Balancing of Science and Art

Posted By Jason A. Wolf Ph.D. CPXP, Tuesday, October 4, 2011
Updated: Wednesday, October 5, 2011

With the emergence of HCAHPS in the US and similar measures in other countries and the financial implications now associated with these scores such as underValue Based Purchasing and the Excellent Care for All Act in Canada, efforts to address patient experience are at an all time high. Surveys such as the Institute’s Benchmarking Study now show patient experience to be a top priority for healthcare leaders. It seems these new regulatory pressures have heightened awareness, increased executive support and created a burning platform for action.

This elevation in attention has also presented a challenge. With new regulations, especially those tied to financial reward, arises the need to perform to the test. Our research has shown that US hospital’s priorities aligned often with the very domains being asked in the HCAHPS survey, from reducing noise to providing proper discharge instructions. These are not bad things on which to focus, but by simply focusing improvement on the questions themselves, the ‘science’ of patient experience, we miss the foundation, the culture (the ‘art’) on which to build.

In some ways addressing the questions is easy. We can measure our quietness at night and we can time ourselves on responsiveness, but we cannot manage service elements in the same manner as core quality measures, which are truly process driven, can be tracked via checklist and easily monitored. The science of service is not that cut and dry. Instead, it relies on a delicate balancing with the culture of the organization in which it is performed.

John Kotter and James Heskett (1992) have a nice way of framing culture in the workplace at two levels, the deeper level of shared values and the visible level of shared behaviors. This is the art of patient experience. We cannot create a checklist to ensure a shared base of values or behaviors exist, but without them the performance of the items being measured is at risk. We are presented with a need for delicate balancing – a measure set to manage what we are being evaluated (and paid) on and a culture on which our performance relies.

Through my On the Road visits and other discussions with healthcare leaders I have been privy to hearing about this delicate balancing first hand. The organizations that perform well in scores are doing more than teaching to the test or focusing on scores. Our paper The Four Cornerstones of Patient Experiencehelped frame the importance of a dedicated role and organizational focus in driving better outcomes (a clear blending of art and science) and my visits to leading performers have reinforced this message. For example at Inova Fair Oaks Hospital they insisted that you can try all the service tactics you want, but you first need a strong culture on which to build and at Medical Center of Arlington they helped us see that it is about aligning leadership and people, establishing clear expectations and living to them at all levels that was the foundation of their success.

The challenge is clear (and perhaps daunting); that true success in patient experience comes from our ability to manage the balancing of the science and the art. I say "balancing” as this effort is in constant movement, from a focus on measures to a focus on culture. There is not one perfect spot to stand, but sustained success comes from our ability to acknowledge the impact that both measures and culture have on providing the best experience for our patients overall. Here is to effective balancing!

Jason A. Wolf, Ph.D.
Executive Director
The Beryl Institute
 

Related Body of Knowledge courses: Metrics and Measurement.

Tags:  culture  Excellent Care for All Act  HCA  HCAHPS  improving patient experience  Inova  Medical Center Arlington  Patient Experience  service excellence  value-based purchasing 

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Service Recovery Should be the Exception, Not the Rule…Consider Service Anticipation

Posted By Jason A. Wolf Ph.D. CPXP, Tuesday, September 6, 2011
Updated: Wednesday, September 7, 2011

"Mind the Gap” is a phrase most often associated with the Tube in London. I hadn’t thought about it before, but in fact these famous words help frame the overall service experience. They remind us to be aware during this critical part of our journey and help us recognize that someone else is being mindful of our experience as well. This raises the question, why do we focus so much of our time on service recovery when we could be focusing on ensuring the best experience from the start? Minding the gap should be about our ability to anticipate our customer’s experience prior to it taking place at all.

This past weekend I passed a sign hanging on a lamppost posted by the city of Edinburgh that immediately caught my eye. It read "We are aware this light is faulty and are working to repair it as soon as possible.” It then provided contact information for further questions. Through the use of a simple yellow sign, a service experience was framed. Here too, it was clear someone was being mindful of the experience.

What do these examples show us? They reinforce the opportunity we have in creating positive patient experiences by anticipating the needs of our patients.

My current On the Road visit is with Inspiration NW, a part of NHS North West in the United Kingdom whose focus is on raising the profile and importance of patient experience (story to be published in the September Patient Experience Monthly). This incredible team has been working on the very issue of actively anticipating patient’s needs versus always reacting to them. One powerful tool they have introduced is Care Cards. Care Cards support patients and their relatives in exploring how the emotional needs and care preferences of patients can best be captured, monitored and addressed in real time as part of a quality-led care experience. The process reduces the sense of anxiousness patients bring to the care setting and ensures a stronger and more proactive approach to addressing a patient’s overall experience. This too serves as an example of anticipating needs, a "mind the gap” moment.

Even with anticipation, there will still be times where service recovery is necessary. The key is to make this the exception, not the rule. I myself have been guilty of espousing giving staff members the freedom to act in addressing service recovery issues without pushing for another freedom; the freedom to act in anticipation of patient needs. If service recovery is about restoring trust and confidence in the ability of an organization to "get it right”, service anticipation is about creating moments where people are wowed by our transparency and understanding of needs and know we will do right for them from the start. By being in action well before recovery is needed we can mind the gaps in service that may arise, instead providing winning moments that ensure a lasting and positive service experience.

Where have you seen or implemented service anticipation? I look forward to seeing your examples.

Jason A. Wolf, Ph.D.
Executive Director

The Beryl Institute

Related Body of Knowledge courses: Service Recovery.

Tags:  improving patient experience  Inspiration North West  NHS  NHS North West  patient  Patient Experience  service anticipation  service excellence  service recovery 

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Value-Based Purchasing is Underway…How Will You Distinguish Yourself?

Posted By Jason A. Wolf Ph.D. CPXP, Tuesday, August 2, 2011
Updated: Wednesday, August 3, 2011

I would not be the first to express concern if the only motivating factor for a healthcare organization or system to address the patient experience was due to the pending threat of reduced reimbursement connected to Value-Based Purchasing (VBP). Yet, I can also say that the attention this possibility has brought to the cause for how patients are engaged in the healthcare setting is also warmly welcomed. Managing this juxtaposition of feelings is what I find many organizations are now struggling with in addressing their patient experience efforts.

Many leaders accountable for improving patient experience outcomes are both supported by this elevated attention to policy, but also challenged by its parameters. Through the use of the measures incorporated in VBP one path for addressing the issue of service is seemingly set out. Succeed in certain domains of the HCAHPS assessment and you have a better chance of getting more of your withheld reimbursement dollars. (While I will not get into the full details of VBP, you can read more here.)

This sets up an interesting game of sorts in which many have seemingly begun to focus completely on the test (performance on the HCAHPS domains). This is not an impractical route to take (in fact we at The Beryl Institute are launching a series of interactive dialogues for members on these very topics), except that every other hospital aware of the ramifications of inaction are at least doing the same thing. The dilemma this poses is that if reimbursement through VBP is based on comparative measures to your peer organizations and everyone is prepping for the same test, what are you going to do to distinguish yourself?

Month one of the initial nine-month performance period is complete. In essence, the first inning is over and the question this raises is what have you done to move beyond simply increasing performance on the key HCAHPS domains? (Note I said moving beyond, not overlooking.) We have suggested, along with many others, that patient experience success is grounded in broader cultural improvements, in engaging your workforce in positive solutions and in finding new and powerful ways to involve patients in your delivery of service, before, during and after care. At the Institute we have gone as far as to suggest you need to consider such components of your patient experience process, from people’s first encounter with you through a scheduling experience to their post clinical interactions when dealing with the revenue cycleand collection process. It also encompasses the programs you initiate such as Patient and Family Councils, the processes you implement such as experience mapping or the important considerations you give to cultural competence.

While the domains being tested and tied to VBP drive you to look at internal issues, it is important to recognize that the respondents to these surveys – the patients and their families – are assessing you on encounters well beyond their clinical experience at the bedside. With that you still have an opportunity to distinguish yourself. Take some time to examine the results you have achieved so far and consider areas in which you can create broader opportunities for patient experience impact. You will find that by in engaging beyond the test, you can achieve even stronger and lasting results.


Jason A. Wolf, Ph.D.
Executive Director
The Beryl Institute

Tags:  cultural competence  culture  improving patient experience  Patient Experience  revenue cycle  service excellence  value-based purchasing 

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Patient experience is as much about the patient, as it is the experience!

Posted By Jason A. Wolf Ph.D. CPXP, Tuesday, July 5, 2011
Updated: Tuesday, July 5, 2011

My experiences over the last few weeks have challenged me to consider a critical context to the work we do in addressing the patient experience. Most importantly that we need to recognize that patient experience is truly two distinct words - patient and experience. I think it is easy sometimes for those of us on the healthcare front lines, and even in organizations such as The Beryl Institute, to turn our attention to the latter term, experience. Our efforts, processes and programs are aimed at issues such as reducing noise and responsiveness, cleanliness or post discharge, all of which are critical to providing a better experience for our patients…but in working so hard on experience itself, do we at times run the risk of overlooking the first term, the patient?

I had the privilege of addressing the Maine Hospital Association Summer Forumand while there heard from Tiffany Christensen – a provocative speaker from the patient’s perspective and a recipient of double lung transplants as a result of being born with cystic fibrosis. Tiffany reminded me that the patient is not simply the recipient of an experience we in healthcare provide, but rather the patient is a vital member of the healthcare team. We can catalyze the patient experience by ensuring the voice of the patient is involved in all we do and how we do it. If we simply remember, as Tiffany so eloquently offered, that we are truly "humans treating humans”, perhaps we ensure that the experiences we provide are more than business decisions; they are life decisions that provide for an inclusive, caring and positive experience.

Tiffany’s words stuck with me as I had the chance to hear more from the patient and family perspective at the Avatar International 2011 Symposium. While Avatar is an organization focused on providing survey data, they are clear in their commitment to placing priority on "Patient One”. Regina Holliday, a healthcare activist and patient family member, offered the story of how the patient journey sometimes takes place well beyond the attempts we make to provide a great experience. She challenged the audience by suggesting we sometimes forget the most basic question in providing care, what would the patient want? She also urged us to think less about rating scales, such as that for levels of pain, based on "smiley faces” and instead consider the very faces of the patients we serve to guide our actions. Regina’s story again reinforced the powerful context at the core of patient experience – we are truly humans treating humans.

If we use that as a central premise in what we do, we then must ask ourselves, who is our "patient one”? Who is that one individual or what was that one experience we have had as healthcare providers that shaped the way we want to provide care? What is the true experience we want to create as a result? What will we never let happen again or ensure always takes place as a result of this example? And then…how do we use that experience to shape what we do in ensuring the best patient experience possible?

My journey over the last few weeks helped me to get very clear that patient experience is as much about the WHO, as it is the WHAT. If we choose to start with what we do, we may miss providing the experience our patients truly need and as a result, we may fall short in achieving the performance outcomes or scores we hope to realize.

Every patient (and their family/support network) has a story. They are a life lived, a road travelled and a hope held. A great example of putting this story to work is our recent case study from CGH Medical Center on the Living History Program©. Patients are interviewed and a one-page life story is created. It is presented to the patient and their family as a gift; a copy is posted in the patient’s room, while another is filed in the medical record. Every caregiver is asked to read the story and find ways to improve their connectivity with the patient and the family. This truly represents making the experience about the patient first.

To achieve true excellence in patient experience requires a willingness to address both components equally. Beyond simply implementing the best processes or programs for a positive experience, we must ensure the patient is not just the focus, but an active part of all we do.

Jason A. Wolf, Ph.D.
Executive Director
The Beryl Institute

Related Body of Knowledge courses: Patient & Family Centeredness.

Tags:  improving patient experience  patient  Patient Experience  patient stories  service excellence 

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While we can’t please all of the people all the time, any goal short of 100% is unacceptable

Posted By Jason A. Wolf Ph.D. CPXP, Monday, June 6, 2011
Updated: Monday, June 6, 2011

For those of you lucky enough to hear Dr. David Feinberg give the closing keynote at The Beryl Institute Patient Experience Conference 2011, you heard a story of an organization with a clear commitment to patient experience. I was struck by the clarity with which Dr. Feinberg stated the mission of UCLA Health System - Healing humankind one patient at a time, by improving health, alleviating suffering, and delivering acts of kindness. While Dr. Feinberg reinforces that UCLA may be the only healthcare organization that incorporates kindness into its mission, I am also struck by the essence of this mission with its focus on "one patient at a time”.

Since my
On the Road visit to UCLA I have been churning with this idea of what one patient at a time truly means, so it is only fitting that in another encounter with Dr. Feinberg something he shared helped me frame this in a way that should cause anyone committed to improving patient experience take pause. In a new era of measurement where scores will equate to dollars, it seems there is new motivation to address patient experience issues. The challenge I think this continues to raise is that scores do not equal people. Dr. Feinberg challenged this very notion by stating that his commitment was not to achieving percentile improvement, but rather percentage improvement.

Ah-ha! This is where one patient at a time truly lives and should live for any of us committed to the highest quality, safest and best service-driven care. Percentages are the people themselves, percentiles becomes faceless statistics that will eventually numb us to what we committed to in the first place. We cannot let a new focus on scores actually pull us farther from our mission of care. This is something Dr. Feinberg was clear in sharing, that in looking at percentages, nothing less than 100% is acceptable.

Now I can already hear my friends in healthcare administration roles around the world asking me, Jason haven’t you ever heard the quote
"You can please some of the people all of the time, you can please all of the people some of the time, but you can't please all of the people all of the time"? While the quote has been attributed to many, namely Abraham Lincoln (who it was noted used the word "fool” where "please” has been substituted), it raises the very issue that in healthcare we are dealing with human beings. We are unpredictable and curious creatures that are driven both by personality and habit, yet influenced by the things that happen around us in any moment.

So how can I suggest and support Dr. Feinberg’s assertion that nothing less than 100% is acceptable? Easily. In healthcare we are, and must be, about one patient at a time. Experience is not a generality found in statistical comparison; rather it is found in the eyes, smiles and hearts of the patients, families and support networks we provide experiences for every day. We do this not for our scores and dollars, though this now incentivizes us to act with greater vigor. We do this for those individuals who put their trust in us that we will give them our greatest of care, attention and service, as we did for the person in the bed, outpatient suite, exam room or waiting room that came just before them and who will follow. If we play the game of numbers, while we may retain some short-term financial viability, we all lose. And while we will still not please all of the people all the time, our patients deserve nothing less than our commitment to 100%.

Jason A. Wolf, Ph.D.
Executive Director
The Beryl Institute

Related Body of Knowledge courses: Organizational Effectiveness.

Tags:  Dr. David Feinberg  HCAHPS  improving patient experience  Patient Experience  service excellence  UCLA  value-based purchasing 

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You are not alone in addressing the patient experience! Expanding your capacity and impact is your choice.

Posted By Jason A. Wolf Ph.D. CPXP, Tuesday, May 3, 2011
Updated: Tuesday, May 3, 2011
This April, leaders from across North America joined together to engage in a dialogue on the critical importance of the patient experience in our healthcare systems. The gathering at The Beryl Institute Patient Experience Conference 2011 was headlined by top healthcare executives from such places as UCLA and Henry Ford Health Systems and speakers from healthcare organizations across the continent. While the content was unparalleled and the learning well received, what emerged as the most profoundly important takeaway was the connections made and the network of peers formed.

In reading post conference evaluations one comment seemed so personal and touching it cased me to pause for a moment. The words on the page were simple:

"I'm not the only person struggling with how to make the patient experience better.”

In reading this statement I realized that while we can talk about the patient experience in a collective way, it is truly an individualized experience in each organization and facility.  According to The Beryl Institute’s recent benchmarking study, patient experience was deemed a priority by almost 800 healthcare executives, yet they lacked definition and a clear path forward. Beneath the data what I saw was 660 healthcare organizations that have taken it upon themselves to, in their own way, tackle this issue.

For the amount of time we each work to address patient experience in our own facility, many individuals have done the same. They have tried new ideas, and created others, failed terribly and succeeded wildly. What lies beneath these efforts is an even greater opportunity for shared learning and connection. It is the chance for those of us in healthcare to collectively see improvements in the experience of our patients, their families and in the communities we serve.

No…you are not alone!  But you must be willing to take the step to connect with and engage others. While the Patient Experience Conference was a microcosm of how this can be done, it is creating your own network of peers where the connections created, energy unleashed and shared passion realized at events like the conference can be experienced all year round. This was poignantly observed by an attendee who said, "Everyone in attendance wants to see a shift for the better within the industry, this is not one of those conferences where everyone is trying to prove their own magnificence, rather everyone is trying to come together and make a significant difference in Healthcare as an industry.”  This is the opportunity we have and the difference we can make in coming together each and every day.

I believe that most (if not all) of us chose to take on addressing patient experience for more than simple competitive advantage. It is and continues to be a much higher calling.  One in which the collective energies of many will far outweigh the attempts of one. The connections and resources you gain from choosing to reach out to others will help you realize even greater success.

Therefore, I would assert that being alone in this work is also a choice, one that may serve ultimately as a roadblock to progress.  In the end, you are alone in addressing the patient experience, only if you choose to be.  I challenge you to find others with which to take this journey. That may be the most important choice you make in your journey to improve the patient experience.

Jason A. Wolf, Ph.D.
Executive Director
The Beryl Institute

Tags:  improving patient experience  networking  Patient Experience  service excellence 

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Do we need “rules” to do what is “right”? And are ACOs and Value-Based Purchasing reasons to now take action?

Posted By Jason A. Wolf Ph.D. CPXP, Monday, April 4, 2011
Updated: Monday, April 4, 2011

We have all heard the quote "what gets measured, gets done”. What this reveals is how leaders have been conditioned to act, yet this has not always led us to our desired results.

This quote also touches the very issues facing patient experience. For years we have discussed patient-centered care, domains have been identified that define patient-centeredness, and patient satisfaction measurement is now not only an accepted practice, but also a growing and profitable industry. These standards and measures have helped remind us who our customers are and provided data on which to act. Yet, even with this information, while some have tackled this important issue, many have not.

Now with the emergence of new policy measures such as the Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) survey in the U.S. and the Excellent Care for All Act in Ontario, Canada, as well as efforts in other locations around the globe, a patient’s experience is now a variable in not just ratings, but also a component of individual and/or organization compensation formulas. Even more so, these scores are being publically reported in an attempt to provide transparency (or is it to truly capitalize on the competitive nature of the healthcare business – see my blog from November 2010)

Even with the advent of the HCAHPS survey, when we conducted a survey of The Beryl Institute’s membership last summer (almost 4 years since the launch of HCAHPS), just over 50% of the respondents had a comprehensive patient experience strategy. So can we say what gets measured, gets done?

But perhaps now, specifically in the U.S., the stakes and implications have been raised with the introduction of the proposed rules on both the measurement and payment process for Accountable Care Organizations (ACO) and Value-Based Purchasing (VBP). The headline of these rules in relationship to patient experience is simple - perform well on the standard metrics, specifically HCAHPS, and you will reap the "benefit” of maintaining reimbursement dollars (VBP) or of obtaining payments resulting from the new shared savings arrangement (ACO). Simply stated, patient experience is now a measure that equates to dollars lost or gained.

This leaves me with the question, why the frenzy now when we have always been in the business of delivering care to patients? Has health care become something we simply do to people for revenue? I am not saying we do not need effective financial performance, as this is critical to sustaining services. What is disconcerting is that it seems we have carefully crafted our processes and practices, structures and systems to accommodate us – meaning the deliverers versus the recipients of our services.

Perhaps it has been a harmless oversight on our part, though I have heard many healthcare leaders emphatically say, "We are not in the hospitality industry”. With that I can agree. People do not usually choose to spend their hard-earned dollars with us, but rather circumstances, some dire, bring them to our doors. I do suggest instead that we are in the service business. We always have been and always will. Care is not the privilege of a few (though with the current systemic issues it could be perceived and even experienced as such by some) -care is a service we provide- be it in our medical practices, long-term care facilities, outpatient centers or hospitals.

I am not advocating for or against the measures or processes put in place, rather I am holding up a mirror to ask why it has taken these policies and programs to truly see action and activity on improving patient experience. What has been our motivation to act now? Perhaps more importantly what slowly had us move away from service to process, from relationships to transactions, from patient to diagnosis?

During my recent On the Road visit with the UCLA Health System, both CEO, Dr. David Feinberg and CMO, Dr. Tom Rosenthal said a key to their success was helping their staff uncover and rediscover the passion that brought them to healthcare in the first place – the care and service of others. My hope is that while we may now be motivated by measures to get things done, this is not the fundamental reason we respond to this expanded commitment to the patient experience. Let’s use this as an opportunity to exceed expectations and provide quality care, not because it is in the rules (or being measured), but because we know it is fundamentally the right thing to do.

What are your thoughts on the implications of these new rules around Accountable Care Organizations and Value-Based Purchasing? And how can continue to do what is right for our patients regardless of what we may be required to do?

Jason A. Wolf, Ph.D.
Executive Director
The Beryl Institute

Related Body of Knowledge courses: Metrics and Measurement.

Tags:  accountable care organizations  HCAHPS  Patient Experience  service excellence  value-based purchasing 

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Find Your Magic Moments in Creating an Unparalleled Patient Experience

Posted By Jason A. Wolf Ph.D. CPXP, Tuesday, March 1, 2011
Updated: Tuesday, March 1, 2011

Last week, I had the opportunity to spend time with our friends at the Disney Institute and visit Walt Disney World. My experience raised some issues for me that often come up in conversations I hear in our healthcare environment. From my first days in healthcare I heard the comments, "We are not a hotel so that won’t work here,” or "we are not in hospitality so we can’t do that here.” I must admit I have too become a creature of our own environment and have slowly been pulled into what I have come to call the "we are unique” zone.

As someone that has worked with numerous hospitals of all shapes, sizes and locales, I have heard time and again the rally cry that healthcare is a unique environment. While I do not think any of us inside (or even outside) of healthcare would ever challenge that statement, I believe we need to consider two things. One, that every industry is unique in its own right and therefore has its own opportunities and challenges, and two, that we all have an opportunity to learn from those other experiences. While we may not adopt others’ ideas directly, we can find new ways of addressing our own issues by broadening our perspectives.

My "ah-ha” emerged from a jumble of hand-scribbled notes about how wonderfully Disney operated based on a culture committed to service. This was mixed in with a simultaneous questioning of how these points would translate into any of the healthcare environments we serve -- from hospitals, to medical practices, to surgery centers and beyond. My question came from the observation that people choose to show up at the Magic Kingdom, to spend their hard-earned dollars, to have what for some is an experience of a lifetime. For these guests the wow often hits with the anticipation of the visit before even setting foot on the property. So, I reasoned, of course these people will be satisfied, even overjoyed with their experience…and asked…so what more is there to do? The fact is that Disney (named for the sake of my experience here, but I have also seen this in certain hotels, airlines, small businesses and elsewhere) could let people thrive purely on that excitement and anticipation, yet they choose to provide quality service by exceeding guests’ expectations every day.

Here is my point. An organization that represents a magical experience doesn’t leave service to chance (or magic). They are purposeful in their actions to ensure they provide what their guests desire. So what are the implications for healthcare? For as much good as we do every day and for every life we touch (and often save), people don’t lay in bed "too excited to sleep” prior to a hospital visit. They may be awake, but it is due to the anticipation, fear, nervousness and anxiety that accompany any health issue. In this way, we are unique. But where we cannot be unique is in our commitment to exceed our guests’ expectations. If an organization that people choose to visit recognizes the need that service takes effort, we in healthcare must recognize it takes just a little bit more. We must be committed and focused on efforts that ensure unparalleled experiences for our own guests (our patients, their families and support groups) and we must be a little more intentional every day through every encounter to ensure these people are wowed.

In the chaotic environment of healthcare, we can always find excuses for what will distract us, or what takes precedent strategically, clinically or financially. The one thing we cannot find excuses for is our commitment to creating magical moments in every encounter. It is even ok to acknowledge that in healthcare we are in fact unique. We have to do just that little bit more for each individual we touch to alleviate their pain or anxiety and ensure they are on a path to healing. And we need to do so knowing that we delivered (and they received) not just quality care, but an unparalleled experience.

We are working to collect and share your stories and invite you to comment on what you are doing in your organization to create magical moments. What you share here is a true gift for others and we thank you in advance for your contributions.

Jason A. Wolf, Ph.D.
Executive Director
The Beryl Institute

Tags:  magic  Patient Experience  service excellence 

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Service Excellence: Team Sport or Improve Troupe? Both!

Posted By Jason A. Wolf Ph.D. CPXP, Tuesday, February 1, 2011
Updated: Tuesday, February 1, 2011

En route to my most recent On the Road visit to Rush University Medical Center, I was privy to an exemplary service "moment.” My flight from Washington to Chicago should have been a simple 2-hour trip, but winter weather took hold and turned that short trip into an almost endless journey. It was a situation that for most would be stressful, frustrating and all too often one in which the customer is left "in the dark." Rather, what occurred on this trip was an incredible orchestration of service that had what could have been a plane full of angry travelers leave with an appreciation for the care and attention they received.

I emphasize the word "moment” because too often service is viewed as a single encounter at one point in time. Rather, I suggest effective service is an integrated effort and a connection of experiences over time. In healthcare, I do not think any of us would suggest the valet at our front door, the person in admissions, the nurse on rounds, or the discharge manager represents the totality of the service experience in our facility. It is the work that these individuals do in concert with one another (whether consciously or not) that shapes the perceptions of a patient’s, family’s and support network’s overall experience.

While on my flight, I thought of the core elements of service excellence often suggested including ensuring the "right people” are hired and providing them with the "right words.” Selecting for fit is often easier to say than do and takes a significant commitment and patience in the hiring process. Scripting, while also a practice that generates positive results, still faces resistance and often raises the concern of removing the passion from the healthcare process. What stood out to me on the flight was that while these service keys may have been used, they represent fundamentally individual activities. The right individual or the right words only work in one-on-one encounters, yet as suggested above, our healthcare journeys are built on countless interactions.

What I experienced on that plane was a coordinated team effort, including consistent communication on our status from the flight deck and engagement by flight attendants who went above and beyond in reassuring concerned travelers about connections, while providing comfort with either beverages or blankets. It included the actions of the gate agent (when we needed to land in an alternative airport to refuel) who greeted us, kept us informed, and provided thoughtful options for travellers with specific needs. More importantly they were communicating with each other, across roles, in addressing the specific needs of the situation. The group of individuals interacted as a team, covering all aspects of our service needs at every moment of the experience. There were plenty of individual "moments of service,” but it was the synchronized actions of the group as a whole that led to service success.

Clearly this was not a typical situation for which these specific individuals could rehearse. What they had to do was improvise, not just as individuals, but rather through a coordinated effort that helped them best address the situation at hand. Unlike the story shared during my visit to Rush of the rental car shuttle driver who recited her complete script even though there was only one individual on the bus, they adjusted what they did to the situation. In service encounters, where no two individuals or experiences are exactly the same, improvisation becomes a critical team skill.

Service delivery, especially in our healthcare environment, cannot be over-structured. We need to create a team consciousness that helps our people realize they each play a part in the service picture and that every action they take is part of the overall patient encounter. We also need to challenge them to respond in the moment to what is needed.

While understanding the parameters of what is acceptable, we need to ensure these individuals have the ability to "dance in the moment” and share the passion for care that draws so many of us to this work. As we ask our patients to both take on the wholeness of their experience, while accepting the need for flexibility along their care journey, we too must recognize that service is a team sport, requiring agility and the need to improvise in order to ensure the greatest of patient experiences. Our flight "team” did just that, turning a "moment” into a service experience to be remembered.


Jason A. Wolf, Ph.D.
Executive Director
The Beryl Institute

Related Body of Knowledge courses: Organizational Effectiveness.

Tags:  patient experience  service excellence  team 

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When Focusing on the Patient Experience, Every Day Provides the Opportunity for “New Year’s” Resolutions

Posted By Jason A. Wolf Ph.D. CPXP, Tuesday, January 4, 2011
Updated: Tuesday, January 4, 2011

I wish you a Happy New Year, both personally and from The Beryl Institute. The idea of the New Year has been around for millennia and has always symbolized a time of both reflection and foresight. It represents an opportunity to review past events and to plan for new actions.

The recognition of January 1 as the start of the new year (for many, but not all cultures) was solidified when Julius Caesar reset the calendar year to start on January 1. It was associated with the mythical King Janus, who represented beginnings and served as the guardian of doors and entrances. I found this metaphor of great relevance as we think about the patient experience and how important beginnings are. The patient experience is not simply represented by the doors and entrances of our healthcare facilities. We must think more broadly to the initial interactions that patients have with our organization. Whether it is on the phone searching for a physician, making that first appointment, or pulling up to be greeted by a parking valet, these are all critical beginnings in the patient experience process. These actions set the tone and frame the perspective of how a patient, their family and support network experience your facility.

In addition, Janus is traditionally depicted with two distinct faces – one looking towards the future and one into the past. I believe this is symbolic of the work we take on every day in healthcare. We engage in moments of care that have both strong histories and hopeful outlooks. Our patients’ stories are not simply single encounters in time, but rather they are grounded in the experiences that carried these individuals to our doors. And while rooted in the past, these stories are also focused on a future of healing and replenished health.

In looking towards 2011, we personally will look back at what we accomplished and plan ahead for what we want to achieve. I would suggest we also need to be aware that our patients are managing this in a much more vital way. As we create our patient experience resolutions for the year to come, one important consideration is to make an effort to understand the past for each of our patients. In doing so, we create a connection and present a level of understanding and compassion that can establish a foundation for a greater overall experience. We must also challenge ourselves to look forward and help our patients exceed expectations for what they hope to achieve through our care and what they aspire to be doing once they leave us.

At The Beryl Institute we are purposeful in our definition of the patient experience as "the sum of all interactions, shaped by an organization’s culture, that influence patient perceptions across the continuum of care". This includes all that comes before and after the clinical encounter. In this same way, as each of us considers our resolutions every year, we do not spend the time just thinking about New Year’s Day itself. The day is simply a doorway that transitions us from one point in time to the next.

When we realize that for most patients their stay affords this same experience – a chance to reflect on the past and an opportunity to plan for the future – new possibilities emerge. This happens, not just on January 1st, but each and every day. In healthcare, we have the opportunity to create resolutions with every encounter and more importantly to support the resolutions of our patients every day of the year. It is our job to look both forward and back, to help people cross that threshold of healing, and to ensure that the experience we provide is one that allows for dreams of a bright future ahead.

So what will your resolution be as you focus on the patient experience in 2011? How will you support the resolutions of others at every interaction? It could be the most important thing you do in caring for others this year! Here is to a fulfilling and rich year ahead.

Jason A. Wolf, Ph.D.
Executive Director
The Beryl Institute

Tags:  Continuum of Care  Patient Experience  Resolutions 

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