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Expanding the Possibility of Human Experience - A Conversation with David Feinberg, MD, VP Healthcare, Google Health

Posted By Jason A. Wolf, PhD, CPXP, Thursday, March 7, 2019

In 2011 when the Institute was still learning to crawl as a community committed to improving patient experience, I had the opportunity to meet Dr. David Feinberg. He attended our first Patient Experience Conference at the Institute with his team from UCLA, where he was CEO at the time, and offered a powerful keynote on the power of leadership, culture and presence. He told a powerful and compelling story grounded in the very humanity of our healthcare system, of the potential at its core and of the possibility ahead for our healthcare organizations to ensure we took the next steps in elevating the care in healthcare.

 

Our connection has been maintained through the intervening years via On the Road visits and roundtables, shared panels and Grand Rounds, all the while through our friendship we realized often implicitly we were working to do something bigger for healthcare. That story of connection, that idea of commitment to purpose, that alignment around possibility and the humanity of healthcare frames the core ideas that have been the foundation for the Institute on our journey. It is these connections, these opportunities for learning, these shared commitments that makes this community a unique, innovative and safe place.

 

It is what also led us to my latest opportunity to connect with Dr. Feinberg as we launch a new offering from the Institute, The Beryl Institute’s To Care is Human podcast series. What was an opportunity to connect turned into a rich and robust conversation on the current state of affairs in healthcare and the opportunities we have ahead. While I won’t share everything we discussed (you can listen to the full podcast and access the transcript), I will offer a few reflections on what we discussed and how it frames the experience trajectory on which healthcare now finds itself.

 

Healthcare should be here to help

 

For the expertise on which healthcare is built, we cannot forget its purpose. It is not just about operational efficiencies, though we need them. It is not just about process improvements, though we aspire to realize them. It is not just about clinical excellence, though we must expect it. Rather it is around the needs of those that seek care to feel helped, cared for and understood. How do we ensure our systems can deliver on that human need? As Dr. Feinberg offered, “What we'd like the healthcare system to do is to say, we've been expecting you, we're ready to take you in, put our arms around you, and love you, and get you all the right stuff that you need to make the right decisions. That to me is the experience that we're trying to create every time for every patient.”

 

We must address the issues of healthcare systemically

 

So much of what we have done to improve healthcare has dispersed versus aligned our efforts. Games of improvement whack-a-mole, internal battles over constrained resources in protection of our operational silos have not done service to what healthcare can be. Rather than disparate, competing or even redundant efforts, we must strive to look at the needs of those healthcare serves and those who serve in healthcare as one opportunity for excellence. This applies to improving clinical quality and safety or overall experience, tackling burnout and fatigue and even financial challenges. And it stems from larger systemic and population health issues, not simply those confined to organizational boundaries.

 

Dr. Feinberg suggested, “I see burnout as something different. Burnout started (and continues today) because doctors couldn't get things they needed for their patients.” He noted that if the circumstances around us prohibit our ability to do the work of healthcare, that may be our biggest impediment. If we cannot take care of the broader circumstances that impact experience and outcomes, we will continuously be spinning our wheels. He added, “To me, burnout is (tackled by) actually addressing the social determinants of health for those we care for. [This] will decrease the burnout of our providers.” Yes, we still need to ensure effective and efficient systems to support care, but [let’s] ensure “patients come first. Let's take care of them, and let's give our caregivers all the tools they need to be able to deliver on that care.” If we get that right, we are laying the groundwork for the best in overall outcomes.

 

Healthcare is fundamentally relational

 

If healthcare is about helping and our ability to think systemically, it calls for us to change the way we think about how we operate. As a system built on task, checklists, and protocol, healthcare has become a primarily transactional system. This was done with purpose, but at what cost? As the largest people-facing industry in the world (for patient and consumers of care alike) the expectations as we have discussed are to support the relational nature of care. As a transactional healthcare system, we have attempted to bolster our transactions with relational practices to make it feel more personal, but rather our opportunity is in creating a relational system, and then working to find the best transactions to ensure that that relational system is effective. This idea summarizes much of how Dr. Feinberg has led in his two previous organizations. Dr. Feinberg added, “[Healthcare is] people caring for people, and if we give them the right tools, and get them the right caregivers, it's an incredibly rewarding occupation. I think you could put it up there as one of the most rewarding. If we can get that system to hum, I think bi-directionally, people will feel cared for. Those caregivers will feel also cared for because you just get to really enjoy very intimate parts of people's lives.”

 

Healthcare must ultimately be about keeping people healthy

 

If we are helping, with a systemic perspective and relational intent, then our ultimate calling is to keep people healthy. Keeping people healthy is about a focus on well-being, around changing the systems and structures of health and about access and affordability to care and services that can impact longer term care issues. If we separate out social determinants of health or population issues as something else we do outside of caring and the experience we provide we minimize voices, we shrink the possibilities of experience and we limit the ultimate capacity of care.

 

Dr. Feinberg supported this idea in sharing, “I'm a believer in customers. I just think it's really crucial to have that mindset to make things much better for those that we care for. I believe that when we talk about patients, it almost, by definition, means that our healthcare system only takes care of you when you're sick. So what do we call you when you're not sick? When we still could be taking care of you and preventing you from getting sick? Then are you a person, are you a customer? To me, those words are really important, [but] if we keep only focusing on "patients", we're only going to continue a sick care system. Instead of really talking about keeping people healthy.”

 

Healthcare experience remains at the “N of 1”

 

This idea that we have an opportunity to reimagine healthcare as a system that keeps people healthy as a means to ensure the best in human experience is significant in its simplicity. In many ways it feels the weight of the systems we have built in healthcare is the primary impediment to our capacity in healthcare to do what we know is needed and right. Yet if we can collectively recognize this challenge, we should be able to collectively address it. It feels as if much of the journey we have been on has been to elevate just that conversation. It is also the reality that for all the evidence we seek in the science of healthcare, the ultimate sample size we have is the “n of 1”. Human experience happens at the point of interaction of one person to another. This also means that anyone, in any place in our healthcare system globally can make a difference right now.

 

Dr. Feinberg reinforce this point in saying, “Often times I get asked the question, ‘You know, the CEO of my hospital doesn't think like you, [so what do we do?]" My answer is, wait a second, wait a second. There is a patient right in front of you. There's a clinic you're responsible for, there's a team you're working with. Everybody can fix this. You start with one patient. If you do it with one patient, it will have a ripple effect. Don't use excuses that your system doesn't think this way. You can think this way yourself. No one is going to stop you, and so you have this opportunity to do this stuff in your own little ecosystem. Even if those people up in the [c-suite] aren't talking the same language. Don't wait to take care of people.”

 

That may be the essence of human experience in itself. As Dr. Feinberg shared, “Don’t wait to take care of people.” And I would reinforce that this is not just those you care for, but those you work with and the communities you serve. Our capacity in this health system we have created is grounded on the possibilities we create between people. While the science may be miraculous, the humanity at the heart of healthcare is where the magic truly occurs. It is incumbent upon us to realize the opportunity we have as the dynamic evolution of healthcare will continue to gain speed. If healthcare is to realize its ultimate role as a place that exemplifies the pinnacle of human experience, and I dare say it should, these ideas will be central to our next steps. In an attention to helping and a systemic view, in a focus on the relational and a commitment to health, with a recognition that the person right in front of you is where you have the greatest opportunity right now to make the biggest difference, that is where the possibility of human experience is found. That is where the possibility of healthcare is rooted as well.

 

Dr. Feinberg’s generous spirit, vision and commitment to what is possible is inspiring, but as he has taught me, it is about what we all do with those seeds of inspiration that will have the greatest impact. I look forward to where it will lead us and am so grateful to Dr. Feinberg for our conversation and his commitment to this cause. Now is the time we all must sow the seeds of possibility.

 

> Listen to The Beryl Institute's To Care is Human Podcast Series
> Download the transcript

 

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

Tags:  burnout  conference  health  human experience  podcast 

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Healthcare’s 10 Year Challenge: Reflecting on the Past Decade in Patient Experience

Posted By Deanna Frings, Thursday, February 7, 2019
Updated: Wednesday, February 6, 2019

Recently Facebook challenged its users to post a current and a ten-year-old photo of themselves side by side. While I didn’t participate, seeing the many photos of those that accepted the challenge, did get me to think beyond what I looked like ten years ago to how much can really happen in a decade. I also heard a recent commentary by John Dickerson, co-host of CBS This Morning. His position was that reflecting back even a decade ago can interject perspective. What perspective can we gain by looking back and reflecting on the last 10 years in healthcare?

My first job in healthcare over 35 years ago was as a Respiratory Therapist. At that time, employees were still allowed to smoke at work. It wasn’t until 1991, the Joint Commission on Accreditation of Healthcare Organizations (JCAHO) mandated that accredited hospitals go smoke-free by December 31, 1993. Talk about perspective.

Working in healthcare my entire career has come with many changes. Ten years ago, I was working for a large integrated healthcare system in southeast Wisconsin. It was another five years before I joined my colleagues at The Beryl Institute in the role of Director of Learning & Professional Development. My role within The Beryl Institute is not the only thing that has changed. The healthcare organization where I worked my entire career up until that point, doesn’t even exist today. It was sold and joined another organization approximately three years ago.

Looking at our past can bring perspective to the present and even give us hope for the future. Before becoming a member of The Beryl Institute in 2012 and attending my first Patient Experience Conference, I came across the Institute’s definition of patient experience. This community inspired and developed definition has stood the test of time and continues to be a core foundation in any conversation on patient experience. In fact, in the last 6 years US hospitals that now have a formal definition of patient experience has grown by 38%.

During my first conference experience with The Beryl Institute, I heard Tiffany Christensen share her powerful lived experience as a life-long cystic fibrosis patient having received two double lung transplants. Today, Tiffany is part of The Beryl Institute team in the role of Vice President of Experience Innovation and will be introducing the first inaugural Patient Experience Innovation Awards recipients at the Patient Experience Conference 2019 this April.

It was also during the 2012 conference that I was introduced to the Patient Experience Body of Knowledge Framework. While I had the responsibility within my organization leading efforts on experience, it was the first time I had seen a framework that outlined the knowledge and skills of healthcare leaders doing this work. This framework has guided the development of comprehensive learning opportunities including the ability to earn a   Certificate in Patient Experience Leadership and Patient Advocacy. Today over 470 individuals have earned one of these certificates. These milestones demonstrate not only the Institutes’ commitment to the field of patient experience but the growing commitment within healthcare organizations across the country on supporting the professional development of their leaders and continuing to engage in efforts that have resulted in innovation in this field of practice.

Related to this milestone and another example of how things have evolved over the past ten years is remembering how my journey as a patient experience professional started. Like many, I was invited to join a system-wide committee within my organization charged with improving our patient satisfaction scores. This was not an uncommon beginning. In fact, when we first asked the question, Who in your organization has the primary responsibility and direct accountability for addressing patient experience” (State of Patient Experience 2011), 42% of the respondents indicated it was by committee and only 13% had a dedicated individual leading their efforts. Since 2011, we have seen a significant increase in organizations reporting they now have a specific person in a dedicated patient experience role. In fact, 70% of US hospitals that responded to the study, now identify having a senior leader with this responsibility.

As I continue to reflect on the past ten years in healthcare and the patient experience movement specifically, something that is becoming more and more common today that was not seen ten years ago are individuals with the credentials of CPXP behind their names. CPXPs or Certified Patient Experience Professionals is a relatively new phenomenon in our industry thanks to our community and our sister organization, Patient Experience Institute for developing a path to certification. This endeavor has brought a level of rigor and credibility to the field not seen in the recent past. According to PXI, today, over 860 individuals now hold the designation of CPXP.

So much has happened in a decade with so much more to do. The ten-year challenge is definitely more than comparing two photographs from then and now. In this age of social media which brings the dynamic of immediacy, pausing and reflecting back does interject a perspective that reacting to the immediate can never do.

For example, the inaugural study, Consumer Perspectives on Patient Experience 2018 was an incredible journey into the lens of consumers across the globe and their view on patient experience.  It profoundly reinforces that human interactions are most important when assessing their experience. That patient experience encompasses quality, safety, service and all that is experienced in any given health encounter. For those of us doing this work for a long time, on the surface, these two ideas might not seem like huge revelations but when we think about the conversations, we were having just ten years ago, these two ideas, that have become foundational cornerstones in the work of experience today, were still forming thoughts in our recent past.

Taking a snapshot of a moment in time can tell a powerful story but being intentional and purposeful of how we choose to move in the world will ensure we pass the next ten-year challenge. What are your hopes for the next decade? More importantly, what wisdom today will guide our actions tomorrow to ensure that the future of healthcare is what we know it can be?

 

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

Tags:  body of knowledge  certificate  definition  healthcare  human experience  intentional  patient advocacy  patient experience conference  patient experience leadership  perspective  purposeful  pxi 

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5 Ways to Impact Your Patient Experience Success in 2019

Posted By Stacy Palmer, Monday, January 7, 2019
Updated: Monday, January 7, 2019

Embarking on a New Year tends to bring forth much reflection and anticipation. While 2018 was often shadowed by political tensions and shifting pressures on our healthcare systems globally, it was also a year of significant reinforcement of the value and purpose of the patient experience movement. 

We introduced two new research studies at The Beryl Institute in 2018, both intended to help validate and focus the patient experience field. A study on Consumer Perspectives on Patient Experience confirmed that 91% of consumers believe patient experience is extremely or very important and will be significant to the healthcare decisions they will make. And most recently, we published To Care is Human, exploring the factors influencing experience in healthcare today and reinforcing the relational nature where healthcare is grounded in human beings caring for human beings. 

As we begin 2019, I believe the patient experience movement is better prepared than ever to accelerate its efforts. And as your organization embarks on the new year, I encourage you to consider a few suggestions that have potential to positively impact your success:

  • Evaluate Your Strengths and Opportunities – As you reflect on the direction your PX journey took in the past year and plan for future success, I encourage you to take time to examine where your organization excels and where you have opportunities to grow. The Beryl Institute’s Experience Framework identifies the strategic areas through which any experience endeavor should be framed, provides a means to evaluate where you are excelling or may have opportunities for improvement and offers a practical application to align knowledge, resources and solutions. If you find there are areas of great strength for your organization, let us know so we can share your successes with the community. And if you identify potential opportunities in your journey, contact us and we’ll help you navigate the many resources available in the Institute’s library of content. To further assist the overall community, we’ll also begin highlighting a new strategic lens each month, offering new webinars and other programming around that lens and curating a selection of resources to help you amplify your efforts in that area.

  • Enhance Your Organization's Foundation in Patient Experience – When building a culture of patient experience excellence, it is essential to establish a foundation where all team members clearly understand what patient experience is, what it means to them and how they can positively impact experience excellence. Consider ways in which you can share patient experience knowledge on the front lines of care to positively impact experience outcomes. Last year the Institute introduced PX 101, a community-inspired and developed resource for use in orientation programs and other staff education. While not intended to be used in isolation or as a stand-alone resource, PX 101 can enhance your journey by distilling the resources and knowledge available via the Institute into practical, transferable learning to support your larger patient experience training strategy. 

  • Celebrate Your Patient Experience Efforts – Wherever you are in your journey, it’s important to recognize successes and commitment. Not only does this offer a chance to celebrate great work, it also provides an opportunity to reinforce the significance and impact of your efforts. Start planning now for Patient Experience Week 2019: April 22 - April 26. Patient Experience Week is an annual event to celebrate healthcare staff impacting patient experience. Inspired by members of the Institute, it provides a focused time to celebrate accomplishments, create enthusiasm and honor the people who impact patient experience everyday. 

While I believe the suggestions above can have great impact on your organization’s patient experience focus, I encourage you to be just as thoughtful in developing your own growth plan for the new year. We likely all have personal resolutions around health, fitness, finances, etc., but it’s important to also consider ways we can grow professionally as patient experience leaders. Whether you’re looking to make a career move in 2019 or build knowledge and value in your current role, consider these key steps to impact your success: 

  • Expand Your Patient Experience Network – One of the greatest benefits cited by members of The Beryl Institute is the power of the community – the ability to network, share and learn with others passionate about improving experience. Make a commitment now to attend Patient Experience Conference 2019 to be held April 3-5 at the Hyatt Regency Dallas. It’s the largest independent, non-provider or vendor hosted event bringing together the collective voices of healthcare professionals across the globe to expand the dialogue on improving patient experience, and you’re sure to leave with new information, inspiration and connections. 

  • Distinguish Yourself as an Expert in Patient Experience Performance – The best way to impact your professional success is to ensure you have the knowledge and tools necessary to succeed in today's healthcare environment. Through PX Body of Knowledge courses, The Beryl Institute offers certificate programs in Patient Experience Leadership and Patient Advocacy. With over 440 certificate program recipients to date, the PX Body of Knowledge frames the field of patient experience, defines its core ideas and provides a clear foundation of knowledge that supports the consistent and continuous development of current and future leaders in the field. Also consider earning your formal certification as a Certified Patient Experience Professional (CPXP) which is awarded through successful completion of the CPXP examination, offered through our sister organization, Patient Experience Institute. CPXP Prep Course workshops are available through The Beryl Institute to help you prepare.
At the Institute, our 2019 commitment to you is that we will continue seeking ways to support and elevate your efforts through offering the most relevant research, resources and connections – and by helping you to easily navigate these offerings. We have tremendous respect and gratitude for the work happening globally each day to improve experiences for patients, families and caregivers, and we will continue to provide a place for our community to share, learn, celebrate and inspire together.

If you have specific needs we can assist with as you embark on your 2019 organizational or personal PX journey, please let us know. We’re here to help!

Stacy Palmer, CPXP
Senior Vice President
The Beryl Institute

Tags:  accountability  body of knowledge  celebration  collaboration  community  community of practice  connection  culture  Field of Patient Experience  global healthcare  healthcare  Human Experience  improving patient experience  Leadership  member benefit  member value  movement  Patient Experience  patient experience community  patient experience week 

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To Care is Human: 3 Considerations for the Future of Patient Experience

Posted By Jason Wolf, Wednesday, December 5, 2018
Updated: Wednesday, December 5, 2018

This has been an exciting year for the patient experience movement in which an unwavering commitment to human experience has been elevated and expanded globally. In our efforts at the Institute we have had the opportunity to engage the voices of healthcare consumers on their views of experience and what drives their decisions, we introduced the Experience Framework to reinforce the integrated nature of the human experience in healthcare and now just last week released our latest study on the influence factors on patient experience.

This is significant in that in linking these efforts together we begin to see for the first time in practice and evidence that there is alignment around what we can and should do to ensure experience excellence. This work lays out a pathway that while not surprising has been sometimes difficult to ensure a commitment to in a healthcare system driven by transactions, checklists and processes that overlook the very essence of healthcare itself – the human caring at its heart.

I shared a story to open Patient Experience Conference 2018 about how my son Sam taught me a valuable lesson in the power of human connection and how simple and brave we must be to ensure these connections occur. He showed me sometimes it just takes commitment, the willingness to reach out and acknowledge another human being in front of you for who they are, not what they have or what they do. This too is what consumers told us they wanted, and it is what we discovered in the findings of the Influence Factors Study as well.

For the Influence Factors Study, over 1400 respondents identified the factors of greatest importance to patient experience. In addition, almost 300 high performing healthcare units (as defined by achieving and sustaining high percentage of scores in the top box of 9-10 in the overall rating question on the CAHPS survey) representing 175 organizations provided input as well.

The study revealed that for both respondent groups how patients and family were treated and how they were communicated with had the greatest influence on experience. This was followed closely by the teamwork and engagement of care teams and core clinical indicators such as responsible management of pain and care coordination. Interestingly enough what was shared here, that is that experience is driven by 1) how we treat people we serve, (2) how we treat each other and (3) how we provide the quality people expect, perhaps provides the triangulation of factors that sums up the potential of and opportunity for an elevated commitment to the human experience in healthcare overall.

This discovery reinforces that at the end of the day our opportunity to care for one another as human beings is the essence of our work in healthcare. This was supported in the alignment of the influence factor responses with the voices in the study, Consumer Perspectives on Patient Experience released this summer, which found that that top-rated items of importance to consumers were, in order, ‘listen to you’, ‘communicate clearly in a way you can understand’ and ‘treat you with courtesy and respect’. The most significant realization in this finding in comparison to what were identified as the top influence factors was that not only were the top items nearly identical, in essence effective communication and respectful treatment, but also that these items scored significantly higher response percentages in both studies. This had them stand out clearly as the top items in both surveys and coming from two very distinct respondent groups.

What this means is that what people are asking for from healthcare, it is evident healthcare organizations know and high performers provide. So, then what has been in our way of meeting those expectations and needs? I offer it has been healthcare’s commitment to process at the expense of people and transactions at the expense of interactions that has undercut its very capacity to achieve this ultimate goal.

This is not offered to diminish the complexity of healthcare we face today, but rather to call us to ask if we are the reason for the very complexity that gets in our way. If we were to focus on these simple things, to build processes, programs, technologies and innovations to support and sustain this focus on the humanity in healthcare, would we see something very different in how we look to lead healthcare globally. That is our opportunity and the story I hope you will find of interest in our latest paper: To Care Is Human: The Factors Influencing Human Experience in Healthcare Today.

With this we are called in healthcare to come back to ground with three considerations that can help us all lead the experience effort forward. These include:

  1. Patient experience must be seen with an integrated focus that ties together the many facets impacting how human beings on both sides of the care equation experience healthcare. It must be operationalized with this broad and inclusive perspective.
  2. Experience excellence, at its heart, is about the relational interactions we have in healthcare. It is grounded in the kind of organizations we build to sustain quality, safe and effective healthcare for all engaged. We must move beyond simple transactions and find comfort in the human complexities that are at healthcare’s core.
  3. To care is human and above all else that must be a rallying cry for what healthcare can and must be. Yes, medicine is a complex science, but healthcare is not just about medicine. When we mix that science with the art that healthcare ultimately represents, we get a symphony comprised of the greatest experts, but one that only works when all those expert parts play together. And if we do that, the outcome will be truly magnificent.

The Dalai Lama is quoted as saying, “The human capacity to care for others isn’t something trivial or something to be taken for granted. Rather, it is something we should cherish.” I would add it is something we must acknowledge will require hard work, unwavering commitment, a willingness to try and fail and a focused commitment to excellence.

The things healthcare has shown it knows to be true and the things consumers are asking for consistently come down to something so essential I could be blamed for saying it too much – that in healthcare we are human beings caring for human beings. So, whether I am walking the halls of a VA facility or waiting in an essential hospital’s emergency room, seeking new research innovations from an academic medical center or being cared for in my rural healthcare center, or standing on any continent in any health system, in any healthcare setting across the continuum around the world for that matter, this universal truth remains.

It then is up to us to consider how we balance the science that has driven healthcare with the art that is what will enable it to ultimately succeed.  We can no longer say that all people want is for us to make them better. That has been healthcare’s driving outcome, but for the patients and families we serve, it has been a fundamental expectation that we do so. Where the real difference and ultimate distinction lies is in HOW we make them better, in the acknowledgement that in caring for the human in front of us and those who serve around us we are realizing the true potential healthcare has to offer.

Yes, to care is human, the evidence bears out its impact and value. And in giving ourselves the permission to hold that idea as central to all we do in healthcare we can and will reframe a system with a potential for care, wellness and healing we have only dreamed could be possible. Experience is not something else we must or should do, it is all one does in healthcare, it is time we acknowledge this and move forward with this new sense of possibility. What will be your first step?


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

Tags:  amenities  cleanliness  Clinical  defining patient experience  employee engagement  feedback  HCAHPS  Human Experience  improving patient experience  Leadership  patient and family  patient engagement  Patient Experience  policy  quality  safety  service excellence  signage  thought leadership 

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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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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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A New View: An Unwavering Commitment to the Human Experience in Healthcare

Posted By Jason A. Wolf, Ph.D., Thursday, August 3, 2017
Updated: Tuesday, August 1, 2017

This month’s Patient Experience blog is an excerpt from the recently released research report, The State of Patient Experience 2017: A Return to Purpose.

We have always maintained that in patient experience there are no major secrets and with that believe strongly that the differentiator is not in the private processes you create or the proprietary models an organization might produce. Rather it is in the spirit of an open sharing of ideas through which all should play and in the distinction of a true commitment to execution through which you should compete. Experience will be and is already emerging as a key, if not the primary, differentiator in healthcare. The opportunity in front of each organization is how they will seize this moment.

For us at the Institute, part of this moment is to acknowledge that patient experience will forever be central to healthcare, but also as we learn from the community and from the very data in this year’s benchmarking study the healthcare experience we are speaking to reaches beyond patient experience itself. In an environment where we clearly base all work on human beings caring for human beings we are ultimately addressing and impacting the human experience in our midst. For this reason, we believe at The Beryl Institute as we remain committed to patient experience we must address the reality of the human experience that is central to healthcare overall.

With this, we have set a bold and fundamental desired impact for how we look to move into the years ahead. Our intended focus is simple, clear and true:

Changing healthcare by advancing an unwavering commitment to the human experience.

In doing this we honor the work each of you are doing and the reality of the healthcare world we find ourselves collectively creating around the globe. In a commitment to shift how healthcare works, we must dedicate ourselves to the broader human experience, honoring both the patient experience at its core and the experience of all driving and supporting healthcare’s efforts every day. With that we believe this commitment must be grounded on four key points:

  • Understanding experience is defined as the sum of all interactions shaped by an organization’s culture, that influence patient perceptions across the continuum of care.
  • Acknowledging experience (1) encompasses the critical elements of healthcare from quality, safety and service, to cost and population health issues that drive decisions, impact access and ensure equity and (2) reaches beyond the clinical encounter to all interactions one has with the healthcare system.
  • Recognizing that human experience reinforces the fundamental principle of partnership and is therefore inclusive of the experiences of those receiving and delivering care as well as all who support them.
  • Reinforcing that focused action on experience drives positive clinical outcomes, strong financial results, clear consumer loyalty, solid community reputation and broad staff and patient/family engagement.

This commitment has been spurred by all we have seen in this work and by all each member of the broader patient experience community has taught us. As we travel a journey to reinforce the critical role of the human experience in healthcare all that we learned in this year’s study takes on even greater relevance.

We must strive for what we believe is important collectively and then ensure we find ways in each and every one of our organizations to apply these principles, practices, ideas and findings for the good of all engaged. This is not idealism, but rather a practical reflection on where we are and what we can achieve. The state of patient experience is about much more than what we have or will do, to what we are and what we can become. That is the inspiration we glean from those that contributed their voices in this year’s study and the motivation we garner from working collectively as a community dedicated to the human experience in healthcare.

The state of patient experience is strong, your efforts and commitment are true and the possibilities of all we can accomplish as a result are yet to be realized. That makes this perhaps one of the most exciting times to be committed to this work. We look forward to traveling the next steps of this journey with each of you.

> Download the full State of Patient Experience 2017 research report


Jason A. Wolf, Ph.D., CPXP

President
The Beryl Institute

Tags:  community of practice  culture  global healthcare  healthcare  Human Experience  Patient Experience 

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The State of Patient Experience: A Global Inquiry for Local Action

Posted By Jason A. Wolf, Ph.D., Wednesday, January 11, 2017

Earlier this week in a webinar hosted by the Institute, I shared thoughts on why patient experience matters now more than ever. At a time when policy uncertainty hangs in the air, there must not be any uncertainty about the importance of a commitment to experience and the actions required to ensure it remains at the heart of what we do in healthcare. We have a collective responsibility to ensure the strategies, practices and processes necessary to drive experience excellence continue with unwavering commitment. We too must underline and be willing to speak to the impact a focus on experience can and does provide.

This focus is what is guiding the strategic intent of The Beryl Institute as we look to ensure the human experience is the heart of healthcare around the globe and is grounded in the very efforts we not only look to take on ourselves, but also encourage others to explore. We are at a critical time where we must gather evidence, reinforce value, provide grounded research and share efforts in ways that help people act with confidence and support leaders in making strong and committed choices.

This is not a time for passivity; in simply accepting consumerism has arrived or that a focus on value has become central to our efforts. Rather those committed to experience in healthcare must be doing more; not just to achieve individual and organizational outcomes, but to support an expanding dialogue that ensures all corners of healthcare commit to and reflect in their actions the principles central to an industry which at its core is about human beings caring for human beings.

With that call to action, I asked four questions of those listening. These questions were more than a cause for reflection. Rather I see them as an opportunity to plot a course forward for each of us engaging in the experience movement. I provide them here to both encourage your own consideration, but also to invite your comments. I hope you will share what you plan to do.

  • How will you reinforce the importance of experience in your work and/or as a consumer of care?
  • What top issues are most critical to you in this effort and how will you elevate them as a focus for your work?
  • How will you support others in standing as champions for experience excellence?
  • How will we expand the experience conversation to change healthcare for the better?

In this, the experience era, a fundamental commitment must be a readiness to share wildly and steal willingly. This means we must not only try new things, and whether succeed or fail share our lessons learned, but we must also search out other’s ideas and see how they fit, challenge or complement our own. This free flow of evidence, of practice, and of thinking is what will strengthen the capacity of all focused on experience across the healthcare continuum. It is what grounds our ability to achieve all we aspire to in providing the best outcomes possible. It is also this sense of sharing that underlines our biggest research endeavor at the Institute – our State of Patient Experience Study.

It is time once again for you to share your voice and encourage others to do the same in our 4th biennial study. I invite and ask each of you to not only participate in this year’s exploration, but also share this opportunity with your colleagues and peers. We look to gather input from organizations across the continuum of care, perspective from consumers of healthcare and insights from around the world to best understand both the ‘whats’ and ‘whys’ that are driving experience efforts today. This commitment to taking action and sharing your voice is critical to this endeavor and I do hope you will participate. You can get started by clicking this link: http://bit.ly/StateofPX2017. We will share the initial findings of this year’s study at the opening of Patient Experience Conference 2017.

In concluding our 2015 study I wrote, “In our patient experience movement and in the data that frame its efforts, we are not just seeing incremental movement, but fundamental shifts in behavior, practice and perspective. We are experiencing a shift in the very habits of the people and organizations in healthcare. We are seeing an alignment around the idea that patient experience matters.” It is the very efforts that every one of you are taking on, helping lead or encouraging others to tackle that is inspiring this possibility. That in recognizing experience matters, now more than ever our global understanding can drive local action. In doing so we are staying true to our commitment in providing the best experience possible for all those in or affected by healthcare around our world. Thank you in advance for your input and contribution.

Again, you can begin the survey here: http://bit.ly/StateofPX2017

 

Jason A. Wolf, Ph.D., CPXP
President
The Beryl Institute

Tags:  benchmarking  commitment  global  healthcare policy  human experience  inquiry  matters  movement  research  state of patient experience 

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