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 reinforces 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
The Beryl Institute