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The Practice of Experience: A Relentless Pursuit of the Truth

Posted By Tifffany Christensen, Wednesday, September 5, 2018

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

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

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

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

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

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

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

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

Experience is not only an outcome.

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

Only then can we design meaningful improvements.

 

Tiffany Christensen
Vice President, Experience Innovation
The Beryl Institute

 

Tags:  design  improvement  partnership  staff  strategy  transplant 

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The Patient Experience Deserves More Than 63%

Posted By Jason A. Wolf Ph.D. CPXP, Tuesday, February 4, 2014

I have yet to meet anyone in healthcare who suggests patient experience is not important. In fact, I often hear it said to be "one of our top priorities”, "a central pillar in our strategy” or "a critical initiative for our organization”. I do not question the sincerity of these declarations or the intent they suggest. I also recognize in the highly dynamic world of healthcare today we are in a constant struggle to balance our priorities. With that, I offer these thoughts to shift our thinking in how we approach experience overall.

To frame what I mean about patient experience I return to the definitiongenerated by the members of The Beryl Institute community – the sum of all interactions, shaped by an organization’s culture, that influence patient perceptions across the continuum of care. I also want to challenge the perspective of some in equating patient experience only to service and question our inside-out focus in healthcare as we often operationally differentiate quality, safety and service. While we may operate these efforts in distinct and at times competing manners, I do not believe patients distinguish between these areas. Yes, we must focus on quality, safety and service and align the appropriate resources to each, but we must address these efforts from the eyes of our consumer and the perspective that they together create but one experience.

As I have continued to hear patient experience identified as a strategic priority, it has caused me to ask, does this mean based on needs there are then specific times when we actually focus on it (and therefore times we don't). That is, do we truly focus on every one of our priorities at all times? Continuing this thought, if patient experience is seen as an initiative, it has all but been declared a limited effort, for every initiative I have experienced in healthcare and elsewhere has a beginning, middle and therefore an end. Do we truly think the patient experience is an idea where the effort eventually concludes?

These ideas around alignment, priority and initiative were supported in the findings of the 2013 Benchmarking Study, The State of Patient Experience in American Hospitals. The research revealed something one could potentially overlook in all that was uncovered. In the U.S. Hospital System the individual with primary responsibility for patient experience spends 63% of their time on these efforts. In contrast, I do not know of a CFO that spends 63% of his time on finances. The data itself reinforces the opportunity we may very well be missing. Have we made patient experience a 63% priority? If we take that to the extreme, does that mean it is only something we consider for 63 out of every 100 patients we see? I do not believe any organization or leader has done this intentionally, but it does cause us to hopefully stop and think about how we lead and operate our organizations and systems.

I know those in healthcare are more committed than what the number reveals. We are an industry of caring and compassionate people who give all they can in every moment. But the data opens our eyes to the opportunities we have. Perhaps what we have lost in our efforts to address patient experience is our realization that experience is all we are about in healthcare. I know that if any one of us were laying on an exam table, recovering in a bed, or sitting holding the hand of a family member that we would not expect anything less than 100%. In fact I believe we would say we want the best in quality, safety and service – the best experience – in every encounter. I believe we all do want the best in patient experience for all those in our care. I hope we too agree the patient experience deserves more than 63%. So how can we start to do things differently today? I look forward to your thoughts.

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

Related Body of Knowledge courses: Metrics and Measurement.

Tags:  bottom line  change  choice  Continuum of Care  culture  defining patient experience  expectations  healthcare  improving patient experience  Interactions  partnership  Patient Experience  priorities  quality  safety  service  service excellence  strategy 

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