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The Beryl Institute invites members to submit posts on patient experience related topics. For guidelines and information on submitting a post for consideration, please contact us at


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Connecting to our Purpose in Patient Experience

Posted By Alison Tothy, M.D., Tuesday, July 26, 2016
Updated: Monday, July 25, 2016

What if bringing visibility to positive experiences helps connect us to our sense of purpose? In a recent shift in the Pediatric ER, I watched an interaction between a nurse and a child. We were getting ready to sedate an eight year old boy. The nurse engaged the patient and made him smile, while gently preparing him for the sedation and the upcoming orthopedic bone reduction. I watched as the patient relaxed under her calm hands and in turn, the father waiting on the bench next to the child took on a calm demeanor, his shoulders visibly unclenching as he observed his child receiving amazing care that was kind, compassionate, and gentle. As the physician, I spoke with the child and the parent, explaining the procedure thoroughly, but with easy to understand language. I answered all questions, and then in partnership with the nurse and the orthopedic resident, proceeded to sedate the patient and reduce the broken arm.  With the sedation and reduction completed, I informed the father that everything went well and that his son was doing great. I left the sleeping child and the less anxious father in the hands of the nurse to continue my shift, taking care of at least another thirty patients that evening.


Walking out at the end of my shift, I saw the nurse that helped me with the child during the sedation.  It would have been so easy just to walk out the door, wave over my head, and shout "Thanks for all your help, good night, see you tomorrow” - isn’t that the usual sign off after finishing a shift? But instead, I stopped, paused, and then said "Thank you so much for your help with the child that we sedated. You were so good with that child. Did you see how he relaxed when you talked to him about how he looked like an astronaut with the oxygen tubing in his nose? You made him smile. Did you see how he was relieved he was only ‘getting a hug’ from the blood pressure cuff? And, did you notice how reassured the father was, when you alleviated the worry and suffering of his son? Thank you!” Then, I watched the nurse… her eyes lit up, she smiled and sat up straighter.  Not much later, I walked out and got in my car, drove home and went to bed. I did not imagine I would think about it again, but I did.  Strange, because it was not the usual case that I perseverated over, such as the complicated case, the stressful trauma, the new diagnosis with a bad outcome -- instead, I thought about this powerful interaction I shared with my colleague. 


I would like to believe the nurse left her shift with a sense of pride that was always there, but maybe had not felt in a while. I hope that she saw for a moment what I saw in her, the impactful way she cared gently for a patient. I wanted her to realize what it meant for the patient and parent and what her interaction meant for both of us. This interaction led to a moment in which I had the opportunity to highlight how she helped someone in a time of stress and to perhaps help the nurse feel more valued and appreciated. In emphasizing her connection with the patient and parent, I was also able to link back to my own sense of purpose.  

Sometimes I forget how much I enjoy taking care of patients and their families. As a Pediatric Emergency Medicine Physician and the Chief Experience and Engagement Officer (CXO), I often have oversight of caregivers as they interact daily with patients and their families. The above interaction reminds me that there is much more than just looking at an x-ray and diagnosing a fracture or looking in an ear and searching for an infection. This encounter above could have been exactly that. Imagine that scenario If I had just walked by and did not stop and chat with the nurse and did not thank her for the work she did? If I had not helped her recognize how she helped changed this patient’s world in the moment? It could have happened, has happened, often happens. It is easy to get bogged down in the clinical work as a physician and the administrative work as a CXO. The day to day grind is exactly that, normalcy that moves me through standard work, allows me to complete tasks.

However, recently I have been increasing my efforts to take a step back and reflect on my work and the efforts of others taking place around me. I have begun to ask "what if”? What if I stop and help someone remember why they went into healthcare? What if I stop and say how can I help this patient, this family, this colleague be healthier, happier, have a better experience and stay engaged? What if I move from bettering individuals, to helping my department, the hospital, and the community engage in their health? These are not far reaching goals if I begin with the basics and consciously make an effort to pause and reach out, when it is easier at the end of a shift to just say a quick goodnight and thank someone without meaning behind it. Changes take effort, but good changes are worth the effort.

So, I chose to make an effort to change. Both as a clinician and as an administrator, I began to pay more attention to engaging those around me. I endeavored to notice how my interactions affected others and how other’s interactions affected patients, families and colleagues. Then, I started to call these moments out. I began to work with others to remember why they chose the job they did, often asking the question "Why did you go into healthcare?”  I would provide subtle ways that demonstrated how important each interaction was to another and then tie it back to a sense of one’s purpose.  Subsequently, this was connecting me back to my purpose as well.


Several weeks ago I began to think about how my journey has led me to change how I care for patients and care givers and why I continue to ask "what if” questions.  As a visible leader in patient experience, I turned the "what if” question back onto myself. What if I could use my leadership to not only give a voice to the importance of strategies, but to also influence how each of us see ourselves as caregivers and its importance collectively as a community of caregivers?


About a year ago, as part of the journey to continually develop my skills as well as improve the experience for my patients, families, and colleagues, I researched the new Certified Patient Experience Professional Certification through the Patient Experience Institute. By definition, a certified patient experience professional (CPXP) is a formal or informal leader who influences the systems, processes, and behaviors that cultivate consistently positive experiences as defined by the patient, resident, and family in settings across the continuum of care. This certification fit my journey both as a physician and administrator. I enrolled, completed the necessary training, passed the exam, and became part of the inaugural certified class this past spring. This is a piece in my ever continuing training to become a better leader, and helps strengthen my ability to cultivate a community of caregivers that can reconnect to the importance of what they do each and every day.


In closing, I would ask each of you to think about the "what ifs” and how that can help us all connect to our purpose in the significant work of healthcare.

  • What if we all carry this forward?
  • What if we all pay attention to actions that positively affect others?
  • What if we help others see the beautiful interactions that occur day in and day out while we care for our patients, their families, and each other?
  • What if we were all more connected to purpose?
  • What if we advance our skill set so that we can become exemplary leaders in the world of patient experience? 


As the Chief Experience and Engagement Officer for the University of Chicago Medicine, Alison Tothy, MD leads efforts to optimize patient experience and engagement across the medical system.  From high level strategic planning to oversight in development, implementation, and optimization of national best practice standards, patient-centered care strategies, and innovative approaches to patient care, Dr. Tothy strives to improve patient outcomes through strengthening patient, family, and caregiver engagement.

Tags:  Community  healthcare  Leadership  patient experience  person-centered care  physician  physicians  voice 

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Patient and Family Engagement to Improve Patient Safety

Posted By Tejal K. Gandhi, MD, MPH, CPPS, Monday, March 7, 2016
Updated: Monday, March 7, 2016

Patient engagement is an essential component of safe, appropriate, high quality healthcare. But what do we mean by patient engagement and how does it relate to patients’ experience of care?

A recent report published by the National Patient Safety Foundation (NPSF) notes that most definitions of patient engagement include the common themes of "partnership, communication, information exchange and respect.”

The Beryl Institute defines patient experience as "the sum of all interactions, shaped by an organization’s culture, that influence patient perceptions across the continuum of care.”

There are overlaps between patient experience of care and patient engagement. If patients are not respected as partners in their care and if clinicians do communicate with patients effectively, then it is highly unlikely that the patient’s experience will be a positive one. Moreover, research has linked patient experience to clinical outcomes, with a 2013 paper finding "patient experience is positively associated with clinical effectiveness and patient safety and [data] support the case for the inclusion of patient experience as one of the central pillars of quality in healthcare.”

The NPSF report, Free from Harm: Accelerating Patient Safety Improvement Fifteen Years after To Err Is Human, makes a number of recommendations for improving patient engagement to improve patient safety:

  • Training and education: Clinicians and health professionals need to be educated about concepts such as shared decision making, health literacy, cultural sensitivity and respect.
  • Ease of access to information: Patients and families need timely access to medical records, test results and tools and resources that help them understand complex medical information.
  • Patient representation: Members of the community served by a healthcare organization should be represented on the governing bodies and committees of those organizations. Only by such representation can we ensure that safety and quality initiatives and care processes that affect patient experience are designed with patients in mind.
  • Tools and strategies: From including families in bedside rounding to the use of tools like the Ask Me 3 program, which encourages patients to ask key questions about their health and care plans, there are tools and strategies that can help engage patients and improve their experience of care.
  • Reporting and measuring: The Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) serves to measure, to a degree, a patient’s experience of care while hospitalized. We also need ways to measure patient engagement, including ways to capture patient reports of safety lapses.

Arguing for greater patient and family engagement is not new to NPSF, and is in fact an issue that we and others have been advocating for some time now. While educational efforts such as the Agency for Healthcare Research and Quality’s Questions are the Answer campaign are useful for patients and consumers, we also know that even experienced health professionals sometimes have trouble speaking up when put in the vulnerable position of patient.

While patients should be encouraged to be full partners in their care, their clinicians are the ones who really hold the key to making that possible.

Improving patient and family engagement is one of eight recommendations in the new NPSF report, which is a focal point of Patient Safety Awareness Week, March 13-19, 2016. The theme of the week this year is United for Patient Safety, a reflection of the belief that clinicians, patients, policy makers, researchers and everyone involved in healthcare must be part of making care safer for everyone.


Tejal K. Gandhi, MD, MPH, CPPS, is President and Chief Executive Officer of the National Patient Safety Foundation, the NPSF Lucian Leape Institute and the Certification Board for Professionals in Patient Safety. She is advocating for patient safety at the national level, driving educational and professional certification efforts, and helping to create and spread innovative new safety ideas.

Tags:  healthcare  patient and family engagement  patient engagement  patient safety  research  service excellence 

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Rare Care – The Specialty Pharmacy Patient Experience

Posted By Christopher W. Kennedy, MSM, Tuesday, October 13, 2015

Nearly 7,000 diseases are classified as rare in the United States. These disease states require some of the most cutting-edge and technologically advanced therapeutics. Patients with chronic rare diseases will often require long-term medications throughout their lives. The management of a rare disease requires a multidisciplinary approach to healthcare. Continuity of care is front and center as patients are transitioned from inpatient hospital settings or outpatient clinics to their homes. Many will require frequent treatments, nursing visits, on-going monitoring, medication adherence plans and disease state education.

The Patient Experience drastically changes for patients after they are discharged from traditional care settings. Advancements in the Patient Experience movement within inpatient hospital settings has set an example for specialty and home infusion pharmacies to follow. While some hospitals have found it difficult to determine where their inpatient pharmacies fit into the Patient Experience movement, other leading health systems have fully recognized pharmacy as the medium that crosses all levels of the healthcare continuum.

Regardless of the progress being made in the hospital setting, the Patient Experience has stalled on the doorstep of the specialty and infusion pharmacy industry. This challenge requires organizations to redesign their "customer service” models. Heritage Biologics is a specialty pharmacy providing nationwide infusion and rare therapeutic services. The pharmacy was founded by a rare disease patient who asked a really BIG question: How do we improve care for people like me?

We have established Four Fundamentals that guide the organization’s framework for creating a successful Patient Experience platform:

  • PARTNERSHIP: Customized solutions are designed to ensure the continuity of care between providers and all healthcare stakeholders.
  • COLLABORATION: Insights are captured and shared with healthcare partners to allow for better outcomes management.
  • EXPERIENCE: A new standard in pharmacy patient care is being established with our patient-centered solutions.
  • GUARANTEE: A clearly defined emphasis on placing the patient before the business allows for a commitment to rare care that is unmatched.

The complexities of the evolving healthcare system in the U.S. have posed significant challenges for rare disease patients. Pharmacies must team with healthcare providers, payers and manufacturers to coordinate care efforts. This creates an environment where therapeutic health outcomes become the common denominator for everyone involved. Collaboration is critical for patient healthcare, and we hope other pharmacies will join the Patient Experience movement.


Christopher Kennedy is Vice President of Business Development at Heritage Biologics. He has spent the last 14 years as an executive leader and innovator in the healthcare space. His background includes launching several entrepreneurial start-up ventures designed to help advance patient care.

Tags:  collaboration  environment  healthcare  patient experience  pharmacy 

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Be a Change Agent and Shift the Culture of Dementia Care

Posted By Kristen Cribbs, Wednesday, August 19, 2015
Updated: Wednesday, August 19, 2015

As healthcare providers working with individuals who are living with dementia, we have a lot on our plates. It’s easy to get caught up in the busy day to day and to lose patience when Mr. Jones is "just being difficult.” The Alzheimer’s Foundation of America (AFA) seeks to cultivate a more skilled and empathetic dementia care workforce by teaching professionals to look beyond behaviors and to be curious: What might Mr. Jones need? What is he trying to communicate?

Putting ourselves in the shoes of individuals living with dementia who are confused and experiencing communication challenges helps us to provide dementia care that is truly person-centered. Through setting aside our biases and agendas and being attuned to individuals in the moment, we are better able to offer the support that they need to be healthy, fulfilled and safe. Taking a "one size fits all” approach to care can limit a positive patient experience and impact an individual’s ability to make his own decisions and maintain a meaningful life with dementia. We suggest taking the time to get to know a person, their family, history, preferences and goals. Building a relationship forms the basis for effective communication – by gaining insight into the person, you are better able to understand how they convey their needs and desires.

Reflecting the mission of AFA, the Foundation’s training and education division, Dementia Care Professionals of America (DCPA), works to ensure that dementia care is person-centered, valuing the uniqueness of each individual. DCPA’s philosophy encourages interdisciplinary collaboration among care providers, care facilities, families and individuals living with dementia and ensures decision-making processes and care plans reflect an individual’s needs and desires. This approach is of the utmost importance in promoting wellness and health while improving both delivery of services and the experience of the individual who has with dementia and his family.

It is this shift in thinking that leads to an increased ability to build positive relationships and improve the experience of the individuals and families with whom we work. We are proud of all of our programming, including our new training video, which goes beyond the basics and encourages participants to think critically about their work. Emphasizing relationship-building as the cornerstone of high quality dementia care will cultivate a more skilled and empathetic workforce that is prepared to meet the unique needs of this growing population.

Although individuals with dementia may experience certain challenges as a result of the condition, this does not negate their right to lifelong learning and meaningful living. We encourage you, your staff, and your organizations to take the time to focus on the abilities, stories, and knowledge within this incredible group of people the individuals with dementia with whom you work. The relationships built in the process will be enriching not only for the people you serve, but you, as well.

Kristen Cribbs, M.P.H., is Deputy Director of Educational Services at the Alzheimer’s Foundation of America (AFA), where she oversees AFA’s Dementia Care Professionals of America and Excellence in Care programs. Her efforts focus on establishing and promoting best practices in dementia care across sectors and care settings and she is deeply committed to improving the health and quality of life of older persons. AFA is a national nonprofit dedicated to providing optimal care and services to people with dementia and their families, ultimately improving quality of life through support and education that elevates care.

Tags:  dementia  healthcare  long term care  person-centered care 

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A Thin Line - The Nature of Care*

Posted By Paul Westbrook, Thursday, June 4, 2015
Updated: Thursday, June 4, 2015

The etymology of the word hospital indicates that it derives from two rather divergent concepts. The first is the Latin hospes, from which we get warm words like "hospice”, "host” and "hospitable.” The second, also from Latin, is hostis, the root for the rather alarming concepts like "hostile” and "hostage.” As the saying goes, "There’s a thin line between love and hate.” For us in the hospital profession, perhaps we also walk on a thin line.

In my work with a renowned healthcare system in Northern Virginia, I noticed that there are day-to-day elements surrounding us that seem both hospitable (hospes) and hostile (hostis) in the care environment. Hospitable concepts include ideals: emotional connection, welcome, compassion, service, intrinsic joy, extraordinary care, empathy and excellence. Seemingly hostile topics include realities such as: regulatory pressure, profit preoccupation, command and control, task driving, growth planning, provider centrism, compensation concerns, and too many patients and not enough time. Perhaps on any day, we might forgive ourselves when instead of acting as hosts, we catch ourselves treating our patients as hostages. When even small feelings of hostility supersede a spirit of hospice and warmth. Maybe and simply that’s the human nature inherent in the nature of care.

I came to healthcare from 27 years’ executive service with Ritz Carlton and the Marriott Corporation. In the hospitality industry, hospes should always prevail, yet often doesn’t. Again, human nature. Over the past three years, I’ve had the privilege of leading the transformation at Inova Health System in its desire to achieve patient experience excellence. The commitment, collaboration and the results are inspiring, yet have not been without their challenges.

Central in this transformation was our focus in examining 5 key work streams: Culture, Communication, Human Resources Process, Leadership Development and Service Excellence and inculcating these with hospitality principles. As noted, in our introspection, we found both hospitable and hostile elements, both the hospes and hostis.Again, human nature inherent in the nature of care.

Given the power of human nature and our propensities, especially under the many pressures that we face each day both on the business-side and the care-side of healthcare, how do we keep ourselves focused to "deliver the unexpected,” to provide "extraordinary care” and to experience transformation expressed in "service excellence?” At its base, perhaps such service requires a spirit of genuine intentionality, and if I can borrow a word from the hospitality industry, maybe it takes a spirit of "Concierge,” which etymologically means to act "with service.”

Hospitality and hospital share the same linguistic roots. Hospitality principles like making emotional connections, individualizing service, recognizing and celebrating success and striving for service excellence guided us at Inova in our transformation. Integrating these hospes ideals into our work streams helped us gain immediate and sustained patient experience success.

 *This is the first piece of a special three-part guest blog series focusing on various components of patient experience excellence, including patient and family care, culture and leadership and employee engagement.

Paul is the Vice President of Patient Experience at Inova Health System. Prior to joining Inova, Paul began his service delivery consulting company, Westbrook Consulting, LLC, with the mission of transferring his 35 years of hospitality service in branding, strategic deployment, and operations to other service industries, to give back to his community and make a meaningful difference in peoples’ lives. Paul is also part of The Beryl Institute's Patient Experience Executive Board.

Tags:  culture  healthcare  hospital  Leadership  patient experience 

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Improving Patient Experience with the Right Healthcare Degree

Posted By Julie Sweet , Thursday, June 4, 2015
Updated: Thursday, June 4, 2015

When asked about their career choices, it is not uncommon for healthcare professionals to recount memorable patient experiences that helped inspire their career paths. Both positive and negative experiences can prompt individuals to pursue a career in healthcare. Although becoming a physician certainly has a direct impact on patient experience, there are a myriad of other careers in healthcare that play a critical role as well. It is important for future healthcare professionals to pursue a career path that fits their unique personality, skill set and professional goals. This is particularly important when considering advanced degree programs.

For example, a Master of Health Administration (MHA) is an ideal degree for someone who wants to make a difference in how patients experience healthcare from a broader systems perspective rather than a one-on-one interaction with an individual provider. MHA professionals are equipped with leadership ability, business decision-making skills and knowledge of current trends in healthcare delivery to ensure patients experience efficient and effective healthcare systems. For business-minded individuals who are interested in making the patient experience better by improving healthcare systems, an MHA is the degree most likely to facilitate a fulfilling career path.

On the other hand, a Master of Public Health (MPH) program is better suited to those who are interested in creating a healthier community or population by reducing illness, encouraging healthy lifestyles and developing community health programs. MPH training gives community leaders the skills they need to effectively influence preventive health measures and reduce a variety of illness. These efforts emphasize the idea that healthcare isn’t limited to a hospital or clinic setting, but happens in our homes, schools, workplaces and communities.

For those who already work directly with patients as a registered nurse, but wish to grow in the field, a Master of Science in Nursing (MSN) may be the best fit. The demand for MSN-prepared nurses continues to grow as the prevalence of complex medical conditions rise and life expectancies increase. MSN-prepared nurses have more autonomy and can make independent decisions about patient care, which makes them uniquely qualified to work in a wide variety of healthcare settings such as long-term care and rehabilitation centers. Infusing the healthcare system with skilled MSN-prepared nurses means more options for patient care outside of the hospital setting and a greater degree of control over one’s healthcare experience.

Healthcare in the U.S. is an ever-growing and changing entity that touches everyone’s lives. It takes innovative and diverse minds to ensure the patient experience remains a priority among all healthcare practitioners. The wide variety of career opportunities in healthcare allow individuals to leverage their strengths in helping to drive progress forward.

Julie Sweet is an editor of Healthcare Information for

Tags:  degree  education  healthcare  patient experience 

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Thoughts from a Commodity

Posted By Brandon Parkhurst MD, Monday, May 4, 2015

From the perspective of the patient, healthcare is a commodity. I’ve spent the last 15+ years of my medical career getting my head around that statement and coming to an understanding of it. Today I accept it as fact. Commodities are exchangeable one for another. From the perspective of a patient, the technical aspects of treating high blood pressure, or asthma, or heartburn, or even having a hip replacement or heart bypass surgery are going to be based upon the diagnosis and aren’t going to change much from one provider to the next. I was smart enough to get into, and through medical school, but otherwise I don’t know how to prescribe blood pressure medicines in a way that’s wildly different from anyone else. The experience of a patient receiving care from my practice is the only thing that sets us apart from everyone else.

As it turns out, in this age of decreasing physician and medical provider autonomy, I do control, or at least significantly influence, the experience of receiving care from me! I control my priority of placing my patients’ medical needs before everything else. I can insist on my patient not leaving my office until I know that patient understands what I’ve said, the diagnosis, what signs/symptoms to watch for, the follow up plan. I can model patient-centeredness and raise the performances of those who assist me and are integral to my practice. I can work to ensure access to my care is meeting my patients’ needs. We can all demonstrate empathy and caring.

A patient’s experience is of the highest priority when the service one provides is a commodity. As Pine and Gilmore wrote in their landmark 1998 article Welcome to the Experience Economy, commodities are interchangeable and experiences are personal¹. When I provide an optimal experience, my patients should not only be healthier, for a wide variety of reasons, but should also be more loyal and more likely to return to my care. They might even promote my care services to their friends, promotion that is surely good for business. In general, providing optimal medical care and a positive, memorable experience for my patients is good for my patients and good for me.

As I’ve been writing this blog, I’m reminded of the difficulty of delivering an optimal patient experience and truly patient-centered care. A colleague just sent me a link to an article dated April 17, 2015 and published in The Atlantic. The title of the article is "The Problem with Satisfied Patients.”² The article is well written yet falls into the trap of treating patient satisfaction and patient experience as synonyms. Improving our patients’ experiences isn’t about satisfaction, happiness, or scores; improving our patients’ experiences is about understanding, collaboration, patient-centeredness, and most of all, personalization to the one situation we are a part of at a given time. Improving patients’ experiences isn’t about turning hospitals into 5 star hotels or restaurants; improving our patients’ experiences is about tailoring care to maximize every patient, resident, or family’s ability to Flourish³ and enjoy life on their terms.

My medical expertise is a commodity, yet the experience of receiving that medical expertise is unique to me. I firmly believe that providing an optimal experience of care improves the lives of those with whom I interact. I will spend the rest of my medical career seeking to improve their enjoyment of life and seeking to make their experience of receiving care from my medical practice, optimally positive and personal.

¹ Pine II, J. and Gilmore, J. (1998, July). Welcome to the experience economy. Harvard Business Review ² ³ See Seligman, M. (2011). Flourish: A visionary new understanding of happiness and well-being. New York, New York: Free Press


Brandon Parkhurst is the Assistant Medical Director of Patient Experience for Marshfield Clinic and splits his time between the practice of Family Medicine and leading patient experience improvement. Brandon was born and raised in rural north Missouri where his parents and grandparents consistently taught him that you do right by people because it’s the right thing to do.

Tags:  healthcare  Interaction  medicine  Patient Experience  physician 

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Patient Experience Seen Through the Eyes of Future Healthcare Leaders

Posted By Martie Moore, Friday, May 1, 2015
Updated: Thursday, April 30, 2015

Today, we live in a complex healthcare world. And unfortunately, the excellent patient care always desired, sometimes gets lost in the chaos.

Yet every day, we have the opportunity to calm the chaos and bring to life what Patient Experience Week is truly about: aligning head and heart with compassion.

As Chief Nursing Officer at Medline, it’s my job to uncover new ways to help clinicians meet their patients’ needs. I spend a lot of time in the field talking with clinicians about patient satisfaction and clinical outcomes. For this week, I wanted to do even more. I talked with nursing students, the future of patient care, about aligning head and heart with compassion.

On choosing healthcare:
"I went to college to become a graphic designer. You were always trying to compete with the next person and it just didn’t match my personality, so I started seeking other opportunities. During that time, my grandfather was going through some bouts of cancer. We had good experiences and bad experiences with clinicians. That’s when I knew I wanted to be a nurse and provide patient care.”
Christopher Galloway, MSN candidate at Resurrection University in Chicago

On defining patient experience:
"To me, patient experience is the overall perception a person has about the care they received from a healthcare provider. No matter the diagnosis, if a person feels that they were well-taken care of, they will be satisfied.”
Julie Neske Bierach, Accelerated BSN program at Goldfarb School of Nursing at Barnes-Jewish College in St. Louis

On your first face-to-face interaction with a patient:
"I felt unprepared to handle that level of responsibility, making decisions that directly influence the well-being of another person who has put their faith in the health care system. Often times, patients value the things that you take for granted. My patient may not remember that I ensured her fluid status was adequate every day, but she was sure to thank me upon discharge for making sure she was warm each morning and had enough blankets and pillows. These experiences highlight the balance between the art and science of medicine.”
Jordan Gales, third year medical student at the Cleveland Clinic Lerner College of Medicine

On dealing with life and loss:
"For those that have ever met me, it’s no secret that I’m an emotional person. In nursing, this is almost a paradox—you need innate compassion and emotion to feel for each of your patients and their individual journeys in order to help them, but on the other hand, nurses deal with loss on a daily basis. And they must learn to move on, and not carry each lost patient with them or that can take a huge toll on them emotionally, mentally and physically. When I think about what I need to do to deal with life and loss, I know I’m the kind of person who will put myself in the affected family’s shoes and think about that person that was taken too young, too soon or too unexpectedly. It will weigh heavily on my mind, and more so my heart. Yet, I know I will bounce back, move on and let it go without forgetting the memories of these individuals.”
Lauren Cummings, third-year nursing student at the University of Iowa, College of Nursing

Martie Moore is chief nursing officer of Medline Industries, Inc. based in Mundelein, Ill, a leading provider of medical products and clinical solutions across the continuum of care. In this role, Moore provides nursing leadership for solution-driven clinical programs, delivers product development to enhance bedside practice and launches quality initiatives across the continuum of care. With what she learned during the nearly 30 years of clinical experience and extensive executive leadership, Moore now develops forward-thinking solutions and programs for those in the field today.

Tags:  community  culture  healthcare  interactions  patient experience 

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Adapting and Cooperating to Scale a Shared-Decision Making Program to Improve Patient Experience and Outcomes

Posted By Gloria Stone Plottel, MS, MBA, Wednesday, April 1, 2015
Updated: Thursday, April 2, 2015

Global payment structures and evolving reimbursement calibrations are driving innovation in healthcare to improve patient experience, become more patient-centric and manage for population health. The magnitude of these changes requires individuals and organizations to willingly adapt and cooperate to develop the processes and programs to thrive in this altered landscape. It is worth pausing and reflecting on these efforts, especially when done well.

We’ll take an in depth look at a successful change initiative from Partners HealthCare, an integrated health system seeking to more fully engage patients in their own care so as to improve patients’ health and care outcomes. Partners HealthCare was founded by Brigham and Women’s Hospital and Massachusetts General Hospital and, in addition to its two academic medical centers, the Partners system includes community and specialty hospitals, a managed care organization, community health centers, a physician network, home health and long-term care services.

As part of its patient engagement strategy, Partners wanted to scale a successful Shared-Decision Making (SDM) program at Massachusetts General Hospital across its 10 hospitals, so patients throughout the health system would benefit from SDM. SDM helps patients who need to make significant medical decisions with their primary care provider and specialist by providing patients with evidence-based, balanced decision aids and coaching services. Decision aids give patients information (written and video) about diagnoses, different treatment paths and variables to consider as they think about treatment options that best reflect their values, life style and health goals. After reading and viewing the decision aids, patients meet with their coach – physicians, nurses, or other licensed healthcare professionals trained to guide this type of conversation – and together evaluate treatment options, the patient’s goals and values and decide on a treatment path that will work best for the patient.

Scaling this program involved a number of departments throughout the health system:

  • Legal and Finance to obtain rights to use patient decision aids in the other hospitals
  • Training of clinicians and staff – doctors, nurses and medical assistants needed to be trained to use patient decision aids and have shared decision making conversations with patients and family members
  • Worksheets and other tools needed to be developed to support shared decision making conversations when there are no patient decision aids available
  • IT needed to develop applications within the electronic medical record to notify physicians when patient decision aids were available for a diagnosis, and to enable ordering of decision aids and access through the patient portal, and to document delivery of patient decision aids
  • Mail Services was needed to deliver hard copies of patient decision aids to patients who did not have portal access
  • Physician office staff in some specialty practices needed to implement new protocols to incorporate delivery of decision aids to eligible patients when scheduling a visit
  • Leadership was needed to prioritize and champion this initiative
  • An advisory group with representatives from the major hospitals and patient representatives was created to provide input on the expansion strategy

Seven departments at a minimum and their staff were involved in scaling the SDM program across the health system. SDM aims to engage patients in making informed decisions about their treatment path, and in so doing increase patient satisfaction, increase patient adherence to treatment plans and improve patient outcomes. The initial expansion targeted primary care practices and orthopedic departments, specifically spine and hip and knee arthoplasty. At the time of writing, the expansion has been underway for five months and several practices at four of the hospitals are now using the decision aids, and the roll out to the rest is underway.

Many individuals – physicians, nurses, clinical and administrative staff, and patients and family members – are involved in scaling the SDM program to make it available to thousands of patients. Scaling the program requires significant willingness on the part of individuals to adapt and work together to increase patient engagement, improve patient experience and improve outcomes. The degree of change in healthcare delivery is large and stakeholders need to work together to build the processes and infrastructure that will enable organizations to thrive. Are you and your colleagues willing to adapt?

Gloria Stone Plottel, MS, MBA is the Founder and CEO of GSP², a boutique consultancy focused on helping healthcare organizations develop and implement strategies and infrastructure for patient engagement, advisory councils, communications and marketing. Ms. Plottel consulted to Partners HealthCare to develop the patient engagement strategy for the health system and Pioneer ACO.

Tags:  healthcare  leadership  patient experience  shared-decision making 

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Patient Experience Builds Brand Equity

Posted By Jim Lahren, Monday, March 9, 2015
Updated: Monday, March 9, 2015

Healthcare in the US continues its radical transformation with the rollout and rapid adoption of high-deductible insurance plans. More than even value-based purchasing, this has the potential to reshape the healthcare landscape because it has awakened the healthcare consumer. In its 2014 Employer Health Benefits Survey, The Kaiser Family Foundation reported that 41% of all firms (32% of large employers, 61% of small firms) have rolled out high-deductible insurance plans.

With the patient now responsible for large deductibles at insurance company negotiated rates, households are forced to become smarter consumers of healthcare services. New businesses and services have been introduced to meet market needs. Witness the rapid expansion of urgent care facilities, the availability of vaccinations at pharmacies, and most recently, staffed clinics within retailers. These all serve one purpose: providing consumers more expedient, cost effective access to care on their terms.

This ever-increasing trend in consumer activism necessitates that healthcare providers start to view their patients as healthcare consumers. In a January 2015 article titled "Improve patient satisfaction from the eyes of the consumer,” this author advocated that providers improve patient satisfaction in order to build their brands. With a stronger brand, they can better compete, and be among the winners as the industry consolidates. Overwhelming feedback to the article questioned the appropriateness and relevancy of patient satisfaction as a stated goal. Instead, reviewers advocated that patient outcome should be the sole focus. Notably, the article’s premise: "How will hospitals compete given the structural changes facing their industry?” was not addressed.

Why did this happen? Simply, the phrase "Patient Satisfaction” has become polarizing. CMS measures hospital patient satisfaction and ties reimbursements through standardized patient surveys called HCAHPS. Many clinicians believe that the HCAHPS survey is misguided, inaccurate and leads to excessive costs in an effort to please the patient. And as one nurse said, "And you can’t make everyone happy!”

An expert on patient experience development and cultural transformation, Jake Poore of Integrated Loyalty Systems, says: "Many providers today feel like they are set up to fail. With the pressures of new requirements, tools and processes for documentation (EMRs) and having to see 10-30% more patients than last year just to make the same productivity or revenue, they feel like they are literally running ‘on the daily gerbil wheel.’ When you add the fact that most patient clinic appointments are in 15 minute windows, you have a perfect storm: The last thing on a provider’s mind is patient satisfaction or survey results.” What is the root cause? Poore suggests a misalignment of priorities between what healthcare organizations measure, reward and hold accountable and the priorities patients expect from their caregivers. When Poore and his team ask healthcare leaders, providers and staff to identify the top 4 most important operational priorities and prioritize them in order, they say: #1. productivity, #2. competency, #3. safety, and #4, courtesy.

On the other hand, when you ask patients (which Poore and his team have done with nearly all of their clients around the country) what they want most from the front desk to their physicians and nurses, patients rate their priorities as: #1. courtesy/compassion, #2. competency, #3. productivity, and #4. is safety. In explaining the patient priority order, Poore says that it rarely even occurs to patients that a hospital or the caregiver is not safe. As one patient said it, "safety only becomes my concern when safety has been jeopardized.” Overwhelmingly, what patients say they want FIRST is a care team member (clinical and non) who is "warm, welcoming and listens” and talks with them, not to them: "… as an individual, with dignity and respect. As patients, we assume you are smart and an expert of your trade, but we want you to start the conversation on the human side first, do your exam second.”

As consumers, we purchase products and services we like. We are most loyal to brands where we have an emotional connection and where the people behind those brands seem to share our priorities and values. But when managing our own healthcare, we have traditionally been the "Patient.” The patient has now become the consumer who expects the healthcare provider to treat them as such. But how should providers adapt to this new paradigm? They need to focus on their client, the patient, and improve the patient experience. More than ever before, healthcare consumers have many choices for their care. Providing a poor patient experience will damage an institution or provider’s brand, resulting in lost loyalty, lost patients, and above all, lost revenue. By improving the patient experience, providers will not only enhance their patients’ well being, they are better equipped to prevail in the new healthcare marketplace.

Jim Lahren is the Principal of Lahren Consulting. A former Chief Marketing Officer, he has worked in highly competitive consumer categories where he developed a comprehensive understanding of consumer behavior. His retail experience spans big box, department store, specialty, and online. He believes that patient experience will become the driver in building the institution's brand and is excited to attend The Beryl Institute’s Patient Experience Conference 2015.

Tags:  branding  HCAHPS  healthcare  patient experience  survey 

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