Posted By Alison Tothy, M.D.,
Tuesday, July 26, 2016
Updated: Monday, July 25, 2016
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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.
Posted By Andy Roller,
Thursday, July 9, 2015
Updated: Tuesday, July 7, 2015
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The patient journey is rapidly changing. The old patient journey went something like this:
- Scenario 1: You got a referral from your primary care doctor and unquestioningly followed the directive. Based on your experience, you became a loyal patient, advocate (for better or worse), or indifferent.
- Scenario 2: You asked a trusted friend or utilized some form of word of mouth. Based on your experience, you became a loyal patient, advocate (for better or worse), or indifferent.
- Scenario 3: You became aware of a particular doctor, specialist, or practice – maybe through some form of traditional marketing (TV, Billboard, Newspaper, Direct Mail). You then considered and evaluated. You proceeded to set an appointment. You went through with the procedure or treatment. Again, based on your experience, you became a loyal patient, advocate (for better or worse), or indifferent.
Of course, every reputable practice will work to make the experience and the resulting word of mouth the best it can be. But my, how things have changed. With a rapidly increasing digital population, the patient experience starts much earlier. The journey-experience increasingly begins with online search. It continues through their experience with care they receive; then through online reviews and social media posts they publish.
According to 2014 Pew research, 86 percent of patients search online before booking a doctor’s appointment. And, as of 2013, 41 percent of patients were using social media to determine their choice of Healthcare Provider (HCP). 43 percent of medical visits originate from a search engine. These numbers are rising at a rapid pace.
A full 90 percent of patients 18-24 of age trust and make decisions based on what they find on social media. And over 25 percent of conversations on Facebook are about a health-related experience. Yet only 26 percent of hospitals in the US actively engage via social media. It's true that prospective patients don't often convert based on a single Facebook update. But the influence on patient decisions and advocacy is foolish to ignore.
The new patient journey looks more like the following:
The patient searches online related to symptoms, providers, reviews. They may share social updates and interact as they search. Keep in mind, what they're finding is largely the result of other patients who have posted about their experience. Marketers call this the the Zero Moment of Truth.
Once the prospective patient finds what they are looking for, they make a decision to move forward. This is often called the First Moment of Truth. They may call or send an online form, make an appointment or schedule a consultation. Again, this moment may also be something they share with their social networks.
The patient then attends their first appointment or procedure or hospital stay. This is their Second Moment of Truth. We most often think of this moment as the patient experience. It may be the core of their experience, but it's only part of the journey and experience.
During and after the stay or procedure is when the majority of social sharing takes place. This sharing becomes the next prospective patient's Zero Moment of Truth.
What will prospective patients find? How well are HCPs facilitating the patient experience along this journey?
At Expio, we teamed up with TCU's Neeley School of Business to create the following short report. We present the information in the context of a true story from the perspective of a Father dealing with his young son's medical care. View the full report here.
Andy Roller is the Founder and Owner of Expio. As a believer in the power of entrepreneurship for commerce and community development, he is also a community volunteer, board member of Panhandle Twenty/20 and part of Leadership Fort Worth. Andy was named one of Amarillo Chamber of Commerce’s Top 20 Under 40 Business Professionals in 2011. Andy is a fitness and health geek, guitar player, father to 5 super cool kids and husband of an Enchantress.
Posted By Dorothy Sisneros,
Thursday, January 8, 2015
Updated: Monday, January 5, 2015
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I was watching the wonderful video by The Beryl Institute in which person after person says, "I am the patient experience.” I’ve watched this many times and each time, I feel touched and inspired. This video showcases the contribution and impact every one of us makes on patients and families.
The last time I watched, I surprised myself by having a very different response. If each of these staff members IS the patient experience, where is the PATIENT in the patient experience?
Where is the patient in the patient experience?
We might think we create the patient experience, but the patient’s preferences, goals and expectations need to drive the experience and they need to drive us to do our part in creating it. The main player and the key actor in the patient experience needs to be the patient.
How could I be the Patient Experience, when I am a constant, and every patient has a different experience? I might, for instance, have routines that I have carefully crafted to have a positive impact on each patient. I’m kidding myself if I think every patient experiences my routines the same way with a similar impact.
So, how can we include the patient in the patient experience?
By starting with the patient’s voice and ensuring that this voice guides us to personalize the experience so that it is appropriate, healing and gratifying for THIS patient NOW.
In my view, the one thing we should standardize is a process for amplifying the patient voice, so that we can personalize our part in the patient experience. The patient experience needs to be what we do WITH people, not FOR and TO them. And we need to invite the patient to be our coach to guide us through agenda-setting and the entire encounter.
Getting concrete, how would we do this?
- Invite the patient (and family) into the conversation immediately. Make them feel safe talking with you. "I’m here for YOU. I want to support your care and healing..."
- At the start, set up the relationship as a partnership, unless the
patient clearly does not want this or cannot participate. "I rely on you
to tell me how you feel, what you want, and any concerns you have. I
want to work together with you on your plan and then we’ll work that
plan together. I see us as a team.”
- Ask open-ended questions and encourage multiple responses, so you can
together prioritize the important few among the many. "What do you want
to get out of today? And what else? And what else?” Then, "You said X, Y
and Z. Tell me, which feels most important to you right now? I want us
to be sure to address that!”
- Listen with rapt attention and respond with caring. Don’t interrupt.
- Show that you’ve listened by checking your understanding. "I want to
be sure I understand. You feel... You want... You don’t want...”
- Ask yourself, knowing this about this person, how can I do my part in creating the best possible experience?
- Explain WHY you want to do or not do something for or with the
patient before you do it. Make your intentions explicit, giving the
patient the chance to say, "Yes, that works for me, or NO, that doesn’t
work for me!”
Without the patient, we are not the patient experience. We have been invited to participate in the patient’s experience, not to own it.
Dorothy Sisneros is a respected healthcare leader inspiring others to achieve breakthroughs in leadership effectiveness and the patient, family and employee experience. As a Partner of Language of Caring, LLC, she has spearheaded effective implementations of the Language of Caring and breakthroughs in CAHPS scores with large health systems, hospitals and medical practices.
Posted By Joel High,
Thursday, September 18, 2014
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It’s on all of our minds. It keeps us up at night. HCAHPS scores are not improving (or at least not fast enough). Value Based Purchasing is becoming more and more established. The competitor across town just remodeled their patient rooms and are wooing our patients their way. Employee morale and engagement are stagnant or declining. To top it off, your board members and CEO are demanding action.
Is this a worst case scenario? Perhaps. However, improving patient experience tops the list of strategic priorities for many health care organizations around the country. Medical school, nursing school, nor business school has prepared today’s healthcare leaders to manage, much less improve, the patient experience. A common misconception is that improving patient experience is a huge and complex undertaking, but in reality, improving patient experience doesn’t have to be complicated. In fact, in many ways it’s simpler than you think.
During my years working across the continuum of healthcare including hospice, long-term, acute care and now as a Patient Experience Improvement Coach, I have seen some simple and inspiring ways that healthcare organizations have improved the experience for patients and their loved ones. I share two examples of easy to implement initiatives below.
Every Patient Is My Patient
At a community hospital where I served as the Patient Experience Lead, we implemented an innovative patient experience program called "Every Patient Is My Patient” in response to declining HCAHPS scores around staff responsiveness. The program hinged on the philosophy that every employee and volunteer has an impact on the patient experience. The ask: Employees and volunteers were expected to respond to call lights immediately if they noticed one illuminated. Although it was known that on occasion there would be needs that fell outside of the expertise of the responder, we believed that the impact of responding to the call light right away would be important to patients and would communicate that the organization cared about them.
What we found was that the "Every Patient Is My Patient” program reaped immediate and sustained improvement in the patient experience and an increased level of team member accountability. In less than 6 months, this simple initiative resulted in a 5% increase in HCAHPS scores around staff responsiveness.
Through The Voice of Our Veterans
By leveraging insights gleaned from real-time patient feedback and improvement coaching support, one of our Veterans Affairs partners found that Veterans were having a difficult time finding their way to their appointment, securing post-discharge assistance and basic post-visit transportation services. Faced with these issues impacting their patients, a Roaming Ambassador program was put into place. The Ambassadors main objective: seek out Veterans who appear to need assistance and offer to assist. This was contrary to the traditional approach of having Veterans looking for assistance. The Ambassadors assist Veterans through every aspect of the discharge process and ensure that the needs of each veteran are supported. Comprised of volunteers and work study students, the Roaming Ambassadors worked weekdays with a team of about 30 on rotating shifts. To make the Ambassadors more visible to Veterans and others visiting the facility, donated funds were used to purchase Navy blue vests which on the back read "The Price of Freedom is Visible Here.”
The result of the initiative paid off with Veterans raving about the great service of the Ambassadors. This simple approach has made a big difference in the patient experience at this medical center and has helped create a more warm and inviting atmosphere at the medical center.
Creating an exceptional Patient Experience in today’s healthcare marketplace is extremely important. Everyone within the organization should be focused and committed to delivering an exceptional patient experience. Similar to a rowing team, progress becomes easier when all of the team members are working together towards the same goal. It doesn’t have to be complicated. Quick wins that sustain are possible with focus and attention.
Joel High, MDiv, MBA is a Performance Improvement Coach with TruthPoint. Joel’s passion is in helping healthcare organizations to transform their culture and create patient centered processes and practices. Joel has been engaged in patient centered care and patient experience work at both locally and nationally for more than a decade.