Reinforcing a Commitment to Community

On the Road with The MetroHealth System – October 2016

by Jason Wolf

As part of our Regional Roundtable Meeting in Cleveland this year I was honored to spend time On the Road with the team from MetroHealth. What I learned and experienced directly was a passion and commitment to experience excellence grounded in a true sense of community. As the county hospital for Cuyahoga County, and a vast and visionary public health system, MetroHealth is grounded in a 180-year history of serving the greater Cleveland community.

As the Institution developed its strategy to meet the needs of its diverse population, a focus on patient experience, and ultimately the experience of the community they serve, became a fundamental and unquestionable choice. With that MetroHealth has embarked on a journey to reinforce its care for the community, engaging patient and family voice and develop a staff committed to experience excellence. They have clearly recognized that this combination of community, patients and families and those who care for them all play a critical role in the experience conversation.

Caring for the Community
In speaking with our host, Sara Laskey, MD, the VP and Chief Experience Office for The MetroHealth System she set this framework right away. “While we are committed to our scores, that is not our ultimate focus,” she shared. “We are working to build loyalty with our patients, families and community.” She reinforced that the commitment at MetroHealth was to create a healthcare experience, clinically and personally, that people would choose and then they would choose to return.

This strategy is grounded on the idea that healthcare must move from the idea of transactional to relational care and it must be committed to meeting people where they are. This is driving MetroHealth’s commitment to creating not only fundamental principles on which experience is framed and how it is delivered, but then supporting this with a commitment to ensure that wherever you experience the system, be it in the main hospital or in a community clinic that you receive consistently positive and engaging experience. As Dr. Laskey added, “We want people to know what they are going to get when coming to MetroHealth.” It is clear they are committed to ensuring that happens.

Executive Rounding
In spending time rounding with VP, Nursing, Melissa Kline she shared the increasing focus on executive level rounding. While she acknowledged some of the challenges many organizations note about rounding efforts from consistency to time conflicts, MetroHealth has a significant effort underway to have their leaders from across the organization personally engage with patients and families. They have established about 10-12 rounding teams, each led by a VP level individual and divided up to have accountability for certain sections of the hospital.

Primarily these leaders will try to engage patients within their first 24 hours of admission to make both a contact and ask some key questions from expectations to wait time, responsiveness to any needed information. All rounds are logged and weekly reports are disseminated to track progress and identify both moments for recognition as well as opportunities for improvement. It was clear from this effort that MetroHealth has built both the process and solidified the intention needed to accomplish this successfully and they are starting to reap the results.

Office of Patient Experience
This commitment at the leadership level was also reinforced by the breadth and thoughtfulness of MetroHealth’s Patient Experience team themselves. As a group of individuals covering a vast range of responsibilities from managing complaints to educating staff to engaging patients and family members, the team acknowledged the vital role they play in both increasing the focus on patient experience and expanding the impact these efforts can have. While covering the roles of every individual could take an article in itself, it was the collective commitment and voice through which the team spoke that was compelling. They spoke of the critical levers it took both to establish their organization – a true commitment by CEO Dr. Akram Boutros who joined the organization in June of 2013 and in less than two months put a Chief Experience Officer in place with Dr. Laskey.

But they shared it was not just the commitment to a role, foundational to their efforts was and remains a commitment to a new kind of culture and a primary commitment of service to others – the first value of MetroHealth. In their desire to move quickly, the team noted a clear focus on figuring out the right thing to so and then working on the how to get it done. As Dr. Laskey added, “We move quickly to do what is right.” Another team member added that their growth in efforts is built upon the reputation they have built to listen, learn and get things done.

An example of this type of action came early on when Dr. Laskey made the case to level-set the organization on both commitment and intent in how they were going to tackle their patient experience effort. This required training the over 6000 employees of the system. Something strongly supported by executive leadership, in so much that for the over 200, three-hour training sessions held to accomplish this launch, a senior leader opened and closed every one. It is this type of commitment to not only purpose, but also action that seems to exemplify the efforts at MetroHealth and connect them back to their cause of caring for the community they serve.

Building for the Future
This vision and purpose is carrying them forward in some new and unique ways as well. I had the chance to speak with Walter Jones, Senior Vice President, Campus Transformation, whose role it has been to consider a full campus revitalization that will have positive ripple effects for the surrounding communities. What was powerful to learn in my discussion with Walter, was that this effort reaches way beyond a typical design and build project to a proactive and significant example of true experience-based design. While many organizations today take the step to engage patient and family feedback on the designs of new spaces, MetroHealth is engaging patient and family members in the co-creation of the design itself. From understanding both the experience patients, families and community members look for in the facility and what staff needs to manage safely and efficiently, Walter and his team have been working painstakingly to ensure what patients and families see as ideal experiential opportunities are considered, in essence as he called it a “pre-step”.

As in many other design projects of consumer spaces such as malls or hotels, the design is created for those experiencing and engaging in the space first, not those operating in it. Walter offered it was time we brought that thinking to healthcare in a way that honored both this new focus as well as the critical and unique needs we need to maintain in healthcare. That said, the input, ideas and expressed needs of patients, families and the community have become the backbone of decision making. In then entering the design process, this allows the questions to be asked slightly differently, “Our patients and families want this, how do we make that happen and maintain our commitment to quality and safety?” This is a subtle, but significant shift in what I think will be a more rapidly rising tide in healthcare overall. As experience-based design continues to gain standing and expand in use, priorities will shift and perspectives will broaden that will ensure experience is an essential consideration – one fundamentally in the best interest of providing the best outcomes possible. That has been and remains a core commitment for MetroHealth and underscores their true focus on serving the community in which they live.

Engaging Patient and Family Voice
The ideas of rounding to co-design exemplify MetroHealth’s clear commitment to seeking and acknowledging the patient and family voice, but it is the structures and practices they have put in place to formally hear from those voices that provide a great example for others. MetroHealth started the patient and family advisor effort not long after beginning their experience effort overall in 2014. What was significant in their start was that rather than just creating a council and checking the box, the organization first invested in having a collection of patient and family advisors (PFAs) tackling direct work with no formal council in place. The PFAs were engaged directly on organizational project teams and committees and participated in events as speakers, sharing their stories with others. It was not until a year later in 2015 that a Patient and Family Advisory Council was formed. Now over 60 PFAs are in action working on over 70 projects throughout the organization. (You can see a comprehensive profile on the MetroHealth PFA effort via The Institute for Patient- and Family-Centered Care.)

What most moved me in my opportunity to sit down with a number of these advisors was what the experience has meant to them. First, on more than one instance members of the PFA team stressed, “People here listen to what we had to say and actual changes were made as a result.” Expanding on this another PFA noted that the organization is consistent and active in seeking advice and input from patients and family members. Another member. Terri Mosely added, “You know your voice is being heard.” The PFAs also had something to add about the organization itself. Eartha Weston noted, “When you walk in here you can feel the culture is different. This is no longer the city hospital I was born in, but much, much more…Here everyone cares.”

A critical aspect of the PFAs success is aligning people’s desire to contribute, their individual skill sets and experience and the opportunities that exist where PFAs can have an impact. Many of the PFAs mentioned Jennifer Lastic, Program Coordinator in the Office of Patient Experience, as playing a critical role in matching skills and needs and helped foster both individual engagement and overall success. To a person, the PFA team was clear on one thing, they were having an impact, were respected for their contributions and appreciated for their commitments and were without question considered part of the MetroHealth team. As one PFA, Raman Krimpuri, added, “We are engaged here as leaders, not simply as passive or reactive patient voices.” And that has made all the difference.

Developing Staff Champions
Complementing both an unwavering community commitment and an engagement of patient and family voice, MetroHealth’s efforts are underlined by a commitment to developing their own people. Three powerful examples were shared to frame the idea that a commitment to serving others means we must ensure we are at our best as well.

Pathways to Caring
I was privy to sit in on a mini-session of MetroHealth’s “Pathways to Caring” program. This was the follow-on program from the initial patient experience workshops that kicked off the experience effort. Pathways to Caring consists of 12 mini-sessions which are led by leaders across the various units of the organization. Designed to reinforce the central ideas of the patient experience effort and the organization’s core values, the course addresses one new topic each month. The lessons can be conducted at quick huddles or team meetings. The program itself is also tracked in the learning management system to ensure people are engaging in the process.

Topics range from body language to empathy, personal accountability to service recovery. Each of the mini lessons provide core ideas, define skills and include commitment statements as people begin to implement these practices into their own work. As a former learning and development leader in healthcare I would add that the simplicity of the program, matched with the breadth of its reach, and the comprehensive nature of its content creates a perfect opportunity for collective and intentional learning. And as the organization keeps pace on this journey the entire team can support one another in the learning and more so the impact it will have.

Patient Experience CARE Champions
Another critical structure for support and development is in the emerging group of Patient Experience CARE Champions. Specifically focused on emerging leaders, CARE stands for Career Advancement for Nursing Excellence. This is a project-based effort where selected participants work a real issue they identify in their unit or department. Participants have to research the evidence, apply and test new ideas and ultimately offer their learning and recommendations as a result. The ultimate goal is not only individual professional development, but replicable outcomes that can help efforts throughout the organization.

As example of the efforts shared by a current CARE Champion was a focus on making the Emergency Department (ED) experience more effective and easier to navigate. The project exploration was around how you can simplify the process map for people coming to the ED. It included testing ideas such as walking people where they need to go as they transition through the ED.

Currently there are 14 champions in the program. They are nominated by peers or if someone has an idea they wish to explore, they can self-nominate as well. The group of participants meets monthly to share new discoveries, practices and processes, which helps with not only learning, but also spread. One of the keys shared was that when peers see one another exploring, testing and then acting as a champion around a new idea, it changes the perspective and the level of engagement. Rather than being told to take on a new practice or tactic, team members are watching these ideas bloom in their very midst. Not only do they emerge as proven practices to apply, people have already experienced them having an impact.

Relationship Centered Communication
This idea of impact touches on the work of the providers at MetroHealth as well. In meeting with David Kuentz, DO, who was one of the first facilitators of the Relationship Centered Communication Program offered via the American Academy on Communication in Healthcare (AACH). The power of the program, David shared, was in its ability to get to the core of people’s commitment to caring for others. In thinking about the ideas of common courtesy and human connection, many of the things that seem to pull the opposite direction on providers causing compassion fatigue or burnout are slowly combated. By engaging people further in their humanity and in the how and why they connect with others they have seen some incredible and even inspiring results.

The course itself is one-day in length and is now mandatory for providers across the organization. The key is that it is taught in the context of the experience providers have and is led by their peers, so open and honest discussion can take place about both the successes and struggles these individuals are facing. The intention of the effort is also creating a new level of self-awareness for individuals while creating a common language, skill-set and understanding among colleagues that can support and sustain a commitment to more positive relationships with patients, families and peers.

This effort and the other development opportunities shared during my visit reinforce an idea central to the definition of patient experience. That in driving experience excellence, our primary resources are the very people that comprise our organizations. It is those individuals that lead interactions with those a healthcare organization serves as well as those who comprise it. And it is the very type of organization you build that will support and sustain these efforts. This evident focus on the people of MetroHealth directly offers a clear insight to where some of the greatest opportunities can be found and successes realized in working to positively impact the overall patient experience.

Reinforcing a Commitment to Community
As I closed our Regional Roundtable hosted by The MetroHealth System the day after my On the Road visit I had the chance to publicly thank the incredible team from the Office of Patient Experience for their efforts and found myself moved. In experiencing this organization with roots almost 200 years in length and with a role as the community’s hospital you had a sense of the true and pure nature of what we are all trying to achieve in healthcare. By providing for the best in experience – that is the highest quality, safest and most service focused encounter – we in healthcare are reinforcing our commitment to care for those in the communities we serve.

In looking at the powerful triangulation of efforts, from an experience strategy that covered practical efforts to physical settings, the comprehensive effort to engage patient and family voice and the clear commitment to ensuring the best team possible, MetroHealth has begun to build an organization that can serve as an exemplar for us all. Experience efforts aren’t simply about how much you can invest, but rather their significance emerges in a commitment to something bigger, that can be done within manageable means and with a clear line of sight to why this work is important. Dr. Laskey and her team have made clear commitments and investments and taken on focused actions with one thing in mind. To provide the best for those they serve. That is a commitment to all we do in healthcare and one we should never stray too far from.

Thanks again to Dr. Sara Laskey and Jennifer Lastic for their support of this visit and in making the entire team from The Beryl Institute feel at home. Your efforts are to be admired and I hope others will take the time to learn from you.