A Strategic Perspective on the Patient Experience

On the Road with WellSpan Health – October 2013

by Jason A. Wolf

Our October On the Road led me to the rolling hills of central Pennsylvania and the first signs of fall. But amidst the cooling air and changing leaves was a healthcare system hard at work on a broad effort to impact the experiences of patients and families touching all aspects of the care continuum. My host, and Patient Experience Advisory Board member of The Beryl Institute, Jamie Markel, planned a day to see the various levels of the experience effort both up and down and across the organization. From systemic perspectives and strategy, to front line practices and engagement efforts, a broad effort to address the patient experience was evident. The team at WellSpan is hard at work looking both within and outside their organization for the proven practices and ideas that will support their performance. The examples they provide show us the true pride and purpose with which they address this important cause.

A System View – Patient and Family Experience Steering Committee

My visit was shaped by an early morning meeting with the Patient and Family Experience (PFE) Steering Committee. Comprised of senior leaders and key players in the experience efforts at WellSpan, the committee was a standing group responsible for the oversight of patient and family centered care initiatives and customer service strategies. This was a powerful statement of commitment in that not only has WellSpan committed to an experience leader, but they are also engaging a critical cross-section of leadership voices in their improvement efforts.

The group was chaired by WellSpan’s SVP/Chief Human Resource Officer, Bob Batory, and includes individuals from across the entirety of the system. Members represented Nursing and Clinical Leadership, Physician Champions, Patient Access, Marketing and Planning, Outpatient/Ambulatory and Experience Directors from the front lines. This powerful collection of roles enables a comprehensive conversation about the experience issues facing the system. As a standing and regular meeting, coming together also has afforded the team an opportunity to refine and focus the system’s experience efforts over time.

Most significantly could be that with the bringing together and alignment of various roles and perspectives, the group also has a clear focus on the overall strategy of the organization. As one of nine core elements of the system’s strategic plan, providing a patient and family centered experience is clearly linked to other elements of the overall plan. The PFE Steering Committee ensures this by working on big issues to drive overall efforts. At the end of the day the team collectively agreed their role was to support and ensure success in this strategic element. In doing so they have to provide clear direction, set strong expectations of their people, provide the best tools, resources and technology, and recognize that the effort never truly stops.

This last point is an important one, not just for the fact that it has pushed the PFE Steering Committee to continue to explore opportunities in an ongoing way, but also because I see time and time again those places that form experience task forces, or launch patient experience initiatives to create finite and static solutions without realizing significant sustainability. As a standing group, the committee works the big issues, brings in various perspectives and can disseminate and support new ideas quickly for the benefit of the organization overall.

The Power of PFACs

From the experience of a systemic and strategic focused group, I was also introduced to the Patient-Family Steering Committee. This group, comprised of leaders of the system’s numerous patient and family advisory councils (PFACs), comes together regularly to share their efforts and support each other’s actions. While individual PFACs may follow different paths in purpose, use and frequency, there was incredible consistency and alignment around the power of patient and family voice. One leader noted that not only did they see great engagement from patient members, but they too showed growth in understanding, awareness and ultimately broader contributions that added value to the overall care experience.

What was compelling and unique from other PFAC experiences I have had, was the collaborative, connected and broad nature of PFAC use. There was not just a system level PFAC or facility focused one, but rather a collection of councils that touched on all aspects of care and each had their own stories of practices identified and successes achieved. Perhaps as important was the inspirational nature of these councils and their impact on these leaders themselves. In fact one individual offered that while there was resistance at first to using a PFAC and challenges to its purpose and value, once things got underway and patients and families were actively involved and these leaders had engaged teams, it became a motivator for both intentional action and for personal engagement. She added, “Now that we have the PFAC implemented, it is what gets me up and excited to come to work in the morning!”

Aside from espousing the power of PFACs, I often get the question of how do I get a PFAC started, how to keep them moving forward, how can I best use them in our organization. To dig into this further I asked the group for their recommendations for others in starting, building and sustaining an effective PFAC effort. The group returned with a very clear list of twelve ideas, including:

• Clarify your core purpose from the start and share how priorities and results will be shared.
• Have clear, specific and measurable goals that are driven by the council members.
• Don’t limit yourself. You don’t really know what will be raised or what you can or can’t do until you try.
• Don’t wait for the perfect number of advisors to get started. Start when people are ready and take advantage of the energy and commitment to build interest.
• Ensure member diversity to the broadest sense beyond just physical attributes or other core distinctions, including broad perspectives and ideas.
• Create a standardized orientation process to ensure consistency in understanding of role, expectations of participation, behaviors, etc.
• Be mindful of the time needed. These are not commitments to be taken lightly, but it should also be recognized that most members are volunteers with other responsibilities or commitments.
• Ask key questions up front: What are the major concerns? Take time to identify issues and solutions to get the group comfortable in their role.
• Be mindful to set ground rules. These are solution groups, not complaint or therapy sessions.
• Be willing to manage members. Have a clear selection process, including referral opportunities with clear and rigorous criteria.
• Create clear talking points to keep messages and communication on task and to help members understand key issues and objectives.
• Don’t try to do too much. Focus on a few key items as targets for shared success.

The valuable lesson from WellSpan is that there is more to effective implementation and use of PFACs than one might normally put in place. It is more than simply bringing a group of people together. PFACs require rigor, they require focus and they must have the clear and intentional support of the organization.

Lessons from the Front Line

As part of my visit I was able to learn about experience efforts on the front lines of care to improve patient experience, in particular at WellSpan’s two main facilities, Gettysburg and York Hospitals.

Leadership

At Gettysburg, Patient Experience Director Tracy Lee reinforced a critical point I continue to see across organizations succeeding at experience improvement. While it is recognized that everyone plays a role in execution, it is the focused and intentional support and reinforcement of leadership that ensures the sustainability of an effort overall. Gettysburg’s President, Jane Hyde, made it a clear priority for the organization that a focus on experience was a must-do for everyone in the organization, it is a clear and unwavering expectation of leadership and is supported at the very top of the organization.

With this strong leadership intention, there was also recognition that front-line engagement and involvement was the means to drive lasting improvement. To support this the facility now holds a daily leadership huddle in which leaders from all departments gather to share news and information as well as identify and address opportunities for improvement. This shared sense of leadership, of true ownership for outcomes, is then reflected in actions across the facility. From the daily huddle, regular department huddles are also held to discuss pressing organizational headlines and identify and address unit level issues.

Tracy acknowledged that while central tactics to drive patient experience success were of value, the strength of the effort at Gettysburg was the power of engaging employees at all levels and educating and reinforcing why their actions in addressing experience are important. Then on this foundation of an engaged staff, patients and families are also engaged in the process in sharing their voice and being true partners in improvement efforts. This simple, yet powerful modeling of staff alignment, clear messaging, broad engagement and leadership focus exemplifies the critical elements of successful experience efforts. There is no need for complicated ideas, programs or processes when you focus on the fundamentals, and the team at Gettysburg does just that.

Bedside Engagement

At York I was able to explore efforts at the unit level and the supporting processes being used to focus on experience improvement. Guided by Customer Relations Director Christine Foore and Physician Patient Experience Champion Elizabeth Hall, we saw some clear ways in which to ensure better experience efforts. The first, Structured Interdisciplinary Bedside Report (SIBR), served as a powerful example of getting all the right players together from the caregiver team to the patient and family. It moved the conversation of care from nursing station to bedside and created a partnership with patients and families around understanding and engaging in their plans of care. We saw a similar process during a recent On the Road visit to Scripps Health.

Elizabeth Hall also spoke about the critical needs to not only engage, but also to educate physicians on their critical role in patient experience. She has built patient experience lessons into their residency program and has ensured that patient stories are heard first hand during grand rounds. She has also worked to reinforce the importance of physician leadership rounding to expand beyond the clinical conversations and reinforce the expected behaviors the facility has for its physicians overall.

York Hospital also had great unit level efforts; one in particular was on the 6th floor surgical unit. It was focused on a plan to engage their patients in the best in experience by supporting them on their healing journey. Laurie Hlodash (pictured with her unit director Mark Kahler) shared how they realized patients were lingering longer and not healing as quickly as they could. The habits patients left with also led to potential readmissions and the associated implications. The solution that emerged was a collaborative effort of staff and patients called “walking for wellness.” This collaborative effort through which patients are acknowledged and rewarded for taking strides towards healing caught on like wildfire, not only in the response of patients, but in the overall scores of the unit.

This effort, integrated with a few additional keys points of focus, such as bedside shift report, helped this unit move from one of the lowest scoring to one of the highest scoring units in the hospital on experience. How did this happen I asked? Here too, it was committed leadership that provided the space for staff driven and supported solutions that engaged the patients themselves. The story of improvement was so compelling that the team has continued to explore ways in which it can continue to improve. This even led to an application for and ultimately receipt of a 2013 Patient Experience Grant.

While a short visit does not provide the chance to explore every practice or discuss every effort across the continuum, it was clear there is a systemic focus at WellSpan. This was reinforced by extensive efforts in the ambulatory setting as well, which was reinforced by data transparency in which everyone could see the scores for all, a shared level of accountability and clear benchmarks of success.

The front line efforts at WellSpan may sound familiar to some. But it should be recognized that it was the ability to see a broader integrated effort in what could truly be disparate pieces that serves as a powerful indicator of the WellSpan commitment to experience excellence. This was also exemplified in the last stop on my visit, an introduction to the system’s patient partners.

The Importance of Patient Voice

I wrapped up my visit at a dinner event in which patient partners were coming together to share the work they were doing with care teams across the system. In fact, there are over 130 patient partners in the system committed to focusing on improvement efforts. Their work is supported by the Robert Wood Johnson Foundation and the Aligning Forces for Quality (AF4Q) effort.

While each of the individual projects was compelling, what stood out for me was the vast level of engagement both encouraged and supported in this effort. In each of the various organizational settings, patient partners were identified, trained and then engaged in solving real problems. The message here is not so much in the “what” was done, but how it was done. From where I started my visit in looking at the strategic implications of patient experience for WellSpan, to the broad use of PFACs across the system, to examples of front line patient engagement and finally the patient partners effort, it was clear that at the core of this strategic effort was a recognition that it could not only be about patients, but had to be worked through and with them as well.

The Power of Focused Intention

No organization I have visited has achieved the perfect experience effort; in fact I would suggest there is truly no such thing due to the unique and personal nature of each healthcare organization and system. With that, I have seen an emerging set of core ideas that are central to a successful endeavor. It was those central efforts I saw at play at WellSpan and from which I think we can continue to learn.

In establishing a focused and supported strategy, in having clear leadership support and presence, in providing for staff engagement in all roles at all levels and in reinforcing the opportunity for significant contributions from patients and families, the effort at WellSpan exemplifies thoughtful and intentional effort and a systemic approach to experience improvement.

During my lunch with Jamie Markel and Bob Batory, they asked my thoughts on the greatest key to patient experience success. I perhaps threw them a curve in saying it is the ability for an organization to recognize it is not “there” and most likely never will be (with “there” being the “perfect” experience effort and outcomes). This is what has exemplified those that tend to outperform. In asking why, I offered that if we believe patient experience is more than an initiative and rather serves as a true way of being for an organization that there is never truly a “there” at which to arrive. To achieve the greatest in experience requires a relentless and unending pursuit of excellence. It was clear to me during my visit that WellSpan understands this and is building its efforts on this premise. I wish them the best on their continued journey and appreciate the gracious time and energy of so many members of the WellSpan team during my visit.