Patient Experience Planning and Collaborative Action for Improving Results

On the Road at The Beryl Institute Regional Roundtable Chicago – September 2012

by Jason A. Wolf

The latest On the Road took us to Chicago and to Northwestern Memorial Hospital, our host for the most recent Regional Roundtable from The Beryl Institute. Most often on our On the Road visits we spend time in a hospital or with a healthcare system learning about their patient experience journey in order to help others gain insight from their successes and challenges. For this issue, we will be sharing the stories that emerged and the learning generated in bringing together leaders from numerous organizations for an interactive dialogue on key patient experience issues.

The roundtable brought together healthcare executives and leaders committed to improving the patient experience for their organization, facility or system. This working event focused not only on creating valuable connections but also engaged participants in rolling up their sleeves and developing actionable plans they can implement in addressing patient experience issues.

The session began with an inspiring presentation from Liz Jazwiec, a former vice president of patient care and director of emergency services at Holy Cross Hospital in Chicago. Liz also authored the book Eat That Cookie and spoke passionately about the importance of workplace positivity in impacting the patient experience. In sharing her experiences in driving improvement, she challenged participants to consider how to create a positive workplace for all staff members.

She offered a number of significant considerations for healthcare leaders as she discussed the importance of accountability in healthcare organizations. One of her greatest lessons was that when she was not holding her own team accountable, she was actually stealing their success. The idea of accountability is not just accomplished through promises or checklists, but through the actual rigor of leaders in personally reinforcing expected behaviors and correcting misdirected action in the moment it happens. She suggested, “What you permit, you promote!” In support of this, Liz also reinforced the importance of recognition in ensuring accountability, adding, “What’s recognized, gets replicated.”

Liz then drove home the point that we need to reconsider our strategies for creating an engaged workforce. She offered the following thought, with all the effort to ensure staff manages what is expected of them, we cannot build our efforts on the idea that buy-in is a path to success. Rather in an environment of accountability, she shared, “Buy-in is not a strategy, it is a result.” The bottom line of creating and reinforcing accountability is buy-in, rather than it serving as a means to the end. This leads us back to the point Liz made that vigorously reinforcing accountability is where you can achieve the greatest outcomes.

Framed by the powerful lessons shared by Liz, the core of the workshop focused on a highly active dialogue among participants. The central purpose of the Regional Roundtable is to connect participants and engage in the creation of actionable plans on critical patient experience issues. To this end, the attendees reviewed a number of experience issues in the healthcare workplace and identified the top issues they face today in improving the patient experience. The central areas of discussion addressed a range of important topics. The topics selected also tell the story of where patient experience efforts are focusing today. They were:

• Building a Culture of Accountability
• Creating a Culture of Service
• Physician Engagement
• Creating a Patient Experience Training/Education Program

Interestingly enough there seems to be a consistent theme emerging, with the topic of accountability, service culture and physicians also being highlighted as central points of focus in previous roundtable events as well. Once the topics were selected, participants split into four work groups to definine the issues and build action plans they could use when they returned to their organizations. The plans were reviewed with all participants for feedback and discussion. The outcomes shared clearly represented both the opportunities and challenges organizations are continuing to face in improving the patient experience.

What did we learn in exploring these topics?

1. Driving a foundation of accountability to support patient experience efforts remains a work in progress. This topic addressed the ideas of both clarity of purpose and consequences for action. In ensuring accountability, key steps include setting clear expectations that are shared by all, establishing consequences for action and inaction, providing opportunities for recognition and empowering staff to act. Success in sustaining accountability hinges on a clear definition of expectations and consequences for action/inaction, consistent communication and an ongoing evaluation of resource needs and performance to expectations. It was also stressed the importance of staff training and organizational leadership that is intent on acknowledging and reinforcing the requirements of accountability with consistency and rigor.

2. Organizations continue to focus on strong service culture as a cornerstone of patient experience success. Culture is a core component of the patient experience. This idea is central to The Beryl Institute’s definition of patient experience: the sum of all interactions, shaped by an organization’s culture, that influence patient perceptions across the continuum of care. Creating a culture of service is not an overnight occurrence, but rather takes intentional effort and a structured process to achieve. While each organization will most likely move at its own pace, the key elements include securing executive commitment, setting standards, defining your specific culture of service vision, detailing baseline measurements and goals, recruiting & training staff, communicating consistently, and measuring performance for success. The key is to ensure staff at all levels are engaged and have a sense of ownership for the type of culture you want to create.

3. Physician engagement remains a critical component in creating positive patient experience outcomes. The way we have structured the healthcare system, especially in the United States , physicians often face a different set of expectations and incentives from their peers in healthcare organizations . They also may have to deal with a different set of perspectives and expectations from the patients (and their families) to whom them provide care. There is an opportunity to engage physicians in institutional strategy by coaching and mentoring physicians around patient experience, providing ongoing education on the issue, and giving individual feedback on the metrics such as patient surveys or HCAHPS scores. This also includes improving the incentive structures for physicians who work to address patient experience overall. Here too, it comes down to setting clear expectations, providing feedback as needed, coaching for improvement and following up on performance. This might include the idea of leader rounding on physicians in the same way you would staff. There is great opportunity in engaging physicians as partners in the improvement of patient experience.

4. Working to establish patient experience training programs is emerging as a means to engage staff members in experience efforts. Healthcare organizations are working diligently to build patient experience training programs that develop and enhance the skills needed to deliver an exceptional patient experience. While there is a concern that training may be a strain on resources (be it time, money or others), there is a growing recognition that ensuring a working knowledge of what patient experience is and an understanding of the actions required to address it, are central to the overall healthcare effort. It also reinforces a subtext to this topic, which is the need to have comprehensive programs for identification and selection of the best talent for healthcare organizations. The underlying point being that while you can train people on the basics of skills and process, you can do very little to change the underlying attitudes and behaviors of staff members across the continuum of care.

While the Roundtable focused on the four topics identified by the participants, it remains clear as the dialogue represented that improving the patient experience requires a broader range of actions. One significant discovery across the discussions held among participants was the reinforcement of the need for a solid definition of the issue and its importance and the clear recognition that to ensure success there was a need for clear and sustained senior leadership support. The participants acknowledged that while these issues were selected as priorities, they were not distinct items, but part of a comprehensive and integrated effort to improve the patient experience overall.

The opportunity to share practices that improve patient care and the overall service experience is significant, and an often overlooked means for healthcare leaders to address critical issues. All too often the competition for market share or recognition trumps the opportunity for collaborative action that will significantly impact the patient experience for all who enter the healthcare system. A core commitment of The Beryl Institute will remain to provide the space for these important conversations and the sharing of ideas that will impact the patient experience overall.

The Chicago Regional Roundtable supports the critical conversation and represents the type of collaborative dialogue necessary to address the patient experience. The dialogue will continue this November in Orlando, hosted by Florida Hospital. Regional Roundtables provide the opportunity for real ideas to emerge that have been tried and tested in practice. They also allow for the pushing of boundaries in the thinking of how we can continue to improve patient experience. They bring practitioners together for a day to collaborate in the interest of improving the patient experience with the realization as one attendee stated, “we’re all in this together.”