Culture & Leadership | Global Perspective

PX Competencies: Making Experience a Priority, the VA Way

I suspect that very few of us worked our entire careers in patient experience. We came from other areas, but eventually we found it or it found us. For me, it was a temporary detail that led to an interest that led to a passion. Try not to laugh, but my undergrad is accounting. But measuring operational output and designing operations to achieve specific outcomes turns out to be a very transferable skill.

Early on, our Pathways nurse pointed to “Hardwiring Excellence” by Quint Studer as a starting point. What amazed me was not that the content was new or innovative; rather that it was organized into a 300-page operations plan that was easy to follow and included many catchy phrases to remember the key points. “Inspect what you expect” really resonated – maybe because of the auditor in me (honest, that’s not profanity) or maybe hearing Reagan’s “trust… but verify” many times as a child of the 80’s (refers to the Soviet Union’s agreement to reduce nuclear arms, for those of you too young to know.) 

Expectations are challenging. First, you have to create them (hopefully with front-line staff buy-in.) Then you have to convey them. Then… that’s where it often stops. Then the numbers come in lower than expected. What could possibly have gone wrong?? Everyone signed the Behavior Standards. Everyone got emails. Everyone took the communication training. But how often do we go back to see whether people are living up to the expectations? We’d never give surgeons scalpels after they sign off that they read a book on surgery. Why wouldn’t we do the same for other practices? We establish competencies for so many tasks in health care; it’s natural that we would develop them for practices and behaviors that drive patient experience. So… we did. 

The documents aren’t perfect or complete but give a starting point and range expectations for various roles in the organization. All are derived from some proven tactic that drives patient trust, alleviates frustration or concern, and supports HRO principles. To support psychological safety and to build awareness of patient experience as an organizational priority, we are slowly implementing them as feedback tools and for reinforcing expectations – not quite how true competencies are used. As an individual organization, we have to achieve competence in these practices and behaviors across the enterprise, or we risk losing patients to organizations that are more competent. As an industry, we should strive to achieve it, because we value our patients and our relationships with them. 

Outpatient Nurse

Mental Health Outpatient Provider

Primary Care Outpatient Provider

Specialty Care Outpatient Provider

Medical Support Assistant


ED Provider

ED Nurse

Ambulatory Care Nurse

Ambulatory Care Provider

Inpatient Nurse

Inpatient & Resident Provider

Author Bio:

Fred Lesinski is the Chief of Community Engagement & Veteran Experience at the Ralph H. Johnson VA Health Care System in Charleston, SC. Fred is a native New Yorker, Desert Storm US Air Force Veteran as an AWACS crew member, and a graduate of the University of Oklahoma.