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Creating Accountability for Patient Experience

Philip Betbeze, for HealthLeaders Media, February 13, 2012
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"We made it more abstract. The idea being, let's just tell our people that anything that affects the patient outside the delivery of medical care is patient experience."

Not that they don't strive to do well on metrics like HCAHPS and other patient experience measures, but Merlino says he wants to avoid a "teaching to the test" mentality that may result from an exclusive focus on how the hospital system performs on measures that might affect reimbursement.

Rather, a more holistic approach is needed to fully incorporate the core idea of patient experience—that one bad experience can ruin the whole effort. By focusing exclusively on measures that are on the HCAHPS survey, essentially, you're missing both the ethical obligation to do best for the patient at all times, as well as the potential long-term benefits of patient loyalty.

"One bad interaction can define the impression," he says. "This is well documented in retail and other service businesses."

So how does one begin to incorporate accountability and responsibility for a patient's experience throughout the institution?

In stages, he says.

HCAHPS' focusing role
At the beginning, despite his misgivings, Merlino did focus on HCAHPS scores. He explains: "We chose HCAHPS initially not because we're chasing numbers, but because it was the only thing that had leverage. If you don't do it well, you will be penalized financially. We had started on this journey for the right reason before HCAHPS, but needed something to focus on."

But more important was to get the message to everyone who works in the hospital that each of them is responsible for patient experience.

"You can talk to anyone at our main campus and ask them about patient experience. They will say it's important and they are part of it," Merlino says.

Merlino says Cleveland Clinic faced an interesting challenge culturally, because it had always been thought of as an organization founded by doctors, for doctors. Instead, it's for patients, Merlino says, and the rest of the employees, whether they regularly encounter patients or not, have at least as important a role to play in patient experience.

Cleveland Clinic took a big risk to deliver that message to the entire staff of 42,000 employees by taking them offline over a period of months in small group sessions that lasted a half day. Everyone spent valuable time, from neurosurgeons to housekeeping staff, discussing why it was important, how everyone is in this together, and service excellence standards and how to improve.

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3 comments on "Creating Accountability for Patient Experience"

Sue Wintz, BCC (2/15/2012 at 12:14 PM)
Excellent article that states clearly that patient experience can't be measured only by focusing on numbers. As a board certified chaplain, when I am asked to see an "unhappy patient", what I hear from patients is a wide range of emotions, beliefs, and values that have not been addressed in their plan of care. Whether the room is clean or the transporter greets them with a smile doesn't replace the need for patient and family centered care that looks beyond superficial "fixes." As health care providers, we often forget in our routine work that the experience is new to our patients: they are fearful, anxious, trying to find meaning in their illness or injury and what lies ahead. The other issue that is key is the statement in the article: "We needed a culture of engaged and satisfied caregivers. If we don't get that, we don't get to any other level." I agree that there must be buy-in from leadership, however leadership needs to come to the clinical units, spend time with the staff and patients, and really understand the load that is placed on caregivers - from MDs and RNs down to housekeepers. Simply pronouncing that one more layer of expectations on already burdened staff isn't going to make the difference. Find out what it is that engages the workforce and what needs to be done to bring their level of satisfaction up. Chaplains often hear from staff that they, too, are wrestling in the midst of their workload to find meaning and a sense of respect for what they do. The experience of staff does matter when an organization is seeking to increase the satisfaction of their patients; one cannot be addressed without the other. Leadership: ask your chaplaincy staff about the importance of beliefs and values on both patient and staff experience. You will find valuable input.

Kristin Baird, RN, BSN, MHA (2/14/2012 at 9:07 AM)
Thanks for a great article. The real teeth behind a great patient experience is the culture which requires dedicated leadership and clear accountability. I often see healthcare leaders panicking about HCAHPS and then scurrying to enroll front line staff in "smile lessons." In this attempt to fix what's broken, they end up with a short term surge followed by a return to "business as usual." The examples you cite here demonstrate that it takes a compelling vision articulated by top leaders and driven by front line managers who hold staff accountable and know how to coach,mentor, model and manage for consistent service behaviors. That won't happen through sheer hope, it must be by design and without ever taking your eye off the ball. As for a definition - I ascribe to The Beryl Institute's which is - "the sum of all interactions, shaped by an organization's culture, that influence patient perceptions across the continuum of care."

Jason Wolf (2/13/2012 at 4:11 PM)
You pose an interesting challenge as it pertains to the patient experience. In speaking with leaders around the country your article captures some of the very keys we saw that can drive patient experience success. First and foremost is a DEFINITION. In working with healthcare leaders around the US they helped us define the patient experience as "the sum of all interactions, shaped by an organization's culture, that influence patient perceptions across the continuum of care". In fact, recent research from The Beryl Institute has shown that only 27% of healthcare leaders actually have a definition for patient experience. The key in the definition is as Dr. Merlino shares about the Cleveland Clinic experience or Dr. Feinberg talks about at UCLA, that the patient experience occurs at every potential encounter. More importantly it is grounded on the culture of an organization...the people, expected and accepted behaviors and the very way in which a healthcare organization engages with its patients and families. The last key in the definition is that patient experience is not just within the four walls of the clinical experience...but must be part of a systemic effort that starts well before the clinical encounter and continues well beyond its completion. Second, after definition, organizations need to consider a FOCUSED ROLE to drive patient experience efforts. Dr. Merlino serves at a senior level as the Chief Experience Officer for the Cleveland Clinic. While not everyone needs that title, having a senior level leader with not just accountability, but full ownership for the overall experience ensures greater success. Third, healthcare organizations need to recognize that experience is MORE THAN A SURVEY, teaching to the test only gets you good test scores, not necessarily powerful experiences. Lastly as your article suggests is the COMMITMENT OF LEADERSHIP. It may seem cliché to say it starts at the top, but the same study mentioned above revealed that the top driver of patient experience success, recognized by more than 72 percent of respondents, was strong, visible support from the top. Would love to know other's thoughts on these priorities as well as these research results.