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Making Patient Experience Initiatives Stick

HealthLeaders magazine, November 13, 2009

HEALTHLEADERS: What is the role of leaders in the patient experience?

HENVEY: It's all about leadership and it starts with them. Are they transparent with the data? Are they as passionate about this as they are everything else that they do? Are they living it? Are they genuine about what they're doing with that? The CEO has to lead it in a genuine way along with board members. For us, it starts with the board chair for the health system and cascades down through the other system boards. After that, it comes down to the CEO for the health system. Then it breaks down to everybody. In our case, that's 7,000 coworkers. My goal is to create 7,000 senior VPs of service excellence.

KEYSER: The board and executive team are the champions. You find out if leaders are serious by looking at their calendars and checkbooks. At the operational level there are a host of strategy leaders. My role as an executive is to create and connect tactics that people can deploy every day.

GNIDA: One of the changes we've seen is the commitment from leadership at the board level and the CEO level to create positions like Sean's and Rick's: someone at the VP or senior VP level who has authority to implement patient experience initiatives. It used to be one person in marketing trying to get all the nurses involved—and the results were mixed at best. The best practice model is to build a team that's capable and tasked with doing these things.

KEYSER: It helps to have one person whose only agenda is experience. We can say that everybody owns it. But you need somebody who gets up every day and asks themselves, "What did we do today that was a part of the operational implementation of this experience?" Someone's got to be thinking about the steps and the plans and the timelines and the human beings and the materials and the resources.

HENVEY: For years we've had a CFO and a chief quality officer. So those got the attention. Now we know that to focus on service and patient experience, you have to have somebody taking charge of it, someone who knows operations.

Engaging physicians

HEALTHLEADERS: How do you engage physicians in patient experience, especially those who might be reluctant to embrace it?

HENVEY: You can't just walk in and talk to a physician about changing everything. A lot of leaders and board members think you can just tell doctors what to do. You can't unless you have a relationship. I'm 110% behind physician champions. But you've got to develop them. Every six months I take a group of physicians to a conference put on by physician leaders to drive excellence. Everyone I've taken out there, every one of them, has had some sort of spike in their outcomes. And they had more buy-in.

NYSTROM: On the floor, we've changed a lot of the processes. It's not your traditional way of delivering care. We do multidisciplinary rounds. We have charts in the room. Our pharmacists are interacting with the patients. There's a certain workflow that the physician has to be involved with in order for it to run smoothly and effectively. There's been a lot of resistance but we're making steps in the right direction. Physicians start to embrace it when their patients tell them about their experiences and their patients have better outcomes.

KEYSER: We have to have a philosophical shift from thinking of physicians as customers to thinking of them as partners. Two of the seven members of our system executive team are physicians. There is a physician leader in every market along with the market presidents. That's a symbolic statement of the partnership with physicians. If we have physician leaders talking to physicians there's a greater chance they'll have some degree of engagement. We're starting conversations with, "We want the same thing—a remarkable experience for your patients. Getting there is not going to be easy. It's going to mean that we're going to have to support you more effectively at the system level. It's going to mean that you work to understand and respond to their expectations. It's going to mean making some tough choices." We weren't making the best strides with the physicians before we started having meaningful conversations about what a remarkable experience looks like and agreeing that this is not going to be easy work to do.

HEALTHLEADERS: Are physicians starting to recognize that patient experience is not a fad?

GNIDA: It's not so much that physicians are against us as much as they're just not informed. We've never really included them in terms of what we're doing, our strategy. Also, they need to see tangible results and hear the stories from their patients. Ultimately, there's nobody who cares more about our patients than the doctors. Physicians push back at first but once they get it, they are the best champions you have. They're the ones who help drive this.

KEYSER: Experience isn't part of medical training. That doesn't mean they don't innately understand that patient care is about experience. But it requires behaviors, processes, and systems. We're asking them to consider an entirely new body of knowledge. They have to be introduced to it and understand what that means in terms of behavioral change. For many of them it's natural, but for some it's not.

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