Advocate Health strives to listen to groups of patients and individuals, then redesign care at scale.

Patient experience is crucial for healthcare organizations because it impacts health outcomes and patient satisfaction. A positive patient experience leads to greater patient adherence to care plans. A negative patient experience leads to decreased patient loyalty.

Advocate Health, which operates 69 hospitals, tracks patient experience for more than 6 million patients annually and implements related redesign of care at scale.

Listening to the feedback of millions of patients then redesigning care based on that feedback is a differentiator for Advocate Health, according to Bradley Kruger, MA, MBA, vice president for patient experience at the Charlotte, North Carolina-based health system.

"We get more than 2.5 million patient experience surveys back every year," Kruger says. "That is a lot of feedback, and the patterns we see are actionable."

An example of patient experience feedback that is actionable in real-time is related to medication, Kruger explains. A patient may have a medication change, and with that change, they could not afford to pick up their script.

"We have feedback loops hard-wired at the clinic level," Kruger says. "When we get feedback, we call the patient and learn more, then help them get the resources they need to get their medication."

Advocate Health aggregates other feedback and looks at the patterns across different groups of patients. Scale allows the health system to hear things that other health systems may not hear, according to Kruger. For instance, during this year's flu season, there were a lot of RSV cases, so there was a large respiratory illness spike in January and February that resulted in patient feedback.

"We could see the impact that spike had on patient experience, quality, and safety through listening and feedback," Kruger says.

Advocate Health is taking the information it gathered on the respiratory illness spike and planning for the future.

"We found that patients needed information on access urgently and acutely," Kruger says. "Wait times became a concern for patients in the emergency room and urgent care centers."

By listening intently to patient experience feedback, Advocate Health also implements changes based on the experience of individual patients.

"We had a patient at Advocate Illinois Masonic Medical Center in Chicago who had been hit by a car while riding a bicycle and came into the emergency room," Kruger says. "As part of the care process, she had to have her hijab cut off. She put into her survey feedback how unsafe that made her feel."

Advocate Health investigated the incident and looked for ways to avoid a repeat patient experience.

"We partnered with a Muslim-owned startup that makes disposable hijabs," Kruger says. "Now we have disposable hijabs stocked across the enterprise."

Bradley Kruger, MA, MBA, is vice president for patient experience at Advocate Health. Photo courtesy of Advocate Health.

Using volunteers to improve patient experience

Advocate Health is using volunteers to boost patient experience.

"At Advocate Health, we have more than 10,000 volunteers who contribute more than 500,000 hours of effort every year," Kruger says. "That time supports patients at the bedside—we are using the volunteers to improve patient experience, quality, and safety across the organization."

One volunteer initiative uses 100 virtual volunteers who are mainly pre-med students.

"They learn how to navigate Epic and how to talk with patients," Kruger says. "They call patients within 24 hours of them being admitted to a hospital, mostly patients over the age of 65 who have been admitted from the emergency room."

The virtual volunteers welcome the patients and ask whether there are any family members that they would want to contact. If they do, the volunteer can reach out to family members and connect them to the patients.

The virtual volunteers also ask patients whether they left any essential items at home before they were hospitalized. For example, if a patient comes to the emergency room via ambulance with trouble breathing and they are admitted to the hospital, they might have left their hearing aids or glasses at home.

"In the past, this would be communicated to a nurse, and the nurse would have to call the family," Kruger says. "Now, a virtual volunteer can take this task off the nurse's plate—the volunteer can contact the family and coordinate pickup and delivery of anything the patient may need that was left at home."

Volunteers are a touch point that can personalize and individualize the patient experience, Kruger says.

Keys to patient experience success

To provide a positive patient experience, listening is crucial. According to Kruger, leaders must put aside any premise they may have as an individual, healthcare leader, or health system and listen to the patient

"You need to ask questions. You need to ask what you can do to improve," Kruger says. "It needs to be a continuous process that becomes part of your culture. We are constantly listening, then by acting, we move into innovation."

Health systems should constantly look for new ways to engage patients, Kruger explains.

"You need to look at creating new communication pathways or implementing new technology to help a specific group of patients feel that they understand their plan of care, understand their medications, and understand how to live their healthiest life," Kruger says. "You must utilize resources across the health system to help achieve these goals."

Health systems need to listen to their patients then act on the feedback, according to Kruger.

"Listening then acting tends to move healthcare organizations and drive innovation," Kruger says. "It also provides the ability to use new technologies in a way that moves outcomes and personalizes care for patients."

Physicians should lead physician oversight efforts, according to this CMO.

Robert Kopec, MD, MBA, became vice president and CMO at Morton Plant Hospital on March 30. The hospital is part of Clearwater, Florida-based BayCare Health System. He has held several leadership roles at BayCare, most recently serving as CMO of Morton Plant North Bay Hospital.

According to Kopec, clinical oversight of physicians is best accomplished through other physicians.

"Physician oversight is best done by other physicians—meaning that physicians want to be overseen by other physicians who are in their specialty," Kopec says. "For example, it is hard for me to make any kind of oversight comments in women's health, where I do not have the background of obstetrics or gynecology."

Physician leaders who serve as department chiefs are well-positioned to provide physician oversight, according to Kopec.

"It is important to have strong department chiefs who help to drive opportunities for improvement and to find specifics where physicians need to improve on certain diagnoses in terms of length of stay and readmissions," Kopec says. "It is helpful to have those strong physician leaders to lead oversight by peers."

Peer reviews should be confidential, fair, and evidence-based, Kopec explains, and physician oversight should be provided in a culture that is non-punitive.

"We are all human—there are going to be mistakes," Kopec says. "As long as there is no pattern to mistakes and there is no other egregious nature to mistakes, we can always learn from something that has happened in order to make sure that we drive positive change."

To establish a non-punitive culture, CMOs and other healthcare leaders should focus on processes rather than people, according to Kopec.

"The processes are what drive a lot of the issues that arise in a hospital," Kopec says. "The leaders of service lines need to understand the importance of processes and to impact them positively."

A pivotal element of physician oversight is having clear expectations for a medical staff, Kopec explains. This can be accomplished by making bylaws, rules, regulations, and policies as transparent as possible.

"Our physicians can look at them any time online," Kopec says. "You need to consistently enforce those policies and bylaws with each physician or advanced practice provider."

Finally, physician oversight should include rewards and recognition. At Morton Plant Hospital, Kopec says this happens on an annual basis.

"For example, we have a Physician Leadership Award that is given every year," Kopec says. "We highlight physicians who have exemplified extraordinary care."

Robert Kopec, MD, MBA, is vice president and CMO of Morton Plant Hospital, which is part of BayCare Health System. Photo courtesy of BayCare Health System.

Keys to success in infection prevention and control

Several factors drive success in infection prevention and control, according to Kopec, who previously served as medical director of infection prevention and control at Morton Plant Mease.

"You not only need a strong infection prevention team," Kopec says. "You need to make sure that you have a strong environmental services team that helps to maintain a clean environment."

At Morton Plant Hospital, they have implemented Tru-D, which is a technology that uses ultraviolet light for disinfection.

Kopec explains that hospitals and ambulatory surgery centers should have a strong sterile processing department that helps maintain surgical instruments to make sure they are sterile for surgical procedures.

A hospital's pharmacy department also has an essential role to play in infection control and prevention, Kopec explains.

"You also must have a pharmacy that assists with antimicrobial stewardship—pharmacy makes sure that the right antibiotic is used," Kopec says. "You want to use the most narrow-spectrum antibiotic for the shortest amount of time."

At the national level, nearly 50% of the antibiotics that are given in the hospital setting may not be necessary, according to Kopec.

"We do our best possible with our pharmacy team to make sure that if we are using antibiotics, we are using them for the shortest time possible for a specific disease process," Kopec says.

Infection prevention managers and infection preventionists should conduct daily surveillance of medically needed devices such as urinary catheters and central venous lines, Kopec explains.

"We try to discontinue as many urinary catheters as possible," Kopec says. "When they are medically necessary, we need to make sure urinary catheters and central venous lines are maintained properly."

Successful physician engagement

To promote physician engagement, CMOs and other healthcare leaders should focus on creating an environment where physicians love to work, Kopec says.

Encouraging physicians to express their opinions is also crucial in physician engagement. Kopec says his organization’s leadership has an open-door policy to hear from physicians all the time, not just in department meetings.

"We want to hear from physicians as soon as something comes to life and is an issue in their world," Kopec says. "We want to be a part of the solution, and we want physicians to help drive change."

Physician engagement requires open communication and an understanding that when change is needed, CMOs and other healthcare leaders need to support that change. Kopec emphasizes that patience is an essential element of supporting change for CMOs and other administrators.

"You must understand that there are going to be certain people who are early adopters to change and some people who are late to adopting change," Kopec says. "You must be patient when there are things that need to be improved."

The new campaign will address a range of issues, including rural healthcare, challenges in post-acute care, and the state of mental health services in New Hampshire.

Dartmouth Health has launched a public education and patient engagement campaign, The Thread.

The healthcare system is notoriously complicated, and The Thread is designed to educate patients, policy makers, and members of the general public about key healthcare issues.

"One of our greatest motivators for launching The Thread is that historically a lot of our campaigns have been driven by informing communities about the services we offer, and we wanted to go beyond that approach," says Maria Padin, MD, CMO of the Dartmouth Health Southern Region/Community Group Practices. "We are the only academic medical center in New Hampshire dedicated to education—not only the education of our future clinicians, but also the education of the public."

In this edition of HL Shorts, Padin discusses Dartmouth Health's goals for The Thread. Click on the video below.

The National Labor Relations Board has rejected the health system's bargaining unit objection.

The National Labor Relations Board (NLRB) has ruled in favor of Mass General Brigham (MGB) primary care physicians who are seeking to unionize.

Primary care physicians at MGB began organizing efforts for a union last year with the Doctors Council, the country's oldest and largest union of attending physicians. MGB filed with the NLRB seeking to block the unionization effort by arguing that many of the 400 doctors trying to unionize did not belong in the same bargaining unit.

The April 18 NLRB ruling rejected MGB's claim, clearing the way for the primary care physicians to hold a union election in May.

MGB declined a HealthLeaders' request for an interview about the NLRB ruling, but the health system provided a prepared statement.

"Primary care physicians are critical to the health of our patients and community," the prepared statement says. "We know that PCPs across the Commonwealth are facing unprecedented volume and stress as a result of a confluence of factors that are not unique to our organization. We share the common goal of offering world-class, comprehensive care for our patients and believe we can achieve this best by working together in direct partnership, rather than through representatives in a process that can lead to conflict and potentially risk the continuity of patient care."

The prepared statement says MGB is reviewing the NLRB ruling.

Zoe Tseng, MD, a primary care physician at Brigham and Women's Primary Care Associates of Longwood and a union organizer, told HealthLeaders that her colleagues were confident the NLRB would rule in their favor.

"We expected this outcome," Tseng said. "We were confident that the bargaining unit that we had established was the proper one—it included all primary care physicians."

Tseng called MGB's bargaining unit objection a delay tactic.

Doctors' motivations for forming a union

MGB's primary care physicians are seeking to unionize for several reasons, including the lack of a voice in decision making and onerous working conditions, according to Tseng.

"We have had a very limited voice in the decisions over the years, and it has gotten worse," Tseng said. "We want to be able to represent the patients and the clinical staff that we work with. We want to advocate for resources and the services we need to do adequate primary care for our patients."

"We have understaffing—there are not enough staff to help us with administrative tasks, whether that be paperwork, getting patients the prescriptions they need authorized, or answering phone calls," Tseng said. "That burden is falling on primary care physicians as we try to see patients."

MGB has not invested in primary care, instead concentrating on more lucrative specialty care, according to Tseng.

"They have had the opportunity to lead in investing in primary care as a world-class institution, but they have chosen not to," Tseng said. "Instead, they have built up their specialty care."

Primary care is an essential service for a high-functioning health system, Tseng explained.

"You get into a crisis when you do not build a foundation for primary care," Tseng said.

Forming a union will give the primary care physicians more sway at MGB, according to Tseng.

"The reason for the union is so we can hold them accountable for all of the things that we need and they have promised," Tseng said. "As we have seen over the years, promises have often been empty."

Photo: Primary care physicians affiliated with Mass General Hospital and Brigham and Women's Hospital (BWH) hold an informational picket line outside BWH in December.