Silence: The Invisible Tool for Patient Experience Excellence

2016-02I must start my comments with a disclaimer that this blog is not about noise reduction, though I still have yet to find an organization that has conquered this great challenge in healthcare today. In fact our own research at The Beryl Institute continues to show noise reduction to be a leading area of focus, public survey results continue to highlight it as a challenge and a simple walk around most healthcare facilities reinforces the opportunity this issue represents.

Interesting enough was that in our own work on the issue of noise and hearing from recognized efforts in the field of healthcare acoustics that we will never and in actually should never strive for perfect silence. Not only would it be unachievable, it would not meet the true needs of so many in our care. Rather what I mean by silence as we look to patient experience excellence is a much different idea. I wish to frame this not as a negative – i.e., the result of suppressing noise, but rather in the appreciative, as the art of creating a space in which we can hear.

I spent the last week traveling the halls of healthcare organizations and was warmed by the buzz of humanity, and embraced by the rhythmic symphony of conversations and footsteps, beeps and clicks all symbolizing the living nature of healthcare. But what was most moving and perhaps most powerful was a lesson hiding invisibly in front of all us in healthcare trying to have a positive impact…it was those subtle moments between the beats that have incredible power.

In providing a sense of silence for those we work with, care for and serve we create a space for their voices to be heard, their ideas to find opportunities to grow. In affording the gift of silence – that is the space of silence – we enable people to feel acknowledged and listened too. Yet we must also admit that of all places healthcare may be the hardest place to provide this space of silence.

What I mean by this is our ability to be with someone so they can express themselves, providing time to think and reply, to open our eyes or inform us even in the face of the great expertise so many bring in this work. In the space of silence we do more to offer a sense of dignity and respect, of care, compassion, and commitment than we almost ever do in providing a monologue pertaining to our expertise. There is a time and a place for that as well.

In a world where speed so often matters and chaos is the foundation of normality, the ability to sit with someone and allow them to be heard is profound. So how can we proceed in this way for better outcomes in all we do? It may be the most simple, yet difficult concept I have yet proposed in tacking patient experience opportunities. Yet I see it over and over, when we take the time to listen for needs, understand pains, work to connect with the human standing across from us that most of all wants to be heard, great things can and do happen.

As an extrovert I am guilty of violating this trust more often that I would like to admit, so I feel comfortable challenging us all in how we can proceed. How often do we provide the space for a reply, invite a comment or simply choose to be with someone by sitting at their bedside, holding their hand. Words at times do more to create our noise problems than anything else. More so we hear from many that in their attempt to be heard we in healthcare often miss their voices…our lack of silence being the very liability we look to avoid.

This was no more apparent to me than in the moving story shared by a brave colleague Tanya Lord who in all she tried to raise about the care of her son in a mishandled post operative situation was simply given the typical responses and they were eventually discharged from care. In many ways to me her story, and the tragic and painful loss of her son, was a bold splash of our cold reality in healthcare. We must find the time for silence and to listen…in those moments we have the greatest chance to change, if not save, lives. We must also acknowledge this is about much more then the act of listening. I am sure many of the folks with whom Tanya engaged listened, they just did not hear. They too missed the art of silence. To be clear, I am not suggesting a silence in which people are not heard, but rather in creating the space in which we actually allow hearing to happen.

If we are to achieve the best in experience for all in healthcare it cannot simply be about what we say or know, the strategies we shape or the tactics we employ. At its very essence it must be about how we as humans choose to address this sacred and critical work. In all that is sacred I maintain the most transforming moments are less often found in the words and more in the silent moments and what they contain in between. If we can intentionally bring silence to our work in patient experience it may be the boldest and I dare say loudest statement of our humanity and all we strive to achieve in caring for one another. I am willing to give it a try…are you?

Jason A. Wolf, Ph.D.
President
The Beryl Institute

Considerations for Patient Experience Excellence: 2016

2016-01 jan2016blogAs we have watched the patient experience movement grow in the last five years of our journey at The Beryl Institute, we have seen increasing levels of commitment to this effort and a refocusing on what matters versus simply what is measured. Many began their involvement in patient experience efforts purely due to motivation by policy, measurement and then eventually financial implications for outcomes. These dynamic shifts driven by policy in the United States were not unique to the country, but rather we have experienced a global wave of acknowledgement of and commitment to action around addressing the experience in healthcare.

What has stirred this broader global movement and created a dynamic shift in how healthcare operates regardless of system or policy? I offer it is connectivity and proximity – not necessarily physical proximity, but what I would call “social proximity”. Social proximity, driven by connectivity, access to information, an open willingness to share ideas, constant access to research, news and even rumors all contribute to an environment for humankind that has dramatically shifted in the last decade and with increasing speed in the last few years.

So what are the implications for this on patient experience? We are now at a critical turning point where one can no longer diminish or downplay that experience matters. In fact, I would warn those that do or more so resist or fight this shift, that you will soon be swallowed up by the tides if you choose not to climb aboard. We are at a pivotal time in the journey due to these and many other dynamics changing how we deliver care and how consumers of care perceive and expect it.

2016 provides an interesting transition point now 15 years into this rapidly flowing century. In thinking about the year ahead, I offer some considerations whether patient and family member, healthcare provider or a company providing services and resources to healthcare – we are now all in this together.

  • Experience is a MACRO issue. We are no longer talking about “experience of care” as first portrayed in the Triple Aim. Rather we are now readily acknowledging and acting to encompass quality, safety, service, cost, environment, transitions and all the spaces in between in the experience equation
  • Patient and family (consumer) voice is stronger than it has ever been (and won’t be quieting down any time soon). Patients have found their voices in new ways and are showing a fearless willingness to challenge what was once a paternalistic model to raise their own wants and needs.
  • Technology is no longer a differentiator, i.e., specifically saying you are engaging in technology solutions. It will be how you use technology, the information it can provide and the way it impacts your ability to provide care and more positive experiences that will matter most.
  • Tactics, even strong ones may move you forward, but will not support you in achieving ultimate success. There is now a clear recognition that experience efforts are no longer driven simply by a list of tactics, but rather by comprehensive strategies with unwavering focus and committed investment.
  • The “soft stuff” matters and all engaged in healthcare are expressing this in their own ways. Our latest State of Patient Experience study reinforced this very point; that culture, leadership and the people in your organization are the primary keys to driving strong outcomes and overall success.
  • We need to stop calling the “soft stuff” soft. It is perhaps the most challenging and intense area of focus we can and should have in organizational life. Culture change, aligning leadership, ensuring actively engaged people is perhaps the hardest work we can take on. So while deemed soft (perhaps even as an excuse for an inability to affect them), we cannot relent in a commitment to make these efforts central to any plan.
  • “Sharing is cool” – yes for you parents out there I just quoted Pete the Cat (Pete’s Big Lunch to be exact). It remains astonishing to me how so much of what we espouse to our children as critical skills, we lose as we move forward in our careers. Experience excellence is driven not by how much you know as an organization, but rather how much you are willing to share. A value-based world competes on the execution to excellence not simply volume and we should not be hypnotized by one “way” as sacred. It is in our willingness so share broadly and openly that we collectively win. The new healthcare environment calls on us to do this.
  • The global dialogue on experience excellence is emerging as boundary-less and systems will look beyond organizational constraints to the commonalities they can find in driving the best in outcomes for all being cared for or caring for others.

I conclude with one more consideration:

  • Aim high, but start where you have solid ground. I remain resolute that we all have a commitment, whether we have yet acknowledged it or not, to provide the best in experience in healthcare (and must be willing to fully engage in what experience encompasses). Change will increasingly be transformational in healthcare and in simple choices great shifts can occur, but it will take the building blocks of success on which to reach the greatest heights.

Icarus, who in an act of great hubris and in an attempt to achieve it all, flew too close to the sun with his wax wings and fell to the sea. As we look to 2016, we must never let the big ideas fade from view or the small ideas impede our progress. It will be finding a way in which to move each of our organizations forward from where they are, with an understanding that the world is dramatically shifting all around us with increasing speed, where success can be achieved. This is our new world in healthcare and in the patient experience movement that now churns at its core. I believe if we are clear in our efforts and intent, we can and will achieve the best in outcomes for all. Here is to a great year ahead.

Jason A. Wolf, Ph.D
President
The Beryl Institute

How Will You Invest in Patient Experience in 2016?

2015-12 BlogWe recently celebrated our first five years as a community of practice and looked back, somewhat in awe, at the incredible growth of this organization over such a short time. The Beryl Institute is now a global community of almost 40,000 individuals passionate about improving the healthcare experience for patients, families and caregivers.

The momentum continues, as does the realization that organizations are making significant investments in time, energy and dollars to ensure they are prepared to deliver the best possible patient experience. We see these investments in many forms from hiring teams to training leaders and staff to building and supporting cultures of excellence.

As we shared in the 2015 State of Patient Experience Benchmarking study, senior patient experience leadership and staff investment is growing with 42% of respondents having a Chief Experience Officer (or comparable position) compared to only 22% two years ago.  Along with that, the size of patient experience teams is growing; 33% of organizations reported having five or more staff members supporting patient experience efforts.

The Beryl Institute community reflects this trend as well. This year over 200 organizations will invest in institutional membership – meaning they provide unlimited access to the Institute’s white papers, webinars, topic calls, learning bites, etc. to everyone within their facility. They are making a statement that people in ALL roles impact the patient experience and should have access to research and collaboration that will assist their efforts.

We have also seen tremendous interest in learning and professional development programs intended to train patient experience leaders and other staff. We recently increased our virtual classroom offerings in the Patient Experience Body of Knowledge courses to support growing participation in the community-developed program that provides Certificates in Patient Experience Leadership and Patient Advocacy.

Patient Experience Conference had its largest attendance to date this year and we were honored to partner with member organizations to host sold out Regional Roundtable events in San Francisco, Charlotte and Minneapolis. Our community is eager to gain (and share) knowledge and to invest in their personal career growth. In fact, today our sister organization, Patient Experience Institute, will offer the first testing opportunity for those hoping to earn their CPXP, the professional certification for Patient Experience Leaders.

While we’re excited to celebrate the five-year milestone, we acknowledge how much work is still to be done. We imagine (and hope to help inspire) a world where all healthcare organizations appreciate the power and impact of patient experience efforts and make without hesitation the investments necessary to be the best they can be for patients and families.

Earlier this year we released Our Stand, a list of guiding principles we’ve identified in our five years of leading this work that can have significant impact on patient experience success. I share them again as a reminder as you evaluate your own efforts and consider what investment opportunities make sense to support your specific needs.

We believe organizations and systems committed to providing the best in experience WILL:

  • Identify and support accountable leadership with committed time and focused intent to shape and guide experience strategy
  • Establish and reinforce a strong, vibrant and positive organizational culture and all it comprises
  • Develop a formal definition for what experience is to their organization
  • Implement a defined process for continuous patient and family input and engagement
  • Engage all voices in driving comprehensive, systemic and lasting solutions
  • Look beyond clinical experience of care to all interactions and touch points
  • Focus on alignment across all segments of the continuum and the spaces in between
  • Encompass both a focus on healing and a commitment to well-being

As you prepare for the coming year I challenge you to reflect on your organization’s commitment to experience improvement. Where are you exceling and where are your opportunities to do even more for your patients, families, caregivers and staff? Our patient experience community is here to support your journey and I encourage you to take full advantage of the incredible resources and knowledge available.

Wishing you a wonderful holiday season and a successful New Year!

Stacy Palmer
Vice President, Strategy and Member Experience
The Beryl Institute

Reframing the Core Values for Patient Experience

2015-11 blockbwWhen we began the patient experience journey at The Beryl Institute just five years ago, we were surprised to find that in a healthcare landscape peppered with talk of patient centeredness and an expanding dialogue on patient engagement and grounded in the fundamental principles of quality and patient safety, there was not an overarching discussion on the broader experience of patients and families – beyond that is what was dubbed the patient experience of care. I believe we have from and through that time to today come to recognize that when we talk about experience – the healthcare experience – it encompasses all those ideas. We can also acknowledge that in its simplest of forms, patients, family members and loved ones and individuals serving as care providers or in support services all have an experience in healthcare every day – whether it is strategically planned or just left to fate.

For this reason, in our first steps at the Institute, we gathered a team of individuals to wrap our arms around what we meant in discussing the patient experience. From the contributions of many voices, we found a broad and encompassing idea. That patient experience is the sum of all interactions shaped by an organizations’ culture that influences patient perceptions across the continuum of care. The simplicity of these words was meant, and still does mean, to reflect much more. Experience is about interactions across the continuum, in the spaces in between, grounded in who we are as organizations in our actions and engagement with both those who encounter and work within them. Ultimately, it is about the partnership we establish with patients and the perceptions they take away. These are the lasting ripples of personal and quality care that represents the dimensionality of any human journey across the healthcare continuum today.

This need for definition was reinforced by the rapid focus on these core ideas in the experience conversation and was supported by an integrated and broad conversation on what the patient experience, and the healthcare experience, truly means today. In continuing to watch these ideas in action, I also saw a pattern emerging in those organizations with a commitment and focus on positive outcomes. Interestingly enough, these same ideas were evolving as fundamental to who we were at The Beryl Institute ourselves, as a collective community of front line caregivers and healthcare executives, resources providers and consultants, physicians, patients and families alike. What we saw emerging was a core set of values fundamental to community and experience success overall.

In this, we came to offer the following ideas as core values for our work at The Beryl Institute. I, too, believe in traveling the experience journey over the last five years and seeing all the good being done in providing the best in experience that these values, whether made explicit or not, are central to experience excellence overall. They include:

  • Accessibility: A commitment to open access, a spirit of generosity and the active invitation to engage and contribute that continuously expands reach and sustains growth
  • Agility: The ability to rapidly reconfigure and realign resources to lead new directions and respond as needed within the industry
  • Innovation: A vigilance in continuously searching for new ways of thinking, doing and disseminating ideas
  • Inclusivity: The purposeful consideration of expansive ideas and the engagement of all voices to ensure the broadest perspective and awareness
  • Collaboration: A recognition that overall success is driven by a willingness to partner with others in the sharing of ideas, information and action that ensures better outcomes for all involved

In a healthcare marketplace now expanding its efforts to get at not just the science of healthcare, but the humanity on which it is built, reframing and aligning around a set of core values becomes a fundamental opportunity. As we see efforts now to broaden the conversation, just years ago grounded in clinical checklists alone to now purposefully engaging in not just how patients and families are cared for, but also the fulfillment and well-being of those providing care, we are experiencing a fundamental shift.

I do not believe we ever forgot that this was a caring industry; rather, our caring came in appropriate models. In reframing our efforts around shared values – on a sense of openness and a mindset of abundance; on the capacity of agility, not just a willingness to change; on the acknowledgement that the status quo leaves us slipping behind in the face of a world of innovation; that all voices matter and must be sought with intention; and that in a world of value, competition is now driven in how we execute and in the sharing, not in the secreting of ideas – we are setting a foundation for perhaps one of the most revolutionary periods in healthcare. A focus on experience, on what it represents and the values on which it is built is not a soft idea. Rather it is the bedrock on which the best in outcomes will be built for years to come. It is quality, safety and service, it is cost and the health of our populations globally, it is about the well-being of those delivering care and it is represented in an integrated perspective of bringing ideas together. That is the opportunity we have been presented with today. Our choice now is a simple one: take the first step and act.

Jason A. Wolf, Ph.D
President
The Beryl Institute

Community Matters in Patient Experience

Earlier this year at Patient Experience Conference we introduced our latest video,What really matters in Patient Experience?, which called us, through the voices of patients and family members, to consider “all voices matter”, “every interaction matters” and “you matter” in patient experience performance. The subtle message in this video was that for as much as there is clear and recognized individuality in each patient experience story, the needs identified and the outcomes achieved, there are also strong and important commonalities of which we should be aware and on which we must be ready to act.

community1015This same consideration of the value of individuality, yet the power of commonality has arisen with the recent emergence of special interest communities in The Beryl Institute. These groups of individuals focus on key areas of healthcare including patient advocacy, physicians, pediatrics and now patient and family advisors, represent an interesting and critical dichotomy and a balancing we see is needed as we address patient experience. In fact we are encouraged by the interest from all corners of the community to look at other opportunities of focus, such as behavioral health, emergency departments, post acute care, home health and others.

It is clear then that there is a definitive need, one asked for by members of The Beryl Institute, in focusing conversations around shared and special interests. This provides an important opportunity for learning, the collection and dissemination of ideas and the connection among peers. Yet we must also be aware that in doing this, we run the risk of missing opportunities for broader learning and collective focus. While we believe and fully support these independent conversations for all they represent, we too reinforce that there is power in the greater community in which these groups exist. More importantly we cannot lose sight of the opportunity for these communities to learn and share with one another, cross fertilize ideas and grow stronger together as a result.

This idea of creating distinction, or as often seen in healthcare, the delineation of our work in silos, provides us an opportunity to seize, especially as it related to the idea of patient experience. While we might distinguish our efforts and even establish infrastructure and resources in areas such as quality, safety, and service, we too must recognize that these investments collectively are part of our overall experience effort. The question we then should ask, is how are we framing our broader investment in experience excellence overall.

Our recent State of Patient Experience Benchmarking Study revealed that people identified clinical outcomes as the top result of effective experience efforts. This trumped consumer loyalty, customer service and others. Outcomes are what we strive for in healthcare – be they healing and recovery or managing the remaining days of life or be they financial imperatives to create a healthy, vibrant and sustained system of healthcare services. This is the very opportunity we then have in creating alignment among our efforts; weaving together quality, safety, and service, a focus on cost and outcomes, honoring the individuality of all we care for and serve while finding strength in our common actions and purpose; identifying special areas of interest and learning, while striving for collective understanding.

These ideas all come down to one core idea – community matters. In the bringing together of ideas or functions, we do two things – honor and address individual needs, while strengthening our collective stand. This captures the unspoken essence of patient experience itself. As we learned from the voices of the patient and family members so gracious in sharing their stories, while each unique, they too have common desires – to have voice, to be heard, to be treated with dignity and respect, to feel compassion and to receive clinical expertise, to be understood and cared for.

As no two people and in the same light, no two healthcare organizations can or should be alike. We must respect that distinction, while honoring all that brings us together. In balancing this intention in every encounter and every moment we create the opportunity for the best interactions and the most positive of experience. Community matters in patient experience and we must ensure it does for the power of the collection of voices in our movement and in the work it calls us to do every day. We must remain vigilant in ensuring the critical balance of individuality and community. In doing so, we reinforce our call to action – we are all the patient experience.

Jason A. Wolf, Ph.D.
President
The Beryl Institute

A Research Agenda for Patient Experience Excellence

penpicAs we continue our work at The Beryl Institute in moving the patient experience conversation from one at the fringes of healthcare just a few years ago to a central discussion point in healthcare globally today, we remain committed to developing a true field of practice for this work. This idea, of building a field and framing a profession, requires some fundamental cornerstones be put in place. This includes a professional community from which ideas are percolated and connections are made, a foundational and widely supported body of knowledge that drives professional alignment, a process for identifying and certifying those formal professionals in the field and a solid grounding in research from both an academic and practitioner perspective.

The community is represented by the over 35,000 of you around the world actively involved in accessing and engaging with resources of The Beryl Institute. The Body of Knowledge continues to find great value and expanding reach now through not only a conceptual framework, but also 15 full courses and the ability to achieve certificates of completion for coursework in Patient Experience Leadership and Patient Advocacy. Formal certification is now available through The Beryl Institute’s sister organization – Patient Experience Institute (PXI) – with the inaugural offering of the Certified Patient Experience Professional exam later this year. The first class of CPXPs, our profession’s pioneers, will be announced early next year. All of these efforts have been born from the contributions of hundreds of voices across our global community.

The last cornerstone builds on this idea of community contribution. It is a focus on rigorous research, and the importance of expanding the research agenda for patient experience. This has been building over the 5-year history of The Beryl Institute; first with the establishment of thePatient Experience Grant Program in June of 2010 (applications for the 2015 Grant and Scholar programs are open now), followed by the launch of the open access, peer-reviewed, Patient Experience Journal (PXJ) in April of 2014 (the next call for submissions closes January 2016), and lastly through PXI’s expanding philanthropic outreach to establish even greater support of research efforts (opportunities to donate will soon be available).

This type of reflective thinking, is seen in such government-supported programs as the groundbreaking comparative effectiveness work found at The Patient-Centered Outcomes Research Institute (PCORI), whose mandate is specifically “to improve the quality and relevance of evidence available to help patients, caregivers, clinicians, employers, insurers, and policy makers make informed health decisions.” It is also seen in many of the recent efforts supported by the Gordon and Betty Moore Foundation, and their focus on patient and family engagement.

And while there are even other efforts taking place, I still believe we have a significant opportunity to tackle the real tangible nature of the human experience in healthcare itself. The essence of these opportunities is reflected in the patient experience grants, in recent journal articles found in PXJ and elsewhere. When I look to the definition of patient experience itself and the simple, yet intricate nature of the key concepts such as interactions, organization culture, perceptions and cross continuum issues, all linked to outcomes and driven by safe, quality-focused, high reliability, service-driven efforts, there are incredible variables to explore at each point on the continuum of care and across all segments of the healthcare experience. This reaches from chronic illnesses to primary care encounters, long-term residential issues to rural settings or underserved populations. Underlying it all is the nature of human dignity and respect we all know is central to providing the best in healthcare overall.

To drive these ideas, we need to continue to frame, refresh and execute on a robust, thoughtful and I dare say edgy research agenda for patient experience. This is not research to just validate the usefulness of new solutions, but rigorous explorations of what practices, processes, systems, behaviors, communication styles, engagement efforts, tactics and tools not only show promise, but lead to lasting and sustained positive outcomes.

I ask you as the patient experience community what it is that we need to be asking, exploring and proving on we move forward. Are there practices you have taken for granted we could test? How can we explore key elements of the Guiding Principles for Patient Experience Excellence and determine which have the greatest impact, what that looks like and where we should focus our efforts first? How can you partner with your own vendors and resource providers to test new solutions? Or perhaps I will push you even further…how can we as a community come together to provide global insights into many other questions. Our biennial Benchmarking Study represents the kind of opportunity we have at hand to explore ideas both locally and around the world in identifying new concepts that can and should push our thinking in the realm of patient experience overall.

If we are to continue our endeavor in not just shaping, but solidifying and expanding a true field of practice and a profession that can positively influence outcomes for years to come, what questions should we be asking? What should we include in our PX research agenda? I look forward to your thoughts and commit to pulling together these ideas so we can collectively engage and continue to push the patient experience movement forward together. We now just need the right questions to ask.

Jason A. Wolf, Ph.D.
President
The Beryl Institute

Patients and Families Included

patients_included.001Just a short, but incredibly exciting 5 years ago, I was writing my fourth patient experience blog in what has become a monthly occurrence. In that blog I introduced the definition of patient experience created by early contributors to The Beryl Institute community. In those first months of our work we were focused on reinforcing some fundamental ideas and values that have remained at the core of our work at the Institute since that summer we got underway.

In introducing the definition we offered,

“A positive patient experience is created by partnering with patients and their support network (i.e., families or caregivers) to anticipate needs and exceed expectations, recognize the individuality of each patient as a decision maker, form a caring, compassionate and lasting relationship.”

From those very roots we have operated, not from the perspective of providers only, or espoused a singular model or organizational perspective. Rather, we have comfortably left that to those with personal or business interests in what they saw and see as the potential of the patient experience marketplace. Our belief was and remains that the ability to improve the patient experience at a global level is grounded in collaboration and partnership, a welcoming of all perspectives and encouraging open sharing of ideas across segments of healthcare, organizational boundaries and even national borders. This philosophy has led to the largest community of practice dedicated to patient experience improvement, now almost 35,000 people strong representing almost 50 countries around the globe.

The significance here is that from the very beginning of our work we have operated from the mindset that patients and families are partners in the overall experience conversation, or simply stated, patients must be included. I offered this perspective as recently as my Hospital Impact Blog last week, but perhaps more importantly have lived it through our work as we have continued to learn and grow as a community. These efforts have been realized through the inclusion of patient and family voice on our boards from the outset, in our establishment of our Global Patient and Family Advisory Council (GPFAC) and the cutting edge work they continue to push us to explore (including some exciting news to be announced later this month), and they have been seen in our provision of learning and content from webinars and papers, to Patient Experience Conference itself, which has included patient and family voice on stage, in breakouts and in participation for the past few years.

It is for these reasons and grounded in our founding values that we are excited to also reinforce our commitment to the formal efforts around having patients included in healthcare gatherings. The phrase “nothing about me without me” is not new to healthcare, but what is emerging is a more critical intent on ensuring the consumer voice is engaged and included in the broader healthcare conversation – not simply around individual episodes of care, but in the very discussion of policy, procedures and processes that impact all engaging in healthcare globally.

For this reason, “patients included”, is much more than a nice phrase, it is our commitment and should be the commitment of so many other organizations espousing to include or more significantly represent the patient and family voice in healthcare. As a community comprised of all voices, we believed it was important to reinforce this important point.

The “patients included” movement was inspired by an experience and subsequent blog authored by a virtual colleague and thoughtful healthcare leader Lucien Engelen. He offers in recounting the roots of this effort, “When it was my turn to deliver my keynote, I asked the audience ‘How many patients are present here?’ Not one, it appeared. That there should be so much talk about what patients need and want without them being present prompted me to take action.”

The action resulted in the “Patients Included” movement and most recently a full charter guiding a true patients included effort around healthcare events. The charter, created by the voices of patients, caregivers and healthcare leaders in Spring 2015, calls on healthcare events to commit to the following:

  1. Patients or caregivers with experience relevant to the conference’s central theme actively participate in the design and planning of the event, including the selection of themes, topics and speakers.
  2. Patients or caregivers with experience of the issues addressed by the event participate in its delivery, and appear in its physical audience.
    • The Beryl Institute Patient Experience Conference 2016 keynote speakers includes patient and family voice and perspective. In addition, when sessions are selected late August, they will also reflect patient and family representation.
  3. Travel and accommodation expenses for patients or carers participating in the advertised programme are paid in full, in advance. Scholarships are provided by the conference organisers to allow patients or carers affected by the relevant issues to attend as delegates.
    • The Beryl Institute Patient Experience Conference 2016 offers patient and family scholarships to conference participants to support engaging more patients and family members in the overall patient experience conversation. In addition, patient and family voice throughout our conference keynote speakers are fully covered for fees, travel and accommodation.
  4. The disability requirements of participants are accommodated. All applicable sessions, breakouts, ancillary meetings, and other programme elements are open to patient delegates.
    • The Beryl Institute Patient Experience Conference 2016 will accommodate all disability requirements of conference participants for all parts of the program elements.
  5. Access for virtual participants is facilitated, with free streaming video provided online wherever possible.
    • The Beryl Institute Patient Experience Conference 2016 will provide conference access and updates to virtual participants through social media and the #PX2016 hashtag. Conference participants actively engage online via social media and conference presentations are made available to participants after the event.

While not every organization may be able to accommodate these commitments due to constraints or other considerations, they reinforce a powerful statement on what including all voices and providing the access to do so truly means. At The Beryl Institute, we ourselves have met these very commitments for our own Patient Experience Conference. Patients and families contribute to program development and review and are critical voices on stage and in breakouts. Scholarships, though modest are provided and accessibility, one of our core operating values, is reinforced, including virtual access to the extent possible via social media and other means.

We do this for more than it being the right thing to do. As a community of practice committed to experience improvement, we also believe that which we espouse and encourage in organizations behavior, we must be willing to do and model ourselves.

Patients included is more than a nice slogan or a feel good effort, it is a fundamental premise to executing on the best in patient experience efforts in healthcare today. We welcome the opportunity as we continue to grow to ensure we maintain this perspective and challenge and encourage the patient experience community and the broader healthcare community to take note. Patient and family voice matters in our ability to provide the best in outcomes, it has and always will.

Jason A. Wolf, Ph.D.
President
The Beryl Institute

Patient Experience: From Evidence-Based to Proven Practice

julyblog15The conversation on how we both measure and show the value of patient experience continues to grow. With the emergence of systems such as the Center for Medicare and Medicaid services (CMS) 5-star rating systems in the US and other performance measures coming online in countries around the world, healthcare organizations, and the people that use them daily, are struggling to identify measures with meaning. Adding clarity to this conversation has been central to our efforts at The Beryl Institute.

Healthcare, as a scientifically grounded industry, has had its roots in evidence. This has driven our quality conversations and more so outcomes-based focus for most of its history. In all we have done to cure humanity, we often overlooked the very humans in our midst. My grandfather, a pediatrician himself, used to note that “bedside manner” was not just a part of the job, but rather the way we “treated” people as people, not just treated them as patients, mattered most.

This is why I believe we need to move beyond just evidenced-based, which is driven in the scientific mindset, to proven practice, which is about driving outcomes through doing. I am not suggesting that scientific exploration is a bad idea, just that it cannot be the only way in which we generate, share and disseminate new practice and the opportunity for expanded outcomes.

For this reason, we have built The Beryl Institute as a global community of practice. Sharing efforts that people put in place that not only sound good, but also do good things is critical in our work in patient experience. This level of flexibility provides for the open-minded creativity necessary to drive better results in the highly variable world we live in. Healthcare as a field should be first and foremost about human beings working for the betterment of human beings.

For that reason we launched Patient Experience Journal (PXJ), as a scholar-practitioner outlet to both share rigorous research and leading practices backed up by strong data. By showing what works in practice and sharing it, we can collectively become stronger in our efforts. (Note: The next submission deadline for PXJ is July 31, 2015). For this reason we also created the Patient Experience Grant and Scholar programs. Through these small, but significant grant opportunities, we are supporting exploration on the front lines of experience, leading to new, interesting and innovative solutions that can be replicated in practice.

Lastly, we have found one of the greatest gathering grounds for sharing proven practice in patient experience has become Patient Experience Conference. Now 5 years old, PX Conference brings together over 50 sessions exemplifying the best in practice and ideas and positive impact and measurable outcomes are shared. Not only through these direct learning sessions, but also via personal interactions and networking, people in the experience community are helping to seed and spread practices that can touch the lives of so many in healthcare around the world. (Note: Patient Experience Conference 2016 will be held April 13-15, 2016 in Dallas, TX. Call for presentations is open through July 17, 2015).

The point being here, that if we share the belief that experience is grounded at the point of interaction between one human being and another, we MUST drive the conversation beyond evidence to proven practice – what works in that moment of interaction and leads to the positive, strong and lasting outcomes. If we are to collectively impact proven practice, consider the following:

  1. Outline your process. Capture the process you are putting in place. This helps create institutional memory and replicable practice. What process did you put in place? What resources did it require? Who was involved and what time did it take?
  2. Test your practice. Yes this is where experimentation must come into play, but beyond theory to practice. Proven practice is much more than best practice. It must be shown – proven – to work.
  3. Document your results. Make sure you write up your findings. What worked, what didn’t? What were the key lessons learned? What recommendations do you have for others?
  4. Share your findings. Consider avenues to share your information. The power of proven practices is not just the impact they have for your organization, but how they can bring value to others. Consider outlets such as PXJ, Patient Experience Conference, Institute Case Studies and others to share your story and results.

The power of our patient experience community has always been in the space it has provided all of us to share and learn. The key is that we move beyond theory, to where practice is having an impact and driving positive outcomes. The value of what we do together in creating a growing library of ideas is truly the foundation of what patient experience is about. Through our collective voices great things can and do happen… I invite you to contribute.

Jason A. Wolf, Ph.D.
President
The Beryl Institute

Reframing Patient & Family Experience

experienceBWAs the experience conversation grows and more voices enter the discussion, I have come to recognize a need to reframe how we think about experience overall. In much of what I have written and shared in my talks, I have stressed an important point, that experience at its broadest point is all a patient, long-term care resident and/or family member encounters while they are engaged in our healthcare system. Critical to this idea is that, as outlined in our stand at The Beryl Institute, experience also reaches across all segments of the continuum and the spaces in between.

I raise this again now for as recently as this week I have been asked about how experience fits with quality and safety efforts or compares to patient engagement. My concern and therefore my desire to align our conversation is that many in the experience discussion have become trapped by our own warnings – that we continue to address experience from the perspective of providers rather than what the actual experience is for those in our systems.

I start by reinforcing what patient experience is not, in order to build a framework and encourage a discussion of what experience truly must be. For a long while experience was simply aligned with service or service excellence or even more simply satisfaction. For many it still is. Service in healthcare is critical, as it is the domain through which we find ourselves engaging people with dignity and respect, as one human being to another. Yet service is also not the full extent of what the users in our healthcare systems experience. It is but one piece of a complex pie inclusive of quality, safety, service, cost, outcomes and influenced by caregiver engagement, in which we must work diligently to drive integrated actions.

This leads to the question is experience engagement? There has been incredible work around the processes and tools to drive patient and family engagement and in their very creation believe our answer is provided. If engaging patients and families in care encounters is of value, which it has proven to be, this too becomes a critical practice in positively impacting experience. Engagement tools, and in similar light the concepts of patient and family, or person centered care, all provide an incredibly important set of resources for ensuring the critical positioning and involvement of patients and families as partners in their care. These ideas too then are not experience in total, but rather are central to ensuring a positive experience overall.

I continue to raise this issue for one central reason. That in all we do to ensure the best in healthcare as I note, from quality, safety and service, to driving outcomes or addressing cost, to implementing processes of engagement or person-centeredness, these ideas are OUR language inside healthcare looking out. Yet when looking from the outside in, they are all but parts of one experience.

With this mindful integration I do not suggest we eliminate all distinct efforts to drive results in these various segments of experience. In fact in order to manage the dynamic nature of healthcare today, we need to focus our work on each of these critical efforts to ensure directional progress and continuous improvement. Rather, I do suggest we MUST NOT tackle each of these efforts in isolation, or under the false pretense that they are not part of the broader experience for patients and families.

So what is the opportunity we then have in reframing patient and family experience? I believe we must:

  1. Look beyond experience as just satisfaction or service to the reality of what our patients and families see every day. We do them great disservice by simplifying this idea in a way it becomes tangential or even “soft” to the hard work we do in healthcare every day.
  2. Align and coordinate our divided efforts, and in doing so, our collective language, to reinforce a commitment to the perspective of the end user in healthcare today. We can still segment our work efforts and improvement opportunities to tackle these often complex opportunities and problems, but we cannot and must not do so to the detriment of providing a coordinated and comprehensive experience.
  3. Work together to address experience from the broadest perspective across and at all touch points and the moments of truth we create clinically, interpersonally, virtually, etc. and include the voices of those we care for and serve to ensure an integrated and experience focused effort overall.

Yes we must focus on the basics – the blocking and tacking of what impacts experience everyday on the front lines of care, at points of transition and in the many seams we have created in between, but if we lose perspective on the broader opportunity, our smaller steps may not help us realize our greater goal. If we are committed to providing the best in experience for all in our healthcare systems – quality, safe, service-oriented, cost efficient, outcomes driven, inclusive, coordinated and compassionate – like I know most in healthcare are, then we still have great opportunities ahead. I challenge us to think about reframing our view of experience. In doing so I believe we will identify and achieve all we know is truly possible for all those touched by healthcare every day.

Jason A. Wolf, Ph.D.
President
The Beryl Institute

Taking a Stand for Patient Experience Excellence

The last month saw an incredible amount of activity for the patient experience movement, from Patient Experience Conference 2015 and its broad opportunity for learning and connection to last week’s Patient Experience Week, that had organizations around the world acknowledging and celebrating the work of so many and the voices of all in ensuring the best in patient experience. Underneath these efforts that are representative of the work taking place each and every day in healthcare, we at The Beryl Institute and through our global community believed it was time to move beyond just action to true commitment in our collective focus on experience excellence.

What does this look like? Beyond the incredible range of resources developed and shared through our global community of practice that can inform and guide each of our journeys, there was a realization that we had a much greater opportunity and I dare say responsibility in aligning our focus and intent on the true importance of patient experience in healthcare today. As a community we have focused every day to reinforce an important point – that patient experience encompasses all that a patient or family member encounters, be it quality, safety, service, cost or outcomes; it is impacted by the engagement of the very people providing and supporting the provision of care; it is driven by a recognition thatpeople, process and place are all fundamental considerations; and it is not a passing fad or simply a measure of satisfaction. Rather, it is a central construct that impacts healthcare organizations and their efforts around the world each and every day. Simply stated, patient experience matters!

We too have recognized that patient experience is more than just an idea; it is an emerging field of research and practice. So in conjunction with the incredibly powerful and energized community of practice that exists, we also framed a foundational body of knowledge, have pushed to expand the boundaries of research via Patient Experience Journal and solidified a professional designation and process for development with the new Certified Patient Experience Professional (CPXP) designation via Patient Experience Institute.

The last piece in all this – from philosophical and strategic alignment, to the physical framework of a vibrant, strong and lasting field of practice – was to identify and underline the critical actions that have emerged as central to achieving excellence in patient experience. We often are asked the question and see it in the conversation throughout the community, “what can we do to achieve the best in experience?” In our work and through the incredible examples of so many doing this critical work each day, we have come to identify what we believe are the guiding principles for patient experience excellence.

As we introduced these ideas last week – our stand for patient experience excellence – we reinforced an important point. These eight essential actions should serve as aspirational and affirmative statements about where we as individuals, organizations and collectively as the patient experience movement should focus our efforts. We offer these as aspirational – as ‘wills’, not ‘shoulds’ – for as the data show so many of us are just starting or are in the midst of our patient experience journey. In fact, if we believe experience is a continuous effort than the journey truly never ends. With that we warmly invite and strongly encourage healthcare organizations globally to consider and commit to theseguiding principles:

We believe organizations and systems committed to providing the best in experience WILL:

  • Identify and support accountable leadership with committed time and focused intent to shape and guide experience strategy
  • Establish and reinforce a strong, vibrant and positive organizational culture and all it comprises
  • Develop a formal definition for what experience is to their organization
  • Implement a defined process for continuous patient and family input and engagement
  • Engage all voices in driving comprehensive, systemic and lasting solutions
  • Look beyond clinical experience of care to all interactions and touch points
  • Focus on alignment across all segments of the continuum and the spaces in between
  • Encompass both a focus on healing and a commitment to well-being

As we look at the potential we have in our focus on excellence in patient experience, there is boundless possibility. More so, at its core we find an unquestionable opportunity to reinforce the great value of all who participate in the healthcare conversation and all who are touched by it. Commitments as strong as they may seem, or as aspirational as they may be, are only of impact if they are moved from words to action. That is my ultimate challenge to you as the patient experience community and as the healthcare community as a whole.

These are not just concepts, but rather they are commitments to action – for our organizations, for our people, for all those we care for and serve and for the kind of healthcare world we have the desire to, and I know we have the capability, to create. I invite you, encourage you and call on you to join us in taking a stand for all we can do for experience excellence. Only good things can come of these actions if we take them together.

Jason A. Wolf, Ph.D.
President
The Beryl Institute