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.
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.
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.
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.
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.
The Beryl Institute

Patient Experience Matters

As the final hours before Patient Experience Conference 2015 count down, I am reminded of the importance of the journey we have set out upon. When we work, as one community, encompassing a diversity of thought and experiences, on a cause so central to healthcare – the experience of all in our global system of care – only good things can happen. For so many committed to the best in experience for the patients, residents and families they serve – be they the almost 35,000 members and guests of The Beryl Institute Community, the readership of Patient Experience Journal from over 100 countries, the volunteer leaders and content contributors, writers, tweeters, caregivers and support staff around the globe – we often find ourselves in small pockets of people, likeminded in purpose and focus. Tackling this work in small bands spread far can at times be exhausting, even knowing you have the support of the thousands in our virtual community.

I, too, know that there is power in the ability to come together and recall the words shared by a participant in the closing conference discussion session we held at the end of our first patient experience conference now five years ago. (Yes, it was intimate enough we could all have one discussion.) That person stood, with the polished, but worn glean of a conference well spent, of learning gained and new connections made, and said “I now know I am not alone.” It was a profound and awakening statement that has been a fundamental root of our last five years in growing the Institute community. First, that you, as professionals or as patient or family members, are not alone on this journey and second, there is a place you can come to connect, find support, contribute, be vulnerable, breathe, smile and grow. But more so, there is a special moment when you can do that with one another together at Patient Experience Conference.

I have heard some call the event a family reunion and others call it the recharge they needed from a year of draining work. In all descriptions, I have heard something underlying it all – Patient Experience Conference, while a “conference” in title, is nothing like any other healthcare conference experience you can or will have. Others may have summits, conferences or symposiums with the requisite healthcare structures, protocols and learning. From that we do not differ, but what you do find are the people and the connections that last well beyond just three days a year.

Since our first Patient Experience Conference, I have opened reinforcing that important point – that in looking around the room, the power of our time together is in more than lessons shared, PowerPoints projected or even compelling stories told. It is in the gift of being together, of those around you, and all you and they have to offer. When we spend the next three days in Dallas, that will happen once again. Together, we will create a gathering not meant to highlight one organization or a specific product, but rather bring life to an event that is committed to the very idea that is at the heart of the importance I mention above. Simply stated, patient experience matters.

It matters because it touches the lives of so many leading to quality, safe, service-focused encounters conscious of cost, committed to outcomes, open to all voices and intent on nothing but the best for all we care for from healing to the fate of spending one’s last days in dignity. You see, we are all the patient experience. So I, too, look forward to the next few days ahead, but in highlighting their importance, return to a point so central to our work. We are not in this alone, and there is a community to support you every day of the year. I am proud of what we – our community of committed leaders around the world – have created, humbled by the cause we have taken on and inspired by all I know we have yet to do together.

Jason A. Wolf, PhD
The Beryl Institute

The importance of invitation in patient experience excellence

I was talking to a member recently who asked what has been the key to our growth at The Beryl Institute over the last few years from an idea to a global community now engaging over 30,000 members and guests from around the world. My response came quickly. It is the willingness to ask – that is to invite people to participate, to get involved, to offer ideas, to provide input, ultimately to engage in our efforts and in this movement.

It was for both of us, a subtle, but profound moment, as the individual was struggling with how to move from mandating compliance to experience efforts in their organization to creating a sense of involvement and ownership for action. For me, I realized it has been a sense of openness to all ideas, perspectives and voices, the value of abundance I challenged us all to consider in starting this year, that has supported our own ongoing efforts to invite the engagement of so many of this journey. I too recognized in our conversation that invitation was not only an opportunity for growth, it provided a powerful idea for patient, resident and family experience excellence itself.

Invitation is a simple, yet profound act. It requires a strong sense of self-understanding, a willingness to be vulnerable and open to new discoveries. In offering an invitation we acknowledge the value of others and express our respect for and trust in their presence. More so invitations themselves are the seeds of new possibilities.

When I think about what organizations work to accomplish for those in their care at all points of interaction across the continuum, the greatest opportunity we may have is to invite. If we believe experience excellence is driven by both the engagement of the people in our organizations and those we care for, why just create opportunities for engagement and hope others respond? Rather we must create them and invite people to act.

How can we do this in healthcare today? For our own teams we can invite input on new ideas or participation in strategic efforts or even tactical planning. For patients, residents and families we can invite their participation in both personal and organizational opportunities. As individuals, we can engage them in their care planning, involve them in shift transition conversations or even post care decisions. Organizationally we can invite involvement in patient, resident and/or family advisory councils, we can engage people in strategic planning sessions or on operating councils or boards.

I believe there is a significant difference in hearing “people are just not engaged” if we simply work to create opportunities we hope people will take advantage of versus creating those opportunities and actively inviting participation. Yes, it is through inviting that we have the greatest of opportunities in creating cultures and interactions that will drive the best in experiences. How will you create opportunities for invitation in your own organizations for both whom you work with and those you serve?

In that spirit of invitation then I would be remiss in not living up to the response I offered my colleague. While there are so many ways to engage in the patient experience movement, first I invite you to consider joining us for Patient Experience Conference 2015. As a central community gathering for people committed to experience excellence at points all across the continuum of care and supporting those efforts, this event provides for a coming home and/or a recharging for some, and an awakening and/or learning opportunity for many others. More importantly it connects you with fellow travelers on this journey and committed to this cause from which to build lasting connections.

With that I too must invite you and your organizations to consider our most rapidly growing opportunity in the Institute itself, Institutional Memberships. These incredible connections have stretched the boundaries of the experience conversation in ways we could not anticipate and to corners of the world we could not imagine. It also reinforces the fact that the experience of those in our care is an ongoing and relentless pursuit and connecting to a broader community and support network can only help each of us be stronger. That is it, the power of invitation exemplified.

Many of you may have heard of Shel Silverstein, one of the earliest poets I digested as a child. And while seemingly focused on children in his writings, his message resonates for all of us. He wrote a wonderful piece called “Invitation”:

If you are a dreamer, come in
If you are a dreamer, a wisher, a liar,
A hope-er, a pray-er, a magic bean buyer…
If you’re a pretender, come sit by the fire
For we have some flax-golden tales to spin.
Come in!
Come in!
– Shel Silverstein

There is incredible simplicity in the art of invitation, and yet it has the opportunity for unparalleled impact on all we do in healthcare today. I invite you to join us. Come in!

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

Understanding expectations matters to experience excellence

In a recent personal encounter shared by our Director, Member Experience, Michelle Garrison, she told a story of her own healthcare experience related to a surgical procedure and how it made her feel as a patient in the process. Her experience and insights reinforced a critical point central to the conversation on experience excellence – expectations matter.

I first addressed this issue in the Patient Experience Blog two years ago when I wrote:

“Expectations are powerful. They influence what we see, how we act, and the way we react. They stir emotions and create real feelings from joy to anger, surprise to sadness. The reality of expectations is that they present an intriguing paradox in how they can and do influence the situations in which we find ourselves. Expectations are an individual and even very personal experience, yet at the same time they can be set by organizations, businesses and other people outside of one’s self. This makes expectation potentially the most valuable and perhaps most precarious tool in the discussion of consumer experience and in healthcare, the patient experience.”

As Michelle shared her story, she reinforced an important point from her personal experience. She noted, “We are continually looking for the best methods to help prepare patients and family members by ensuring they know what they are likely to face when they visit with a doctor, arrive at the hospital, leave a healthcare encounter and beyond. By setting their expectations ahead of time, we help prepare them and give them the opportunity for the best patient experience. However, even with the most comprehensive of processes in place, there are going to be times when expectations are not met and the patient experience will fall short.”

This was a profound statement for me as I realized in Michelle’s words reflecting on her encounter that she felt the provider would have provided expectations. It also raised an important point, and I dare say an opportunity. That in providing the best in experience we must also be willing to ask the questions and take the steps necessary to understand the expectations of those we are caring for.

In talking about her experience Michelle said “I was not the best of patients. Though, I am pretty sure if you were to ask my doctor, the nurses, anesthesiologist and the others who took care of me, they would not have anything bad to say about my behavior or me.” In asking why she felt that way, she added,

“Here is where I fell short. I did not ask enough questions and the questions that I did ask were not the right ones. I was not as informed as I could have been about what was going to take place and how I would feel after the procedure, and so my expectations did not match the reality of what occurred. I was given instructions both before and after, on the procedure and what to do if there was a problem, but there was nothing about how to deal with the lingering after effects and how I might feel. I mistakenly thought all of the information I needed would be given to me without my having to ask for it, but it was not. Of course, I could have reached out to my doctor, but instead I did what I am sure a lot of patients do, I turned to the internet to see if what I was experiencing was normal.”

This statement is powerful and eye opening in its potential reflection of the way many other patients or family members may feel in the midst of the healthcare system and their own experiences. This is a significant realization we may often miss, that while patients want to engage, they are not sure how to participate or what to ask. Or they believe what they need to know will be provided so don’t think they even need to ask. In concluding her story, Michelle shared, “It is important to understand that patients and family members are not always going to ask all the questions they should or even the right ones. They may not know what questions to ask because they will assume, like I did, that the answers will be in that packet of paperwork they were given.”

I think we would all agree Michelle was not a “bad” patient, but perhaps quite the opposite, a patient that was trusting in the system to take care of her. Michelle’s procedure was successful and the system did its job, but the realization here is that there is an opportunity for much more. In many ways creating a process for clarifying and understanding the expectations of all participants in the care encounter be they patients or family members, doctors, specialists or support services and in doing so together could be one the most clear, simple and impactful ways to create the best in outcomes overall. Thanks Michelle for helping us to see and understand this point with greater clarity. You are the patient experience!

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

Patient experience excellence requires moving beyond resolutions

In talking with an old healthcare colleague this week about our plans for the year ahead, she shared one of her New Year’s resolutions was to focus more purposefully on improving the patient experience in her organization. While an admirable intention and perhaps also shared for my benefit as she knows I focus on this effort, it actually caused me to take pause.

The statement had me wonder where in the priority list experience now rests for both individual leaders and organizations. The Beryl Institute’s bi-annual patient experience benchmarking study as well as other research continues to show experience remains a top priority in healthcare. But, as my friend’s statement raised for me, I began to question if this priority was a resolution or response based on something one thought they should say or rather a statement of commitment to purpose and action. 

As we start 2015, we can say with confidence that great strides have been made as we continue to push the experience movement forward. I believe there is a greater agreement on the importance of experience overall as a driver of better outcomes clinically, organizationally and fiscally. There is also stronger recognition in the power of patient and family voice and perspective and an acknowledgement of the need to align efforts around an integrated approach to quality, safety and service improvement. Also of significance is an increase in formal definitions of experience being adopted by healthcare organizations (a question we will explore again in the 2015 benchmarking study) and the associated focus on personal interactions and culture as reinforced by The Beryl Institute’s shared definition of patient experience. Finally we have seen a rise in the role of senior experience leaders, i.e. Chief (Patient) Experience Officers, system level VPs of Experience, etc.

In thinking about what these indicators of progress represent, they represent much more than resolutions, which are simple statements of intent. These efforts and the impact they are having reflect clear commitments to action and they represent tangible investments in time, people and resources. That commitment is what I have come to not only believe, but also see as the differentiator in patient experience excellence and success.

I am often asked the question ‘what should we do to improve patient experience in our organization’; in fact my colleague posed just that question after sharing her resolution. I could tell that she, as many others do, were looking for the checklist of practices, in order of priority, she could put in place to make a difference. My challenge to this question was reinforced in the very conversation and came back to what the growth of this movement has shown us all.

The tactics are clear, reasoned and can have an impact, but it is a commitment to something bigger that leads to the best in outcomes. Commitment is about purpose and intent, focus and strategy. It is about building a plan that meets your organization and those your serve where they are and works to stretch them all as partners and contributors to where you want to go. Yes commitment is a choice, which I find to be at the heart of experience success, and then smart choices can help you to identify the “what’s” we all are searching for.

As we look to the year ahead, I can say without hesitation that the patient experience movement continues on. We look to help guide this at the Institute through our own commitments: the growth of our resources and a global community now almost 30,000 strong, the continued support of research through the expanded reach of Patient Experience Journal and the development of professionals through new learningand formal certification. And I believe the movement continues on more so because of what choices you and your peers will make.

In committing to experience improvement, be it in physician practices or ambulatory settings, acute care or pediatrics, long-term care or hospice, you have moved beyond the idea of a resolution. Your choices, the ones you help others make and the ones you offer and honor are where we will build the next levels of our collective efforts. I, your team from, and your peers in the Institute community remain committed to keeping this movement progressing and together it will lead to even great things for the year ahead. Happy New Year to you all.

Jason A. Wolf, Ph.D.
The Beryl Institue

Reflecting on the Future of Patient Experience: Four Considerations for the Year Ahead


The end of the year always brings a flurry of activity to finish what we set out to do and/or plan for what awaits in the year to come. It also serves as a time for reflection and looking ahead. This can be both an exciting and overwhelming exercise, but one that simmers at the core of our humanity, one filled with hopes and aspirations, commitments and goals. This is no different when we look to the very humanity at the heart of excellence in patient experience itself.

Dec2014_BlogI remain inspired by the exponential growth in energy, commitment, resources and interest in positively impacting the experience for patients, residents and families and for those providing care at all touch points across the continuum. Our commitment at the Institute remains to ensure this conversation continues to grow. I reinforce often that experience is not a fad, but rather it is fundamental to all we do in healthcare. It is both what we expect as participants in our respective healthcare systems and what we aspire to deliver in every encounter.

To support this in the last year we have expanded our resources and increased accessibility to The Beryl Institute. We have added both complimentary offerings, such as the new open-access and peer reviewed Patient Experience Journal (with forty new articles and commentaries this year) and community member benefits with PX Learning Bites, providing short educational insights into experience excellence. We have developed the core of the PX Body of Knowledge, our community developed framework of learning and development, and will offer twelve new modules before year’s end.

We have also expanded access to our community of practice in launching new Institutional Memberships, engaging thousands of individuals at all levels in healthcare organizations with a passion for patient experience improvement. We also have broadened the experience dialogue across the continuum with new content and engagement for Patient Advocates and in one of the fastest-growing segments in healthcare – Long-Term Care. And while these items were initiated in this year, they also represent a looking ahead and an investment in where we can go together as an experience movement.

This commitment, grounded in the contributions of our almost 28,000 members and guests in over 55 countries, is driven by four considerations I believe are central to driving patient experience excellence across care settings (and have been critical to our work in growing The Beryl Institute community itself). Consider these ideas as you look to the year ahead and your own experience efforts.

  • A mindset of abundance. Experience excellence is grounded in a spirit of generosity, in openness and access, sharing, and the active invitation to engage and contribute. It is the expanding of possibility and an understanding that rather than a zero-sum game, there is much to learn from and enough to spare for all; for those we care for and serve and for those with whom we work.
  • A commitment to inclusivity. The greatest opportunity we have in driving the best in experience is to ensure all voices are not only acknowledged, but also engaged and heard. In expanding our listening and the opportunity for contribution we open up possibilities we have yet to consider or even knew existed.
  • A focus on agility. In the dynamic world of healthcare and in our human environment in general, static state is now equivalent to falling behind and change in many ways is simply treading water. We must build the muscles of agility – the capacity to rapidly reconfigure and realign resources to lead new directions or shift as needed with the needs of our communities and the industry.
  • A drive for innovation. Excellence in experience may be best served by a vigilance to continuously searching for news ways of thinking, doing and disseminating ideas. This is beyond improvement of existing systems to look for concepts, constructs and practices that can lead us to new levels and to positive and lasting outcomes.

I offer these considerations as we look to the year ahead to suggest something significant. Yes, we have defined experience; yes, we are aware of the critical strategies and tactics that can frame and drive positive outcomes; but, if we are truly committed to a lasting and positive future in this work, we need to think not only about what we do, but also how we continue to stretch ourselves in doing it. The year ahead for patient experience will bring exciting new discoveries, powerful lessons and compelling stories that will move and inspire us to new levels. We do this not only out of passion, but out of our commitment to one another and the care we hope to provide to all.

I wish you all the best of holiday seasons, may it be warm and joyous as you connect with loved ones and friends. And as we look forward, here is to each of you for the positive impact you have committed to in caring for others and each other, as we continue this critical and exciting journey. I am honored and grateful to travel this road with you and anticipate with great excitement all that the days ahead will bring.

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