The Conversation on Patient Experience Improvement Continues: A Reflection on Three Years

Most people would suggest that change doesn’t happen overnight, and while I believe change does take time, it does not need to take a lot of time. In fact, change, like most things in life, requires nothing more complicated than a simple choice. It is this same idea – the power of choice – that I use to frame all my discussions on patient experience improvement.

I share this idea of choice and change on the week that The Beryl Institute itself turns three years old. As we have seen the patient experience movement grow and flourish, it too has been a journey of change and choice. From the very first member signing on in September 2010, to the now over 18,000 members and guests from 45 countries around the world, The Beryl Institute community has made big choices and as a result driven big change.
Over the course of the last few years I have written about engagement, involvement and community and I am excited to say that the state of The Beryl Institute community is strong. We have seen a growing use of thedefinition of patient experience. We have also experienced almost a doubling in organizations having a formal definition of patient experience (something we stress as critical) as revealed in the 2013 State of Patient Experience study and represented in the recent powerful infographic of the findings. We have also been inspired by the growing “#IMPX” movement with increasing numbers of organizations creating compelling videos of their teams reinforcing the message – “I am the Patient Experience”!

At the Institute, we have also worked hard to ensure all voices are engaged in the conversation on patient experience improvement. We have authored an extensive series of publications to be a resource to all those working to impact the patient experience – from the C-Suiteto the front lines from students to patient and family members. This effort has been expanded by the launch of the first of its kind Global Patient and Family Advisory Council to ensure this critical perspective is central to all we do. It has been supported by not only our virtual community connections, but also the consistently growing annual Patient Experience Conference providing practitioners the space to reconnect and reenergize every year.

In shaping the knowledge and information base for patient experience improvement, we have led the effort to create a comprehensive body of knowledge focused on developing patient experience leadership now and into the future and guided by the input of over 400 healthcare leaders around the world. We have also awarded over 25 patient experience grants to support direct research projects on patient experience improvement where it is taking place – on the front lines. Most recently we have announced the launch of The Patient Experience Journal, a multidisciplinary, peer-reviewed publication designed to share ideas and research, and reinforce key concepts that impact the experience of patients and families across healthcare settings.

The full history of the Institute is rich, but more importantly it exemplifies the very power of choice and of community I mention above. It was the choices of so many that made these offerings and resources possible. It will be the continued contributions of community members that will maintain this growth and drive the patient experience movement forward. These choices have led to great change and our hope is to continue to support this growth by providing a gathering place for ideas, a dynamic space for interaction and a vibrant hub for continued dialogue on patient experience improvement. We have arrived at this point with the guidance, leadership and support of so many around the globe…for this we are forever grateful. We now humbly go forth knowing there is much more work left to do. Happy Anniversary to you, this passionate and engaged community. We celebrate how far we have come together and look forward to continuing this journey with you!

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

Involvement is the Path to Patient Experience Excellence

InvolvementBlogThe words of the day in healthcare of late, especially in light of the policy undertones influencing the system in the U.S., are around engagement and activation, especially of patients, but also focused on staff, physicians and community. Studies show that activated patients are more apt to have greater patient experiences (When Seeing the Same Physician, Highly Activated Patients Have Better Care Experiences Than Less Activated Patients, Health Affairs, July 2013 32(7):1295–1305) and the e-patient revolution is well underway as exemplified by such organizations as the Society for Participatory MedicinePapers espouse the power of staff engagement as the means to better experience (The Role of Organization Culture in a Positive Patient Experience, The Beryl Institute, 2012) and community engagement is reflected by growing involvement in strategic efforts such as what I experienced at the William Osler Health System in Brampton, Ontario, Canada.

While these ideas are external efforts that influence specific organizational strategies and associated actions, I was struck with the recognition this too is what we have worked to model via The Beryl Institute ourselves. As a global community of practice, we have been clear in declaring a mission to create a dynamic space for members to convene, engage and contribute to elevating, expanding and enriching the global dialogue on improving the patient experience.

In just the last two weeks we held the very first call for our Global Patient and Family Advisory Council (GPFAC), an incredible group of patients and family members committed to serving in ensuring patient and family voice is part of the patient experience movement. Their generosity of spirit and commitment to this cause left me inspired and excited for all we still have to do in our efforts to improve experience. We also met with our Patient Experience Advisory Board for their quarterly call to review our direction and strategy as an Institute and ensure we are meeting the needs of those on the front lines addressing the patient experience every day. In that conversation I was moved by the excitement and commitment to the movement we all support. It is through the generosity and spirit of these two groups, and also the continued contributions of members and guests via On the Road visits, sharing case studies, and through a record number of Patient Experience Conference speaking submissions, as just a few examples, that the sense of involvement was palpable.

Involvement, you could argue is a play on all these words: engaged, activated or even participatory. I do not want to play the semantics game, but for sake of discussion, one can be engaged or even “activated” without a true bias for action, they can simply serve as states of “being”, not doing. Perhaps this is why the Gallup Organization uses the term “actively engaged” to reinforce their measures of a highly engaged workforce. Participation, more so, suggests action, as it requires the individual to be doing something. Involvement continues to expand that reason, from one of a state of being to one of acting. In fact one definition of involvement I saw encompassed these very terms (parenthetical comments are my own): to engage (an action) as a participant (an active contributor).

The takeaway for me here is simple, as we have seen in countless organizational visits, cases and presentations, as we have uncovered in research efforts and benchmarking studies and perhaps most importantly what we have experienced in our very organization is that not only does involvement matter, it has significant influence on what can be achieved, how it is achieved and how quickly it can be achieved. An unassuming word on its own, involvement, may provide a profoundly important key to success in a healthcare world now intently focused on the improvement of the experience of all, patients, family members, community and caregivers. I believe that involvement is a fundamental component of any path to patient experience success. The question that now remains is how involved are you in your efforts and how willing are you to involve others in your success? I also strongly invite you to get involved in the patient experience movement and The Beryl Institute. We all still have significant and exciting work ahead!

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

Patient Experience and the Freedom of Choice

IPatient Experience and the Freedom of CHoice - The Beryl Instituten writing a blog for a US-based, global organization on the week of July 4th, I am hard pressed not to think about the concepts of independence, of freedom and of what those concepts provide for. To be independent, to be of free will, is something most, if not all, aspire to. It is ingrained in our human nature, for at its base is an idea so simple, yet at times so complex – the power of choice. For me this concept of choice is the essence of patient experience itself.

When I talk to people about the strategies and tactics of patient expedience improvement, I start with the simple recognition that what we do in healthcare – as human beings caring for human beings – is about the choices we make. From leaders guiding organizations on what priorities are set each day, to frontline caregivers across healthcare settings we are making choices in every moment, not just on what care to deliver, but how to deliver it as well.

This power of choice is profoundly important, and of increasing influence in our healthcare systems today. While we once may have gone directly to our local physician or hospital and listened intently with respect, following every word and instruction, the nature of healthcare itself has changed. I know to some this poses a great concern and others even disdain. For me, it reveals the true potential for excellence we have in healthcare systems around the world.

The debate has long simmered on if patients are customers of care. Using this term allows supporters of the historic healthcare hierarchy to diminish the very voice of patients, most often unintentionally. And you may be surprised to hear that I agree. Patients for the most part in healthcare today are not the customers of care. Customers are those individuals or organizations that choose to pay for a product of service. In fact following this logic, most often, insurance companies and/or government entities are the true customers of healthcare as they are the one’s directly funding services or paying the bill.

What does this mean then for our choice as patients? While many rightly make the argument, that as patients we do not choose to fall ill, have an accident, etc., that is we do not most often choose to be customers of healthcare, we overlook what I suggest above – that as human beings we still have choice. This distinguishes to me where patient experience plays it most significant role, especially economically. Patients are without question consumers of healthcare, regardless of systems, locality or structures. From an economic perspective it is the consumer who drives markets and influences business viability. Consumerism is the consideration that the free choice of individuals strongly influences what is offered to a market, what grows and what is overlooked. Therefore consumers and the choice they bring have strong economic impact.

The bottom line is that as patients have independence, even with some constraints based on insurance or in governmental healthcare systems, and therefore they have choice. Patients will note where the experience – the culmination of quality, safety and service – is best. And they wont keep it secret. Outside of the increasing use of government surveys globally to measure and publicly report performance, other consumer outlets are quickly booming – have you yelped your physician’s office lately, or seen the dialogue on Facebook about the care in your local hospital? This is consumerism at its finest and it is having great impact.

Patients have discovered they too have choice in the system, to not just expect, but to directly ask for and seek the best care they can find. Yes, patients do not choose a healthcare encounter like they would a hotel or an entertainment experience, they actually do so MORE significantly because this choice is about their own or a family member or friend’s well-being. A dear colleague, an inspiration for patients as true consumers of care, and a contributor to our Voices of Patients and Family paper – “e-Patient Dave” deBronkart clearly expresses the need for us as patients and family to choose to engage in our care, in ensuring we are fully informed and in doing so make the right choices.

I too am reminded about a story a gentlemen shared once with me about his 80-year old mother who when finding she needed hip replacement, scoured the internet for information on the procedure, recovery times, outcomes, etc. She discovered, that while scheduled for surgery at her local hospital (where she had gone for years), there was a better place for her to have her surgery in another state a plane ride away. She booked the ticket, made the trip and had her surgery. Now while all patients choices may not be that extreme, we must acknowledge that we all have choice – in some ways it is all we have – in how we decide to deliver care or on where we decide to receive it.

On a week where independence is held high, it is important that we remember it is not just a holiday in the United States, but a statement about the very freedom we have as individuals, as consumers: the freedom to choose. The Declaration of Independence declared that individuals “are endowed by their Creator with certain unalienable Rights, that among these are Life, Liberty and the pursuit of Happiness.” There may be no stronger place for us to remember these choices than in the decisions affecting our health. As healthcare leaders we must remember this, as caregivers honor it, and as patients and families never forget – the choice is truly ours.

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

 

Patients are Partners in Experience, Not Just Recipients of One

JWBlog6.13In my most recent Hospital Impact blog I noted that “how” we choose to do things in healthcare will and should trump the “what”. This is supported by my travels through numerous healthcare organizations where it is becoming evident that the core practices organizations are using to drive patient experience success are more and more consistent. While some might see this as limiting, I see it as encouraging.

Why is that? It means we are listening to one another, learning from each other and showing an incredible willingness to “steal ideas shamelessly” as a well respected CEO once shared with me in describing a component of their organizational success. That means the ‘what’ we do is not very different location to location. The distinguishing characteristic in experience is not the things you do, but the way in which your deliver. This is at the core of the very definition of patient experience as “the sum of all interactions, shaped by an organization’s culture”.

This ability to listen and learn from one another is a central value of all we do at The Beryl Institute. As a global community of practice we can (and must) learn from all edges of the community – those Institutions rated the “best” or seen as the “biggest” do not represent the only expertise. Rather it is in trying and executing of ideas in organizations of all shapes, sizes and focus through which excellence is supported and shared. It is based on this premise that the idea of a broad and inclusive range of voices has been so central to our work.

In returning to the conversation of “how”, I reflect on the recent conversations I had with 18 incredible patient and family advocates committed to the work of improving quality, safety and service for patients and families around the world in preparing the most recent paper from The Beryl Institute – Voices of Patients and Families: Partners in the Patient Experience. The stories these individual’s shared of compassion personified and at times the uglier side of care help us realize that there is power in how we choose to manage the interactions we have in healthcare every day. That it is truly more than the tactics, and rather the execution that matters.

The point I make here is all the tactics in the world amount to very little if all they are is something we do TO people in our care. The old language of provider and recipient may well still be used in healthcare, but its use is outdated and indicative of a system in need of change. Patients – yes, you and I, our children and parents, family and friends – are active parts of the healthcare equation, not passive recipients of it. We need to ensure we start acting this way. This perspective is exemplified through the work of such great organizations as the Society for Participatory Medicine.

While there are countless lessons shared by the individuals interviewed in the Voices paper, we inherently know many of them ourselves. Our contributors helped frame three central ideas in ensuring partnership in the care environment:

1. Acknowledge patients are not subjects in the healthcare process or “something” you should talk about or plan for in third person.

2. Recognize patients are not necessarily wired to actively engage in the healthcare process, due both to the complexity of healthcare and the nature of the system itself (that potentially diminishes the role of the patient in an unspoken hierarchy of expertise). You must ask, encourage, and act on the patient’s voice.

3. Consider coordinating efforts to identify and incorporate patient perceptions into the overall planning of care.

Personally, as I continue the journey of new fatherhood, I saw this play out in the very interactions we have had with our pediatrician. At our stage as new parents, we could be scolded, challenged or even talked down to about how we handle situations. Instead our doc engages us based on our questions, our hopes and fears. I know she is getting all the needed clinical work done, but she is including us as patients and family, as partners in the process. This is an active decision on her part, it is one that engages us in the care of our son and ensures a positive experience with every visit. “How” is a choice we can all make in healthcare and is one I believe will make all the difference.

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

You are the Patient Experience: A Reflection

2013-04BlogIn just two weeks, hundreds of healthcare leaders, resource providers, patients and family members from around the world will gather together at Patient Experience Conference 2013. This annual gathering continues to amaze me, for while I get to take part in the organization and preparation with an incredible team of planners and volunteers, what happens during these days together is still, in many ways, a surprise.

Why is that, you ask? It comes down to a simple philosophy we work hard to ensure permeates our community at The Beryl Institute each and every day. With as many resources as we continue to provide – from papers, to case studies, On the Roadvisits to research – and our commitment to be the global community of practice and premier thought leader on improving the patient experience, we fundamentally believe the greatest power in our community is the connection and sharing with one another. That is what makes the annual gathering of patient experience leaders so powerful; it is grounded in the learning from and connection with one another and provides a new level of support for what many can feel at times may be a very lonely and challenging adventure.

No one person, organization, provider or vendor “owns” the patient experience and they should not claim to; rather it is ALL of the people who live it, struggle with it, work to improve and yes experience it every day, who do. It is you who truly are keepers of this movement. You are the patient experience. I see our job to create the space for this to happen, provide the information from which you can learn and fundamentally encourage the connections that will help all of us ultimately improve.

In my March Patient Experience Blog, Why Community Matters in Improving Patient Experience, I suggested, “…to provide a true experience, you must think well beyond the physical nature of your facilities or practices to recognize that experience resides in the network of people that surround and are connected to your organization, both near and far.” I would suggest that in the call to action to address the patient experience we remember this fundamental point. This is what also has me encourage people to get engaged, be part of the community, contribute and learn from one another. It is why at the Institute we have launched our Voices of the Patient Experience series to start this year from the perspective of executives, the front line, healthcare students and patients and family members and why we are ensuring patients and family members can participate in Conference 2013 (#patientsincluded).

I also share these thoughts with a new perspective on this passion, from that of a patient and family member myself. Personal experience has led me to spend time (and as someone committed to patient experience, observe the experience) in an emergency department and primary care setting, and has blessed me with the chance to encounter the preparation and expectation setting that happens with both physician and hospital in anticipating the arrival of your first child. These personal encounters have reminded me that each and every one of us committed to this work are also (or will be) that patient or family member.

I share all of this to reiterate my central point, if we are committed to improving patient experience, to ensuring all voices are heard, to providing the best in quality, safety and service, then the opportunity we have and must take advantage of is to tackle this not alone, but as a true global community. Whether in person at Patient Experience Conference, on a call or via an electronic network, the impact that we can have is only heightened through our connections. I encourage your engagement and I urge your sharing. This is an effort worth every moment we spend. I most look forward to all that will still emerge as a surprise!

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

Why Community Matters in Improving Patient Experience

CommunityBlogThey say when someone mentions a Red Beetle – the automobile version from Volkswagenor “bug” – you go from not seeing them at all to seeing them everywhere you look. In a similar fashion my recent conversations on the patient experience have raised this sense of “everywhere” awareness to the idea of community. From as recently as our March 5 webinar on patient engagement to the final interviews I just conducted for our pending paper on the Voices of Patients & Families on Patient Experience, there is a recognition that while patient experience is built on the foundation of countless personal interactions, when pulled together it is a true community issue and, I would suggest, opportunity.

The idea of community aligns strongly with the definition of patient experience that asserts patient experience crosses the entire continuum of care. I need to reinforce from the perspective we hold at the Institute this is not just the continuum within the four walls of the clinical experience, but from the very first encounters someone has with your organization to the stories they share well after their departure or discharge. Where are these stories told and where do they live beyond the boundaries of what you can control? In your communities, in the voices of people that have either had encounters with your organization or who have heard the stories, true or embellished, about what happened within your walls.

This means to provide a true experience, you must think well beyond the physical nature of your facilities or practices to recognize the experience resides in the network of people that surround and are connected to your organization, both near and far. This is at its heart, the essence of experience. As defined, experience is all that is perceived, understood and remembered. Those perceptions and memories and the stories through which they are shared are not collected at your doors, but rather they flourish in the sunlight and in the air of the streets, towns, and cities around you. The experience you provide is a community story and one you must be willing to acknowledge and address.

But I want to suggest another angle on community as well that is as equally important in all I have seen. That accomplishing the greatest in experience is a true community effort. It is not just something that can happen at admissions or discharge, or in your top performing units or departments. It must happen across the organization or system. More so I strongly believe the essence of patient experience thrives in much bigger ideas of community, which is why we have worked so hard in creating a true community of practice in The Beryl Institute itself.

I continue to be amazed by the generosity of spirit and sharing that has been afforded by the safe framework of our community. The realization that in healthcare if we are to be about the patient experience, holding our cards close to our chest or believing our “secret” process is our competitive advantage, is counter to what we are all trying to achieve. As much as I admire systems and organizations big and small for what they accomplish, I can tell you from my travels and encounters around the world, there is no one secret to success. What I have seen as the greatest resource comes back to the idea of that red beetle – community. It is in our willingness to share ideas and practice, to be open to exposing where we may have been challenged and celebrate and disseminate that which drove success, through which we can all impact patient experience.

This is not just a lesson for those in the delivery of care, but for those that support it; the resource providers and vendors, from survey companies to technology tools. It is their willingness to collaborate and share in community through which even greater things can happen. While their distinctions may be in variations of a theme in process and clearly more on level of service and the personalities involved, the reality is that they too play a part in this critical community conversation. From leadership to the frontline, from the future to patients and families themselves, it is the spirit of community and through the action of community that we can ensure the greatest in patient experience for all the patients, families and yes the very communities we serve.

As we approach Patient Experience Conference 2013, and we bring our virtual global community together physically for a few days this April, we hope that we are all reminded that it is through our connections that we have the opportunity for greatest impact. It is in our collective efforts and shared learning that we have the clearest path to success. My hope, and my vigorous invitation, is to join us, join this community and our efforts at The Beryl Institute as member or guest; as caregiver, physician, administrator, resource provider, patient or family member and to be in conversation on what we can accomplish as a community, together. The greatest of opportunities will emerge when we find our collective voice and there is so much yet to learn from one another.

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

The Importance of Voice in Improving Patient Experience

As The Beryl Institute has grown from a small group of committed individuals to a true global community, I have learned something very important. There is tremendous power in giving voice to ideas. Voice is not just the spoken word, but also the expression of opinion and thought, of creativity and passion, through multiple avenues. It is this essence of giving voice that rests at the core of excellence in patient experience itself.

My hope is that the Institute has reinforced that very fact. More than just a membership association or a research organization, the Institute’s strength in supporting those working to improve the patient experience has been in giving voice to the over 15,000 members and guests that engage in our community of practice. It was members and guests that provided input on the largest patient experience benchmarking study to date, it was members and guests who over 400 strong have contributed to creating the Patient Experience Body of Knowledge, it was members and guests who came together to author the definition of patient experience.

Why is this important? Because we have been built by and for our members in the way I have seen the most successful organizations address the patient experience itself. Those organizations have created the means to engage the range of voices they encompass. Those successful facilities and practices, systems and centers have made a commitment to intentionally listen and actively engage the voices of their community. They did this by:

  • Creating the opportunity for the voice of patients and families to be heard, not just in formal advisory roles, but also in common interactions. Those organizations that have incorporated patients and families as critical partners in the care experience excel at ensuring the best in service, quality and safety.
  • Providing the means for the voice of staff to be heard, not just through engagement surveys, but also as active contributors to an environment of continuous improvement. The ability to speak-up, offer ideas and even challenge the status quo without fear of repercussion has led to great improvements and important changes in the delivery of care.
  • Offering the chance for the voice of the community to be heard, more than just asking for contributions to foundations or causes. The engagement of community through strong presence and focused outreach shapes the nature of a healthcare organization, be it a rural community health center or a major urban hospital. In healthcare we hold a unique place in the communities we serve and play a role no other service provider can.

The importance of voice plays a central role in improving patient experience in healthcare settings around the world. In fact, in our most recent paper, Voices from the C-Suite: Perspectives on the Patient Experience, the executives we interviewed consistently talked about the importance of engaging the voice of patients, family and staff.

In no small part then is the importance of continuing to ensure the power of voice is included in all we do at the Institute. We have opened the year with a series of papers, including the Voices from the C-Suite mentioned above, that provide the opportunity for voices to be shared. This will be followed by Voices in Practice and ultimately Voices of Patients and Family, as we look to reinforce this simple, but significant tool and the lessons it offers in impacting patient experience.

Perhaps more importantly, we commit to ensuring the voice of the patient experience is heard. It is in our collective expression and sharing in which each individual and the organization they represent can learn and grow. It is ultimately in expressing our voice that we give the greatest gift to one another, it is in inviting that voice that we show the greatest of respect.

Improving the patient experience is not just an act, it is critical dialogue; one that we must foster and encourage. Its impact is greatest when all voices are heard. Our commitment is to provide the space for that to continue. My question now is how will you use your voice to impact the patient experience and how will you engage the voices of others? This is one conversation we must never let end.

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

The Power of Expectations: A Thought for the New Year

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.

The example of how personal expectations can modify the perception of reality has long been part of the healthcare world. As Chris Berdik notes in his new book, Mind over Mind, the power of expectations lies at the center of the placebo effect. Berdik makes a compelling case that what we expect from the world changes how we experience it. He notes that research into placebos is expanding to examine everything that affects a patient’s expectations for treatment, including how caregivers talk and act and even the impact of the wealth of online information now available – and how those expectations can help or hinder healing. I believe the same is true as we look at the overall healthcare experience. Patients and families come with personal expectations and more often with ones that healthcare organizations worked to create. It is these very expectations that impact how individuals experience an organization and ultimately rate its performance overall.

I can share a non-healthcare example of this from just this past week. My wife and I had the chance to take a few days away for the holidays at a small inn near our home. We had heard great things about the service and quality of the experience and were excited by some of the extra amenities they offered. When we arrived we discovered our room was the only one missing the special amenities they touted in their promotions, and while the service was impeccable, this missed expectation had already impacted our experience. The hotel did all they could to accommodate and provide service recovery for our experience. To an extent they even exceeded what we would have anticipated in response, but it was the missed expectation that still lingered for us as guests.

Now imagine in the healthcare setting where our patients and families come with their own set of anticipations and clear expectations. Most do not choose to visit, but rather are dealing with illness or other issues that may be cause for great concern and even fear. They come with expectations of how they will be treated, but even more significantly they come to your doors with the expectations your organization has set through the stories shared and the messages disseminated via advertising or other means.

I saw an example of this at a recent hospital I visited. They were so proud of their new facilities, including new amenities, private rooms, etc. The advertisements and billboards they produced promoted the newness of the hospital. Yet, they still also had an older wing, where the rooms were dated, semi-private and lacked the sparkle and shine of the newer rooms. While the patient experience of the facility was not designed to be about the physical nature of the buildings, but rather the encounter people have with staff, they set the expectations publically that the facility itself was at the heart of their overall experience. In essence, they set expectations they could not always fulfill…and it set up the potential for disappointment before they even had the chance to make an impact.

The lesson here is simple, yet significant and one I think is critical to looking at the year ahead. For as much as we can control our efforts in healthcare, we must work to set the best and most realistic expectations we can for our patients and families. This is not what I have heard some describe as lowering expectations to outperform, but rather it is about setting the right expectations for what you want to deliver in your own organization and ensuring the means – both in resources and process – to deliver on it.

In maintaining a focus on providing a positive patient experience, consider starting the year by identifying the expectations you hope to deliver, ensuring your leadership and staff are aware of these touted expectations and establish a process to check your performance to these expectations at every point in the care experience. While you cannot dictate every expectation people bring with them to your doors, healthcare organizations can shape their own story in a way that ensures expectations are realized and the patient experience is one that will always be remembered. Wishing you fulfilled and exceeded expectations for the year ahead!

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

7 Steps to Accountability: A Key Ingredient in Improving Patient Experience

As I continue to visit healthcare organizations and engage with leaders globally there are clear emerging trends at the heart of effective efforts to address the patient and family experience. In my recent series of blogs I suggest we must recognize the implications of patient perceptions as a focus of our patient experience efforts. I support this by reinforcing that culture is a critical choice for organizations to consider in terms of how they look to shape those perceptions. In fact we cannot overlook the centrality of culture to the very definition of patient experience overall. I add that it is on a strong cultural foundation that we can then ensure a sense of engagement for our staff and patients.

The missing piece in this important dialogue is that of building a foundation of accountability in our healthcare organizations. It has been identified as a top issue for healthcare leaders during my On the Road visits and at our Regional Roundtable gatherings. In looking at all the suggested paths and plans to accountability some general themes emerge.

Building a basis for accountability in organizations requires a number of committed actions. Without these organizations run the risk of falling short on their defined patient experience objectives. They include:

1. Establish focused standards/expectations – Determine and clearly define what you expect in behaviors and actions as you create a culture of accountability.

2. Set clear consequences for inaction and rewards and recognition for action – Be willing to reinforce expectations consistently and use as opportunities for learning.

3. Provide learning opportunities to understand and see expectations in action – Ensure staff at all levels are clear on expected behaviors and consequences.

4. Communicate expectations, reinforcing what and why consistently and continuously – Keep expectations top of mind and be clear that these are part of who you are as an organization in every encounter.

5. Observe and evaluate staff at all levels providing feedback and/or coaching as needed – Turn actual encounters, good or bad, into learning moments and opportunities to ensure people are clear on expected behaviors and actions.

6. Execute on consequences immediately and thoughtfully – Respond rapidly when people miss the mark (or when people excel) to ensure people are aware of the importance of your expectations.

7. Revisit expectations often to ensure they meet the needs and objectives of the organization – Remember standard and expectations are dynamic and change with your organization’s needs. They must stay in tune with who you are as an organization (your values) and where you intend to go (your vision).

Accountability has been tossed around more and more in conversations today in healthcare organizations as something that leaders want to see more of. The reality is that accountability is not just something you simply expect and it just miraculously appears, it is something you must intentionally create expectations for and reinforce. As with patient experience itself, accountability needs a plan in order to ensure effective execution.

I often speak of patient experience efforts as a choice; one that requires rigorous work. This is overcoming something I call the performance paradox, which helps us recognize that many things we see as simple, clear and understandable are not always easy, trouble-free and painless to do. Yet I would suggest we have no other choice. As a positive patient experience is something we owe to our patients and their families in our healthcare settings, creating and sustaining a culture of accountability is something we actually owe to our staff in supporting their ability to create unparalleled experience.

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

Organizational Culture: A Critical Choice at the Heart of an Exceptional Patient Experience

The Beryl Institute defines patient experience as the sum of all interactions, shaped by an organization’s culture, that influence patient perceptions across the continuum of care. While healthcare organizations may not be able to directly control the perceptions of patients and families, the opportunity to influence these perceptions is grounded in their very culture. I suggest that culture is fundamentally based on the choices an organization makes.

When I first explored the characteristics of high performing organizations in healthcare, “seven simple truth’s” emerged that were tied to positive outcomes. They represented committed choices of action in the organizations studied. These truths included:

  • Visionary leadership
  • Consistent and effective communication
  • Selecting for fit and ongoing development of staff
  • Agile and open culture
  • Central focus on service
  • Constant recognition and broad community outreach
  • Solid physician/clinical relationships

It was this combination of efforts that helped organizations drive exceptional outcomes in experience, engagement, quality and the bottom-line. These characteristics have continued to emerge during my exploration of what is driving patient experience success in healthcare organizations around the world.

As recently as my last two On the Road visits, with St. David’s Healthcare and Scripps Health, the central role of culture in patient experience efforts was reinforced. In the St. David’s system, at the core of the process for reinforcing system-wide values and focus on exceptional experience are three questions. They ask daily how staff will define, live and manage the culture. The recognition at St. David’s is that the experience tactics you implement are only as effective as the foundation of culture on which they are built.

This was also the case at Scripps Health, where they recognized the very nature of the organization has a significant impact on overall experience. Vic Buzachero, Scripps Health’s Corporate Senior Vice President for Innovation, Human Resources and Performance Management shared, “It is important that we build a culture that drives consistency in our effort. We must have the infrastructure to show the genuine nature of our organization, reinforce our focus on the patient and shape the balance of systems, processes and behaviors that will help us realize our goals.”

This is not just a U.S.-based phenomenon. My visit to the NHS in the United Kingdom reinforced the importance of culture to experience. They created an opportunity for patients, family and community members to interact directly with senior leadership and initiated processes that improved communication and understanding of patient’s needs. They also focused on creating happy and engaged staff to ensure happy patients.

This idea is reinforced by recent research conducted by Britt Berrett and Paul Spiegelman. They suggest in any business, and especially healthcare, you can’t take care of customers ifyou don’t take care of employees. The realization, as we saw exemplified in the cases above, is that to ensure the best experience and focus on patients and families, there must also be an intentional focus and effort to create employee engagement and loyalty. Again, this is driven by the culture of an organization. (They offer a complimentary survey in which you can gauge your own organization’s culture of engagement).

Through all our explorations at The Beryl Institute into what drives the best in experience there has always been an element of those simple organizational truths above, all which represent a commitment to creating a culture of service. Simply putting tactics in place has you run the risk of turning your patient experience efforts into the latest flavor of the month activity. Patients and their families and yes your colleagues and employees deserve much more. To truly drive an exceptional patient experience, you can only influence perceptions through the choices you make. One of the most critical of those being the type of organizational culture you choose to create.

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