Silence: The Invisible Tool for Patient Experience Excellence

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

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

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

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

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

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

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

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

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

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

Considerations for Patient Experience Excellence: 2016

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

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

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

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

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

I conclude with one more consideration:

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

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

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

A Research Agenda for Patient Experience Excellence

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

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

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

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

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

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

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

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

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

Taking a Stand for Patient Experience Excellence

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

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

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

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

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

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

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

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

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

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

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.
President
The Beryl Institute

How Will You Inspire the Patient Experience Movement? Four Considerations for 2014

InspiredI am inspired. The New Year has arrived with great energy at The Beryl Institute. We start 2014 as a global community of practice of over 20,000 professionals, focused without hesitation on ensuring the best in experience for patients, families and one another in healthcare.

I am inspired by the continued commitments expressed for this work: by The Beryl Institute’s Patient Experience Scholars who met recently to share their research and reinforce their willingness to encourage and support others; by the members of the Global Patient & Family Advisory Council who want to influence how patients and family members are heard and engaged in making a profound difference in healthcare; by the many contributing to the development of the Patient Experience Body of Knowledge courses soon to be available to the community; and by many more.

I am inspired by how in the first two weeks of a new year, such commitment and intent can emerge, built on all that has come before and focused with purpose on the great opportunities ahead. As I reflect on this idea, a question emerged and perhaps a challenge for each of us to consider:

How will you inspire the patient experience movement in the year ahead?

I pose this question with the hope that actions and considerations from the smallest moments of unparalleled kindness to the largest strategic triumphs all find room to take root and grow. Inspiration comes in all shapes and sizes, but in this diversity it has strong commonalities – it causes us to feel a sense of something special and powerful. It provides a boundless energy to influence, lead, change and make a difference. This is an exciting prospect in seeing that each of us can choose to have an impact. And while no two actions will be exactly alike, I do want to offer a few thoughts on how you can continue to frame your patient experience efforts to inspire yourself and others.

As we return to the definition of patient experience, I continue to experience its relevance time-and-time again in the application of these words to central actions associated with excellence. In reviewing its words – the sum of all interactions, shaped by an organization’s culture, that influence patient perceptions, across the continuum of care – I again see clear directions on moving your own experience efforts forward. They include:

1. Reinforce strategic focus. Patient experience has proven itself to be a relevant part of the healthcare conversation. It has surpassed the challenges of being dubbed a fad; it too has shown it has stronger legs than just serving as a policy framework. Experience is a central strategic pillar to organizational performance and success. Patient Experience in its broadest sense should be a clear and transparent component of every healthcare organization’s strategy.

2. Clarify and map your critical interactions. Experience doesn’t happen on billboards or in espoused actions, it happens at the most personal moments, at those points of engagement between one individual and another. The ultimate tool in patient experience improvement is your self, your heart, your hands and arms, your minds, your compassion and your common sense. We have a huge opportunity to map the interactions that occur on the patient path to ensure we consider the most effective way to respond at every touch point.

3. Model desired behaviors. Simply put, if interactions drive experience, then the behaviors that comprise them are the conduits that direct these interactions in one way or another. Organizational culture is shaped by behaviors, they represent the people, presence and purpose of an organization overall and no slogan, policy or program will trump the power of individual behavior. We must model, observe, coach and improve constantly to impact experience outcomes.

4. Expand your listening. As we ended 2013 exploring the Voices of Measurement, we learned that the power of data is only as valid as what we choose to do with it. Collection or reporting data for the sake of data misses the opportunity for learning and relevant action. To capitalize on the value of the voices that surround us in healthcare we must expand our listening. Experience is measured first in the direct voices of healthcare consumers, who remain our most significant mirror into our own efforts, but it is also found in the voices of our peers and colleagues. We are only capable of achieving our strategy through our people. They are much more than pawns to direct, but rather living resources accountable for ensuring excellence.

Perhaps these ideas will help spark your own thoughts on how you will choose to inspire the patient experience movement. Regardless of which direction you go, I hope you recognize the power that exists in your own personal choice and the ability to impact the experience of the person that is coming next. The year ahead can and should be about a great many things both personally and professionally. My hope is that you find you can and will be an inspiration in your efforts. This cause is too great for your efforts to be anything less. Now the question remains, what will you do? I look forward to your updates with great anticipation.

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

Reflecting on The Patient Experience Movement: The Power of Voices and Collaboration

As we stand at the end of each year, we tend to look back at all that led us to this moment and anticipate all that lies ahead. I stand here now with all of you that comprise our patient experience community, who live and breathe in your every action this patient experience movement, and can say without hesitation that together we have accomplished great things and together there are even more powerful moments to come.

Collaboration-v2

This year has exemplified our core values at The Beryl Institute – the importance of community and the integral role of collaboration. We have worked to reinforce the true power of engaging all voices in the patient experience conversation. This gathering of voices has seen our patient experience community grow from 11,000 to 20,000 members and guests this year alone, representing over 45 countries. This gathering of voices has led to a year in which the foundational ideas of this movement have been reinforced and solidified. In our commitment to expand access to the greatest breadth and depth of individuals across healthcare we recently expanded our membership framework to provide access to all associates in any healthcare facility. These Institutional memberships enable staff at all levels, in all roles, across the range of healthcare organizations to engage, to learn and to lead in their own environments.

In expanding the conversation on voice itself, this year has been shaped by the Voices of Patient Experience series in which we heard from the C-Suite, front-line practice, students across healthcare disciplines, physicians, patients and families and those measuring the impact of our patient experience efforts. This collection of voices served to complement the many others that contributed to learning and sharing of ideas via webinars and case studiesPatient Experience Conference presentations and On the Road visits. Hundreds of you added your thoughts to the conversation via these and other outlets. This open sense of sharing, of giving, of collaboration has allowed the patient experience movement to thrive.

The voices series also raised a significant awareness for the community; to be an organization truly committed to patient experience, we had to move beyond the talk about what we do “to” patients and families, and reinforce an unwavering commitment to do “with”. This partnership in care underlines the very intent of the Institute to provide a place to learn from one another, and it was clear that included the voices of patients and families themselves. This led us to establish the Global Patient & Family Advisory Council, comprised of leading patient and family thinkers, writers, speakers and activists. It also had us collaborate with IHI at the 2013 National Forum to support the “Patient is In” Booth in which patients and family members could share input and ideas with forum participants. These voices remind us of the boundless value of this partnership in patient experience improvement.

The expansion of voices also led to the 2nd State of Patient Experience Study, the largest conducted to date on patient experience efforts, and revealed some interesting trends in the both the focus, intent and awareness of patient experience efforts. Yet, while the movement continues to push on, less than 50% of U.S. hospitals have yet to formally define patient experience for themselves. We still have great opportunities to educate and learn from one another.

This awareness made it only natural that we expand our efforts overall on the professional development of patient experience champions, furthering the work on the Patient Experience Body of Knowledge with domain outlines and the anticipated release of the domain courses in 2014. As a community you reinforced your desire and the greater need to shape this work in ways that will allow each and every one of us to grow stronger. The year ahead brings even more exciting work on this front.

In a recent Hospital Impact blog I mentioned my great excitement about the growth of the patient experience family overall, from new sister organizations to research entities focusing on this area, to critical gatherings in numerous places in support of this important discussion. We will continue to support and reinforce the value of all these efforts and maintain that in collaboration we all win in this movement. We remain committed to serving as a hub and connector of the many voices focused on this effort and keep our arms open for the opportunities for further collaboration.

This very idea led to us to begin conversations with and engage in a formal collaboration with the Society for Healthcare Consumer Advocacy (SHCA) and its 40 years of incredible history and commitment to patient voice, rights and advocacy. A strong and storied organization whose roots can be found at the very start of the patient experience movement, SHCA felt they found a home for their future with The Beryl Institute, but I would say while the container is the Institute, the home is the community of peers, of leaders and teachers, of resource providers and caregivers, of patients and families who make up this growing professional home for so many. The integration with SHCA and the purposeful collaboration with a growing number of organizations committed to this cause help reinforce the power that collaboration itself brings to this conversation.

I would be remiss if I did not add a personal note to this reflection on the year, that as I stood on stage to close Patient Experience Conference 2013 and received the call that I needed to rush home for the delivery of my son, I shifted abruptly from champion and advocate for a movement to a family member surround by a healthcare system still admittedly learning itself. My eyes were opened, not only by the magic of the birth of a child, but of a family member watching your loved ones cared for, your new child handled, complications managed and tense moments relieved. We must not forget we are all patients and family members and need to continue our work as such.

The work you do may at times seem like small gestures, part of your standard process or even done automatically as a seasoned veteran, but to a patient or family member you are providing an incredible gesture of service, of quality, of safety – of experience. In every moment we have the choice to create the experience for our patients and their families. And every moment each of you as members of this community, of this movement, have that choice as well…to engage, to learn, to contribute, and to encourage the involvement of others.

You see this is your community, it is built on the power of your voices, it is driven by the collaboration we find with one another and it is from that place that we look to the new year knowing that the greatest opportunities still lie ahead. Thank you for your contributions, support and leadership. May you have a healthy and happy holiday and be ready with great excitement for all the New Year will bring.

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

A Patient Experience Lesson from the Latest U.S. Congressional Showdown

USCapitolWhile I don’t wade into the political spectrum often in these discussions, in light of the news of the day, I am hard pressed not to at least share a reflection on what is taking place in Washington, D.C., its impact on the U.S. Healthcare system, and the broader economic implications it is presumed to have. I do not intend to advocate for one position or another here, but rather share a core reflection on the lesson I see for patient experience professionals in the current state of affairs.

For those of us in healthcare (and in reality for all of those that are not), this week signifies a historic time with some of the first steps underway in the implementation of the Affordable Care Act, also referred to as Obamacare. Regardless of the actions (or inactions) on Capitol Hill, and whether you are in support of or against it, the healthcare law will move forward for now. I do not intend to break down the law and examine its detailed impact on the patient experience here. Rather, I hope to share a simple but significant realization about the entire U.S. Healthcare system revealed in this debate.

Recent polls conducted separately by both Fox News and CNBC found that when asked, Americans often distinguish between the Affordable Care Act (ACA) and Obamacare. Much of this distinction is driven from the very mouths of congressional and other political leaders. In fact in exploring people’s opinions on the programs under these two naming conventions there was a variance in the value, interest and support for each of these programs. The challenge (or perhaps surprise) in this discovery is that in fact these two programs are exactly the same thing – the ACA is Obamacare and vice versa.

The reality is in healthcare we have many words that raise this same challenge in our delivery system, driven by providers, supported by payors and serving patients and families. The example above, of divergent opinions on, in essence, the same idea, driven by language, expert opinion or pure rhetoric, is one of the best I have seen reinforcing with clear data the power of language and more importantly perception.

The concept of perception – the way you think about or understand someone or something – is a central part of the patient experience itself. Defining patient experience as the sum of all interactions, shaped by an organization’s culture, that influence patient (and family) perceptions across the continuum of care makes explicit that perception is both the result of experience and also the lens through which people make choices now and into the future around their care.

For the reported confusion created in the language around two names for the same healthcare law – ACA or Obamacare – there are limitless levels of confusion created in the language of our healthcare system itself, from diagnosis to medications, acronyms to systemic issues. In the simplest of terms we all too often and in many cases unintentionally create confusions for the healthcare community, our patients and their families in the terminology and language we choose to use. I recently sat on a panel at DePaul University on the future of healthcare in the U.S. and this very issue emerged – that in creating true accessibility we have to not only have the proper processes and checklists in place, but also the right, and perhaps more importantly, the clearest language possible.

I am not suggesting the healthcare system is facing the same levels of dysfunction as the U.S. Congress, but I do believe there is a great opportunity for clarity in making the healthcare experience easier and better for all receiving care. Finding language that works for patients and families, as well as for those working in the system, will only serve to better engage and inform patients and families and support the invaluable nature of their role as partners in the healthcare process.

This could perhaps be one of the first and most important steps in driving patient experience success. There is power in language, in its application and perception…the US congress taught us that again this week in a way I don’t think we cared to learn. But in this chaos I see a silver lining, an important lesson for all of us either entrusted with and/or committed to the best in patient experience. Manage perceptions with clarity and honesty in each and every healthcare encounter. It may not change the system overnight, but it will have a positive and powerful ripple effect that will be very hard to diminish.

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

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

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