Reframing the Core Values for Patient Experience

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

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

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

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

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

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

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

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

The Patient Experience Must Be Owned By All: Welcoming the Society of Healthcare Consumer Advocacy

In The Beryl Institute’s recent research report – The State of Patient Experience in American Hospitals 2013 – I noted in conclusion that the state of patient experience is growing stronger every day because of the many voices committed to this work. I too reinforced my belief that a patient experience movement is afoot, one that requires continuous and focused efforts and one that should be grounded in and built upon collaboration and alignment versus competition or the desire to stake a claim.

This idea rests at the very core of the global community of practice we have built at The Beryl Institute. We do not claim to own the patient experience, but rather to be a place where people can gather together to share what is best in what they are working to accomplish. Our philosophy has been and will remain that through collaboration not just great, but greater things can happen.

It is in this very spirit of collaboration that I am excited to share the bridging of two great organizations to expand the alignment and dialogue on patient experience improvement. We have been in discussion with and will soon be welcoming the Society for Healthcare Consumer Advocacy (SHCA) into The Beryl Institute community. After an incredible 40 year history and supportive home with the American Hospital Association (AHA), our three organizations – The Beryl Institute, SCHA and AHA – saw great potential in supporting the next 40 years and beyond for SHCA within the Institute (You can read a letter from all of SHCA’s Past Board Presidents here). As of January 1, 2014, our communities will align to continue to expand the patient experience conversation and in doing so model the power of coming together in this critical dialogue.

More details will soon be available around this exciting next step in the history of focus on patient advocacy and more broadly patient experience improvement, but suffice it to say, the commitment to engaging all voices and growing those engaged in this important work is top of mind for us all. I am excited and proud to welcome the SHCA community to The Beryl Institute family as their new professional home and in doing so reiterate the very critical message I share here. That it is in coming together, not attempts at market distinction, in which the greatest outcomes are possible.

I have watched in recent years as patient experience has moved from an emerging term to an active conversation at the center of policy and now financial focus. I have also seen a great game of ownership being played out. Much like one might have experienced during the gold rush, claiming their small bit of mountain stream to pan for hours, days or more in search of that one bright speck, many organizations – some well established, and some quite new – have all worked on positioning for their piece of the pie.

While I am a true believer in free enterprise and recognize the great potential for market savvy in this new world of healthcare, I also believe we have something bigger we are attempting to do in working towards patient experience excellence. It is in the bringing together of disparate thoughts or competing ideas, be they those of resource providers of similar services or healthcare organizations occupying the same market, in which the greatest outcomes can be realized. You see no one organization owns the patient experience, yet we in healthcare must all take ownership of it.

For this reason we have worked to bring the many voices together, for as I asserted above, this is where the strength of our work and its impact rests. This idea has been realized in the Institute’s Regional Roundtables where market “competitors” join together in sharing thoughts and crafting shared plans focused on improvement. It has been realized at Patient Experience Conference where numerous resource providers join in and engage in support of a true, independent community dialogue. It is seen in the willingness of some of the largest players in experience measurement to come together to share ideas between the covers of our soon to be released paper on the Voices of Measurement.

If we are to make the greatest differences in the lives of our patients, families, peers and community we must be open to the idea that above all else through collaboration and coordinated effort profound possibility exists for improvement and sustained impact. And while by my very words, I cannot claim The Beryl Institute is the only place this can or will be done, I do hope and in fact commit that we will continue to stand for the bringing together of all ideas, of every voice and of each hope in each and everything we do. As a community of practice it is our calling, at The Beryl Institute it is our cause and we are so very excited to see (and hopefully be a catalyst in) the patient experience family continuing to grow.

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

 

Patient Experience: A Global Opportunity and a Local Solution

Last week we held the second call of the new Global Patient Experience Network supported by The Beryl Institute. The call included Institute members from eight countries and spread across 18 time zones. Despite our differences in location, time of day, native language or accent, when the conversation started, we discovered that the concepts at the core of improving patient experience are fundamentally the same. Providing the best in experience for patients, families and the communities (and countries) we serve is an unwavering focus for people across healthcare systems and functions around the world.

As I listened to the conversation and we dug deeper in identifying what posed the greatest challenges and offered significant opportunities for improving patient experience, I was struck by the recognition (and even relief) that participants showed in how similar their issues were. One participant offered, “It’s comforting to know we are all contending with the same challenges and questions moving forward,” with a second individual noting, “It is amazing that at the end of the day we are all working towards the same end and facing the same issues.” This realization drew agreement and raised the excitement of the group in understanding that even with great distances between us, there are great similarities and therefore possibilities.

The group identified the same top issues central to patient experience efforts that I have seen in my travels. They included:

  • The importance of organization culture and our ability to manage change in today’s healthcare environment
  • The understanding and effective implementation of patient (and team) interaction processes from patient, physician and staff engagement and involvement to service recovery, post care follow-up and building consumer loyalty
  • The implications of measuring our patient experience efforts to gauge perception and understand the impact of each effort
  • The value of the structure of patient experience practice itself, ensuring a clear focus, supportive leadership, aligned roles and right structures to deliver on the best experience possible

While these are not the extent of the issues faced in addressing patient experience, it was evident that among peers separated by great distance, they still had closely knit similarities. This was especially significant for our team at the Institute as we have always approached our work from the belief that while systems may operate differently and policies might be distinct, the very fundamentals that drive a positive patient experience – the power of interactions, the importance of culture, the reality that perceptions matter and the realization that experience covers the continuum of care – as framed by the definition of patient experience, continues to hold true.

With this great commonality and the excitement generated in the discussion, it was also evident that our members recognized that patient experience is a local, dare I say personal effort. Each and every individual that plays a role along the care continuum has some level of responsibility. It is based on the sum of all interactions, as we suggest, that a patient and their family members gauge their own experience. Therefore in building a patient experience effort, it requires an understanding of your own organization, the people that comprise it, and the community (and demographics) that you serve. Patient experience success is not driven by a one model fits all solution, it is and forever should be something that meets the need of your organization and your patients whether in San Diego or Sydney, New York or New Delhi. Ultimately, patient experience is a global issue, but it is and will continue to be up to each of us locally to bring these grand ideas, the critical practices, and the day-to-day needs to life in every encounter. There is a great opportunity we have been given to move beyond policy to true cause, beyond process to effective practice and beyond “have tos” to “always dos”, that will impact the lives of patients and families globally. I have always suggested it is a choice…I maintain that and hope it is part of all our resolutions for positive and healthy New Year!

In reflecting on the launch of the Global Network and other Institute efforts in 2012, it is clear that this has been an amazing year for our growing global community, with now over 11,000 members and guests in 28 countries focused on improving the patient experience. We have all committed to something noble and important, the best possible experience and the health and well being for our fellow man. And we have been given a great opportunity, to turn a global need into something each and every one of us can impact directly. Happy Holidays to you all and I look forward to continuing to learn and grow together in the year ahead.

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

Regardless of U.S. Supreme Court Decision, Patient Experience is Central to the Future of Healthcare

One question I was consistently asked in anticipation of last week’s U.S. Supreme Court decision was what impact the outcome would have on the importance of patient experience. My response was unwavering; that if healthcare organizations are simply driven by policy or perceived political pressure they might want to reconsider their true purpose and very existence. Regardless of the outcome of last week’s decision, I believe the increasing focus on experience in healthcare is more than practical or pragmatic; it is central to the highest quality healthcare encounter.

This week I was posed the question again during a workshop I had the privilege of leading titled Shaping Healthcare Experience: The Power of Interaction. The audience included healthcare and service professionals from across Europe. The discussions that were ignited and the passion with which the participants engaged in the subject supported my belief that the effort to achieve excellence in patient experience is not simply a phenomenon in the United States or one simply driven by policy. This is also reinforced by the fact that over 23 countries are represented as members and guests of The Beryl Institute itself. Patient experience is a without question a fundamental and global discussion.

Whether it is global perspective or political or policy motivations, those of us engaged in healthcare in whatever capacity need to consider the impact of our work on the experience of patients and families. As I discussed in my workshop, we are all touched by healthcare in some way either directly or indirectly through family or friends. More so we are aware of not just the outcomes, but also the stories we take from those encounters. Those stories are comprised of powerful and important interactions – as suggested by the Institute’s definition of patient experience as “the sum of all interactions…” In the workshop I posed the question of which interactions are most important in the healthcare encounter. After a long brainstorming effort the realization was that every interaction from the most critical clinical interventions to the almost unnoticeable or mundane encounters collectively equate to the experience people have and all are equally important.

At their core, each of those interactions is about a choice. As healthcare organizations you choose how to structure processes or determine what behaviors and expectations to establish and reinforce. With this, healthcare organizations are also held to the individual choices their people make at every touch point across the care continuum. It is here where you may be making things more complicated then necessary. By focusing on policy or political constraints you overlook the simplest of human factors; that people most often want to do the right thing. What must be done as leaders is to provide the support, the environment, the culture in which the right choices can be made, the right interactions provided and the best of experiences ensured.

I hope we can shift the discussion on experience from “why” and “what”, from policy or politics, to understanding there is a fundamental choice to provide the best experience possible for our patients, families and guests. In the desire to engineer this process we overlook the basic fact that healthcare at its core is human beings caring for human beings. In recognizing this, you ensure patient experience is a central and driving force to a continuously improving global healthcare system. It just starts with a simple choice.

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