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

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

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

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

Creating a Field of Patient Experience – A Call to Action

Something powerful took place at this year’s Patient Experience Conference and it took some time in reflection for me to sort it out. We opened the conference with the powerful video “I am the Patient Experience” showing the faces of the many individuals key to the Patient Experience. We then reviewed the efforts underway to create a Body of Knowledge, shaping a model for ongoing development of patient experience leaders, and the potential for formal certification. The days together were filled with the connections and learning central to the vision of The Beryl Institute (see the pictures and review the lessons learned).

It culminated with our closing speaker, Tiffany Christensen who brought us the voice of the patient and suggested something profound. She noted that our work in patient experience is truly a movement. In fact, what we are doing together is shaping a field. As the faces of participants declaring “I am the Patient Experience” flashed on the screen to close the time together, it was evident something bigger was happening than a conference or even the growth of a global community of practice.

Captured in the energy and spirit that filled those three days in April, was the same commitment and possibility that was shared by the over 300 individuals from 8 countries that have contributed to framing the 15 domains in the Patient Experience Body of Knowledge or even the over 8,000 members and guests that engage with the Institute community every month. The Body of Knowledge now stands for something bigger than just things we “need to know” to be effective practitioners in patient experience. It represents the foundation of a field grounded in knowledge and experience that can have lasting and profound impact on how those in healthcare work and how patients and families are ultimately cared for.

Creating a field is no small task and will not emerge from any one individual or organization. It must result from the voices of many, which is why I encourage your continued involvement in the Body of Knowledge effort. At The Beryl Institute, we look to be the catalyst, convener and coordinator of this important work. The next steps in the process will be the creation of work teams that will outline the key content for each of the domains of knowledge. Together with respected subject matter experts these outlines will help shape the learning needed to sharpen the skills of current practitioners and create a path to develop future leaders for the field. I invite you to learn more about the process and consider contributing to the work of these teams

I mentioned in a recent Hospital Impact blog that patient experience is not a fad, but is now a critical component of healthcare overall. We must work together to solidify the knowledge needed to lead, continue to support the research that will stretch our ideas and practice and come together as a global community that will take a stand for what we know is right in ensuring the best of experiences for our patients and their families. If we do this with the passion that I saw during our three days together at Patient Experience Conference 2012, there is no doubt that what we are doing is truly creating a field of patient experience.

Jason A. Wolf
Executive Director
The Beryl Institute

Whose experience is it anyway?

During two of my recent On the Road visits (one with Children’s National Medical Center and another for an upcoming story on Banner Health) what I observed and what came up in conversation caused me to pause and ask the question – whose experience is it anyway?

In one example, Kelli Shepherd, the Director of Service Excellence at Banner Good Samaritan Hospital, shared a subtle, but profound change in the language they were using. The shift was one in perspective – from “our” beds to “their” beds. A simple change, but one I believe challenges one of the central mental models I have seen in healthcare. We have often viewed patients as individuals that things are done TO, not necessarily done FOR.

I would not say we have turned healthcare into a heartless, mechanical process. Rather, I caution that what we may have done in not recognizing “ours” versus “theirs” is to design processes and systems and implement requirements and standards made to work best for us, not our patients and families. So what can we do to address this?

1. Clarify perspective. Are we building our programs, and even our patient experience efforts, from what we believe will best fit our needs? Or are we considering the perspective of patients and families as our guests? Stop and ask yourself, especially as you consider developing your patient experience effort, if the process is based on what is easiest for you or what is best for the patient?

2. Build an active process to engage patients, families and the community at large in how we can provide the best experience possible. Many organizations are now using patient focus groups not only to gather feedback post experience, but also to design processes and programs. At Children’s National, Patient Family Advisory Council members are embedded in many departments. They review and offer feedback on processes and provide an open avenue to ensure a broader perspective is available in all planning; they have even participated in the redesign of units.

3. Find ways to show you “listened”. The biggest return on experience investment is ensuring that patients and families not only feel heard in the moment, but also that the experience they are having overall reflects their wants and needs. Find avenues to show you are listening; be transparent about the input you seek and when and how you can (or cannot) use it.

As many of us in healthcare call hospitals the “house”, we must acknowledge that we are welcoming patients and their families into “our” house as guests. Our efforts should be focused on ensuring we provide the best experience possible. To do so we must recognize whose experience it is in the first place.

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

Your Patient Experience Priority for 2012 May Be as Simple as Taking the First Step

With all the predictions of new healthcare trends and the expanding requirements being placed on healthcare providers, one thing holds true – at the center of all these efforts and initiatives lies the patient. This is not patient-centeredness in the traditional sense of simply the care setting, but it is now clear that whether you are ready or not, the patient has taken center stage in our healthcare system.

For some, the patient experience was the fundamental driver of their efforts well before any requirements were raised; providing the greatest service and highest quality outcomes for the patients and families served at every touch point. Others have found new initiative in addressing patient experience with expanding financial implications. Yet many still struggle with where to focus, what to do or even if to act.

The harsh reality is that as of today over two-thirds of the initial performance period for Value-Based Purchasing is now in the books. With a closing date of March 31, 2012 and then the reality that reimbursements will be impacted just six months later, this is not the time to get stuck in a state of confusion. If you are not already moving, you still have time to act.

I have been asked by many healthcare leaders for the secret to the “best” patient experience. And while I will be the first to say I do not believe there is one specific formula that leads to patient experience success, I have offered a few considerations. In my recent blog with Hospital Impact, I reiterated the importance of four central strategies:

1. A clear organizational definition for patient experience.

2. A focused role to support patient experience efforts.

3. A recognition that patient experience is more than just a survey.

4. A commitment at the highest levels of leadership.

These suggestions are not complicated initiatives, but rather they should be a simple choice.

In every instance of high performance in patient experience what I observed above all else is that willingness to make a choice. For some it was a broad strategic effort where patient satisfaction was a key measure in performance compensation. For others it was finding that one area where they could begin to move the needle – creating a more quiet and relaxing environment, rounding with intention and empathy to ensure a patient and their family felt attended to, or simply communicating consistently that they were taking every action possible to ensure their patient’s pain was managed. I have suggested and will reassert here that excellence in patient experience emerges in the ability to balance its need to be a strategic imperative with clear measurable, tangible, and yes tactical action.

Most importantly, as my grandfather so wisely shared with me years ago, the more complicated we choose to make things, the more difficult they seem to accomplish. Patient experience is a critical issue, with increasing demands and pressures intertwined with a passion for care and an understanding that it is the right thing to do. This does not mean we need to make it bigger than we can handle. Or even that we need be discouraged if we have finally been able to make it a priority after others may seem “so far ahead”. The reality is that whenever and wherever you start is the right time and place if the intention is right and true. Now you have the choice, one as simple as committing to take that first step. My hope is that each of us, in every healthcare setting, has resolved to do something to improve the patient experience in 2012.

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

The Power of Interaction: You are the Patient Experience

In looking back at 2011, I have touched on a cross-section of topics on the patient experience – from service excellence and anticipation to value-based purchasing and bottom line impact. This year has led us to heightened awareness of the impact performance scores will have on dollars realized and increasing recognition that the patient experience is a priority with staying power. The Beryl Institute’s benchmarking study, The State of Patient Experience in American Hospitals, revealed both the great intentions and significant challenges that are at hand in addressing the critical issue of patient experience.

Our research supports, and I fundamentally believe, that there is a need for a dedicated and focused patient experience leader in every healthcare organization. Yet in the midst of all this attention, we may have overlooked the most important component – the immense power, significant impact and immeasurable value of a single interaction.

What does this mean? Interaction is simply defined as a mutual or reciprocal action or influence. The key is mutual action; something that occurs directly between two individuals. No interaction is the same, but it requires a choice by both parties to engage and respond as they best see fit. In healthcare settings, be it hospitals, medical offices, surgery centers or outpatient clinics, there are countless interactions every day. The question is: are they taken for granted as situations that just occur or are they seen as significant opportunities to impact experience? Perhaps in thinking about experience as a bigger issue, the importance of these moments of personal relationship has been missed.

What this means for improving the patient experience may be simple. Rather than waiting for that one leader to build the right plan or for your culture to develop in just the right way, you each instead recognize one key fact – you are the patient experience. I acknowledge there is a need for a strong leader and a solid cultural foundation on which to build, but at its core patient experience is about what each and every individual chooses to do at the most intimate moment of interaction. If these moments are used as the building blocks to achieve our greatest of intentions, patient experience will be the better for it. As you look to next year, whether you sweep the floors or sit in the c-suite, the choice should be clear. In today’s chaotic world of healthcare, the greatest moment of impact may be in the smallest of encounters. It is here that the most significant successes be they for scores, dollars or care will be realized. Happy holidays to you all!

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

The Smart Thing to Do: Patient Experience and the Bottom Line

Most now agree that patient experience is not just a nice to do, it is a must do. The idea of patient experience has recently taken on greater significance, first, through the emergence of surveys such as HCAHPS that make performance transparent and followed by the reality that reimbursement dollars, performance pay and compensation are being tied to outcomes through policy being implemented around the world. Improving the patient experience is also what is right to do. It is about providing the type of care experience for patients and families that you would want for yourself and your loved ones.

But recognizing patient experience as both a must do and a right to do, is not enough. It should also be addressed as the smart thing to do. Why? The patient experience has true financial implications for healthcare organizations that reach well beyond regulations. With all that is done to address patient experience from the cultural, organizational and process sides, we also need to consider its financial implications. This is perhaps the area that patient experience champions have focused on the least, but could have the most significant impact in making the case for the important work being done.

Patient experience influences the performance of healthcare organizations on a number of fronts. In The Beryl Institute’s newest white paper, Return on Service: The Financial Impact of Patient Experience, three perspectives are suggested as we look at the bottom line impact of the patient experience: financial, marketing and clinical.

  • From the financial perspective, it has been shown that satisfied patients lead to higher profitability. In a 2008 J.D. Power study, it was discovered that hospitals scoring in the top quartile in satisfaction had over two times the margin of those at the bottom. These findings were supported by the 2008 Press Ganey paper, Return on Investment: Increasing Profitability by Improving Patient Satisfaction. The paper revealed that when hospitals were ranked by profitability into quartiles, the most profitable hospitals had the highest average satisfaction scores.
  • From the marketing perspective, we need to look no further than the power of word of mouth. In her 2004 article, Jacqueline Zimowski shared that a satisfied patient tells three other people about a positive experience.  In contrast, a dissatisfied patient tells up to 25 others about a negative experience.  The issue worsens, as for every patient that complains, there are 20 other dissatisfied patients that do not. And of those dissatisfied patients that don’t complain, only 1 in 10 will return. When you run the numbers, for every complaint you hear, you could be losing a potential 18 patients. In essence by not focusing on experience we are potentially driving patients away.
  • From the clinical perspective, we must be clear to recognize that experience and quality are not distinct efforts but critically interwoven aspects of overall care. Patient Experience is not just about pretty or quiet environments, positive service scripting or even consistent rounding. At the end of the day it is about ensuring our patients leave better than when they arrived (as often as we can). This was exemplified in a powerful way in the 2011 study, Relationship Between Patient Satisfaction with Inpatient Care and Hospital Readmission Within 30 Days, reported by Boulding et al. They examined quality factors (as defined by CMS Core Measures, specifically on acute myocardial infarction, heart failure, and pneumonia) and satisfaction factors (as determined by the two HCAHPS questions – How do you rate the hospital overall? and Would you recommend the hospital to friends and family?) in relationship to readmission rates within 30 days of discharge. The finding was surprising. The HCAHPS scores, i.e. experience outcomes, were reliable and even more predictable indicators of readmissions than quality indicators. In essence, patient experience, herein measured by HCAHPS was a distinct and measurable driver of readmissions, a key quality issue and a significant financial issue for healthcare organizations and one taking on even greater interest as it will impact future reimbursements that hospitals are eligible to receive.

As healthcare leaders take on the challenge of patient experience, it is important to recognize that it reaches well beyond simple measures of satisfaction. A commitment to patient experience has significant and measurable impact, not only in doing what is right for the people and communities you serve, but also in ensuring the best quality and most financially sound experience for all who are in and who deliver your care. To be responsible stewards for healthcare systems that are both vital and viable, it is essential to recognize and be willing to address the bottom line issues influenced by patient experience efforts every day. It is the smart thing to do!

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

Patient Experience – A Delicate Balancing of Science and Art

With the emergence of HCAHPS in the US and similar measures in other countries and the financial implications now associated with these scores such as under Value Based Purchasing and the Excellent Care for All Act in Canada, efforts to address patient experience are at an all time high. Surveys such as the Institute’s Benchmarking Study now show patient experience to be a top priority for healthcare leaders. It seems these new regulatory pressures have heightened awareness, increased executive support and created a burning platform for action.

This elevation in attention has also presented a challenge. With new regulations, especially those tied to financial reward, arises the need to perform to the test. Our research has shown that US hospital’s priorities aligned often with the very domains being asked in the HCAHPS survey, from reducing noise to providing proper discharge instructions. These are not bad things on which to focus, but by simply focusing improvement on the questions themselves, the ‘science’ of patient experience, we miss the foundation, the culture (the ‘art’) on which to build.

In some ways addressing the questions is easy. We can measure our quietness at night and we can time ourselves on responsiveness, but we cannot manage service elements in the same manner as core quality measures, which are truly process driven, can be tracked via checklist and easily monitored. The science of service is not that cut and dry. Instead, it relies on a delicate balancing with the culture of the organization in which it is performed.

John Kotter and James Heskett (1992) have a nice way of framing culture in the workplace at two levels, the deeper level of shared values and the visible level of shared behaviors. This is the art of patient experience. We cannot create a checklist to ensure a shared base of values or behaviors exist, but without them the performance of the items being measured is at risk. We are presented with a need for delicate balancing – a measure set to manage what we are being evaluated (and paid) on and a culture on which our performance relies.

Through my On the Road visits and other discussions with healthcare leaders I have been privy to hearing about this delicate balancing first hand. The organizations that perform well in scores are doing more than teaching to the test or focusing on scores. Our paper The Four Cornerstones of Patient Experience helped frame the importance of a dedicated role and organizational focus in driving better outcomes (a clear blending of art and science) and my visits to leading performers have reinforced this message. For example at Inova Fair Oaks Hospital they insisted that you can try all the service tactics you want, but you first need a strong culture on which to build and at Medical Center of Arlington they helped us see that it is about aligning leadership and people, establishing clear expectations and living to them at all levels that was the foundation of their success.

The challenge is clear (and perhaps daunting); that true success in patient experience comes from our ability to manage the balancing of the science and the art. I say “balancing” as this effort is in constant movement, from a focus on measures to a focus on culture. There is not one perfect spot to stand, but sustained success comes from our ability to acknowledge the impact that both measures and culture have on providing the best experience for our patients overall. Here is to effective balancing!

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