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

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

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

All Voices Matter in Improving Patient Experience – A Reflection on Election Day

In some of my most recent blogs and in current publications from The Beryl Institute we have expanded the dialogue on the importance and power of voice in driving towards a positive patient experience. It is only fitting to take pause of this, as today – November 6, 2012 – in the United States represents one of the most powerful examples of the expression of voice to be found. In electing a President, citizens of the U.S. of all backgrounds and beliefs have the opportunity to be heard. The intention is that every voice regardless of how young or old, soft or loud, rich or poor has value in a broader dialogue about the greater good and direction of the country.

As I travel to healthcare organizations and engage with patients and families, caregivers and leaders, one thing stands out. It is the great alignment these individuals have in desiring and working to ensure the best care outcomes and overall experience possible. The recognition in this expanding dialogue on experience is not one of cynicism or even submission to simple performance on surveys, but one driven on the same passion and commitment to the wellbeing of our fellow human beings as those that vote to support the best in what they believe.

The common denominator in these ideas is the most critical component of all we do in healthcare, in our world of human beings caring for human beings. The power is that of voice and the voice of all, be it spoken, written, sung or signed. Healthcare organizations around the world bring people together at the most critical times of our lives – from the joys of birth, to the tears of a last breath – and this is not something any of us do alone. It takes the hearts, minds and yes, voices of many to make it work. It is the voices of patients and families in expressing their needs, but also sharing their fears and pains. It is the voices of caregivers who contribute to the best processes of care and support for one another. It is the voices of physicians who bring great insight and education along with the powerful ability to heal. It is the voices of staff that in basements, back rooms, and labs sew together the web through which the paths of care are supported. It is the voices of leaders who set visions and inspire and hold the space for all voices to truly make a difference in how we care for one another.

I had someone suggest to me once that if we allow room for all these voices, we give in to chaos at the cost of processes of care; that the input from all corners of a healthcare experience, be it acute or pediatric, ambulatory or practice-based, cause a murkiness that only leads to confusion. My response was simple, and my experiences have proven it to be true more and more each day. The chaos only exists if we fail to listen. When we get beneath what some may perceive to be noise, we realize there is a great commitment to the idea that every one is working towards the health and well being of those in care. By bringing together a symphony of voices we not only engage people, but we also expand the potential of what we can accomplish.

There is no magic formula or process for the gathering of voices. The methods and processes are rather clear, be they surveys, focus groups, advisory councils or committees for patients, staff, physicians and leadership. More important is the fact that we choose to acknowledge that all of these individuals have a voice to share and it may be in the most unsuspecting moment that the most impactful idea emerges. Perhaps in the end it is simple, that improving the patient experience is nothing more than a critical dialogue that must be fostered, nurtured and supported in ensuring that we listen and understand that each and every voice matters.

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