My pager went off 20 minutes into my case. The circulating nurse announced that it was the chief of staff’s office, and as I migrated over to the phone, everyone was wondering what I had done to warrant a call from the boss. The nurse held the phone to my ear and Dr. Joe Hahn, a neurosurgeon and second-in-command at Cleveland Clinic, congratulated me: “You’re it,” he said. I thanked him and went back to work. My scrub tech wanted to know what happened. I told him I was just appointed chief experience officer at Cleveland Clinic. With a befuddled look, he asked what that meant. I said I wasn’t sure.
Jim gets a fast lesson on how to lead patient experience
Patient experience was a signature issue for Dr. Toby Cosgrove, our then president and chief executive officer. Although the Clinic was revered for its high-quality care, patients did not always like going there. Dr. Cosgrove passionately believed that providing a high-quality experience was as important as the best medical care, and that the experience at the Clinic needed to be improved. Another physician had held the role of chief experience officer before me, but she came from outside the system and was not practicing, which proved to be a challenge in the Clinic’s physician-dominated culture. Dr. Cosgrove wanted a physician who “grew up” in the organization to lead this initiative.
When I left my initial interview with Dr. Cosgrove, I could not define patient experience, did not know what HCAHPS (Hospital Consumer Assessment of Healthcare Providers and Systems) was—at the time were in the 10th percentile—and frankly had no idea how I would move a culture of 45,000 people, including 3,000 employed physicians, to embrace patient-centricity. By the time I left the Clinic in 2015, however, we had pushed our experience scores to the top quartile, realigned our culture, and had become world renown for patient experience.1
I knew intuitively that improving the patient experience was the right thing to do. In 2004, my father had died at the Clinic from surgical complications; his experience had been terrible. At that time, we did not use the term experience, but based on the items that hospitals are graded on today, my father would have failed us on all of them.
What is patient experience?
Patient experience is not about making people happy. Fundamentally, it is about delivering safe, high-quality, patient-centric care. A 2017 Press Ganey analysis of publicly reported data from the Centers for Medicaid and Medicare demonstrated that when performance on experience measures is high, safety and quality also are high.2 Similarly, in 2015, JAMA published an article using data from the National Surgical Quality Improvement Project demonstrating a significant association between patient experience scores and several objective measures of surgical quality, including mortality and complications.3
In my new role, I mercilessly told my father’s story, changed the narrative to include safety and quality, and asked my physician colleagues for their help to improve patient experience. People in health care pay very close attention to what physicians do and say, and I needed the doctors to “own it” if we were going to implement the desired change.
I also had to convince them to see themselves on the “other side.” It was not just a matter of “treating patients the way you would want to be treated.” It was about putting yourself in your patients’ shoes—having empathy for what they are experiencing and recognizing that you or a family member could be sitting in that bed. Before my father was ill, I had never been on the other side so intimately, and it was an eye-opening experience.
Retooling communication competency
For the physicians, we zeroed in on helping them improve how they communicate with patients. Communication is a high-value target for experience improvement, and it directly influences safety and quality. We produced a physician-centric communication guide that provided useful tips (see “Practical tips to help physicians improve communication with patients”). We made communication scores transparent. In addition, working with the American Academy on Communication in Healthcare (AACH), we developed a program specifically designed to help physicians improve their communication skills and practice management.4 The outcome was not only better scores but also higher physician engagement and lower burnout.5
Practical tips to help physicians improve communication with patients
- Introduce yourself and your role
- Address the patient by name and use common courtesy
- Make nursing your partner
- Ensure that the patient knows and understands the plan of care
- Explain what the patient can expect (tests, procedures, consultations)
- Address questions
- Understand that house staff, care partners, and consultants impact your communication scores
- Respect the patient's privacy
- Be aware of what you do and say in front of patients
- Include the patient's family when appropriate
- Ask patients and visitors how they are being treated and if they need anything
- Discuss pain management and set expectations
- When necessary, apologize--try to right a wrong
- Role model good behavior and address bad behavior
Keeping it real
Being married to another member of the medical staff—a strong-willed and opinionated one at that—ensured that my strategic approach to improving patient experience was grounded. It gave me a safe place to test ideas and concepts, which in turn allowed me to keep my instincts framed and relevant to the needs of key stakeholders, particularly the physicians.