It's not an admission, it's an experience

When former hospitalist M. Bridget Duffy, MD, became chief experience officer at the Cleveland Clinic last year, she explored every aspect of the hospital’s operation and set out to improve it. The changes instituted by her office of patient experience are making the Cleveland Clinic look and feel more like part of a very customer-service-oriented industry. That's no coincidence, say experts.

When former hospitalist M. Bridget Duffy, MD, took the position of chief experience officer at the Cleveland Clinic last year, she could have sat around in her office waiting for ideas about how to make patients happier.

Instead, Dr. Duffy personally explored every aspect of the hospital's operation. “I was asked to come in and climb in the trenches. I walked in the shoes of the housekeepers, patient transporters, nurses and the doctors and I tried to learn from them how to improve the patient experience,” she said.

M Bridget Duffy MD talks with staff at the Cleveland Clinic
M. Bridget Duffy, MD, talks with staff at the Cleveland Clinic.

The knowledge she gained is now being used to make those trenches a more pleasant place for patients, families and health care providers. The planned improvements will affect not only a hospital's clinical environment, but also the emotional and physical aspects of a facility, according to Dr. Duffy.

From the art on the walls (selected by a curator) to the Internet in the air (free wireless in waiting rooms), the changes instituted by her office of patient experience are making the Cleveland Clinic look and feel less like a branch of the usually utilitarian health care sector and more like part of a very customer-service-oriented industry.

That switch is no coincidence. The focus on patient experience, and even the idea of a chief experience officer (CXO), was borrowed from customer-service industries, particularly retail and hospitality, according to Leigh Adamson, chief development officer of Starizon, a firm which consults with businesses, including hospitals, on the experiences they provide.

“You've got a lot going on in mass customization and personalization in other industries. Today you can even have customized jeans made to fit you exactly. Consumers' expectations have changed,” she said.

Hospitals like the Cleveland Clinic are going the extra mile to please these modern, more demanding consumers—especially the baby boomers, who are likely to need more hospital services in upcoming years. Perks range from gardens and fountains to aromatherapy, massages and extra space for visitors to sleep, eat and pray, according to Barbara Findlay, vice president for the optimal healing environments program at the Samueli Institute in Alexandria, Va.

“At one hospital, whenever a baby was born in the hospital, over the intercom system there would be this little riff of harp music,” Ms. Findlay said. “It's those attempts to interject into the craziness of the hospital this little piece of joy.”

Getting docs on board

If you're a physician thinking that you're too busy actually dealing with the craziness of the hospital to offer little bits of joy, you're not alone. Some physicians have led patient experience efforts, but a fair number have also shown little interest in the projects, according to Ms. Findlay.

“It's just one more thing to learn,” she said. Interest also varied by specialty. “You were more likely to see an oncologist being more interested in transforming the therapeutic relationship in a positive way than an ER doctor, for example, or an orthopedic surgeon.”

Barry Egener, MD, medical director of the Foundation for Medical Excellence, understands physicians' reluctance to get involved in patient experience efforts and believes it can be overcome. “I think the challenge is to frame this as a medical-professional initiative rather than a commercial initiative—more about quality of care than pandering consumerism,” he said.

As an internist herself, Dr. Duffy is well positioned to convince the Cleveland Clinic's physicians of the value of her mission. She served as medical director for one of the first hospitalist services in the country, at Abbott Northwestern Hospital in Minneapolis, before moving into health care consulting and foundation work.

“I think my background as a hospitalist was instrumental in setting me on this path. I viewed my role as a hospitalist as being a navigator and an advocate for the patient and their family,” said Dr. Duffy. Health navigators are, incidentally, another patient experience pilot program that Dr. Duffy plans to implement. Navigators will assist patients in accessing services, guide them through the hospital system and support them after discharge.

Dr. Duffy notes that her work was met with some skepticism at first, but that overall the response has been overwhelmingly supportive, especially as physicians and other staff come to see that improving the patient experience does not have to increase their workloads. “This can't be something added on to an already overburdened work schedule. We're not adding more for them to do,” said Dr. Duffy.

In some cases, improvements to the patient experience can actually lighten physicians' workload, said Ms. Adamson. For example, she has worked with hospitals on improving their systems for treating patients who are readmitted. “We act as though we didn't even know them from before. There's nothing we're anticipating for their next visit,” she said of current hospital operations.

Setting up a system in which information from a previous visit is easily accessible markedly improves the experience for both patients and physicians. If a first-line pain reliever disagreed with the patient the last time, the physician will know not to give it again. “They can have at their fingertips the information they need,” said Ms. Adamson.

Experiences for employees, too

Dr. Duffy is focusing some of her efforts on creating a happier, healthier environment for health care providers—including stress reduction programs, nutrition education and exercise opportunities—and some hospitals have gone even further.

Staff at Mid-Columbia Medical Center in Oregon attend MCMC University a 40-hour employee-employer orientation
Staff at Mid-Columbia Medical Center in Oregon attend MCMC University, a 40-hour employee–employer orientation.

Cynthia Kortge, of the Mid-Columbia Medical Center in The Dalles, Ore., is also a chief experience officer, but she concentrates almost entirely on the experience of hospital employees.

Mid-Columbia began revamping its patient experience back in 1991, when it adopted the model of care developed by Planetree, a non-profit organization which promotes patient-centeredness. At first, the Mid-Columbia administration thought that the staff just needed a little more support and orientation about the new concept. “The idea of not having visiting hours and having open charts was something that was really new and really unsettling to our staff,” said Ms. Kortge.

Gradually, however, it became clear that something more was called for. “Employees would come back and say, ‘This is great and I really am excited about what I get to do for our patients, but what about me?’”

Today, Ms. Kortge has a lot of answers to that question. Like the Cleveland Clinic, Mid-Columbia has created spaces for its health care providers to relax away from patients, but in addition, through contracts with local merchants, it offers dry cleaning, oil changes, housekeeping and grocery-shopping services to staff.

Although there is not yet any hard data, the long menu of perks is expected to help with the challenges of recruitment and retention. “Everything from physicians to nurses to clinical staff has become really competitive and employees have become very savvy. It's just not enough to have a good wage,” said Ms. Kortge.

Another reason that some patient experience programs have morphed into employee experience programs is the link between satisfied health care providers and satisfied patients, the experts said. Dissatisfaction even among the staff that clean the floors or serve the cafeteria food can affect patients' impressions, said Dr. Egener.

“You want those folks to be happy where they are working or they undermine the experience. It's about getting employees to identify the hospital's goals as their goals. Then they'll want the patients to like the organization,” he explained.

The right thing to do

Whether or not patients like an organization is rapidly becoming a more important question for hospital administrators, noted Susan Frampton, PhD, president of Planetree. Hospitals around the country are showing their concern about the issue by creating patient experience coordinators or similar positions, but the Cleveland Clinic's hiring of a CXO may be unique, according to Ms. Findlay.

“I have not seen anything like that, with the exception of the some of the largest faith-based organizations, which might have a vice-president of mission,” she said.

No matter if improvement of the patient experience is handled by a coordinator or an officer, Dr. Frampton credits wider public reporting of patient satisfaction scores with being a major driver of the trend. “Consumers will be able to compare not only the quality outcomes at a hospital but also the patients' satisfaction with the experience there,” Dr. Frampton said.

The little things that comprise the patient experience also tend to have an outsized effect on patient satisfaction scores, according to Dr. Egener. “Patients are really good judges of the service they receive. On the other hand, they are not very good judges of the technical aspects of their care. In fact, they tend to judge technical aspects of care based on their impressions from the interpersonal pieces,” he said.

Patient experience is also one of the few ways that a hospital can find to stand out in a competitive marketplace. “There just isn't that much differentiation among hospitals in terms of the technical quality of care,” Dr. Egener said.

“I think they're driven on one hand by trying to find a niche,” explained Ms. Findlay. On the other hand, she found that most hospital administrators had a different stated reason for their efforts.

“The first thing out of their mouths would be, ‘We're doing it because it's the right thing to do,’” she said.

Without much hard data available yet, doing the right thing probably is one of the biggest reasons that hospitals focus on patient experience, Ms. Findlay said. “The initial motivation either comes from a philanthropic gift, the personal experience of one of the leaders there or a mandate from the mother ship,” she said of the hospitals in her study.

Hospitals in the Cleveland Clinic system got the “mother ship” approach, in effect, as Dr. Duffy's position was the brainchild of the Clinic's CEO and president, Delos M. Cosgrove, MD. Plans that come from the top do have to be modified for varying hospital conditions, said Dr. Duffy, noting that one of the hospitals in her system is focused on serving the inner-city poor.

“You can have a healing encounter and a great experience in a place that doesn't have the resources to improve the physical environment. I think the focus for these centers is to empower your staff and make sure that they know what they do every day is aligned with the mission,” Dr. Duffy said.

But even in the best-funded hospitals, patient experience efforts must show some cost savings if they are to continue, Ms. Findlay said. Administrators, while acknowledging the value of the efforts, have asked, “But we've been doing it for two years now and we need to find a way to make this sustainable. We need to demonstrate the return on investment,” she reported.

Through her research, Ms. Findlay hopes to identify some of those returns. She believes that gains will be seen in staff retention, expanding market share and quality measures. “We're trying to build a body of knowledge in this area that is generalizable and accessible to others. Before there's widespread uptake, there will need to be a better business case for it,” she said.

Ms. Findlay expects to see the business case become convincing enough for widespread adoption within the next five to 10 years. “It's like pain management or end-of-life care. These things have evolved to become standards. I would hope that within five years there would be some standards for what is a healing environment.”