HMGT 420 ASSN 1 PART 1
BYSTANDER
PerspectiveTheStateofPatientExperience1.docxPerspective: The State of Patient Experience
25-02-2016
HEALTHCARE SUCCESS LEADERSHIP PODCAST: Dr. James Merlino, president and chief medical officer of the strategic consulting division at Press Ganey, talks with Stewart Gandolf, CEO of Healthcare Success, providing a unique and insightful perspective on healthcare’s evolving landscape, significant leadership issues and the state of patient experience.
Stewart Gandolf: Hello everyone , Stewart Gandolf, welcome to another one of our podcast today I’m please again to be speaking with Jim Merlino, who is president and chief medical officer of the Strategic Consulting division of Press Ganey and our readers and subscribers will recognize Jim he used to be with Cleveland Clinic previous or prior to Press Ganey and we've had him on this podcast many times and I always enjoy speaking with him we're just talking offline about how much fun it is to talk and invite him to these things because he's just has a plethora of insights that I think you'll find extremely fascinating and helpful. So today as we mentioned a moment ago that Jim was the Chief of patient experience for Cleveland clinic, now in his new role at Press Ganey and it's been awhile since we've talked and so I thought we’d like to start off and catch up on how his perspective has changed as he's taken on a different role for Press Ganey Obviously at Cleveland Clinic Jim had a very broad and important role not just there but along other hospitals being involved with the summit and Association patient experience and so forth. But at Press Ganey obviously will have a new perspective. So, Jim I’d like to start off by asking you , broadly speaking share with us now that you're at a new organization some of the new insights you’ve had about you know how different Health Care organizations, hospitals, are thinking about patient experience
Jim Merlino: Sure Stewart, First of all I’d like to say it's always a pleasure to have to be having these conversations with you I really enjoy the interaction and appreciate the work that you're doing to get the message out about the work that’s being done across the country and across the world of health care. It's fascinating to have this perspective now that I'm on the other side and having come from the provider side and obliviously working in private sector to help support health care and Health Care operations and your strategy and a couple interesting learnings for me have been- Number one : is our work with Healthcare Systems really goes beyond just the patient experience. And we’re much more in now to help organizations with patient operations, improving broader definition of patient experience improving safety and quality. What I thing has been one of the interesting findings for me is that you can pretty much list the top 10 or so issues that hospital C-suites across the country are really paying attention to today but it was a little surprising for me the priority of those listings is very different. So some organizations are you focused on market share , some are focused on safety, some have elevated the patient experience attack, some have elevated integration, so everybody has their own kind of list of what their priorities are. But I think what is the most surprising to me and it’s probably something that I shouldn't have had insight into going into this role but it's really been just been an epiphany for me is how differently organization's approach problems and it is interesting I use this analogy of treating disease around executing a cure path. A cure path essentially you have a couple ways of doing things well and right and then if you if you do something outside of that right, it’s outside the standards of care. You think of the analogy of a highway, if you’re in the middle lanes you’re in the standard of care as you start to move towards the edges you get outside the standard of care. Is the same way to think about how hospitals approach operations around their strategies it is that there's a handful of ways of doing things for any particular issue and there's a myriad of different ways that may not be as successful as some ways that other hospitals are doing them. And the variability on how organizations execute to me is just fascinating and I should point out that there's a lot of right ways to do things and probably less wrong way when it comes to hospital operations but the variability of how organizations, how C-suites think about execution is really really striking to me.
04:26 Stewart Gandolf: So you mentioned the different 10 priorities, you know that we can all think through, market share would certainly be one , for profit hospitals- profit would be one , market share, consolidation , you know building the brand, working on safety, working on patient experience so clearly there's different ways for approaching things. Are there any strategies that from your perspective you know are the leads? So for example we were talking offline about something that you know we've had discussions about, another of our clients have, the insight that you know for example hospital are spending time thinking about branding but really from the patients point of view the patient experience is the brand, right? You can all types of great ads, but my patient experience and my most intimate dealings with the hospital are really the brand from my perspective. I guess as you’re thinking though these various priorities, where do you feel for most hospitals, because everybody is different obviously, where do you recommend they start focusing or where do you think would be the place that would be more appropriate than others?
05: 36 Jim Merlino: Well I go back to my roots in where I came from in hospital leadership and operations-which is around the patient experience. I think that when I started in that role at the Cleveland Clinic we had a very narrow experience of what the patient experience was and it was really more around service and satisfaction. But I think as I evolved there and we evolved with strategy there, and now stepping into this role at Press Ganey, the way we see the patient experience is really much broader around this concept of delivering safe, high quality care in an environment where essentially the patients feels cared for, or the service piece, or patient centeredness- however you kind of define that third piece. But the patient experience is really all three components and everything else that we do in healthcare. If you think about the patient promise, so what is it that healthcare organizations deliver to people? or patients more specifically. It’s this idea that you’re going to provide safe care, that you’re going to provide high-quality care you're going to do it in a patient family-centered environment- that's what we do. I think that organizations should elevate that to really becoming their top strategic priority. Because if you think about it that's what we do. and if we can't get that part of what we do right and don't do it well then organizations aren’t going to be successful. Frankly, in today's environment, as you know with increasing consumerism, more information, greater choice, people going to differentiate against you if you don't hit the nail on the head with that patient promise.
07:20 Stewart Gandolf: You know that’s so critical and I love that you know, that obviously that the broader definition that and you know we talked before about how certainly in the past and even today, you know doctors and administrators and so forth, can dismiss patient experience with that idea and I don't care if they get better or I don't care if they like me I just want to get them better but that's not really getting the broader picture -but on the other hand , the idea of just giving the hotel experience, the outcomes are terrible and the safety is terrible that’s not a good idea either. So really I can see demanding all three of those things is critical. Going forward, I'm thinking about there's a hospital locally here that was just acquired and on some of the quality and safety scores scored really low. It's funny I'm watching with interest what they're going to do and again worrying about new billboards and new colors and so forth I think misses the point. One the things we talk about a lot in our seminars and as we write and speak is I think most marketing people from the marketing standpoint start with the promotion, which is to me the last thing to talk about. Basic marketing theory is Product, Place, Price and Promotion. Promotion is the end. The product is the most important thing. In this case with healthcare, the product is keeping people alive, so that's really the product but it's more than that. So looking at this again, let’s drill down on each of these things a little bit. Let’s talk about the safety component –the high reliability-tell me more about that.
08:59 Jim Merlino : Well safety is obviously a very important topic in healthcare and if you step back and think about that broader definition, you can create an environment or culture where people are nice, people are working together but if the organization is delivering on harm? patients to caregivers? and there is a lot of safety errors in the organization , then you are not going to fulfill that promise and that patient experience. As it stands today you know we have approximately 440,000 deaths in the United States from serious safety errors. 1 in 25 people coming into the hospital encounter a hospital acquired infection .Senior citizens, people over 65, have a 25% increase risk if they come to the hospital suffering a serious safety event. All told it adds about $2,000 per Hospital discharge in the United States and if you treat safety like a disease and it’s not but if you did it would be the third leading cause of death in the United States. So we have made tremendous progress in the United States since the institute of medicine study came out “To err is human”. But we have not me enough progress and it is unconscionable to think that we create such harm in healthcare As a surgeon I always hated the analogy to the airline industry because my first refrain would be that taking care of people it's not like flying planes but the reality is when you look at organizations that have achieved high performance in higher liability like the airlines, like nuclear power, like the military. The reality is that we can be more like them and we can do a better job of delivering on safer healthcare. We have to standardize more of what we are doing; we have to elevate reduction of harm to a top strategic priority. We have to make safety and other comprisable core values of our organizations. We have to do more to protect people.
11:09 Stewart Gandolf: It’s still shocking to me after all these years and hearing the first about the number of airlines planes going down in comparison but still obviously this is still a huge issue. Tell me can you think of any, I can image as a CEO because the CEO’s that I know at hospitals , it’s kind of like when you think about the President of the United States, people blame the president for everything, they can't really do everything they don't have the power that you would like to think. and for a CEO of a hospital you know one of the CEO’s we work with right now has union problems and all kinds of issues that are not something that's directly in his control, so it must be daunting if you're taking over a hospital as ..let me ask you this. Let’s say you had a CEO of a hospital that came to you and said “hey I just took over this Hospital we’re an ex-community and it has a terrible reputation and frankly you know privately it’s deserved, it’s been a real problem for safety”. How and what are some of the case studies that you could share with them or one of the successes that would kind of inspire them that you really can make a huge impact or maybe you can think of a specific hospital or system that really had huge improvements. What would they do first?
12:18 Jim Merlino: That's a great question and I think that the role of that CEO stepping into a role like that certainly has their challenges that’s not a huge gap but I think your point is right they can't do everything, they can’t focus on everything but there are some basic things I think an organization can do . Number one , they can we can put this messaging out that we were going to commit to zero harm, that we have to raise awareness around the issue and that we have to make an organizational commitment. They have to, they should instill safety as an uncompromisable core value. If it’s not in the value stream it should be. If it is, it needs to be elevated; people need to talk about it. The second thing they need to do is really put a face on safety. What I mean by that is part of the reason I think we don't pay attention to errors and other opportunities as much as we should is because we create statistics or I should say we have statistics. But people are not statistics. you know if your family member or you experience that harm or serious safety events, you are not just some number on the paper you’re a person, you have a family, you have friends you’re whole life changes depending upon the magnitude of what happened .So I think we have a responsibility to talk about this, the way it is . It’s about people, it’s not about statistics. When you look at organizations who really raised the bar on safety one of the tactics they use is that put faces on the statistics, the actual patients face on the statistics, so that everything time they’re are seeing the death rate they are looking at a person's face and knowing that that person died because of a serious safety event. It wasn't just the wound infection in room two, it was this person and they have a family. The third thing that I think they can do is be transparent and this fits very nicely with, what you already mentioned you know what’s going out in your market today and that is there's more and more information out there and when we have information available we are transparent about it and it drives change. So we should be transparent to our organization about the safety event so people know what’s going on we should make it personal and we should commit to the goal of zero harm and when you look at organization that have just driven those three topics you see change in safety rates.
14:47 Stewart Gandolf: That’s inspiring. I can imagine transparency is not always easy. I can just think of somebody coming into a hospital where they haven’t been transparent that must be quite an uphill battle or is it I don't know. We talked before about the importance of leadership and really embrace it, transparency. Certainly there are some hospitals that are leading this effort but can this be a real challenge for some of the people you speak with?
15:10 Jim Merlino: I think it's a tremendous challenge and you’re right we have talked about this before. I think we, Healthcare has a lot of progress on topic of transparency. More and more organizations are transparent with their information but we still have a lot of work to do. One the things that we’re finding and my colleague at Press Ganey , Dr. Tom Lee , talks about this a lot is that, by the way, It’s not just being transparent about the opportunities we have, our physicians have, but it's also being transparent about the accolades and it's interesting when you look at work that's been done and published by the University of Utah, Vivian Lee, who’s the CEO out there put doctors scores and comments on their website and she got some expected pushback . But a couple things happened. Number one - their scores improved. This idea of getting information out to the physicians got their attention, got them working on it. Number two- the doctors had many many more positive comments than negative comments and they actually like seeing their positive comments out there and third- it has a significant impact on their brand because it's change the search dynamics on a site like Google, so instead of when type up University of Utah, ask for a specific physician, instead of all the for profit sites coming up the real information, the good information which is what the university put on the site come up first. And since most of the comments are positive, that’s what patients’ see.so there's a lot of benefits toward driving toward greater transparency. I think we have a long way to go but we're definitely making progress.
16:51 Stewart Gandolf: You know that it's funny, I’ve spoken to some of the people from University of Utah and it’s an inspiring case study and I’ve seen some hospitals doing it but to me again going back to inspiring, the people are taking leadership , you know that's the thing , because it's easy to talk about leadership until you have you a board and a bunch of people looking, or 500 or 1,000 or 10000 employees looking at you like you're insane. It's a different kind of thing. So to actually have the courage and the will to put to deal with the inevitable pushback is terrific. Let's talk about health care reform and you know value based care and some of those developments because of course patient experience is a lot more evolved because of the reimbursement issues and the way things are going but you know what's happening there and what should we be thinking about?
17:40 Jim Merlino: Well I think that overall, everybody has an opinion on Health Care reform in the ACA and the thing that strikes me the most is it really doesn't matter what side of the aisle you sit on, what your political meetings are because the ACA is not really a homogeneous modeling of change it's something that incorporates a lot of pieces of change . There’s good and bad and people argue the merits on all the little pieces for a long time but the bottom line is that healthcare reform has fundamentally brought some good things to healthcare. The thing that I get excited about is this focus finally, on metrics that matter. What I mean by that is if you look at the value based purchasing program for instance, finally what it has done, which has never been done before in the United States to the degree that it has been, is that it’s taken things that are really important to patients- things like safety, quality and the service experience and it's linked providers performance to reimbursement. That is driving significant attention and changes in healthcare and it’s driving change for the better. Now we know that healthcare organizations have always had wanting to do the right thing for patients in fines?? no question, nobody goes into healthcare because they want to hurt people or harm people. Sometimes the priorities on driving improvements didn't double up to the appropriate places again you see, you saw it when the institute of Medicine issued their report in 1999 problems, all the safety problem. But what this is doing is it’s really saying is look, this is important stuff and this is important for patients and we're trying to improve the delivery of what we do and by the way ,we are going to incentivize performance by linking it to how you get paid and that is a good thing for healthcare and it is driving significant change . So, I think that again regardless of where you sit politically or what you think about the law the good pieces that relate to that are probably going to be around and it's going to be full for a long time and it's going to continue to drive significant improvements in health care.
20:03 Stewart Gandolf: you know it's funny I know we probably talked about this in the past and I have talked about this a lot as there's also Beyond whether it’s a law or not, there are Market forces in place anyway that were driving somewhere aspects of it and number two it's kind of, there’s aspects of this that are just sort of the right thing to do, so it's again I agree totally whether you are a Democrat or Republican or whomever that's not really the issue it's just that it's obviously complicated and maybe sometimes convoluted but some of the core underpinnings are I think inevitable. It’s just going to happen in respect to this particular law.
20:45 Jim Merlino: It’s interesting sir ,because if you think of it we’re all part of this healthcare ecosystem, not just because we work in healthcare, or workaround Healthcare, or support healthcare but at the end of the day we’re all in this together because we’re all going to be patients and our families are all going to be patients so we should all want to work together to figure out what is the best way to drive improvements around this idea of the patient promise of safety, high quality and patient experience It’s essential for all of us.
21:13 Stewart Gandolf: I totally agree and you know we’ve talked offline ,while we have trainers and we do staff training and forth, patient experiences isn’t the core of what we do we’re a marketing firm but in terms, on the other hand it is exactly the core of what we do it right- It’s the product we have to our clients and that's why I'm so passionate about this because just like you said we’re all going to be patients one day and certainly family members are . Right now I happen to be in an epicenter where my personal family is doing pretty good health wise, but people around me, all kinds of friends and family and professional colleagues has families, either personally or family that have a real health problem right now, there are lots of people, something about it so it's vital to all of us and for me it just as a mission statement for me that’s why I love helping get the word on this about this because I think it's so vital. Tell me about it, we alluded to, sort of , one of the things you mentioned is value based care and our preparation any additional thoughts about value-based care or the concept and what you really think that means today and where we're going ?
22:16 Jim Merlino: I think that it was about other than the fact I think it's finally putting a focus on things that really matter for patients and driving significant change is the other thing it’s starting to ,do, because we need to do it to accommodate it is getting us to focus on our cultures. If you think about the way we used to execute on hospital operations- there would be a new mandate or new law or regulation or something and we’d create a process and the dutiful hospital leaders would execute on that process and we’d move along. Today when you think about all the things that organizations have to be held accountable for or I should say are being held accountable for, just executing a new process is not enough. What we need to do to be successful is really get to this core issue of how we start to align our cultures so that everyday people coming to work focused on this idea that the patient is at the center and as a result of that I think what you’re seeing a lot of health organizations do is investing in developing competencies in their people to deliver better compassionate connected care, to be more empathetic ,to teach the skills to drive towards an organization that delivers high reliability consistently, to develop competencies like emotional intelligence that directly lead to this idea of how we promote better team work. My colleague, Dr. Tom Lee, wrote this book called Epidemic of Empathy, he talks about how people come together around common desires to do the right thing and one of the things he talks about is this idea of really driving empathy across an organization. I think that value based care because of the need to transform our cultures to create cultures of caregivers that are more empathetic, that are more connected is going to have a dramatic impact not only on the elements that are in the legislation and in the law but ultimately in how we deliver better care across the country.
24:28 Stewart Gandolf :And you know again we talk about engagement or the culture of caring I can imagine it's daunting sometimes if a hospital doesn't have that history, so just like we talked about some tips on safety anything specific or that you think you know if you're the same CEO or different CEO saying everybody I guess is a good clinician or wants to be good clinicians or they don't seem to, if they care about the patients they don't show it, where do they begin to change that? It must be like moving aircraft carrier.
24:59 Jim Merlino: I think that's a great question I think it starts with building blocks I think first we need to measure a lot of organizations don't measure caregiver engagement so just as we need to listen to the voice of the patient , we need to listen to the voice of the caregiver. Because ultimately you'll never hear me say that the caregiver, the employee is more important than the person we serve, the patient and her family, but we should be making sure that the way we treat our people is as good as the way we treat our patients because we have to create environment where we support people in a healthy environment -where people can flourish, where people can work together. So measuring it and messaging it, spending time with your people really getting to know the organization, listening to the organization, communicating, these are all things that don't cost a lot of money and don’t take a lot of time- it just requires us to put some attention to it.
25:49 Stewart Gandolf : In terms of the Press Ganey and now that you’ve changed your role , tell me more about ,because I'm curious ,not so much from a plug standpoint ,how does your division help because again this is a very complex, its easy from the outside to poke holes at it or criticize a hospital but it's really really really hard so I guess you know what is your division do and how can that help because I'm really curious about..
28:05 Stewart Gandolf : I had totally agree. You know it’s funny, one of the things that you know it really comes down to in a way is another best practice. No matter how smart you are as an individual executive at a hospital, you know what can you learn from dozens, hundreds or thousands of others have done. It’s a different view point. You can be the most intelligent person in the room but it’s nothing like experiencing and seeing what other people are doing .So that and then of course so just the perspective you guys have, plus of course you got some smart people I'm sure works great. Which is, you know in my own life I try to do as much as I can. I like to think I'm pretty smart at what I do but I'm always looking to learn and I can see how in your field that must be vital to see the experience of others, for sure.
28:52 Jim Merlino: It’s an honor
28:54 Stewart Gandolf :Excellent. Any parting thoughts before we go I mean this is a passion for both you and me anything else or any final words of advice you’d give to our listeners?
29:04 Jim Merlino :No, I think I would say to anybody out there thinking it’s really tough in healthcare today, first of all it is tough. We certainly have to acknowledge that but we can also see it as an opportunity and I think it’s very exciting. There’s so much opportunity out there to really drive to high performance in healthcare. This concept of how we start to pivot the discussion from delivering care for people to reduce suffering for people whether they are patients or fellow caregivers it’s a great focus, a right focus and I think we have tremendous opportunity to really do the right thing and to improve the delivery of the services that we provide to people.
29:45 Stewart Gandolf: My final comment on that is to bring people back to why they got into healthcare in the first place, right, to do the right thing. It's easy to fall astray in our world but to come back to the principles of safety, high quality care and making patients feel cared for it ,it seems like a “no duh” , but honestly it's not , not with all the competing priorities so that's an excellent insight really it’s just to come back to you know what matters and everything else, will maybe not quite take care of itself but almost take care of itself when we do that .You've been terrific as always I love doing things with you, actually our discussions have already inspired another topic we’ll have to talk about it another day but for now thank you so much you've been great and to our listeners ,thanks for listening.
30:30 Jim Merlino: Thank you Stewart, it’s my pleasure.
