The way patients feel about their treatment has grown increasingly important to HCOs — and their payers — in the evolution from volume to value. Many have created leadership positions dedicated to it.
“Patient experience” is one of the buzziest catchphrases in health care today. Along with safety, quality and value, physician leaders are finding it matters more than they thought.
“Good patient experience reflects their trust in the care we provide,” says Thomas Savides, MD, a gastroenterologist who was named the first chief experience officer, or CXO, at the University of California San Diego Health in December 2014.
“It is the sum of all the contact points in their care journey — from the first phone call, to arrival, to receiving care, and then the transitions between care,” he says. “When patients feel trust, empathy and respect, they will likely have better clinical outcomes.”
In that vein, a chief experience officer keeps patients “top of mind in decision-making,” Savides says, not only at leadership meetings with administrators and physicians, but also in observational walks through hospitals and clinics.
More of these C-suite positions have emerged nationally as patient experience has become the cornerstone of optimal health care delivery and the reputation driver for facilities and providers; the average salary for a CXO exceeds $220,000, according to research by Experience Innovation Network.
Consumers perceive patient experience to be paramount. Of utmost significance is how strongly people feel connected to their health care team, according to The Beryl Institute of Southlake, Texas, a global organization that aims to enhance patient experience across the continuum of care.
Patients consider how well the team listened, communicated in a way they could understand, and treated them with dignity and respect. Recommendations and referrals take precedence in guiding their choices, the Institute revealed in its study, “Consumer Perspectives on Patient Experience 2018,” which surveyed 2,000 respondents from five countries — the United States, Canada, the United Kingdom, Australia and the Philippines.
“Consumers told us that their health care decision-making is going to be driven by the stories they’re told by other people,” says Jason A. Wolf, PhD, CPXP, Beryl’s president and founding editor of the Patient Experience Journal. (The American Association for Physician Leadership partnered with Beryl in 2017 for a special report on the role of communication in the patient-physician relationship.
This trend in consumer-guided health care has fueled job growth for chief experience officers. “It’s a reality that health care is coming to that we have to address experience strategically,” Wolf says. “We can’t leave it to chance.”
Patient experience came to the forefront with the implementation of value-based payments by the Centers for Medicare & Medicaid Services. CMS tied reimbursement to outcomes as well as patient experience, says Liz Boehm, research director at the Experience Innovation Network, which fosters partnerships with physician leaders, nurses and C-suite executives. The international network was co-founded by Bridget Duffy, MD, the first CXO in health care, establishing that role at the Cleveland Clinic.
Despite CMS’ incentives, a growing number of organizations “recognize that it’s not just about the reimbursement,” Boehm says. “It’s about serving patients’ emotional, spiritual well-being in addition to their physical well-being.” She adds that “for most chief experience officers, and the organizations that hire them, it’s a bigger aspiration and not just chasing scores.”
Most CXOs divide their time between contemplating theory, assembling strategies, building teams, evaluating data and responding to complaints and grievances. Increasingly, they’re heading to the front lines in attempts to understand the barriers and pressures that stand in the way of providers striving “to give patients a great experience.” CXOs are aware that these clinicians have heavy workloads and try to lighten them while expanding resources to serve patients and families more effectively, Boehm says.
CXOs ideally report to the chief executive officer, she observes, but sometimes to the chief operating officer, chief medical officer, chief nursing officer, or even the chief marketing officer. “It is a lot about wielding influence with other leaders in order to create alignment and efficiency,” she says.
The consummate candidate does not necessarily have to be a physician, experts say. But he or she ideally should partner with one for the purpose of gaining credibility and fostering collaboration with physician colleagues.
For several years, the health care industry has leaned toward using the term “patient experience” over “patient satisfaction,” says Beth Drolet, MD, the first and current CXO at the Children’s Hospital of Wisconsin in Milwaukee. The shift in terminology is for good reason, she says, explaining that “in health care, you may not be satisfied because you’re still sick.”
At least half of her time on the job entails patient experience, a role she has embraced since 2015. Drolet is also a professor and vice chair of dermatology at the Medical College of Wisconsin, which is affiliated with the pediatric hospital. Management sought a hands-on person for this C-suite position, which would be “very representative of the leadership in their organization,” she says. “All of our physician leaders actually practice medicine.”
As a clinician, Drolet cares for patients in the hospital and in the emergency room while balancing a busy dermatology practice during clinic hours. “I know how hard it is,” she says of the concurrent demands placed on physicians, who are often evaluated by patients as well as peers. “Every day, I’m getting patient reviews and comments and occasionally complaints.”
Data obtained from surveys shed light on patient experience and how to best serve patients seeking care when they are most vulnerable. In a children’s hospital, Drolet notes that parents or guardians typically respond to questions such as:
• Did you feel listened to?
• Cared for?
• Guided in making decisions?
• Overall, on a scale of 1 to 10, how would you rate your experience?
• And how likely are you to recommend this facility, hospital or provider?
Past surveys have shown that “we were really respectful but didn’t always communicate in ways to families that they could understand,” Drolet says. Effective solutions, presented to providers at an optional skills-building event, have included eliminating medical jargon and relaying information at a slower pace and in smaller increments. “On average, patients will remember three things, so don’t tell them 10,” she says.
Suggestions for improvement come from directly observing physicians’ and nurses’ interactions with patients and families. Providers should introduce themselves, acknowledge everyone in the room, answer all their questions and give follow-up instructions. Using teach-back methodology, providers can ask patients to restate what they heard, says Chaun Cox, MD, regional patient experience medical director at Mayo Clinic Health System in Mankato, Minnesota.
“It’s easy for us to think we’ve communicated things well to someone, and they got a totally different version of that,” he says, adding, “We’re realizing that we need to find better ways to meet our patients’ needs and to hear their voices.”
The majority of the week, he practices family medicine; the rest he devotes to patient experience. “I lose my credibility if I’m not seeing patients and just go do this,” says Cox, who has reported to C-suite executives in Rochester, Minnesota, since he became CXO several years ago. “But if I can tell them, ‘I’m seeing patients. I face the same challenges most of the time,’ that carries a whole different weight. It increases your credibility immensely.”
For Shannon Phillips, MD, MPH, practicing as a pediatric hospitalist at Primary Children’s Hospital in Salt Lake City, Utah, helps her remain in close contact with other physicians, caregivers and patients. As the CXO for the umbrella organization, Intermountain Healthcare, a Salt Lake City-based health system serving Utah and southern Idaho, she handles matters concerning not only safety, quality and experience of care, but also risk management, patient advocacy, documentation improvement and infection prevention.
“When patients have been harmed, I have the opportunity to participate in making sure that we’re forthright,” says Phillips, who relocated to Utah for the CXO position in March 2017. Accepting responsibility and taking care of both patients and families and our caregivers is “a very important piece of this role.”
Many physicians assume that providing evidence-based care results in positive reviews from patients. They’re confused when the feedback is negative. But in the realm of patient experience, simply prescribing the appropriate medication or giving sound advice for chronic disease management falls short of consumers’ expectations, Phillips says.
“If they don’t feel a connection to you, they’re not as likely to do what you want them to do,” she says. “If we want patients to have the best outcomes and the best health, those connections matter.”
Susan Kreimer is a freelance health care journalist based in New York.