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Chief experience officers improve the patient experience-and the experience of caregivers.
As payers tie more reimbursement to patient satisfaction scores and demonstrated outcomes, and as patients are more informed about the choices they can make, health systems are increasingly developing new ways to improve performance. Some of these methods include the creation of new executive roles aimed at ensuring patients and caregivers have the tools they need for success.
One such role is chief population health officer (CPHO), driven primarily by a movement from fee-for-service to value-based reimbursements. CPHOs and another newer role, data scientist, identify data and trends to support improved outcomes and processes.
These roles support a larger executive trend: chief experience officer (CXO), which is driven by the desire to improve the larger patient experience-a combination of excellence in clinical care and patient perception-and the experience of caregivers.
Bridget Duffy, MD, chief medical officer of Vocera, which provides secure communication platforms to healthcare organizations, served as the nation’s first chief experience officer at the Cleveland Clinic from June 2007 to July 2009. She says the creation of the CXO role follows the historically reactive nature of the industry. Chief quality officer roles, for example, weren’t created until after adverse events were noted. Likewise, chief experience officer roles didn’t really take hold until after the government mandated higher patient satisfaction and quality, and tied reimbursement to it.
Before Duffy took on the role of CXO at the Cleveland Clinic, she told leadership that it had to be willing to address fundamental problems with the culture and structure of the organization. Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) scores were between 40% and 60%, and people came to the Cleveland Clinic for its reputation of clinical excellence while tolerating the poor service that accompanied it, Duffy says. So, she spent nearly three years working with staff to repair broken trust and relationships between physicians and nurses and addressing caregiver burnout.
“Instead of taking on 100 things, organizations should just focus on culture, communication and fostering trusted relationships,” she says. “The ones that have moved the scores are the ones that have focused first and foremost on culture and leadership.”
Liz Boehm is director of research at Vocera and its Experience Innovation Network, which has
. These individuals have their work cut out for them, says Boehm.
“We’re reaching a place now where there’s concerns about cost but also access and coverage,” she says. “We need to take a deeper look at the systems we’ve created and the challenges.”
This means asking how healthcare can be restructured at equal or lower costs to deliver more powerful outcomes-outcomes that are about health, not just procedural success, she says.
“If we’re honest about the motivation of many of the organizations [in creating CXOs], it comes primarily through the reimbursement tied through HCAHPS,” Boehm says. “For others, there’s a deeper understanding that HCAHPS points out that there is a flaw in the system: It is an imperfect measurement system.”
Focusing on simply making patients happy isn’t enough, says Duffy, adding that health systems that focus on hospitality measures to improve scores are a bit misguided.
“It’s not the customer is always right. It’s the patient is always heard and feels heard and is connected,” Boehm adds. “It’s about making the experience more healing for patients and families, but also more fulfilling and humane for the physicians, nurses and other care team members.”
Executive support positions, like chief experience officers, population health officers, and data scientists, must work together to identify deficits and build better structures and training protocols that make the humanized experience the path of least resistance so that it’s easier to deliver care with dignity and respect.
“Some organizations do look at it as customer service, but there’s a much deeper work to it,” Boehm says. “One role is to recognize that compassion needs to be nurtured. Part of the success is recognizing that there is a provider and a patient and a family side. Piling patient experience work on clinicians is not a strategy for success. They need care for themselves in addition to aspirations for the patient.”
Patient and caregiver experience must also be linked to qualify and safety.
“When you are providing a more humanized experience, you are delivering better quality,” Boehm says. “If you train those as separate silos, it becomes easy as a clinical to focus on safety and quality and forget that human component.”
Health systems need to find a way to integrate these teams, agrees Duffy, who co-founded the Experience Innovation Network to create partnerships that advance the development of more humanistic care models. In the future, she says CXOs might work under an umbrella of an innovation or resiliency department, where the entire patient and caregiver experience is considered.
“What I see now is a movement back toward integration and more coordination of roles and a changing or shifting of titles due to what I call the silo-ification of healthcare,” Duffy says. “Too many silos have been created that are focused on different things without aligning the efforts within an institution.”
Susan Murphy, RN, is the chief experience and innovation officer at The University of Chicago Medicine. Although she has the executive title, Murphy says she considers herself first and foremost a caregiver and that drives her work.
“As caregivers, we’re just trying to do our checklist and end up putting our blinders on. How do we take that moment, and take that breath, and put those observers on?” Murphy says. “The most powerful thing we do, which is kind of simple, is when we’re going to work with a new team, we ask them why they’re here. When you open that dialogue, when you get to the heart of the leaders and caregivers, you get to the heart of the patient, and that’s what I feel our job is. There’s a certain kind of person it takes to walk into a patient’s life and start doing very personal things to them.”
Murphy says her role isn’t to tell caregivers how to improve scores or performance, but to serve as a mentor and coach and support the frontline providers to make sure they have the tools and equipment they need to do what they already know how to do. Skills are one thing, but helping caregivers remain patient-oriented and not task-oriented can take some work.
“People who come in and care for people every day may not recognize that what they’re doing every day is changing people’s lives,” Murphy says. “People know me, they know me here. I don’t really look at scores. The scores will come when we look at stories and we look at how caregivers feel when they’re here in the organization.”
Caregivers who feel appreciated and supported can better focus on the needs of their patient and, in turn, improve their own performance and their patient’s satisfaction, says Murphy.
“It’s really about providing the options of individualized patient care and remembering the physician and nurses need ways to find out what works for the patient. To talk to them. To have a dialogue with them,” Murphy says.
Caregivers also need to learn to meet the patient where they are. In terms of both technology and wellness, it’s not enough to provide the tools. Caregivers must realize that each patient is coming from a different place and it may be more beneficial to find out where they are in terms of willingness and ability to learn and change rather than to hand them a generic recipe for their health.
For example, an elderly patient with a joint replacement might not buy into the care path that requires physical therapy and rehabilitation. Instead of pushing a plan that the patient will never follow, the caregiver might instead educate the patient on being their best with limited mobility-interventions for preventing pressure ulcers and proper nutrition.
“I think it’s really about not making people feel bad for who they are and what they do, but giving people at the frontline the tools they need to take care of patients in the future,” she says. “Patient experience is not just about the scores and not just about what goes on inside the four walls of the hospital, but about the whole picture. We want to help them feel when they walk away that ‘they really care about me.’”
Rachael Zimlich, RN, is a writer in Columbia Station, Ohio.