Patients Come Second

Leading Change by Changing the Way You Lead

Paul Spiegelman, Britt Berrett

• Publisher: An Inc. Original
• Year: 2013
• ISBN:
  9780988842816
• Topic: Business
• Subtopic: Workplace Culture
• Index: Business

FROM THE NEW YORK TIMES AND WALL STREET JOURNAL BESTSELLER Americans enjoy the finest healthcare delivery system in the world, but most people will tell you that we still have a long way to go. Far too frequently, patients leave the doctor's office or hospital feeling confused, angry, or neglected. Healthcare leaders recognize this problem, but in their focus on patients (and sometimes financials), they often overlook the true key to lasting patient loyalty and satisfaction: their employees. Patients Come Second shakes up the traditional healthcare model, arguing that in order to care for and retain patients, leaders must first create exceptional teams and find ways to engage nurses, administrative staff, physicians, supervisors, and even housekeeping staff and switchboard operators. By connecting employees' work with a higher purpose and equipping them with the tools to become leaders themselves, patient care can be dramatically transformed. And with continuing healthcare changes on the horizon and ever-rising pressure to acquire and keep patients, doing so now is more important than ever. Britt Berrett, president of an 898-bed hospital, and Paul Spiegelman, founder and CEO of a successful patient-experience company, are the perfect guides to the changes needed in healthcare leadership. With a rich combined experience in their field, they have filled each chapter with an abundance of engaging, insightful stories and write with a humor and friendliness that balances and enhances the urgency of their message.

CHAPTER ONE

What Does Come First?

The United States has the finest health care delivery system in the world, bar none. But it doesn’t always seem that way—especially when you’re the patient.

Consider the following story: A middle-aged husband—let’s call him “Paul”—gets talked (we won’t say “guilt-tripped”) into getting a vasectomy. Now, getting a vasectomy means that your doctor is going to get very personal with you in a very meaningful way. It should also go without saying that you don’t want the doc to screw anything up. That’s why Paul first asked around for references from his coworkers and friends as a way to make sure he got the very best urologist on the case. It turns out that several people steered him to the same doctor—a particular guy who operated out of the local hospital. “He’s the best there is,” everyone gushed, so Paul went ahead and scheduled an appointment.

When Paul showed up for his first visit with the doctor—let’s call him “Dr. Gillespie”—he ended up sitting in the waiting room for almost two hours before someone even acknowledged that he was there. When Paul was finally called into an examination room, a physician’s assistant explained what was going to happen. “It’s very quick, snip-snip,” he told Paul. “We’ll get you on the calendar for surgery next month.”

“But wait!” said Paul. “Don’t I get to meet the doctor?”

“No, you don’t need to meet him,” answered the PA as he handed Paul a piece of paper with the date of his surgery printed on it. “He’s done thousands of these things. You don’t have to worry about anything.”

On his way to the car, Paul looked at the piece of paper in his hand. Then he simply crumpled it up and tossed it in the nearest trash can. “If someone is going to cut me down there, he needs to look at me up here,” he said to himself, pointing to his eyes.

A few months later, with his wife still asking (we won’t say “nagging”) about the vasectomy, Paul connected with an old friend of his—a guy who operates a different local hospital. Let’s call him “Britt.” Paul told Britt about this predicament, and Britt suggested he make an appointment to see another doctor named, for our purposes, “Dr. Spock.” Paul somewhat hesitantly agreed to call up the doc for an appointment.

This time, before he could even get in the door, Paul was told he needed to watch three ten-minute videos on YouTube that explained the risks of the surgery as a way to prepare him for his first visit. On the day of the appointment, this Dr. Spock met Paul not in the examination room but in the consultation room. Paul was already starting to feel more comfortable.

“Did you have a chance to watch the videos?” asked Dr. Spock.

Paul nodded.

“And did you have any questions about them or about the surgery?” the doc continued. Only after Dr. Spock had answered Paul’s questions did he actually examine Paul, which he did in an efficient five minutes.

From Paul’s point of view, Dr. Spock had done all he could to earn his trust. This time, Paul carried the piece of paper with his appointment date all the way home to his refrigerator door.

The best part, though, was that after the surgery was successfully completed, Paul received a handwritten note in the mail from the nurse who had discharged him. She wanted to make sure that everything was okay with him post-surgery. In other words, Dr. Spock and his team treated Paul with respect from start to finish—something that he appreciated immensely, especially when compared to his earlier experience with Dr. Gillespie’s office. Want to guess whom Paul told his friends and colleagues to go see when they needed a vasectomy?

REFOCUSING ON WHAT REALLY MATTERS

If you didn’t connect the dots from the vasectomy story, Paul and Britt are real-life characters. In fact, they’re the fellows who have written this book. And yes, while we did change some names, the story itself is true—and was told with a key point in mind. Namely, that attention to the socalled patient experience is often lacking in today’s health care arena.

What does “patient experience” mean, anyway? A group of patient experience leaders across the country, whose research was sponsored by The Beryl Institute, coined the following definition of patient experience: “the sum of all interactions, shaped by an organization’s culture, that influence patient perception across the continuum of care.” Here is a less MBA-like explanation: The patient experience centers around the story you tell your spouse when you get home from your appointment. Nobody comes home after a surgery saying, “Man, that was the best suturing I’ve ever seen!” or, “Sweet, they took out the correct kidney!” Instead, we talk about the people who took care of us, the ones who coordinated the whole procedure—everyone from the receptionist to the nurses to the surgeon. And we don’t just tell these stories around the dinner table. We share our experiences through conversations with friends and colleagues and via social media sites like Facebook and Twitter.

When we asked Andy Leeka, CEO of Good Samaritan Hospital in Los Angeles, about how he defines patient experience, he told us this:

There are a lot of phrases, technical terms, and acronyms that are thrown out and bandied about in healthcare discussions. “Patient-centered care” is one of them, used to describe the involvement of patients and their families in the decision-making process as you explore options for treatment. But what does this mean to an admitting clerk, laboratory phlebotomist, or patient transporter? It is important for leaders to demystify language so that every member of the team understands the goal and can have the authority to achieve it. “Patient-centered care” can be summed up as the way I want my parents to be treated in a hospital. Period.

People cede a certain level of personal control when they become a patient. Whether they don’t have the complete understanding of a procedure that will be performed on them or their clothes are taken from them and replaced by a short smock that opens in the back—they give up something. At that point, patients are vulnerable and rely upon one thing: trust. Trust that you are competent, have their best interests at heart, are prepared and able to perform, and will tell them the truth. They are relying on you after having met you only briefly. They are nervous, anxious, and are not at your hospital for entertainment or fun. They go to Disneyland for fun. At a hospital, they may be there to be healed, give birth, have diagnostic testing, and ultimately restore their life to normal. We owe it to them to take the best we have to offer and deliver it in the most caring, compassionate, and gentle manner we know—just like we would deliver it to our parents.

Case in point: A friend of ours, Melody Trimble, CEO of Sparks Health System in Fort Smith, Arkansas, shared with us the following story told by her human resources director:

A few weeks ago I was talking to a patient in the hallway, and he was telling me about the great experience he’d just had on one of the hospital floors. In the same breath, he told me about a terrible experience he’d had in another unit. The story was so intertwined that I couldn’t keep up with when the good and the bad experiences had actually happened. As I continued to talk to him, I learned that the bad experience had been two years ago; the good experience had just concluded that day. Yet the patient was relating both stories as if they had just occurred.

My thought on the encounter was this: The patient experience starts whenever the patient thinks it starts. That might be when a potential patient hears a news story about us or when he or she calls in for an appointment. But the patient experience never ends, because it’s not linear. We tend to think of it as linear, because that perspective helps us keep track of our work. But patients don’t see the patient experience as a separate thing. It’s just part of the web that is their life. That has very positive and negative consequences for those of us in health care. Because we’re part of the patient’s web, we can really advance Sparks Health System if we get it right. If we get it wrong, though…

This is such a poignant story because, let’s face it, most of us would rank going to the doctor somewhere between watching The Lion King with your kids for the thousandth time and visiting your mother-in-law (just kidding, ladies—we love seeing you!). But building a relationship with a patient means that every interaction health care providers have with that patient really matters.

Given how nervous and keyed up we as patients usually are when we interact with our health care providers, because that’s when we are likely to be at our most vulnerable, the experience of having someone say hello or take an extra minute to make sure we’re okay—let alone send off a thank-you note!—can often outshine any experience we have in receiving the actual physical care. Don’t forget the paradox we’re talking about here: This is a business in which no one wants to be the customer!

The truth is that the patient experience now extends beyond the clinical result, beyond the four walls of the doctor’s office or the hospital, to include anything from pre-care assessments to post-care phone calls and checkups. But an industry-accepted estimate holds that the average person comes to the hospital only once every seventeen years and to the emergency room once every three years. That means we don’t get many shots to get it right.

To deliver a great experience, then, health care leaders have to care about their impact from all angles—each and every way they interact with their patients. That’s why the off-putting story about “Dr. Gillespie,” an all-too-common scenario these days, could be a competitive disadvantage for a doctor, a hospital, or an entire system of health care workers, especially given the rapidly changing health care market. It used to be that patients had limited choices when it came to whom they could see about their health care. This allowed the industry to develop a “build it and they will come” approach. Now, choice is the name of the game. For example, there are some 2,300 post–acute care home health agencies, skilled nursing and rehabilitation facilities, and other specialty niche services in the Dallas–Fort Worth area alone. And patients are taking advantage of this wide selection of health care options, with an increasing number relying on high-deductible insurance plans that allow individuals the freedom to choose their health care providers.

The availability of many health care options is a big part of the reason Bob Kelly, president of New York–Presbyterian Hospital, told us this:

As the demands of health care are sort of evolving, no one can keep up with any of them, and so people change for a lot of reasons—but in general, they change because they have to. I think right now everyone is feeling like they have to change—the way we learned, the way we did things, isn’t working anymore. The current model goes like this: You get sick, you come into the hospital, you see the doctor, we take care of you, we tell you to follow up but we don’t know whether you do or not, we send you out, you either stay well or get sick again and come back, and it starts all over again. I don’t think people are feeling ultimately like this is a great system.

We agree that change typically happens only when it is forced upon us—often by circumstance but also, at times, by the federal government, which has emerged as the largest and most influential player amid this jungle of providers. The government now limits reimbursement to providers based on positive patient feedback (HCAHPS scores) and low readmission rates, so delivering an exceptional patient experience could be the difference between financial success and failure for health care providers in the coming years. And while it is a big enough challenge to focus on our own organization, the changing market will force us to work more collaboratively with our competitors!

Wayne Lerner, CEO of Holy Cross Hospital in Chicago, framed it for us in this way:

The future will not be centered around the hospital experience. It will be the entire patient experience, which includes more than hospitals. Organizations that used to be competitive will now need to work together. Just add that to the list of challenges!

This fact has not gone unnoticed by other health care executives. If you had surveyed the nation’s top health care executives three years ago about what issues kept them up at night, patient experience wouldn’t have even made the list. Today, patient experience is a top-three kind of issue, ranking even higher than cost reduction. Yet three-quarters of health care organizations have yet to define what patient experience means to them, let alone set aside money to address it. The more progressive executives who have tried to tackle the challenge head-on, however, have gone about trying to solve it in a backward manner. They have plowed money into adding more beds or developing new technology such as electronic medical records, all while overlooking the obvious solution: investing in their employees.

Hospitals have missed the point that the best way to improve the patient experience is to build better engagement with their employees, who will then provide better service and health care to patients. To put it another way: Patients come second.

DELIVERING AN EXCEPTIONAL EXPERIENCE

We know, we know—right about now you’re saying something like, “What do you mean, ‘patients come second’? Why would you focus on your employees if you want to improve the experience of the patient? Sounds like you guys must have written yourselves an extra prescription or two.” Well, while we admit to being somewhat wacky and fun loving, we’re stiff-lipped serious when it comes to the notion that an organization’s culture—specifically, how engaged its employees are in their work—is the primary driver for delivering an exceptional patient experience. Bob Kelly from New York–Presbyterian Hospital offered an apt analogy: “Focusing on employee engagement is akin to being on an airplane and putting your oxygen mask on first, before attending to your kids. How can our people help their patients when they, too, are suffering?”

While this may seem counterintuitive to you, consider how important this topic is in the general world of business, where well-known and wildly successful CEOs Tony Hsieh of Zappos and Howard Schultz of Starbucks have written best-selling books about how they empowered their employees to deliver great experiences to their customers. But we have more than just anecdotal proof to lean on. In the 2007 book Firms of Endearment: How World-Class Companies Profit from Passion and Purpose, authors David Wolfe, Rajendra Sisodia, and Jagdish Sheth tracked a series of companies known for having strong employee cultures—a list that included such familiar names as Whole Foods, Harley-Davidson, and Patagonia. The authors found that the companies on their list produced an impressive 1,025 percent return for their investors over a ten-year period. In comparison, the companies in Standard & Poor’s 500 index produced a mere 122 percent return over the same period. Not too shabby, right?

Well, it gets better. You’ve probably heard about or maybe even read the book Good to Great by Jim Collins, which, more than a decade after its initial publication, continues to top business book bestseller lists. But do you know what happened when the Firms of Endearment authors calculated the return on investment for the Good to Great companies over the same ten years? They found that these companies produced a 316 percent ROI—a satisfying result, but one that is less than one-third of the return produced by companies known more for their level of employee engagement than for their “greatness.” To put it another way, employee engagement pays off big-time—something executives all around the country are beginning to realize.

The connection isn’t lost on Ron Swinfard, CEO of Lehigh Valley Health System, who told us he uses symbolic imagery to get the point across: a slide presentation that shows several links in a chain, starting with employee satisfaction and leading to patient satisfaction and finally to financial success. “I tell my employees that this isn’t just a feel-good idea; it is also a business strategy,” Ron said.

Let’s consider an everyday example of how this works. Say that you love starting off your mornings with a venti half-caf soy latte. Given the proliferation of Starbucks across the country you may, depending on where you live, have access to two, three, or even more locations where you can buy your coffee every morning. And for the most part, each cup will taste about the same. The key difference in where you choose to buy your latte, then, could be the location where you most enjoy interacting with the baristas. It might be an extra smile, a sincere word of thanks, or just the sight of an employee who seems to take great pleasure in frothing milk that can help start your day off right. A frown, a mixed-up order, or even a lack of eye contact, on the other hand, might result in a grumpy start to your day—and for that Starbucks location, a lost customer.

Now do you get it? The type of customer experience you receive begins with the employee who served you. “Engaged employees are willing to go the extra mile—for themselves, their coworkers, and their customers,” explained our friend Dane Peterson, CEO of Emory University Hospital Midtown in Atlanta. “They seek out problems and work to solve them.” And their customers take notice.

It’s our contention that customers are smart. They can tell whether the stranger pouring their cup o’ joe in the morning is fully engaged in his or her work. Sure, the barista could fake it by simply following the training script. But customers know—especially when something goes wrong with their order. What happens then, Mr. Unengaged Employee? Does your script cover the fact that you left out the milk or ground the wrong coffee bean? Great employees, on th...