A Forgettable Experience: Part 1

Recently, my ongoing patient interviews have focused on several items I need to validate for an assessment tool project. As I interviewed these patients, a pattern emerged - many of them suggested their experiences felt more like a transaction rather than an interaction. They categorized the experiences as cold, forgettable and mechanical.

One patient explained it by saying the impersonal nature of her visit to her doctor was no different than her conversation with the bank teller that same morning. And I get it. In all candor, all of us physicians have had busy clinic days where we wish we had a three-inch plexiglass wall between us and our patients… it hastens the conversation and allows us to get on to the next patient faster.

Q: While we don't have definitive data to draw conclusions about this aspect of the physician-patient relationship, it calls for the question to be asked: Are there some things within our control that lend themselves to fostering quality interactions with patients that feel less transactional? Are we doing enough to build a patient-centered organization?

A: Yes… and Not yet.

Many organizations face challenges in moving from merely satisfying patient needs to true patient-centeredness, but the benefits more than justify the effort. Leaders play a pivotal role by setting clear expectations, aligning all units of the organization to become more accountable to patients, and improving the capture and analysis of more relevant/useful information.

Building a patient/customer-accountable organization isn't hard to do but it is impossible without the right culture. From Steve Jobs to Jeff Bezos, a number of legendary business leaders have built cultures whose very identities are defined by the loyalty (and even the love) of their customers.

They did this by going beyond mere customer satisfaction into the realm of customer-accountability. They aligned their respective organizations to truly understand what matters most to customers (wishes and challenges), and to respond quickly and respectfully at every stage of each interaction. In return, customers become forgiving, fully-engaged and even evangelize the organization's culture to friends and acquaintances.

Rest assured, the rewards for this emphasis on the interaction, vs. the transaction, can be measured in dollars and cents.

But why do so many outside of healthcare including patients believe our industry lagging when it comes to patient/customer accountability? Shouldn't healthcare be informing other industries and companies like Apple, JetBlue or Amazon how how to build customer/patient centricity. Could it be the market and patients just hold us to a higher standard since we are arguably the most personal of industries?

Compounding expectations, we’ve done just about everything in our power to encourage the transactional experience. I’m not the first physician to point our how our medical schools ignore listening, teamwork, empathy, assurance, etc., and train in captain-of-the-ship approaches to encourage obedience and standardized rapid transactions. To make matters worse, we have a legacy culture that emphasizes hierarchy and heroes rather than rewarding and recognizing collaboration and team problem solving. These rules of engagement foster touch-points that erode patient trust.

Our next issue will discuss what we need to do to migrate organizations from their current state of providing inconsistent, episodic service excellence to a more patient accountable culture.

Is your culture aligned to what matters most to patients?...

In The News...

A Patient Dies. A Hospital Heals

By Bill Santamour
H&HN Managing Editor

A fictional account of a tragedy and how a hospital changes for the better.

A patient dies after surgery despite the fact that checklists and other cutting-edge policies are in place to prevent such a tragedy. The clinical staff become defensive. Physicians close ranks to deflect blame. Nurses know that if somebody has to take the fall, it will, no doubt, be one of them. The hospital CEO understands that the fault lies not with individuals or policies, but with a staff too focused on their own task-filled workdays to see the bigger picture and too cynical to believe that things can ever fundamentally change. And the CEO herself is so overwhelmed by putting out everyday fires that she has no time to think about long-term solutions.

That’s the set-up of Heroes Need Not Apply, Brian D. Wong’s fictional account of Angels Hospital and the aftermath of a patient’s death, a death that could and should have been prevented. Wong, an M.D. and founder of The Bedside Trust, paints a familiar picture of today’s hospital staff, in which the sincere goal of putting the patient at the center of everything they do can get lost in the crush of workloads, silos, egos, long-standing hierarchies, skepticism and plain fear. His vivid cast of characters includes a brilliant but intransigent surgeon, a young doctor with conflicting loyalties, an outspoken nurse, a new CEO and the person she brings in to help change the culture.

OK, I can see you rolling your eyes at the term “change the culture.” But by getting inside each individual’s mind and allowing us to listen in on their thoughts and conversations, Wong avoids consultant jargon and preachiness. He presents a true-to-life scenario of personality conflicts common to all hospital staff and the endemic skepticism that often straitjackets any leader’s efforts to foster meaningful change. And he shows how a hospital CEO can overcome those obstacles to, as the book’s subtitle puts it, “build a patient-accountable culture without putting more on your plate.”

The crux of that culture change is eliminating the chain-of-command structure and moving to one in which listening and respect across job titles and individuals can lead to true team care. As someone at Angels Hospital says, “No one person, no matter how smart, was nearly as smart as a roomful of people.”

In his introduction, AHA President and CEO Rich Umbdenstock writes that Wong’s story “brings a human element to the equation and underscores the importance of making patients and their families full partners in the care process."

Heroes Need Not Apply is an excellent resource for you and your physicians, nurses, C-suite and board members. Might even make a good stocking stuffer. For more information, click here.

The opinions expressed by authors do not necessarily reflect the policy of Health Forum Inc. or the American Hospital Association.

H&HN Daily, December 10, 2013

Heroes Need Not Apply... now on eBook

Improved care coordination is essential to gaining the efficiencies required in this healthcare reform era. To move metrics in patient safety, experience, and quality, we must become effective at delivering coordinated team based care.

In his new book, Heroes Need Not Apply, Brian Wong MD, uncovers the reasons why many of us experience spotty improvements in patient safety, episodic service excellence, and insufficient engagement and accountability. To make sustainable improvements, we need to know how to migrate from a system that can best be described as uncoordinated (i.e. poor hand-offs, suboptimal staff interaction, medical hierarchies, etc.) to one that delivers consistent coordination of team based care.

The purpose of Heroes Need Not Apply is to give healthcare organizations a template for creating a strong foundation for effective coordinated care. This “how-to” book gives every executive, physician, nurse, and clinical team member the tools to make specific changes at the local level, and uses relatable characters to showcase effective patient-centered skills to improve efficiency, decrease costs, and improve the patient experience. If your hospital is looking to accelerate improvements in care coordination and improve team care,Heroes Need Not Apply is a timely resource designed to equip your organization with the practical skills required for improved care coordination.

The book has already caught the attention of many top physicians, nurses, and executives as an innovative resource to lead our industry into a new era of value based healthcare that is both cost effective and accountable to patients.

Dr. Wong's Heroes Need Not Apply is receiving praise by noted physician leaders and industry experts throughout the country...

“Heroes Need Not Apply examines the root causes of healthcare’s most pressing safety and quality challenges. It offers practical strategies to improve communication among staff, dismantle silos, and build high-performing teams.”
— Richard J. Umbdenstock, President and CEO of the American Hospital Association

“I believe this book will help save lives, improve quality, and recommit healthcare providers and patients to new levels of trust.”
— Sue Collier, MSN, RN, FABC - Performance Improvement Specialist, Patient-Family Engagement, NC Quality Center/NC Hospital Association

“Dr. Wong’s book “Heroes Need Not Apply” breaks new ground as a field manual for what WE can all do on the front lines to be leaders as opposed to “reactors’ of healthcare transformation.”
— Stephen K. Klasko, M.D., M.B.A., President and CEO, Thomas Jefferson University Hospitals

"...[Dr. Wong] speaks the truth of what we must become as leaders in health care."
— Jeff Selberg, EVP and Chief Operating Officer, Institute for Healthcare Improvement.

“Amazing! Timely, accurate, stunning, motivating, frightening. More than reading, I consumed the book. What a wonderful story of cold truth.”
— Jack Cochran, MD, Executive Director, The Permanente Federation, LLC

“On the journey to team-based and patient-centric care the evolving healthcare system is indeed a place to which Heroes Need Not Apply."
— Joseph S. Bujak, MD, FACP

“Dr. Wong draws the reader into the world of the hospital and an understanding of the cultural barriers that contribute so much to preventable medical error.”
— Gordon R. Clark, President and CEO of iProtean

On Sale Now!