Healthcare // Leadership
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3/24/2014
02:40 PM
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Hospitals Elevate Patient Satisfaction To The C-Suite

Chief patient experience officers, or CXOs, are an uncommon but valuable addition to hospital executive suites.

As consumer satisfaction begins to have a bigger impact on the bottom line, more hospitals are hiring a chief patient experience officer (CXO) to treat patients like valued customers.

Never has patient satisfaction been more important to healthcare organizations: the Hospital Consumer Assessment of Healthcare Providers and Systems Survey of consumer satisfaction, population health initiatives, and value-based purchasing all show that revenue now depends on patients' satisfaction with providers. The hospitals naming a top-level executive to design, oversee, and collaborate on patient-centric efforts expect to see a financial benefit, given that government and private payers are building patient satisfaction into reimbursement formulas and consumers are playing a larger role in making their own healthcare spending choices.

A few hospitals are now recruiting CXOs. Both Sibley Memorial Hospital and the University of Wisconsin Hospital and Clinics have been seeking CXOs on LinkedIn for at least a month. However, most hospitals do not have a CXO. Catalyst Healthcare Research estimates the industry employs less than 100 professionals with this title. And while the research firm's database of workers at 642 large (100-plus beds) hospitals in 11 Southeastern states includes 29 employees with the world "patient experience" in their title, they are typically VPs or directors, not members of the C-suite.

(Source: The_Warfield via photopin cc)
(Source: The_Warfield via photopin cc)

Having a high-level point person is important for both employees and patients, said Dr. James Merlino, CXO of the Cleveland Clinic, in an interview. The move underscores the hospital's commitment to delivering a better experience, said Merlino, who reports to the hospital's CEO. Hiring a CXO gives departments a point person for all their experience initiatives. And hospitals then have an executive focused solely on accountability, he added. Strong, visible support from leadership was the top driver of successful patient experience initiatives, according to 62% of respondents in Catalyst's 2013 State of Patient Experience Study; 48% said the biggest roadblock arose when leaders appointed to head up patient experience got dragged in too many directions.

"It's one thing to talk about how important [patient experience] is, but it's another to hold people accountable for it," said Merlino. "To be successful with this you have to get people to believe it's important. I think hospitals that don't pay attention to it do so at their own peril. We are in a competitive environment today and this is an important differentiator for payments. This puts the focus back on how we deliver care."

Ideally, patient experience is inherent in all aspects of a hospital's interactions, so CXOs work across departments, executives said. They are involved in human resources to ensure organizations hire the right people and partner closely with IT to learn how new technologies can align with their goal.

"The CIO and CXO have to work hand in hand. Technology is changing every minute," said Jennifer Jasmine E. Arfaa, CXO at Thomas Jefferson University Hospitals. Her training includes a PhD in Organizational Leadership and Development in Health and Human Services from the University of Maryland. "Why not talk about the great things other hospitals are doing? Patients and families are the ultimate beneficiaries of good communication and teamwork throughout a hospital."

For example, a screensaver created by the hospital graphics department and installed by information services reminds nurses and other staff to be quiet at night when patients wanted to sleep, Arfaa said. A simple idea prompted by observation, it cost little to design and implement, yet shows patients how much staff respect their wishes, she said.

"The CXO is not someone who just sits in the office. It's management by walking around," Arfaa said. "In my case, the CXO represents the work of 12,000 other people, all of my colleagues who work at Jefferson." They do the work of delivering the patient and family experience, she said, "but I have the distinct honor and privilege to lead the effort."

It may be tough to measure the ROI of a screensaver, but CXOs have plenty of metrics to track initiatives' success, said Merlino. Cleveland Clinic holds department chairs responsible for how their doctors communicate with patients. Doctors undergo a daylong course to develop better relationships with patients, and nurses use checklists to ensure nothing is overlooked. The hospital instituted "no pass zones" where employees are directed not to pass by the room of a patient who has the call light lit without going in to see what the patient needs.

"You don't need to be a nurse or doctor to get someone a glass of water," Merlino said.

As a result, Cleveland Clinic has seen a record rise in engagement numbers. "When you create an environment where you have absolute focus on customers, that drives employee engagement also," he said.

Despite Cleveland Clinic's many awards, until it put an emphasis on patient experience, its scores were in the lowest tenth percentile nationally, said Merlino. Today, the hospitals' HCAHPS scores are above the 92nd percentile, he said.

Some hospitals have turned to the hospitality industry to recruit CXOs, according to Becker's Hospital Review. Others come from nursing, were physicians, or have hospital administration backgrounds. CXOs must also consider the changing shape of healthcare, said Asif Dhar, principal and chief medical informatics officer at Deloitte Consulting in an interview.

"What will the experience be and look like when it's not confined to a place with walls?" Dhar said. In other words, as hospitals begin to be judged by the quality of their follow-up care, preventative care, and care coordination, the patient experience must reach into the patient's life beyond the hospital.

Download Healthcare IT In The Obamacare Era, the InformationWeek Healthcare digital issue on changes driven by regulation. Modern technology created the opportunity to restructure the healthcare industry around accountable care organizations, but ACOs also put new demands on IT.

Alison Diana has written about technology and business for more than 20 years. She was editor, contributors, at Internet Evolution; editor-in-chief of 21st Century IT; and managing editor, sections, at CRN. She has also written for eWeek, Baseline Magazine, Redmond Channel ... View Full Bio

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Alison_Diana
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Alison_Diana,
User Rank: Author
3/31/2014 | 11:49:14 AM
Re: Who is elevating all of the other patients?
I'd also argue this is why some healthcare-specific ratings sites stink. Whereas you can rate doctors on specifics such as punctuality or knowledge, some of the more popular medical-ratings sites don't give you the room to add more information unless you write a novel in comments. They don't have enough areas with check-mark boxes, IMHO, almost as if the creators of these sites haven't been to many doctors or hospitals (lucky them!). Sure, you can go to more mass market sites like Yelp, but i'd love to see a healthcare-focused site that did a better job with a broader array of grading categories. As you say, PaulR, there are many areas at which a practice can excel (or fail), some of which happen long after you've left the examining room -- and they can be the most important.
Alison_Diana
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Alison_Diana,
User Rank: Author
3/31/2014 | 11:44:19 AM
Re: Who is elevating all of the other patients?
Those are terrific points, PaulR -- and as hospitals (and other healthcare providers) focus on population health and expanding their role beyond the time a patient checks out, you are spot-on in saying they're even more critical to an organization's "patient experience." 

While I have not been a patient at any of the hospitals interviewed here, I believe hiring a CXO is one small step in building an organization that (at least in theory) focuses on EVERY experience a patient, would-be patient, family member or friend of a patient has with every single member or representative of a hospital. So that would include ensuring nobody is on hold for long; that all calls get returned in a timely (and polite) manner; that it's easy to make and change appointments; that all staff -- from janitors to doctors -- are polite and helpful; that refills are easy to get from any legit pharmacy; that parking lots are well lit, etc. And if one or more of those areas fail, that because I'm the CXO -- with a Chief in my title -- I have enough heft and authority to make changes (like retraining or firing an individual). 
David F. Carr
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David F. Carr,
User Rank: Author
3/27/2014 | 9:56:09 AM
Re: Who is elevating all of the other patients?
The population health management structures being put in place, such as Accountable Care Organizations, are supposed to help change the equation toward treating the whole patient, caring for them both in and out of the hospital and helping them manage their own conditions. That those that succeed in helpin us take better care of ourselves will be the ones that build a better relationship with us, making us want to do business with them and respect them -- because they're showing respect for us.

Let's hope some of them get there.
RobPreston
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RobPreston,
User Rank: Author
3/26/2014 | 4:41:42 PM
Re: Who is elevating all of the other patients?
I think most of PaulR's excellent analysis applies just as much to medical practices as to hospitals. From my limited experience, they both have a woeful understanding of a well-rounded customer experience.
PaulR438
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PaulR438,
User Rank: Apprentice
3/26/2014 | 2:42:03 PM
Who is elevating all of the other patients?
Hospitals continue to do a disservice to themselves and their patients by limiting their definition of patient experience to what it has always been or to how the regulators define it.  Patient experience as defined by most is defined as only those events that occur within the hospital, and only for those individuals who happen to be inpatients.

That implies that once someone is discharged, or if a patient happened to be an outpatient that any experience that person had is of no consequence.  Most hospitals sure treat it that way, and they do so at their own peril.

So, if you are a hospital administrator—CEO, CFO, COO, CMO, CIO, or CXO—why should you be alarmed? 

You should be alarmed because you have no idea of the experiences of most of the people who interact with your hospital.  And not knowing whether those experiences are good or bad is costing you patients; lots of them.  Those people include outpatients, discharged patients, former patients and prospective patients.  It includes people coming for labs and therapy. It includes people trying to schedule an appointment, those calling for a refill, and those calling to speak to a nurse. 

If I have a bad experience as an outpatient I will never consider being an inpatient.

If I cannot get an appointment or a refill, I will go somewhere where I can.  How many thousands of your hospital's prospective patients do that every year?

Implementing a screen saver will not improve any of those experiences.  Measuring the satisfaction of individuals at those touchpoints and designing an excellent experience will improve them.

I spoke with a woman last year who was undergoing chemotherapy at the top cancer hospital in the US.  She called the hospital to schedule an appointment because her medicines were making her ill.  She spent three hours on hold and having her call transferred.  She volunteered that she will make it her mission in life to tell others how poor her experience was with that hospital.

So, while there may be merit in trying to bump your HCAHPS score from sixty-four to sixty-five, there may be just as much merit or more in making sure that the experiences from each patient touchpoint are excellent.

More people visit your hospital every day online and by phone than are admitted.  Who is in charge of improving their experience?  Who is in charge of retaining them and their family members and making sure that their experience was so good that they refer other people to your organization?

If the answer is 'nobody' you had better have one heck of a screen saver.
Ariella
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Ariella,
User Rank: Ninja
3/25/2014 | 2:03:07 PM
Re: Is naming a Chief Experience Officer important to a better patient experience?
@Rob I find that title easier to take than "Chief Happiness Officer," which I've seen for other businesses.
RobPreston
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RobPreston,
User Rank: Author
3/25/2014 | 1:27:48 PM
Re: Is naming a Chief Experience Officer important to a better patient experience?
One thing it does suggest is that the organization is serious enough about these issues to devote a C-level executive to it. Whether a fancy title like Chief Experience Officer survives is a whole other question. 
David F. Carr
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David F. Carr,
User Rank: Author
3/25/2014 | 1:06:09 PM
Is naming a Chief Experience Officer important to a better patient experience?
Does giving some senior person this formal title translate into a better patient experience? I'd have to imagine it still depends very much on that person's strategy and leadership qualities, not just the fact that they got the CXO title.
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