Laying the Foundation of a Culture of Improvement

My father is a physician who operates an independent medical practice. We recently spent quite a few hours in the car together on our way to Northern Michigan. Our conversation drifted towards the need for health care organizations to think holistically about the patient experience in order to succeed. I asked, “Who is in charge of the patient experience at your practice?” He replied, “Everybody, of course.” I responded, “Whom do you hold responsible when things don’t go well?” to which he muttered, “No one.” I’m positive that he is not alone in this. That said, how can any true improvement to the patient experience be successfully implemented if this is the case?

My previous life was in mental health counseling. One of the most important lessons that counselors learn early on is that we are often our own worst enemy; most barriers to our success as individuals reside within ourselves. Similarly, I can’t help thinking that the primary barrier to optimal patient experiences resides within the organization. It’s not usually an issue of knowledge; we know the proven best practices that result in high patient satisfaction and other key aspects of high organizational performance. What differentiates high performers from the mediocre is not some secret recipe that only they know. It’s the underlying organizational culture and structure that supports improvement and sustainability of high performance.

Health care organizations are usually organized around departments that “own” certain functions. Nursing is in charge of patient care. Marketing is in charge of organization brand management. Physicians are in charge of diagnosis and treatment. Operations is in charge of the facility. This structure can easily create a mindset that individuals within these functional areas also only own pieces of the patient care experience – no one feels responsibility for the entire patient experience, and problems are always someone else’s fault. In my dad’s practice, he’s in charge of patient treatment. The front office is in charge of scheduling and reception, and the back office is in charge of billing and other functions. No one looks at the entire patient journey.

Instead of viewing the patient experience as a set of discrete interactions, we should instead think about it like patients do – as a set of continuous, related interactions that add up to their perspective of the total experience. In this way, we remove the traditional boundaries or silos and are forced to start thinking more about the connections and less about the separations. As we all know, the trickiest challenges in the patient experience occur within the care transitions or handoffs. Success requires collaboration.

As organizations move in this direction, I’ve seen that something interesting happens. Less talk about the data and more talk about how to use it. More focus on patient experience metrics and recognition of how they drive other performance metrics. More development of cross-functional alliances that coordinate patient experiences across the organization. Employees gain an understanding of how they fit into the global patient experience and a broader understanding of their responsibility.

In fact, in studying our top performing organizations, we see five underlying areas at their core. While there may not be “silver bullets” to high performance, organizations that foster these five core areas of their culture have a solid foundation that supports successful improvement efforts. These areas are vision, leadership engagement, employee partnership, transparency and trust, and accountability. Press Ganey works with organizations to identify opportunities for improvement in these areas while supporting clients in improving the patient experience.

All health care organizations essentially practice the same kind of medicine. What differentiates high performers is how they come together as an organization to optimize each aspect of the patient’s care and total experience. It’s developing a strong core that leads to high performance in all aspects of the organization. To my father and other health care leaders, this may feel overwhelming – it’s not a quick fix or surface-level change. This kind of thing isn’t taught in medical school, nursing school, or even most MBA programs. But is it worth the fight? Most definitely.