NewYork-Presbyterian CXO Rick Evans: Improving patient experience cannot succeed without physicians, but how do you engage them?

I am sure we would all agree that physicians are core to the quality of patient experience. They are the quarterbacks for care and stand at the center of the care team.

However, anyone who works on improving patient experience knows that engaging physicians in this work is very challenging. Many factors drive this challenge. Perhaps the biggest is finding time in between floor rounds, OR schedules and office sessions with patients to have conversations. There is also the need to address the questions about the validity of patient experience data that many physicians have. We also need to accurately describe what patient experience is truly about and address misperceptions that often drive physicians crazy — for example, the notion that every patient has to be made "happy." It's not about happiness as much as it is about confidence. And, perhaps most importantly, we need to show how patient experience improvement supports physicians in their work and helps them succeed.  

While it's still a work in progress, we've had success with physician engagement at NewYork-Presbyterian. One way that we transformed our approach is by adding physicians to our patient experience team. Our team is small but powerful. We have patient experience improvement experts aligned with each of our campuses. However, historically they have not been clinicians. We knew clinician involvement in the team could make us even more effective, so we hired medical directors for patient experience, Paul Martin, MD, and Taylor Sewell, MD. In our case, they are practicing hospitalists — Dr. Martin in internal medicine and Dr. Sewell in pediatrics. We worked with their clinical departments to fund part of their time. They provide direct inpatient care like all others in their divisions, but they also devote a percentage of their time to working as members of our PX team. 

Our medical directors perform a few roles. They provide the clinical perspective as we develop, deploy and evolve our strategy to improve patient experience. This includes weighing in on the right metrics to focus on and the right evidence based best practices to move the needle. They help us find the "sweet spot" for interventions that improve patient experience and will also make clinicians' days better. They facilitate meetings of our physician advisory council and represent us in numerous venues with other physicians. They also help us innovate and conduct research connected with patient experience improvement. Here are examples of other initiatives led by these physicians:

Dr. Sewell led the creation of a video series for providers. "We created the videos to level-set everyone on what patient experience is, what it isn't, how it's measured and why it matters," says Dr. Sewell. The videos are 3-4 minutes each and feature provider leaders and role models from across the organization. "Crucially, we devised an interactive deployment strategy for these videos that involves facilitated conversation," Dr. Sewell adds. "We hope these video sessions will build understanding and set a solid foundation for robust provider initiatives down the road. What's more, we are wrapping a research project around the deployment of the videos so we can evaluate whether or not this strategy accomplishes our objectives."

Dr. Martin developed and deployed a novel provider-focused communication observation and coaching program. "The aim was to extend our communication training for physicians and advanced practice providers in a way that was provider-centric and embedded into their workflows," Dr. Martin says. In this program, a certified communication coach joins providers and resident teams on their morning rounds, and afterwards provides them with feedback based on his observations as well as comments obtained from patients. "Being integrated in the provider's routine and providing immediate, detailed, and actionable feedback are particular strengths of this program," said Dr. Martin.

Looking for new strategies to further enhance provider engagement in improving patient experience, Dr. Martin and Dr. Sewell also created an innovation grants program. Physicians and APPs across the enterprise were invited to apply with their own innovative, physician-led projects aimed at improving the patient experience, with the chosen projects being supported financially as well as with project guidance and mentorship. "We had two dozen submissions, including some very creative ideas, and are looking forward to partnering with some highly engaged providers," says Dr. Martin.

We are grateful to these two physician leaders for everything they have done to make our patient experience strategy better, sharper and more relevant and credible to clinicians. 

It's also important to share some of the insights these physicians have shared with us as we move through the COVID-19 pandemic. New York was the first epicenter in the U.S. Dr. Martin and Dr. Sewell were both frontline caregivers. Among many themes they identified, they highlighted the need for continued transparency with regard to how organizations are planning for a possible resurgence, including communicating proactively how physicians may be redeployed in a response. They talked about the critical need for a continued focus on wellness and support for clinicians. They also discussed the need to find ways to continue to support important work around teaching and research, even as we respond to the pandemic. They also recommended that any organizational planning include the voice of frontline physicians. All of this is good advice worth sharing and reflecting on.

As I have said many times before, improving patient experience is like any quality improvement effort: It must be based on actionable data and use evidence-based interventions to succeed. Another key element must be the meaningful involvement of physicians in any strategy that is developed. Drs. Martin and Sewell are helping us lead the way here at NewYork-Presbyterian. 

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