Patient-Centered Environment

“Organizations around the country are working to create a patient-centered environment.” So said Sandy Myerson, MBA, MS, BSN, RN. Myerson is one of a growing number of executives who occupy the role of chief patient experience officer, a position she has held at the seven- hospital Mount Sinai Health System in New York, N.Y. since November 2014.

This role “ensures a seat at the table for the voice of the customer to be heard and acted on when senior leaders gather and make decisions.”1

Larger, more forward-thinking organizations see the value in the position. The Cleveland Clinic was the frontrunner, becoming the first academic medical center to appoint a chief experience officer and make patient experience a strategic goal.2

With the Affordable Care Act now linking part of Medicare’s payments to how patients rate hospitals, having a point person to oversee patient experience is becoming more crucial for both a facility’s reputation and its bottom line.

 

Filling a Niche

Before her career at Mount Sinai began, Myerson was a managing consultant for Press Ganey, the company that processes the majority of patient satisfaction surveys in the U.S., working with hospitals all over the country to improve the patient experience. The Mount Sinai Health System leadership asked her to assess three of its hospitals to see where they could improve. One of Myerson’s recommendations included the appointment of a chief patient experience officer to orchestrate all the improvement initiatives around the patient experience.

The road to hiring a chief patient experience officer is a fairly typical one. Organizations first realize something is lacking when it comes to their patients’ experiences and then prioritize improving the experience of care. A chief patient experience officer is brought on board, and he or she builds a team and begins to implement changes.

Since most organizations are still in the early stages of having a chief patient experience officer on staff, comprehensive feedback on the effects of this new model of leadership – both financially and on patient perspectives – remain a few years out.1

Kenneth L. Davis, MD, president and CEO of the Mount Sinai Health System, and Jeremy Boal, MD, chief medical officer, agreed with the need for this new C-suite executive. The individual hospital leaders were focused on the day-to-day running of their institutions. A system-level person could provide support and implement change drivers.

When they had difficulty filling the role, Myerson presented herself as a candidate, a win for all sides. She explained, “What excited me about this organization is the passion and drive that exist here to make the experience for patients and their families better; they had a vision of where healthcare needs to go to be successful.”

 

Connecting With the Nurses

Reporting to Boal, Myerson describes her role as an internal consultant. Being an executive-level position brings a certain clout to the role. “Our CEO, Dr. Ken Davis, and CMO, Dr. Jeremy Boal, speak highly of me and promote my knowledge and expertise,” she said. She interfaces regularly with the board of directors and articulates the value of patient experience, calling to it the level of attention it deserves.

Myerson has strong working relationships with the chief nursing officers, chief medical officers and the chief operating officers of each hospital, and meets frequently with other leadership team members, including the individual nurse managers at each facility. She works to uncover both the challenges and the opportunities at each hospital and figure out which changes will bring the greatest improvement.

Besides dealing with the higher ups, she noted, “I’m in the weeds, rounding with the front-line staff.” Her background as both an ED and a critical care nurse means she has walked in their shoes and can bring her own experiences.

“Nurses often have the most one-on-one contact with patients of any care provider, so CNOs and other nurse with executive experience have made successful CXOs,” noted an article in Becker’s Hospital Review. “Nurses have seen the good, bad and the ugly of patient care and are behind the drive to improve it.”3

Myerson concurred. “I think it’s helpful for someone with a clinical background to be in this role because it brings a level of credibility. I’m not just another suit walking around saying ‘do this.'” Knowing how hospitals operate makes it easier for her to know what changes are the most feasible. Her forward thinking can help predict the operational and financial impact of changes and to figure out how new programs can be implemented both efficiently and effectively.

 

Change at the Unit Level

Many of the initiatives Mount Sinai Health System has undertaken under her watch involve the individual nurses, those employees who have the most contact with the patients.

One focus is daily nurse manager rounding. They look at issues from the patients’ perspective and figure out what patients need and want. When patients see the care team members working well together, it adds to their overall experience.

Successful communication, both with patients and among clinicians, is a big factor on positive patient experiences. Myerson explained, “We expect people to know how to communicate with patients but haven’t taught them. We need to coach people on communication best practices.”

Mount Sinai is focusing resources on that goal, including improved physician communication skills and making physician satisfaction scores transparent and more accessible. Executive leader rounding builds employee engagement and buy-in. Taking a page from Lean Six Sigma, the system is reducing waste and implementing processes that reduce variability.

For a chief patient experience office like Myerson to be impactful, the support of both peers and higher-ups is instrumental.

Myerson acknowledged, “I am at a huge advantage,” due to an endowment created by the Joseph F. Cullman, Jr. Institute for Patient Experience to fund patient experience initiatives across the healthcare system.

Listening and building relationships help her to better understand the barriers to improved experience of care. She says it is helpful to have sufficient resources to provide support, and those resources can vary for different teams.

 

Measuring the Impact

One of those resources is a team for data reporting and analysis, so she can assess the impact of changes. Outcome measures are a critical component of patient experience. The healthcare system analyzes its success by way of its HCAHPS score, which are the national, standardized surveys of patient perspectives of care.

The surveys are sent to a random sampling of patients after discharge. They contain 18 core questions about particular aspects of the hospital experience, focusing on clinician communication, response time, pain management, discharge instructions and whether they would recommend the hospital. Sample questions include “Does the nurse always communicate well?” and “Did you receive help as soon as you needed it?”4

When compared to other New York hospitals, Mount Sinai Hospital, the flagship hospital of the system, got higher than average scores on its most recent survey of patient experiences. The hospital received its highest marks for the question, “Were patients given information about what to do during their recovery at home?”5

Myerson observed, “There’s a lot of positive energy and many people working to make things happen.” Along with other leaders, she is striving to create a “Mount Sinai experience,” a patient-centered culture that will provide a similar, positive experience across all parts of the system.

The goal is for all hospitals in the system to be ranked in the top 10% nationally with their HCAHPS scores within the next four years. That is an ambitious undertaking, but with Myerson’s vision at the helm, it’s entirely feasible.

 

References

1. Padilla, D. “The Chief Experience Officer.” Executive Insight. August 18, 2014. http://healthcare-executive-insight.advanceweb.com/Features/Articles/The-Chief-Experience-Officer.aspx. Accessibility verified February 28, 2015.

2. Cleveland Clinic. About the Office of Patient Experience.http://my.clevelandclinic.org/patients-visitors/patient-experience/about. Accessibility verified February 28, 2015.

3. Punke, H. “New Seat in the Hospital C-Suite: The Rise of the Chief Experience Officer.” Becker’s Hospital Review. September 6, 2013. http://www.beckershospitalreview.com/hospital-management-administration/new-seat-in-the-hospital-c-suite-the-rise-of-the-chief-experience-officer.html. Accessibility verified February 28, 2015.

4. Centers for Medicare and Medicaid Services. HCAHPS: Patients’ Perspectives of Care Survey. http://www.cms.gov/Medicare/Quality-Initiatives-Patient-Assessment-Instruments/HospitalQualityInits/HospitalHCAHPS.html. Accessibility verified February 28, 2015.

5. Medicare.gov Hospital Compare. Mount Sinai Hospital. http://www.medicare.gov/hospitalcompare/profile.html#profTab=1&ID=330024&Distn=7.4&dist=25&
loc=NEW%20YORK%2C%20NY&lat=40.7143528&lng=-74.0059731&name=MOUNT%20SINAI%20

 

Danielle Bullen is on staff at ADVANCE. Contact dbullen@advanceweb.com

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