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August 4, 2017

How Cleveland Clinic doctors save time with a 'single statement'

Daily Briefing

Read Advisory Board's take on fostering empathic connections with patients.

The health care industry's increasing focus on patient safety and quality can obscure the importance of patient experience, but Cleveland Clinic has put it at the top of their priority list by emphasizing empathetic communication—boosting the organization's bottom line along the way, Debra Beaulieu writes for HealthLeaders Media.

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Why patient experience is so important, according to Cleveland Clinic

Patient experience is key because it affects an organization's bottom line in several ways, particularly given the industry shift toward value-based care, Lori Kondas, senior director for the office of patient experience at the Clinic, said.

For instance, Kondas pointed out that as of this year, a hospital or health system's Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) score determines up to 2 percent of the organization's Medicare reimbursements. "The risk for not giving patients a good experience financially now becomes very high, so hospitals or practices that don't stand behind the fact that we need to take care of our patients both behaviorally and clinically stand to lose a significant amount of money," Kondas said.

And the payer angle is just one of many ways patient experience affects the bottom line, according to Joshua Miller, the Clinic's VP for regional family health center operations. Miller explained that the Clinic will "sit down with our doctors and say, 'We really care about this.'"

How Cleveland Clinic uses empathy to boost patient experience

The Clinic has long prioritized patient experience by focusing on provider-patient communication, Beaulieu reports.

The Clinic in 2011 implemented a class for providers that focuses on relationship-centered communication—a curriculum that Adrienne Boissy, the Clinic's chief experience officer, and colleagues in 2016 compiled into a book called, "Communication the Cleveland Clinic Way." The curriculum, Miller said, is basically an "MBA for communication."

She explained that paying attention to certain cues from patients can improve patient experience dramatically. "[I]f someone is coming to me emotionally charged and I ignore those cues and continue on my own agenda, those cues will either continue to surface and escalate, or the patient will stop talking because you've demonstrated that you're not willing to 'see' the emotional human in front of you," she said. "The evidence suggests that you can actually save time by making a single empathic statement," Boissy added.

On the other hand, if the provider addresses those cues at the initial appointment, he or she can sidestep a lot of the negative fallout, saving time for both the patient and the hospital, Boissy continued. Moreover, according to Kondas, patients who feel heard are less likely to sue their provider—meaning a proactive, empathetic provider can help a hospital or health system save money as well.

In another example, Miller cited the financial ramifications of patient experience by outlining a hypothetical situation in which a patient is upset about a long wait time before an appointment. The patient is likely to be distracted by his or her frustration and will be less interested in talking about medical concerns with their provider, which could then cause poor adherence—and a potentially preventable hospitalization, Miller said.

According to Kondas, the bottom line is this: "If you want patients to come to your hospital, you better make them happy" (Beaulieu, HealthLeaders Media, 8/1).

Advisory Board’s take

By Hollie Freeman, iRound for Patient Experience

One key to fostering empathetic connections is to approach the critical best practice of patient rounding in a more holistic way.

Often the way a nurse leader might categorize the details of an inpatient’s stay would look something like this:

  • The patient in room 182 admitted two days ago
  • S/he was diagnosed with gallstone pancreatitis
  • An ERCP has been scheduled
  • S/he is acting irritable today
  • Additional pain medication twice has been requested twice

There is nothing clinically wrong with this record, but it is impersonal—and it does not reflect on why the patient may be irritable or what could be done to improve the situation. In this instance, for more purposeful rounding, it would be best practice to also include an understanding of the patient’s perception of his or her situation, such as:

  • "I’ve never been admitted to the hospital before."
  • "I’m anxious about an inpatient stay"
  • "I’m concerned about long-term impact of surgery"
  • "I’m worried about missing an upcoming event"

Organizations that have incorporated these two elements—the clinical and the patient perspective—into their rounds have improved their patient experience and their provider engagement, as clinicians feel more fulfilled and satisfied in their work. Incorporating both elements also yields higher patient engagement in care planning, resulting in better outcomes, as we are engaging the person, not just "the patient."

It's not that providers don't want to be empathetic toward their patients—but building a culture of empathy is not an easy thing to do. To learn more, read our white paper on how to build a culture of empathy.

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