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Dr. Michael Bennick has worked at Yale New Haven Hospital (YNHH) for decades. It was only recently that his own health scare and emergent bypass surgery turned him into a patient. Small acts of kindness outside the surgical suite profoundly affected him and led to an epiphany about what influences how patients perceive YNHH. As a result, Dr. Bennick and colleagues created a formal patient experience program. He now serves as its Medical Director and is working towards creating a single care signature for all YNHH.
“It was an eye-opening experience going from walking the halls to laying down staring up at the ceiling. The Section Chief of Cardiology happens to be a friend. He came in on his day off to perform my coronary angiography. But what made an equal impression was when a food service worker, Marlene, whom I have said hello to for years, happened to pass by as I was waiting to go into the surgical suite. She stopped and touched my knee and told me ‘get well soon.' That kindness made me feel as safe as knowing such a talented cardiologist was coming to the hospital to care for me on his day off,” said Dr. Bennick. “Then, a nurse heading home after her shift came to an end, reminded me that I had cared for her 17 years ago and she still remembered how that had changed her life. Her expression of gratitude, and saying that she'd be praying for me during surgery, made me feel both cared for and about. It was then that I realized just how many elements go into the experience our patients have everywhere in the Yale New Haven Hospital System.”
YNHH agrees with how the Beryl Institute defines patient experience as “the sum of all interactions, shaped by an organization's culture that influences patient perceptions across the continuum of care.” This is the mandate that guides how we seek to improve the experience of our patients and is becoming firmly rooted in the culture of YNHH.
The first step to implementing patient satisfaction programming was to break down two types of silos:
Those that were a result of training and the job titles.
Those that were a result of walls separating functional domains within the organization, such as safety, quality, engagement and experience
They accomplished this by creating ‘dyads' or leadership teams composed of a nurse and a physician who would oversee the patient experience in their domain. Next they encouraged clinical leadership to address all issues concomitantly rather than sending pieces of the issue off to a functional group to be rectified. The clinical endorsement of the dyads on the front lines helped encourage staff to support behaviors that were enhancing patient experience and adjust those that weren't. Endorsements from this group ranged from requiring communication skills training for physicians and nurses to standardizing how central lines were to be maintained. Combined with a direct line to administrative leadership, this proved to be a much more effective method to promote change than senior level administrative mandates and oversight.
Like many groups, they identified areas for improvement with patient satisfaction survey data. In addition, they encourage staff from all areas, including environmental services, spiritual care, food and nutrition and human resources to share their experiences as patients or with patients. Each team meeting is kicked off with a patient story that helps ground the group in the reason that they're a part of Yale New Haven Hospital. A recent patient story exemplifies this:
“There isn't a single person I have encountered that hasn't been wonderful. They all come in the room smiling, remember the back and forth banter from the prior visit. They always ask if they can get me anything and if I ask for anything, they take care of it immediately. I watch as my roommate gets the same caring treatment as well. I don't recall all the names but Nurse Britney has been wonderful, the young man that draws my blood at night, Fernando who cleans the rooms, the young lady delivering my meds, I am sure there are a couple more. I am a manager of people as well and I am sure you would appreciate knowing this.”
Patients and families are consulted as part of a formal advisory group and often sit with front line staff to review issues in their service area. This approach has uncovered ways to improve patient experience with billing, visiting hours and procedures, and accessibility of visit notes. In addition, there are no staff meetings scheduled from 9 a.m. to noon each Friday. This is to encourage leadership rounding. Administrators are supposed to be out on the floor talking with staff or patients in a way that they don't often get to experience in their role. While YNHH acknowledges that this will be a challenge to roll out system-wide and to all staff members, it is something that is greatly valued and yielding positive results for culture and patient experience.
Excellence is recognized and rewarded every month with the Patient Experience Award for Caring and Excellence (PEACE) statuette of a hand holding a heart. This award is given to staff who go above and beyond for patients. Storytelling, rewarding and recognition have become a part of YNHH's culture.
“‘Patient’ means ‘I am suffering.' And our goal is not to add suffering to those doing the work while alleviating the suffering of the patient at the same time,” says Dr. Bennick. His partner and colleague, Susan Haufe, Executive Director of Patient Experience, offers these words of advice to those starting a program of their own: “Leadership connected to the top is a must for a patient experience program to thrive and evolve. The teams need to work together with quality and safety, with employee engagement, and with each other to improve the experience for providers and patients. Identify those specific behaviors that reflect your values every day into elements of care.”
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