It’s Not the Same As It Was

Podcast Transcript

Steph Bayer: Welcome to another episode of Studies in Empathy, a Cleveland Clinic podcast, exploring empathy and patient experience. I'm your host, Steph Bayer, senior director of the office of patient experience here at the Cleveland Clinic in Cleveland, Ohio. And I'm very pleased to have Sven Gierlinger and Rick Evans here. Sven's the Chief Experience Officer at Northwell Health, the largest health provider in New York. As Chief Experience Officer he's responsible for advancing both organizational growth and patient experience. Prior to assuming the role, Sven served as Vice President of Hospitality and Service Culture at the Henry Ford health system in Detroit, Michigan. Sven began his career in the luxury hotel business, holding numerous leadership positions, including roles at the Ritz Carlton hotel company.

Rick Evans is the Senior Vice President of Patient Services and Chief Experience Officer at New York Presbyterian hospital, one of the top ranked health delivery systems in the nation. Rick previously served as the Vice President of Support Services and Patient-Centered Care at New York Presbyterian, as well as the Chief Experience Officer at Massachusetts General Hospital. Prior to his career in healthcare, he worked for numerous nonprofit organizations, both at local and national levels. Thanks for joining us guys.

Sven Gierlinger: Thanks for having us.

Rick Evans: Thanks for having us with you.

Steph Bayer: It's a real pleasure to talk to you and I'm so grateful for the time. I would love to start though, by hearing about your role as Chief Experience Officer and how it's shifted, especially since the pandemic began. And do you anticipate any of the changes that you've seen being permanent?

Sven Gierlinger: It's hard to remember actually, when the pandemic began, I just reflected on that and I can't believe that we're going on two years and it feels like 10 years based on what we've been through and what we've gone through. And I think that as I reflect on my role and on these last two years, how has it changed? Everything's really centered around doing what needs to be done, especially in the height of the pandemic. And I think that was the beauty of some of the things that have transpired is that at least what I saw in our organizations, that everybody put their titles aside, they put their roles aside, they just jumped in whatever it was with the goal of saving as many lives as possible. And as the theme of this podcast is about empathy and to do all of this with amplified empathy, more than I've ever seen in the past. In addition to my daily responsibilities, things like resilience and team support, they really have come to the forefront here, partnering closely with our friends in human resources and other areas like behavioral health services to really make sure that we support the team members at the front through various programs in integration, into decision making, that was coordinated with quality and safety.

And, we have a clinical advisory group here where I'm probably one of the very few members of that group that is a non-physician, but that makes centrally the decisions that were so crucial for the health system in terms of clinical protocol, but also how that overlapped, making sure that the patient was represented there and the patient voice, and that all those decisions are made with the patient families in mind, ie. visitation changes, vaccine requirements, all those things. And COVID recovery work streams and the teams we've set up after the initial phase to recover. But it really has more turned into a long-term view in terms of how to manage this ongoing situation with COVID. And there's many other items I could name, but those are some of the essential ones. Rick, what about you?

Rick Evans: Yeah. I mean, I think you said it so well, Sven. I can remember when I was first oriented as a healthcare employee that we were told in orientation, there may be a crisis or a disaster or something, and you may be called upon to do something that isn't your day job. Well, it all came true with this particular pandemic, this situation and as Sven says, it's remained true to this day. We had an incident command structure here and it's still in place, still meets every week. And I have a role in that. And some of those things that I'm overseeing were not part of my day job, but are today because as Sven said, we're all doing whatever needs to be done in this pandemic, which is a rolling series of crises in addition to the illness itself.

But now we find ourselves in these very difficult times with staffing, supply chain issues, et cetera. So, there's constantly work to be done even this far into it. And it's all hands on deck, because there's even less of us to go around, quite frankly, from a staffing standpoint. I also agree with Sven on culture pieces. I think CXOs, chief experience officers, we've always been key people at the table when it comes to discussing and building our cultures and our organizations along with our human resource colleagues and many others. But I think in particular now I have found myself in a role in my organization where we are trying to not only maintain our culture that we've worked so hard to build, but to put it back together.

And I think a lot of us, well, I think most of us, particularly those in New York will never be the same. This has forever changed us. And I don't think we fully understand yet what that really means for all of us. It'll take years for this to truly unfold. And so, a role that I'm playing, it sounds like Sven is too, and as we talk to our colleagues, I think around the country is we're helping the organization. And even in some cases leading with others, the organization through a recovery period, a reconstituting of who we are as we emerge from, hopefully emerge from the pandemic.

Steph Bayer: Those are such true points. And what I heard both of you say, and it's so true here in Cleveland as well, is that you're jumping in, people are doing things beyond their day job. And it doesn't seem to feel like there's an end in sight, that this is a new normal for us in many, many ways that we haven't unpacked yet. And from an empathy perspective, I just want to thank both of you for doing that. Leaders aren't often thanked for that kind of work. And that you both mentioned that you show up and you do what's asked and you keep doing what's asked, thank you, because your patients are grateful for that, I'm sure. And we all have to keep doing it and it's hard. So I kind of want to fold that into, what do you think is your biggest challenge today as a leader?

Sven Gierlinger: I think we've touched on that already and to piggyback on what Rick said, the times have changed and the challenges are, staffing shortages, for example, where we already had staffing shortages that have now been amplified through the crisis and other reasons as well. And we don't know when that is going to end or where that is going to lead us. So that's really profound. The vaccination mandates that we've put in place like Rick and his organizations have as well. And that's very fresh still. We just went through that, where we educated and we did everything we possibly could do. And there was still some team members that chose not to get vaccinated. And we had to say goodbye. Michael Dowling said, he didn't terminate anybody, they chose to leave. They chose to leave. You just can't work in healthcare if you're not vaccinated.

But that has ripple effects. Just the ongoing burnout. And we went from phase to phase to phase. I don't even know what phase we're in right now. I think four or what we just came out of three or four. One of our physicians put it very well once. And I think that was when we went through the last year as the holiday surge in January, February when it really went up again, he said, it feels like we're running a marathon and we don't know where the end is. It's not a 26.2 miles. It just keeps on moving. And that's really hard. So I think that we don't know where the end is. And I think that's something that we've all been, from the beginning have been waiting for. Right. There's going to be an end to this, but it's not. And I think that takes processing and it takes making sure that how do we live with this moving forward and how do we continue to provide the best care for our communities in a COVID world?

Rick Evans: I would add to that in terms of leadership. I mean, you mentioned it with the vaccination mandates Sven, which I felt so strongly about it, I can hear it in your voice too; I just very, very strongly about it. You look at what's happened to our country over the last few years and the division that we're experiencing. And some of the, I'll say it, craziness, lack of a fact-based approach to things, some of the racial and cultural unrest that we've been through. So from a leadership perspective, I have found more than ever it's important for me and for us to stand up for our values, what our organization's values are.

For example, respect is one of our values, inclusion and belonging is one of our values. It's something that we prize and it's really been important for leaders to take a stand and to firmly stand on those principles and not be afraid to speak to them so that people feel safe, that they feel they've got a base to stand on. So, that's been confirming for me of what I believe in, I guess, but it's also been a challenge because there are people that do not think that way, we have got to stand for what we believe in. The other piece of the leadership thing for me is I've learned that we're talking about burnout and exhaustion, which is very real, including in myself and maybe you too, Sven and others, we have to be authentic and we have to normalize as leaders, what we're all feeling and going through.

And that's not something that we all do naturally I think, admitting that we're vulnerable or that we're having a bad day or that we need support. For senior people to stand up and acknowledge that makes it okay for others to do so. The worst day of the pandemic at our hospital was when one of our clinicians took her own life. When you think about out what she must have been feeling, she was a wonderful person, just wonderful in every way in a clinician, a great clinician, we realized that we had to make it okay to talk about feelings and being overwhelmed, being burned out and asking for help. So that's another aspect of leader and I'll never think about that the same. And it's certainly changed the way I provide leadership in my organization. And I want to say her name, Lorna Breen, it's important to say her name and her family has taken on the work of helping caregivers and clinicians who might be suffering.

Steph Bayer: Wow. Those are some really powerful answers and thank you for sharing that. It does feel the times have changed and that our values are more important than ever. And there's an erosion of civility in a lot of spaces. So it makes it hard to hold onto that and to make sure that we're towing the line for others, by example. So I love that you're willing to say, this is what matters and this is where the challenge is in leadership. And in leadership, there's also an expectation of certain deliveries like certain metrics. So while we all find that the most important thing, and I agree with you, the most important thing right now is the values that drive empathy, the respect, the civility, the saying it's okay to be vulnerable and supporting each other. That to me is also the most important thing. And we still have to hit certain metrics as an organization because I think Sven said it, we're living through COVID, it's not necessarily an endpoint.

So given all of this noise, what's the best way to look at metrics with patient experience right now? How important are surveys, how important is it to look at that traditional part today?

Sven Gierlinger: Oh yeah. I think we can have a whole podcast series about that one question I think, and because that's also something we're grappling with, Rick and I are on a group through the Beryl Institute where we are working exactly through that question in terms of what is the best way to measure for a patient experience. And one thing we know is there's not one single way and how we've done it to this day is also not adequate anymore. I mean, we're grateful that HCAHPS arrived at the scene a decade or so plus ago, but that's a decade plus ago. And then I think, or we just talked about the last two years probably changed another decade. So we have to figure this out. But I personally, and I'm sure Rick will have his thoughts on that. I think that our patient service are antiquated at this point, we measure for experience in what I call in slices.

We ask somebody how their emergency room visit was and then they have a follow up appointment that we'll ask about that specific one. They may have an inpatient visit. There's nothing that measures in between. There's nothing that has a holistic approach about patient experience and we need to ask what really matters to the patients, right. And that is their experience across the continuum of care. And how do they feel about the experience with the organization and not just about individual encounters they had. And so there's a lot of discussion around that. I think we're moving in a better direction because we are focused on listening more, truly to the, what we call the voice of the customer, which also, I believe we need to quantify their qualitative data, whether what they say, what they tell us better and turn that into actionable data because it that's really what matters to them. Our CEO always says the comments from the patients, that's free consulting. We just fix that.

Steph Bayer: I love that.

Sven Gierlinger: They're telling us, we spend a lot of money on consultants and here we get something for free and that needs to be taken seriously at the front lines. Rick, why don't you chime in here?

Rick Evans: Sure, I mean, Sven is right. And I think our colleagues, we all agree. And, and our patient advisors agree when we are together and we're together frequently, the whole system needs to be updated of patient experience measurement. Sven, I think covered it well. It's both how we measure, how we think of the journey, what modes we use, even why should you get a survey for example, on anything other than the exact thing that you experienced? We have AI, we have all this technology. We should be able to give you a customized survey just for what you experienced.

So there's a lot of room there. Having said all that we still are measuring experience right now today, patients are giving us their feedback and I would say, and maybe Sven you want to push back on this or not. But the themes that come out of this are pretty consistent. And I wish I could say we topped out in healthcare on addressing these issues, but we have not. It's fundamentally about communication, one on one and team communication and how we coordinate, how we connect with our patients, how we inspire confidence in our care, help them feel that they're in good hands, let them know what's going to happen next. We still have a lot of work to do in that area. So I'm all in favor of updating the measurement system. Totally in favor.

I'm also in favor of us solving problems that quite frankly have been problems that predate HCAHPS and the themes are remarkably consistent. And in this period we're in right now with staffing shortages, burnout, all the things we've talked about, boy is it hard to talk to a nurse or a doctor about a best practice in patient experience and ask them to do more or do something differently or even to do something that they were doing prior to the pandemic. So the patient experience work I'm involved in and every day is how do we make sure that our patients, pandemic or no pandemic, they're in the same beds and on the same exam tables, expecting the same things from us, compassion, communication, connection. How are we going to rise to that occasion, now when it's really, really hard? We even had the physical barriers of PPE and all those things.

So we're trying to find that balance and the one insight that I'll share, because it's something we learned from is there are less of us on almost every team to do anything, but if we involve the whole team in some of this work more broadly than we used to, we have the potential to still get it done, support one another and give the patients what they need. So, again, I don't know Sven will validate this. I've been doing this work now for two decades. I'm an old patient experience person, but it's never been harder than right now. It's harder now in November of 2021 than it was during that horrible spring of the pandemic because we're just depleted. So we're trying to, yeah, we got to measure better and measure more broadly, but we also have to figure out how to continue to deliver our promise with staff that have been through a lot and finding that way. It's like squeezing through a keyhole right now, but we're working on it.

Sven Gierlinger: And I agree with everything that Rick said, I think just to add to that, the expectations are constantly shifting of our patients and to what you were saying, Rick, during the it's harder now than it was in April of 2020, because we got a lot more grace during that period, we got a lot more forgiveness and people were understanding and they were cheering with the pots outside at 7:00 PM every day. And we have to realize that the communities we serve are as tired as the staff is, right? So their attention span, the tolerance levels have changed. And I think it's not just in healthcare. I think we're all frustrated with the lack of customer service that we are receiving now and how long everything takes and all the daily nuisances or the daily frustrations that we have to deal with.

And then that is multiplied and magnified in the healthcare experience. And they can go in, like they can accompanying somebody who's in the ED right now, and giving that same support and adding to what Rick said, it's about communication. It's also about connections. And I think that's something that we see too, in terms of the challenges that we're experiencing. And we actually, talking back again about measurement, we started to add a question about how well we are facilitating the connection between the patient and the family member, and whether that is in person or whether that is virtual or through telemedicine modalities. And we see correlations there also to the other metrics. And we also see when we started to restrict visitation again, our patient experience slumped again, so that I believe also that has impact on quality of care and safety as well because the family helps out in the room, help out, help the patient get to the bathroom. And it increases falls and then there's other things also when the family is not at the bedside, as it was before.

Steph Bayer: Visitation, I'm helping to lead that here at the Cleveland Clinic. It is the single hardest thing I've done in my career so far, there's strong emotions on all sides, and it just feels so heavy. And I wish that would be easier for all of us. I heard you both though talk about while we want metrics to change and maybe be updated, there still has to be some strategy to improve communication. So what we're doing here at the Cleveland Clinic, we're doubling down on what we call planning care visits. So it's our strategy in which it sounds basic, but sometimes as we've shifted, some of the basics get a little bit muddied, but what it is, is a nurse, a doctor, a patient or their representative if they can't participate, having a conversation every single day about what your plan of care is for that day. We're documenting it, we're asking it in our surveys, did this happen. And we're seeing a correlation the more we communicate as we would expect, the better the patient metrics and quality and safety and other things. Do you have a strategy or do you have something that you can actually hang onto right now during this complex time that's helping you balance all of this?

Rick Evans: It is a balancing act right now. So it is looking at things that we think need to be done. In some cases, it's picking something back up that was dropped either because of just the crisis or because the treatment of COVID patients, visitation, bedside time were impacted by that. And we had to truncate or adapt our best practices, things that we were doing. So I think what we're trying to do is reanimate that strategy in a titrated way. So what can our staff, well, what can the environment allow? And as COVID patient loads go down and thank goodness in New York they are, although we've been here before, hopefully they won't go back up. So wear a mask and get vaccinated, please, everyone. But, we're able to reanimate best practices as teams recover, as some of our staffing gets a little more solid, people have the bandwidth, then we're adding things back in, and then we're in the business of persuasion and motivation, right?

Hardly anybody reports to us, right? So we've really got to be very thoughtful about how we communicate with staff, acknowledging what they've been through and what they're going through, helping them reconnect to purpose, and then titrating our reanimation of things very thoughtfully and carefully and doing a lot of listening. And by the way, I find that when staff feel you understand where they are and what they've been through, they will walk through walls for you. They will hear what you're asking them to do. They will hear what our patients are wanting when they know we under, this is empathy we're talking about, right? When we show that we understand their circumstances and what they might be thinking and feeling at this point. And I would say for us, it's working pretty well. Like many hospitals, we saw declines in our patient experience scores, particularly in 2021 as the year turned. And we're seeing those recover now because we're hopefully finding the right way to put things back in place.

Sven Gierlinger: I would add to our roles, the Chief Collaborating Officer, that we have to collaborate with all the other entities. If I think of what's a single strategy and it's very much what Rick said also. It's about the people. It's about the strengthening the culture, leveraging the culture that we've built. And I really think that if we would not have invested so much in building a culture over the last, whatever, five, six, seven years, we would've been, or we would be in a very different situation now. Supporting the employees, listening to the employees, like Rick says, understanding where they are and leading by example, I think is key in this situation.

It starts with being on the floors. And in my role, it's a little different than Rick where we have, and I'm in a corporate office building here, and we have 23 facilities where, I don't have a hospital close by here that I can walk to, but it's just going to those hospitals, showing up, going to the floors that is so cathartic, I think, to that local leadership and the employees to see you there. And that's something that's encouraged also, and inspired by our CEO, who was in the thick of things on the floors in the middle of COVID, on the COVID unit against the advice of physician leaders. And he needed to be there. He needed to be close to the troops. And that is key, right now, especially with the staffing shortages and everything that we're going through and celebrating the successes that we have. We can't do enough of that, we can't.

Steph Bayer: Showing up is such a powerful way to lead with empathy. And you're right. We have to keep doing that. There's not enough of that. You both, by your answers are incredibly empathetic leaders. What are some ways that you might advise people that are listening to show up and lead with empathy too? What are some other ways we can make sure that we're amplifying that empathy?

Rick Evans: Well, at the risk of sound like a hallmark card, asking how you're doing and really waiting for the answer. And we start a lot of our meetings now with "How is everybody today?" And sometimes as I said earlier, I've had to say, "This was not a good week for me and here's what I'm working on." Being transparent, again, I think gives other people permission to also be transparent. Healthcare people, we're really suck it up people. We think we just got to deal with it and we'll work it out some other place, some other time. And that's fine if it's one or two days, but it's another thing if it's two years of a crisis. So asking people how they're doing, encouraging the honest answer, encouraging people to ask for help, if they need it, acknowledging what everyone's been through. You can't do it enough as you said, Sven. It's these basic... God, it's really not very complicated, it's a lot of it we learned in kindergarten, right?

So that's how we're doing it here. We're allowing people to speak about their experiences, opening up space for that to happen. And then once you do that, you can start to talk about the work that also needs to be done. I don't know, it's a little Hallmarky, but trust me, I've been doing it for months now, and it's very, very effective.

Steph Bayer: I like the, "How are you doing today?" And the permission for that to change, that's a beautiful way to look at it. Sven, what are your thoughts?

Sven Gierlinger: Yeah. I compare it to what we've been working on to actually train our physicians on how to interact with patients, with empathy that we have rolled out a program here, the Relationship Center Communication Model for physicians. We have, I think we've close to 3000 now that have actually gone through it. And what strikes me is that many of the physicians that are going through that are in leadership positions. They report back to us. This is good, this is not just good in how to deal with patients and to come from an empathic perspective, making sure that we deliver the care, this is also good about how to lead other people, other employees, other physicians, it's the same principles. And as I look at that, it's the first step, it's a three-step approach. And the first one is building the relationship, making sure that we have a connection. If we don't have the relationship and the connection with our people that we can't be, we can't lead with empathy.

And then it's about what Rick said about you know really understanding the problems and not just asking a perfunctory question, but really asking what are your concerns and it's not "Do you have any concerns, yes or no?" It's a, "What are you dealing with right now?" And then to respond through that with empathy and with empathic statements, and then it's about collaborating, it's about finding the solutions together so that they feel that their voices are heard and we're doing something about it. And I think that's the ultimate empathy than when we just say, "Great, I hear you, I feel with you." But it is about let's work together and make this better. And also, I think that I'm not better than you. I think that's that the whole concept around servant leadership, I think has a very close connection to how to lead with empathy and that we can be vulnerable. And Rick said that so well that we can share that you know we're struggling with this as well and give license for everybody else to do that as well. Nobody's perfect.

Steph Bayer: Man, I have a hundred more questions. I wish we had all day for this. I might leave us though with a question that I'm just curious, because I don't have an answer myself and I'm not sure if it's been enough time for you to come up with any answer. But if you have to say there's some bright side to patient experience and what we've been going through in the last couple years, can you find any bright sides to the state of healthcare today?

Rick Evans: I certainly can. I mean, first of all, I never felt more privileged in my entire life to work in healthcare than I do right now, to be in the building with the people that take care of our patients and to play some role in that and to have been a part of the response to what I hope will be the worst health crisis we've ever faced in our lifetimes. I hope we never have to go through this again, but what a privilege it's been to be in this field, doing this work. I mean, I think many of my colleagues feel that way. I also think it's been very confirming of our values and our purpose. I mean, I've always sort of thought healthcare people were heroic, but I've seen it now daily with my own eyes. And the other thing I think we learned from this is that we can change very quickly.

And I think healthcare, we haven't been good at rapid change. We're not good at that. And think this has shaken us out of our due diligence. I now feel empowered to change all kinds of things that I thought maybe were just, this is just the way healthcare is killing clipboards and waiting rooms and facilitating virtual connections so that people can get what they need when they need it, the way they want it. I just feel like we've also learned we can change on a dime if we need to. And we should take that with us through this pandemic. We should not go back to the old ways, we can change quickly. We can evolve quickly. Let's keep doing that.

Sven Gierlinger: Agreed. And I pinch myself every day too, to have the privilege actually to live through this and still am living through that and to see up close the heroism that has been going on here. And that's what I thought about too, is how quickly we changed and how it forced us to innovate. And I'm not just talking about big innovation, like small innovation that the staff came up with the ideas that they so quickly developed for their units was really mind boggling to see that. The amount of red tape that was cut so quickly and not just within organization, I think also within government and the healthcare organizations and the special waivers that were granted that really got us to the level of how that we can utilize telehealth, for example, better than before the payment parities that are now in place and that are probably not going to go away. That's all good stuff.

And just how telehealth has exploded and like Rick said to the advantage of the consumer, of the customer. Now they don't have to take half day off anymore for a doctor's appointment that maybe a follow up and that may only take five minutes. And the doctor came in and just, they said, "You're good to go. You're clear." Now that can be done now via a computer screen. And everybody benefits from that. So the adoption and acceleration of technology is something that will also help us, I think, through these staffing shortages and labor shortages and all the things that we're going through right now.

Steph Bayer: Thank you for helping frame this challenging time and reminding me of what a privilege it is to serve and what a privilege it was to talk to both of you today. Thank you so much for giving me that time, too.

Rick Evans: Thank you. I mean, I just love being in this conversation with both of you. I feel very lucky to be your colleague.

Sven Gierlinger: Yeah. Likewise. Are we done? Can we just go on or is this it?

Steph Bayer: I know, right? Can we talk all day?

Sven Gierlinger: But it's been a real privilege and pleasure to be speaking with both of you.

Steph Bayer: Yeah.

This concludes the Studies in Empathy podcast. You can find additional podcast episodes on our website, my.clevelandclinic.org/podcast. Subscribe to the Studies in Empathy podcast on iTunes, Google play, SoundCloud, Stitcher, or wherever you get your podcast. Thank you for listening. Join us again soon.