Using Your Left and Right Brain: What Every Patient Experience Leader Needs to Know

Podcast Transcript

Adrienne Boissy:  Welcome to another episode of Studies in Empathy, a Cleveland Clinic podcast exploring empathy and the patient experience. I'm your host and guest today, Adrienne Boissy, Chief Experience Officer here at the Cleveland Clinic in Cleveland, Ohio.

I will be interviewed by Dr. Amy Greene, absolute pleasure to have her here. Welcome to Studies in Empathy. Amy, I turn it over to you.

Amy Greene:  Thank you Dr. Boissy, it's great to be here with you. Tell me a little bit about yourself, in particular, I guess what I'm most interested in is your background as a bartender and a ballerina. I'm assuming you didn't do those-

Adrienne Boissy:  Well, that's for starting with that.

Amy Greene:  At the same time, I'm hoping. What did those roles teach you?

Adrienne Boissy:  Yeah. It's a funny thing. Earlier in my life I had a somewhat of a difficult childhood, as many of us do, and I think my escape became ballet. I probably did ballet two or three hours a night all through grade school and high school. I was very serious about it and intense, constantly worried about what role I would get in The Nutcracker. And then I went off to a ballet school for high school, a performing arts school outside of Boston. And, it was shortly thereafter that I realized that although I was okay, I wasn't gonna be a spectacularly amazing ballerina.

And part of the reason for that was because I was constantly worried, I think part of growing up in that environment made me not wanna rely on anybody else, so it felt really important to me to be financially viable and independent. I was constantly worried as a 12 or 13-year-old at the school, about what I would do to support myself if I broke an ankle or like, what would you do next? You teach ballet, you try to go back to school. So, that bothered me a lot.

So, I actually left the school and returned to Maryland, taught ballet for many, many years, but just never quite achieved my ballerina status again, and certainly now you don't wanna see me in a tutu. But, and then while I was in college, that sort of independence message still rang true. I taught ballet at night time, I worked full-time at a sporting goods store, and then I was a bartender at night. And then after college, I did neurobiological research at Women's for some time and then at Boston University.

And, it turns out you can make a lot more money bartending than you can doing your biological research. It's a funny thing about society. And so-

Amy Greene:  Well that's quite a leap though. I mean speaking of leaps, I guess you knew how to do them, but-

Adrienne Boissy:  Yeah, well it was a great mix for my brain. I do have a right and a left brain. And so, that artsy side I think was really fulfilled by the creative potential of ballet and being swept away by the music, and at the same time that rigor or research. So, it fit my personality pretty well.

Amy Greene:  Well you also ended up, not to mention medical school, and you also earned a master's in bioethics. So, tell us a little bit about the bioethics track and-

Adrienne Boissy:  Sure. I did walk a twisty road now that you're bringing it up. I was constantly interested in human behavior, just why we do what we do. I think emerging out of that environment, I was constantly looking at people like, "What? Why are you doing that? Why are you saying that? That doesn't make any sense, doesn't feel good." And so, it was really the drive to understand human behavior, that probably led me into neuro-something as a piece of what my future would be.

I, I think during was deciding whether that was gonna be psychology or psychiatry or neurology, but the black and white-ness, what I thought was black and white at the time appealed to me about neurology.

Amy Greene:  Oh.

Adrienne Boissy:  And so, I've learned since-

Amy Greene:  I'll network that for you.

Adrienne Boissy:  It's much more gray, and that even neurology is just a lot about treating human beings. So, but that was sort of the course I took and once I decided to go to med school, it took me some time to figure that out. And then I got in and had the experience of just appreciating that we were probably missing something all the time with our patients. I was that weirdo med student sort of who would leave the room and then be worried about the blank look or sort of empty look in people's faces, when we walked out of the room after dispensing all of our medical wisdom.

And, I found myself worrying about that, right? I would worry about what was going on with that family or if we had really missed the mark. And so, I thought bioethics might be an interesting additional career for myself, you know, wrestling with all those tough questions that they see in ethics. And, I got a master's in ethics as I was a fellow in neuroimmunology, and right about that time the clinic was starting its movement around patients first, and Toby had come and appointed the first Chief Experience Officer in the country. And then all of a sudden I just saw the light down the tunnel, that that was what I was supposed to be doing.

Amy Greene:  Well, you do see the threads coming together, because just as you said the patient face, something was on that patient's face that no one addressed and no one said, and your curiosity was still there. Do you think that led you to your path as a Chief Experience Officer?

Adrienne Boissy:  I think that curiosity is probably a part of it, I think a lot of times we see behavior or do it a certain way and then assume that's just how it should be done. And I know people say that all the time, but for me it was about pausing just to be curious. What else could we have said before we left that maybe would've taken that away for people?

If I went back and talked to them longer, what would that do? What words would I say? So, it was that, I would say it's curiosity but also a hunger to take some of that pain away. You know, you have many phrases that you like, but I worry that sometimes you have to have experienced suffering to wanna help ease it, and that was a theme I think throughout my life.

Amy Greene:  I think that's right. You're one of the first people I've heard as an Experience Officer to talk about suffering as much as you do, and I really appreciate that. I wonder what has surprised you most about the role you're in, and do you find that talking about suffering is surprising to other people, if they think that's what patient experience even is?

Adrienne Boissy:  Yeah. That's a good point. We've worked pretty hard. I've been in this role four years. I think we've worked pretty hard and consistently hard about trying to make sure that people don't reduce the potential for what we can do around the patient and family experience to a bunch of scores that are required by the government through HCAHPS surveys, that's still happening across the country, and it hurts my heart. Because that's a fraction of what we do, that's a fraction of our potential. And, it doesn't resonate with people and it certainly doesn't resonate with me.

So, I wanna go bigger than that, I wanna dream bigger than that, I wanna just have a different vision for what that needs to be.

Amy Greene:  Yeah.

Adrienne Boissy:  And suffering is a ... I don't know what other to call it, right? It's not patient satisfaction, we don't make people happy. That's not the business of healthcare. I hear people sometimes say, I think there are these cool phrases in other industries like delight, we're creating customer delight. And every time I hear that I grimace probably because we're not creating moments of delight. Maybe we're making it easier for people, maybe we're taking a bite out of their suffering.

Amy Greene:  Yeah. Suffer less. That's our goal.

Adrienne Boissy:  But it's ... Suffer less. But, you're not gonna wipe it from the face of healthcare, nor is that even an appropriate goal. So, I just think we have to be diligent about bringing that word into the dialogue, and making it clear to people that we're capable of much, much more than running around and getting a high score.

Amy Greene:  Well, I loved your TED Talk about patient experience not being a soft fluffy thing. I don't know which one that was but I was really proud.

Adrienne Boissy:  It was empathy, right? We do, we keep thinking about it as this soft, magical, unicorn, optional thing that goes on if you have extra time to go to a class.

Amy Greene:  Yeah. Yeah.

Adrienne Boissy:  And, we need to think about, how do you make an organization that cares? How do you make it feel as though I'm so attuned to your experience as a patient or a family member, that I've designed my processes and systems to be more empathic.

Amy Greene:  Yeah.

Adrienne Boissy:  That is the challenge in big ways.

Amy Greene:  Yeah.

Adrienne Boissy:  I've been creating the small wins as nice, leaving flowers on your bed, I think that's great. But, to me the big empathy operationalized gestures are those, making it really easy for people to get in this place. Making it really easy to get an appointment when you're worried about something. Making it easy to pay your bill or understand what costs you're gonna be facing, and your family is gonna be facing. Making it easy to navigate where you're gonna be spending that night when your kid's in the ER.

Amy Greene:  And just knowing who to ask.

Adrienne Boissy:  Those burning questions, those are opportunities for organizations to operationalize empathy.

Amy Greene:  What gets you most excited?

Adrienne Boissy:  Probably that. When I started this job, I would say that we spent a lot of time thinking about evidence based best practices in patient experience. And there's only a few of them, right? It's having the nurse come when you call, it's doing bedside shift report, and a lot of them are nursing-driven, right? And we know that overall performance in experience ratings are often associated with how your doctors and nurses communicate. That's the bottom line.

And historically we do pretty well in that. But, I think these other pieces, we need to expand the conversation to these other pain points for people. And the pain points I'm still constantly hearing about, which drive me nutty are these types of issues. Can't get it, can't get an appointment, I'm delayed without updates, I don't know when I'm going home, and I don't know how much this costs.

Amy Greene:  Right.

Adrienne Boissy:  Those pieces we gotta fix. So, that gets me jazzed up. I think the other piece that gets me jazzed up is making sure that innovating around how we do that, right? So, talk about digitizing what can be and protecting what must remain human, right? We should never have an app that tells you, you have cancer.

Amy Greene:  Right.

Adrienne Boissy:  That makes no sense.

Amy Greene:  Right.

Adrienne Boissy:  That's a moment is fragile and intimate and has to be protected.

Amy Greene:  Yeah.

Adrienne Boissy:  But, we could probably have an app to estimate your costs for your liver transplant. And so, I think that thoughtful design of a journey that is based on relationships and trust and empathy, that is enabled by technology where it makes sense.

Amy Greene:  But not replace-

Adrienne Boissy:  That gets me pretty excited.

Amy Greene:  Yeah.

Adrienne Boissy:  I think we actively have to work against the idea that techno is best. It's not about that, it's about humans actually still matter and AI can't give you a hug, machine learning won't give you a hug, and some of the most powerful moments I have in my own career as a neurologist or as a clinician, are those moments.

Amy Greene:  What keeps you up the most at night? I mean I've heard some of the things just now that, the pain points that you recognize and you wanna fix, you wanna impact those.

Adrienne Boissy:  I think that's it. I think I've learned a lot over the last couple of years about leadership, in in the sense that leadership require, especially in this space, in patient experience requires a left and a right brain, right? If I just ran around the organization and telling stories and giving people chocolates, I think I'd last about six months.

Amy Greene:  Yeah, if that.

Adrienne Boissy:  So, that operational knowledge, that ability to think strategically, that ability to get some things done that maybe are hard for people to do, have all-

Amy Greene:  Especially for the touchy feely.

Adrienne Boissy:  Have all really been important to success in this role. So, some of that keeps me up, because being a leader, although empathy is required I think to lead, it doesn't work for all situations, right? There are some decisions that I'm gonna make that people aren't gonna like, and I can do that with transparency and collective input, but that responsibility, good or bad, the consequences of those decisions and the impact of those sits with me. And I know it doesn't feel good for people.

So, for me that's hard personally about how do I continue to lead in a way that matters, while also engaging both parts of I think real leadership is. It's empathy and execution.

Amy Greene:  Yeah. Well like you said-

Adrienne Boissy:  And I don't mean like the bad kind.

Amy Greene:  Yeah, the bad kind.

Adrienne Boissy:  Ability to get things done.

Amy Greene:  Get it done. Yeah. Well like you said, it's a patient experience, not patient satisfaction.

Adrienne Boissy:  That's right. And I still get it. I think there still is some bias, right? I still feel like sometimes I'm working against this concept that, you know-

Amy Greene:  You're there to make everybody happy.

Adrienne Boissy:  Well, or the, right. That as the Chief Experience Officer, I'm gonna come in with unicorns and rainbows and, you don't want the magical solution without appreciating that.

Amy Greene:  Yeah.

Adrienne Boissy:  I have some awareness and insight into operations and thinking in a way that's not just magical.

Amy Greene:  Yeah, you have to, to get anything done. Speaking of that, I know that you have some thoughts about the whole idea of the HCAHPS scores and kinda being driven by that and having people feel like that's the goal. Do you wanna say more about that?

Adrienne Boissy:  Well, I talked just yesterday about some goals we're thinking about as an organization moving forward. We have a brilliant new CEO, Tom Mihaljevic, who has really I think set the stage for us in terms of talking about treating patients and fellow caregivers like family. And so, some of the exciting work I'm trying to do now with our partners across the system is, what metrics then do we need to be held accountable for, that would deliver on that promise?

That's a very different question than was it quiet at night? And, some of those questions probably get asked in some of the surveys that we deliver and some probably don't. Because treating people like family is probably, well, it depends, hopefully we mean not just treating them like your own family, but in the way that they would wanna be treated. And that required, A that we're asking, "How do you wanna be treated? What are you preferences to care? What are your values around end of life or other pieces of it?" And then respecting those.

Well that's very different than I think our current approach. So, the metrics we're sort of noodling on are around, what would it feel like to a patient to have them treated like family? The other buckets I think involved team work, they involved processes, making it easy for people and trust. And how can we hold every single caregiver here responsible for building those for a given patient?

Amy Greene:  How would you say the field has changed, while it's changing constantly and you're part of the change, it's a pretty new field. I mean I think as you said, the first one here was the first one, and-

Adrienne Boissy:  I think it's-

Amy Greene:  That was only 11 years ago or 12?

Adrienne Boissy:  I think it's much more popular than when we started. I think Toby in a sense was a pioneer around the vision for how important this was. You know, he has two powerful stories about how that came to the forefront for him.

I would sort of reference back to some of what I talked about earlier, is that idea that we've emerged out of this space that there are known best practices that enhance patient experience, but the patient experience of the future will be about a much more comprehensive partnering with our patients over the lifelong journey that they have, which includes empathy, seamlessness, and personalized approached. You heard that in our vision statement that it needs to be consistent in our experience, whether you're a Cleveland Clinic Abu Dhabi or London or Cleveland.

Amy Greene:  Well that's part of trust, right?

Adrienne Boissy:  It should feel the same. You should know you're gonna get treated like the way you wanna be treated, no matter where you are. And I think that's part of that trust, right, that we don't miss on that promise.

So, that's a big piece of it. I think to just the sheer volume of information, I mean I'm contacted, you know, gazillion times a day by vendors with best of intention who are telling me cool new ways to engage our patients, or apps I can download. There's lots of issues there, right? We talked about some of them but the idea that those all have to talk to each other, right? A seamless, coordinated, individualized experience for patients is not 30 different apps that don't talk to each other.

Amy Greene:  Right.

Adrienne Boissy:  One telling you to check your blood pressure on your right arm, the other telling you to check on the left arm, and none knows what the other is doing. And, your clinician has no time to look at any of the data you've just spent three hours entering. It's complicated.

Amy Greene:  Yeah.

Adrienne Boissy:  So, I think what's required is really thinking about that high touch journey, whether it's human or digital, and crafting that without patients.

Amy Greene:  Yeah. I'd love to ask you more about that, 'cause I know that wait time drives you nuts and you've got ideas about that, but in the interest of time I wonder, could you tell us what one ask do you have of everyone in healthcare, to build a better experience for our patients, their patients?

Adrienne Boissy:  To add to my list of Adrienne-isms, I would say own it. That what I see, I mean I've gotten multiple texts just over the last couple of days of situations that have come up across our enterprise, some about the amazing power of our caregivers and their impact that they're having on our patients. This amazing letter came through not that long ago about how we allowed a patient to dance with his wife again, and that's what healthcare should be doing. And that is what we do most of the time.

A few of those texts were about moments that we dropped, you know, where people waited three hours without eating, and didn't get updates about when they were going next or how to navigate. The one I got yesterday was a newborn who was diagnosed with cancer and the parents don't know where to stay. So, its own it, that that's not my experience to fix, right?

Every single one of us needs to be a Chief Experience Officer for the person who's standing in front of us.

Amy Greene:  I like that.

Adrienne Boissy:  And that means that you own it end to end.

Amy Greene:  Yeah. I like that. Well, thank you so much for your time. This was great.

Adrienne Boissy:  So, I'm concluding The Studies in Empathy podcast. You can find additional podcast episodes on our website, my.clevelandclinic.org/podcast. Subscribe to Studies in Empathy podcast on iTunes, Google Play, SoundCloud, Stitcher or wherever you get your podcast.

Thank you for listening, join us again soon. Thank you.