As the healthcare industry continues to move to value-based care with its emphasis on patient experience and reducing costs, some hospitals and health systems are putting stock in a new leadership role: chief experience officer (CXO). Hospitals that designate a C-suite executive expect to benefit financially from higher patient satisfaction scores and positive publicity.
It’s still a relatively new focus in healthcare but it’s growing. In a 2016 survey by Vocera Communications, 44% of healthcare organizations reported having a chief experience officer, and 39% of those reported directly to the CEO or president of the organization. A 2017 survey by The Beryl Institute counted CXOs at 58% of hospitals and health systems, up from just 22% in 2013.
“There’s a growing recognition that if you are going to deliver exceptional quality and safety, that needs to be coupled with empathy and respect,” says Liz Boehm, research director for Vocera’s Experience Innovation Network. “Just giving someone great care, if it’s not followed with great communication and a connection that builds trust between the care team and the patient and family, then you haven’t done the whole job.”
The same goes for process improvement, which many organizations are focused on as they try to contain costs, she adds. Organizations need to support and protect caregivers’ time with patients and families even as they strive for greater efficiency.
One of the core reasons that experience breaks down for patients and families is that physicians, nurses and other hospital staff are under enormous pressure to do more with less, says Boehm. The CXO represents a shift in culture by engaging front-line leaders and front-line team member in the process of driving improvement.
CXOs “are going out and building relationships with the process improvement team so that the skills that organizations are building around process improvement get paired with skills around experience mapping and design … kind of hardwiring empathy and making sure that as you’re restructuring these processes they include the human connection,” she tells Healthcare Dive.
This means taking experience out of the silo where it has often existed and working with clinical and other staff to bridge the divide across all areas of strategic importance for an organization and illuminate where opportunities for improvement exist, Boehm says. And then using that front-line energy and talent to achieve more optimized experiences, she adds.
Patience and relationship building
As chief patient experience officer at Johns Hopkins Medicine, Dr. Lisa Allen combines coaching and best practices to work with all levels within the organization to improve patient experience.
“Our model is really around setting goals, engaging front-line staff, providers, patients and families in the improvement work, making sure that we’ve created an enabling infrastructure so that people can do what we’d like them to do, and then reporting transparently,” she tells Healthcare Dive.
Among the changes Allen has fostered is to ensure new employee orientation is constantly focused on patient- and family-centered care. She’s also added patient and family representatives on a number of advisory committees. To keep the message alive, her team partners with marketing and offers cohort classes for staff.
“We have an annual plan of how we roll out different caring communication skills, and then we’re very consistent in rewarding that behavior when we see it and making sure that we stay focused on that so that behavior starts becoming very ingrained in the way we do our work,” Allen says.
Doing her job requires patience and relationship building, an improvement science approach to work and an understanding of data and how to communicate data into stories, Allen says. A good CXO also needs to be “inspirational around the work and know that [change] doesn’t happen overnight,” she adds
While a healthcare background isn’t necessary, it can help to make a CXO more effective, says Sue Murphy, a registered nurse and chief experience and innovation officer at the University of Chicago Medicine. “When you’re talking to clinicians, be it physicians or nurses or environmental staff, if you’ve walked in their shoes, it builds credibility,” she says.
The CXO role also involves looking at what’s new and innovative in healthcare and how technology can work in the context of patients’ lives. “Technology is bringing about a fundamental shift in the way in which we think about experience overall — whether through virtual visits and telemedicine, access to records, text message reminders, video discharge, etc.,” says Stacy Palmer, senior vice president at The Beryl Institute. That requires CXOs to work closely with their organization’s chief information officer or CMIO.
“One of the biggest challenges is understanding that every single experience for a patient is individual,” Murphy tells Healthcare Dive. “The other is just the ever-changing healthcare environment — reimbursement and pay for performance and value-based care — keeping up with all that but still remembering let’s just treat people really well.”
CXOs also face competing priorities within their organization and challenges pulling people out of their workday job environment for training and education around improving experience.
To boost experience, UCM launched a real-time staff-training program called Heart of Medicine. Murphy and her team talk with patients, families and caregivers about what healthcare staff are doing that is making a difference — e.g., how they are treating patient and families, the words they are using, tactics around kindness and compassion. “It’s getting back to people knowing that they’re making a difference in people’s lives,” she says.
Efforts like Heart of Medicine can impact an organization’s bottom line. While having a CXO doesn’t guarantee an organization’s HCAHPS scores will improve, it can have a significant effect, according to Palmer. “The CXO typically has ownership of measurement and analytics” and they or their team will “disseminate survey scores among department and drive accountability for scores among staff,” she wrote in an email.
Murphy sees tangible results in CXO leadership. “The more patients say we’re caring for them, the more reimbursement we get,” she says. “I also think it has a lot to do with word of mouth and our credibility.”
The real challenge for the experience team is not just showing that an organization’s experience is going to improve, but how that ties to safety and quality and financial.
Boehm recalls a health system in the Midwest that wanted to redesign its cancer center. Knowing that people would come in frequently for chemotherapy infusion, they decided to put the infusion center on the first floor to make it as easy as possible for patients to get their treatment. But when they walked cancer patients through the design and took them into a cancer center with a similar design, five out of five patients got physically sick because the smell of the chemotherapy had such resonance for them, Boehm says. As a result, they ended up putting the infusion center on the second floor and wellness, integrative therapies and support on the first floor.
“I don’t want to make it sound like if you don’t have patients at the table, people aren’t trying their best,” says Boehm. “But having patients there, having front-line team members there, the people who are actually doing the work and the people who are actually receiving the care, makes a huge difference.”
Murphy agrees. “CXO is a really important job, but it’s not about the title. It’s about how they influence the organization to focus on employee satisfaction along with patient experience to make the whole picture the outcome," she said.