Patient Experience

Navigating Healthcare: The Importance of a Hospital Advocate

/ Jonathan Sachs

Working for the last decade in large hospitals, I get calls. Even though I am not a doctor or nurse, family and friends call when they get sick. All are experiencing some combination of being scared, stressed, and confused by how healthcare works in the United States. They generally ask for advice about how to navigate being a patient.

I always give them the same advice:

Make sure you have someone advocate for you while you are in the hospital.

I will share in this post why I absolutely hate having to give this advice and what can be done about it.

Why it is Important for Patients to Have a Hospital Advocate

Family and friends can serve as hospital advocates

Hospitals are busy places. They are designed to care for the sickest of the sick. A good rule of thumb is if you feel like you are not getting enough attention at a hospital, it means that your doctors do not consider you among the sickest patients in the hospital.

So that’s the good news.

With that said, it can also mean long wait times for simple tests, bumps in the operating room causing your surgery or procedure to be postponed, and limited face-time with your care team. Unfortunately, these delays are all patient dissatisfiers and the uncertainty involved can be stressful to anyone receiving care.

There are many reasons why hospitals operate this way, many of which are economic and operational, so I won’t get into that for this post. (Although if you want to know, just ask, I’d be happy to hear from you).

Because of these factors, navigating care at a hospital can be difficult. Furthermore, The patient in the hospital is usually in a compromised and vulnerable state. They are sick, medicated, in pain, anxious, bored, and sleep deprived, among other things.

That is why you need an advocate in the hospital.

The Best Hospital Advocates

The best advocate for a patient is generally a family member or a close friend. For more complex cases, there are for-hire patient advocates who are usually trained medical professionals.

Sometimes, there is an employee or volunteer affiliated with the hospital called a “Patient Advocate” or “Patient Representative.” These roles range in functions from risk (Dealing with the threat of legal action) to service recovery (Trying to fix a patient’s experience reactively) to ombudsman (Listening to patients and investigating issues to correct them for future patients).

Unfortunately, many hospitals cannot provide someone to advocate for your needs as a patient like a family member or friend can. The simple act of walking over to the nurse’s station, getting to know them, and asking questions about your loved one’s care can go a long way to helping to improve a patient’s care.

To check myself on this advice, I have asked former colleagues of mine what they think about it. Almost universally, doctors, nurses, and administrations I speak with agree with this advice.

The best thing you can do as a patient is to have someone with you to advocate for giving you care and attention while you are in a hospital.

The Downside to a Friend or Family Being a Hospital Advocate

Within the last 13 years, my father, mother, and sister have all been neurosurgery patients. Without exception, during any hospital stay, none of them were alone for any period of time. When my father had emergency surgery, my mother never left the hospital and vice versa. My mother stayed with my sister during the entirety of her multiple hospital stays as well.

At first, I thought they were crazy. But, having now worked in hospitals, it is clear to me that this had major benefits to each of them as patients. Furthermore, the nurses and physicians welcomed the help. My mother and father refilled water, brought up food, and helped to make sure the room was tidy. These responsibilities almost always fall to a nurse or another member of the care team.

In fact, during the COVID-19 pandemic, we frequently heard from doctors and nurses that patient experience was worse when family members were restricted from visiting.

However, this schedule was not without cost. Both of my parents are self-employed and had to miss work and reschedule other life events. They often slept upright in an uncomfortable chair. They didn’t shower. The stress they felt was palpable. While they appreciated the people on their care team, they didn’t trust the hospital to take care of them.

It shouldn’t have to be like this.

I often say that my life’s work as a leader in healthcare is to create an environment where I wouldn’t have to give this advice.

In this reality, family and friends can stay with a patient, of course, but could feel confident that their love one is in good hands. That they can go home and shower, sleep in a bed, and work knowing that the people at the hospital care about their loved one.

What Can be Done?

Fundamentally, patients need an advocate in the hospital due to a lack of trust.

Hospitals generally don’t do a great job building trust. Hospitals are almost always running late and timelines get missed. Doctors and nurses are overworked, rushed, and often burned out. It is difficult for doctors and nurses to empathize with patients because of the mundanity effect, which happens when something extraordinary (like caring for patients and saving lives) becomes routine.

From my point of view, the solution here is three-pronged:

  1. Fix the aspects of the hospital operation that make doctors and nurses jobs unnecessarily difficult or that take them away from patient care.
  2. Create and enforce behavioral expectations for how doctors and nurses treat patients and family members.
  3. Create ways for patients to see more of their doctors and nurses.

While this list is pretty easy to type out, actually making these changes could take decades. Most hospitals are still operating under business strategies and process improvement models from the 1980s. Remember, healthcare is highly regulated and complex. Making change doesn’t take weeks, months, or years. It usually takes decades.

The issues in healthcare are systemic and ingrained. There are many large stakeholders involved in the system today including large care providers, insurance companies, health plan administrators, etc. Large players like Amazon and Walmart are even trying to disrupt this behemoth of an industry, which has been notoriously hard to do.

Trying to change or cure the underlying diseases of healthcare has too long of a time horizon to make meaningful change for struggling patients and families today.

The Role of Technology

Luckily, technology can help with #3 – Create ways for patients to see more of their doctors and nurses.

This is why I made a career change recently.

I recently joined a company called WUWTA (pronounced “What-ah”) as their CEO. I first met WUWTA co-founder and Chairman of the Board, Jock Putney, when I was Chief Experience Officer at Robert Wood Johnson University Hospital.

On the WUWTA platform, physicians can guide patients through their healthcare journey personally from referral to discharge and follow up appointment. When I led Patient Experience, I spoke to patients every day. They desperately wanted more of their physician’s time and often were so excited when the physician spoke to them, they could not retain what the physician said!

WUWTA addresses this patient experience pain point simply. At each stage of the patient’s journey, the patient gets a video from their physician, explaining their next step in simple terms. The WUWTA platform enables doctors to hold a patients hand digitally and at scale.

Platforms like WUWTA are the necessary interim step to helping patients have a better experience without having to immediately address every systemic healthcare system disfunction.

After meeting with Jock, I felt so passionate that WUWTA represented a way forward to make healthcare better for patients, that I left RWJ to join the company.

What’s Next

We are far from my dream of a hospital system where having an advocate would not be necessary. Technology offers an important interim step to achieving this goal.

My belief is that it is a good thing that technology has enabled patients have access to more information. As the healthcare system continues to shift to be more consumer centric, patients will use that information to demand a better experience. That is when real change will happen faster. I am excited to be a part of it.

Key Takeaways

A hospital advocate is essential for patients navigating complex healthcare in the US, ensuring personalized attention and care in busy hospital settings. Technology platforms like WUWTA provide interim solutions by improving patient access to doctors, empowering them with information, and enhancing their healthcare experience.

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Book Review: Prescription for Excellence

/ Jonathan Sachs

You may have noticed that health care has been in the news a lot recently. Whether it is the Democratic Party presidential candidates talking about their plans, price transparency, or access to prescription drugs, it is fairly safe to say that the current system is not working for a group of people in our country.

There is so much to fix, including the experience of receiving care. Many patients experience customer service outside of health care and they expect that same level of care, treatment, ease, and convenience.

RxforExcellenceSeveral years ago, the University of California, Los Angeles (UCLA) health system decided to work on fixing the experience of care. Their results were astounding, going from the 30th percentile of U.S. hospitals to the 99th percentile. Dr. David Feinberg, the then CEO of the UCLA hospital system (he has since run the Geisinger Health System and now is the VP of Google Health), was committed to doing better as the UCLA system grew in Southern California.

Using the lessons from other retail leaders who are known for their customer experience, UCLA did some progressive things to enhance and enrich the hospital’s patient experience. The progress is summarized in Joseph Michelli’s book Prescription for Excellence: Leadership Lessons for Creating a World-Class Customer Experience From UCLA Health System.

I appreciate that Dr. Michelli, who has written on companies like Starbucks and the Ritz Carlton, used part of his introduction to the book to acknowledge why it was important for him to write about a health care organization. The demands are high, regulations abound, safety is paramount, and politics are rampant. Delivering excellence in that environment is a unique feat and one that keeps those of us who are part of the business aspect of health care both fired up and very busy.

What I enjoyed about Prescription for Excellence was learning about the leaders from the organization who invested in the patient experience system, called “CICARE” (pronounced See-I-Care). Leaders modeled the behaviors that they asked the staff to model as well, and they were constantly present, speaking to patients to learn more about their care.

What UCLA figured out is that, just like in another industry, the three main elements of hard-wiring a consistently excellent and customized patient experience are: alignment, empowerment, and engagement. CICARE was their system of alignment, they empowered the team to act on it by training them, and engaged them in the work, partly by emphasizing the importance of it.

The following quote in the book sums this idea up nicely, “Relationships-based caste is often about empowerment. Empowerment starts with leaders giving staff members the tools and the trust they need to provide extraordinary service. Those tools include structure service behaviors…When well-selected employees are given resources, trained, and empowered effectively, extraordinary service relationships developing, and customers are empowered to build skills that meet their needs.” (Michelli 64).

Developing systems and allowing people to innovate within those systems are keys to delivering service excellence whether in health care or any other industry.

KEY TAKEAWAY: Excellent service systems are created from aligned, empowered, and engaged team members.

Prescription for Excellence is available for purchase on Amazon for $30 (does not include Prime discount)

Who’s “in the box”?

/ Jonathan Sachs

My wife and I have been traveling more than usual over the last couple of weeks. Like clock work, when we are in the airport (usually in line to board the plane), I look at my wife and say, “Uh oh. I am so in the box right now.”

What I am referring to is an anecdote from the book, Leadership and Self-Deception published by the Arbinger Institute. The book discusses how many of us remain “in the box” in our work lives, where we tend to see people more as objects or obstacles rather than as people who have the same hopes, desires, needs, and wants that we do.

By way of example, picture boarding a Southwest Airlines flight. They are known for their unique boarding process where passengers are not assigned seats, but are instead assigned boarding numbers that create a queue for entering the plane and choosing any open seat. When traveling with a companion, most people with early boarding numbers sit one on the aisle and one on the window, hoping the plane is not full, and no one will choose to occupy the middle seat.

Angie’s post as part of “Project Outward” about our conversation about Leadership and Self Deception

However, the people with later boarding numbers are still people. They want to enjoy a flight that they purchased and reach their destination safely and comfortably just like anyone else would. But when we are sitting in our self-selected seat, avoiding eye-contact in hopes that the next passenger walks past us, those other passengers lose their humanity in our eyes and become an obstacle to our wants. When we do that, we are “in the box”

The book goes deeper to unpack this idea in a user friendly, narrative form. It explains how we get into the box and what we can do to get out of it.

Reading this book has made me think deeper about being “in the box.” I am more aware of times when I view people critically rather than trying to see the whole picture. It is a vital concept in patient or customer experience, because sometimes we create systems that put bedside caregivers,”in the box.” In those cases, not only are other people in the organization seen as obstacles, but our patients can be seen as obstacles too. In that environment it is almost impossible for one to display the empathy needed towards a patient in the hospital.

One of the biggest benefits of the book is the use of common language, including the “in the box” phrase. One of this blog’s loyal readers, Angie Bryl, Clinical Director for Dankmeyer Prosthetics and Orthotics, has used Leadership and Self Deception to advance the culture of her organization. Team members at Dankmeyer frequently use the term “in the box” to point out barriers in collaboration between team members. She has found the framework helpful not only at work, but personally too.

I have enjoyed Angie’s Facebook posts called, “Project Outward”, which she writes about people in her life who inspire her or make her think more deeply about a topic. She told me that being focused on being “outside of the box” has helped her be more true to herself, be more generous, and be less inhibited when her initial instinct is to do something nice for another person.

It is for all of those reasons that I recommend we follow Angie’s example and really internalize all of the lessons in Leadership and Self Deception. Angie gifted me a copy of the book and shared her experiences with me. I think it is making me a better person, both at work and in my personal life, and I so appreciate the thoughtful recommendation and gift. I only wish I had read it sooner!

KEY TAKEAWAY: Being “in the box” means seeing people as obstacles rather than as human beings with needs and wants just like us. As leaders, we must take steps to encourage team members to live “out of the box”, especially when interfacing with our patients or customers.

Leadership and Self Deception is available for purchase on Amazon for $16.95 (does not include Prime discount).

Customer Service or Customer Experience?

/ Jonathan Sachs

One of the recurring topics of this blog relates to, “How we treat each other.” I am passionate about improving the patient experience at hospitals because I believe it has powerful implications for how we treat each other. If clinicians can demonstrate compassion, courtesy, and kindness during a difficult moment in a patients’ life, imagine how that level of care could impact how that patient will treat others in the future. Like other social epidemics, I believe that kindness can catch on as well.

A colleague of mine at Adventist HealthCare shared this 17 minute video with me. In the video, Fred Lee, the author of If Disney Ran Your Hospital, gives a TED talk about the difference between customer service and customer experience.

Lee defines a service as, “Labor done for me that I would otherwise do for myself”. He goes on to share and explain how an experience is far more emotional, difficult to measure, and impossible to fully control through mechanisms like scripting. Defining the journey of a patient as an experience allows us to embrace the fact that it doesn’t mean our patients have to be happy all the time when they are under the care of a hospital.

Lee uses a helpful analogy in the talk to explain this idea. When we go to the theater, sometimes we go to see plays and musicals that make us happy, while other times we see dramas or tragedies that touch our emotions in a different way. Both instances are experiences that speak to the human condition, not necessarily only positive emotions.  Lee describes this as, “We in the hospital business have the job of meeting the emotional needs of a family going through fear, pain and even tragedy together.”

Further, he says that “A hospital without compassion is like a trip to Disney without fun.”

When hospitals and other companies deliver an experience, it resonates with the consumer emotionally. In a hospital setting, emotion is already present. How clinicians understand the emotions of the patient and anticipate the patient’s needs shows how much they care and that they are attentive to the situation.

Lee tells a story of a caregiver who comes to take blood from a patient. In the first scenario, the caregiver follows a script. In the second, the care giver provides an experience. He quotes a Gallup organization study that found that just using the word “gentle” reduced a patient’s pain when receiving an injection. Small touches can radically change a patient’s care experience but it has to be individualized – not every interaction will be the same or have the same effect for every patient.

Lee posts this quote during his talk: “Experiences occur with any individual who has been engaged in a personal and memorable way…on an emotional, physical, intellectual, or even spiritual level. The result? No two people can have the same experience – period.” B. Joseph Pine III, The Experience Economy

Since experience is so individualized, it involves developing active listening skills, focus, compassion and empathy. Conveniently, these are the same skills that we can all demonstrate on a daily basis to each other to make the world a better place, not just in the work setting. While health care is a powerful setting to deliver an incredible experience, we can all be human experience ambassadors with our friends, family, colleagues, neighbors, and even strangers.

The first step is to want to make a difference in this way. Will you join me in being a human experience ambassador?

Can empathy be taught?

/ Jonathan Sachs / 2 Comments

On May 29th, I spoke to the leaders at Adventist HealthCare at our semiannual Mission in Motion conference where patient experience was the theme of the day. As part of the plenary session I explained to our leaders why I am so passionate about the work of improving patient experience.

One of the reasons, I explained, was that last year, we touched nearly 80% of our community within 1-degree of separation. By one degree of separation, I am assuming that each employee and each patient has at least, on average, one other member of their household. For example, if we treated a mother, her experience in our care would have influence on her whole family. Imagine if we demonstrated kindness and compassion in a way that exceeded the patient’s expectations. If our team and our patients take those behaviors home, imagine the multiplier effect it could have of people leading by an example of deep kindness.the war for kindness

If you attended the Mission in Motion conference, you would promptly leave the plenary for a mandatory breakout session on selecting the right employees for the job. The session educated attendees on certain behaviors, like empathy, which lead to kindness and compassion that can’t be taught. If leaders do not follow a good process for hiring, it may hurt the whole group. This conventional wisdom is present in the literature around excellent service organizations, like the Ritz-Carlton, that deploy a rigorous hiring process to prevent “bad apples” from entering the bunch.

Enter Stanford University psychologist Jamil Zaki, who presents a compelling challenge to the notion that empathy is not a learned trait. In his recently published book, The War for Kindness: Building Empathy in a Fractured World, Zaki describes how his work and research can help people become more empathetic.

Zaki describes his childhood living in parallel worlds after his parents divorced. He described this experience as an “empathy gym,” noticing how two people could have completely different and yet totally valid views of life. He has created a similar type of course at Stanford, sending students to various exercises and experiential learning environments to build their empathy muscles. While the work is rigorous and difficult, he has shown results.

Further, Zaki shows his work in a way that builds trust in the research. At the end of the book, he takes the reader through each study mentioned, chapter by chapter, and rates the quality of the research on a 5-point scale. While some of the research is yet to be validated, it is certainly interesting, controversial at times, and quite progressive.

The initial set up of the book is quite dense, describing several research studies, as well as a general orientation to historical notions on empathy. It was worth the dense crash course to get to the stories and real world examples of building empathy. Zaki takes us through experiments in using literature to stop recidivism, truly understanding “compassion fatigue” in hospitals, and positive and negative impacts of technology on empathy.

The War for Kindness has many implications. It is a helpful roadmap for how we can be more kind, compassionate, and empathetic as a society. It has challenged my thinking on hiring in health care. While I still strongly believe that systems and processes help protect the team and enhance service, I now believe that a motivated candidate can be taught how to empathize. I also believe that we must coach motivated caregivers to have empathy in a way that does not cause burnout or eventually result in emotional numbness towards patients.

I have already bought copies of this book to give away to friends and colleagues, because it is powerful, hopeful, and challenges assumptions about how we can repair our seemingly broken world. It is surely worth the read not only if you lead people, but if you are interested in making society a better place (this should be everyone!).

KEY TAKEWAY: Can empathy be taught? Jamil Zaki in The War for Kindness argues that it can be. The implications in healthcare mean that our team members would benefit from a culture that has built in systems to train people on demonstrating empathetic concern for patients. This is a must-read book.

The War for Kindness is available for purchase on Amazon for $27.00 (does not include Prime discount).