Patient Experience and

Clinician Well-Being
Aren’t Mutually
Exclusive
 Is the work of improving patient experience in conflict
with physician well-being? The tension between them
has been magnified by the challenges of the pandemic.

Patients have faced complex new care delivery models, including telemedicine,
increased reliance on digital messaging, and restrictions on family members
accompanying them on visits for procedures.
And many clinicians are exhausted emotionally, mentally, and physically as they
have sacrificed their own safety and well-being to take care of their patients,
shouldered even greater workloads due to staff reductions and lack of resources
to support new care models, and have had to contend with frustrated patients’
increased anger.
As a result, many are in no mood to receive information about how to improve the
patient experience and may feel “this is just one more thing you are asking me to
do.”
This situation may make health care leaders feel that they have to make one or
the other the priority. But both are essential; in fact, it is impossible to have one
without the other.
A path forward is suggested by what philosophers call Hegel’s triad (thesis,
antithesis, synthesis). In this construct, the thesis is the idea that health care
delivery needs to improve. The antithesis is the resistance that idea generates —
We believe that there is a synthesis that can help drive
in this case, the anger of exhausted clinicians. The synthesis is a third idea that
improvement and sustain clinicians.
emerges as a result
It has three of the debate.
parts:-
1. Emphasize the
Positive
Instead of telling clinicians they must become better, help them recognize when
their care is at its best, and support them in providing such care with high
reliability. We believe in the improvement methodology appreciative inquiry, which
asserts that if people understand their strengths and apply them reliably, their
weaknesses become irrelevant. And the fact is that the vast majority of patient
experience data highlights clinicians’ strengths, not weaknesses.
Physicians worry that the people who respond to patient experience surveys are
more likely to be critical of their care. Even as concerns for their safety intensified
during the pandemic, we found the same 4:1 positive-to-negative ratio among 2.2
million insights extracted from patients in the ambulatory setting between January
1, 2020 and September 30, 2021.
Many organizations do not share these comments with physicians; they should.
Our data shows that physicians and everyone else in health care are deeply
motivated by the experience of giving good, patient-centered care.
The reason to do this isn’t just to be nice; it is an important tactic for keeping
people in the organization and health care itself. An analysis of our workforce
database of over 1.2 million health care employees, including 120,000
physicians, reveals that individuals who like what they are doing, are highly
connected to their work, are able to see patients as individuals, and believe the
organization is doing its utmost to deliver great care for patients are four to six
times more likely to stay with the organization in both the short term and long
term than an employee who doesn’t.
2. Build Psychological
Safety
To support improvement of all types of quality, health care organizations need
cultures that support psychological safety. They need clinicians to trust and
respect each other and openly share lofty values that include a commitment to
principles of high reliability. And a core element of any high-reliability culture is
the psychological safety necessary to give and take feedback.
Our data on the engagement of physicians and other employees with their
organizations over the last few years underlines the importance of such
cultures. It shows that “the pack has separated” during the pandemic: stronger
institutions improved engagement, and weaker ones weakened it. And when we
looked for the themes that characterize the organizations where engagement
strengthened, we found that clinicians and others described environments that
supported teamwork and nurtured respect.
Our data consistently shows strong correlations between the engagement of
clinicians and every outcome of interest — including safety, patient experience,
and other quality metrics.
The strongest cultures are those so committed to excellence that leaders create
the space for team members to speak up and speak out when they see
opportunities for improvement, small or large. We know that those closest to the
work are the ones with the experience and expertise to know when things are
not working, but this knowledge can be lost if they do not speak up due to fear of
retribution.
3. Fix the Systems
The observation that “every system is perfectly designed to deliver its current
performance” seems to be true. Whenever we see marked improvement in
patient experience and other quality metrics, we can virtually always identify a
systemic improvement. The explanation is never “we put more pressure on
individual physicians to do a better job.”
To develop these systemic fixes, health care organizations need to tap the
expertise of those on the frontlines of care: both clinicians and non-clinicians.
Caregivers experience dysfunction and understand its impact on themselves and
patients. They are also best positioned to appreciate the benefits of
improvements.
An example of a systemic improvement initiative that enhances clinician well-
being and supports their engagement with their organization is the GROSS (Get
That was started at Hawaii Pacific Health, which invited all employees to help
weed out meaningless documentation requirements and other wasted activity.
This program was quickly adopted at the Cleveland Clinic and other
organizations. One benefit has been the reduction in things that didn’t contribute
to better patient care and wasted caregivers’ time, but another has been
conveyance of the message that their organizations understand the duress of
working in health care today and are committed to improving work processes.
So while it may appear we are at a stalemate, with burned out physicians who
cannot tolerate additional stress and an experience in health care that is far from
perfect for many patients, there is a path forward. First, focus on the positives,
including those things highlighted by patient-feedback data, to spread the
understanding of what is working.
Next, work to create cultures that are committed to the high reliability and the
psychological safety needed for improvement. Finally, work relentlessly to
improve systems to make the work of patient care a more doable job with more
reasonable amounts of stress.
Thank You