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 — in this case, the anger of
exhausted clinicians. The synthesis is a third idea that emerges as a result of the debate.

We believe that there is a synthesis that can help drive

improvement and sustain clinicians.
It has three 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 Rid of Stupid
Stuff) program-
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