Patient Experience Week is April 24-28. In honor of this event, Dr. Pendharkar, Founder and CEO of Valeet Healthcare, sat down to chat with Sven Gierlinger, VP and Chief Patient Experience Officer at Northwell Health System, to discuss his perspectives on patient experience.
Dr. Pendharkar: I understand you worked in the hospitality industry prior to healthcare. How did you make the transition into healthcare?
Sven: I was approached to go into healthcare by Henry Ford Health System. Henry Ford was opening a new hospital, and they wanted it to be very service centric — very hospitality focused. Hospitality, wellness, and obviously, clinical excellence. It was a unique opportunity to start a hospital from scratch with that vision, and they wanted somebody from the hotel industry to lead the non-clinical operations.
At first they knocked on my door asking if I knew anybody from the hotel industry who would like to join them?” I said, “no and I didn’t consider it for myself because I was very happy with what I was doing at the time. They were persistent and after the 3rd call I realized that it might be me they were interested in. I know, I’m a little slow. Then it all clicked though: I have this personal experience as a patient — a lot of experience as a patient — and I have a passion for hospitality, so it makes perfect sense.
I started working a year before the hospital opened. I was involved in the final planning, putting the processes in place, planning of the physical plant, etc. What was amazing is that I thought about my own care experience throughout it all.
I remembered what it was like to be a patient being transported, what it was like in the bed. I remembered all those different aspects from the ICU to step-down to med-surg, to rehab care. Then discharge instructions, leaving, and post-hospital care.
Dr. Pendharkar: So your personal experience really impacted your decision to go into healthcare. Do you mind sharing your story?
Sven: Yeah, I’ll share my story. I had my first symptoms on the Friday before starting a new assignment with Ritz Carlton in Washington, DC. I had tingling in my fingers and numbness in my toes, and I was feeling weak. I completely ignored it and told myself “ah, it’s going to go away. I’ll be fine.”
Monday, I started my new job and the symptoms were getting worse. I had a hard time ambulating up and down the stairs. Still, I pushed it aside, until later that day. I have a vivid memory of crossing the street to go to a deli. I was in the middle of the street, jay walking, the light was turning, and cars were speeding up. I needed to run but I couldn’t. My feet just kept on walking. I was totally freaked out and thought, “oh my gosh, I do have to see a doctor.”
I went to an urgent care center, and they and couldn’t figure out what was wrong with me. They told me to follow up with my primary care physician in two days. The next morning, my wife saw me struggling to put my suit jacket on. I was ready to go back to work — my good German work ethic. She insisted I go see my doctor, we argued, she won. My primary care physician evaluated me and gave me an urgent appointment to a neurologist.
I saw the neurologist the next day, who told me I had Guillain-Barre syndrome. I said, “what? I’ve never heard of that before.” She explained I was going to be paralyzed, I’d be in a wheelchair probably, and it was going to be a long recovery process. “Here are treatment options…it may be weeks, it may be months, it may be years…some people have residual effects their whole life…some people have died from it…you’ve got to be prepared that this is serious…you get really sick.”
I was sitting there in one of those fogs where you don’t really hear anything anymore.
Sven: I was admitted to the hospital that Wednesday, and by Friday I couldn’t walk anymore. I ended up in inpatient care for 3 months.
Dr. Pendharkar: Wow, that’s a long time.
Sven: Five weeks in acute care — two or three weeks of that in intensive care. I had 25 courses of plasmapheresis, including a little relapse later. The rest in the rehab facility and discharged in a wheelchair. Then it was home care, home nursing, home physical therapy. Then I could go to an ambulatory care facility, to do my therapy.
Around the 12-month mark, I was back to full strength. That was a very …profound experience for me. I was in bed, paralyzed from head to toe with no movement left whatsoever. Feeding tube, the whole nine yards.
Dr. Pendharkar: How was your care experience?
I saw enormous variability in terms of the care experience. From one shift to the next. From one physician to the next. There was an amazing doctor, a resident, who gave me a spinal tap. Very painful, yet he was so skilled so good at it, that I thought “wow, this guy’s amazing.” Just how he treated me, and interacted with me, treated me as a person. Not just as somebody that he must do a procedure on, if that makes sense.
Amazing nurses. Horrible nurses. Some were very impersonal, almost to the point where they were rude and short. Some were fantastic and very responsive to my urgent needs. When you’re paralyzed, you have enough to worry about in terms of recovery, without having to worry about who’s on at the next shift.
I was amazed about the compassion people put into healthcare — it really has to be a calling. Then there were so many instances where I felt they either lost their calling, or they lost the empathy in patient care.
Dr. Pendharkar: Recently, there’s a paradigm shift where we are referring to patients as consumers. Patients are empowered and can be demanding — sometimes asking for things that don’t really have a medical basis, especially from the clinician’s point of view. Drawing from your personal and professional experiences, how do you resolve that shift in paradigm?
Sven: They are asking for it now because they are informed, right?
Dr. Pendharkar: Yes, this is true.
Sven: That’s the good part. They actually know more about what’s happening to them. Better than being completely in the dark.
Dr. Pendharkar: Exactly.
Sven: To navigate to where it is a mutual journey, where the physician actually takes the patient-as-a-consumer view into consideration and affirms it by saying “I’m so glad that you are learning about that, and that you’re invested and interested. Let me tell you my perspective, and let’s see where we end up.”
I don’t always see that positive acknowledgement of a partnership. Before, physicians were the knowledge experts. I love a statement that one of our patients, actually the mother of a pediatric patient, said when we filmed her about the experience. She said on video, “I have a PhD in my child. I have a degree in my child, I know my child inside and out.” I believe we have PhD’s in our own bodies, and that’s key. To be able to navigate to that understanding between the physician and the patient, makes care so much better.
Dr. Pendharkar: A development over the last few years in healthcare organizations is adding Patient Experience Officers, such as yourself. How do you describe your role and your mission?
Sven: My mission is to make experience not something that stands alone, yet stands on its own. That the experience is how the patient defines the experience. Patients who go to reputable organizations believe they have highly competent physicians and expect great outcomes.
If you ask patients how they define quality, the experience is part of quality. It’s not just clinical quality, patient safety, and how we define it in healthcare. In surveys or interviews, patients talk about things that are important to them, things that are not always necessarily top of mind for the clinician. That’s my mission, to make sure that the patient experience encompassing everything.
Dr. Pendharkar: Can you give an example of an area identified by patients that needed improvement and how you advocated for a change through the hospital system with so many key decision makers?
Sven: One of our biggest issues that affects patient experience, is the transition of care from the ED to the inpatient setting. We send them the HCAHPS surveys and we ask about their inpatient care, but what the patients are often talking about is the ED experience, and how they spent 10, 15, 20 hours on a stretcher and not in a bed. The ED is packed with sometimes 50, 60 patients waiting in the ED, and the ED staff is busy taking care of the next emergency walking in the door. We don’t have any beds upstairs, and the patient is caught in between. What do we do for them in the meantime? How do we compassionately treat them in this limbo?
Process changes with an intensive focus are required. We work with our nursing teams on the inpatient side to take the patient over, if you will, after an hour of admission from the ED staff. Before, the ED staff were responsible for patients until they went upstairs to a bed. Now, there’s almost like a virtual team caring for the patients, wherever they are. The patient receives inpatient care whether they’re still in the ED, in the identified holding area, or even up on the floor in the hallway.
Dr. Pendharkar: Those issues of throughput are very challenging, and I’ve seen them pretty much at every hospital I’ve worked.
Sven: I’ll tell you what the challenge is. The challenge is that we focus on throughput, right?
Dr. Pendharkar: What do you mean?
Sven: We don’t focus on patient suffering while they are waiting, and that’s the key difference. We have all these throughput initiatives. We reduce the wait time from 12 hours to 8 hours, and we celebrate, isn’t this amazing? Is there really a difference to the patient whether they wait 12 hours or 8 hours? If they wait for 12 hours and we took great care of them during those 12 hours, they’re happier than the 8 hours we ignored them. That’s the key.
Dr. Pendharkar: Right. I agree with you. It’s hard for patients to feel they’re being cared for if they’re in a stretcher in the hallway in the ER.
Sven: They feel ignored. We think they’re fine, we have other emergencies to tend to. We know what’s wrong with the patient in the hallway. They’re in the hospital, going to be in a bed, but we don’t know there’s enormous suffering happening during that time. They may have an incredible four day stay on the unit until they get discharged, but it’s those few hours where we messed it up that we can’t recover from.
Dr. Pendharkar: That makes sense. In looking at the role of technology in transforming care, what tools do you think can impact the ability of a physician to provide a great patient experience?
Sven: I think technology is a blessing and a curse. The arrival of the electronic medical record is probably the biggest pain point for physicians, especially physicians who have been around for a long time. Based on what I see, and certainly the conversation within healthcare, this leads to burnout – the thinking that “You’re asking me to give this compassionate care to my patients. I want to spend time with my patients, but I’m spending more time with a machine.”
How can we use technology to enable human interactions? For me, that’s the key. Culture and communication is an important part: like how we position the interaction of using the computer to the patient – collaborate with them, involve them in the care by showing them exactly what we’re typing on the screen so we can look at this together. The transparency is key, so it’s not viewed as, “I’m spending time with technology where I should be spending time with you.”
Dr. Pendharkar: There was an interesting article I read about the future of medicine. It predicted that in 50 years, physicians would be able to spend all their time engaging with the patient. In today’s system, that’s not happening. Physicians have to worry about billing, notes, documentation, all those things.
Sven: Exactly, we spend the time on things that in the eyes of our patients don’t add any value to them.
Dr. Pendharkar: I agree.
Sven: There will be ways, and I think that’s what the article is referencing, to automatically record all the stuff physicians are currently taking time to type into a system.
I’d like to know more about ways technology can help determine who the patient is as a human being. We have all this patient information in the medical record, but what do we know about them as a person? How can we capture that? How can we use technology to feed that information to the provider, to the caregiver, at the right time, so it can be taken into consideration as care is being delivered? That builds the engagement, the personal relationship, and it builds the connection with patients. In this way, we create a relationship with a patient, whether it is in two minutes just by a specialist coming in and looking at that patient, or over the course of time.
It all boils down to, do you know me? What makes me tick? Who am I when I get out of the hospital again? I’m not somebody who’s in a gown at home. When I’m upright and out walking around, I’m this person.
Dr. Pendharkar: I’m giving a talk for new physicians at the upcoming American College of Physician meeting. One thing I tell residents and med students is that the most fascinating part for me as a physician is hearing the patient stories. You learn. You get a window into somebody’s life, and there aren’t many professions where you experience humanity at this level.
Sven: That’s the key back to compare back to the hotel industry. We realized that in the hotel industry, we are in the relationship business. To build relationships with our customers, with our guests, and deliver on their expressed and unexpressed wishes and needs.
Healthcare is the ultimate relationship business. It is like the most intimate relationship. We know the customer inside and out literally. As a patient, you lose your sense of modesty, and at some point, when you’re in the hospital for a long time, privacy doesn’t even matter anymore. You may worry about that for the first week, then you’re like, whatever. It’s just the way it is.
Dr. Pendharkar: How would you envision your job ten years from now, in an ideal environment?
Sven: The consumer in 10 years will have different expectations from what they have today.
Dr. Pendharkar : That’s a good point.
Sven: I think today we are trying to catch up to the demands of the consumer, and everybody is not the same. In places like Manhattan, digitally savvy consumers need to do everything on their phone — they live their life through it. In other areas where we provide patient care, that may not be the case.
The iPhone is now 10 years old — this changed everything in 10 years in ways we could not have imagined. I don’t know what my role will be in 10 years, because it depends on what the customer will expect from healthcare delivery. What we will need to figure out is how to deliver on that, in the appropriate timeframe. Hopefully, we will have worked through the medical record issues, but I’m sure there will be other glitches to work through. I believe the inpatient experience will be very different. We’ll have major ICU centers, and many things that are done today in inpatient settings will be done outpatient…or at home…or through telemedicine. They will be done …who know? That’s the exciting part.
Dr. Pendharkar: It is! Healthcare is changing and evolving at a rapid pace, with lots of possibilities. Well, that sums up the questions I have for you. Thank you so much for your time!
Sven: You’re welcome.
At Valeet Healthcare, we are committed to helping healthcare systems and providers succeed in delivering an excellent patient experience. To learn more, contact us today!