Doctor to oversee hospital experience

In a move that hospital industry leaders say reflects a growing movement toward patient- and family-centered care, the Cleveland Clinic recently named M. Bridget Duffy, MD, its chief experience officer.

The position, which at its heart focuses on and works to improve patient experiences, has been more prevalent in the business world in recent years. Going by the acronym CXO, the position's focus is to improve customer service. In her new position, Dr. Duffy will lead several patient- and employee-centered initiatives, including creating patient advisory councils, mapping patient and employee experience and appointing "health navigators" to guide patients through their hospital stays.

The Cleveland Clinic, with locations in Ohio and Florida, is likely the first hospital to create such a position, said Rick Wade, senior vice president for the American Hospital Assn. But he noted that other hospitals are taking steps to improve patient experience by hiring consultants and following the Planetree model, pioneered by the Derby Conn.-based nonprofit organization of the same name, which emphasizes whole-patient care, including nutrition, massage, empowerment and spirituality.

"They may be the first to give it that name," Wade said of the Cleveland Clinic. "There has been a trend in recent years to look at it [health services] from the patient experience and to lessen the stress and frustration of patients and family."

The Cleveland Clinic appointment is notable because of the position's stature, he said. Dr. Duffy reports to the hospital's chief of staff, Joseph Hahn, MD, who, in turn, reports to the clinic's CEO, Delos M. "Toby" Cosgrove, MD.

"Given the person has top-level visibility, that sends a message to everyone that patient experience is paramount," Wade said.

Dr. Cosgrove said that's the message the clinic wanted to relay. "We must exceed the expectations of those we serve, offering compassion, showing empathy and providing patients with the responsiveness they deserve."

In her new role, Dr. Duffy is focusing first on the experience of patients with epilepsy and the physicians and health care professionals who treat them.

"We need to understand, from janitors to nurses to surgeons, what it is like for them to care for epileptic patients," said Dr. Duffy, who also served as medical adviser for the Earl and Doris Bakken Foundation, the entity responsible for helping establish the Heart-Brain Institute at Cleveland Clinic.

Past patients also are being asked to map each step of their care, highlighting waiting time as well as their emotional state along the way. "We want to create an environment conducive to healing," Dr. Duffy said.

During discussions with past patients, a car dealer treated at the hospital said patients need a global positioning system. That suggestion triggered the idea to create health navigators, Dr. Duffy said.

In addition to guiding patients during their visits, navigators also may help patients with insurance questions and present them with information on rehabilitation services and support groups.

Dr. Duffy says the hospital may re-deploy current employees to fill that role, perhaps employees in patient services. She envisions "health navigators" would work within each of the hospital's institutes, including cardiology, oncology and others.

Dr. Duffy expects employees will embrace the plan because when they were surveyed about job satisfaction, they said the desire to be a valued part of the medical team outweighed their wish for more money or more vacation time.

In turn, Dr. Duffy believes the initiatives will positively affect the hospital's bottom line through improved patient satisfaction scores and diminished staff burnout and turnover.

"We'll be more efficient," she said, "and we'll see a cost savings."

Her boss, Dr. Hahn agrees. He noted that a plan to ask nurses to conduct their shift changes in patients' rooms should benefit patients and inherently save money by decreasing the number of front-desk phone calls and the number of relatives pressing doctors for answers.

Other patient-centered efforts include bringing dogs into some of the children's wards as pet therapy and expanding the program into the cardiac wards as well, said Dr. Hahn, who admits his desire to improve the patient experience is both professional and personal -- his wife has multiple sclerosis. "Our experience could be a lot better in a lot of places," he said.

Dr. Hahn, however, noted that the clinic's commitment to patient- and family-centered care has faced some resistance along the way.

"It doesn't mean we're making it into the Ritz Carlton," he said of Cleveland Clinic. "We're talking about empathy and teaching people to be empathetic [to patients]. ... It's about changing the whole attitude."

The simplest of measures may entail instructing cleaning staff to ask patients, "Is there anything else I can do?" or to say "goodbye" at the end of their shift, he added.

"At the same time, Hahn said, "we're meeting some skepticism. People wonder if it is the fad of the day. But we come across more people who are willing to give it a try and even more who want to wait and see what happens."

Laurel Simmons, project and grants director for the Institute for Healthcare Improvement, said more health care professionals see the importance of patient-centered initiatives. "People are beginning to say it's not enough to have a poster on the wall," said Simmons who also serves as co-director of the IHI's Patient-Centered Care Innovation initiative. "More can be done in a meaningful way, not just focus groups."

Government is getting involved

The government also is steering more attention to this area through transparency, she added.

Beginning in fiscal year 2008, hospitals must submit data on patient experience through the Hospital Consumer Assessment of Healthcare Providers and Systems questionnaire, to receive the highest possible reimbursement from the Centers for Medicare & Medicaid Services, she said.

"More people perceive a crisis in health care," Simmons said. "We're struggling to find a solution, and patients and families are untapped resources."

Although the effort remains new, Simmons said, "I see a lot of people trying to go there."

Wade said more women and young physicians working in hospitals also have fostered the movement. "They're more focused on patients," he said. "The younger physicians are sometimes more sensitive to patients than their older colleagues."