Hospitals Elevate Patient Satisfaction To The C-Suite

As consumer satisfaction begins to have a bigger impact on the bottom line, more hospitals are hiring a chief patient experience officer (CXO) to treat patients like valued customers.

Never has patient satisfaction been more important to healthcare organizations: the Hospital Consumer Assessment of Healthcare Providers and Systems Survey of consumer satisfaction, population health initiatives, and value-based purchasing all show that revenue now depends on patients' satisfaction with providers. The hospitals naming a top-level executive to design, oversee, and collaborate on patient-centric efforts expect to see a financial benefit, given that government and private payers are building patient satisfaction into reimbursement formulas and consumers are playing a larger role in making their own healthcare spending choices.

A few hospitals are now recruiting CXOs. Both Sibley Memorial Hospital and the University of Wisconsin Hospital and Clinics have been seeking CXOs on LinkedIn for at least a month. However, most hospitals do not have a CXO. Catalyst Healthcare Research estimates the industry employs less than 100 professionals with this title. And while the research firm's database of workers at 642 large (100-plus beds) hospitals in 11 Southeastern states includes 29 employees with the world "patient experience" in their title, they are typically VPs or directors, not members of the C-suite.

Having a high-level point person is important for both employees and patients, said Dr. James Merlino, CXO of the Cleveland Clinic, in an interview. The move underscores the hospital's commitment to delivering a better experience, said Merlino, who reports to the hospital's CEO. Hiring a CXO gives departments a point person for all their experience initiatives. And hospitals then have an executive focused solely on accountability, he added. Strong, visible support from leadership was the top driver of successful patient experience initiatives, according to 62% of respondents in Catalyst's 2013 State of Patient Experience Study; 48% said the biggest roadblock arose when leaders appointed to head up patient experience got dragged in too many directions.

"It's one thing to talk about how important [patient experience] is, but it's another to hold people accountable for it," said Merlino. "To be successful with this you have to get people to believe it's important. I think hospitals that don't pay attention to it do so at their own peril. We are in a competitive environment today and this is an important differentiator for payments. This puts the focus back on how we deliver care."

Ideally, patient experience is inherent in all aspects of a hospital's interactions, so CXOs work across departments, executives said. They are involved in human resources to ensure organizations hire the right people and partner closely with IT to learn how new technologies can align with their goal.

"The CIO and CXO have to work hand in hand. Technology is changing every minute," said Jennifer Jasmine E. Arfaa, CXO at Thomas Jefferson University Hospitals. Her training includes a PhD in Organizational Leadership and Development in Health and Human Services from the University of Maryland. "Why not talk about the great things other hospitals are doing? Patients and families are the ultimate beneficiaries of good communication and teamwork throughout a hospital."

For example, a screensaver created by the hospital graphics department and installed by information services reminds nurses and other staff to be quiet at night when patients wanted to sleep, Arfaa said. A simple idea prompted by observation, it cost little to design and implement, yet shows patients how much staff respect their wishes, she said.

"The CXO is not someone who just sits in the office. It's management by walking around," Arfaa said. "In my case, the CXO represents the work of 12,000 other people, all of my colleagues who work at Jefferson." They do the work of delivering the patient and family experience, she said, "but I have the distinct honor and privilege to lead the effort."

It may be tough to measure the ROI of a screensaver, but CXOs have plenty of metrics to track initiatives' success, said Merlino. Cleveland Clinic holds department chairs responsible for how their doctors communicate with patients. Doctors undergo a daylong course to develop better relationships with patients, and nurses use checklists to ensure nothing is overlooked. The hospital instituted "no pass zones" where employees are directed not to pass by the room of a patient who has the call light lit without going in to see what the patient needs.

"You don't need to be a nurse or doctor to get someone a glass of water," Merlino said.

As a result, Cleveland Clinic has seen a record rise in engagement numbers. "When you create an environment where you have absolute focus on customers, that drives employee engagement also," he said.

Despite Cleveland Clinic's many awards, until it put an emphasis on patient experience, its scores were in the lowest tenth percentile nationally, said Merlino. Today, the hospitals' HCAHPS scores are above the 92nd percentile, he said.

Some hospitals have turned to the hospitality industry to recruit CXOs, according to Becker's Hospital Review. Others come from nursing, were physicians, or have hospital administration backgrounds. CXOs must also consider the changing shape of healthcare, said Asif Dhar, principal and chief medical informatics officer at Deloitte Consulting in an interview.

"What will the experience be and look like when it's not confined to a place with walls?" Dhar said. In other words, as hospitals begin to be judged by the quality of their follow-up care, preventative care, and care coordination, the patient experience must reach into the patient's life beyond the hospital.

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