There may be no hotter concept in US healthcare today than “patient experience”. Intuitively, who doesn’t believe that optimizing something called “patient experience” wouldn’t be a good thing? It also is one of the most misunderstood concepts because there is very little in the way of a commonly accepted definition or a commonly understood idea of what contribution patient experience is to make. Everyone has their own definition. Without a common definition of what it is and what it is supposed to contribute to health outcomes, it is very hard to measure. I generally use the definition promoted by the Beryl Institute which studies the concept intensely. They define patient experience as “The sum of all interactions, shaped by an organization’s culture, that influence patient perceptions across the continuum of care.”
It would also seem intuitively obvious that professional health care chaplains could be and should be serious contributors to something called “patient experience”. And yet, again, it’s not clear to me that anyone knows what that contribution is. I have talked to several hospital administrators who have reassigned chaplains to report to their patient experience officer but really have no idea what they expect chaplains to contribute to that effort.
One way out of this issue for the moment is to look to the institutions that have clearly made what they would call patient experience work for them. There may be no better example of that than Cleveland Clinic. I was privileged to hear Dr. James Merlino, Chief Experience Officer at Cleveland Clinic, present recently at the Association of Professional Chaplains’ conference.
Several points in his talk stood out for me.
Patient experience is not the same as patient satisfaction. Patient satisfaction is not unimportant and is a part of patient experience, but the end game is not to make every patient happy. It is to deliver high quality patient care. High quality care is, first, safe care and, second, care which improves clinical outcomes. As a consequence of those two outcomes, costs are reduced. Patient satisfaction was third on Dr. Merlino’s hierarchy of the outcomes of patient experience.
Patient experience has to be everyone’s business on all levels. Everyone in the hospital needs to be trained in and devoted to improving the patient experience in whatever way they can. That means there needs to be a climate that promotes patient safety in which everyone participates. It is not just the business of the safety officer to understand and promote safety. It is interesting that the Joint Commission in its standards for advance accreditation in palliative care makes the very same point.
In the Q & A after Dr. Merlino’s talk, George Fitchett asked what metrics Dr. Merlino would recommend for chaplains in view of this new reality. Dr. Merlino suggested that chaplains pick metrics which “bump up against” clinical outcomes. He specifically suggested anxiety and depression. That is, since anxiety and depression affect patient outcomes, if chaplains can affect anxiety and depression say by reducing spiritual distress, it can be said that we have impacted patient outcomes. This kind of evidence is already developing.[i]
For chaplains, this is still a brave new world. We were just getting good at demonstrating how we impact patient satisfaction only to be told that’s now only a marginally important metric. We have never seen it as part of our responsibility to be majorly concerned with patient safety but how can we justify saying that we shouldn’t be called to do our part to keep patients safe? And what about “clinical outcomes”? As long as the list of options here includes reduction of pain and suffering along with cure of disease, it seems we should be all in.
We as chaplains have long felt like we were not fully included or appreciated on the health care team. Dr. Merlino has called us out to step up with a clear direction and a clear purpose that is a fit for both our skill set and values and the expressed direction of US healthcare. He has called us out to be major contributors to the experience of our patients in ways we are well trained to do. My hope is that we as chaplains can see this for what it is. It is a call to be who we are, to make the contribution we have always wanted to make, but for maybe the first time to make that contribution as central players in the health care process. It’s time to answer the call.
[i] Gaudette H, Jankowski K. Spiritual Coping and Anxiety in Palliative Care Patients: A Pilot Study. J Health Care Chaplain. 2013;19(4):131-139.