The word ‘audit’ has never conjured up a positive image. No one wants to be audited — especially nurses, who already face a tremendous burden being the front line of patient care. The last thing they need to worry about is receiving poor ratings from the individuals for whom they’re providing care. What both nurses and patients needed was a way to facilitate productive conversations, and so University of Chicago-Pritzker School of Medicine has done just that. For the past four years, the organization has partnered with Vocera to provide a more accurate care picture for providers and help them access information in more efficient ways. The result? A more open, honest dialogue with patients.
In this interview, Sue Murphy talks about how the organization has transformed rounding and discharge procedures to improve the patient experience, and how they’re leveraging data to continue to tweak those processes. She also discusses the critical role CXOs play in building and maintaining strong relationships across departments, how she utilizes the tactics she learned as a nurse to care for caregivers, and why social media has truly “changed the world for patients.”
- CXO’s role in “creating exceptional experiences”
- Teaching, training & mentoring
- The “ongoing journey” of building relationships across departments
- Working w/ Vocera to “capture the patient’s voice”
- Less rounding, more conversations
- Shared decision-making with patients: “Instead of doing it to them, we’re doing it with them.”
- Avoiding the ‘audit’ mentality
- “We’re not looking for negativity.”
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Everyone who goes into healthcare, no matter what role they’re in, has a story — something that helps drive them to get into the job they’re doing to care for others. If you care for those who are caring for others, it becomes contagious.
We all have our silos, but having collegial, professional, and caring relationships with other departments helps us get to the outcome we want. And so our team spends a lot of time building those relationships; making sure we’re rolling up our sleeves and looking at process improvement.
It’s evolved to where instead of rounding on patients, we call it ‘creating conversations.’ We’re using the technology and working very closely with Vocera Care Experience to say, ‘Instead of having patients audit our behavior, what conversations can we create with patients?
I’ve learned the hard way that you can’t just tell people, ‘Here’s what we want you to do. Go out there and do it,’ and not have them understand their involvement in it.
Gamble: Hi Sue, thank you so much for joining us. Let’s start with an overview of your role, looking at your main objectives as chief experience officer and kind of what falls under your purview.
Murphy: My name is Sue Murphy, and I’m chief experience officer at University of Chicago Medicine. My background is in nursing; I’ve been a nurse for about 30 years. That has given me the ability to understand the role of the healthcare provider and the day-to-day operations in caring for others. I’ve been with University of Chicago for six years as the chief experience officer. The role is really about providing oversight and doing everything we can to create exceptional experiences every day for our patients and those that care for them.
I have a department with 36 full-time equivalents who help with wayfinding, understanding the survey process, innovating, and providing training, coaching, and mentoring for those that care for patients to help bring out the best in them, and understand what the experience is like and what engagement occurs. We work with everyone from physicians to nurses to hospitality to food services — everyone who encounters patients, and talk about what means most to them, and how we can encourage them to do the best job they do every day.
Gamble: So quite a bit falls under that. When you talk about creating a culture that improvise the care of patients and the lives of clinicians, which is one of the key roles of the chief experience officer, what does that mean to you?
Murphy: That’s a great question. What it means to me, and how it’s weaved into my philosophy, is I truly believe that everyone who goes into healthcare, no matter what role they’re in, has a story — something that helps drive them to get into the job they’re doing to care for others. If you care for those who are caring for others, it becomes contagious. And so we talk to those who care for others, even if they work in finance, about why they’re in healthcare, how what they’re doing is changing the world for a patient by helping them through the journey of their healthcare experience. That is my philosophy. And I’ve noticed over the past three or four years that when we really focus on that, we see a change in our outcomes.
Gamble: Right. So it’s about patients as well as clinicians. I imagine you have to have a really good team to be able to meet all these needs.
Murphy: Yes. I believe the burden of proof starts with leadership. We have to have leaders who understand the philosophy; who we can teach, train, and mentor to practice tactics on how to make that happen. We teach leaders how to work with their staff and their team to be able to transfer that to those they care for. And so we really believe that it starts with leaders, and how leaders then care for their staff to care for the patients.
Gamble: Okay. At your organization, do quality, safety and performance improvement all fall under the umbrella of the experience officer?
Murphy: No, but we are all aligned. We have chief medical officer — quality and safety falls under them, but we all work together. Because it’s such a large organization, to have that all under one element would be too difficult. But we do work together to ensure that quality, safety, and experience are all aligned.
Gamble: Right. I would guess there’s a lot of coordination with other departments really across the organization. Is that a key part of your role — working with so many different constituencies?
Murphy: Absolutely. I’ve found that building the relationships with other leaders is really important. I spend a lot of time building relationships and making sure we’re all coming to the table with a common goal. We all have our silos sometimes, but having collegial, professional, and caring relationships with those from other departments helps us get to the outcome we want. And so our team spends a lot of time building those relationships; making sure we’re rolling up our sleeves and looking at process improvement. Because we already have relationships, that’s a little easier to accomplish.
Gamble: Right. And so is that an ongoing goal to maintain those relationships?
Murphy: It’s an ongoing journey. And I think setting the tone for what you’re trying to do in the beginning — making sure you’re walking into establishing a common goal and a common outcome — helps tremendously, rather than coming in with different agendas or ideas. Again, it’s not always perfect, so when it doesn’t feel right, we need to find out how to go back to make sure we’re doing the right thing.
Gamble: Sure. Let’s talk about some of the key initiatives you’re involved with now, one of which was the care rounding solution, which I believe went live last year. How did this come about, and what where the goals of using this type of solution?
Murphy: To be clear, we’ve been live on the rounding solution for four years this August. The suite, which is called Care Experience (Vocera), includes rounding, discharge calls, and recorded discharge messages. As far as rounding, in my experience, we’ve seen that capturing a patient’s voice is critical to assuring we can learn how their care was while they were here, how we reward and recognize staff who are caring for them, and how we make sure we know where there are areas of opportunity. Those are the key goals.
We’re in a very different place than when we started care rounds almost four years ago. In the beginning, the thinking was we needed some type of iPad technology to capture all the data in one area, and then bring it together to find common themes. That was the ‘why’ behind it. It was about making sure we knew what was happening from one unit to the next, what’s going on, and how we can improve processes. Now, it’s evolved to where instead of rounding on patients, we call it ‘creating conversations.’ We’re using the technology and working very closely with Vocera Care Experience to say, ‘Instead of having patients audit our behavior, what conversations can we create with patients? How can we track patients to make sure they understand the ‘why’ of the care they’re receiving? Why is it important for us to check on them every hour? Why is it important that they understand their medication?’ It’s come a long way. Before, it was just auditing; now it’s becoming a conversation.
Gamble: That really speaks to what we’re seeing in terms of patients and consumers taking a more active role in their care.
Murphy: Absolutely. It also shows patients that we care what they think. Instead of doing it to them, we’re doing it with them. It’s all about shared decision-making from a patient’s view and making sure we understand your individualized care, because it’s not cookie cutter for everyone. That has helped us create quality and safety, together with experience, to make sure everything is aligned.
Gamble: It’s interesting that you use the word ‘audit’. Was the perception among patients that they were being asked to review or audit the care they were receiving?
Murphy: Absolutely. In the beginning, our questions were, ‘Did the nurse round on you? Did they answer your call light in timely manner?’ We found that people always answered yes, because if a patient in a hospital is being asked about the care they’re receiving, they certainly don’t want to say anything negative. We’re not looking for negativity.
For example, we might say, ‘When the nurses come and check on you every hour, are they meeting your needs?’ And the patient may say, ‘Well, no one’s checked on me for three hours.’ And so we’ll look into that. We’ll go back and have a conversation with the staff and make improvements. Or a patient may say, ‘Yes, when they check on me every hour, they make sure I have everything I need and answer my questions.’ We’re not asking patients if nurses are doing their jobs. It’s more making sure that what we’re expecting them to do is making a difference.’
Gamble: I imagine this has changed the rounding process for nurses, or at least changed the way they view it?
Murphy: Absolutely. One thing I want to emphasize is that we don’t make changes unless those who are involved in the practice are part of the process. We sat down with nursing leaders and asked, ‘how is it going?’ They actually said, ‘We don’t think our patients should audit our behavior.’ And so they came up with some questions they think they should ask, and we tweaked it with help from Vocera to come up with best practices. But I’ve learned the hard way that you can’t just tell people, ‘Here’s what we want you to do. Go out there and do it,’ and not have them understand their involvement in it.
Gamble: I think that’s been a universal lesson learned across the industry.
Murphy: It’s easy to slip back into the old way, because you’re in a hurry. You’re trying to get things done. And of course, just because a lesson was learned, it doesn’t mean we’ll always do it the right way, but it does help us slow down a little bit and making sure we’re listening.
Gamble: Right. So, now that you’re a few years into the implementation, are you making changes on a regular basis and making tweaks here and there?
Murphy: We did develop some standard work in which we have certain times when we look to see if we’re getting a certain number of rounds. That’s one of the indicators. What are the rounds saying? When is it time to change the questions? Because in the beginning, every other week we’d say we should choose a different question. We soon figured out that if we kept doing that, we’d never get the information we need, and so we developed standard work on how to evaluate and improve the process.
Gamble: What are some of the other projects you’re looking at right now?
Murphy: Rounding is one of them. “We’ve also developed some standard work along with the rounding, including ‘discharge phone calls,’ in which key members from the organization help us understand how they’re doing at home and how are they progressing. The nice thing about it is that since we have the whole Vocera Care Experience part of our package, the nurse can look at all the data from the round before even calling patient. So if I call Mrs. Murphy and see that she had been having trouble with food, I’ll ask, ‘Did they resolve your food issue?’ It’s good because they see that we’re talking to each other.
The other big initiative we’re working on is the hArt of Medicine program, to hold workshops and focus on strength-based training for staff. The goal is to help bring them back to purpose and understand what they already bring to the encounter with patients, how we’re shining a light on what they’re doing well, and how we can help encourage them to continue that. My team is the part of that development. We’re also working with Press Ganey to analyze the data we receive from patients.
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