Q&A with Rick Evans, Part 2: “The better we understand patients, the better we can meet their needs.”

When the one-year anniversary of the start of Covid-19 rolled around, it may have seemed like an opportune time to reflect on how affected so many aspects of healthcare, from the dramatic uptick in telehealth to the massive vaccination rollouts.

In reality, however, it simply isn’t the case. For those who are in trenches — including the ones providing support and leadership — there simply isn’t enough time for reflection, said Rick Evans, chief experience officer at NewYork-Presbyterian.

“We can’t rush to fully understand it,” he said during a recent interview. “It’s going to take a long time to put ourselves back together, put our health system back together, and put our country back together.” For Evans’ team, that has meant creating best practices for communicating through barriers such as PPE, and keeping a close eye on providers who are understandably exhausted.

But that’s just part of the picture. During the discussion, Evans talk about the “basic blocking and tackling” organizations must do to improve the experience for all patients; the need for healthcare to change its “suck it up” culture; how NYP is taking a stand against racism; and why his relationship with CIO Dan Barchi is so vital.

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Key Takeaways:

• The first step in reducing disparities in care is to “better understand patients and their demographic data,” and to “enlist them in telling us more about who they are, so that we can understand the communities they come from” and leverage data to intervene more effectively.
• Improving patient experience starts with basic blocking and tackling, which includes having strong interpreter services and supports for those with disabilities.
• NYP has made numerous statements on where the organization stands with racism, and how it will deal with those who exhibit racist behaviors. “We can’t be casual about it any longer.”
• One of the most important relationships the CXO has is with the CIO; at NYP, Evans works arm-in-arm with Daniel Barchi to “remove friction for customers trying to reach us.”
• Ending the ‘suck it up’ culture that has plagued healthcare is going to require leaders to create a safe space where staff can express themselves. “You have to be active in reaching out and asking how are you, and then waiting for a real answer.”

Q&A with Rick Evans, Part 2 [Click here to view Part 1]

Disparities in Care

Gamble:  One thing that’s been brought to light by Covid are the disparities in care, especially when it comes to access. I can imagine that’s something that’s really top of mind in your role.

Evans:  You can’t work and live in New York without appreciating and valuing diversity. If people exist in the world, they exist somewhere within blocks of where I am right now. The other piece of this was the racism pandemic — or at least, the awakening of a lot of this country to what we’re dealing with when it comes to race. We did a lot of work on that this year, and even before then.

I’ll give you an example. We put our biggest vaccination site in Washington Heights, which is a very diverse community and a community of underserved people as well. We earmarked a certain number of our vaccines appointments for that community. It’s unfortunate we don’t have enough vaccine for everybody who needs one, but we wanted to make sure that we weren’t just distributing vaccines to one population; a privileged population. And our demographics have looked really balanced toward that community.

We also, along with one of our trustees, founded the Dalio Center for Health Justice. We’re going to wade into this disparity thing. We’re not going to wring our hands of it anymore. We’re going to do something about it. We’ve already started efforts to better understand our patients and their demographic data, and to enlist them in telling us more about who they are so that we can understand the communities they come from, and then look at data and intervene more effectively where there is disparity.

When you look at the Covid deaths in New York, they are disproportionately high in certain communities. I would look every morning at the New York Times’ map which shows where cases are hotter by zip code. You can’t mistake the communities that are hotter. Those are people who can’t isolate because they live with a larger family or have to take public transportation to get to work. There’s just a huge amount of work to be done around racism — which is its own plague — and then its sequelae in terms of disparity.

 

‘Tell me who you are’

Gamble:  Do you have any thoughts on how other organizations can ensure patients’ needs are being taken into account, even when it comes to communication?

Evans:  There’s basic blocking and tackling. You got to have good interpreter services for people, and that’s not cheap. But again, you can’t provide great healthcare if you can’t understand what people are saying to you. And we shouldn’t be forcing family members, for example, to function as interpreters when they don’t know medical terminology. And so you have to have strong interpreter services. You have to have strong supports for people with disabilities, whether that’s the physical infrastructure or other supports within a hospital.

I believe that as a country and as an industry, we need to get better at saying to patients, ‘tell me who you are.’ I’ll give you an example. My partner and I have a son. We’re all different races and our son is adopted. It would be good for the health system to understand that my son isn’t going to inherit the family history. My family history is irrelevant, in a way, to my son. I think we’ve got to get better at asking questions and helping patients understand why it’s important for us to know if you are a person of color, or a member of the LGBTQ community, or where your ancestry might be from. There are demographics we collect at admission, and I think we do pretty poorly, across the country, at utilizing it. We need to get better at that, because the better we understand our patients, the better we can meet their needs and even understand trends in those populations.

 

Removing bias

Gamble:  Right. So even just ensuring that a care provider has that information already and you don’t have to start from zero, which happens too often.

Evans:  The other thing we’re doing is looking at all of our procedures and policies and making sure that they’re distributed and used equitably; that some protocols don’t have bias in them. We’ve taken a hard look at some of our protocols and asked whether they are truly free of bias, whether that’s gender bias, race bias, or sexual orientation bias. And there are times when we find things and say, ‘You know what? That doesn’t need to be in there,’ or, ‘we should do this a different way because this could lead to bias.’

 

Gamble:  That’s so important, but I imagine it can be overwhelming. There is so much that needs to be done. Is it something that has to be approached step by step?

Evans:  I agree, but it has to be deliberate; we can’t be casual about it any longer. The other thing I think health systems can do — because we’ve done it and we’ve taken some hits from people who don’t agree with us — is make very clear statements. We’ve made statements through our CEO about where we stand on racism, and how we will deal with patients, families, and staff, who are exhibiting racist behaviors. It’s not something we will gloss over any more. We’re not going to allow that.

 

CXO and CIO going ‘hand in hand’

Gamble:  I also wanted to ask you about Daniel Barchi, who we’ve spoken with many times. Can you talk about what your relationship with him has been like, and how you’re able to collaborate?

Evans:  It’s funny; we have an engagement survey, and one of the questions is, ‘Do you have a best friend at work?’ He is definitely one of my best friends at work. A chief experience officer will not succeed without strong partnerships with the chief information officer, chief HR officer, and chief quality officer, among others. We need to go hand-in-hand.

Daniel and I talk virtually every day. We are working on a number of projects.  Daniel and I are linked arms on our access strategy to remove friction for our customers trying to reach us. That involves technology and people.

We just installed Epic, and that involves patient experience issue as well, so we worked closely on that. I can’t even imagine doing my job well without partnering with Daniel in his role. Fortunately, we also happen to really like each other, but we see how we need each other to succeed, and it works really well. It’s the best partnership I’ve ever had in healthcare.

 

Exhaustion, not burnout

Gamble:  Let’s talk a bit about burnout. I would think it’s really been an ongoing challenge, especially since things have gone on for so long. Has the pandemic changed the way that you think about burnout?

Evans:  Burnout seems like an esoteric phrase; I would just call it exhaustion. It’s not an academic term for us. We’re all really wrung out. And that has caused us to take a very close look at what we’re doing to promote resiliency. Now, resiliency can be a buzzword, but there are things we can do. For example, we’ll send a fresh wave of food out to our units. It’s not going to solve world hunger, but if a staff member can’t even break free to eat and there’s food right there, that helps. It’s not everything, but it’s something.

Ending the ‘suck it up’ culture

You also need to have good psychological supports in place. We’ve done a lot of that. We had the very tragic loss of a physician here who took her own life, during the middle of the pandemic. The darkest day of the pandemic by far was the day that Lorna Breen took her life. Her family is very passionate. They formed a foundation around dealing with resilience and psychological support. We’ve learned that we have to make it okay to talk about our feelings. Healthcare is a suck it up culture. We’ve got to make it okay for people to say ‘I’m tired,’ or ‘I’m not feeling my best,’ or ‘I need help.’ You can’t just put things on your Infonet page and expect people to come for counseling. You’ve really got to be active in reaching out and asking, ‘how are you,’ and then waiting for a real answer.

We’re also starting to think about recovery. What will it mean to come back together? How will we mark this moment that we’ve lived through?  How will we give meaning to this year of exhaustion, whether that’s putting up memorials to the staff we lost or recording our stories? People need to know that there’s meaning in this beyond just slogging through it. And so we’re thinking about all those things.

 

Gamble:  I think it’s important to call it exhaustion — it depicts it much more accurately.

Evans:  Everybody comes in every day and they do their job. I can’t admire these people more than I do now. I just couldn’t possibly.

 

Gamble:  Great. Well, I think that covers everything. Thanks so much for doing this. I’ve really enjoyed hearing your story.

Evans:  Sure. It’s been an honor to be asked to speak and it’s a pleasure to talk to you.