Rick Evans talks with Chief Healthcare Executive about the importance of communication, giving guidance on patient encounters and improving the patient experience.
During the COVID-19 pandemic, hospitals weathered surges of patients, shortages of staff, increased burnout, and other difficulties.
However, patients are still expecting high-quality care and compassion. More than ever, hospitals must stress the importance of communication to ensure patients have a good experience, says Rick Evans, senior vice president and chief experience officer of NewYork-Presbyterian Hospital.
“It's not about your parking garage,” Evans says. “It’s not about the food most of the time, although in pediatrics and obstetrics, it can be about the food. It's really about how we communicate individually and as a team with our patients and families.”
Evans spoke with Chief Healthcare Executive® this week about developing good communication with patients, establishing a culture focused on the patients, and how the evolution of consumerism is changing the patient experience.
“It’s not about happy customers,” Evan says. “It's about confident customers, confident patients that feel like they're in good hands when they're with us. When they feel that confidence in us, everything tends to take care of itself.”
‘The arc of communication’
When the COVID-19 pandemic began, New York City became ground zero of the pandemic. “I often say we were first and worst in so many ways in what we saw, and it was enormously challenging and painful and difficult,” Evans says.
As hospitals have struggled with staffing, patient satisfaction scores nationwide have dropped in some areas, according to The Leapfrog Group.
Even over the past few challenging years, NewYork-Presbyterian’s patient satisfaction marks have continued to improve.
“We've been able to restore our staffing, not totally, but we're making progress,” Evans says. “And I think we have been very thoughtful about reintroducing patient experience best practices in a way that really takes into account where our teams are, where they are in their own recovery from COVID.”
Evans stresses that improving the patient experience is “all pretty much about communication.
“That can be communication about the care plan, it can be communication about discharge, it can be communication about medications that are given for the first time in the hospital,” he says.
At NewYork-Presbyterian, Evans cites an example of nurses sharing with patients when there’s going to be a shift change. At the end of a nurse’s shift, the nurse will introduce the new nurse who will be taking over and may reassure the patient about the nurse’s experience and skills. They’ll discuss the patient’s care plan and invite the patient to join the conversation, Evans says.
“We're building each other up,” Evans says. “We're building confidence, which is what we're trying to do.”
Health systems should define “the arc of communication” with patients. Doctors and nurses don’t need scripts, but they should be directed to keep in mind certain principles in engaging with patients.
“We have very accomplished people, whether they're doctors, nurses, therapists, housekeepers and transporters, so you're not giving them exact words to say,” Evans says.
“What you're saying is, ‘How do you start an interaction when you enter a room, to the patient? Who do you include in that interaction? If there are family members around, how do you do that? What do you do during an interaction? How are you teaching?’”
Diversity and respectful curiosity
Health systems have a better chance of providing a high-quality experience for patients when they have a diverse workforce. In New York City, that’s a necessity.
NewYork-Presbyterian’s interpreter services, which Evans says are indispensable, help individuals with more than 100 languages each year.
“So if the person exists in the world, chances are they're going to show up at our doorstep,” Evans says.
“If we didn't have diverse staff and leadership, I don't think we could do the job we need to reflect the city and the people that we serve,” Evans adds. “And I think we're very deliberate about that. We have extensive initiatives around diversity, inclusion and belonging.”
The hospital places a strong emphasis on “belonging,” Evans says.
“Belonging is really important to us, that our staff feel that no matter who you are, what type of person you are … that you belong here, and that you're welcome here and we need you on the team,” Evans says.
Undoubtedly, clinicians and staff will be encountering patients and family members of different backgrounds. In those encounters, Evans stresses the idea of being “respectfully curious.”As an example, Evans shared that he’s part of a same-sex couple with an adopted son of a different race. When going to visit the doctor, staff members show respectful curiosity by saying, “Tell me about your family.”
“You're asking in a way that allows us to tell you who we are and what we want and that allows you to better meet our needs,” Evans says. “So it's a mixture of being diverse, and then it's a mixture of cultural competency, and knowing what to ask the people in front of you in a way that helps them to understand who they are.”
The advent of consumerism
By necessity due to the pandemic, health systems have introduced and expanded programs such as telehealth and hospital care in the home. Increasingly, hospital and health system executives acknowledge that patients want the conveniences in healthcare that they enjoy in other aspects of their lives.
While Evans says he’s pleased with the strides NewYork-Presbyterian is making, he says, “I wish that we had better anticipated the advent of consumerism and health care in our organization.”
“With consumerism, there's a new word: convenience,” Evans says. “And you know, healthcare is not known for its convenience. In fact, sometimes it's known for being quite the opposite.
“And even though I'm pretty excited about the things we're doing to respond to consumerism, wanting things to be convenient, wanting multiple choices for how I would interact with the health system, I wish we'd gotten there sooner.”
As consumers demand more convenience, health systems are going to have to adapt, Evans says. If patients are only able to think about getting a physical late in the evening after finishing their work, they want to easily go online or on an app and schedule that appointment.
Patients “want that consistency and compassion, but they want options,” he says.
Looking ahead a few years, Evans sees a health ecosystem that offers a greater mix of virtual services and in-person options.
“I think we can humanize healthcare by giving people more of those options,” he says.
At NewYork-Presbyterian, patients in the hospital can engage with a pharmacist on their television to answer questions about their medication.
Like other health systems, NewYork-Presbyterian is shifting more service to ambulatory settings and the home, as many patients want to get care outside the hospital.
“People want to be home, or with loved ones,” Evans says. “They don't want to be in the hospital. In some cases, it's safer for them not to be.”
‘Ask them what they want’
When asked for other advice for health systems, Evans stressed the importance of talking to patients and not just reading surveys.
“Talk to actual patients and ask them what they want,” Evans says. “They'll tell you. Sometimes they'll tell you what you don't want to hear. But I think we need to do that.”
Hospitals should look to find ways to involve patients in the infrastructure of the hospital. “I have yet to see patient advisors touch something and not make it better,” he says.
Evans also repeatedly mentioned the idea of giving staff time to recover from the pandemic.
“This is historic,” Evans says. “People will ask us a century from now about what it was like during this pandemic. And we need time to recover, as people, as professionals, and even in teams and organizations. It's like grief.
“I don't want to oversell it or overstate it, but you;ve got to respect that recovery process,” he adds. “You have to incorporate that into what you're doing. You can't shortcut it.”