Abstract
The patient experience leadership structure at Northwell Health is strategically championed by Culture Leaders, a novel role established to transform the organizational culture from “service excellence” to “patient experience.” This case report describes how the implementation of Culture Leader structure has aided in the improvement of organizational patient experience performance as well as how Culture Leaders remain highly engaged. Responsible for effectuating change by bridging the gap between local and organizational experience strategies, Culture Leader engages key stakeholders within the strategic pillars of culture, care delivery, hospitality, and accountability.
Introduction
In every organization, there are individuals who are culture influencers. Formal or informal leaders, they elicit followership and have the ability to make definitive impacts on their colleagues, processes, and organizational culture (1). Leaders effectuate change and their interventions impact outcomes (2). This case report focuses on how Northwell Health systematically implemented a patient experience leadership and accountability structure to drive cultural transformation. The Agency for Healthcare Research and Quality describes patient experience as “the range of interactions that patients have within the health-care system (3).” Patient experience remains a national steadfast priority due to the intrinsic and positive correlation with patient safety and clinical effectiveness(4).
Northwell Health is a large, integrated health care organization comprised of 66 000+ caregivers, 23 hospitals, and 650+ medical practice locations, spanning geographically from Westchester to New York City and across Long Island. Due to the inherent growth of the organization by means of mergers and acquisitions, patient experience efforts were historically siloed, fragmented, and inconsistent, with much focus on reactive service recovery. There were pockets of excellence and areas of opportunity to achieve our mission of providing world-class, patient- and family-centered care.
Description
Northwell is continually growing and evolving. Consistent challenges include organizational complexity, geographic span, and diverse communities and workforce. In 2014, Northwell’s first Chief Experience Officer joined the organization bringing a unique and refreshed perspective given his hospitality industry experience at the Ritz Carlton Hotel Company. The Office of Patient & Customer Experience (OPCE) was soon thereafter created to standardize strategy, disseminate best practice, and advocate for customer-centric standards. The OPCE team is comprised of health-care professionals from various backgrounds coming together to create the overarching patient experience strategy. In 2014, the publically reported patient experience survey, Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS), the Northwell health system ranked in the bottom quartile nationally, with individual hospitals ranging from top to bottom decile performance. During OPCE’s initial discovery phase, inconsistencies regarding resources, ownership, scope, and accountability related to patient experience at the local site and service line levels were uncovered. To address this fundamental gap, a novel role, Culture Leader, was created and integrated into the Northwell patient experience ecosystem and strategy (see Figure 1). At Northwell, our promise to patients, families, and customers is grounded in the Culture of C.A.R.E. framework that embodies concepts of
Northwell health patient experience ecosystem.
Creating Structure and Defining Attributes
Aligned with OPCE and reporting directly to their site or service line executive director (ie, CEO), we currently have 63 Culture Leaders responsible for executing local patient and customer experience strategy by engaging key stakeholders around culture, care delivery, hospitality, and accountability. Culture Leaders are multifaceted local experts and change agents who serve on leadership committees, shared work teams, Six Sigma projects, and patient and family partnership councils in addition to leading their respective teams to effectuate local performance improvement and cultural transformation.
Implementing and sustaining the Culture Leader structure required vision, leadership, strategy, structure, organizational readiness, and buy-in. Utilizing the tight–loose–tight leadership approach to effectuate attitude, information sharing, and impact, the cornerstone of the relationship between the corporate OPCE and site/service line Culture Leaders is mutual trust (5). The OPCE leadership set clear expectations and strategy (tight), empower Culture Leaders with the ability and freedom to translate those expectations to best be implemented into local culture (loose) but then holds all accountability for performance (tight). This approach gave homage and respect that each entity embraces a unique culture and history while at the same time creating consistency and responsibility.
Transforming the organization from “service excellence” to “experience” required an elevated, dedicated leader. Culture Leaders embody a wide variety of skillsets, past experiences, and levels of expertise. Site and service line senior leadership hand-selected their Culture Leader with guidance and support by OPCE leadership. Selection criteria outlined essential attributes of passion for experience, managerial courage, critical thinking, and deep understanding of local culture. Culture Leaders come from diverse backgrounds including nursing, allied health, retail, hospitality, theater, administration, and business. Collectively, such varied backgrounds coming together with a shared mental model has resulted in true and honest dialogue. Divergence of complementary perspectives has fostering of a spirit of innovation and challenging the status quo.
Investing in Leadership Development
With Culture Leaders identified, OPCE performed a baseline learning and development needs assessment. Results gave insight into the creation of a Culture Leader orientation and individualized development plans. Alongside structured education and development programming, Culture Leaders receive individual mentoring and coaching by the Vice President of Patient & Customer Experience and other OPCE team members. They attend stimulating and engaging monthly best practice sharing forums and actively participate on system-wide improvement shared work teams. Customized sessions throughout the year are provided for particular topics, including strategic planning, emotional intelligence, data and analytics, and performance improvement. To inspire Culture Leaders, OPCE team hosts an annual patient experience conference as well as Culture Leader Summit.
Parallel to the implementation of Culture Leader onboarding, OPCE launched the cultural transformative large-scale education program, Culture of C.A.R.E. course. Cascading this 2-hour, experiential curriculum across the organization was the Culture Leader’s priority, and within 18 months, over 61 000 leaders, physicians, employees, and volunteers were educated. Culture Leaders and their team of Facilitators led local-level education after receiving robust training in a facilitation and presentation skills certification program. Culture Leaders were held accountable for deploying at their site/service line, sustainment strategies inclusive of new policy, Culture of C.A.R.E. education for new employees, behavioral competencies, weekly huddle communications cascade, and patient experience assessments.
Results
At Northwell, our brand is our promise to consumers, our employee promise is our promise to one another and Culture of C.A.R.E. is our promise to patients and families. We have seen positive results within all 3 of our promises since the implementation of the Culture Leader structure.
Network of Culture Influencers
We have successfully rebranded from North Shore—LIJ Health System to Northwell Health due to a comprehensive internal and external communication and marketing strategy. Culture Leaders supported and educated regarding the rebranding during Culture of C.A.R.E. courses. In addition to the current 63 Culture Leaders, OPCE has educated and certified over 550 Culture of C.A.R.E course faculty who facilitate the courses on an ongoing basis. This large body of patient experience leaders and champions are inspiring and role modeling customer-centric, empathetic care throughout our organization.
Patient Experience Performance
Between 2015 and 2016, the Culture Leader role was being established and is now an integral part of our organization, partnering with clinical and nonclinical stakeholders. As a result, within the past 4 years (January 1, 2015, to November 30, 2018, year to date), every HCAHPS domain system-wide saw improvement. The most significant HCAHPS domain increases have been within Communication with Doctors and Communication with Nurses, both with an increase of 11 percentile points (see Table 1). In 2017, on the ambulatory and medical practice level, 81 (16%) individual sites achieved the 90th percentile nationally for Press Ganey “Recommend the Practice”. According to publically reported data, Northwell system metrics outperform the New York State average in the following HCAHPS domains: Communication with Doctors, Communication with Nurses, Care Transitions and Rate the Hospital.
Northwell Health System Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) Performance Improvements; Source: Press Ganey National Database (discharges 1/15/2015—11/30/2018).
2018 Employee Engagement Scores for Culture Leaders only; Source: Press Ganey Employee Engagement Survey Database; n = 48).
Culture Leader Engagement
Realizing the positive correlation between engagement and experience (6), our organization closely monitors employee engagement as one of the major contributing factors to patient experience performance. In 2018, Culture Leaders participated in the Northwell Health Employee Engagement Survey. The “engagement score” is a score from 1 to 5 regarding our employees’ commitment, satisfaction, and willingness to recommend our place to work (1 = strongly disagree to 5 = strongly agree). The Culture Leader overall engagement score was 4.60, +0.32 versus Northwell average and +0.48 versus national average; see Table 2. This Tier 1 score places the Culture Leader cohort at the 99th percentile nationally for engagement. Between 2014 and 2018, employee engagement across Northwell Health has improved 40 percentile points. Engagement scores for particular patient experience and service-related questions also saw improvement. Within the past 4 years, the score for question, “The person I report to serves as a good role model for delivering high levels of service,” increased 0.37 points and question, “This entity provides high-quality care and service,” has increased 0.15 points.
Lessons Learned
Patient experience is an art and science, and thus, our newly defined and empowered Culture Leader group needed to be prepared and supported to execute complex strategies. Investing time, education, and development in Culture Leaders was essential. As a result, Culture Leaders are revered throughout the organization because they represent the “voice” of our patients and families. Having Culture Leaders in non-patient facing/clinical subsets was also another key driver. There are Culture Leaders from areas of the organization including Finance, Foundation, Information Technology, Procurement, Human Resources, and our innovative Research Institute. Engaging these nonclinical, operational teams around experience helped drive our promises and further engage our people to professional and moral purpose.
Conclusions
Our organization took a pragmatic approach to defining and establishing a patient experience structure. Culture Leaders are part of the C-Suite, enabling patient experience to have a powerful and persuasive presence during strategic planning, decision-making, and innovative programming. Their commitment, dedication, and passion has had a powerful ripple effect and in turn, they role model, inspire, and lead their teams to excellence. As a result, we have seen significant improvement in patient experience scores and are proud they remain highly engaged in this important work and the organization. Since the Culture Leader role is constantly evolving, we look forward to seeing the future great impacts they will have on our community.
Footnotes
Declaration of Conflicting Interests
The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.
Funding
The author(s) received no financial support for the research, authorship, and/or publication of this article.