VP, Applied AI & Growth
Stephanie Stewart (00:00:00):
All right and welcome everyone to the SHSMD webinar, How to Drive Authentic Patients Experiences with Ed Marx and Cris Ross. SHSMD would like to extend a sincere thank you to Actium Health for sponsoring today's event. A few reminders before we begin. Please take a moment to locate and click the chat icon in the lower right-hand side of your screen, there are some reminders there as well. At any point, feel free to type your questions, comments or responses into this chat as we have a lot of time at the end for Q&A. This webinar is being recorded and is broadcast in listen only mode. A copy of the recording will be shared following today's live broadcast. In a moment, you'll notice a poll open, we'd appreciate your responses in the poll or in the chat.
Stephanie Stewart (00:00:41):
And now, it's my pleasure to introduce today's moderator, Chris Hemphillis VP of Applied AI at Actium Health, and he'll kick off today's session. At this time, Chris, the floor is yours.
Chris Hemphill (00:00:54):
All right, really appreciate that. And I just want to make sure that I am off mute. Can you hear me? Okay, well, excellent. Well, that sounds like the right way to start a webinar. We have the good ingredient starting. So, just by way of introduction to this concept, first I just wanted to thank everybody for joining to discuss this topic, because Ed Marx and Cris Ross, their background is not just in as you can see, a former CIO of Cleveland Clinic now Chief Digital Officer at Tech Mahindra, Cris Ross, Chief Information Officer at Mayo Clinic. So, the health executive perspective that they bring to the table. But also, there's the experience that they're discussing and what they're wanting to share in terms of how to shape the patient experience doesn't come from just dealing with large organizations and institutions, it comes with their own experience as patients.
Chris Hemphill (00:01:58):
So, with a very unique combination here, Cris and Ed both had major health incidents that they've discussed, they're shaping these experiences. And that's going to be a critical part of why they're launching into these conversations. And going forward with this to begin with. The other part that is unique about this is that there, I shouldn't steal the show, I want them to go to share some details on this, but what really got me excited about this conversation is the fact that given the challenges of healthcare systems, given the need to have people on your side that know how to navigate in complex healthcare environments, given that that those are all parts of the big equation of what it takes to receive good care, with the patient experience oriented book that, that they're both co -producing.
Chris Hemphill (00:02:50):
It's not just directed at us in the room who have influence and authority from that administrative perspective, it's actually directed at patients who are dealing with the challenges within the system. So, it's the first time that I've heard of a guide that provides patients with a way to operate and move within the modern healthcare setting. So excited to introduce that and Ed and Crris just wanted to give you the opportunity to say hello.
Edward Marx (00:03:27):
Yeah, this is exciting. Thanks Chris and Stephanie for having Cris Rossand I be a part of this webinar. We're really excited. And we do want this to be super interactive. So, I know that you've enabled that capability, so we'll have time for questions and things like that. But yeah, I'm thrilled to be here. Hey, Cris, how are you?
Cris Ross (00:03:51):
Sorry, I just had a couple of challenges signing on this afternoon, I apologize. Anyway, I'm really glad to be here with my colleague, Ed. And Chris, it's fantastic to have you leading our session today.
Chris Hemphill (00:04:06):
Well, fantastic. Let's get started with the format that we're doing today. So, you saw a little bit of PowerPoint, but this is not going to be talking heads at you for the next hour or so. We want you to be involved in the conversation. We're talking about deep, we're talking about personal subject matter. We're talking about impactful subject matter to the patient populations that you're working with. So, if there are stories that you have or questions that you have about this, I mean, this is a rare opportunity. We've got a former CIO of Cleveland Clinic, CIO of Mayo Clinic, all in the same room, all at the same time. This floor is yours.
Chris Hemphill (00:04:43):
If you have any questions or anything that you'd like to share, there's no waiting till the end. There's no 10 minutes of trying to squeeze in some Q&A at the end. This is about you, and we want to hear from you. So, if there's questions or anything like that, let us know. And while we're getting set up with that, let us know where you're from. Any kind of chats or anything that you see from anybody else, feel free to say hello and we'll get into it.
Chris Hemphill (00:05:10):
So, to kick it off, let's go, let's just start. We kind of introduced this concept of Cris and Ed, both have been patients in the past, both have been leading technology and digital transformation efforts at these major healthcare institutions. So, we see so much, you're able to see that the healthcare system flaws from multiple angles. And we know that we can't really wait like patients, we can't as patients, we can't afford to wait for administrators and legislators to fix. It might be a broken system, but that's something we'd have to operate in every day. Can you talk to us about why you're focusing on teaching the patient in this round?
Chris Hemphill (00:06:01):
I'll throw it at Cris first.
Cris Ross (00:06:04):
Well, thanks, Chris. So, I think the issue to a large degree here is, we've always been focused on how to create a better experience for our patients and our clinicians. That's sort of the job of the CIO and people who are looking at a digital transformation. But both of us had some pretty significant healthcare journeys, and you just get a different perspective when you're on the pointy end of the systems that you're managing. So actually, it might be helpful if we could just take a minute, Chris, if you don't mind, maybe to just tell a little bit about what our stories have been like and how that informs where we've been going. Does that sense?
Chris Hemphill (00:06:45):
Cris, not only that, I would say that that's the most important part. Because, again, it's not an academic discussion when you've got that brush with the patient. So, please, by all means.
Cris Ross (00:06:55):
Ed, do you want to go first?
Edward Marx (00:06:58):
Yeah, let's do it. I think we have a couple of slides.
Cris Ross (00:07:01):
We got pictures, man.
Chris Hemphill (00:07:04):
I'll bring them up.
Edward Marx (00:07:05):
Yeah, so it'll give you a little sense. We'll do this pretty quick. But you'll get a sense. Cris, and I, we chose to be CIOs, we chose to serve in health care, like the majority of you. We didn't choose to get sick and become patients. And I know we're all patients, I used to say that all the time. But I was never really a patient until I went through the journeys that I have in the last couple of years. And so, it's a whole different perspective when you're facing sort of life and death, as opposed to being a patient, not to diminish any patient experience, when it's just routine things. But when it's the sort of life and death, and it really opened your eyes to a lot of things.
Edward Marx (00:07:45):
So, I had a couple of bouts. When I entered my 50s, I was like a model I think of health, mental health, spiritual health, emotional, physical. When I had my annual physicals, the doctors would always say, "Oh, it's so boring," because there's nothing. But then, things change. And you never know, that's the way life is, right? So, you got to be resilient and flow with things. And so, the first thing I had was this unexplained heart attack, it was just a random, random, random thing. But I'll just focus on the cancer because the pictures here are related to the cancer.
Edward Marx (00:08:21):
So, a couple years after this weird heart attack, I had cancer. I was diagnosed with a late stage of version of prostate cancer. And so, it really was another awakening in my life. And certainly, being at an organization where we pride ourselves on patient experience, it really opened my eyes to what that really meant. So, the good news is, I had a good experience, and I had a fantastic clinical outcome. So, I'm completely healed. But I won't talk about everything here because I know we'll want to get to some practical things which we will share with you.
Edward Marx (00:09:00):
So, I'll just pick one of the things and maybe it's one that's actually not written, but there's a picture of Stag's Leap Wine. And so, there are some pictures here and my family and my doctor in the pink shirt, my wife and I, but just fantastic stories. I could spend an entire hour on them, but I'll just pick the one on Stag's Leap. So, what I learned is, I love Stag's Leap. It's sort of an expensive wine, at least to me, it's expensive. And so, whenever I'd get one as a gift, I would save it. And when I thought I could be dying, I was thinking about Stag's Leap and how I'm saving all the Stag's Leap, but I could die. So why am I saving these things?
Edward Marx (00:09:41):
And so, the thing that came out of this just from a personal journey perspective, is that I'm going to celebrate life every day. And when I want wine, it's going to be Stag's Leap. I'm not going to go for the for something that I don't like as much. I'd go for Stag's Leap. In fact, one last thing and then I'll pass it back to Cris is when Cris and I were writing the book together, we spent some time in a very unique, on a little boat on the Mississippi River and Cris brought out some Stag's Leap. It was pretty awesome. So back to you, Cris.
Cris Ross (00:10:14):
Absolutely, it was a pleasure to share that wine with you. So, here's my story. Mayo went through a huge project to converge all of our electronic health record system, our clinical systems. And we had gone live in Rochester, Minnesota, which is our largest location where Mayo started in May of 2018.
Cris Ross (00:10:38):
In July of 2018, I was diagnosed with stage three colorectal cancer. And I immediately began treatment and I got to see firsthand how did our systems work for clinicians and for patients a couple of months after we had just gone live with a big foundation to our digital transformation. And I saw a bunch of stuff that wasn't working yet. And all those kinds of projects need to be improved. But it was more than just small things or the typical kinds of mal-configuration things. It was sort of a deeper look at what did I want as a patient and was I getting that through our electronic systems and through our clinicians who are supported by those electronic systems, so I learned a lot.
Cris Ross (00:11:23):
So, I went through that process, chemotherapy, radiation surgery, and returned to work in May of the following year. So, I was away for nine months, eight months, getting well. And I was really happy to return to work in the spring of 2019. And everything was going really well for me until January of 2021, January of this year, when I was diagnosed with a recurrence of the same cancer. And I'm just emerging from that right now, actually. I came back to work at the end of September. Again, chemo, radiation surgery. My surgery this time was 16 hours long and I at six different surgical teams. It was the Lollapalooza of colorectal cancer, of surgeries, I think. And as part of that, because of where the tumor is located, it's a nerve damage. So, my left leg was paralyzed. It's now semi paralyzed and I'm working on walking almost like a normal human being now with lots of physical therapy.
Cris Ross (00:12:32):
So, what did it mean going through those two journeys? I had learned from a friend whose daughter had leukemia twice. She said, cancer is a gift. And I thought, "Wow, you are crazy." And then I saw the way that she and her daughter moved through cancer, and it was an inspiration. So, you can see some pictures on the left, those were all taken while I was being treated for cancer. So, I was looking for what's the gift of cancer for me. I wanted to live fully, like Ed described and began to think about gratitude, really as a verb, and living through my life. So, that's a quick view of our patient experiences and how it informed our viewpoints.
Chris Hemphill (00:13:26):
Well, on both sides, I just can't thank you enough for sharing that level of detail. Especially Cris to know what you're going through, while those pictures were taken is absolutely tremendous and I love the way that you've shared this story. And what our discussion is going to get into then is based on these experiences. Where should we be thinking about going from here? What can we do from the administrator perspective? How should we be thinking about our patient experiences? And I got to tell you, I got to tell you, a strong interruption, because it fired up the chat conversation, too. And there's a lot of questions I want to get into. So, I'll be integrating those into the conversation over time. But we've seen questions from Jill Halsey about data collection, from Richard Cloud, about pricing, transparency, and things like that. These are all things that are extremely impactful to the to the patient experience, and we want to get into those things.
Chris Hemphill (00:14:33):
So, I think that there might actually be a lot of parallels with some of the questions I want to help kick it off with one question that we have, which is just basically around this process that you're going through to develop this book to detail understand there's your own experience, but there's the experience that many other patients and many other people in many different kinds of situations are having too. So, with all those different experience types out there and all those different variables, how would you say that you, and your research, what are your findings on where the most help, where the most change is needed?
Edward Marx (00:15:10):
Well, first thing is Cris and I do recognize that we're two middle aged white men who are serving, have served at very prestigious organizations, and our experience is not going to be transferable to everyone else's. What is transferable though, is the fact that we do have a very, very strong patient perspective and we understand the whole concept of patient experience and what many organizations are trying to do.
Edward Marx (00:15:36):
So, what we did to sort of make sure we had a better worldview of patient experience is, we conducted a lot of focus groups. And we conducted focus groups within the industry. So, federally qualified health centers, small hospitals, critical care, access hospitals. And then, we also met with leadership of medium sized hospitals. So, we tried to get the whole gambit, and some of that included physician practices, so, ambulatory setting.
Edward Marx (00:16:02):
And then we also understand that there's not a complete equity in health care. And so, we also had a focus group with groups that might be marginalized, and to make sure that we bring in their perspectives as well. So, the book is really helpful, that's really the goal. It's a tool for patients or consumers. You can argue, is it patients or consumers? For us, it's kind of consumers, because we want to reach them before they are patients.
Edward Marx (00:16:33):
And so, the book can speak to all these different individuals, as well as hospital administrators, because it's not just our finite experience. But we've gone out and intentionally tried to grab as much of others people's experience and allow that to influence the book as well. So, I just wanted to bring that out, Chris, right up front, just to say that, "Hey, we don't think that this is just for a big major academic medical center."
Cris Ross (00:17:05):
Yep, for sure. And I think we came into this with a bias of, and you saw it in the flavor of how we approached our situation, which is, regardless of where you're getting treated, the patient journey begins with the patient and how do you want to get through this? And I think what we would say is, our viewpoint is, you've heard a little bit of a flavor a little bit of, seize the moment, try to figure out, what is this journey going to teach you? How can you paradoxically be a better person, as a result of a health journey? All those kinds of things.
Cris Ross (00:17:45):
But we're really glad that healthcare organizations are focusing on patient experience, removing things that are just satisfiers. There's no question about that. But I think if we would say anything speaking directly to patients like us, try to put your feet on the ground and figure out in this incredibly disorienting and frightening experience, especially as you enter care, what's this? What do you want? How do you want to approach this journey? And what insights can you find for yourself based on your personality or beliefs, and so on. That may sound kind of airy fairy, but it's not.
Cris Ross (00:18:28):
Trying to create a great patient experience is going to be around trying to help people find that grounding and then to be able to build experiences around that, that help them express their individual grounding. And there's a lot here about individualization as opposed to trying to curate, this is the pathway that patients ought to take, and we're going to make one size fits all.
Cris Ross (00:18:53):
So, and we can get into lots of aspects about how organizations might build culture, and might build capabilities to help meet people as they tried to express what their individualized hopes are as they go through their healthcare journey.
Chris Hemphill (00:19:13):
There's a parallel with what you're talking about with the individualization picture, and some things that I'm seeing in the chat, how people are coming up with questions. If we look at the poll results, I'm not sure if everybody can see the poll results. I'm going to call it now. What's most needed for improving patient experiences? The top answer was better use of data. And I would fortify that with better collection. Joel Halsey pointed out patient experiences. So that was the top answer. Other answers, actually, there's another result. I want to read out all just because there's a [crosstalk 00:19:51].
Cris Ross (00:19:51):
There's a tie, Chris.
Chris Hemphill (00:19:54):
Yes, yes. The tie was with corporate culture as well. So, it sounds like everybody can see the results, which is good, which is good. I didn't know if it was just popping up for me. But it's extremely interesting to see that tie between better use of data and the culture systems around that. Because the better use of data would follow on the culture, on the types of questions and the types of things that they focus on. One thing I didn't think was interesting, it was also that more budget got a 0%. Because again, what is budget without culture, without processes, without the right things in play? So that that that's an interesting parallel, because to get to that level of individualization, that we're talking about, that requires smart and ethical and effective use of algorithms and things like that.
Chris Hemphill (00:20:48):
But another aspect that come that comes in, it's a really difficult question. But Richard, out of Minnesota, Rich Cloud, asked about price transparency legislation. And I'm curious if in the focus groups, and the research, and the things that you've been doing here, the conversations, what you've been learning, how has pricing transparency come up? How do you see that as an impact to the patient experience?
Edward Marx (00:21:17):
So, I do want to answer your question, and maybe Cris can help me, but I want to say two things really quick in response to what you said or alluded to with the poll and things like that. So, I don't know if everyone caught it when Cris Ross was talking about it. The approach we're advocating here is radically different than anything that we've seen. So, a lot of us, especially because we're mostly hospital-based individuals here, we come at it from what can we as the hospital or the health system, payer, provider side, do to enable patient experience, we're turning it upside down.
Edward Marx (00:21:51):
We're saying it starts with the patient. I think, we talked about patient experience for 20, 30 years. We didn't call it patient experience 30 years ago, we called it something else. But in the last 10 years, in vouge is patient experience. And we've been very limited and how effectively been, and certainly there's more we can do, and we're going to talk about those things. But we are going to be advocating the other direction. And the two will meet somewhere in the middle and ideally have a fantastic experience.
Edward Marx (00:22:21):
The second thing that you said and it is really one of our key takeaways and I just want to bring it up right now because the comment or the poll really, really, really highlighted this. And that is, what we found is that patient experience is not limited by title or budget or program. So, a lot of people think you have to have a chief patient experience officer, which is great if you do. I mean, if I were hospital president, I'd probably want the same thing, I don't know. So, it's titles are not as relevant. It's really because back to the culture and then either is budget or programs.
Edward Marx (00:22:54):
So, there's one CEO in a medium sized facility, he happens to be a male. He goes around every day and visits every patient. So, they don't have someone with chief patient experience. It's modeled by the leader and everyone takes their clues from it and they have excellent patient experience scores. And there's no budget or anything associated with it. So, it's a beautiful, beautiful example. All right, I just want to make those two points, Chris, because it went in line with what we saw in the poll in the chat. But we do want to answer the question about price transparency and my friend Cris Rosshas anything to say about that?
Cris Ross (00:23:34):
Well, I think it's going to be super important. People are going to want to figure out how to manage a health care journey. And I don't know what the percentages are. The last time I looked, something like a third of Americans were in a health care insurance plan that had a large deductible associated with it. So, it stopped being just a healthcare choice, it's really a financial choice. So, you've seen the data that where you live is sometimes more important than your, the phrase was, your zip code is more important than your genetic code in predicting an outcome. What the quality and capability is of the healthcare organization around you makes a really big difference. And we would advocate for those who can to shop around.
Cris Ross (00:24:26):
And it's not just price transparency, but also should be quality transparency, and all the ratings that are provided by CMS and so on. It's something that all of us are facing. Where do we want to be treated? Does this organization have what I want? Is there something better that's close enough to me to make it convenient? And I worked for Cleveland and Mayo, a lot of people would pass by hundreds of hospitals or travel hundreds of miles to come to me or Cleveland, because of the things that we would offer. That's not for everybody but everyone can choose and should feel empowered that they don't necessarily need to go to the hospital that their doctor recommends. It may be better for them to seek an adjacent or different healthcare organization that they can drive a few more miles to get to. And price transparency and quality transparency is going to be huge.
Chris Hemphill (00:25:24):
So, one thing that you, and you'd made a point a little bit earlier, just about, hey, we've been talking about patient experience for years yet, they're still these major challenges that people go through. I was trying to pull up this tweet by Andy Mychkovsky, which said it had the year 2015, the quote from the year 2015 is "Consumerism will transform the consumer healthcare experience." Then it said, "2020 consumerism will transform the healthcare experience." So, I thought that was a really good parallel to, hey, we keep talking about this, but now you're aiming at the patient to really drive that change. Not to say that things haven't been improving and technologies haven't been getting better and there's been things that have driven adoption, but I thought that was a funny parallel.
Edward Marx (00:26:13):
Yeah, a couple things. One is, and we do want to get practical and hopefully, we're dropping some practical things here and there. And certainly, I want to make sure everyone gets great value and not just heroes pontificate. But even today, so we have much better technologies today. Let's just pick on patient portals as an example. And I'm sure everyone on this call, and maybe not, hopefully not, but my experience so far shares this type of stories that resonates with everyone, we still use paper.
Edward Marx (00:26:42):
So, I recently had another healthcare experience. And the organization is pretty advanced, and I downloaded all the portals and all that kind of stuff. And because I'm really, I'm curious and I'm also sort of wired digitally, so I do everything online. And I got there and they still made printed out stuff. They still gave me a clipboard. And I was so disheartened because I'm looking for that. What's the one health system that, because someone asked a question earlier about data or the poll. We have this data already. Why do we keep making our patients and our families keep filling out the same forms in hardcopy? We're starting forms from scratch.
Edward Marx (00:27:22):
There was another thing. I always quiz these people. I have very nice [inaudible 00:27:26]. I know it's not their fault. But I'm like, "Well, you know me already, right? So why can't you pre-populate these forms with my address and my name, and in that way, maybe I just do a couple checks, because you need the latest and greatest update. I'll make a couple of checkmarks." But to the point of that tweet is true. We've been talking about patient experience for a long time. The technology has evolved, but our processes haven't. So, the technology is there. It's not a technology issue. Its culture and processes. So yeah, I had a couple things, but I'll just stop with that one. So just to sort of reinforce what that tweet was saying and what we're seeing out there in the industry.
Chris Hemphill (00:28:07):
Thank you. And the areas of consumer experience that you just brought up around, like, make sure that my forms are pre-populated, and a bit about pricing, transparency too. These focus on things that are convenient and important for these financial decisions. But Cris brought up a really good point a little bit earlier, too, with regards to using your autonomy to seek where if you're looking at pricing and looking up information, seek what's going to be the best for you.
Chris Hemphill (00:28:38):
But [Kalia 00:28:40] earlier brought up a good point in the chat, which I'm trying to scroll up here to get back to that, which is, when a medical procedure, sorry, it keeps, one second, okay back up there. Okay. When a medical procedure or medication is denied by the government or private insurance? In that scenario, I know, you've been talking to a lot of focus groups and researching this, what can a patient and or the doctor do to make sure that people are getting the right care that they need from that perspective of the patient experience? If something might be wrongly denied, basically, like the doctor has a recommendation but it's not going through from the insurance program? What are some avenues of recourse that you might suggest there?
Cris Ross (00:29:37):
Well, it's a really tough one. I can think of a family member who's run into that problem of a physician who's prescribed a drug that's not covered on that family members plan, those kinds of things. So, I would advocate a couple of things. One of which is partner with your clinician and make your case. How can you work with the clinician to communicate with the payer around the urgency and relevance of that treatment? We've heard lots of stories, of places where people are denied coverage and it's really, sometimes really challenging and even tragic stories of adverse outcomes.
Cris Ross (00:30:28):
If the payer is in a position of saying, we simply will not pay for something, I'm not sure how far you get beyond that. Usually, and I work for a payer for a couple of years, there's usually an alternative pathway for any kind of treatment or diagnostic item that the payer will pay for. And that's a disappointment and a frustrator if you can get what the payer is recommending, but not what your doctor recommends.
Cris Ross (00:31:00):
There are cases where a physician and a patient working together can make change, but often they can't. That's one of the challenges in our healthcare landscape today, honestly. And there's little that a patient can do, I'm afraid when they've run that road and come to a dead end. I hate to be sort of negative, but I think that's the answer. I do think in the long term, because I also worked on Capitol Hill a long time ago. When it's clear that we've got a problem, sometimes there needs to be a legislative change or regulatory change. And we have seen that, but it's a very long road.
Edward Marx (00:31:51):
Yeah, and to the point that Cris is making, we address this in the book, as well. We have a sort of a model that we developed. I don't know, Cris will get into it now or a little bit later, but I'll just allude to it. And in that model, we try to empower the patient to understand all those nuances. We call it sort of the system that we deal with or the community. Yeah, you see it there. We'll touch on each of these and we already have on the self part.
Edward Marx (00:32:19):
But there's that whole system and community that most patients aren't aware of. We're all aware of it. To all of us, this is common language. But to a patient who believes everything. There's that white coat syndrome. They believe everything they're going to hear from a clinician. And if someone denies them coverage, the average person is going to just say, "Okay, they're not going to understand that they might have some recourse. They might have some empowerment."
Edward Marx (00:32:42):
And so the book again, we touch on all this in the book, where we're exposing them kind of, like Cris likes to say, sort of pulling back the curtains a little bit on how things work so that they can better navigate and advocate for themselves. And we know of stories, I'm sure you all do, too, where there has been successful challenges. So, we want to do whatever we can to help patients go through this journey. Because as you know, there's a big gap between what happens on the provider side and the payer side. And it's very difficult even for those of us in healthcare to navigate. And so, this should be very helpful to consumers and families.
Chris Hemphill (00:33:25):
And we can tell, Ed and Cris, just based on the types of questions that we're getting. We can tell that a lot of people, we know that this is mainly an audience, folks who work in healthcare, but we're seeing this, I'm sure there are other patient experiences too that are people reflecting on during this conversation. So, we who work in healthcare, we see the challenges. As patients, we see these challenges. So, no doubt that there's plenty of people within the system that want to do the right thing.
Chris Hemphill (00:34:02):
But there's been a lot of admiring of the problem. We look at healthcare and we just say, "Oh, it's complex, so, it's disjointed." But like we were talking about a little bit earlier, it's just been a long time coming for finding those solutions, getting to that level of consumerism that that we know is right. So, what do you see as the blockers? I guess, in the research and institutions, both large and small, what are the blockers from being able to get to the levels of transparency, integration that people need for a successful experience?
Cris Ross (00:34:37):
Yeah. So, we're trying to look at things that are systemic and one of the things that we found that systemic is healthcare is still largely oriented around how do we create really great processes and optimize them for patient safety and for efficient operations. So, a process might be, how do we intake a patient? How do we ask the right questions for their visit? So, Ed's example of the clipboard, aside from the issue, why should we still have paper? Part of it is, what questions are we asking and why and why in this particular moment? And what in this context? Why do we even have a clipboard in my hand at all?
Cris Ross (00:35:21):
And it's largely because that group has developed a process for how they're going to manage something. When I think about my journey through chemotherapy, I have a fantastic experience at Mayo, but there's places where it was disjointed. And one was, I wanted, I knew I had to have eight chemotherapy sessions both time through, and I just wanted to schedule them, right? To put them on my calendar. But I couldn't, why? Because there was a safety process that said that my oncologist had to sign off on the next round of chemotherapy treatments. Boy, those are really great processes all the way around. But it created a lousy experience for me, because I had to schedule two appointments at a time. And I had to grab times, and they weren't necessarily the right time of the week. And I had some duties to care for my mother, for example, that I wanted to manage her on that.
Cris Ross (00:36:10):
All right, so writ large, I think we have an issue, that healthcare is still optimizing processes. And that's super important in and of itself. But what we need is to have a singular view across the whole, that is patient oriented and clinician oriented, that sometimes needs to challenge those processes, but most importantly, needs to get them to sync. And I mean synchronized not sinking to the bottom.
Cris Ross (00:36:40):
I think if there's one big theme it is that we need to mature beyond our individual optimization of individual processes within our healthcare organization, and start to think more horizontally in ways that we can synchronize and challenge those processes on behalf of patients. And I would add, finally, we need to do it in a way that meets the patient where they live and maximizes their individual experience, as opposed to trying to force patients to go through a particular shoot through the healthcare process. Because that's going to feel like a lousy process to patient and it's going to feel same old, same old.
Cris Ross (00:37:25):
So, it's hard to say that we want to individualize the experiences. But we can do that with data and we can do it with corporate culture. Those are the two things that were highest in the poll are totally right. If we attend to those things and when we think about an end to end view that is patient oriented and clinician oriented, I think we can get better outcomes. Sorry, you got me, Chris, this is my soapbox item, but this is my big one.
Chris Hemphill (00:37:51):
I'm going to have to ask you not to step off of that soapbox. We have some good questions from the chat that I want to bring in. But Ed, I wanted to give you a chance.
Edward Marx (00:37:59):
I am going back to the practical nature. The example of Cris that he just shared, you can get really practical with that. So, if you really want to change, we can't give you what's going to work best for your organization because we don't know your organization. Everything's a little bit different. But there are these broad themes. And Cris just hit on one of these. It's very practical. Go into your patient journeys. Everyone is like, "Oh, we have patient journeys." "Okay, show me."
Edward Marx (00:38:20):
So, people always tell me that, "Oh, we got patient journeys." So, I ask them in a nice way, "Show me." And no one can produce anything. I'm talking about, you should have every journey mapped out in your organization, and go through it yourself. Now, maybe hopefully, don't need the treatment. But go through that process. And when I say yourself, I mean yourself, walk through it and really understand because when I was CIO, I understood this intellectually.
Edward Marx (00:38:44):
Everything, Cris said, I didn't understand it in my heart. And until the heart changes, the culture doesn't change. And so, if you want to get really practical, go through everything Cris just talked about because he's right. We've got these great processes, but they're all siloed. So, get in there. Do that patient journey work and then start eliminating those gaps that exist. And that's a very practical thing. And so, we already talked about data book challenge and the challenge that Cris has just described.
Edward Marx (00:39:11):
The other thing that it comes down to is leadership challenge. So, I served in awesome organizations. I will never say anything negative, because my organizations are awesome. But I can tell you in every organization, there's a leadership challenge. Who owns what? And just because you have a title doesn't mean you really own it. But someone's got to have the authority to go do these things that we're talking about, and then make the change happen.
Edward Marx (00:39:32):
But what happens oftentimes in organizations, we're really proud of our areas. I'm making up this example, but I might be the chief finance officer in charge of patient access. I'm going to do it this way. And I might be patient experience doing it this way. And I'm the data person, I want to do this way. And I'm the marketing person, I want to do this. And despite having the smartest people and access to technology, it's still a cumbersome patient experience because it goes back to what Cris was saying. So, it requires this leadership, this impassioned leadership to really make this change happen. And again, these are all like little practical things that anyone can do. Okay, I'll stop talking, but that's my sort of my soapbox is the leadership thing.
Chris Hemphill (00:40:11):
Oh, well, we're going to continue. We're going to take it down a little bit of a different path. And that path actually comes from [Jennifer Surrency 00:40:18], who asked the question a little bit earlier, which it's really parallel to what we're talking about. Because her question was, how do we encourage our staff, we have these changes, we have these processes that we want to go through. But who are we asking to do this? Who are we asking to go forward with this change? Well, as Jennifer said, it's staff who have from the past two years been burnt out by working extreme hours in extremely unsafe conditions and things like that.
Chris Hemphill (00:40:49):
So, knowing that it's going to take some change. It's going to take potentially going even another extra mile to deliver a great patient experience. Do you have thoughts at the staff level? How do we get our staff excited about delivering these great patient experiences that people need?
Cris Ross (00:41:10):
Ed, do you want to start? Do you want me to take a bash at it?
Edward Marx (00:41:13):
I'll let you go first because that way, it makes me look smarter, because I take whatever Cris says, and I just repeat it.
Cris Ross (00:41:21):
Yeah. So, this is really hard, right? And I would say I'd look at the example from my institution at Mayo. It may sound crazy, but part of what we focused on is saying thanks to the people who had to work incredibly hard. So, some little things like, we tried to give everybody, not just Thanksgiving, but the day after Thanksgiving off. And of course, people had to serve in the hospitals and so on. But it was an extra holiday added to the day to just say in advance, you can take a really long weekend. It's likely a time that you'll be around family and friends and it was a way of saying thanks. We have sent thank you messages to people's homes with little gifts. Not a lot of money, not huge things, but things that are noticeable.
Cris Ross (00:42:18):
Our CEO likes to talk about bringing joy back to health care. And I'm really pleased with a little team. I've partnered up with our HR department, our finance department, because they are kind of big parts of the administrative side of healthcare. And we have three, four, sorry, now four volunteers. We're working on a joy program. That's nothing more than going out to the staff and asking them how do you experience joy day to day, even in little ways, as we push through all this hard stuff.
Cris Ross (00:42:51):
So, obviously, the focus is on the frontline staff. They're getting hit the hardest and it cascades. It's not just the people who are the intensivist, not just the people are doing pulmonary care, not people who are just doing ICU. The load is, is going into other parts of care. And I got to tell you, when I was hospitalized for a month, last summer, I really saw the staff was feeling it in lots of ways. So I am proud of the way our organization and said thank you in an authentic kind of way. I like the way that we are sponsoring right from our CEO, that we're going to try and find ways to get joy in work, and that we're asking our staff, where are you finding joy, and we're turning that into fun videos that get shared.
Cris Ross (00:43:43):
I get it. For a nurse whose face is pockmarked from wearing protective gear for two years, feels like they just can't take it to see sick and dying patients every day. Those kinds of things aren't enough. We need to do more for everybody who is feeling tired, I think because of this pandemic and especially in healthcare and other industries. And I think saying thanks is a way to start. And then you work into practical things like how do we get the staffing levels right? How do we pay bonus pay as appropriate? All those kinds of things add into it as well. Thanks and joy is a good start.
Edward Marx (00:44:26):
Those are good. I would add, one thing that we did for a clinical staff is we added a GROSS button wherever we could. GROSS stands for get rid of stupid stuff. So even within the EHR, there was a GROSS button. And because they're the ones that find the stupid stuff that we make them do that makes no sense and adds keystrokes to their daily work. So, that was another attempt, very successful attempt to help sort of reduce the stupid stuff that they got stuck doing and in reducing the burnout.
Edward Marx (00:44:59):
And then, for nonclinical people, you know, Cris, what's really worked well? And I've done this extensively at multiple locations where I've served is to allow people, give them the opportunity to serve out in a clinical setting. So, these are non-clinicians. So, I'll just give one quick example, my administrative assistant for eight years. So, we did this program, eight years, you could pick any place you want any hospital, any type of care, how you spend a day with a clinician. She delivered eight babies, one per year.
Edward Marx (00:45:29):
And she just found herself in a situation she always picked. She always picked maternity ward, this big intercity hospital in Fort Worth, Texas. And she, for some reason, it was always a single mom having a baby, having a C section. And she held her hand and just they invited her in, all the right paperwork was done. And she got so much joy from work, not because she was my assistant, heck, that would be the opposite. She would tell people, when they asked her, what do you do? She said, "I help deliver babies."
Edward Marx (00:46:01):
So, again, I mentioned this earlier, but our job as leaders is connect what we know here in our mind, oh, I work in health, and I serve in health care, to hear the chest, the heart, and that's when you get true transformation and true culture of patient experience.
Chris Hemphill (00:46:17):
These are extremely important points, because actually in a recent podcast for Hello Healthcare, we just put out an episode where we talked about healthcare ITs role and the administrator role in the customer experience, but who is the customer of IT? Or who is the customer of finance or whatever you serve. The patient is overall the ultimate customer at the center. But a lot of things that we're talking about are seeing our peers and the other others we served within our organization.
Chris Hemphill (00:46:49):
These are our customers too, and everything, especially a big get rid of stupid stuff button, that just sounds like it goes so long a way to improve their customer experience in a way that kind of transfers over to okay, I've freed up this mental energy from focusing on the wrong stuff, the stupid stuff, and I can focus on who counts and what matters, the patient. And I think we have to steal this GROSS, everybody should write that down, and that should just spread all across corporate America, I think.
Chris Hemphill (00:47:20):
There's another aspect to it. And I know we're coming low on time, but we got a question from, I believe, Jamila Hildebrand with regards to so we're talking about this employee experience. What about inclusiveness, diversity, equity and inclusion? I know that you've done some research and some conversations. You focused in, some of your focus groups were four people who are from underserved communities and populations. Could you talk about the DEI efforts and how that might play into improving patient experiences?
Edward Marx (00:47:57):
Yeah. This is an area of great learning for Cris and the focus groups have been really important and we still some more coming up. I know, one is with Inner City Chicago group, that I've already spent some time. They're very informative. Yeah, we want to make sure, the basis of the book and part of the thesis is to make sure that everyone has the same capability for a great patient experience, no matter where they receive their care. You don't have to go to a big academic medical center to have the best experience or a federally qualified health care center. We should even the playing field.
Edward Marx (00:48:41):
So, all the lessons that we're offering and all the things that we're learning are ways in which that individual can take charge. And with the family route, we didn't get into the rest of the model. But we understand that sometimes you can't self-advocate. We're big believers in self-advocacy. But obviously, there's situations where you can't and it's not enough, even if you can. And so, we talk about this concept of your village, which is not only your family. Families are going to always be your advocate. Sometimes ideally they are but not all the time. So, sometimes you have to build your own your own network and you want to do this ahead of time. But it's things like that, that help even the playing field and make sure that everyone receives equitable care.
Edward Marx (00:49:26):
There are parts of our society today. I know this is so obvious, we all know it, but we don't talk about it enough that it's not equitable for them. And so yeah, that's the reason we're doing this research is, is how do we bring that to light? It's simple things and we're getting better at it, but we spent some time with the transgender community. And unless they live and I'm being very general here, but unless they live in New York City or someplace where it's fairly progressive and they've got medical clinics that help transgender specifically. When they seek medical care elsewhere, oftentimes, it's very awkward for them and it's very demeaning for them, not because people are mean spirited, but they don't understand and they don't have the education on how to make sure that they have a great patient experience. And I could go into examples, but I don't think we have enough time. But anyways, those are some of the learnings that we've made. Cris, I don't know if you had any other insights?
Cris Ross (00:50:27):
Well, the thing that really rocked us as we started working on this at the end of 2020, was people might remember the story of Dr. Susan Moore, who is a black physician who died of COVID and unnecessarily so. And she had documented prior to her death, that she felt like her physician who happened to be white, was not listening to her, and said that she was, "He made me feel like a drug addict." And that really stuck with me, discounting, what kinds of pain she was experiencing, not getting her on the right medications and so on, and probably discharging her too early. And the healthcare institution that treated her did an evaluation of their processes and so on and why did that need to happen, but that was just shocking and disappointing that race was a huge determination of that person's outcome. And we know that the BIPOC community was hit hardest by the pandemic, especially in the early days. There is no denying that there is differential care still in the US, and we got to fix that.
Cris Ross (00:51:54):
Again, I just used an example. I'm really proud of our institution. We pledged $10 million to addressing the issue of racism and eliminating it within our system, looking at things like, do algorithms cause bias? But also looking at things like health equity and what can we do our piece to try to address that? This really plagues us. It's really an issue. The difference in zip code is more important than your genetic code. And that zip code reflects in a lot of ways, diversity, equity, racial issues that are not addressed.
Cris Ross (00:52:35):
So, I think it's beyond the scope of what Ed and I are trying to write about how to fix that issue broadly. I think what we're trying to speak to is what can you do within the imperfect systems in which we operate as a patient and to provide maybe some viewpoints that might help all of us think about healthcare a little bit differently as people who help lead healthcare institutions. So again, it started to be a kind of a bummer, but it's an unfortunate truth that that's the system in which we operate, and we got to fix it.
Chris Hemphill (00:53:14):
Well, Chris, especially though, there's going to be some things that que in on in a conversation like this, especially being black, being nonbinary. These are issues that hit me personally. It would also be really interesting to hear offline about some of the research that you're doing in terms of algorithms, because there's a lot of focus that we've had. I think, some on the call may be familiar with some research that came out in 2019, highlighting how, by an algorithm put in place where there might, I would argue that none of the data scientists who developed this algorithm were in the Ku Klux Klan or anything like that. But still they are biased outputs. They were discriminated against black patients for a particular type of care.
Chris Hemphill (00:54:03):
So, I would encourage everyone to look into those kinds of things and do research on where algorithmic bias is possible. Sadly, sadly, I can go on for this. Actually, we've done some webinars in the past on that I could go on for another hour. But I've been told that if we go over time, that can be upsetting to people. So, I want to give people the opportunity. We still have a couple of things that we want to get through. But please don't feel obligated to stay past the top of the hour. This is going to be available to you on YouTube. People can watch it afterwards. But there are a couple of questions and then we'll wrap up from there.
Chris Hemphill (00:54:43):
So, I wanted to get to, actually, I saw a really good question from the chat that I think helps wrap everything together, which came from Jill Halsey, where she said, "Hey, it's kind of echoing a little bit what we were talking about earlier. We've been talking about patient experience for a couple of decades now. Do you think that we've seen progress in transforming care?" And one thing that I'd be curious about is, hey, if we've seen progress, we've seen a lot of technologies popping up in the past couple of years, remote patient monitoring and things like that. What's going to stick? What are some of the recent changes that are going to stick with us? Or do we see at least some recent meaningful change?
Edward Marx (00:55:28):
Well, I think because consumerism, I mean, we talked about, I dropped something in the chat on it as well. I think we are going to see change. That tweet about five years ago, they talked about consumerism and not much has changed. But what's changed now is all the new entrants into healthcare, and I think healthcare is going to be disintermediated as we know it today. And so, I think hospitals are finally going to be forced to make some radical changes to approach with patient experience.
Edward Marx (00:55:52):
Part of that just to answer that question, is sort of multimodal experiences, Chris, is, yeah, I think there should be for those that like it and all the stats I've seen so far, people really like virtual care. We should continue our investment there and offering that as a channel. You'll still need multiple channels for patients, but you better double down, I believe on the virtual care, because that's what people enjoy outside of healthcare.
Edward Marx (00:56:20):
So, one of the lessons learned and that we bring into the book is the thought of best practices across industries. So, healthcare is very insular. We haven't transformed as much as I think we should have. And especially when it comes to patient experience, so look about what our great experiences outside of healthcare and bringing in those same sort of capabilities into healthcare. And another, a quick example again because I want to be practical. Omnichannel, so multiple channels and push on all of them, especially virtual, because everyone loves it, not everyone, but many loves it.
Edward Marx (00:56:49):
And the other is CRM capabilities. You've got to know your people. You've got to know your patients. You might have to have a CRM system, which is very new thinking to healthcare and you want to get all that data because you want to get to that next best action, right? So that's where you take the data, that's the power of the data. It's not only better care, but better experience is because now we take all that data that we have and the AI and all that kind of stuff. And we now say, hey, based on all this about Ed Marx, this is the next best action for him. So as a patient, I'm like, Yes, I get the next best action all the time for some of my other apps outside of healthcare. I want to know what is it for me and my health long term. So that's how I would answer that question.
Cris Ross (00:57:30):
Yeah, I agree completely with that. The other thing that I would say is we can find some patient journeys that have been mapped and have been optimized, and I think give us optimism that we can extend it. I think about things like birthing centers that so many hospitals now have where they create this really fantastic curated experience for women and their partners and families to go through a birth experience and it's well-choreographed, but it's a slice of care. So, it's kind of easy to choreograph that. No offense to people who've done that work. But compared to other journeys, it's maybe straightforward.
Cris Ross (00:58:10):
I think about cancer care. There are standard protocols and treatments that one goes through. And the routine is going to be some combination of chemotherapy, radiation therapy, maybe surgery. Those are reasonably well mapped out and I had a great experience. But my experience was similar to what I think many cancer patients would have elsewhere because they're that way.
Cris Ross (00:58:37):
Pick the idea of trying to just find patient journeys that bash through and challenge the idea of siloed processes is going to be a big piece of it. And finally, you know, Ed and I are technologists. So, that's where we're most comfortable and probably have the most credibility and meaningful insight. I love my patient app. Really great. It didn't have, what I would be interested in is where's the back door? When I was done with care, I felt I was kind of kicked out the door. "All right, you're done. Next."
Cris Ross (00:59:13):
But there's a lot of survivorship issues that come with cancer care, for example. And how can health care organizations support the idea of healthy living and survivorship once your care is done. And we don't do a good enough job with that, because we haven't included that in kind of our mapping. So, I think the talk about patient experience has been great. What I would say is we haven't had the foundational systems to address that with the right kind of electronic health record systems and so on, and now we do increasingly. We haven't had interoperability so people can move different places in the healthcare organization. We're about 80% done with that job. In some places, it works brilliantly. In some places, it doesn't work at all.
Cris Ross (01:00:00):
We've been trying to think about how to create a healthcare oriented patient experience, which comes from the doctor knows best view. And I think we're being challenged, as Ed said, by other industries around, what does the patient want? And how do we build it around the patient's desire, as opposed to the things we've already done? Anyway, I'm taking us past the end of the hour. And that's not fair. But I think those are some of the things that we're going to write about and advocate for.
Chris Hemphill (01:00:29):
Well, fantastic to hear. And Ed and Cris, from both of those. If we're looking for what kind of change is going to last, there's some North Stars that kind of came out of what you were saying. Not just looking at any kind of specific technology, but understanding and listening to patients. That's a North Star. And there's technology and cultural structures that allow us to do that. There's more technology to do that. There's leaning towards that cultural focus. So, it at least sounds for an organization that's looking at those kinds of things as a North Star, then there's at least more capability as interoperability increases and things like that. There's more capability to then drive the cultural change needed to make it happen.
Chris Hemphill (01:01:13):
So just to close things out. We want you to be able to walk away from this with something tangible, something that you can think about and do. So, Ed and Cris have actually prepared some key takeaways that we want to make available. Screenshot it, we'll send it to you. We'll see in this deck afterwards. But yeah, Ed and Cris, I just wanted to give you the opportunity to go through these takeaways and help you through.
Cris Ross (01:01:40):
Especially given the time, I don't think we necessarily need to walk through them, although I might want to highlight a few. I think we've talked about most of these already in various ways. I don't know, Ed, maybe you can do that two minutes fly by, you're the best at this.
Edward Marx (01:01:55):
I agree. We hit a lot of these. Actually, I've been crossing them out actually, as we as we hit them.
Chris Hemphill (01:02:01):
Edward Marx (01:02:02):
So, I would just, if I do a 20-second summary, you see at the bottom, "Patient experience does impact, influences clinical outcome." We have to get it right. We have a moral and ethical obligation to get this right. We got to make it happen. If not those of you who are listening, then who the heck is going to do it? So, I really implore you, encourage you, give you my complete support. And one reason we're writing the book, taking it from the consumer direction towards you, is we got to get better at this. That's it for me, Chris.
Chris Hemphill (01:02:40):
I can't say any better. If one of you listening isn't going to be the one to do that. Then who the heck is? I love it, Ed? Cris, did I interrupt you?
Cris Ross (01:02:51):
Not at all, sir.
Chris Hemphill (01:02:52):
Okay. All right. Well, folks, we appreciate you staying a couple of minutes past with us. We're going to make this conversation available to you and follow up. If you're interested, we can follow up with these slides. If you want to opt in to that. Another thing from the Hello Healthcare Actium Health side, we'll be talking a little bit deeper about this, about kind of related experience tomorrow with Dr. Tony Slonim over at Renown Health. He's CEO of Renown Health. They did some pioneering efforts around home health systems around the time that COVID started. And it's a very similar focus, physician leader who's focused on how to use these technologies and things like that to help fight disparities and look at where we can bring on lasting change with the patient experience.
Chris Hemphill (01:03:48):
With that, I appreciate you. Yuki, thank you for shouting out. Elena, Marsha, Susan. Stephanie, thank you for helping organize this. We really appreciate you, Mindy. Oh, Mindy asked where she can get the book? Does anybody want to answer that quickly before we sign out?
Edward Marx (01:04:05):
Yeah, it'll come out sometime in mid-2022. It'll be available in all the typical places Simon and Schuster. Mayo Clinic Press is the publisher. Simon and Schuster is the distributor. You'll find it, it'll be out there.
Chris Hemphill (01:04:18):
And I'll just say follow Marx Tango on Twitter, follow Cris Rosson LinkedIn. If you follow them, you'll get awesome healthcare insights every day. And you'll know when the book comes out, whenever it comes. I'm sure it'll have something to say about it when it comes out. All right. Well, thank you. I'll hand it back over to Stephanie with SHSMD.
Stephanie Stewart (01:04:38):
Awesome. And just echoing what everyone's already said, thank you for sharing your stories and perspectives. We look forward to seeing this book. And a copy of this recording and some of the information shared will be sent to all of you later today. Thank you and thank you Actium Health for sponsoring today's session.
Chris Hemphill (01:04:54):
Edward Marx (01:04:54):
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