Cultural, Digital Transformations Bolster Patient Experience Focus

March 13, 2019
Partners HealthCare’s Alistair Erskine, M.D., M.B.A., reflects on experience at Geisinger

In July 2018 Alistair Erskine, M.D., M.B.A., left his position as chief informatics officer at Danville Pa.-based integrated health system Geisinger Health to become chief digital health officer at Partners HealthCare in Boston.

Among his responsibilities at Partners include the “elegant optimization of patient experience and clinician workflow using health IT software, utilizing data collected as a by-product transactional system to abstract information for analytical purposes and identify workflow patterns and other unrecognized discovery to improve the timing, sequencing, appropriateness, safety and personalization of healthcare delivery,” according to his LinkedIn profile. 

On March 12, Erskine gave a Harvard Clinical Informatics Lecture on transforming the patient experience, reflecting on industry changes, technology, consumer expectations and his time at Geisinger.

He noted that at the big J.P. Morgan Healthcare Conference in San Francisco this year, many of the large health systems were talking about their “digital front door,” and some are hiring patient experience officers. He said that traditional provider organizations are seeing competition in this space from tech and retail partnerships seeking to provide a better patient experience.

Erskine credited David Feinberg, M.D., former Geisinger CEO, for bringing the patient experience focus from his time as CEO of UCLA’s hospitals and president of UCLA Health System. Feinberg convinced clinicians and other staffers at Geisinger to adopt a patient communication program with the acronym CICARE:

C – Connect

I – Introduce

C – Communicate

A – Ask and anticipate

R – Respond

E – End with excellence 

Erskine gave an example: If he was walking down a hospital hallway hurrying to get to a meeting, he would seek to make eye contact with patients and if they looked lost, he would give them directions or even accompany them to their destination. When staff members started arriving late to meetings at Geisinger, they might proudly say they had to help a few patients on their way to the meeting.

CICARE also changed how staffers dealt with each other. They would hold monthly meetings of 350 Geisinger leaders and begin by pairing you with someone you had never worked with before and come back to the larger meeting to tell stories of what you learned in your discussion with your partner. “This concept was modeled by leadership and audited as it spread through the organization,” he said, adding that it appeared to have the effect of making workers happier and more welcoming.

“It turns out that patients and families liked that,” Erskine said. “When somebody comes to the hospital, it can be unfamiliar and scary. It’s worse if on top of that they have to deal with people who are busy and rushed.”

In response to an audience question, Erskine said that in order for clinicians not to feel rushed all the time, the organization’s digital and cultural transformation has to offload some of the work physicians do with tech tools, care coordinators and virtual scribes.

My colleague Rajiv Leventhal recently interviewed Geisinger Don Stanziano, chief marketing officer at Geisinger, about the intersection between healthcare and marketing. He spoke about upgrading the digital experience, including a physician directory “to make it more robust, easily searchable, and easy for consumers. We are allowing people to request appointments, and in the last 30 days, we have seen an increase in sessions, searches, and in appointments requested,” he said.

Erskine focused on ways the cultural changes at Geisinger were implemented in clinical settings. He noted that efforts to impact the patient experience are somewhat easier for Geisinger because it has both a health plan and a clinical enterprise. 

Geisinger, he said, is looking to go virtual not just in urgent care, but also in chronic disease management and after surgery. He described a pilot in which before spine surgery, patients receive an iPad with videos of their care team from the hospital. “When they arrived at the hospital, they recognized the people caring for them,” he said. “They kept the iPads during and after hospitalizations to show providers what the wound looks like via Facetime. Ninety days later, they sent the iPad back. They are virtualizing that transition of care.”

Geisinger also launched an app called ProvenExperience that lets patient provide feedback. If they were unhappy with their experience, they could even ask for a refund.

“There was some concern people would abuse it, but that didn’t happen,” he said. People were asking for $5 because they were delayed or because the parking lot was full. The real beauty of this program, he added, is that Geisinger got hundreds of thousands of comments that it could connect to its strategic goals.

Erskine mentioned other ways Geisinger is trying innovative ideas to meet patients’ real needs. One of its clinics that manages diabetic patients decided to create a grocery store called the Fresh Food Farmacy. For diabetic patients who might end up in the hospital, they were given healthful food (and cooking lessons) a week at a time. “The idea was that if we could feed patients whose illness is food-related, we could improve outcomes and reduce the cost of taking care of the patient, and they are going to feel better,” he said.

Erskine noted that consumers are asking for a better experience, adding that a few years ago the term “consumer” was something you couldn’t really use in healthcare. Part of the reason is that everywhere else you go — a hotel or travel or Amazon — the experience feels seamless. “Yet in healthcare, it feels like they have gone into a time machine back to the 1980s.”

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