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Culture Change in Nursing Homes

The Case for the Chief Experience Officer


Culture Change in Nursing Homes

Jim Merlino, M.D. Cleveland Clinic's Chief Experience Officer, the first health organization in the country to employ such a position.

@Cleveland Clinic

There has been a lot of talk in long-term care about culture change, person-centered care, person-centered living. Much like hospitals there has been a lot of lip service to changing experiences. Only recently have hospitals become serious around the issue and that is because there is now financial risk (value based purchasing) associated with patient experience. Something as important as the experience we provide to residents and patients should not be left to chance. That is why you need a Chief Experience Officer.

According to the Beryl Institute, organizations that have a person leading experience management have higher quality, better net promoter scores and more satisfied employees. The example for culture change must be led from the top of the organization.

In speaking at the Cleveland Clinic's Patient Experience Summit, I covered the role of the Chief Experience Officer (CXO). At the Clinic, that role reports right to the President and CEO, and to me that is the only way it can be.

As healthcare starts to blur, experiences will extend beyond the hospital walls. That is why long-term care is now on the radar of hospitals. And remote monitoring will now extend hospital reach into the home as well. And home health care will take on an even more important role too. And experiences across the continuum of care must be consistent. That affects both clinical quality and satisfaction. And that in turn affects word of mouth marketing.

And after all, word of mouth is your most important marketing tool and word of mouth is nothing more than offering great experiences that people talk about. But today that word can spread exponentially through social media.

So here are three roles the CXO can assume to enhance patient experience:

  1. Chief Promise Keeper
    Aging services markets something people do not want. We can't issue a Groupon to buy one right knee rehab and get the left one free! So what happens? Over time the consumer is saturated with marketing messages. Meanwhile people are leaving facilities or experiencing services in the aging continuum. They have a bullhorn in hand sending messages to people they know and others. Over time expectations are set. So when another person becomes a patient/resident and experiences what you have to offer, the experience better match the expectation. If not, you're net promoter score will be worthless.

    As Chief Promise Keeper, the CXO must assure experiences are consistent across the organization, even the marketing experience. Marketing, especially with social media, is about telling stories. And surfacing great patient stories is a haphazard event in most organizations. But when you have a position devoted to experience management you start setting a culture of storytelling. This also allows an organization to fit appropriate roles under the Chief Promise Keeper because let’s face it everyone who is patient/resident facing is a keeper of the promise. That is why at the Cleveland Clinic, for example, departments like environmental services and others report to the CXO. It also makes sense for the resident and family council initiatives to be overseen by your CXO.

  2. Chief Healing Officer
    Quality improvement starts with culture change. Yet the healthcare culture is far different than most organizations. In fact healthcare workers are like firefighters. Bottom line: Firefighters have the community of the firehouse to grieve and celebrate and then go home clean. Healthcare workers take it all home and that has consequences, which lead to quality issues.
    As Chief Healing Officer, the CXO will ratchet up the notion of your Employee Assistance Program, institute policies like Code Lavender and assure that pastoral care is not on the chopping block. And much more.

  3. Chief Context Setter
    If you buy the above, still, experiences have not changed a great deal in healthcare. Part of it is that we layer experience management on to someone's role, not permeate it into the culture. We spend more time charting than caring. Employees do not grasp their ultimate roll as healers. We then try to map experiences and script people when we simply need to show them the way and let them figure it out.

    As the Chief Context Setter, the CXO is an organizational leader who infuses patient experience into the culture. That manifests in the on-boarding processes, orientation and elsewhere. It is a leadership role that must report to the CEO.

Benchmark Senior Living

Benchmark Senior Living employs a VP of Customer Experience that reports directly to the Chief Operating Officer. OK not the CEO but close. This person’s role is to develop and execute long term strategies that enhance the customer experience and drive business performance. This is accomplished by leveraging four connected customer platforms: Business Development/ Strategic Partnerships, Customer Experience Feedback (CRM), Programmatic Development, Execution of Programs. While somewhat tactical in nature, nonetheless it is grounded in research that supports changes initiatives. And interestingly one of the roles of the position is to support the role of the Activity Directors as the experts and drivers and of the customer experience- both internal and external. That’s good stuff.

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