Thomas Lee, MD, chief medical officer for Press Ganey, has a passion for developing clinical and operational strategies that help providers across the nation measure and enhance the patient experience, improve value, and reduce the suffering of patients as they undergo care.

Lee was a primary contributor to a new Press Ganey report, Reducing Suffering: The Path to Patient-Centered Care, which describes how healthcare organizations can identify sources of patient suffering and target opportunities for improvement. In recent discussions with healthcare finance leaders—during a presentation for HFMA chapter members this past spring and a meeting of HFMA's Healthcare Leadership Council, of which he is a member—Lee emphasized the need to examine the patient experience at each point across the continuum of care to identify ways to improve not only patient satisfaction, but also the value of the care delivered.

"One of the things we talked about [during the meeting] was how CFOs should think about things such as reducing suffering and improving patient safety," Lee said. The meeting also addressed how to define the business case for undertaking initiatives that focus on enhancing the patient experience.

In the following conversation with hfm, Lee discusses some of the challenges and opportunities that exist in the effort to alleviate patient suffering—and how CFOs can help initiate changes in organizational culture to support a better experience for patients and improve value.

Q. Why is the issue of patient suffering more important than ever?

A. People in health care have always been striving to relieve suffering. That's been true since the days of Hippocrates. Two or three things are changing that make the need to reduce suffering a strategic imperative for hospitals and health systems.

Because of the tremendous progress made in medicine in recent decades, two things have happened. First, patients' expectations and hopes have increased. Frankly, a generation or two before the baby boomers, people were more philosophical about dying. Now, the baby boomers, in particular, have greater expectations regarding both their life span and the quality of life they should be able to have; they want to go on playing tennis and softball and enjoying life for as many years as possible, no matter what health challenges they face. The expectations and desires of patients have changed.

Second, we can do so much more in medicine because of all the progress and expertise of those who provide care—and there are so many people involved in care now. Patients' experiences in the healthcare system can be scary and chaotic. I was recently exchanging emails with a urologist, a pathologist, and an interventional radiologist regarding one of our patients. It wasn't clear who among the four of us was actually going to speak with the patient about the results of her biopsy and what the next steps would be. The chaos of modern, highly sophisticated health care can exacerbate a patient's suffering, and that effect will only increase as health care becomes more complicated.

There are two major reasons that the push to improve the patient experience has direct relevance to CFOs. One is that there is real pressure from the marketplace to become more efficient—to reduce waste. The other reason is an improved patient experience translates to increased market share. If you can organize providers to work together to meet patients' needs and reduce the anguish, confusion, and uncertainty that are increasing because of the complexity of care—if you can alleviate that kind of suffering—you will be rewarded, because patients will want to come to you.

Q. What are some of the specific challenges that health systems face as they seek to alleviate patient suffering?

A. One explicit challenge that is clearly on patients' minds is how well-coordinated their care is. When I was coming out of med school, I knew my patients were afraid of their diseases and afraid of their treatments. Now, it's very clear they have a third fear: They're afraid we don't have our act together—that we're not talking to each other, that things are going to slip through the cracks, or that they're getting conflicting advice.

That third fear—that their care is not coordinated—is a very important problem. When you're face to face with patients, that fear is very obvious. In the old days, I think many physicians like myself thought the whole game was about how much confidence patients had in us as individual caregivers. I would hang my diplomas on the wall and hope that they impressed patients, and I would use big words and that kind of stuff to make my patients feel they were in good hands. Now, patients still want to feel confident about the expertise of their individual caregivers, but they also worry about the ability of the physicians and other clinicians who constitute their care team to share information with each other and make the best recommendations on behalf of the patient. Making coordinated team care a real cultural value has become a very big deal.

We're not talking about a team that performs one hernia procedure after another. We're talking about teams that are holistic and that are oriented to a segment of patients with similar needs. I have to tell you that the science of measuring team performance is in its early stages. I'm sure that five years from now, it will be much more advanced. Right now, even identifying who is on a particular care team and which patients are associated with the team is harder than one would think. But I think we'll get there.

Q. To what extent is systemwide cultural change needed?

A. At Press Ganey, we hope we are driving the evolution of a culture in which our goal is not only to avoid harming people, but also to actively work to reduce suffering. That means anticipating suffering, measuring it, and doing what we can to organize ourselves to reduce it. Acknowledging that our job is not just taking care of the kidney or the heart, but also reducing the suffering of patients, is critical.

At Press Ganey and across the industry, we've been breaking down the ways in which patients suffer. It's complex, but not that complex. For instance, patients often feel a tremendous sense of loss of autonomy and dignity during the care-delivery process. Once an organization knows its patients are experiencing such feelings, it can work to address the issue with input from clinicians and staff. We also have come to realize that patients worry about the impact of their disease on their families. Now I try to ask every patient, "How is your diagnosis affecting your family?" and listen carefully to their answers. Patients are traumatized by not knowing what's going to happen next, and healthcare leaders and professionals should recognize and acknowledge that issue. When hospitals and health systems take the initiative to involve staff in alleviating patients' fears and anxieties, I believe they will have people who are prouder and happier about the work they do—and will experience less turnover as a result.

Q. How can accountability be established for alleviating patient suffering?

A. A major strategic challenge related to suffering is helping clinicians understand that every single encounter with a patient is a high-stakes interaction. From my experience working with many physicians, I don't think any view themselves poorly. All physicians think of themselves as wonderful healers, but they're basing their self-image upon a limited subset of their interactions. A physician may behave wonderfully with just one or two people a year, but that can still shape the way that the physician looks at himself or herself. When I was in medical school, my tutor said to me, "The next patient for you may seem like just one more patient, but for that patient, the visit with you may be the biggest thing that's happening today—or even this whole month."

In our work at Press Ganey, we are trying to help physicians recognize that every interaction is a high-stakes interaction that is going to shape the way they look at themselves. That's why I think one of the really fascinating things going on right now is provider-driven transparency. The University of Utah Health Care, Piedmont Healthcare, and Wake Forest Baptist Health have begun putting every single comment they receive about their physicians on their websites. When you know that every single patient is going to get an email survey—which is the model that we're increasingly moving to with clients—and that they're going to have the chance to comment on you, and that the comment might be online in just a couple of weeks, it makes a big difference. As one surgeon said, "You're forcing me to be at the top of my game for every patient." She understands that this is a good thing.

It's very good from a business perspective as well as a moral perspective. Patient surveys are a powerful tool that has significantly improved performance and the patient experience, and therefore one would expect that publishing patient feedback online would lead to better market share for Utah, Piedmont, and Wake Forest. I think there are a lot of other organizations that are coming down this road.

Q. What should be the takeaway message for healthcare finance executives?

A. My message for finance leaders is that you have to think of improving the patient experience as something that is critical to market share. It may not improve your profitability on each individual admission or each individual visit to the office, but if you're not paying attention to the patient experience and trying to improve it, you're going to have bigger problems than your margin per case—because you won't have cases. So think of this as a market-share issue.

I think finance leaders have to actually pressure the rest of the organization to worry about market share, and they have to be ready to invest in the kinds of systems that will help coordinate care. They have to help push incentive systems that reward clinicians for working together and improving the patient experience. And some of those incentive systems won't be related to money. Consider the example of publishing patient feedback online—it's a nonfinancial incentive, but it's a pretty powerful one.


Nick Hut is senior editor, HFMA's Westchester, Ill., office.


About Thomas Lee

Thomas Lee, MD, brought more than three decades of expertise in healthcare performance improvement to Press Ganey when the organization hired him as its chief medical officer in April 2013.

Lee has been an internist and cardiologist, a leader of provider organizations, a researcher, and a health policy expert. He maintains a regular schedule as a primary care practitioner in Boston while working full time to help providers identify performance improvement opportunities across the continuum of care in his role with Press Ganey.

Lee, a member of HFMA's Massachusetts-Rhode Island Chapter, also serves on HFMA's Healthcare Leadership Council; the Panel of Health Advisors for the Congressional Budget Office; the Special Medical Advisory Group for the U.S. Department of Veterans Affairs; and the board of directors for Geisinger Health System, an integrated health-services organization that provides care to more than 2.6 million patients in Pennsylvania.

Before joining Press Ganey, Lee was network president of Partners HealthCare and CEO of Partners Community HealthCare, overseeing efforts to improve the quality and efficiency of care provided by a network of 1,000 internists, pediatricians, and family practice physicians, and more than 3,500 specialists.

Lee has written more than 250 academic articles on the patient experience in addition to two books, Chaos and Organization in Health Care and Eugene Braunwald and the Rise of Modern Medicine. A graduate of Harvard University and Cornell University Medical School, he has been a professor at Harvard Medical School and the Harvard School of Public Health, and associate editor of The New England Journal of Medicine.

Publication Date: Friday, August 01, 2014

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