BY: PEGGY KURUSZ, MBA, DAVID FRANZ, MHA, MAHCM, and PAT A. HERRMANN, PhD
Described by the Centers for Medicare and Medicaid Services (CMS) as legislation "that puts consumers back in charge," the tenets of the Affordable Care Act — access, quality and experience — are fundamental drivers of an evolving health care system. And with the creation of government-sponsored consumer information websites such as HospitalCompare.com, our attention to the needs and desires of patients receives even more scrutiny.
At Ascension Health, the Catholic Identity Matrix is the framework that supports the individual needs of patients in the context of Catholic health care. Thus, delivering a consistent, exceptional patient experience is a matter of mission, not marketing or business strategy.
Physicians play an integral role in providing the experience our patients and families desire, not only because of their medical expertise, but because of their role in designing and implementing the care plan, serving as "quarterback" of the care team. Teamwork not only assures patient safety — the level of teamwork patients perceive is one of the highest determinants of an exceptional experience.
In 2006, Ascension Health collaborated with the Veritas Institute of the University of St. Thomas, St. Paul, Minn., to refine a mission assessment tool to gauge how well the principles of Catholic health care were implemented into operational processes and the resulting outcomes.
Ascension and other Catholic health systems use the data-driven Catholic Identity Matrix to document areas of excellence, as well as opportunities for improvement. The tool shows the notable impact Catholic health care's principles can have on the patient and physician/caregiver experience.
The matrix focuses on six principles of Catholic health care, three of which play a particularly important role in improving the physician or caregiver and patient experience — holistic care; respect for life; and participatory community of work and mutual respect. They are defined this way:
Holistic care: Holistic care is the healing of the whole person in and through caring relationships. Each person is an inseparable unity of body and spirit (1 Corinthians 15:44). Catholic health care institutions seek to care for the whole person in an integrated, compassionate manner, attending to the physical, psychological, social and spiritual dimensions of each patient's existence.
Respect for human life: The Catholic health care ministry is rooted in a fundamental commitment to promote and defend human dignity. This is the foundation of its concern to respect the sacredness of every human life, from the moment of conception until natural death.
Participatory community of work and mutual respect: Made in the image of God, people can develop authentically only if they are allowed to use the intelligence and freedom that God has bestowed upon them. To this end, the organization seeks to push decision-making responsibility to the most appropriate level of the organization and to provide the support, including training and development, needed to enable this responsibility to be exercised effectively.
There are strong linkages between these three principles of Catholic health care and the patient and physician experience. At Ascension Health we are committed to measuring and improving these areas.
Providing excellent care requires a particular focus on high quality clinical care in safe, clean environments supported by efficient processes. But the patient as person is fully realized when we focus on the relational elements of care, including compassion and respect, effective communication, empowerment and care responsiveness. Dedication to meeting these needs has guided our intentional improvement efforts over the past several years, advancing the Catholic principle of holistic care by attending to the physical, emotional, social and spiritual needs of individuals. We measure this progress by the "willingness to recommend" question on our patient satisfaction survey, and Ascension Health has experienced a 25 percent improvement in this score over the past seven years.
The principle of participatory community is another significant commitment to our vision that serves as a foundation to the patient experience. As with other health care organizations, Ascension Health has found a strong correlation between associate engagement scores and patient experience loyalty scores. Drivers of physician engagement in many ways mirror what our patients desire — to be treated with reverence — but also the opportunity to use their individual gifts in concert with other caregivers to bring healing to individuals and communities in a participatory community of work and mutual respect.
These three principles — providing holistic care, respecting human life and fostering a participatory community of work and mutual respect — are all significant parts of Ascension Health's meaningful improvement approach that drive overall quality and patient experience. Effective strategies for incorporating the principles include situational training in communication and relational skills; adopting practices that foster improved collaboration and teamwork; and including physicians in formation efforts.
COMMUNICATION TRAINING
Increasingly, Ascension Health and other health systems are recognizing the importance of improving physicians' interpersonal communication skills to achieve improved clinical quality and safety as well as the patient experience. Specific high-impact techniques we have begun to deploy include active listening, engaging patients and families in the care plans and using patient-centered interviewing.
Investment in physician communication competency increases their ability to meet a patient's emotional and spiritual needs. Timely and empathetic communication supports three important attributes of patient experience: compassionate and respectful care, empowerment and care responsiveness.
Health systems should make use of effective learning approaches that not only teach communication practices, but allow physicians to practice and improve them over time. Especially helpful are individual coaching and role-playing using video review in a safe training environment. Effective, timely, empathetic communication supports human dignity when we acknowledge, validate and act upon the needs patients are expressing, thereby demonstrating the unique and infinite worth and sacredness of all persons in our care.
TEAMWORK AND COLLABORATION
Establishing evidence-based practices that support teamwork honors the unique training that physicians, nurses and other caregivers bring to patients and families. Practices that Ascension Health has implemented to support teamwork include interdisciplinary rounding, palliative care, care consults and huddles. These tools improve communication, coordination of care and directly improve the patient experience. Teamwork among caregivers increases the patient's sense of safety and improves experience when a patient perceives a group of individuals with accountability and shared commitment to their well-being and healing.
FORMATION
Physician engagement in formation efforts is another important activity to live out Catholic principles and improve the patient experience. Ascension Health continues to broaden and deepen its physician formation efforts across the ministry.
Many physicians face burnout or have become disillusioned with health care and even their own profession. Formation is an ongoing transformative process that opens physicians to God's creation and connects them more deeply with God, self, others and the world. Involving physicians in formation can allow them to have a fuller understanding of health care as a ministry and a heightened awareness of the healing gifts they bring, enriching their calling of serving in a healing ministry.
Formation efforts enhance a participatory community by offering physicians the opportunity to reflect on their role in relation to other caregivers and how their own beliefs and resulting behaviors can enhance or hinder their ability to relate to and care for patients and their families.
Assessing our Catholic principles of holistic care, respect for human life and participatory community serve as more than a way to define our Catholic health care identity. The Catholic Identity Matrix guides us in providing a holistic and healing experience for our physicians and our patients. Intentionally advancing these principles as a strategic framework builds the foundation for aligning practices and activities that support Catholic health care's strategic priorities — quality, safety, associate engagement and living out our commitment to the dignity of patient and person and the sacredness of all life.
PEGGY KURUSZ is vice president of mission initiatives, DAVID FRANZ is director, experience team, and PAT HERRMANN is director, research and analytics experience team, for Ascension Health, St. Louis.