[Podcast] Embracing Patient Experience

I recently interviewed Sven Gierlinger, Chief Experience Officer for Northwell Health—the largest hospital system and employer in New York—to prepare for our EyeforPharma panel, Patient-Centric Care: Does the Doctor Know Best? This podcast is the first in a series of prep for our panel discussion.

Jim Merlino, Chief Transformation Officer at Press Ganey and mutual friend, describes Sven as, “one of the leaders in patient experience today,” and I couldn’t agree more. Mr. Gierlinger has completely transformed the culture at Northwell Health into the most customer-centric organization it has ever been.

Lynn Nye, CEO of Medical Minds, moderated and co-sponsored the panel with me. She has also moderated this podcast.

“Embracing Patient Experience”

Over the last ten years or so we’ve seen corporate America as well as hospitals hone in on and embrace the patient experience. Mr. Gierlinger is responsible for building an engaging, innovative and collaborative culture that drives organizational growth and customer loyalty through the customer experience with a focus on providing exceptional customer service and delivering the highest quality care at Northwell Health.

Defragmenting patient care

The patient experience in a hospital is very different from an ambulatory setting or urgent care center. Mr. Gierlinger and his team are defragmenting these components to ensure the patient experience is seamless across the continuum of care. He wants patients to feel confident knowing that one side of the business is talking to the other. Too often, people are directly or indirectly affected by a lack of communication between care teams.

After spending time in the hospital as a patient herself, Ms. Nye observed this issue first hand, “The big issue was a lack of communication between the different groups … gaps that made a big difference in my life and were very irritating.”

Getting doctors to embrace the patient experience

Neither Mr. Gierlinger nor Michael Dowling, the Northwell Health CEO, comes from the healthcare industry. With that in mind, I asked if he experienced much resistance while trying to roll out a new culture and attitude through his system. “Our physicians are very open-minded and I think it speaks to the existing culture in our organization, which is driven by Mr. Dowling,” answered Mr. Gierlinger. “We treat physicians with respect and involve them in the decision making process. They’re an integral part of the team.” He further emphasized maintaining strong relationships with key influencers, like physicians, are vital for any new initiative.

So far Mr. Gierlinger says this program has been very successful with experienced doctors who have great relationships with their patients, “[Our doctors] are amazed in what they can learn. We give them specific tools and structure around the communication …teaching them how to frame the conversation.” His team has taken this initiative a step further by partnering with Hofstra University and integrating patient experience into the medical school curriculum.

I also loved Mr. Gierlinger's ‘chunk and check’ communication style. He recommends doctors give information to patients in smaller, bite-sized chunks—rather than all at once—and check to make sure the patient understands before moving on. He believes this strategy helps patients more fully understand their care. He added, “It builds an enormous amount of trust between the patient and the doctor. We're teaching them how to ask the questions, how body language affects patients and why, for example, it's important to sit down instead of towering over them.”

These are just some of the practices Mr. Gierlinger is using with doctors, nurses and PAs to improve the patient experience at Northwell Health. “It builds a better partnership between clinician and patient, and patients are more inclined to follow instructions and to understand why. As a result, we are seeing more engagement and higher patient satisfaction.”

There is a lot of great information about transforming patient experience in this podcast. I highly recommend listening to it or reading the full transcript below.

Complete transcript

Stewart Gandolf:
Hello everyone, Stewart Gandolf here with Aria Agency and Healthcare Success. I'm here today with Sven Gierlinger. Sven is the chief experience officer for Northwell Health. I were on a panel together at this years High Performer Conference in Philadelphia along with Lynn Nye, CEO of Medical Minds, who's moderating our discussion today.

Lynn Nye:
We're really excited that you've joined us because the hospital perspective on our discussion is such an important part of the discussion. So thanks so much for being with us.

Sven Gierlinger:
Pleasured.

Stewart Gandolf:
This conference obviously is about pharma. There's this beginning movement in Pharma to embrace patient experience. Patient experience with a view of a private practice doctor is completely different than somebody in a hospital, which is completely different than pharmaceutical.

Stewart Gandolf:
The Pharma side is catching the religion too. They're probably, I don't know, half or a full decade behind hospitals. And hospitals, as you know, are pretty new to this. I remember 10 years ago, doctors telling me and executives, "I don't care if they like us, I just want them to get better.

Sven Gierlinger:
So that attitude has really evolved over time. So anyway, they're very excited about this. This is a hot topic in pharmaceutical and they're grasping in the dark. They don't have any experience, any contact at all. So, there's a few people that are leading the charge. So, I think this would be a well attended panel session. So, Lynn reached out to me and this opportunity to lead this panel came out for us. So, we thought what we could do if you like is go through some of the questions we're contemplating. And again we're looking for your experience on the hospital side.
Lynn Nye:
Yes, actually Sven, could you tell us a little bit about what you do on a daily basis in the hospital? That will be really interesting to hear your perspective.

Sven Gierlinger:
Yeah. So happy to share that. But thank you for inviting me for this call today and this is very helpful. I'm the chief experience officer at Northwell Health. I've been in this role for the past almost five years and I was the first chief experience officer in the greater New York area, and I basically lead all functions of, or impacts, I should say, on patient experience across the enterprise. And we have grown to be the largest healthcare provider in the state of New York now, we we're also the largest private employer with 23 hospitals.

Sven Gierlinger:
We have close to 700 ambulatory locations. We have two hundred ambulances on road every day. We have a very large post-acute division also with a very large home care business, nursing homes, et cetera. We are 68,000 some employees to 17,000 of them are nurses, 4,000 are physicians. So, that's what you were talking about Stewart, and they experience in a hospital is very different than in the ambulatory setting, than in an Urgent Care Center. And then also there's very different experiences based on the acuity, from routine appointments to something that requires quaternary care.

Sven Gierlinger:
We're trying to stitch all of that together and to make it a seamless experience for our patients. So that it is not fragmented and, which it often looks like to the patient that one side of the business is not talking to another and we have various levels of connectivity to that patient.

Sven Gierlinger:
In my world I work a lot on culture. So having rolled out a patient experience training, if you will, to all of our 68,000 employees that is mandatory. We have launched, to address the physician culture, a training program that is an entire day for doctors that they have to participate in. So far we have trained almost a thousand of them and that is centering them around empathy and relationships sensitive care. And what are some of the principles within that they need to keep in mind as they're training the patients in their encounters with them? Whether it is on the inpatient setting, in the ED setting or ambulatory.

Sven Gierlinger:
We do very specific training also for other employee groups and we partner closely also with our corporate university, which we call the center for loading in innovation and HR especially on the engagement efforts of our staff and that's where the overlap between patient satisfaction and employee satisfaction comes to play, and we're trying to have a cohesive messaging around that to our own employees.

Sven Gierlinger:
Then we work a lot on with the various facilities and service lines on having a patient- centric care design and that the care delivery itself incorporate patient centricity. I'm also then focusing on the elements and aspects of hospitality at whether that is a concierge services at the as first impressions or the hospitals or the general environment that is more conducive to healing and not a stark hospital environment that is loud and noisy and distracting.

Sven Gierlinger:
We also launched a major initiative couple of years ago. It's just a way of life now, and that is around food and how do we see food. It's just a horrendous usually in hospitals. And we've made that a major focus area like that also them reaches, it's not just the food we serve to patients and to our employees also, how do we see food as health? And how does it impact of communities? So that ties to our social determinants of health efforts and community health efforts, et cetera.

Sven Gierlinger:
And lastly, just the overall accountability for experience with the goal to make the patient satisfaction, patient experience, patient centeredness as important as quality and safety. As a matter of fact, to stitch those together because the patient often it's one. And as important as a financial results, and that's why I report directly to the CEO. It is a C-suite position and that's something that's further down the ranks and we put a structure in place that allows us to execute on that strategy. So, that's five minute elevator speech, it was a long elevator ride.

Lynn Nye:
Well, so I have to say to you that I really understand why Jim Amalyno said that you are the expert because I haven't had anybody give that in depth and comprehensive view of patient centric care in the hospital, and I think that's fantastic.

Sven Gierlinger:
Maybe I just bottle that as my opening for the talk.

Stewart Gandolf:
It was interesting by the way, Sven. You've only been there, I think you said for five years, which is a long time and hospitalized, but in the rest of the world that's relatively new and that's to show how new this field is. Right? Being a leader of such a big system and the only one doing it in New York at all and it's been five years, just shows how new to the table this is even with hospital.

Sven Gierlinger:
Right. What I didn't mention is that my background is a little typical. I don't come from the healthcare industry, originally, I grew up in hospitality and I worked for the Ritz-Carlton Hotel company for a long time. Long story short is, I was a patient and I was hospitalized for three months. I was paralyzed from head to toe and then I had Guillain-Barré syndrome, if that means anything to you, and found my way into health care through the patient route with the hospitality background.

Stewart Gandolf:
Wow. That's amazing. Is your CEO a clinical background or an executive background from the hospital?

Sven Gierlinger:
Executive background.

Stewart Gandolf:
Okay.

Sven Gierlinger:
He was working for insurance, for a while he was also the commission if Higher Health and Human Services in the state of New York for the previous governor Cuomo. So, he worked on the payers side, on the government side and now on the providers side.

Stewart Gandolf:
Getting something off the ground, doctors are known for embracing new ideas quickly and particularly from either that aren't clinical background. Have you found a resistance? Do you feel like the CEO support really helps you? How does that... it Seems like it'd be really daunting to try to roll out a new culture and attitude through our system. Do you feel like it's been easy or hard or what do you think?

Sven Gierlinger:
I think it's been, you can't say easy but our physicians are very open minded to that from day one, and I think it speaks to the culture that we have in our organization, that is driven by Michael Dowling, our CEO, although he's not a physician. We treat physicians, how physicians need to be treated. They need to be treated with respect, they need to be involved in the decision making and they need to be loved. And they need to be part of the team. And that's the three principles that I personally hang on to, and it's all about the relationships and spending time with them and with key influencers, then you're able to get something off the ground.

Sven Gierlinger:
And the fact that we've now trained over a thousand physicians, is really or close to a thousand physicians it's actually really cool and we compare notes to, with organizations across the country and there's a lot of pushback and they don't know how to get it off the ground and it's difficult and we figured out a way to do that and we get a lot of support from our docs.

Lynn Nye:
I have two questions for you about that, one is what are some of the things that the doctors didn't know that they get out of the training?

Sven Gierlinger:
What are some of the things? I give you a few examples. What we're teaching now is actually what we're... part of that is what we're teaching to our new medical students in our medical school, which we have also in partnership with Hofstra University, but those fundamentals haven't been taught to physicians that have been in practice for a long time.

Sven Gierlinger:
Physicians that are very experienced that have great relationships with their patients, and they think I know how to treat a patient and it's those that then they go through this training and are amazed in what they can actually learn because what we give them is specific tools and the structure around that communication with the patient that enables impassive communication, and build focuses on the relationship between the patient and the doctor, and that is how to frame the conversation, for example. How to making sure that you teaching them how to make an empathic statement to reflect on what the patient says, not to interrupt them. Because studies actually show that if you let a patient speak down, they speak for a minute in something, but the physicians have right that they speak for 10 minutes and they already have to be onto the next patient.

Sven Gierlinger:
If by then, when they give information to the patient that they don't have a litany of things, a five minute monologue and then say, do you have any questions? That they say, go to the first things, "Do you understand this?" "Yes." "Do you have any questions?" "No." "Okay. Let's go on to the next thing." We call that chunk and check. So, we give them specific tools that they can apply and then go back into the medical practice and find it astounding in what they actually find and how even patients they've been treating for a long time and how much better they respond to that.

Sven Gierlinger:
One of our leaders in this, we have now 36 faculty members, that it's physicians led or physician taught, and that one says that she has had more tears now in her office that she ever had before. Because, she feels she gets a lot more out of the patient that she didn't get out of them before. When you asked me what else, what is happening, and it builds an enormous amount of trust between the patient and the doctor. That it was already in a very positive, and now I feel we're just empathizing that.

Lynn Nye:
That's really interesting, actually when you hear Fasiha Haq from Lilly. And Lilly did something that is not on the same level as yours, but they developed a program working with psychologists and with physicians and patient advocates and patients in rheumatology to help doctors get the most out of a time pressured visit. And they did something that's very different than what you... Well, not very different, but they taught them what questions to ask.

Sven Gierlinger:
And we're teaching them how to ask the questions. The whole body language also, and how to, that's why it's important to sit down with a patient in that towering over them. And it's a very comprehensive approach and we make them role play actually within their specialty. Because, they may be doc, their compensation is very different from a cancer doc for example. And they role play and then put this into practice and then we bring them back for a lunch and learn and they talk as a team and share what they've learned, and what struggles they have, and what's been working really well, and it's been phenomenal.

Lynn Nye:
Does that communication improve outcomes for patients?

Sven Gierlinger:
Absolutely, because it builds a better partnership between clinician and patient, and patients are more inclined to follow instruction or to understand why they're doing it, et cetera. And that's for, besides the fact that they are more engaged and have higher patient satisfaction. Our physician communication domain on the age gap side, has been our largest growing or largest improvement amongst all the age gap domains compared to the other domains.

Lynn Nye:
Do you have published data to show that it improved outcome?

Sven Gierlinger:
Not for this specific program yet. We have a study on physician burnout also. So that is actually physician that burn out, which we definitely believe it does. And we have data on patient satisfaction, not published yet. But yeah, we have some data that we can show.

Lynn Nye:
So, the other thing that I wanted to ask you, now let's do and ask some questions in it. But, so what you're doing is obviously right, and it's obviously successful. So, what's the obstacle in other hospital systems throughout the country? And why aren't they doing this?

Sven Gierlinger:
Tradition, a lot to do with it and hierarchies. Another big obstacle is the electronic medical record having taken over, and organizations can figure out how to untangle that web. And, we have this machine now between patient and clinician and everything is about that. And it's about the documentation and certainly regulational, so there's an obstacle within that. And then, there is how difficult and complicated and complex that the payer system functions. I think those are obstacles that our organizations are dealing with and that it's hard for them to break out of that. To focus back on the patient.

Stewart Gandolf:
Really intriguing you say that, because... and wow, things are changing. If that's the issue, I would've jumped right to the providers don't buy in. So, it truly must be a special culture you guys are, because It really varies a lot, and if people ask me about marketing departments of hospitals and all I can say is it varies wildly. Some are really good and others really not.

Stewart Gandolf:
I think patient experience, I mean I have smaller sample size than you do because I'm in and out of this world but I'm guessing it's probably the same. Right? Some hospitals and the culture is they're much more patient centric and others are not.

Sven Gierlinger:
When you look at the marketing side and the experience side and how that is connected and we've depicted that this, we call it a three promises where you have the out branded promise is, what is the messaging to a consumer? Who do we say we are in our community? And then, our patient promises when they are in our care and when they actually, are face to face with us and they are receiving the services from us and we call that our culture of care. And then we have our employee promise also that makes all of that happen in employee promises.

Sven Gierlinger:
What life is like at Northwell Health and what the expectations are and what you get out, but what you put in and with the deal is between us in that workforce. All these three promises are connected.

Stewart Gandolf:
What does the training for the doctors and then I'm assuming nurses, do you have clinicians doing it or is it trainers you guys have employed and what's the background? How does that work in the real world?

Sven Gierlinger:
Who the trainers are?

Stewart Gandolf:
Yes.

Sven Gierlinger:
They are busy docs. Well, they're actually their ow doctors and many of them are in leadership positions. But we have everybody from the... we call our CEOs of hospitals, they call them executive directors. So, the executive directors of North Shore University Hospital, which is our Courtney Gorilla Hospital, is one of the trainers for that position of course, we have medical directors of hospitals, so, CMOs of hospitals.

Sven Gierlinger:
We have service line leaders, but then we also have frontline physicians that do that really, really well and are really good teachers. They have to go through an eight day train the trainer certification program to be certified for that. That's been I think, a key to the success because when you have physicians of that caliber teaching it and everybody else's paying attention to it and saying, "Oh, if they think this is important and that's who is going to be teaching my class and I'm going to have to show up. If they can make the time, I can make the eight hours and they really believe in it then I'm sure that it's going to be worthwhile to participate in."

Stewart Gandolf:
The reason why I asked that question was I assumed it would be critical to be successful, to have doctors involved in training. Again, it's too easy for them to roll their eyes, and say you're not dealing with these people every day.

Sven Gierlinger:
They have been hand selected by our Chief Medical Officer and myself and we've also involved them in the design of the curriculum. The original 12 faculty to make it their own. And because at first what we rolled out didn't land so well, and that we completely redid it with their input. And that now they own it and they are passionate about it and it's a movement. It's a thing and that's that we put the classes out and they fill up immediately. And because we are geographically dispersed and we decentralized it now where we take it out into our various locations and do it locally also that the physicians don't have to drive that far.

Stewart Gandolf:
I'm guessing that's one of huge reasons why this is successful the way you guys are doing it. Who certifies them?

Sven Gierlinger:
We partnered with an outside authority CA Academy for communication and health care. We actually have an agreement with Press Ganey also now. They help you basically stand up this process. And we have one of our faculty on the medical school who teaches communication to our medical students has been involved in the ACH for a very long time, and she is one of our certifiers.

Sven Gierlinger:
She's our own physician, she's also part of the ACH and then the ACH brings another person in from the outside, and it's those two people that do the eight day train the trainer and certify them at the end. We've had people that did not make it. First time started with 15 and we ended with 12 because there were three that either did not have the presentation skills, the facilitation skills that were needed or there were other issues with them. So it's rigorous.

Lynn Nye:
My question was, you said when you first did it, it didn't look out so well, ans so why was that? And the reason I'm asking that is because it's all the obstacles other institutions need to be aware of, when the rolling out a program like this?

Sven Gierlinger:
We're going to make sure that we involve the physicians. It was too much already baked by the time we rolled it out.

Lynn Nye:
Yeah.

Sven Gierlinger:
So, we thought you need to teach that, that there was some resistance and that they didn't... A lot of it was nuances in certain language and things that we needed to change. We went back to the drawing board and involved them. I would say maybe 80% stayed the same or 75% and then the rest was the input from the group.

Sven Gierlinger:
And they say, "Well, if we do it like this, then we think it will stick better." And there were many different things that needed to be changed and that that just strengthens that ownership of the course. It's Northwell now,] it's ours, and that's so important.

Lynn Nye:
I think that's really interesting because if you look at what Pharma does, they spend huge amounts of money on educational programs with physicians and patients. And most physicians... or many physicians don't have a great amount of respect for the Pharma companies. And I think that's really because Pharma companies don't build, and you can correct me if I'm wrong. They don't build the right level of advocacy with the physician community to get the buy in. I mean, would you say that what I'm saying is right?

Sven Gierlinger:
I don't know that too well, but it certainly, I can see that being a problem.

Lynn Nye:
I mean, they do, do lots of great programs. You're going to hear this program from FSA Hawks & Lily that is what actually is being adopted to train fellows in various specialties. So, sometimes they do great things, but other times they do things from their perspective rather than from the physician's perspective.

Lynn Nye:
So, one of the questions I was going to ask you is what about nurses and PAs? How important are they, in the communication with patient?

Sven Gierlinger:
Hugely important, I think it's nurses, and PA's, it's a nursing assistant also that we often forget about that just deliver a lot of the care, and to the patient and what patients... what we find that the patients are looking for and the data from Press Ganey supports that also that patients are looking for a team to take care of them and for communication amongst the care team that the nurses on the same page as the doctor and vice versa.

Sven Gierlinger:
That instills safety then in them where they feel that they are being in safe hands and they again that they can trust the organization and that's the negative examples of that, are that a patient gets discharged and the patient finds out from one of the two and says that from the physician, the nurse doesn't know and the nurse comes in and say I'm getting discharged and the physicians, "Oh really? Haven't heard that yet."

Sven Gierlinger:
But those specifics that are confusing to patients that are frustrating to patients, but nurses are obviously hugely important, and that we have a whole separate training also that is, we started with physicians and then we're doing nurses also.

Lynn Nye:
Actually I have a personal experience. I don't have time to tell you in detail, but I had cancer about five years ago and I'm fine. I'm in complete remission and I'm going to be fine for the rest of my life, and everyone tells me I'll live until I'm a hundred. So anyway, but it was really interesting being in the hospital because really, the big issue was communication between the different groups and although they had a meeting to discuss patients, there were gaps that made a big difference to my life that were very irritating.

Sven Gierlinger:
One thing that just stood out to me as you were talking about the patient centric care. What would we see is that the pendulum is swinging backwards now because I think that it may be Pharmas behind that, but on the provider side we've talked so long about it's been about provider centric care. It was all the physicians make the decisions in what treatment to give and they wouldn't charge etc. All of that into patients just have to follow that.

Sven Gierlinger:
And then patient centric care showed up and it's all about the patient. And the Cleveland Clinic is a great example of how much a pushback Toby Cosgrove got when he rolled out the statement patients first and when he famously says that physician's not going to throw into says that mean we are last. And this conflict between that to twang or all the way to patient centricity.

Sven Gierlinger:
I believe, and that's what our communication course is built around is that, it is about relationship centered care. That is, it's that partnership between the two, between physicians and patients. And that patients are, both of them are technology in the abled now, have a lot more information than in the past. Certainly the patient does and that all of those components aid in the decision making and that it's the relationship at the core of them that make better decisions, make for better outcomes because the patients are more compliant with what they need to do because they are part of it in there that invested in it. And that's what I see.

Lynn Nye:
Actually when we were talking with me and Niece earlier this week, one of the things that she said was we don't have a healthcare system. We have a sick care system.

Sven Gierlinger:
Yeah.

Lynn Nye:
And what we need to move towards is encouraging preventative care and wellness before we will get sick. This whole thing of patient centric care when you're talking about it and what doctors know and don't know, it just really depends on the specialty?

Sven Gierlinger:
Yeah.

Lynn Nye:
And primary care is so important but we don't give it enough time?

Sven Gierlinger:
We don't and that's the models are shifting though, so where in the future that will be a lot more advanced care providers that deliver primary care. Physician's assistant, nurse practitioners are going to be huge in that field and I think there's a lot of predictions there, that primary care moves towards that and they have more time than to actually spend with the patients and in medications, space cases, patients that we really satisfied with the candidate received from that and positions become part of the other more specialized care or come in when needed. So that model is shifting as well.

Lynn Nye:
Do you find patients are accepting of being with a nurse practitioner versus a physician in the first place?

Sven Gierlinger:
Yes they are. And it's all about how I think it is being sold and how the expectations. And how we also obviously it depends on the acuity and on what the patient is there for. And if somebody has cancer and is very obviously concerned about their outcome, they want the physician and they want the best physician there is to help them chart a course. But if it is for routine visits and for what you're talking about, what do we need to get to keep patients well, and to encourage them in the lifestyle choices. And there's so much education involved that often the physicians don't even have frankly, physicians know nothing about nutrition, and then nutrition is so huge, in health and wellness. That's where health coaches come into play also.

Sven Gierlinger:
All those are a lot less costly care than from a doctor and can have such an impact and that can speak to that because my wife is a Nutritional Health Coach and she has people flocking to her that are frustrated with traditional care and they just get one more prescription prescribed for one of the ailments they have.

Lynn Nye:
Yeah.

Sven Gierlinger:
And then, they say, "I had enough, I need to change my lifestyle and please help me." And then a coach can actually... like what a coach on a team, on a sports team does is to motivate and push and stay on, hold people accountable towards progress of the things that a physician doesn't have time for it. Because we put a lot of pressure on them from a productivity perspective also.

Stewart Gandolf:
Thank you Sven, very, very exciting.

Sven Gierlinger:
Thank you, my pleasure.

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