Latest / Becker’s Healthcare Podcast / Improving Patient Experience Through Frontline Care with Eddie Borrego

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Improving Patient Experience Through Frontline Care with Eddie Borrego · Becker’s Healthcare Podcast

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  - The strategic agenda facing hospital and health system
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  - 400 speakers across four days of sessions that
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  - Not in the abstract, but against the real
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  - It's the kind of event you leave with
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  - what comes next.
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  - So join us November second through the fifth
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  - at the Hyatt Regency in Chicago,
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  - and come ready to do the hard thinking.
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  - Register on our events page at beckershospitalreview.com
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  - upper right.
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  - Hello everyone and welcome to the Becker's Healthcare
• 1:01
  - Podcast.
• 1:02
  - I'm Mackenzie Bean, associate vice president and managing
• 1:05
  - editor of Becker's Hospital Review.
• 1:08
  - Today, I am very excited to be joined
• 1:10
  - by Eddie Borrego, who is chief experience officer
• 1:13
  - of Jackson Health System.
• 1:15
  - Eddie also serves as senior vice president and
• 1:18
  - chief executive of the system's regional hospital network
• 1:21
  - and physician services.
• 1:22
  - Eddie, thank you so much for joining us
• 1:24
  - on the podcast today.
• 1:26
  - Thanks for having me, Mackenzie. I appreciate you
• 1:28
  - and the and the listeners that are gonna
• 1:29
  - join us today.
• 1:31
  - Yeah. It's gonna be a great conversation.
• 1:33
  - Before we dive into
• 1:35
  - the meat of that, I'd love to turn
• 1:36
  - it over to you to to share a
• 1:38
  - little bit more about
• 1:39
  - yourself and your role because I do think
• 1:41
  - you sit in a really interesting
• 1:43
  - seat at Jackson Health System both looking in
• 1:46
  - a CEO role and experience officer role.
• 1:49
  - Yeah. Thank thank you for that. So it's...
• 1:50
  - It is an interesting role and an exciting
• 1:52
  - time for... Here for Jackson Health System. We've
• 1:54
  - been around for over a hundred years, and
• 1:57
  - I've been at Jackson,
• 1:58
  - I'd say about thirteen years
• 2:00
  - in
• 2:01
  - multiple roles and really have learned the organization
• 2:04
  - from the operation side to the consumer side,
• 2:08
  - the clinical side and so my my current
• 2:10
  - role is is a few. I've got a
• 2:13
  - lot of roles.
• 2:14
  - One of them is to oversee our regional
• 2:16
  - hospital network. So
• 2:18
  - we've got three hospitals out in the community
• 2:20
  - and so all of those report up to
• 2:22
  - me on the on the, their CEOs report
• 2:24
  - up to me.
• 2:26
  - And then I also oversee our physician services,
• 2:30
  - network. So that's all of our physicians and
• 2:32
  - our outpatient
• 2:34
  - space.
• 2:35
  - Additionally, I'm also the chief experience officer which
• 2:38
  - is a role I took over about five
• 2:40
  - years ago.
• 2:41
  - So
• 2:42
  - it's it's pretty unique in that typically, you
• 2:44
  - know, you see patient experience more in an
• 2:47
  - advisory role,
• 2:48
  - setting standards and really
• 2:51
  - co, you know, co creating with the operational
• 2:54
  - leaders a a robust patient and consumer experience
• 2:58
  - program.
• 2:59
  - Here, because I kind of sit in both
• 3:01
  - seats, we... I'm really able to blend, you
• 3:04
  - know, what
• 3:05
  - we say we can do and what actually
• 3:07
  - operationally works
• 3:08
  - and what the theory and the research says
• 3:11
  - we we should be doing on the patient
• 3:13
  - experience and consumer side.
• 3:14
  - So it's really been been fun,
• 3:17
  - to to develop a really
• 3:20
  - great program which has taken Jackson from being
• 3:23
  - a one star organization
• 3:24
  - five years ago,
• 3:26
  - to
• 3:28
  - a short four years later going to a
• 3:30
  - three star organization as it relates to patient
• 3:33
  - experience,
• 3:34
  - with CMS and LeapFrog.
• 3:37
  - So,
• 3:38
  - I think the experiment,
• 3:40
  - has worked,
• 3:41
  - and, you know, we'll we'll talk about about
• 3:43
  - it as we get through the interview.
• 3:46
  - Yeah. I mean, as you said, already
• 3:48
  - significant
• 3:50
  - progress. So, I mean, let's jump deeper into
• 3:52
  - that.
• 3:54
  - What what have been the elements of this
• 3:56
  - experiment? What sorts of changes have you made
• 3:58
  - over the past few years that have brought
• 4:00
  - some of those patient experience gains?
• 4:03
  - Yeah. We we had done a lot of
• 4:04
  - work in the past around data and making
• 4:07
  - sure that we understood what the patients were
• 4:09
  - saying and needed. So we we had a
• 4:11
  - great data program,
• 4:13
  - but I think where we were lacking was
• 4:15
  - really, you know, assuming that our caregivers wanted
• 4:17
  - to do the best, but maybe they didn't
• 4:19
  - have a playbook on what the best looked
• 4:21
  - like.
• 4:22
  - And and what for our patients they value
• 4:24
  - and recognize and see as a positive
• 4:28
  - patient
• 4:29
  - and consumer experience because they're, I think they're
• 4:31
  - two different things.
• 4:33
  - So we developed a program, we we brought
• 4:35
  - in, we have an HRO model that we
• 4:37
  - use here at Jackson.
• 4:38
  - We brought in a lot of our frontline
• 4:40
  - caregivers and different, our nurses, our doctors, ancillary
• 4:44
  - teams,
• 4:44
  - as well as some of our patients that
• 4:46
  - have had great experiences but also not so
• 4:49
  - great experiences.
• 4:50
  - So we created a, a playbook, if you
• 4:52
  - will,
• 4:53
  - full of what we call care action tactics.
• 4:56
  - So their actions that are backed by research
• 5:00
  - and by what the front line says,
• 5:02
  - you know, they do on a daily basis,
• 5:05
  - that are visual actions and cues
• 5:08
  - which we train them on,
• 5:10
  - that our patients recognize and see as
• 5:13
  - care in action. So, providing great patient experience
• 5:17
  - is not just that
• 5:18
  - we are hanging the IV bag and administering
• 5:21
  - the medication
• 5:22
  - and and talking to the IV bag, we're
• 5:24
  - actually
• 5:26
  - hanging the IV bag but speaking to the
• 5:28
  - patient, explaining what we're doing,
• 5:30
  - asking them for their preference when we're gonna
• 5:32
  - draw blood, right, what arm do they prefer,
• 5:35
  - really explaining and going through some of the
• 5:37
  - different details in care,
• 5:39
  - some of, some of the things are, they
• 5:41
  - have, we gave them kind of fun names
• 5:42
  - and we have one that's called a warm
• 5:44
  - welcome so it's an action that our nurse,
• 5:47
  - provides for our patients and their families as
• 5:50
  - soon as they get up to the unit
• 5:51
  - from the emergency room.
• 5:53
  - It's commit to sit, so our physicians have
• 5:55
  - a care action tactic where when they are
• 5:58
  - explaining and meeting with our patients and their
• 6:00
  - families,
• 6:00
  - they're, you know, required and encouraged to sit.
• 6:04
  - So all of these are visual cues
• 6:06
  - that,
• 6:08
  - represent to the patient that there is care
• 6:10
  - happening
• 6:11
  - that is patient forward and centric
• 6:13
  - but also it allows our leaders,
• 6:16
  - our nurse managers, our physician leaders
• 6:18
  - to really be able
• 6:20
  - to survey our units and see that these
• 6:23
  - visual cues are happening,
• 6:25
  - right? So they're able to audit that our
• 6:27
  - nurse is explaining, you know, the care, they're
• 6:30
  - able to audit, we have a care action
• 6:32
  - tactic which, which we do for all of
• 6:34
  - our patients which is a discharge phone call.
• 6:37
  - We call all of our patients within twenty
• 6:39
  - four hours of discharge.
• 6:41
  - The caregivers who cared for those patients will
• 6:43
  - call and we'll make sure that, you know,
• 6:45
  - they got the medication that they needed, that
• 6:46
  - they understood their plan of care.
• 6:49
  - So we're able to audit those phone calls,
• 6:51
  - we are able to assess if we provided
• 6:53
  - a great experience
• 6:55
  - and then later when we get our patient
• 6:56
  - experience surveys back, we're able to track and
• 7:00
  - trend if, you know, if certain units are
• 7:02
  - performing
• 7:03
  - based on doing the care action tactics, if
• 7:06
  - that aligns
• 7:07
  - to our actual Qualtrics,
• 7:10
  - survey results.
• 7:11
  - So it was a very methodical program that
• 7:14
  - we put together a playbook,
• 7:16
  - right? We call it the care action tactics
• 7:18
  - playbook and we spent close to a year
• 7:21
  - training everybody on the playbook. There was a
• 7:23
  - playbook for our frontline leaders and then also
• 7:26
  - a playbook for our leaders,
• 7:29
  - and then a playbook for our caregivers.
• 7:31
  - So everyone had a a playbook that all
• 7:33
  - aligned, so the warm welcome had a, had
• 7:36
  - a component that was for our
• 7:38
  - caregiver,
• 7:39
  - the warm welcome had a component that was
• 7:41
  - for our caregiver leader,
• 7:43
  - and then the care, the warm welcome had
• 7:45
  - a component that was for our overall
• 7:47
  - leader so that we could, everyone was kind
• 7:50
  - of following the same, the same path on
• 7:52
  - track.
• 7:53
  - I think that that's that inconsistency
• 7:55
  - has really played a big role in ensuring
• 7:58
  - that our caregivers
• 8:00
  - were trained on the right behaviors
• 8:02
  - that are modeling to our patients that we
• 8:05
  - that we really mean business and that the
• 8:08
  - business that's the most important is the business
• 8:10
  - of care for them.
• 8:12
  - Very much so and I think that's such
• 8:13
  - a
• 8:14
  - great example of,
• 8:16
  - a strategy and initiative that
• 8:18
  - translates the patient experience, work, and strategy to
• 8:22
  - the frontline operations. Like you said, very reflective
• 8:24
  - of your own role and sounds like really
• 8:26
  - trying to maximize
• 8:28
  - every opportunity
• 8:29
  - for human meaningful connection
• 8:32
  - in the typical
• 8:33
  - care journey as possible.
• 8:35
  - Let's zoom into those patient experience metrics,
• 8:39
  - one bit more.
• 8:41
  - How are they tracking
• 8:43
  - this year? I know you mentioned your CMS
• 8:44
  - star ratings.
• 8:45
  - Can you share anything more about some of
• 8:47
  - the successes or challenges that you're seeing?
• 8:50
  - Yeah. I think, you know, I think with...
• 8:51
  - As with all of us, there's
• 8:53
  - challenging environments and populations. We we are... We
• 8:57
  - do enjoy a a very diverse and rich
• 8:59
  - community where we have, you know, hospitals serving
• 9:02
  - urban core areas with the traditional challenges
• 9:05
  - that come with that and then the community
• 9:08
  - setting and we do typically see that in
• 9:09
  - our community setting. Our patient experience, our patients
• 9:12
  - demand a little more but the patient experience
• 9:15
  - scores are better. And then on our urban
• 9:17
  - core, you know, we still see they demand
• 9:20
  - more, but our our scores are not not
• 9:22
  - as great. So, you know, it's... That's always
• 9:26
  - a challenge, I think, for a lot of
• 9:27
  - our healthcare systems that have very diverse populations
• 9:30
  - that we serve.
• 9:32
  - I think in the emergency room is still
• 9:34
  - just a big challenge
• 9:36
  - with such a transient population that,
• 9:39
  - you know, I think what we're seeing is,
• 9:41
  - it's funny because,
• 9:42
  - you know, I think when our patients come
• 9:44
  - into the emergency room, they expect and know
• 9:45
  - that they're gonna have to wait.
• 9:48
  - But what we see when we look at
• 9:50
  - all of the comments
• 9:52
  - is that because it doesn't... The comments don't
• 9:54
  - ask you some questions that are thinking important.
• 9:56
  - What we see, the insights that we gather
• 9:58
  - from the friction in the emergency room is
• 10:01
  - that
• 10:02
  - they knew they had to wait, but what
• 10:04
  - they wanted to really know was get more
• 10:06
  - information. They wanted to know the status of
• 10:08
  - their test. They wanted to know the status
• 10:10
  - of their diagnosis.
• 10:12
  - They wanted to know if the physician had,
• 10:13
  - you know, had next steps or recommendations.
• 10:16
  - They wanted to know what the x-ray showed.
• 10:19
  - They knew they had to wait and that
• 10:20
  - was an expectation,
• 10:21
  - but what they weren't getting was the information
• 10:23
  - that they needed.
• 10:25
  - So it's really how
• 10:26
  - do we tackle that, you know, that in
• 10:29
  - the transient, very busy environment where, you know,
• 10:32
  - you have a nurse managing multiple patients that
• 10:35
  - will change over the period of their shift,
• 10:38
  - right, it's not the same patients that you
• 10:39
  - have upstairs
• 10:40
  - for a whole shift, how do we solve
• 10:42
  - for that? So we're still working through and
• 10:44
  - learning
• 10:45
  - from our patients and our caregivers,
• 10:47
  - what's the secret sauce in the emergency room?
• 10:50
  - So I think that's lagged a bit.
• 10:53
  - On our inpatient side, I think there's been
• 10:55
  - great success,
• 10:56
  - and I think that's attributed largely to this
• 10:59
  - playbook that we developed where again, let's assume
• 11:02
  - no ill intent, assume our caregivers
• 11:05
  - want to do their best and are doing
• 11:07
  - their best, but maybe they're
• 11:09
  - not modeling certain behaviors,
• 11:11
  - right, that our patients are recognizing
• 11:14
  - as
• 11:15
  - very patient forward and as positive for our
• 11:17
  - patients.
• 11:19
  - You know, one of the things that that
• 11:21
  - is changing is, you know, CMS is allowing
• 11:23
  - or will be allowing,
• 11:25
  - our family members or family members to fill
• 11:27
  - out the survey.
• 11:28
  - And and that makes sense because a lot
• 11:30
  - of our patients, you know, maybe geriatric or
• 11:33
  - or, you know, are leaving in a condition
• 11:36
  - that they maybe they're not feeling great to
• 11:38
  - fill out the survey and and family members,
• 11:40
  - especially here in South Florida,
• 11:42
  - our family members are with our patients, you
• 11:44
  - know, many of the times. So they're the
• 11:46
  - ones that are consuming
• 11:48
  - the information, the friction points. So we we
• 11:51
  - do wanna hear from them, But
• 11:54
  - that will require us to change how we
• 11:56
  - communicate,
• 11:57
  - and potentially introduce a new care action tactic
• 12:00
  - where the conversation around care is not solely
• 12:04
  - focused
• 12:04
  - around the patient, it's inclusion and inclusivity with
• 12:08
  - those in the room. Clearly, the patient has
• 12:10
  - to be okay with it. But, you know,
• 12:12
  - we wanna loop in family members into into
• 12:14
  - the care conversation,
• 12:16
  - because
• 12:17
  - family members can now answer surveys and care
• 12:20
  - coordination
• 12:21
  - is a new is a new question. Right?
• 12:23
  - So, you know, how well did your team
• 12:25
  - coordinate care? How well did the nurse and
• 12:28
  - the pharmacist
• 12:29
  - communicate so that when they're delivering the medication
• 12:32
  - that that that patient understands the why of
• 12:34
  - the medication,
• 12:36
  - etcetera. So,
• 12:37
  - I think there's still some challenges that we
• 12:39
  - are trying to work through but by and
• 12:42
  - large there's been great movement. Like I said,
• 12:45
  - we and all of our hospitals have improved
• 12:47
  - incrementally over the past five years.
• 12:50
  - I think in the community a little bit
• 12:52
  - quicker, the rate of improvement has been faster
• 12:54
  - because they're smaller and adoption I think is
• 12:57
  - is quicker and easier, but overall, you know,
• 13:00
  - we've gone again CMS
• 13:02
  - from one star to to three stars to
• 13:04
  - a solid three star. Yeah. And that's, you
• 13:07
  - know, that is due in large part to
• 13:09
  - to the work that's being done at the
• 13:11
  - bedside.
• 13:12
  - Quality and experiences, you know, we...
• 13:15
  - It's not me and it's... I've got a
• 13:16
  - small team, we've got three people.
• 13:19
  - Three people for a system that
• 13:21
  - that discharges
• 13:23
  - more than 250,000
• 13:24
  - patients from our emergency rooms
• 13:26
  - annually,
• 13:27
  - we've got over 2,000 something beds,
• 13:30
  - one of the largest academic health systems in
• 13:32
  - the country, so,
• 13:34
  - yeah, I would say that
• 13:36
  - I think the work that has happened is
• 13:38
  - is quite quite positive and we've got still
• 13:41
  - room. We're we're we're on the journey to
• 13:43
  - four stars,
• 13:44
  - but now it'll require some tweaks because CMS
• 13:47
  - has changed
• 13:48
  - has changed some of the questions.
• 13:50
  - Mhmm. I know the industry is closely watching
• 13:53
  - to see those full year 2025 results from
• 13:55
  - the revamped HCAHPS survey, which should be out
• 13:58
  - very soon. And as you said, we'll probably
• 14:00
  - continue to shape, health systems patient experience strategy.
• 14:04
  - I wanna go back to something you mentioned
• 14:06
  - earlier,
• 14:07
  - talking about patient experience and consumer experience. And,
• 14:11
  - I believe you said, really see... Seeing those
• 14:13
  - as distinct things,
• 14:15
  - where I think in the industry, sometimes those
• 14:17
  - get blurred or we're seeing experienced officers start
• 14:20
  - to have more,
• 14:21
  - responsibility over the consumer experience as well. Can
• 14:24
  - you talk about how you think about that
• 14:25
  - at Jackson?
• 14:27
  - Yeah. I I appreciate the question. That's that's
• 14:29
  - a good one because I, you know, we
• 14:31
  - look at the two... I think I draw
• 14:33
  - a hard line, you know, I don't draw
• 14:35
  - a hard line because our patients don't. Right?
• 14:38
  - The experience starts for them, you know, when
• 14:40
  - they pick up the phone and choose to
• 14:42
  - call
• 14:43
  - any one of our phone lines,
• 14:45
  - when they're looking up... Looking us up online,
• 14:48
  - you know, now,
• 14:49
  - with Instagram and Twitter and all these different,
• 14:52
  - you know, modes,
• 14:53
  - they are consuming,
• 14:55
  - right, they're consuming
• 14:56
  - the the experience
• 14:59
  - of our organization
• 15:01
  - right on Instagram when they see a video
• 15:03
  - of one of our nurses or one of
• 15:04
  - our physicians and their their daily lives of
• 15:06
  - what they do. Right?
• 15:08
  - So,
• 15:09
  - it's, I think it's
• 15:10
  - iterative and it's and it's a bit different.
• 15:13
  - I think if there's a distinction, patient experiences,
• 15:16
  - I think care
• 15:18
  - relationship, how we listen, how we explain, how
• 15:21
  - we treat people,
• 15:23
  - Consumer experience for me is everything around it.
• 15:25
  - Right? Access,
• 15:27
  - wait times,
• 15:28
  - parking,
• 15:29
  - billing,
• 15:30
  - our online reputation.
• 15:32
  - I I joke it's like a a restaurant.
• 15:34
  - Right?
• 15:35
  - The the
• 15:36
  - the greeter is a big part of your
• 15:39
  - experience at the restaurant,
• 15:41
  - but so is the food
• 15:43
  - and all of that can be perfect, but
• 15:45
  - if it takes you fifteen minutes to get
• 15:47
  - your check,
• 15:48
  - that may have sullied the whole experience and
• 15:50
  - and I would argue that that is a
• 15:52
  - consumer component of the experience,
• 15:55
  - not necessarily
• 15:56
  - how kind and attentive and friendly
• 15:59
  - your surveyor was, how delicious the food was.
• 16:01
  - I think there's a bit of a distinction
• 16:03
  - and it's up to us to really
• 16:06
  - marry all of it in a way that
• 16:08
  - that we can... That our consumer
• 16:11
  - slash patient at whatever journey they're in in
• 16:13
  - care is... Sees it as one seamless sort
• 16:16
  - of,
• 16:17
  - journey. And it's up to us to remove
• 16:20
  - those friction points. Right?
• 16:22
  - Wherever those friction points may be, so we've
• 16:24
  - got to really,
• 16:26
  - I think it's important and find ways to
• 16:29
  - truly listen
• 16:30
  - to our
• 16:32
  - patients and consumers, whatever you, however you wanna
• 16:35
  - call it,
• 16:36
  - to listen to them at every point so
• 16:38
  - that we can try to remove the friction
• 16:40
  - points. So it's as seamless as possible.
• 16:43
  - The other example I'll give, because I also
• 16:46
  - have the outpatient space under me, The comments
• 16:49
  - that pull scores down usually aren't about the
• 16:51
  - doctor.
• 16:52
  - Right? They're about
• 16:54
  - scheduling,
• 16:55
  - waiting time,
• 16:57
  - you know, the medical assistant,
• 16:59
  - how friendly were they,
• 17:01
  - so it's
• 17:03
  - a little bit different. And to me, I
• 17:04
  - see it as let's optimize, let's improve how
• 17:07
  - we're delivering the care.
• 17:10
  - Right? Because clinically it's sound,
• 17:13
  - you know,
• 17:15
  - the relationship with the doctor is strong,
• 17:17
  - but they may have had an opportunity with
• 17:20
  - the wait time
• 17:21
  - or with, you know, or how they... The
• 17:24
  - checkout was or the check-in was. So we've
• 17:26
  - gotta understand, I think, a lot of those,
• 17:28
  - then that's why we need strong...
• 17:30
  - A strong operational team and a clinical team
• 17:32
  - that looks at everything as a continuum and
• 17:34
  - not in silos.
• 17:36
  - Very much. I think it's it's so well
• 17:39
  - said of like how is it truly integrated
• 17:41
  - as you said patient experience might be at
• 17:43
  - the core with the human trust and the
• 17:45
  - relationships at the bedside, but really
• 17:48
  - access...
• 17:49
  - Reducing friction, all of that really surrounds it
• 17:51
  - as a consumer experience.
• 17:53
  - Well, Eddie, this has been such an engaging,
• 17:55
  - interesting conversation. I appreciate you joining us on
• 17:58
  - the podcast today to share more about your
• 18:00
  - work and how you're thinking about all of
• 18:01
  - this at Jackson Health System.
• 18:03
  - I appreciate the time with you and the
• 18:05
  - listeners,
• 18:06
  - patient experience, consumer experience, however you wanna you
• 18:09
  - wanna phrase it is is what we do,
• 18:12
  - right? We provide
• 18:13
  - high touch experiences
• 18:15
  - that also provide healing and care.
• 18:17
  - And so really looking at it as as
• 18:19
  - one and making it the what we do,
• 18:22
  - not something that we do on top of.
• 18:24
  - What we do is really, I think, where
• 18:26
  - the secret sauce is and
• 18:27
  - and and yeah I'm excited to continue to
• 18:30
  - learn from our other patient experience colleagues and
• 18:33
  - our caregivers at the front line to
• 18:35
  - to really elevate and continue to elevate for
• 18:37
  - our patients. Now especially when they have more
• 18:39
  - and more choices, right?
• 18:41
  - Yeah.
• 18:42
  - More than ever. I know we're, so thrilled
• 18:44
  - to have you on our chief experience officer
• 18:46
  - advisory board to keep those conversations going. So
• 18:48
  - thank you again so much, Eddie.
• 18:50
  - Thank you, Mackenzie. I appreciate the time.