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Getting health care right

Getting Health Care Right: A Conversation with Eugene Scioscia, MD

NOTE: An earlier version of this article appeared in AHN Network News.

Empathy and Innovation

Boil the complicated “patient experience” equation down to its essence, says Allegheny Health Network (AHN) Chief Experience Officer, Eugene Scioscia, MD, and what you’re left with is a single word: empathy.

“The centerpiece to patient experience is empathy — human-to-human relationships,” he says. “It’s a critical characteristic for every caregiver and every front-line employee to have. And if you don’t have it, you’re probably in the wrong profession.”

Dr. Eugene Scioscia has been in the health care profession for more than three decades, with nearly the entirety of his career spent at AHN member-hospitals. He joined the medical staff at Allegheny General Hospital in 1989, and in 2009, when AGH’s inpatient obstetrical program moved to West Penn Hospital, Dr. Scioscia moved, too, becoming the health system’s vice chairman, clinical operations, for the department of Obstetrics and Gynecology.

Despite the numerous leadership roles, committee appointments, and med school professorships, until 2018, Dr. Scioscia still spent 80 percent of his time seeing patients and 20 percent on management functions. Today, it’s the opposite ratio. As a result, he now takes a much wider view of empathy.

In other words, it’s not just about the patient.

“One of the books I often refer to is Patients Come Second. Which is not to say that the patient is less important than the employee,” Dr. Scioscia says. “But it’s challenging — almost impossible — to deliver the ultimate in patient experience and compassion if we’re not taking care of each other.”

Caring for colleagues and caring for patients are two different jobs, but they both require the same set of social skills.

“You can’t feel empathy without the ability to connect. First and foremost, it’s about connecting with the patient, establishing a relationship with the patient, gaining the trust of the patient, and creating a safe zone for the patient. You can’t deliver the best care for the patient unless they feel safe,” he says.

“The same goes for each other. It’s critical that you connect with each other, establish a relationship with each other, begin to trust each other, and feel safe around each other. And that’s when you start to work as a unit.”

That trust, and those relationships, allow caregivers to transcend the typical patient-provider relationship, and see the health care industry through the eyes of consumers, Dr. Scioscia says. Add it up, and it’s a recipe for innovation, allowing us to better serve diverse communities; to design better hospitals and intake systems; to be cognizant of social determinants that are barriers to health.

That sounds complicated — and it is. Which is why Dr. Scioscia wants to keep it simple, and focus on patient interactions that are within our direct control.

“Every interaction is a chance to brand,” he says. “That’s not my quote — but we have to appreciate the reality of that. We also have to appreciate that while we in health care do this day in and day out, for the patient, this might be their first experience with us. So we always have to be in the moment with them.”

Chief Experience Officer (CXO): The First Year

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Dr. Eugene Scioscia, Chief Patient Experience Officer, Allegheny Health Network

Bill Toland (BT): You’ve been in the CXO position for just over a year. How was the adjustment to the executive suites?

Dr. Eugene Scioscia (ES): It was difficult when I started out, because I didn’t appreciate the AHN culture and the Highmark Health culture, particularly in the executive offices. I had no understanding of this space. I knew the world as a clinician. Even though I’d held several leadership roles in this network — chair, program director, medical staff president — I was still primarily a clinician. Before I took this role, I was 80-20 clinical. Now it’s just the opposite.

Initially, this job was an uncomfortable fit. I come from a clinical background. But those supporting this team and my office were more of a mix — many came from clinical backgrounds while others had administrative and business backgrounds. It was somewhat foreign to me, and I felt like a new kid in school. While all were welcoming, only after several months in the role was I feeling more comfortable.

BT: What have you learned in your first year?

ES: Patient experience is not just a concern for hospitals. Those who pay for health care, including the Centers for Medicare & Medicaid Services (CMS) have learned how to measure it. CMS, and other payers out there, including employers — they’re looking at the concept of value-based care. And they’re starting to look at things beyond, or in addition to, quality and safety measures. They’re looking at value from the patients’ perspective, because the patient and customer want to know what it is they are paying for. Businesses that purchase health insurance care as much about patient experience and value as we do.

BT: Experience doesn’t stop at the hospital walls, correct?

ES: Exactly. Parking, waiting times, the entire experience, the multiple touchpoints. During any given hospital admission, there may be 60-100 touchpoints. Anybody on our team, in our organization, who touches that patient, affects their experience — good, bad or indifferent.

And outside the hospital, revenue cycle and billing, the call center, MyChart — all of that needs to be as easy to use as possible for the patient.

BT: AHN used “Caring People, Caring for You” as a slogan a few years ago. Why are we reviving it?

ES: That tagline came about through a fascinating process. We went to seven hospitals and conducted focus groups with employees, and also hosted several system-wide services focus groups and Allegheny Clinic focus groups. So it’s their tagline — they helped come up with it. We offered them a half-dozen options, including our former tagline, and hands down, almost unanimously, they selected “Caring People, Caring for You.”

The “you” in that is not just the patient, it’s plural — caring for all of us, including colleagues and employees.

We hope that this will become our north star, and will help us focus on the patient and each other. We always have to be in the moment for the patient, and we must be constantly aware of our colleagues.

BT: In what way?

ES: If I’m working with you as your teammate and colleague, I’m aware if your workload is too much for you that day, or if you’ve come to work with some other stressors, or if you have an extraordinarily complicated patient that day who is challenging your ability to do your job. I’ll be watching out for you.

That’s how we help each other and hold each other accountable.

There was a time in medicine when care could mostly be delivered by the individual. You could manage just about everything on your own if you were a physician or a nurse. This is changing, in this complex version of Medicine 3.0. You need to work in teams.

When we begin to do that, and when we remember that empathy is the centerpiece, we become efficient at our work, empathetic at our work, we are more engaged; these things act as antidotes to burnout and the key to wellness.

Transparency Is Part of the Patient Experience

BT: In terms of the patient experience metrics that we monitor, where have we made the most encouraging gains over the last year?

ES: I hate to jinx us right now — we have had a gradual increase in the last year on the “rate the hospital 0-10” question. At the same time, we have also seen accompanying increases in physician communication and nursing communication scores over the last year. Those are big ones.

BT: Where do AHN’s biggest opportunities remain?

ES: Our biggest opportunities are in the area of customer service. Some of the basics that most service industries are familiar with, and where many service industries have a formal program in customer service to help onboard their employees — this is not a part of the formal curriculum in nursing school or medical school.

We think perhaps it should be. So our opportunity is to introduce empathy and service concepts from the point of talent acquisition, to onboarding itself, to continuing medical education. Even if you are someone who has been embedded in this network for some years, we need to have opportunities for you, as well. We have an opportunity to learn and develop better relationships with our patients and each other.

BT: It seems like the very nature of patient feedback is changing. It’s less retrospective and survey-based, and more immediate. There are any number of websites that rate your doctors, for example.

ES: That’s very true. We live in the world of transparency. It’s in every aspect of our life now. Consumer analytics is now a part of medicine, and AHN is on board with it. From patient satisfaction scores and physician-rating systems, we are learning to become familiar with this world of transparency.

If you visit the Find a Doctor part of AHN.org, we have a good story to tell — after conducting nearly 109,000 surveys in the last year, 90.8 percent of our doctors are 4.5 or higher out of 5 stars.

We have excellent clinicians here, and the community should know about it.

BT: When you’re preaching patient experience and customer service to employees, do you link our performance to financial reimbursements? Or is that too in the weeds — do we not want employees thinking about the financial ramifications when they are interacting with patients?

ES: Indeed, hospital reimbursements are tied to patient experience measurements. Some insurance contracts have performance incentives built into them. AHN, along with Highmark health plans, know that patients, consumers, and businesses will be looking at those value-based measurements.

So we all absolutely have to be aware of it.

BT: Are you excited about AHN’s capital expansion projects? Do newer facilities generally provide a boost to patient experience measurements?

ES: It is always nice to have new facilities that look cleaner and more modern. That certainly may impact patient experience and patient perception to a degree.

But the greater impact is that we’re putting more facilities out in the community, so we’re making it easier for patients to receive care. When you make health care more readily accessible to the patient, you’ve made it easier on them, and you’ve already improved their experience.

Health Care through Hamilton’s Eyes

BT: One of our patient experience challenges is maintaining continuity of brand across multiple geographies. Is that difficult for a young network like ours?

ES: I just finished reading Alexander Hamilton, and bear with me, because it applies to our situation here. You had the Hamiltonian federalists, who believed in a strong central government, versus the Jeffersonian republicans, who believed in strong state governments and weaker central government.

The fact is, we need both. We all need each other. AHN here at Fifth Avenue Place, along with Highmark Health, is the central government. But we have to respect the autonomy of the hospitals; each has its own identity and culture. It’s a balance, and we will succeed based on our ability to appreciate each other’s differences while maintaining a certain level of consistency and continuity across geographies.

BT: You sound like a bit of a history buff. Was that your backup career?

ES: I would have been either a history professor or a foreign correspondent. One thing that I’ve learned about myself is that I’m contextual, and I’m consistently asking questions about why things are the way they are.

BT: If you could be a foreign correspondent at any one point throughout history, when and where would it be?

ES: Wow. There are so many good ones.

BT: OK, pick two then.

ES: I think I would have liked to have been there at Yalta. It was the beginning of what I would consider our current era in history. Those leaders — Roosevelt, Churchill, Stalin — set the structure for the world, and defined new boundaries. And it’s the world I grew up in and I’m familiar with.

They not only divided the world, but set about rebuilding it. Europe was demolished, as was Russia and Japan, for that matter. There was nothing left — can you imagine that responsibility and controversy?

BT: You also get one domestic choice.

ES: Hmmm. At the end of the 19th century, there was so much innovation, the Industrial Revolution. And the other would have been witness to the Civil Rights movement. And maybe Lewis and Clark? Fascinating stories.

BT: Finish this sentence: “When I’m not at work or at home, you might find me …”

ES: I love the game of golf. And it’s not because I’m a great golfer. One, I truly appreciate that it relies on the honor system — it’s the only sport where you call an infraction on yourself. But more than that, it is an excellent opportunity to spend five to six hours with your children and family, uninterrupted. In this age of constant electronic entertainment, that’s nearly impossible to do.

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