Innovative Approaches to Patient and Teammate Experience: Vishal Bhalla

<p>welcome to the CX matters podcast a production of the American Journal of healthc care strategy with your host Cole Lions hello everyone this is Cole from the CX matters podcast I'm joined by Vall of Advocate Health Vall please introduce yourself and your role absolutely pleasure to to be here uh Vishal Balor I'm the chief experience officer at Advocate Health uh I have the pleasure of working for an or organization that sees the vision of and Senior leadership of course sees the vision of pulling the entire Human Experience under one umbrella so we can look at the endtoend journey especially in healthcare of our patients and of course our teammates I say those who serve and those we serve so as you may know Advocate El also has not only the whole Continuum of healthcare delivery but also W Forest University and and health system so we have the pleasure of being able to also collaborate with the academic side the the Learners and the faculty it's a very large organization now right now that it encompasses Atrium an advocate Aurora I believe is up there in uh in the Illinois area so can you just give us a a quick snapshot of the scale you know off the top you're at how many employees and and you know patients are you working with yeah we have just under 160,000 teammates uh and just over 6 million PA patient uh unique patients uh we are now in Six States uh and about 30 billion in Revenue we say we're slightly bigger than Starbucks I believe wow that is just incredible that's the scale of that is is amazing um we're so honored to have you on to share your insights with with our audience uh because it's such a unique position that you're coming from and you also have very unique ideas I want to go back to when you got your NBA MIT right it's a renowned institution you know their NBA graduates go on to do some really incredible things so at that time you could have probably done pretty much anything you wanted to why did you go into patient experience how did you get there yeah so first of all uh I don't know how I got into MIT I think I was just lucky uh what one of the classes they have is on leadership by Professor Deborah Alona and she helps you um each of us really reflect upon on what we bring to the table so to speak fig figuratively and how best we can be principled leaders who would make a difference and how best to apply what you bring to the table kind of like the concept of igy but very intense uh it was a very emotional class for me personally and I was going through a lot of personal uh Crucible moments if you will my dad was in hospital uh for about last two years of his life and he was you know a year passed uh in into that and uh I decided because I was spending 20 days on at work and 10 days at home and spending time with him for 10 days a month straight and then decided to serve in healthcare after he had passed because with my education at MIT where I really focusing on System Dynamics and I'm a master black belt in lean and some experience in Hospitality as you know on the people side and I'm a bit of a data nerd as well thought that I would be able to apply my skill set to make a difference because what I found in healthcare is while every individual was really connected to taking care of patient our systems and processes were a bit of a hindrance what uh processes did you see at the time right back then that that you saw were a hindrance if you don't mind being specific yeah I think I'll give you an example is something occurred with my dad which was due to probably lack of Staffing I'm just resuming from one side of the oneway mirror right I have no idea what occurs behind as a patient at that time especially and so I pushed my way up to chain of command gently but firmly to try to find out how or why could something like this happen and the response was lack of re resources right we were not fully resourced and my response to the co at the time was ma'am respectfully your water on down the drain on this side and people dying Thursday on the other so it's it's about really the systems and the process I say in healthcare people are who serve are so connected with the patient they're like this beautiful bird who wants that cake right that's their purpose is to serve the patient and they will sacrifice themselves and their family time even the personal health to get to that cake what do we as a society that includes the various agencies and edmin administration do we put a glass cover over the cake so the bird is so driven that once the cake it will whack whack whack its weak and whack its speak it will bleed some will die some will learn to fly around and get the cake and then they get their Knuckles wrapped so what we need to do is lift the glass and really that that is what I find in alar is to help lift the glass and let people connect back to their purpose because the moral purpose of the people who are serving and people we are serving is aligned and the patient gets better good I appreciate that illustration very much how did you begin implementing what you had saw and what you had excuse me what you had learned at MIT what was some of the first kind of roles that you took on where you started to to implement these skills so as an institution one of the things that really helped us to is learn Frameworks and learn to build Frameworks that we can go out and apply and listening of course is key right go out and assess so so when I joined I was really lucky to have worked at uh barkland in Dallas uh which is a system that really serves everyone and truly serves everyone and and what I learned while my intention was to serve patients what I quickly saw is how people who serve are hurting themselves and the amount of burn out and and so we really needed to to work on the teammate and clinician engagement and experience more than engagement they're engage but their experience really lift that up before we could do the the the the patient experience and then leverage data to really focus in on what was most important using a System Dynamics approach and then basically you look at use surveys and and focus groups to to which everybody does and then drill down on the key variables and identify at what point do you invest in this variable for what output and then at some point you start getting to diminishing returns right then you have to go to the next most important driver if you will and so we built that for both clinician and teammate experience and then patient experience and really mve to needle Parkland and now doing that at a larger scale across the Enterprise the one other thing I would say and imagine a a loaf of bread if you will and various slices of the loaf and in healthcare we are organized just like that each vertical is a specialization and very rightly so and we have to innovate in that in that specialization and the patient imagine now is a baby spaceship like a capsule the patient is in it flying uh uh through through through the various slices of bread and as we innovate and improve our process what happens is that the pores in the bread get misaligned right we're doing it for the right reasons everyone is driven for the right reasons but our systems and processes get slightly misaligned and so that capsule gets stuck in between slices of bread and what the teammate then is doing because they're driven get a hammer and chis will try to pull pull the them out and they spend a lot of energy they get burned out they're not efficient and there they have all these regulations to deal with to pull the patient through and a lot of times when wear in one slice we don't know what's happening with with with the patient two slices before or two slices after and so to try to align across various verticals and to be able to get to see the Journey of the patient from before till post care a entire journey and map what does the ideal Journey look like and then see where it's going off ideal journey and establish thresholds when it does go off the journey so it can trigger the right people at the right time I think that was one piece the second piece I find Co is that you know we imagine the oneway mirror I talked about as a patient family member I don't know what happens behind right so as a patient I see something and I complain so my complaint then goes to Patient experience team over a duration of time between 48 hours to two months right and then it goes from there to the physician right or the physician sees it too but it's in in a with a time lag and then the physician or those who provide care feel punitive right bad bad your scorer you know but by then what we need to do is break this class and really allow that because they're driven to to serve their sense of purpose is to serve the patient and so if if the patients can express in a Psy psychologically safe Manner and the Physicians and care providers can then react quickly and respond because we're trying to solution two months later without the understanding of what was going on behind the mirror we need to enable at the same time so the people behind the mirror can comment on the situation what was occurring and what were causing those outcomes that the patient or family member was seeing and and try to do at the same time that's that's that's where the the juice is and the last piece I would say is teamate experience patient experience safety outcomes are connected intuitively right and we have various papers but how do we see that regularly how is it that we're when we're spending time at a board level or at a Frontline leader level I'm looking at both ends of the spe spectrum and we're looking at it continuously and we get it that this all happens together and instead of a leader having to do an act a survey a teammate having to do a survey on five different things compliance survey magnet or pathway survey uh teammate experience survey clinician engagement survey Dei Sur like we've combined it all into one and instead of doing now five action plans for a leader you can work on one action you know and the institutional resources of them being spent on five different aspects can look on one so that we can really zoom in fine tune the one foundational thing that impacts the others and what is that that one survey or that one thing look like so so what we have recently done I can only talk about our experience I think everything is contextual right I always say data without context is like body without the soul you know a body without the soul is lifeless a soul without the body is SC scary so we we got to put them in in context so from our context from our organization what we did is we we took our culture of safety survey our Dei survey our our teammate engagement our clinician engagement workplace violence compliance put it all into one survey and then we we are looking at that information holistically and then instead of each of these Coes or verticals going to the leader saying hey I need to do X I need to do y we're looking at it holistically and saying what is it that underpins from our data from what our teamat told us what are the key drivers so you can use statistical analysis to identify the key drivers and identify one key driver that the entire organization can focus on and one or two key successes that the entire organization can celebrate we got do both and then move the needle two together as opposed to having a bunch of different separate Silo situations going on yes and so imagine if the entire organization can focus on one or two aspects that we need to improve on so so someone may say I'm a leader and say hey I'm already in the 90th per of I don't want to work on X no we should work on x what why don't you help someone in your vertical or similar business line who's on the other end of the spectrum so that we move as an organization because as an organization that is foundational for us to move to the next level meanwhile you can talk to your team and also see what else you could work on right I think that is the key and instead of working on all those five different pieces you could work on one and the organizational resources then that imagine the weight of the entire organization focused on one or two aspects that makes a lot of sense because previously right every team is going to work on what they scored on or every Department's going to work on what they scored on negatively and it might be completely different from the organization as a whole but in this case the organization is moving as one yes you got to do both so one is at the organizational level and one is at the team level so as an organization so we can lift the entire organiz ation in the same direction and then each team will have its nuances we got to have a framework and then allow for some flexibility in the framework makes sense can we talk about how these fra because Frameworks right when we talk about Frameworks and we talk about organizational movement some people might feel you know a sense of rigidity or a sense of being at the macro level but you specialize in this individualized human- centered approach can you talk talk about how doing structured Frameworks helps you to care about each individual team member or patient to such a level where they're they're you talk about this this notion of customized experience right so can you just expound on that a little bit Yeah so I want to underline that we're still working on it as a team uh as an organization the foundation is being able to understand an individual and being able to understand the individual's journey and motivations right and then you can customize at that so organization and then the market segments right and go down to the individual level the only way we can do that at scale is to leverage data and technology and enable the humans at the point of contact to have their relevant data using the technology at the right time let me give you an it so so let's talk about the framework and then an example so the framework for example we if you were to look at patient experience let's take patient experience starting from the the the the point of I need I moved to Charlotte I need to look up let's say I need to look up uh neuro because of my stutter I need to look up neuro Services right so how many people in in in this ZIP code looked up NE neuros Services how many picked us for for Primary Care how many were referred to Specialty in network how many went to how many went to inpatient how many went to rehab hospice and so on can we slice it so so that we can see the entire Journey today we can't like we were talking about we all can see mostly in the in this I it and then not only how many how we can see the entire journey of the patient or the teammate but also can understand what has been going on and what is their motivation so I'll give you one example from a without any details uh so there was a a patient who it very very very uh engaged physician who gave of themselves like I would believe right amazing physician uh 26 27 year experience in a area a clinic where people were less fortunate lived and and he had a patient he you know talked to me about he saw the patient in an Ed and then the patient passed away and the The Physician was quite shook up about it okay um and we still still stir some emotion and we we talked about and he's like I don't know I I gave him the medication he was a great patient he understood he was a first generation patient you know an immigrant like me and and I can't understand how he why he wouldn't take his medication and he passed away and then we had a conversation after a few weeks with the p patient's daughter who agreed to come and talk to talk to the the patient and she revealed that he was a roofer and upon discussion with the with the group the nurse the we we we were able to understand that if if he took that medication he couldn't work because of the side effects and that would have negatively impacted his earning and their daughters education so the physician was like had I known then maybe I would have given a medication which was less with less efficacy that would have allowed but we don't know so we can't so that's why it's important to be able to look at the whole person and and we talk about social determinance of health and we talk about but how do I let's say I cannot afford three meals a day would I be comfortable sharing that with someone will my cultural bias or my whatever mindset right especially if I'm there with my daughter and she doesn't know and she doesn't live with me I'm just making this up like how do you create that psychological safe space and that's why I talk about that so psychological safety is something very key is one of the key foundational things so that we can customize because we can't understand because in healthcare the awesome thing is that everybody's driven to serve right they want to do the right thing but the person on the receiving end those we serve whether it's our teammates we serve our patients we serve if they aren able to express their concerns or or other aspects that we may not be aware of because they're not in a psychologically safe place then it defeats the purpose to an extent so that's one piece the second piece is you know at each point of the journey your needs may be different and so how do we customize to your needs uh is what we're working on so how do you create that psychological safe space how are you teaching your your staff to do this fun fundamentally we have to remove the glass and we have to build there are many methodologies depending upon so psychological safety has many F facets right there's inclusion there's depending upon which Theory you're looking at but fundamentally in my opinion there are three pieces one is uh do I feel included do I belong right I know inclusion and belonging are different but you know what I mean right I'm just giving a high level over simplification version of V second is is is can I express myself and then can I express myself without fear or retaliation and if there is a blame if there is a mistake is it to learn or to blame like what is the you know I didn't Express that right in English but you know what I mean right if there's an error are we focused on a blame culture and so culture is foundational uh and and to make sure that people are able to express themselves to their leader to to senior leader and or have you know 1 1800 numbers or whatever like anonymously or not and the other thing is listening continuous listening and not when it's convenient for the or organization it's also when it's convenient for those we serve so at the point someone should be able to the difference between pull and push right we push the surveys out or we push saying hey how did we do and we ask specific questions rather than saying what's important to you right and then listen so now technology can do that for for for for us and I was having a conversation with a group yesterday uh us and and like we we we need to re rethink about our when we have all this data we can use a small language model or a large language model depending upon the security that we want to deploy and instead of asking specific questions how did males rate US how did females Rus or what I'm just making this up how did tall Shar people like me Rus versus tall people Rus whatever it is in soad of doing that we can just say just try to understand what are the Clusters amongst all this data and then start looking at which clusters align with our Strategic Mission that we want to focus on which where are strengths we want to amplify where are opportunities that either we want to address or we don't want to go after that market or whatever the case is we need to apply a strategic mindset but we can look at all the data that we have and utilize a different approach rather than us asking questions let's see what Stories the data can tell us and now we can use AI ML and statistical techniques in in combination to help us uh arrive at those ins insights and so you put all this data through through an AI system right and then what does it exactly tell you how much uh research is required after you run it through the system so being honest we're still in the process of building our Frameworks yeah so I can theorize what it can do H I've run I run simulations but uh outside of work but not at with our data uh and so first frame having a a consistent a proper framework is key uh and having data which has common definitions across the Continuum of Care is key otherwise you know you can build a palace on Sand it won't last long and then you have to build another and keep going so so I think the AI Frameworks are key and below that having Translate able data with consistent definition is key that's where we are at right now and we're pulling pulling that together that's that's the foundation so across the Six States you're trying to get everything in like epic for example to have consistent data that that an AI could be able to use yes so AI is a broad broad uh term right so what we want what what what we're hoping to be able to do is Leverage The endtoend Journey understand the end to end journey of both the patient and the teammate understand where we are going off the ideal path and where the choke points whether it's time or volume or both or emotion depending upon the experiences and make sure we are having quick feedback times those Loops from those we serve those will serve and understand where the opportunities May lie prioritize them and then scale them how last question for you and I appreciate your this is very cool uh technology how scalable is this so we look at like Kaiser Permanente they are in California and now they're in Pennsylvania right so would you be able to track for example someone's journey across States and across different hospitals across pharmacies and and be able to monitor their experience and then identify instantaneously where they started to have a negative experience or where they you know things like you said went off the path is that what the goal is that's the vision the dream I'll let you know once we get that but in my opinion we we have the technology to be able to do that we need to bring all the stakeholders on the on the same page right starting with the patient and the Frontline teammate in this case that you talked about the pharmacist the like every we we need to have the voices at the table which are representative of those individuals understand what is the most least frictional way for them to engage in it and take ownership understand their pain points and how can we minimize how can we break that glass for them so that they can get what they need quickly yes working on that absolutely I appreciate your time Vall and I hope that we can have you back on once you build this uh incredible system we're working on one thing I do want to say is none of this is possible without my team and the team that we have at this incredible or organization each of us brings a different perspective and to be able to to learn together on doing things I give you one one last example and as putting the survey together that we're talking about all these into one survey I like how many of us remember learning to ride a bike right we fell a few times I'm sure when I I broke an ankle when I was learning to ride a bike you know those bikes that have like five or six seats on it yeah we have decided that we're going to learn on that bike oh right yeah and why because we can pedal together we will go faster than someone on a single bike and when one is tired another can pick up the speed and we're headed in the same direction mostly importantly right and we we've done that now we haven't broken any bones so we're we're we're we're moving in the right direction uh and it takes everybody on that team to give up a little bit something because someone may want to go left to see the pawn someone want to go right because they saw a bird but we're on the same we're giving up some of our personal SL slant so that we're together so that's so key and foundationally important to collaborate that's a very very impactful illustration from some things that I'm experiencing as well where a lot of our wonderful teammates uh you know especially in volunteer organizations sometimes we have all these different ideas that we're excited about but I like that a lot so I really appreciate that and thank you for your time I know it's during lunch hour there and so I do really appreciate you sharing you know 40 minutes with me to talk about this it's been very impactful for me and I'm sure our audience will enjoy it as well thank you so much cole for the opportunity</p>