“I teach people how to be nice to one another”

An interview with our friend Gretchen Ramsey, MPS
Director of Patient Experience, Geisinger Holy Spirit, Camp Hill PA

Having written many point of view pieces for our blog in recent months, we thought it would be interesting to hear directly from a Patient Experience professional with deep expertise and insights into the state of PX today.

Tell us about the career pathway that led to your current role.

In 2013, I started in the development office at GHS. There are two primary skills I seem to have: 1. to be able to raise money and 2. communication. In 2014 I was asked to join a Standards of Engagement committee created by the Baptist Leadership Group (now the HealthStream Engagement Institute). This was important in my capacity as fundraiser, but it also helped me learn the importance of patient-centered care.

When we started the Geisinger affiliation (2014), what was coming into focus for us was that the Geisinger team/Dr. Feinberg pulled the patient experience idea out of quality/safety departments and made PX their own department. He saw the importance of a dedicated PX professional and in 2017 I accepted the role as my primary occupation.

What are the most pressing challenges to your health system right now?

At the 10,000-foot level: competition among commercial payers. A large payor (UPMC) has aligned themselves with a long-time local competitor.

These competitors obviously bring a lot of money and capability into our market. I am continually asked “Why is Geisinger Holy Spirit not putting a billboard here? Why are we not on television?” My answer to that is “Why do that if at the end of the day your insurance company is telling the patient what health system affiliate they have to go to?” No billboard will influence that decision.

There are a million ways that regulatory agencies and advocates could be solving the meta problem (insurance restrictions), and some of those are under review in the PA legislature.

How do you address these challenges in your work?

That’s a beautiful question, with a simple answer: superior patient experience.

If you are completely supported and blown away by our people when you walk into our outpatient clinic or hospital, you will go back to your peers/family/friends and you will talk about the experience. When people have the option of changing insurance companies, they will then choose a company that participates with GHS.

For local patients, our Urgent Cares are a good gateway (there are currently over 50 different outpatient options in the Geisinger Holy Spirit family). If patients come to an Urgent Care and their insurance is accepted, they can then choose a PCP in the Geisinger system. Our outpatient providers and staff do a great job of “managing up” with PCPs in the system. The patient experience is the differentiator.

I call it the “Chick-fil-a mentality”: when you say, “thank you,” they say, “it’s my pleasure.” It’s a standard experience in TN, PA, TX, AZ. We want to hit that mark (or at least be close to it) to be successful. Chick-fil-a is a fast-food restaurant. Staff come from all backgrounds and walks-of-life. The compensation is not as lucrative as other types of professions. These standards of behavior are a direct result of corporate culture as well as training.

How do we create the culture? It starts with the hiring process. We have a screener test that gets people in, but we need to do further assessments to assure that they’re a good cultural fit: that they have competencies beyond the basic skill sets required. We’re looking for the embodiment of the Sisters of Christian Charity: to serve others that are unable to serve themselves.

Share a brief story about an event that inspired or impacted you:

This line of work requires a significant amount of resiliency. Often, it is hard to find those moments that fill you with joy and inspiration to come back for more. Recently, I fielded a call from a dear friend’s husband who is battling an aggressive form of lung cancer. He called to question the validity of several recent scans he had here at GHS. After a very long conversation of me mostly listening to him, his concerns and his worry, I was able to connect with my colleagues who jumped in to validate these results and call him to walk him through the results. A few weeks later I received a beautiful note from his wife:

“Although the diagnosis remains the same, his level of confidence in Holy Spirit and its team has been restored because of your actions.”

Those words, that note, remains on my desk as my constant reminder I have no choice but to show up resilient and restored each day!

How do you see the discipline of Patient Experience changing, short and long-term?

In the short time I’ve been doing this work, seen a shift from people asking, “What is it?” to “How can we make it better?” As you know, outpatient services are not tied to federal reimbursement as are inpatient services, so this was an eyebrow raiser within our culture. Why would we hire someone in my position? The answer, to me, is obvious: if someone comes into primary care and we treat them terribly, when they transfer into the inpatient space we’ve already managed them down before they’ve even started. Their outpatient experience will impact the perception of their inpatient experience.

So now everybody gets that. Now our challenge is: we have every tool on the table. How do we better manage the patient’s expectations? We live in a world where we can get dinner delivered to our door. And that’s only going to be even more prevalent!

Here’s one reality I’ve been working to resolve: for those who are on the front lines of patient care, the aides and medical assistants, their education and experience are minimal relative to an MD. Think about someone who just graduated from high school, may have had a single parent, has gone through 18 months of postsecondary education as a medical assistant. They are working side by side with someone that has 20+ years of postsecondary education, and likely much more clinical experience. Huge challenge.

I ask my providers, “Can I help you to think about this person you’re working with as your niece or nephew?” We need you to guide them, mentor them and make sure their experience is good to reduce turnover. This was a real “AHA” moment for me: one of the barriers is the patient’s high expectation vs. the capacity and emotional intelligence of the person we hire to manage the patient’s expectations.

When the patient walks in, does the patient access rep have their eyes up? Do the patients feel seen and known? Can that rep have a full intelligent conversation with the provider in a way that results in a quality outcome for the patient? A critical part of the future of PX is bridging the communication gap between provider sand staff.

Share some info on your upcoming Beryl Institute Patient Experience Conference presentation?*

In 2016 we went on a journey to understand PX scores more fully. We had a Chief Associate Medical Officer who dove in with both feet. The question we were pursuing was “What is truly driving HCAHPS scores?” We went to group of hospitalists (26 physicians, 24 of which were non-native English speakers); the thing that stuck out in post-care surveys was the answers given about instructions: they said that the provider hadn’t given instructions to them in ways that they understood. We hypothesized that the problem could be medical jargon, but in the end it was the language barrier. Studies show unconscious bias if not fully trusting of your provider: that bias was present in the inability to understand what the physician was saying.

We partnered with Accents International, LLC. Accents offered a live-online course designed to increase the fluency of the English language. Our physicians were telling us they were unable to make connection with patients in the first moments of the interaction. Accents Int’l. helped our physicians who believed they were struggling with their fluency and helped each of them identify individual areas of struggle and techniques to improve their English.

We’ll talk about how we open that dialogue up: keep it respectful, open, transparent, wrap the service around the physician. We have physicians that are now calling us asking when the next class will start. In our presentation, we’ll finally be able to show a positive correlation between that class and the influence on the patient experience. Of course, there are variables, but very clearly the data suggests that this has influenced it positively.

When you’re not at work, what occupies your time?

Children sports schedule: basketball, baseball, soccer, gymnastics and running. I am an assistant Girls on the Run coach for daughter’s team, a high school Sunday school teacher, a community fundraiser and an avid cook. Most other moments are filled with fishing, family and/or friends.

Best $20 I Ever Spent

I gave it to a guy selling goat meat out of the trunk of his car outside Washington, DC at 9 p.m. on a Sunday night for directions. I was leaving a conference and my GPS (I didn’t have one on my phone at the time) died. I kept circling and circling and coming back to the same gas station. The gentleman attempted to get me to buy the goat meat, before giving the directions. I happily handed him the $20, told him to keep his goat meat and he pointed me about 40 yards away to the exit!

• Gretchen’s presentation is titled “Powerful Pronunciation: Overcoming Communication Barriers and Improving Physician Engagement” and takes place on Thursday, April 4 at 2:45pm in Dallas, TX.

Originally published at connect-cx.com on March 12, 2019.