Authors

  1. Cryer, Donna R. JD
  2. Davis, Richard O. PhD, EdM
  3. Pronovost, Peter J. MD, PhD

Article Content

As hospital and health system executives face demands to perform in an increasingly complex environment, leadership development, and coaching programs are proliferating to keep pace. Typical executive trainings cover communication, change management, strategic planning and execution, and ways to enhance accountability, as well as improving personal effectiveness in time management, public speaking, and leading change. Many physician leaders who take on administrative roles enter MBA programs to build their financial and operational management skills.

 

Despite continued emphases on patient satisfaction scores (from the Hospital Consumer Assessment of Healthcare Providers and Systems survey), readmission rates, and value defined by outcome measures, one competence is conspicuously absent from executive development offerings: how to provide patient-centered care. Health system mission statements and mottos have been redrafted to "Put Patients First" or "Focus on Patient-Centered Care." Chief patient officers have been hired, patient and family advisory councils convened, and patient experience surveys sent. Some progressive organizations conduct executive rounding on clinical units with staff and patients, start meetings with patient stories, or follow recommendations from well-regarded programs such as Planetree (http://planetree.org/), the Institute for Patient- and Family-Centered Care (http://www.ipfcc.org/), and the Gordon and Betty Moore Foundation (https://www.moore.org/programs/patient-care). These efforts, important though they are, only go so far in transforming the fundamental assumptions, intuitive understanding, and operating mental model of executives.

 

To truly change from a check-the-box approach to patient-centered care to a culture-centered approach that focuses on patient-centered thinking and habits, hospital CEOs and other leadership team members would do well to add a patient mentor to their personal development program.

 

A patient mentor is a coach, someone who can speak from both personal experience with the health care system and advise on patient-centered strategies. A patient mentor who has broader experience in health care may be a more effective coach. A patient mentor with experience across multiple conditions or health care settings may be able to generalize and contextualize those experiences. This individual is an intellectual peer who possesses the ability to observe, facilitate, question, and challenge the executive in a confidential manner that creates an emotionally safe space for both parties to develop and move toward shared goals. A pool of candidates suited to be patient mentors is growing as more patients serve in newly created positions on boards and committees throughout the US Department of Health & Human Services and the Patient-Centered Outcomes Research Institute, within medical societies (eg, Society for Participatory Medicine) and health systems, and on patient family advisory councils.

 

PATIENT MENTOR MODEL

The patient mentor model supports patient-centeredness, patient engagement, and patient activation. Patient mentors can help health care leaders be more mindful of the burdens that patients face while navigating the health care system while injured or ill, trying to thrive. Patient-mentored executives may be better equipped to create and maintain such systems and cultures and to design and implement interventions to engage and activate patients and clinicians.

 

Like all relationships, the patient mentor-executive relationship requires a commitment by both parties to invest time to the principles of patient-centered care. The executive and the patient mentor should meet monthly for at least 1 hour to create the time and space for full attention to the discussion. This dedicated time models patient-centered behavior on the part of the organization by prioritizing patient voice and perspective. The meetings also help the executive and the patient mentor develop the rapport, trust, and level of authenticity necessary to explore and integrate the complex patient-health system relationship.

 

The patient mentor can prepare for each session by organizing medical challenges into themes of exploration, concretizing, and even simulating common patient experiences. Such experiences could be how to transfer care (and medical records) from one system to another or how to prepare for surgery, from selecting a surgeon to presurgical testing, postsurgical recovery, and communication across specialists. With support from the executive, the patient mentor may also meet with other hospital leaders to further the focus on patient-centered care. The mentor may share stories, recommend readings, and offer ideas.

 

The executive should protect as sacred the sessions with his or her patient mentor. Also, the executive should approach each session with an open mind and intent to listen rather than assume who patients are or what they care about. The executive should share what keeps her or him up at night, such as low-margin profits, pressures around ICD-10 (International Classification of Diseases, Tenth Revision) conversions, electronic health record dysfunction, payer mix, or low patient satisfaction scores in a leading service line. This dynamic can and should create mutuality to the mentorship, helping the patient mentor understand real and perceived barriers to achieving certain goals desired by patients, providing an opportunity for collaborative brainstorming or simple empathetic appreciation. Executives should follow-up on questions raised during sessions with the respective staff or unit mentioned and consider the value of inviting members of relevant departments or teams to some sessions to explore the feasibility of recommendations emerging from the mentorship.

 

Over the last year, the first author (D.R.C.) served as a patient mentor for the president (R.O.D.) of Sibley Memorial Hospital, a Johns Hopkins Medicine hospital. Both parties found the relationship to be impactful and rewarding; after years of stagnation, the hospital has seen significant improvement in its patient experience scores. As part of this effort, we developed a mentorship curriculum and plan to expand the model to other Hopkins hospitals.

 

The patient mentor model can elevate the quality and capacity of the CEO and, in turn, the health system, ushering in an age of patient-partnered care that is both deemed high quality by patients and family members and demonstrated as workable in the culture, clinical, and operational workflow of a health care system. The mentorship creates a sustained set of attitudes, behaviors, framing questions, and guiding principles for executives to implement personal and institution-wide practices that respect and benefit patients, foster meaningful innovation, and enable continued adaptation to an increasingly consumer-driven health care landscape.