Jeannie Walters: 0:10

Welcome to the Experience Action Podcast. I'm Jeannie Walters, CEO of Experience Investigators, and today is my favorite episode of the month. It's when we get to talk about what is happening out there in the real world around customer experience, employee experience and, today, patient experience as well. And that's because I have a very special co-host with me today. Brian Carlson from Vanderbilt Medical Center is here with us. Brian, I'm so happy you're here. Thanks for being here with me.

Brian Carlson: 0:41

Oh, it's my pleasure. You know it's such an honor to get an invite and I'm really excited about this.

Jeannie Walters: 0:47

Well, I am too, because we've had some fun conversations on these topics in the past, so I knew we would have a good one today. And, Brian, for those of the audience who maybe don't know you, can you give a little introduction?

Brian Carlson: 1:02

Happy to. My name is Brian Carlson. I have the pleasure of serving as Vice President of Patient Experience for Vanderbilt University Medical Center in Nashville, Tennessee. My background is Healthcare Administration, Physician Group Practice Management, but for the last 10 years I've had the distinct honor of serving and leading patient experience at Vanderbilt and, yeah, I'm looking forward to discussing both patient and consumer experience. I love the bridge.

Jeannie Walters: 1:31

So, yes, yes, well, thank you for being here. And when we talk about kind of customer experience in general, I think a lot of times what people think about is that B2C experience, but really the practices, the best practices that are out there, the tools, the way we have to tap into really what are people feeling and thinking, all of that translates to patient experience as well, and in the last 20 plus years that has grown in so many different ways as a discipline as part of different organizations, and I know I have some doctors and healthcare professionals in my family and I know they bring it up to me now. So that's, it's definitely part of the culture. Yes, it is, it is good.

Jeannie Walters: 2:16

So I want to start with a fun one. First of all, it's so hard to keep up with all the shows that we're supposed to be watching because it's gotten so bad in my house that now my husband, this is true, my husband has a list because we're watching some shows that it's my husband and I are watching. We're watching some shows with one kid. We're watching some shows the four of us. You know it gets very confusing. So he keeps a list because otherwise we sit down and we go what are we watching again and what, what are we supposed to be watching? So one of the recommendations we had recently was a show called The Pit on HBO, or I guess it's just called Max now. So have you seen it? Brian, have you seen this?

Brian Carlson: 2:59

I have, yes, in fact, uh looking forward to tonight's episode.

Jeannie Walters: 3:03

So we're we're only two episodes in.

Brian Carlson: 3:06

Okay. I won't do any spoilers.

Jeannie Walters: 3:07

It grabs you, though, right away.

Jeannie Walters: 3:09

It does it really is. You're right there with it. So in the very first episode they made some news because of patient experience and I'm going to pull up this headline. But, more importantly than that, there's a caption I want to show too. So let me do this, all right. So the headline is Press Ganey CMO on The Pit: Doctor Report Cards are Really About Systems. Now this is from Newsweek.

Jeannie Walters: 3:46

And, one of my favorite parts of this discussion, I guess, is it shows nNoah Wyle who is playing the main role, the main character, and the caption says in the pilot episode of HBO's medical drama The Pit, Dr Michael "Robbi" Robinavitch, portrayed by Noah Wyle, I think it's wiley or while uh is a dedicated ER doctor who is reprimanded for his low Press Ganey patient satisfaction scores, and it's quite a scene in the actual show. We noticed right away when the woman started walking across. We were like, oh, she's the administrator, you could tell. And so basically the idea in this little exchange was he's an ER doctor, he's got all this stuff going on, he's taking care of people they should be thankful to just be alive, right.

Jeannie Walters: 4:31

And she's, of course, saying no, no, do you know how many people said they would recommend our hospital and kind of using those terms that are present in a lot of the surveys that they send out, and so it was this kind of classic conflict of are we just worried about the satisfaction scores or are we worried about other things? And the point that was made in this article was you know what? It's never about one doctor, it's never about one thing, it's about the entire experience, which I totally agree with. So I'm just curious what did you think about the show? What did you think about this article?

Brian Carlson: 5:08

Well, you know, first I'm thoroughly enjoying the show. I mean all the credit to the producers, I mean the reality of it is really very, very good to what happens. But I will have to admit that first episode, you know, I think it was in the first 10 minutes that came about and and I almost like I had my jaw just dropped and I had to pause and I'm like, did they really just say that? And then I had to rewind and watch it again and I'll I'll tell you two visceral reactions I had right off the bat. The first was the term patient satisfaction. That term is so yesterday, not even yesterday, years ago, and we need to move as an industry to stop using that term patient satisfaction.

Brian Carlson: 5:57

I think the second thing that hit me was the assignment of, you know, Press Ganey patient satisfaction scores, well they're not Press Ganey scores, they're your, our patient experience scores. So that labeling also is something that we struggle with, you know, even even at Vanderbilt. But words matter and how you label those things go along a long way. So I had those two very visceral reactions from right off the start. And then I moved into being a healthcare administrator and being in patient experience, the whole approach of it and just the antagonistic nature of you know, alerting and, in the moment, which is appropriate to a degree, but there's a way and a method that I think is more productive to doing that.

Brian Carlson: 6:43

So, as you can tell, I was, I was triggered by it, just a little bit.

Jeannie Walters: 6:48

It was kind of triggering. I had a funny reaction as well because when they, when I first heard it, I said oh my gosh, are they doing this? Like I, literally, and my family, of course, didn't even know what I was talking about, but it was so, it was so like I don't know if this is the right term, but it was almost like a little too on the nose. You know what I mean.

Jeannie Walters: 7:10

Like it was, it was that blunt object approach and I totally agree about the term patient satisfaction or even customer satisfaction, like both of those, like get them out of there, because that is not a real emotion and that isn't something that we should be looking at frankly. So the but the whole idea of you know, this is on this one doctor too, like like this is on you, the ER, like the whole ER is on you and and I think that was part of the point of the article too was saying like hey, this is, this is something we have to tap into this, we have to understand what our patients are feeling and what we can do better and all those things. But half the time it's because of you know, I'm disappointed because my bill was incorrect or I'm disappointed because I had to wait longer than I expected and it's really not about that doctor-patient care. Sometimes it is but it's just it really did strike a chord, I think with all of us in the experience business of you know this is-.

Brian Carlson: 8:10

Very much so yeah.

Jeannie Walters: 8:11

But it's so real, it's so much part of our world that it made a hit TV show, so we should be celebrating that.

Brian Carlson: 8:20

I mean, there's probably some truth to that as well. There's a good side to it, yeah.

Brian Carlson: 8:24

It did get some attention.

Jeannie Walters: 8:25

Exactly, exactly. So. I think the whole idea, though, of like managing to the survey is, you know, unfortunately that does live in some organizations. I think that's still happening in some organizations, but we've come a long way with that, and a lot of that is around approaching this in a more holistic way, about who are the people we're serving, how can we better serve them, what does that mean for our organization and our employees and everything else. So I know that's always been your holistic view, so I knew it would trigger you.

Brian Carlson: 9:00

It very much triggered. But you know it is a signal point, it's a message and we have to take it as such. It's not the end-all, be-all, it is one data point. And it can be a very important data point to signal, you know, not only systemic issues but also individual issues that may need to be addressed.

Jeannie Walters: 9:22

That's right. That's right, and I'm glad you mentioned that, because I like to also say there's no one magic metric, right, there's no one thing that's going to tell you. Humans are so complex and in healthcare they're going through trauma and emotion and all sorts of things, and so thinking about not just what are they saying and what is the feedback, but also how are they behaving and what do we observe, I mean, there are things that we as humans do sometimes in stressful situations and we can't even recall our own behavior. So it's complex, it's complicated, but it's yeah. I just thought, wow, I knew a lot of people who were going to have the same reaction that I did to that. So I'm glad that I wasn't alone in that. And now we're kind of swinging the pendulum pretty far from that where, instead of thinking about screens and what we watch, this one I thought was interesting it's not exactly healthcare, but it's more about kind of this whole experience world that we live in and that's the idea that Lush, which is, you know, a retailer, they.

Jeannie Walters: 10:31

The headline is from Marketing Brew and it's what Lush learned from three years of being mostly offline, and the quote here says we were very early adopters in something that felt crazy at the time and now social media feels crazy, and that's from Jack Constantine, the brand's chief digital officer. So really their approach was, you know what, let's not really add to the negativity, let's not participate in this. Let's trust our customers to kind of tell other customers about how great this is. And of course, everybody thought they were crazy, but they're really kind of leaning into this and now, because it's I mean, frankly, it's gotten harder to navigate online, it's gotten more segmented and divisive and all those things. Now people are saying, well, maybe this is the way to go, maybe we need to just put a stake in the ground and communicate with customers differently. So I know social media is handled differently in many cases in healthcare, but I'm just curious what was your take on this? Is this something that you think more brands should lean into?

Brian Carlson: 11:40

Yeah, um, you know. So I mean, to me, social media is just another avenue by which we can communicate each other, but it serves many different purposes. It creates community, it can create identity and it can also, you know, be an information source and and whatnot, but I think, you know, we're at a stage now where it almost feels like, you know, I've heard a couple different great quotes about social media. There's truth whispered and opinions shouted, and David Brooks said social media is an illusion of social connection, judgment everywhere and understanding nowhere.

Brian Carlson: 12:22

And I think, if you think about that from a brand perspective, you know you are trying to attract you know people to your product, to your company, to your healthcare organization, but also use it as a way to potentially communicate in this place. And you know, we, healthcare is not as heavy in social media. Although it's growing, you know, healthcare is usually a little bit behind the consumer brands. It's certainly playing an increasing role in the healthcare space but we are haven't entered the area quite where the consumers are where it's, you know, it's, it's everything, you know, everything is generating through social. But what we're also having to do is how do we manage what comes in because, to your point, it feels like it's just another avenue to communicate with the brand but also communicate with a megaphone to let everybody know what may be working well and what may not be working well, and of course we don't want that image.

Brian Carlson: 13:23

So then we have to address that voice and acknowledge it and try to take it offline and deal with it. So to me it's another channel and as a company, you have a choice to make. You know how many channels do you want to speak to your customers through? And you know, I applaud Lush to say you know what we think we can communicate with our customers without having to lean in, uh, you know, to these major, you know social media companies.

Jeannie Walters: 14:06

Yeah well said. And I think the other thing that kinda struck me about this and one of the reasons that it bridged a little bit with healthcare and patient experience is because, you know, in healthcare there are so many rules and regulations and, frankly, just concerns about privacy and issues that a lot of organizations don't have to really address. And so one of the ways that I think for a long time now, 15 plus years, there have been some private communities for people with, you know, if you identify with a certain disease or health condition or something, there are all these private communities that are available. There are things like in-person education forums in healthcare systems, and they really kind of have already been leaning into creating community in different ways. And I think what Lush is doing is essentially following that kind of older blueprint where they are creating some private communities. They're creating some more in-person events and things like that.

Jeannie Walters: 14:56

So I do, like you know, everything old is new again, I saw something about a neighborhood in I think it was Texas and they said, well, nobody knew their neighbors and it was all this land, and so they created a neighborhood where houses are closer together and they have front porches and they and I was like I literally live in that neighborhood, but my neighborhood is, like you know, more than a hundred years old outside of Chicago and it's just. But it's that idea of we do it a certain way, we try other stuff, and then sometimes we go back to what worked originally, and so I think that might be some of what's happening now, and so I do think it's interesting to watch, and I think that the only thing that gives me pause is that when we create all of these private areas, we're putting a lot of pressure on people to find them, to find where they can find people who can support them, and it's just one more place, right, like I feel like, okay, I've got to check my inbox and Slack and my social media inboxes and all that. It's just one more place. So, yeah, I think we're at a turning point. I just don't know which way exactly we're turning.

Brian Carlson: 16:08

Yeah, I mean it makes, makes I read something not too ago, ago you You know that we're in the attention economy.

Jeannie Walters: 16:14

Yes.

Brian Carlson: 16:15

How are you, you know, how are you grabbing people's, people's attention?

Brian Carlson: 16:19

But then we're also, you know, there's the epidemics of loneliness and whatnot, and, and we need community. We need stronger communities and social media, and these platforms do benefit, but there's a balance to that of just one more thing that we're asking people to participate in and giving them an option and a choice to do it, but as a brand, as a company, how much can you rely upon that to build the business? You know you actually tying outcomes to it, like you're expecting something out of it, versus this is just another forum in a community that we're just trying to create under the umbrella of you know whatever it is you're going through and give you access to people you wouldn't otherwise have.

Jeannie Walters: 16:56

Right, right, yeah, big questions, big questions. It's not just about the survey.

Brian Carlson: 17:01

It's not just about the survey. No.

Jeannie Walters: 17:06

So, speaking of that, speaking of health care and all of these different ways, you know, one of the things that I think sometimes it's easy to forget is when we talked about business and health care in the past, there was a time where we didn't really ask people how was your experience right? There was a time where this was not part of the equation of success, and I always bring up how, you know, customer experience really started booming because customers suddenly had access through the internet, through social media, through these different tools that they didn't have before to help their voices be heard, and I think the same thing can be said about, you know, healthcare and doctor scores and all these things that didn't really happen in the past. So when we look back at what's happened in these industries, there is this evolution that's kind of happened and I think we're still in it. We're still really changing with the times and everything else.

Jeannie Walters: 18:07

This headline is from Healthcare Design and the headline is how has Designing for the Patient Experience Evolved in the Last 25 Years? And so I really started thinking like, wow, I bet those first few years, there was so much resistance to this, right? Like you know, this isn't the way we've always done it and we just respect doctors and everything will be fine, and I think that now one of the points of the article was this is about so much more than we originally thought. This is about the environment. This is about lighting choices. This is about you know, what does the waiting room feel like when you walk in? How do you check in digitally? All of these different things. And so it really just struck me of kind of how far we've come, and I know you've been in the business a while, so I'm just curious, like what are some of the changes that you've seen? What do you see this continuing to evolve to include?

Brian Carlson: 19:09

Yeah, I mean I certainly we have, you know, become more and more thoughtful in, you know, environment design, facility design. You know warm spaces. You know natural lights and it's not just the, you know, old hospital ward with you know four walls and green walls and stuff like that.

Brian Carlson: 19:33

You know that the environment is part of the healing process. I think where I still see opportunity and the evolution needing to go is there's so many different layers to that experience that we have to take in mind in design of the environment we're creating. It's not just the patients, it's also the family members. What's the environment we're creating for them? Because, you know, unfortunately, especially in the hospital setting, some patients are unconscious, they're in a bed, they may not even be aware of what's going on, but the family members and the loved ones are there 24-7 to care for their family member. What's their experience with the environment? What's the staff's experience of the environment? Because we know that the staff experience directly goes into the patient's experience. So how are we designing their workplaces to be functional and efficient and also, you know, warming to them and comfortable, because that's where they spend the majority of their time their, you know, wake days is in that environment um and then you also have to keep in consideration things like, you know, cleanliness. How do we design it to keep it clean? You know, how do we design it to keep it safe from infection and all all the stuff that has to go in there? How do we design it to keep it quiet? How can we design an environment? Because quiet, restfulness is so important, especially when you're in the hospital setting you want to, you're not feeling well.

Brian Carlson: 21:02

Rest is one of the best things for healing, for the body to heal, but if you're getting woken up by noises all over the place and doors clanging. So how can we be thoughtful in that space as well? And I know many architects and healthcare designers are trying to balance all of those things. Oh, by the way, with all the balancing of just the needs for space and all the competing demands, you know, when you design a new facility, you're given a blank which I've been involved in and you think, oh, we have plenty of space. And all of a sudden you know you're having to make decisions about what you have to like cut back on or cut or limit the space because there's so many competing demands of what needs to go into it.

Jeannie Walters: 21:41

So Yep, it is. It is so complex. And I think the the other thing that I think we've learned kind of as a well, I hope we've learned as a society is that it isn't just about that, that interaction between a doctor and a patient you know, nurses have so much to do with the inpatient experience how clean your room is has a real impact on patient outcomes, like medical outcomes, right. So there are so many different layers to this and I think one of the things that I'm encouraged to see is that I think about, you know, it was probably more than 25 years ago now, but my mom used to volunteer at a local hospital and I remember thinking like, what are you doing? And she was a special ed teacher, always, you know, full of empathy, and so her volunteer role was to sit in the waiting room of the ICU and just be there to talk to families, and she would bring her needlepoint and she's like I would talk to them if they wanted to, not if they, you know. And I remember when she first told me about it she said well, the nurse said it takes like the nurses can't keep up anymore, and so they found this need and they kind of said, ok, well, we've got a volunteer, let's figure this out.

Jeannie Walters: 23:04

And I thought about that and I was like I bet there are so many little ad hoc moments like that where people were looking at this and saying this experience could be a little better. We don't have the staffing or the skills or whatever, and so all these little things were happening. And then 25 years ago, people kind of put a name to it and now we're looking at it more holistically, just like you described, and I think that as we move through, we're going to find more and more of those little moments where there's a gap or there's a point of friction or there's something where we say this could be a little bit better for the people we serve. And we're going to continue to learn from one another about that too.

Brian Carlson: 23:41

Because, yeah, the other thing we have to remember there is you know we've been talking here about an inpatient scenario. The vast majority of care now is provided on the outpatient setting. Well, that's a different design that you have to consider. You know local, is it? You know proximity, you know, so we decrease. Is there adequate parking? Is there good wayfinding to find it, because the buildings can be complex? You know what is the waiting room environment, you know, given that there are delays, and do we keep people, you know, occupied and you know, entertained as best we can while they have to, unfortunately, wait?

Brian Carlson: 24:21

And then you know, obviously the exam room or the, you know, outpatient surgery center room is their comfort and all that kind of stuff. So you know, there's equal demand of design ideas for the outpatient settings which are, you know, more likely to be built these days than inpatient beds and inpatient towers, although that's happening as well, and then? You layer on top of all that. We have all these old buildings. How do we refurbish them?

Jeannie Walters: 25:04

Right.

Brian Carlson: 25:04

How do you go in and try to update, which is not an easy operational plan, to take them offline? Because you know that has effects.

Jeannie Walters: 25:09

Absolutely.

Brian Carlson: 25:09

It is a complicated nut to crack.

Jeannie Walters: 25:09

That was one of the things that struck me about watching The Pit, was when you first see him walk in and you're like oh this is an old hospital, this is, this is an old building and it's, you know, they just have to kind of make do with that space, and I think that's that's part of the realism of it as well. Just to your point. And and then you layer on top of that with this whole idea of you know when, when people are talking about outpatient and all of this, they might need support at home, and so they might need people who are outside of the healthcare system. So how do we ensure that they're getting that type of care and support that they need as well? So it is, I mean, just full of layers and different pieces of the experience, and I think that beautifully brings us full circle. So well done, Brian.

Brian Carlson: 25:56

Well, you navigated that, you guided that. So well done.

Jeannie Walters: 26:01

We started with The Pit and we kind of ended with The Pit, but yeah, it's. I mean, there is always so much to talk about when it comes to patient experience and just the evolution of healthcare as we know it. I think there is so much going on there and I really feel like in these next few years we're going to see even more as we embrace digital and AI and all these other tools that are out there as well. So you know we'll have to talk again. What do you think?

Brian Carlson: 26:32

We'll have to. We will have to talk again If I could if I could just make one, one final statement, and that is just to say that you know there's a lot that needs to be fixed in healthcare. Don't get me wrong but we do far more right than we do wrong.

Brian Carlson: 26:48

And there are amazing things lives saved, lives courses corrected every single day and we have to keep our focus on the tremendous and humbling work that the care you know physicians, nurses the care they provide because they really do, you know, amazing things in sometimes very difficult situations and, like I said, we do far more right than we do wrong.

Jeannie Walters: 27:16

I'm really glad you said that. That's a really excellent reminder, and I think it's easy to focus on things that can go better, but, man, when you talk to people about their best experiences, those are life changing, those are really powerful, and that's because of exactly what you just said the people involved and the work that they're doing and hear hear to all of those people and and the scientists doing research and everybody like, let's just, yeah, throw our digital arms around them all. So excellent point. Thank you for bringing us back to that and just thank you for being here, Brian. This was a great conversation, as I knew it would be, and if people want to reach out or learn more about you, what's the best way for them to do that?

Brian Carlson: 28:01

Yeah, I mean, I think LinkedIn is the place to do it. So you know, follow me or connect on LinkedIn, and yeah.

Jeannie Walters: 28:12

Excellent. Well, we will put that in the show notes as well, so people can follow you, because I know you also post and share things. So thank you for doing that. So, and thank you everybody for being here. As always, we love your questions, so don't forget you can leave me a question at askjeannievip, and during the other weeks of the month that's what I do I answer your questions, so don't be shy there. And if you have ideas for CX Pulse Check or anything else, go ahead and reach out to us at experienceinvestigatorscom, where you can also find learning resources, including our CXI Compass, which can tell you where you are on your customer experience journey and how to continue that. Thanks for being here and we'll see you next time on the Experience Action Podcast.