by Thomas H Lee
compassionate care building, 50–51
measuring the meeting of patient needs by, 185
Mass psychogenic illness epidemic, 137
Mayo Clinic
Mayo Way, 179–180
patient-centered experience at, 158, 170
promptly answering beeper pages, 125–126, 130
Mayo Way, 179–180
McTige, Jennifer, 136–137
Measurement
advances in data analysis, 118–122
advances in data quantity/collection, 113–118
conceptual issues, 98–104
concerns about patient experience data, 96–98
data issues, 104–106
governing board role in behavioral change, 184–186
importance of shared purpose, 164–167
improvements in data/reporting, 106–108
of outcomes that matter to patients, 108–113, 190–191
overview of, 85–86
of patient experience, 86–92
patient satisfaction vs. experience, 92–96
performance, 48–51
using transparency as incentive, 175–179
weaknesses of data vs. outcomes, 159–162
Mechtler, Lazlo, 135–137
Medicaid, 90–91
Medical Expenditure Panel Survey, 99–101
Medical progress
era of optimism in, 21–26
at root cause of problem, 14–15
Medical record transparency, 126, 133
Medicare
market share and, 37, 39–41
surveying patient experience, 90–91
Merlino, James, 82–83, 182
Mirror neurons, 56–57
Mission statement, 171
Moods, tracking spread of, 148–149
Moral disengagement, historical periods of, 70
Morale, crisis in clinician, 31–32
Morris, MD, Charles, 181
Mortality data, governing board reviewing, 184–185
Mylod, Deirdre, 97, 110
Narcotics, patient experience for prescribed, 103
Narrative
developing empathy through skill in, 66
shared purpose through, 164, 168
Network, Rules of Life in the, 140–144
Network targeting, 147
Neuroscience, mirror neurons and, 56–57
“Never say no to a colleague,” 150
Nodes, social network, 145–147
Nonfinancial incentives, 175, 192
Novant Health, North Carolina, 128
Nuanced approach, healthcare improvement, 156–157
Nursing communications, 46–47
Obesity, social patterns of, 2, 137–140
Observing patient encounters, and empathy, 63
Oncology
advances in late twentieth century, 26
downside of progress, 27–30
technological advances in 70s/80s, 76
OpenNotes, 126
Operational effectiveness, vs. strategy, 41–42
Opioid analgesics, and patient experience, 103
Optimism, era of, 21–26
Oscilloscopes, 23
Osler, Sir William, 19–21
Outcome measures
of clinical outcomes, 49–50
inherent weaknesses of data vs., 159–162
patient experience related to, 93, 100–102
three-tier outcome hierarchy, 93–96
Outcomes. See Clinical outcomes
Pacemaker experts, 14–15
Pagers, Mayo Clinic cultural norm, 125–126, 130, 179–180
Pain medication, patient experience, 102–103
Partners HealthCare System, 5, 73
Pathophysiology, medical research on, 22
Patient experience
concerns about data, 96–98
history of measuring, 86–92
imperfect measurement of, 106–108
switch from patient satisfaction to, 92–96
Patient reported outcome measures (PROMs), 185–186
Patient satisfaction
conceptual issues on higher, 98–104
history of measuring, 86–92
as interim measure, 93
switch to patient experience from, 92–96
Patient-centered care
Code Comfort protocol for dying patients, 128–129
creating with shared purpose, 168–171
current medical climate not encouraging, 78–80
empathy as essential to excellence, 80–82
importance of shared purpose in creating, 165
measuring quality of, 87–88
measuring what matters to patients, 108–113
reduction of suffering in, 76
role model for, 78
Peace of mind
as driver of patient loyalty, 44–46
as healthcare goal, 5–6
measuring outcomes that matter to patients, 190–191
patients seek healthcare for, 92–93
reduction of suffering as, 7–8
Penicillin, discovery of, 22
Performance improvement
advances in data analysis, 118–122
advances in data quantity/collection methods, 113–118
brokerage fostering, 125–131
competition in healthcare driving, 188
data measurement issues and, 105–106
financial incentives and, 172–174
measuring patient satisfaction, 90–92
in measuring/data/reporting, 106–108
new measurement goal for, 162–164
overview of, 48–51
as perpetual focus, 48–51
from positive person in groups, 148
sustained, 85–86
using feedback on patient experience for, 97
Personnel, improving empathy of, 8–9
Physicians
compassionate care surveys of, 12–13
consumers using online reviews to choose, 177
drivers of patient loyalty to, 45–46
improving empathy of, 8–9
improving patient care with transparency, 175–179
problems with shared purpose, 167–168
Physiology, medical research on, 22
Piedmont Health, 178
Porter, Michael, vii, viii, 93–96
Positive influences
building social capital by identifying, 153
impact on groups of, 180–182
Positive moods, tracking spread of, 148–149
Press, Irwin, 89–90
Press Ganey, 90, 97, 119
Problem with healthcare
chaos, 16–19
compassionate care concerns, 11–13
downside of progress, 26–30
era of optimism, 21–26
people like me, 30–33
what happened, 13–16
what we have lost, 19–21
Profile of Mood States (POMS), 77
PROMs (patient reported outcome measures), 185–186
ProQOL (Professional Quality of Life) questionnaire, 80–81
Prospect theory, and financial incentive, 173
Providers
anticipating/detecting/mitigating suffering, 110
benchmarking performance of, 120
business imperative of patient loyalty and, 43–47
competing for value, 39–41
dynamics of healthcare marketplace and, 37–39
embracing market forces, 188
measuring clinical outcomes, 49–50
organizing to improve outcomes, 191
Quality
accepting responsibility for, 188
governing board role in, 183–184
measuring outcomes that matter to patients, 190–191
nonfinancial incentives preferred for, 175
Radiology, advances in 1970s/80s, 76
Real teams, 141–142
Recording patient encou
nters, for empathy, 63
Reliability
clinical imperative of, 49–51
in delivering evidence-based medicine, 41
as goal of performance measurement, 22–23
of technical quality, 53
Reporting, improving, 106–108
Respect
in compassionate care, 12
for doctors in earlier times, 13, 31
as nonfinancial incentive, 175
patient shown lack of, 111
treating patients with, 171
Riess, Helen, 57, 67
Risk, data vs. outcomes and, 159–162
Role models
developing empathy by exposure to, 63–64
during medical training, 78
Role playing, 64
Rose-colored glasses, transparency vs., 175–179
Rules of Life in the Network
network has a life of its own, 144
our friends affect us, 143
our friends’ friends’ friends affect us, 143–144
our networks shape us, 143
overview of, 140–141
we shape our networks, 142
Sacrifices, for patient-centered care, 165
Safety, patient experience of, 86–87
Same-day access, Cleveland Clinic, 126, 169
Same-sex marriage, and cognitive empathy, 58
Sarasota Memorial, 40
Self-interest, as incentive for change, 158
Service Fanatics (Merlino, MD), 182
Shadowing patients, developing empathy by, 64–65
Shared purpose
appreciative inquiry and, 171–172
importance of, 164–167
improving goal of measurement, 162–164
as incentive for healthcare change, 158–159
problems about creating, 167–171
Skin conductance, empathic relationships, 57
Social action, Weber’s models, 158–162
Social capital
accumulating through brokerage/closure, 152
defined, 124
increasing with brokerage, 125–131
increasing with closure, 131–134
overview of, 123–125
as prominent concern, 191
using with social network science. See Social network science
Social isolation, 149–152
Social network science
contagious behavior example, 135–137
enhancing team care with, 192
implications of networks, 152–153
mapping social networks, 145–147
overview of, 123–124, 137–140
rules of life in, 140–144
social isolation and, 149–152
tracking spread of emotion, 147–149
understanding, 134
Social norms, influencing behaviors, 2, 134
Specialists
downside of medical progress, 26–30
overview of, 3–4
problems of medical progress, 14–15
Star ratings, online reviews and, 177–178
Stories
creating shared purpose through, 164, 168
developing empathy by telling, 66
Strategic imperative, 41–43, 47
Stress tests, 18
Subclasses, empathy, 54
Sub-specialists
downside of progress, 26–30
overview of, 3–4
problems of medical progress, 14–15
Suffering
avoidable, 110–112
clinician burnout linked to patient, 33
goal of reducing patient, 7, 108–109
measuring by deconstructing, 109–112
patients seeking relief of, 92–96
previous taboo on use of word, 7, 73–76
understanding patient, 8
Surface acting, emotional labor, 60–61
Surveys
compassionate care concerns, 11–13
improving empathy of personnel with, 8–9
improving patient care with transparency, 175–179
measuring patient satisfaction, 90–92
tracking spread of emotion, 147–149
via electronic data collection, 114
Sympathy, empathy vs., 58
Synthesis, in brokerage, 130
Team care
building social capital via, 124–125, 152
development of, 25, 141–142
downside of progress, 27–30
emergence of integrated practice units, 121–122
identifying teams, 192
impacting empathy/coordination of care, 138
Mayo Clinic radiologists and, 180
need for holistic, 4
problems of medical progress, 15–16
risk of chaos in modern, 16–19
shared purpose in. See Shared purpose
Technology, medical advances in, 26–30
Thanks for the Feedback: The Science and Art of Receiving Feedback Well (Stone and Heen), 96–97
Theatrical performances, developing empathy via, 67
Three Degrees of Influence Rule, 140
Three-tier outcome hierarchy, 50, 93–96
Titchener, Edward, 54
To Err Is Human (IOM, 2000), 48–49, 86–87
Tools, healthcare provider, 182
The Town That Caught Tourette’s documentary, 136
Tradition, 158, 179–180
Training
apprenticeship approach to, 181
empathy declining during medical, 77–78
empathy short course, 67–68
in patient communication skills, 182
tactics for acquiring empathy, 62–67
Transitivity, 142–143
Transparency, improving patient care, 175–179
Traumatic stress syndrome, compassion fatigue, 80–82
Trifiletti, Rosario, 136
Trust
building social capital via, 152
enabling closure, 131–133
measuring outcomes that matter to patients, 190–191
social capital and, 124–125
understanding, 132
Truth and Reconciliation Commission, South Africa, 58
Ultrasound, history of, 23
Units of accountability, performance measurement, 120
Units of improvement, performance measurement, 120
University of Utah Health Care
governing board role in, 184
publishing online physician reviews, 40–41, 126
transparency of patient experience data at, 133, 176–177
Value
competing on, 39–41
driving healthcare marketplace today, 88–89
improving for patients, 41–43, 95
influencing where patients go, 38–39
meeting patient needs as primary goal, 187–188
strategic imperative to create patient, 50
Value-based purchasing initiatives, 185
Values
spread of social, 134
tracking spread of, 147–149
Variation
decreasing through closure, 133, 134
encouraging through brokerage, 134
information brokering vs. closure and, 125
Videotaping patient encounters, and empathy, 63
Wake Forest, 178
Weber, Max, 158–162
Weeks, MD, Jane C., 103–104
“What Is Value in Health Care?” (Porter), 93
Widower effect, 137
The Wisdom of Crowds (Surowiecki), 109
World War I, Christmas Eve soccer game, 71
World War II, medical research in, 22–23
About the Author
THOMAS H. LEE, MD, is chief medical officer of Press Ganey Associates, Inc. He is an internist and cardiologist, and practices primary care at Brigham and Women’s Hospital in Boston. Before assuming his role at Press Ganey, he was network president for Partn
ers Healthcare System, the integrated delivery system founded by Brigham and Women’s Hospital and Massachusetts General Hospital. He is a graduate of Harvard College, Cornell University Medical College, and Harvard School of Public Health. Dr. Lee is also a professor of medicine (part time) at Harvard Medical School and a professor of health policy and management at Harvard School of Public Health.
Dr. Lee is a member of the board of directors of Geisinger Health System, the board of overseers of Weill Cornell Medical College, Special Medical Advisory Committee (SMAC) of the Veterans Administration, the board of directors of Health Leads, and the Panel of Health Advisors of the Congressional Budget Office.
He also serves on the editorial board of the New England Journal of Medicine. He is the author, with James J. Mongan, MD, of Chaos and Organization in Health Care (MIT Press, 2009) and the author of Eugene Braunwald and the Rise of Modern Medicine (Harvard University Press, 2013).