Download the “Care Delivery_Joan Cox audio file directly.
Care Delivery_Joan Cox: this mp3 audio file was automatically transcribed by Sonix with the best speech-to-text algorithms. This transcript may contain errors.
Manav Sevak:
Welcome to the Memora Health Care Delivery podcast. Through conversations with industry leaders and innovators, we uncover ways to simplify how patients and care teams navigate complex care delivery.
Matt Troup:
Hi, everyone. This is Matt from Memora Health, one of the medical directors and co-hosts of the Care Delivery podcast. I’m excited today to be joined by Joan Cox. Joan, thank you so much for joining me today on the podcast. Would you take a moment to introduce yourself?
Joan Cox:
Certainly, Matt, it’s my absolute pleasure to join you today. My name is Joan Cox. I am the Chief Experience Officer here at Yuma Regional Medical Center in Yuma, Arizona. I have been in this organization for about six months, and prior to Yuma, I was in a national role for Steward Healthcare and, prior to that, with Atrius Health and Data Medical and Vincent Corporation. And other than delivering pizzas for Bertucci’s, when I was out of college for a few months, I’ve been in healthcare for my entire career.
Matt Troup:
Yeah, awesome. Well, it’s wonderful to spend some time with you today. In talking with you before the podcast started, you mentioned about a passion around finding your why. I would love to know what got you into healthcare. You’ve spent your entire career, most of your entire career, in this space. What started it, and why does it continue?
Joan Cox:
Sure, this is just one of my favorite topics because it’s really critical, I think, now more than ever in healthcare to help people find their why and for all of us to continually work to define our why, because it is such a tool to keep us connected to purpose and really guide us to our true north. So like any role that you have over an extended period of time or any relationship you have professionally, your why changes. So my why started because I needed a job. My sister ran group homes in Rhode Island, and she needed someone to work in the afternoon. So I got a job working in group homes, helping children with special needs keep themselves safe and find a voice. Very quickly, I realized that that was incredibly powerful and meaningful for me, and that really started my journey throughout up to today in healthcare, in various different forms, to be the voice of the patient. My why changed drastically at times when I became a super patient, and I experienced my own angels in the healthcare world as well as those that left marks both on my soul and my husband’s soul in positive and negative ways. And then, with both of my in-laws and my father, we lost them all within a 14-month period in very complicated end-stage navigation of the healthcare system. So it’s really, truly been my honor, but also my mission to help connect the patient voice with caregivers, to help patients be heard, but also to help use that voice to enrich the lives of those who are giving their lives to healthcare as their careers and as their passion. So yeah, I would say that my why has always been the voice of the patient. There’s been different motivation behind that across the way, but throughout my journey.
Matt Troup:
Wonderful. And speaking of the voice of the patient, you know, there’s there’s a lot of emphasis on patient-centered care model. Patient experience has long been a priority for health systems. Where have we started to see that go well, and where are we still lacking when it comes to that experience?
Joan Cox:
Oh, I don’t know if we have enough time in this podcast. You know, I think without question the focus. So even though patient experience is something that’s been never not been a part of care delivery, and arguably when healthcare delivery was less complicated, we did it in a very different, more organic way, so that’s changed, obviously. Healthcare delivery has become incredibly complicated and incredibly intricate, and there are many, many agendas that have to be met on a daily basis in order to reach our goals. So the refocus or the prioritization of patient experience or experience in general, that’s been beneficial, that’s given organizations the space and permission to prioritize human connection. That can’t be overstated how valuable and how necessary that is, especially today after having lived through COVID and navigated that process, but also the changing reimbursement structures and the changing base of really what care delivery looks like today. Where we potentially have lost our way is focusing on metrics and numbers and having those be our guiding light instead of patients, and experiences, and people.
Matt Troup:
Great, you bring me to a question I’d love to ask, which is, how do you properly measure the patient experience? I think a lot of times, we get pressure about patient experience metrics. Clinicians, like me, get rated on this quite a bit when we’re practicing medicine. Is it effective, or is there a better way?
Joan Cox:
I think there is no one way. I think the bottom line is that there is a very robust conversation that is constantly happening around patient experience performance, and I think metrics are certainly a piece of it. You cannot measure whether the interventions and the innovation that you are producing are actually working unless you’re able to measure an increase in the data. So we have to, data is critical. We can’t make informed and meaningful decisions operationally and structurally without it. But the data is only part of the conversation. We lose our way when that data replaces the value of anecdotal information, qualitative information, it’s all really critical. We need to be asking questions in many different areas, not just from one survey that is, you know, we are bound by contract to deliver. We need to really engage on a community level, we need to engage on PFAC level, we need to engage in employee level. Most of our healthcare systems are employees are also our patients.
Matt Troup:
Right.
Joan Cox:
So to be able to really get, and our physician level without question, I mean it’s, it is a dialogue, it’s not a monologue. And oftentimes, when we are not listening to all aspects of the conversation, we’re losing really, really critical insight.
Matt Troup:
Yeah, you mentioned something interesting there, and we talked about this a bit before the podcast, that Yuma is the sole provider in a pretty wide radius and that a lot of your clinical staff probably are also patients. And so there’s this experience that kind of transcends most individuals of being an employee plus sort of a client of Yuma at times, right? Being a patient, a client of Yuma. So how do you see the patient experience and the clinician experience kind of coinciding together and allowing them both to be elevated without at the, one at the expense of another?
Joan Cox:
Absolutely. I think the most important element of engaging and of connecting the two is through recognition of positive feedback and really celebrating those successes, and facilitating those human connections at every step possible. We tend to not do that when we’re really focused and really engaged and facilitating metrics, but the magic happens in those moments. The magic happens in those really critical but small connections. So providing the patient feedback in a way that’s meaningful and palpable for the provider. First of all, I’m also a very firm believer that you do not measure a provider’s performance without providing them with the tools needed to improve that performance, no matter what it is, whether it’s clinical outcomes, whether it is patient experience, whether it’s patient-centered communication. I’ve been in organizations and in initiatives where that was not provided, and I can’t tell you how many times I would hear, during part of my career, I was a physician coach. So I would spend my days in exam rooms with NPs, PAs, and MDs, observing them with their patients and creating personalized, patient-centered communication coaching plans for them. The amount of times I would hear, and my first part of that process was to sit with them and just understand where they were at, understand what their perspective of their current state was, and many of them had received feedback prior to that without any context of improvement options. And the number of people who, clinicians who I worked with who would come to me in a demoralized state was overwhelming. Even those that weren’t necessarily performing poorly, quote-unquote, I’m using air quotes, but who just would, benefited, we thought would benefit from that, from the coaching program. So that being said, that’s a long way of saying I think the way that you connect to both the provider experience and the patient experience is by sharing that patient voice and doing it in a constructive and supportive way, and also focusing on the positive as much as you can. That being said, providers need to hear the true impact of their lack of engagement on a patient in order for them to understand what it means and how significant those small moments are, and they’re really an investment in the future clinical outcomes, that it’s those moments that provide that connection and that bond between the patient and the provider and that trust and that willingness to take the steps that the patient may be hesitant or scared to do so.
Matt Troup:
Yeah, the empathy component is so critical to that relationship, and it really does drive that long-term engagement and certainly better clinical outcomes. Well, thinking about Yuma specifically, and we’d love for you to talk again about kind of the uniqueness of your medical center. We’d love to hear more about some of the innovative initiatives you’re undertaking, given how you are the sole provider within a pretty large radius.
Joan Cox:
I think it’s safe to say that innovation, just by the nature of our location and the nature of the different populations that we serve, innovation is our survival technique. It’s probably our trauma response. But we truly, so from a patient experience perspective, probably the two largest forms of innovation that that I’m engaging with right now, just created a role that we’re calling the Patient Experience Representative, and we’ve put an individual on each of our inpatient floors, and that individual is non-clinical. They are dedicated to comfort care rounding, and connecting between the patient and family member and clinicians. They’re facilitating, the thing, so the goal of this obviously is to reduce the need for call lights. We’ve known, you know, through studies that have been done, we’ve found that call light response time does not necessarily increase the patient experience. It actually can decrease the patient experience because a quick response from a nurse to a call light does not necessarily facilitate the resolution of that need, it’s a reprioritization. So the call light may get shut off quickly, but then if it’s not something that’s a clinical priority on the floor, that patient is then potentially left without their needs being met because there’s another patient with clinical need, so we’ve actually seen it decrease. So we decided to kind of step outside the box and put our focus in another part of that equation, which is what if we really had someone dedicated to anticipating, or to meeting those non-clinical care rounds needs on a regular rounding basis? And we have seen, already we’ve seen an increase in our real-time satisfaction surveys. We’ve seen better collaboration on the units. We’ve actually seen time now for the nurses to spend more face-to-face engaged time with the patient because they’re really, truly focusing. Those call lights end up being really clinically appropriate, and they have the time to be able to spend with the patient. So all around, it’s been an incredibly positive initiative. So we’ve just started that, that’s only been a few weeks in the making, and it’s continuing to develop. We are in the process of implementing real-time ambulatory or medical practice, I should say, surveying. We’ve been doing real-time surveying, but we are really going to be implementing a more comprehensive survey that mirrors the caps domains, creating improvement initiatives and action plans and prioritization around that feedback, so that’s kind of my ’23-’24 fiscal year goal. But we also, as far as investing in the community, which is a main priority of this organization, I shouldn’t even say priority, it is an absolute intrinsic value in this organization, in the leadership, in this organization, we are stewards of this facility for the community. The executive leadership team and the board feel that viscerally, it guides us and drives us, which is such a, what’s the word I’m looking for? I don’t, “pleasure” doesn’t even begin to really explain how I feel. It’s a privilege. It’s an absolute privilege to be in a position, in a community where I can truly walk hand in hand with my colleagues to meet those needs. But because we are a rural medicine facility, we’re not a desolate community, but we are definitely a remote community, it is a robust area, but it’s not easy for us to recruit. So we have decided we’re partnering with Arizona Western College to build a health sciences facility where we are going to build the programs to educate people in the community, first of all, with the intention of providing that secondary level education to the community that they may not have had in the past, but also to hopefully retain some of that talent and be able to really give them a viable career path and education path within the community to contribute to continued care. So that’s an example, I’m in the process of developing a longitudinal residency curriculum for a three-year residency program. We have primary care, family medicine, and internal medicine residency, psychiatry residency, pharmacy residency in the process of being started, so we’re actually, I think that’s the other way around. So really, really making sure that patient experience is not just a concept, but it’s a skill that we’re teaching right alongside all of the other elements of care delivery.
Matt Troup:
Yeah, wonderful. And it really sounds like you’re taking that perspective and that priority of the human voice and instilling it into every aspect, right? So even as you educate the future clinicians and care team members, you know, ingraining that into the practices, so yeah, that’s wonderful. I would love to know, as you think about the directions that you want to head or do you want to take more towards, are there other industries that you look towards for inspiration? Where does your inspiration come from as you start to plan out what your kind of strategic plans are for the next couple of years?
Joan Cox:
Gosh, well, really, my inspiration comes from the ideal patient experience. I have a really hard time comparing healthcare to other industries. I do truly believe that there is a necessity and a place for technology and innovation in healthcare, without question. But I think that we have to make sure that that’s complementing the human element and the human experience, not replacing it. You know, think about this all the time. Yes, younger generations are very technologically focused, and that’s how they engage, and that’s how they communicate. But when they’re sick, they still want somebody there. They still want a human being to walk them through. I think about my own, you know, young adult, kids, and they’re fully capable and competent and tech-savvy and, but when they need help, when they are not feeling well, ultimately it’s that human connection and that human support that’s needed. So I do truly believe that technology gives us opportunity to be the most efficient and the best seeded for analytics and care delivery and certainly the technology in our healthcare interventions, but I do truly believe that that needs to be in conjunction with that human relationship.
Matt Troup:
Yeah, absolutely. I think about that a lot too, even from the seat I’m in now on the other side of the street on the tech side, that really the goal here is to augment care delivery, allow technology to be extension of care teams by giving them time back to really be a clinician once again. In some ways, we’ve lost our way when it comes to that, but yeah, giving time back that can actually be used to sit at the bedside or to spend an extra couple of minutes with a patient in the clinic. I love that perspective. Joan, I would love to know, as you sit right here and the long career that you’ve had in healthcare, what really excites you most about where healthcare is currently and the direction you see it moving in the next couple of years?
Joan Cox:
Wow, so believe it or not, the instability, which probably isn’t a very comforting word to use about healthcare, but things are pretty shook up right now in healthcare in the United States, and that excites me, to be honest. It’s, because I think it’s giving us an opportunity to recalibrate. It’s giving us an opportunity to do exactly that, to reconnect. We’ve tried to replace human interaction with technology, thinking that that’s what people want or thinking that that was going to be more cost-effective or whatever the ultimate goals or the ultimate priorities were there. But I think we’re realizing now that data is showing us that a lot of things that we thought were going to improve the care experience maybe complicated it a little too much. So I think it’s exciting. Any time there’s disruption and any time there’s instability, it gives us the opportunity to be better. And I think there’s a lot of people who want to make things better, and that can’t be a bad thing. So I’m excited, I’m excited to see how the human element is kind of reborn in healthcare. And I also think we’re in a place where we can’t afford not to, because of what we’ve all been through, specifically around COVID, but we have to reconnect. As an industry, we have to reconnect, as you know, as a human race, we have to reconnect in so many ways, and now’s the time to do it.
Matt Troup:
Yeah, I love that. And I think healthcare should lead that movement right. We should be the ones to lead the charge for recognizing the human voice and bringing kind of the humanity back to medicine, so, this has been a wonderful conversation. I love your approach to innovation, and I love that you’re keeping the human voice centered. So thank you so much for spending time with me. I hope we get to connect again soon.
Joan Cox:
Thank you so much, Matt. It’s been my pleasure, and I hope so as well. Take care.
Manav Sevak:
Thanks for listening to the Memora Health Care Delivery podcast. For more ideas on simplifying complex care for care teams and patients, visit MemoraHealth.com.
Sonix has many features that you’d love including automated subtitles, upload many different filetypes, generate automated summaries powered by AI, advanced search, and easily transcribe your Zoom meetings. Try Sonix for free today.
