There is a tension in patient experience that I have often seen about who owns patient experience. From a system level, there is the broad belief that ‘everyone’ owns patient experience. I have discussed this before, but for those who have missed it, my core belief is that when everyone owns something, no one owns it. I would often joke about the fact that every breakroom in America has a microwave, and, on every microwave, there is sign that says, “Your mom doesn’t work here, clean the microwave after use.” The one thing we know about all those microwaves is that they are all dirty. Yes, patient experience happens at the bedside, and it is executed by that staff. It needs to be something that everyone is aware of. But without some guiding principles and people that are tasked with aligning the message—so everyone is rowing in the same direction—an organization will struggle. But on the other hand, PX teams are often too protective of patient experience. Part of the problem with PX being the ‘junk drawer’ of so many different responsibilities is that PX people will can believe that they are the only ones who can manage, can drive, CAN UNDERSTAND the patient experience. Because we feel like no one really understands what we do, we overcompensate by imagining that no one can understand what we do.
There is a mindset that can plague a nursing unit, a bunker mentality, where we must protect ourselves because no one is going to protect us. I certainly understand this feeling, as it can feel like no one takes your interests to heart. This self-identification breeds collegiality and puts a premium on teamwork, since we must protect ourselves. Since the organization is functioning in their silos and not looking out for your needs, you need to patrol the border constantly protecting your interests. Any time you hear someone say, “But you just don’t understand what we are going through!” you are hearing someone protecting their team, their clique, their colors, their department.
To be clear, awesome patient experiences can happen in this environment. But the problem is that this team-first approach can often attempts to make a positive experience by dragging down the rest of the organization; by saying that THEY could not give you the attention or experience that WE can. This approach is protective of the team itself. I am showing my allegiance to my unit, standing up for our needs and interests. But, from an outsider’s perspective—another team or a patient—it feels very defensive, even confrontational. It reinforces the silos and it makes it harder to provide a seamless experience. “We in ICU gave you one-on-one 24hour care and now we send you to a step-down unit, where they won’t give you that same intensely personal attention…”
This extends beyond clinical spaces. In managing complaints and grievances, I have seen, without the glint of self-reflection, Billing and Finance bat a patient back and forth across the fence when it comes to some complex question. That is not MY job; that is YOUR job. All these departments are more interested in defining their work and protecting their own team and responsibilities rather than finding solutions. When people say, “I don’t determine the tests, I just draw the blood” or “I don’t make the food, I just deliver the food” or “I don’t know why, but I just don’t see that you have an appointment today” they are protecting themselves at the expense of someone else.
You might think that PX would be different, but sadly we are often not different. PX can be highly protective of our plot of land as well. We can feel like if we don’t do this, no one will do this. We cannot expect others to take this as seriously as we do. It is the same defensive posture we see in others.
Just like other departments, this can be borne of past experiences where the patient’s perspective was given short shrift in the face of other concerns and issues. We have seen what happens when we don’t stick our noses into something. But it leads us to the same place as other departments, where we feel like we must put our fingerprints on every shred of paper that even remotely concerns the patient’s experience. I joked in a previous essay that PX must do the PX training, but if I am being honest, part of that is because PX wants to do the PX training. We just complain about it at the same time. PX does it because PX doesn’t trust organizational learning and development to do the PX training, because they won’t do it right. Is this a legitimate concern? Maybe, maybe not. But by demanding ownership of it, we are defending our team, our perspective, at the cost of making it easier to spread the gospel of patient experience. We can effectively manage the message by speaking it ourselves, but we also limit its reach, since we cannot always be in all places talking to all people.
Now some of you may be rolling your eyes at some of my purple prose. Yes, I am painting with a broad brush here. The real world is full of nuance that I am not addressing. Please forgive me if I overdramatize here. The point is not that we NEVER, or that we ALWAYS, so much as: please notice how often all of us retreat to well-worn positions rather than pushing ourselves to provide context and perspective. This all grows from the sentiment that it takes longer to explain how to do something rather than to just do it yourself. Like everyone else, I have said this more often than I can count. But this only paints me as awesome, as much as it paints everyone else as incompetent. I would never say that my team is incompetent at data analytics, but isn’t that what I am saying when I say that it is easier for me to do the analysis than train someone else? You might be impressed by the work but also wonder why I tolerate a team not working up to its potential. A statement to make it sound like I am great at math also makes me sound incompetent as a leader.
We have all heard the same sentiment, “It’s a _____ thing, you wouldn’t understand it.” This is fingernails-on-chalkboard, when I hear it. While sometimes it is a throwaway line meant to be humorous, it is often used to draw a line between ME and YOU. It does not seek to engage in a common understanding; it is a phase that tells the listener that you are not in the club and never will be in the club. In its most charitable form, it might be meant as an invitation to understand the speaker’s struggles. But what people don’t understand is that this phrase does not inspire in the excluded person a desire to join the club or understand the club’s perspective. It creates a “fuck me? No, fuck you!” response. It elevates the tension in the room. You are not saying, “It’s a _____ thing, you don’t understand it.” Using the word “wouldn’t” versus “don’t” is purposeful. It is the functional equivalent of the “I can explain it to you, but I cannot understand it for you.” It does not foster conversation or understanding. It slams the window down. You don’t understand; you will never understand; leave me alone.
Now, I may have said, “It’s a PX thing, you wouldn’t understand it” at some point in my life, but (a) it was meant as a joke, and (b) it was said to other PX folks. My core philosophy is that, YES, there are things that I think about all the time that you probably don’t think about all that much. But it is my job to educate you on these things. Ideally, in a way that will make you feel empowered and not judged. Having special knowledge or experience is not badge you get to wear; it is a responsibility you must own.
Depending on the moment and the situation, my response to that phrase is, “Well, either educate me or don’t be surprised if no one ever understands you and you go through life alone and unappreciated. That phrase makes you sound like an asshole who likes making people feel small and stupid.”
The essential truth is that we all need the village to understand our truth, if we want the village to help us realize our needs. A vast majority of the people who work at a hospital do NOT work in the emergency department, do NOT work in food service, do NOT work in scheduling. Further, while they may oversee them, none of the senior leaders work actively in those departments either. So, if you need something or need to have others understand why the simple thing they are asking of you isn’t really that simple, then you need to be able to open the door to your situation and not make someone feel small for not getting it.
In patient experience, it is the same thing. We cannot get people to do what we need them to do with every employee, every encounter every day by making this feel alien to them. We need to own the vision on the mission, but at some point, we need to release control over that work, or that work will never get done. If we treat PX as a religion that the masses cannot really comprehend and it can only be understood as it is filtered through the high priests and priestesses, don’t be surprised if people would rather watch football.
Now, how do we do this? What does that look like? That will be the subject of other essays. For the moment, I ask PX people to look in the mirror and ask, “Is my advocacy for patient experience empowering staff or alienating them? Am I lifting them up, or shutting them down?” If you cannot explain what the PX thing is, that says a lot more about you than it does your audience.
PX Matters with Joseph Snipp 
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