Supporting Patient Experience and Caregiver Well-Being

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In this episode, Dr. Elizabeth Harry welcomes Keith Gran and Devin Lippert from the Office of Patient Experience (OPE). Gran is Michigan Medicine’s chief patient experience, with over 30 years in academic health care leadership. Lippert is OPE’s administrative director with over 25 years in the field.

Both bring deep professional and personal insights into improving care through empathy, data and collaboration. They share how their team supports patient and caregiver well-being, highlights impactful programs like peer mentorship and medical improv, and discusses strategies to create a consistent, compassionate experience across Michigan Medicine—emphasizing that every human interaction is an opportunity to improve health care.

Transcript

Dr. Elizabeth Harry:

Hi, everyone. My name is Dr. Elizabeth Harry and this is the Well-Being at Michigan Medicine podcast. I'm excited to have Keith Gran, our chief patient experience officer, and Devin Lippert, administrative director from the Office of Patient Experience with us today.

The work of patient experience is critical. When patients feel heard, valued, and comfortable, they are more likely to trust their health care providers, follow their treatment plans, and actively participate in their own care. Positive experiences can lead to better health outcomes and faster recoveries. A positive patient experience can significantly contribute to a person's overall well-being and we are excited to discuss how patient experience and well-being are deeply interconnected.

Briefly, I'm going to introduce Keith and Devin prior to turning it over to them. 

Keith Gran is our chief patient experience officer and executive director of the Frankel Innovation Initiative at UM Health, which he joined in 2015. With 30 years of academic health care experiences, he focuses on enhancing patient experience through data, research, and engagement. Previously, Keith served in the executive roles at the University of Miami, University of Southern California, University of Mississippi Medical Center, and University of North Carolina Chapel Hill. He holds an accounting degree from the University of Texas at Dallas and an MBA from the University of North Texas, and is a licensed CPA in Texas.

Devin has over 25 years of health care experience. She currently works at Michigan Medicine and previously served as a patient experience advisor at Press Ganey Associates, collaborating with health care organizations nationwide. Prior to that, she was the director of service excellence at the Children's Hospital of Michigan, where she led initiatives on patient experience and employee engagement. Devin also worked at Beaumont Health System, where she created a guest services department. She holds an MBA from Oakland University and a BS in dietetics from Western Michigan University. Devin resides in Wixom, Michigan with her family.

Well, now that we've talked about your formal on paper introductions, Keith and Devin, could you please tell us a little bit about yourselves and what experiences led you to your current roles?

Keith Gran:

Yeah. Thank you for having us, Dr. Harry. I have been in academic medicine for 30 years, as you mentioned, in many various roles. All of which had patient experience as a key component of those, whether it was running practice plans or in the departments of medicine.

One of the unique, well, maybe not unique, but one of the aspects of my tenure at the University of Mississippi is I had both my in-laws living with us and my mother, all in their 80s, with different disease types and driving different needs through the health care system. It gave me a really good insight in dementia, cancer, neurologic issues. It really helped form what works well, the coordination of care, and how can we make things better to improve the care of all our patients. For me, it was both the personal experiences and my work experience that led me to where I am today.

Dr. Elizabeth Harry:

Wow. That's such an important story. I think when we get to be on that side of health care, on the other side of health care, it really does demonstrate the importance of the connection with our patients.

Devin, how about you?

Devin Lippert:

Yeah. Thank you again, Dr. Harry, for having us. We're so grateful to be here with you.

As you stated, I actually started out as a clinical dietician many years ago. But being a dietician, I actually, what led me to this was I was really investigating the patient feedback about food. I feel like it is the one thing at times that patients feel that they can own in their inpatient hospital experiences, but it started there. Then I went to learn more about the patient experience while I was at Beaumont, and understanding what are the concerns and complaints. That just led me through my journey. Then going to Children's Hospital of Michigan, and then Press Ganey.

Personally, I think what I've learned over time is the patient resilience, but really a lot of times our patients are suffering just because of their diagnosis. That brings along a lot of challenges for our workforce, for our caregivers in dealing with a person that feels out of control, or dealing with a life-altering condition at times. When we think about the well-being, we know that that's the foundation. That's what's brought me here, is to help reduce patient and caregiver suffering. There's so much we can do for our teams in order to give to our patients and families.

Dr. Elizabeth Harry:

Well, I just love both of those stories and the humanity in it. In how important it was to see these interactions that drove you to this role, and then really to say, "We can do better. We want to do better."

I'm curious if you can tell us a little bit about the Office of Patient Experience and the purpose of your work?

Keith Gran:

About 10 years ago, nine years ago, we created the Office of Patient Experience, which today includes what we call our patient and family engagement team. Which is the analytics group that does all our surveying, the patient education group, our analytics group, and our project managers that do some of the heavy work across the organization. We also have the patient relations and outreach group, which really is our outward-facing part of our office with our referring physicians across the state trying to drive our strategic priorities here at the organization.

Having said all that, Michigan Medicine has always had a focus on patient experience. What this has allowed us to do is put a focus on it, help coordinate it across the organization, and really get everyone working together towards the common goal of improving a patient's experience so that they get the right care at the right time with the right provider in the right setting.

Devin Lippert:

Yeah. I'll add a little bit to that, Keith, thank you.

When we think about the analytics piece, it's a number, it's a score, but really it is the patient voice. As Keith stated, as we look throughout that patient journey, that continuum of care, being able to give to our staff and faculty that real patient voice is critical. All of our teams really do that.

One of the areas I just wanted to highlight too is interpreter services. When we think of our non-English speaking patients that are not primary English-speaking patients, our hard of hearing or hearing impaired patients, this team is critical for those patients to understand health care needs here while they're with us and beyond.

The other piece is we connect and partner with our human resource department to understand the staff and faculty voice too, as we're getting that feedback. Every time that we're meeting with teams to help them with the patient experience, we definitely start with that foundation of, "What is your culture? How do your teams feel? How is the safety and quality of the care you're providing? Not only for your people, but for your patients." We connect those dots all the time with our work.

Dr. Elizabeth Harry:

Well, what I love about that focus is there's so much literature that supports that if providers, if care teams are more burnt out, the patient experience does suffer. We know that the quality of care also goes down and self-reported medical errors go up. It really is this very tightly interconnected experience where the experience of one group can really drive the experience of the other, and that we are just humans together trying to get through what is, for our patients, often the hardest time of their life. For our care team members, to be consistently part of that part of people's lives also takes a toll. I love your guys' approach of really trying to support all the humans involved in the process, acknowledging what a challenging process it is.

Keith, you mentioned supporting our strategic framework at Michigan Medicine. I know we've had guests on in the past that have talked about the BASE-Plus strategic framework. Could you just remind our listeners of what that is and how your work specifically supports it?

Keith Gran:

The base strategic framework, BASE stands for belonging, access, safety and quality, and experience. The patient experience portion of that is under the E for experience. It's really to have an organizational look at how do we improve experience? What we look at is the overall rating of care, which is really the experience a patient has from the moment they decide they want to come to Michigan Medicine until the moment they're either discharged out of a clinic or out of the hospital, and then all the care that happens in between that. And even in between visits.

We do a lot of support with our ACUs, our ambulatory care units. The largest ones, like Northville West, Ann Arbor East, Ann Arbor, Kellogg, and Brighton. We have teams at each of those working on areas around communication, and that staff worked well together to care for you, and some of these key factors that drive their overall rating of care. We also work in the adult emergency room, trying to support their activity and make sure that the patients have the best experience possible as they enter there.

I believe that it's the little improvements that add up to a major improvement. Every year, we change our targets and really look at those targets being aggressive, but things that we believe we can attain. We want to be the best in the country and that's in the top decile, so that's what we strive for.

Dr. Elizabeth Harry:

Wow, that's amazing. You highlighted a huge breadth of work. I'm wondering if you can share one of your favorite examples of either a program or a service that you feel like really positively impacted the mental and emotional well-being of maybe not only our patients, but also our care teams that really helps that interdependence that we were talking about?

Devin Lippert:

Yeah, absolutely, Dr. Harry. I think the program that definitely comes to mind for me is our peer mentor program. I've been around patient experience in health care organizations for quite some time and University of Michigan, we lead the way in this. We have over 32 peer mentor programs right now and we have 260 actual peer mentors. What they do, they are actual patients of Michigan Medicine that have gone through treatment with us. Some of the examples of peer mentor programs that we have is palliative care, cochlear implant patients, transplant is our biggest peer mentor program, scleroderma, radiation oncology, that's just to name a few.

Let's take transplant for an example. We have a patient that has gone through transplant, and they've been a patient with us and they're an ongoing patient. What they do is they offer support for new transplant patients.

Dr. Elizabeth Harry:

Wow.

Devin Lippert:

For example, and transplant does this extremely well, if they have a new let's say kidney transplant patient coming in, they will offer this service on their first visit with us. This peer mentor never gives medical advice. What they do do, and they partner very closely with the clinical team, is they will answer questions, they will talk with family members. They will be there to take a phone call in the middle of the night or a text. It's really, what we've heard, is not only the patient but the peer mentor, they both get so much gratitude and just comfort because it's a been there, done that. "You've been through my situation, you know what I'm feeling." To be able to provide that peer-to-peer support, what we've heard is it's so helpful to the patients and the former patient or current patient.

It's also extremely helpful to the clinician and the care team. They find that they can give so much information and communicate, however when they're able to talk to someone who's been through it, it makes a really big difference. They feel that that compassion's coming through as a whole.

Dr. Elizabeth Harry:

Wow, that's so inspiring. Does that also extend to caregivers and family members, or do you have other programs that you'd like to highlight that support the folks that are caring for our patients during these difficult times?

Devin Lippert:

Yeah, it actually does. It does extend to family members. We actually have peer mentors that are family members and they care for other family members, too.

In addition, I do want to highlight a couple other programs. During COVID, we actually had to have limited visiting hours, which everyone's aware of and family presence during that time. It does help to have our families at the bedside, so we have gotten back to that 24/7 visiting hours. Sometimes we do have to limit number of people in some situations in some smaller areas, however we are so excited to be back to that while we can safely.

Another really important program that we continue to emphasize and work on here is our bedside handoff program. When are an inpatient and you have new nurses coming to take care of you during shift change, this helps our families and caregivers to be involved in that continuity of care. Not only is the patient hearing from all the different disciplines and care team members, when the family member is there to hear and be a double set of eyes and ears, it's really helpful. It also emphasizes that we encourage the patient family centered care principles. Again, nothing about the patient without the patient or the family at the center, and it is key for safety and quality.

Yes, we call it patient family centered care. And I would say in addition to, is while we are checking safety and quality, we have the eyes and ears of the patient and family to speak up if they do have concerns, or have noticed something that we said that they have more questions about or they disagree with.

Dr. Elizabeth Harry:

As I'm listening to you, I'm thinking about that it's really describing our whole care team as involving the patient and their family members too, so that when we think of the patient's care team, we are also thinking of all of the caregivers at home and the patient. And really, then thinking about how do we function as a team with that in mind? Which I just think is so beautiful. With

We are growing, which is really exciting. It also brings the potential for variability, especially as we're integrating and learning about different systems and different cultures across our system. I'm just curious what your teams are doing, what strategies you have in place to really ensure that the patient experience is consistent across Michigan Medicine as we continue to grow?

Keith Gran:

Yeah, that's a great question. We do try to look at things from a consistent perspective in the areas that we're working at. We use data to drive the work. So not all ACUs for example have the same key driver, but we want to work on those things that they need and ensure that there's consistency across the system. What I would say is, is that in several of the ACUs, one of the issues has to be wait time to be seen. We've implemented across several ACUs a process to notify patients of their wait, how long they will be, keeping them updated, and those kind of things.

We've also, from a regional perspective, because now that we have Sparrow and UM Health West, and helped them implement Press Ganey so we have a consistent way of measuring data to ensure that we're all looking at the same data the same way to understand where we need to address issues.

Devin Lippert:

Yeah. In addition to that, I would say one of the ... We'll give you a little sneak peek, but what we're looking at for next fiscal year. To your point, Dr. Harry, when we think about what is the expectation? What does the Michigan Medicine experience look like? I think if you were to go around and ask 10 people day, you may get 10 similar but different responses. We feel it's important to really define what the experience definition is. Of course it's our patients, and of course it's us. It's human-to-human connection and how we care for one another so that we can care for our patients.

With that, what are those behavior standards? We have our mission, vision, values, and we all know what those are. We feel that there can be benefit for a consistent definition as well as standards of behaviors that we all live in breathe by to each other in order to give to our patients and families. We are going to start some work in this space. Absolutely, the Office of Patient Experience is going to partner, and integrate, and align with many other departments. But really, how are we hiring people? What are we looking for when we think of the evaluation period? What are we talking about in addition to those values?

We are excited to do that to ensure that there is that consistency. If a patient comes here in Ann Arbor, and then they go to Sparrow, does it feel different? Does it look different? It may. However, are there unique standards of behaviors that we all live in breathe by? I think there's some improvement that could be had there.

Dr. Elizabeth Harry:

That's really exciting. It's this idea of the Michigan experience and that that is consistent across wherever you get care. You can feel, when you come in, that that's what it's going to feel like and that will be the experience.

You have mentioned so many partners. It just strikes me that your work touches and partners with almost every other group in the health system, if not every other group. I'm curious if you could share an example of a partnership that resulted in improved patient experience that you're excited to share?

Keith Gran:

Yeah, I'd actually like to share our partnership with Packard Health. I believe, and I think the organization has committed, to taking care to the community where we can. Packard is a federally qualified health center. They have two locations, Ann Arbor and one in Ypsilanti. We've done several initiatives with them, given our lack of access to primary care. When patients either present at the ED and don't have a primary physician, or they call the call center and there is no availability in a timely manner, we offer them a slot at Packard Health. Packard has seen hundreds of our patients. During that time, they try to establish a medical home for them and really care for them. Because our goal is for our patients to be healthier, not have to use the ED for things that they don't have to, and to really improve.

We've also implemented Epic at Packard so that we can have a communication tool between us and them. We're starting to do some of this work at Hamilton and Flint as well.

Dr. Elizabeth Harry:

Wow. I was even thinking partnerships within our system, but that's even more amazing to be reaching out and really demonstrating this partnership across the state.

Devin Lippert:

When we think of within, our team continues to think outside the box of how do we partner with faculty, who this is why they're practicing medicines. However, there's a lot of barriers sometimes for them to be able to take the time, show that compassion they have for patients and families sometimes because of just the nature of health care.

One of the exciting new opportunities that we're offering to our faculty is called a Medical Improv Course. We recently piloted this with our inpatient hospitalist group. We heard great feedback. What I'm going to talk about today is our orthotics and prosthetics group. It's three different sessions for 90 minutes, so it does take some time. However, they are sessions where they learn about communication, respect, listening and explaining. We know that those are our top key drivers that our patients really want when they seek care with us.

We have two team members in OPE that are trained specifically in medical improv, so they hold these sessions. Keith and I have been in attendance and we've seen the dynamic of a provider sitting in the room at the beginning and how their mindset at the end, there's light. They say, "Well, I've been explaining it to my patient this way. I wonder if I explain it this way, it would be more impactful for them."

Dr. Elizabeth Harry:

Wow.

Devin Lippert:

We do pre and post tests. One of the things I just wanted to share, one of the questions. Of, "The provider gave easy to understand information in response to questions and concerns that we ask our patients." For this group that went through medical improv, they improved statistically in that specific question. All the other provider communication questions went up, too. It wasn't statistically significant, but it was definitely improvement. That's the number. When you saw that light go on in that provider's face, to try something different that wouldn't take more time. It was really powerful.

Dr. Elizabeth Harry:

What I love about what you're saying is so many things. Again, I didn't know about this and this sounds fantastic. The acknowledgement that the providers want to do a good job, they care so deeply, and that there are so many competing priorities sometimes and demands on time, so they want the skills and the resources to do this well. It sounds like, at the end of this training, you're saying their face lights up. That this actually contributes to their own well-being in some ways, because it helps them feel like they can deliver the kind of care that they want to deliver.

I'm curious if you see that in other parts of your work, where you guys have initiatives that you implement that seem to also improve the team well-being?

Devin Lippert:

Yeah, one of the examples we can give, our interpreter services team. They've been working with the family medicine department, they have a program at Domino's Farms in Livonia Health Center for specifically Japanese-speaking patients. It's called the Japanese Family Health Program. They have Japanese-speaking clerks, MAs, RNs, and providers, and then they work with our interpreter services team who can provide either in-person, on the phone, or video interpreting.

Behind the scenes, that team that takes care of that clinic population contacts us all the time. There was a situation recently where the social worker contacted us because a patient filled out the Partners in Care questionnaire, and there was some concerns with some of the responses. Our team was able to contact that patient outside of the clinic, understand where the challenges were, and together as a team, they are able to give the best possible care to that patient beyond just when they're here onsite or in a telemedicine visit.

That partnership, and we have many of those partnerships across the system that they know they can call on us, we're a member of the team. How can we continue to help our patients and families beyond when they're just here seeking medical treatment?

Dr. Elizabeth Harry:

It sounds like the teams really know that they can lean on your team too, for a lot of support as they're trying to deliver this quality of care that they're striving for.

Devin Lippert:

Correct.

Dr. Elizabeth Harry:

You've talked a lot about incredible programming, and you've talked some about data and moving some of our partners over to Press Ganey. Can you tell us a little bit more about how we measure success in this patient-centered culture that you're talking about? Maybe any metrics or feedback that illustrate how we think about this.

Keith Gran:

Yeah, that's great. We measure based on the overall rating of care that I mentioned previously through our Press Ganey surveys, which is solicited feedback from our patients. But we also have over 1000 patient advisors, patient family advisors that give us feedback all the time about either programs we want to try to implement, or just getting their thoughts on different aspects of experience across the system.

I mentioned that we were at five of the large ACUs. We spend a lot of our time in ambulatory. We have over three million outpatient visits a year, so that's the majority of our patients. We have seen a remarkable improvement in the ambulatory setting. We set targets that we felt are aggressive and we've hit them all. We are now at 96, 97 scoring on the survey. Really, a lot of great work and a lot of effort, both on the staff and the providers at the ACUs, and also from our group.

Dr. Elizabeth Harry:

That's amazing and work to be really proud of, because again, it just speaks to why we're all here. We are all part of this because we want to deliver excellent care.

It sounds like you have really exciting things going on in the office. I'm just curious what you two are most excited about for the future of your office?

Devin Lippert:

I can definitely say, looking at my colleague here, continuing the success that Keith has built. Over the last 10 years, he has built this office from the ground up. We just want to continue building and experiencing strategy that aligns with BASE, it is our strategy.

When you think of BASE, belonging, access, safety and quality, experience, it is all about that experience for us and our patients. We want to build it on the foundation of an engaged care team that provides the safest care with the highest quality that is patient and family centered. We really want to focus on creating clarity around the Michigan Medicine experience, as I shared earlier, for all, with the defined behavior standards that connect us back to our mission, vision, values. This will help all of us to provide the compassionate care to our patients and families that we all desperately want to.

Keith Gran:

I would just add that we have great leaders in Devin and Josie within the Office of Patient Experience, great staff. I think that the future is bright. We're working with all the segments within the organization and they are totally engaged in the work we're doing. I think everybody's goal here is to ensure that our patients are not only receiving the high quality care that we always deliver, but that experience that goes along with it.

Dr. Elizabeth Harry:

Wow. And I think the impact that that has on our teams, too. That they really know they can deliver the care they want to deliver. It sounds like you're putting so many things in place to help them feel that they can do that.

We've talked about a lot. If our listeners were to walk away and remember one thing from today, what would that one key takeaway be?

Keith Gran:

Well, I would say that patient experience at Michigan Medicine is all of our jobs. It's not just the Office of Patient Experience or the segments. We have to ensure that every day, we're thinking about the things that we can do to improve to make those experiences better. I think that that's the track we've been on.

Devin Lippert:

Yeah. In addition to what Keith said, I would just highlight patient experience is not a siloed effort. It's not a nice to have. It is really about the entire experience for all of us. The well-being of our caregivers is our foundation and we must focus on us first, so we can all give the experience and compassion that we all truly want to.

Dr. Elizabeth Harry:

Oh, I love that. It's the airline put your oxygen mask on first idea. If people are interested in learning more about this topic, the relationship between provider and team, care team well-being and our patient experience, are there any books, podcasts, or resources you'd suggest to our listeners?

Devin Lippert:

Yeah. One book that comes to mind for me is Compassionomics by Stephen Trzeciak. He talks about compassion as a remedy for burnout and it's just telling, especially for a provider I think to read that, because he is a provider.

We also, with the Barrel Institute, we partner with them at Michigan Medicine. They have a lot of research, white papers, as well as Press Ganey. If anyone is interested in learning more about a specific topic, that is what our team spends a lot of time in to just do a little bit more research and investigate. We have those materials.

Another podcaster that I think connects to this a lot is Brene Brown. A lot of you have probably heard her. We actually use her a lot of empathy. We use a lot of some of her stories in some of our teachings for PX101, for example. Our teams look at a lot of different areas. But if anybody ever has questions in a particular topic, we'd be more than happy to brainstorm with them.

Another resource we have is our own personal website, which is on SharePoint and it's our resource hub. We have a lot of information in there on different best practices, tactics, ways to understand your patient experience feedback, and even links to suggest one-on-one support from our project management team. It's a wealth of information there that we just wanted to make sure everyone was aware of.

Dr. Elizabeth Harry:

Well, that's amazing. Well, thank you both for being here. Thank you to all of our listeners for listening to another Well-Being at Michigan Medicine episode. I want to thank Keith and Devin for your incredible work and for joining us. Until next time, I'm Elizabeth Harry with the Office of Well-Being.