The Health Management Academy

Episode 3

Building Trust Among Patients and Employees

Episode Description

In this episode, Tom Lee, M.D., Chief Medical Officer at Press Ganey, sits down at The Table with Renee. Their conversation explores what’s needed to build trust in the healthcare system for both patients and employees. Tom walks us through Press Ganey’s data on factors driving employees’ likelihood to stay at a health system, and the importance of ‘gooey’ and ‘lofty’ ideals. And in the patient context, they examine the impact of simple changes in fostering confidence and improving overall experience.

About Our Guest

Tom Lee, M.D., Chief Medical Officer, Press Ganey

As CMO, Tom is responsible for developing clinical and operational strategies to help providers measure and improve the patient experience, with the overarching goals of reducing patient suffering and improving the value of care. Tom has more than three decades of experience in healthcare performance improvement as a practicing physician, a leader in provider organizations, researcher, and health policy expert. An internist and cardiologist, Tom continues to practice primary care at Brigham and Women’s Hospital in Boston.


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Renee DeSilva 0:06

Welcome back to the Academy Table. I’m Renee de Silva, CEO of The Academy and your host. This week, I was joined by Dr. Tom Lee, who is the Chief Medical Officer for Press Ganey. As you’ll hear, we discussed two big topics first, the ongoing healthcare workforce crisis, as well as some of the data his team is seeing on what is driving loyalty among Health System employees. Second, we covered evolving consumer expectations and the patient-provider relationship. The one unifying theme of our time together was trust. In recent years, there’s been any erosion of trust in our healthcare system for patients and consumers but also for employees. It was great to dig into Tom’s many insights and suggestions for improving that situation. Here are my takeaways from the conversation. First, I loved Tom’s definition of the word Trust. He believes it’s the confidence you will be treated fairly. In circumstances you have not thought of yet. I think it’s concise and powerful, especially in times as uncertain as now. Next, and workforce, Tom points to likelihood to stay as the single best expression of trust and employee has pay attention to the most strongly correlated factors in that loyalty. It’s less about pay or even staffing levels, and more as Tom calls them, the gooey and lofty ideas, belonging and being seen and respected as an individual. Third, when our industry discusses consumer sentiments in navigating healthcare, it’s easy to over-rotate on the quantifiable data. It was interesting to hear Tom describe how we might strike a better balance stories are in color, and data is black and white. And we need both to understand the full picture. And lastly, we ended our conversation with a reflection on the recent tragic passing of Dr. Paul Farmer, the public health leader, humanitarian and friend of Tom’s Dr. Farmer’s work brought the term moral imperative to life. And I think it’s a mission that everyone in healthcare you connect with. So with that, let’s head to the table.

Tom, welcome to the table. I’m so happy to have you join us this afternoon.

Tom Lee 2:38
My pleasure, Renee.

Renee DeSilva 2:41
So you have such an interesting background. You are currently serving as Chief Medical Officer at Press Ganey, and you are still an actively practicing internist. And so I just wonder, what were some of the early forces that shaped your interest in health care?

Tom Lee 2:57
Well, I am a child of immigrants who came from China in 1948. And like many children of immigrants, I wanted to have a career where I could have impact and make the world a better place and do work that I could be proud of, and healthcare fills the bill.

Renee DeSilva 3:16
And when you I’m struck by the fact that you’ve kept a clinical element in your portfolio, how does that active seeing patients every week? How does that clinical practice impact the way that you think about the challenges facing the industry?

Tom Lee 3:32
Well, I know that a lot of position executives give up their patient care. I I always wanted to keep it and my boss, Pam Ryan, the CEO Press Ganey, he actually told me he wanted me to do it. And he thought if I wanted to broaden it, go ahead. And I think the main reasons I want to continue doing it freedom first, it’s, it’s interesting. But secondly, you know, you can understand what patients and caregivers are going through by being a primary care doctor. The third thing I’d say is you can understand the changes that are happening in the environment LightWave, COVID, hid, and messages from patients to their health care providers tripled almost overnight, I could feel it, I can feel it myself by logging on in the morning and seeing that two or 3% of my patients had emailed me overnight, almost every single night. And then finally, you can get to feel the pressure for improvement because you can feel the friction in the system, where you know, when things aren’t going well because it’s rubbed in your face. So being in a role where I hope I’m trying to make healthcare better, knowing what I’m supposed to do and for whom, that’s what patient care does for me.

Renee DeSilva 4:48
I bet I bet you that bi-directional, almost real-time feedback lab environment makes you both probably a more sensitive physician and then also, when you think about what you can do Do your current platform at scale and formed by the anecdotes and stories of your patients, I bet you that’s a very powerful combination.

Tom Lee 5:07
Well, you know, when you when you find yourself saying things to patients, like, someone will call you some time, and tell you something, and you have no idea who it is, when they will call and what they will say, you feel silly, and you know, that’s a problem to be fixed. Now, most of us, you know, just cringe and go on with our life. But if you’re supposed to be a leader of improvement, you cringe, write it down, and then you try to make a dent in the problem somewhere down the line.

Renee DeSilva 5:41
So speaking of challenges to solve, maybe there’s so much ground to cover with you, Tom, you are encyclopedic about so many facets of healthcare. So I’m going to try to cover several different themes with you. And I want to start with workforce, which I would say in my executive conversations, it’s it’s the number one, two and third issue that CEOs are most focused on. And so let’s maybe start with workforce is our first topic. And I know that you think about and focus on lots of different data underpinning the loyalty as it relates to the workforce challenge. What would you say are the most powerful correlates with an employee’s likelihood to stay at a health system these days?

Tom Lee 6:29
Well, you know, I think focusing on likelihood to stay is a really smart thing to do, Renee, I increasingly feel like likelihood of staying by employees, that is the equivalent of the metric of likelihood to recommend for patients, it is the single most powerful expression of their trust in the organization. So we’ve got to train more doctors and nurses and other personnel, we’ve got to recruit them, but then we have to hold on to them. And when you ask people have their likelihood of staying, the ones who indicate that they’re looking around, or that they might not be there three years, about 1/3 of them do move, move on. So in a time where we got to retain people that we have, looking at likelihood staying and what drives that is a very important thing to do. Now, it’s very clear that paying people adequately and fairly is an is table stakes, and staffing so that they feel supported. That’s table stakes, too. You can’t be in the game, if you don’t do those things, but to differentiate yourself and have a better chance of holding on to them, when they might have jobs that are paying as well and that are staffing as well. Well, the data show interesting and really very encouraging opportunities. Our data at Press Ganey, you’ll base upon hundreds of 1000s of people surveyed in the last year, they show the what moves lose people make them feel proud and nice and want to stay in an organization are lofty things the gooey thing that we all feel good about. Yo, yo, does the organization let you treat everyone as an individual. Does the organization treat you with respect? Is it committed to quality? Is it committed to safety? Is it committed to being ethical, these values, they, they make people feel better about themselves? And make me clear that yes, these actually are the organization’s values and showing that you’re authentic? They are very important.

Renee DeSilva 8:43
Tom, I really like that the GUI and lofty things really do matter. So staying with that, because that to me feels you know, really, I can feel that right? Like you can get your heart and head around the lofty and gooey things that that build connective tissue with with your team members. One thing I heard you say was it stood out to me was this individualization both I am seen as an individual, and then also, I then see every patient as an individual can be really important in terms of retaining both folks in clinical and non clinical roles. Talk to me more about how you’ve seen that expressed in some of the data that you look at.

Tom Lee 9:22
Oh, it seems very clear that you know, equity and inclusiveness, these, these are hugely important as drivers of getting people to stay. We can it makes perfect sense. I mean, people want to be at a place where they feel like they belong. If they feel like they don’t belong, of course, they’re going to be looking around. You know, this is just one of the deeper insights about diversity and equity inclusiveness that we’ve all been acquiring since the murder of George Floyd in May of 2000. 20 is embarrassing that these insights are are new to us, but, but they are new. And they’re and they’re very powerful. You when people walk into a room, and they don’t see anyone else like them, their loyalty is not going to be the same. Even if many of the other GUI things are hard are there, you need diversity, you need diversity management need diversity in the C suite. And it’s not just race and ethnicity, you know, it’s gender. And it’s, you know, every other type of subgroup that you can think of making everyone, everyone feel that they have a chance of being valued as an individual. That seems like rhetoric. But it really is an operational imperative. And it’s very analogous to make every patient feel like they are being listened to, and respected for who they are. Yeah,

Renee DeSilva 11:00
I mean, it’s stunning, really, I think it’s something like employees are four and a half times more likely to look for a new job if they don’t really feel that equity and inclusion is is permeating through the organization. So, you know, we talk about the business imperative for investing there, you know, that that’s a that’s a great guiding principle.

Tom Lee 11:21
And it’s something that people can work on tomorrow. You know, and and if not, today, is not something where you have to be making long term plans around, you can start working on the culture, right away in what you say, when you walk around, and you talk to people who you talk to, I know that changing the diversity in the C suite that takes years, but beginning the work of making the culture more inclusive, that is something that can be done in a very short timeframe.

Renee DeSilva 11:51
Yes, you’re reminding me and I’m going a little bit off on a tangent here. But you mentioned a moment ago, that is something that can be done today. So maybe I’ll offer an anecdote that I shared with another another podcast guest that we talked about how all of us as individual leaders can play a role here. And one of the things I think is just a really practical way to think about it, that anyone that’s listening could even activate on was just this notion of the power of a nudge, which is when you see talented people, especially talented people who may not necessarily be in your regular social connection, right, you may meet that you may see them presented a meeting and they really jump out at you as being very strong in terms of how they, how they emote, it’s, you know, can you help them get connected to places that could put them in momentum building career roles. So the power of a nudge to get people to imagine that are there possible in their own career is something that I think I’ve benefited from, and hopefully I’ve been able to contribute to. So I don’t know, as you’re talking, I’m thinking through what’s the one thing all of us could do, which would be to help people see the potential in their career path. And maybe, especially if they maybe don’t look like you, right?

Tom Lee 12:59
You know, we have found over and over again, that employees of all types are happiest, when they feel like they are getting better. And they are part of an organization that is also getting better. So having a growth mindset is good for performance. And it’s good for retaining employees. And frankly, they go they go together.

Renee DeSilva 13:21
Indeed. So I want to stay on this thread, but maybe maybe zoom in a bit you published recently in Harvard Business Review around the challenges facing in particular, women physicians. And so let me let you elaborate a bit on that. Tell me a little bit around. Why do we see maybe a now strapped level of or outpacing attrition within physician leaders these days? Well,

Tom Lee 13:46
women are having higher rates of burnout in all types of roles. But women physicians are particularly vulnerable to this. And a lot of them are cutting back and they’re leaving the workforce with the extra stresses of the last couple of years. Now I’m married to a woman physician, one of my daughter, one of my three girls, is a woman physician, and I wrote this with a woman physician Jessica Dudley, I think I would summarize by saying women do a better job with your overall, your ID unlike the data show that women spend more time with patients, they spend more time documenting. And there are even some data showing better outcomes with women physicians, like for patients with myocardial infarction, if your cardiologist to the woman, you have a very slightly higher chance but statistically significantly higher of surviving. So women do a good job and there are good male physicians of course, but but women do a good job and they pay the price for it. You know, they stay they spend more time, late at night. documenting in electronic records, their notes are longer and more complete. And then they have more women patients and women patients, you know, they need things like pap smears, good breast exams, the things take more time. And as a result, women get paid less, because they do, they do a more complete job and on population and use more. Meanwhile, they are less appreciated, they, you know, they don’t get promoted as much at work, they don’t get paid as much as I indicated in a fee for service environment. And even no patient ratings, patients give a break to male doctors, compared to women doctors in terms of overall likelihood of recommend recommending, even though women doctors get ready to hire on all the specific functions, so they’re not as appreciated, despite doing a better job. And then they go home, and they have so much more to do, then, then, then the men if they’re if the household responsibilities are supposed to be shared with a male, like that, you know, and I think it’s not a shock. But the data are still shocking, when you look at the percentage of time that women are spending during COVID working on, you know, the, you know, remote schooling and all the kind of family responsibilities. These responsibilities have been difficult in ordinary times, but they’re crushing during this time. So I think that, you know, what’s the takeaway message, the takeaway message is, you can’t treat all your doctors the same, if you want to hold on to women, physicians, at most medical school graduates today are women. So that means you better come up with a flexible strategy that’s tailored for women, if you’re going to hold on to them, and prevent them from leaving your organization or leaving medicine.

Renee DeSilva 17:07
Yeah, that’s I mean, so I’d love so much of what you said, in particular, if I can just ping on two things I thought you did really well there, which was to say, new grounding in the experience of physician leaders in your circle, that’s a really powerful way to really tell the story of your wife and your daughter and your and your colleague, and then I’m struck just by an and I had not heard this range so eloquently before, which is the nature of how care how women physicians, deliver care, you know, the level of of documentation and such is also a driver of that. And I think, you know, in some ways, we know that some of the social and behavioral patterns after work have long been part of the conversation. But you know, we probably don’t spend enough time on, on within the four walls of the workday, the things that can can drive that in a way that maybe leads to some of these challenges, especially when we know that we are at clinical workforce crisis levels in terms of shortages. So your actionability around flexibility and, and how we create a value proposition that keeps us more likely to engage that population is I think, really, really an important point to just underscore.

Tom Lee 18:16
For, you know, I think that you’ll we learned in the last couple years that since George Floyd that the goal isn’t to be colorblind, but the goal actually has to be to be anti racist, and to try to undo some of the spiritual harms that have been done to blacks and other minorities and to that we can have a chance of you taken care of all of them as individuals. Similarly, you know, the goal can’t be to, you know, be gender blind, and and expect anything other than harm to the women are our workforce, the women, the women physician issues, what we focused on in the article, but these are generalizable to women in a wide range

Renee DeSilva 19:00
of roles. Indeed, all right, I want to switch gears a bit. We’ve been talking a lot about just some of the challenges from a workforce perspective, let’s shift to patient trust, and you’ve called it a defining issue of our time in terms of how trust has been eroded and the importance of of strengthening that why why do you feel that that’s the case?

Tom Lee 19:22
Well, you don’t trust is something that people have traditionally taken for granted. You know, what, particularly in healthcare where we know we’re good people, and we’re working really hard. We just feel like people should trust us. And in ordinary times, that might be true, but in times where people are vulnerable, and everything is changing and uncertain, like today, then trust cannot be taken for granted. And because of that people are thinking, what is trust now that you’ve trained to get what get at the core of what is trust about and then how do I build it in my organization, both with patience and employees. And, and a simple expression of trust that I like is, you know, trust is confidence, you’re going to be treated fairly, in circumstances you haven’t even thought of yet.

Renee DeSilva 20:14
And then again, say that, again,

Tom Lee 20:16
confidence, you’re going to be treated fairly in circumstances you haven’t even thought of yet. So, ideally, if you want to be in an organization where you know that, who knows what’s going to come next it might be, it might be another pandemic, it might be, you know, a heat wave, it might be fires, but whatever it is, the organization is going to do all it can to take care of you. You want patients to feel that way, and you want employees to feel that way. And, and that is something that can be done by your by taking steps that I think are best summarized by this simple three component model that Francis Frey from Harvard Business School, wrote about in Harvard Business Review, when she gave a fantastic TED Talk. That’s f r e i, if you want to search for the article, her TED talk, but her three basic elements are you have to have empathy, authenticity, and logic, your empathy, you have to show that you get it you get what they’re going through. And what’s important to them. Your authenticity is you have to show you’re for real, and and they’re not just forgetting about it when you walk around the corner. And then the third part logic is you have to show, you know, what to do you’re have you’re going to be effective. And part is actually having clear thoughts about what to do. But then it’s also conveying those thoughts, conveying that you have the thoughts and convey what those thoughts are transparency, basically. And I think that there’s a lot that we’re all learning in this era, about how do we build trust by by doing things like, you know, showing that with a new model of care, it’s still us taking care of you, and we haven’t changed, and we’re still committed, that means a lot to patients, and it means a lot to employees. Yeah,

Renee DeSilva 22:27
I think that’s a that’s that’s powerful. You know, we’ve certainly seen, there’s been some erosion in patient perception around that over the last couple of years. And so I guess I go to the action, which is, what are the things that providers in particular should be doing to really rebuild that trust? And I go back to where you started this conversation, which is you finished with a patient encounter, and you say, someone will call you at some point to cover some topic? And I sometimes think about, like, where the, the the challenging points on trust come in is sometimes not when you’re sitting down just your physician in that moment, but it’s all the peripheral items that impact if you feel like that experience served you well. So maybe with that broader aperture, you know, what are some of the things that we should be thinking about from the provider lens to really rebuild that trust experience? Well, you

Tom Lee 23:21
know, I think you’re really on something important here. And, and I think there was a time where doctors like me thought all that really matter was how wonderful I was going to be when they’re right in front of me. And that the key thing is for me to try to be wonderful 100% of the time, not just like when I feel like being wonderful. And it’s still important that clinicians be wonderful when they’re face to face with patients. But all the other times around that during the patient episode, they matter too. And because patients know that healthcare is a team sport today, and that even if their clinician might be wonderful, if everything else is dysfunctional around them, they lose their trust, that they’re going to be okay, that they will be taken care of in circumstances that they haven’t thought of yet. So I think that where the arc of, of healthcare history is is zooming toward is working across the value chain of activities, working with payers, working with other organizations to make things smooth, and, and decrease chaos. You know, so that one thing I believe that, you know, we should be doing is online scheduling, a online appointment making for giving that access to patients, and many organizations are now starting to do this. I think that I was just part of a meeting where some organizations come about 7% Even 15% of their visits being made by computer, but the truth of the matter Is it ought to be offered for, you know, as the default, because anyone is trying to make phone calls, make phone calls appointments, has gone nuts lately because no one has enough people to answer the phones, that kind of chaos makes patients lose their trust that that things are going to be okay. They’ve got to be thinking, if they can’t get this right, what else might they mess up on. So working on the systems that surround the clinician patient interaction is important in a way it never was in the past. I’d also say that transparency, high reliability, those two basic principles should be baked into the DNA of everyone working in healthcare, you cannot be too transparent, you cannot push high reliability far enough. And so sharing your data on like patient comments, for example, that’s what Press Ganey focuses on but not only sharing them on your website, but exporting them to the other sites that patients can slash consumers might look at even pair directories, that kind of thing. It is only going to make patients feel more trust for you when they see the same thing. Everywhere.

Renee DeSilva 26:24
Yeah, maybe just staying on that I was gonna ask you when you’re talking about transparency from what lens at but you’re so you’re running at this point running sort of deep around the consumer perception of the care that they received, and having that available as consumers are making choices in care? I guess just staying on that. I mean, just given how much noisier is, you know, whether it’s and I’ll sort of stay agnostic as to the various platforms. But how much noise there is? What is I think about how you effectively curate that for patients? How you have the right, and like, how do you how do you inform that holistically? Just maybe comment a bit on that, what have you seen as effective ways to break through that noise to give patients the right input versus just maybe one or one or two different anecdotes? What a split is good practice look like as it relates to this transparency point?

Tom Lee 27:15
Well, you know, I think that you, you, you need to give multiple types of data, you’ve got to broaden and deepen the way you’re listening to patients and responding and showing people that you’re listening. And when I say broaden, it means not just like after the doctor patient interaction, because that’s what we can build for, but, but actually clicked the information about the whole process, like, you know, when they wake up and find some lump on their neck and think what the heck is this? That’s really when the episode begins. And I think that using technologies that were really developed by consumer researchers to do quick, timely, short surveys of at these various moments in time with their friction, that is, the that’s where improvement is is where the work of improvement is, is beginning to really focus and, and then the flip side is going deeper. And you’re listening using AI and natural language processing to extract insights from narrative data. That is very powerful, as well. One of the little lines that one of my colleagues said recently, what struck me was he said, stories, meaning patient comments are in color. And numbers are black and white. Yo, you need both. And you need to collect both, and analyze both. And then share both with with the broader world to gain your trust.

Renee DeSilva 28:57
Yeah, as you’re as you’re, as you’re talking, I’m thinking through we are in such the early innings as an industry of our ability to do that. Do you agree with that statement? Pretty nascent in packaging that for consumers in a way that’s digestible? Yes, we

Tom Lee 29:12
are. But I’m, I’m really excited. I think we’re we’re at an inflection point where things are really accelerating. I think we’re past an inflection point. So I’ve seen demos of new approaches where you can do online, online, Zoom focus groups, and you’re not only extracting information from what people are saying, but from their facial expressions, and our our ability to gain insight into what matters to people is, is really being accelerated by technology and then our ability to interact with them. Is, is being transformed to, you know, you know, one thing that we’re all recognizing now is You know, because of COVID is that, yes, the the clinician patient relationship matters. But there’s the team family relationship. I mean, it’s a team of clinicians working together and other non clinicians and the whole family matters. And then there is the delivery system, community relationship. All of these matter, they’re actually all important for gaining trust and holding on to your market share and your business, but our ability to capture the data and respond to it. I think technology is putting us into a very exciting new place. And I think things are things will be changing in 2022. It’s not the it’s not a decade long transition. We have a fun time in it. Yeah, I

Renee DeSilva 30:47
love that. And I’m sure all that all the physician friends that I’ve met at the Academy will appreciate that because my current way of figuring out where do I go, my mom needs a knee replacement is you know, asking a physician friend that’s contacting my cell phone. Right. So I do think getting to a place where and I consider myself a an informed consumer of healthcare. But getting to a place where that’s easier to serve up for folks, I think will is incredibly meaningful.

Tom Lee 31:11
You can always fall back on emailing me.

Renee DeSilva 31:15
Yes, perfect. Be careful what you say though, because I am unapologetic with my my, my attempts at doing so. So I’ll be judicious in that though. Dr. Lee. All right, final question. Not at all related to health care, unless you take it there. Ask all of my guests this, which is if you could invite two people for a conversation at a table that you curate, what who would you invite and why?

Tom Lee 31:41
Well, I love that question. And, and I’ll the first one will be someone who I can’t invite anymore. It’s my very good friend and colleague who passed away two days ago, Paul Farmer, and a human who started Partners in Health. And the one that I I pair him with is another wonderful colleague from the Brigham Atul Gawande. Now, in fact, all three of us have sat at dinner tables before and I’m grieving that the three of us can’t sit together again. But what I would say about Paul Farmer, and what I would say about the tool Gawande, that the reason I’d love to have dinner with them, again, is that first, you know, we all love healthcare, I mean, health care, people can be pretty boring. But I think we’re all the kind of people who like go to parties, and they go off to the side, but someone who wants to talk about health care. And I’m certainly in that category myself. But then the thing about them that I hope is true about myself is that I think that they’re a great combination of being idealistic, but also optimistic. And, you know, I think that they’re all that, you know, they’re both grounded in reality. And but, but they have that right combination. And, and I feel like, if I in my professional life, or in doing things that they would approve of, that would be I’m on the right track. So that’s what I’d like, I’d like to have dinner with,

Renee DeSilva 33:11
that’s fantastic. I did not know Paul Farmer directly. But just I’ve sort of been immersing in a little bit of his story just given given the recent events. And he seemingly has built an incredible healthcare legacy. So I can, I’m sorry for your loss there. And really probably for our the loss for us as a global healthcare community, given his impact there. So that that is a great response. And I will tell you, Yes, you healthcare folks can can be boring. But I’ve spent a lot of time with healthcare leaders. And you also are a lot of fun, just driven by mission, and also just a deep commitment to the work. I’ve really enjoyed the opportunity to spend time with many of your colleagues over the last couple of years.

Tom Lee 33:49
By pleasure and you’ll pull former brought good term moral imperative to life. For me. I mean, it wasn’t just read or put to him it was for real. And I think that if we look at our work, will feel that more often when we think of Paul,

Renee DeSilva 34:06
it’s wonderful. Well, Tom, thank you so much for joining. I really appreciate it getting to know you a bit more today.

Tom Lee 34:10
My pleasure. I look forward to more.

Renee DeSilva 34:13
Thank you. Thanks again for joining me at the table. The table is a podcast produced by the Health Management Academy. Make sure you catch future episodes by visiting our website, The Academy or by subscribing on the podcast platform of your choice. And if you have suggestions for topics or guests, I’d love to hear from you. Please drop me a note at Renee at Hm I look forward to talking with you soon.