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00:00:00:29 - 00:00:29:15
Tom Haederle
Welcome to Advancing Health. In health care, there is a very strong link between positive employee engagement and positive patient engagement, experience and outcomes. Hear some of the reasons why in this podcast hosted by Elisa Arespacochaga, AHA's vice president of Clinical Affairs and Workforce. This podcast was recorded at the ºÚÁÏÕýÄÜÁ¿ Association's 2025 Leadership Summit in Nashville, Tennessee.

00:00:29:17 - 00:00:54:19
Elisa Arespacochaga
I'm really excited to be here today with two leaders in the field and really enjoy a conversation with Nell Buhlman at Press Ganey and my colleague Chris DeRienzo to really talk about the connection between employee engagement and patient engagement and experience. Over the past year, we've had such a great time building a partnership with the team at Press Ganey to get at the heart of that connection and help hospitals and health systems build

00:00:55:20 - 00:01:12:09
Elisa Arespacochaga
the engagement with their team and ultimately drive increased patient engagement and experience. So Nell, I'm going to start with my first question for you. What are the facts on the ground? What are you seeing? What is the data saying? How tight is this connection and how important should this be to our members?

00:01:12:10 - 00:01:31:24
Nell Buhlman
So, great opening question. Really glad to be here with both of you. This has been a fun year of getting to know each other better and partnering on papers and blogs. In terms of what we see in the data, at Press Ganey we measure patient experience for a good chunk of the provider industry, about 70%. We do workforce engagement for 40% of the industry.

00:01:31:24 - 00:01:53:29
Nell Buhlman
So we have a ton of data that we can bring together and look at the relationships and at the outcome level, as we think about engagement being an outcome and we think about the two outcome indicators in patient experience, which are really likelihood to recommend and overall rating of care. There's a very strong association between employee engagement and patient engagement or patient experience of care.

00:01:54:06 - 00:02:14:01
Nell Buhlman
So much so that if you look at quartile performance and workforce engagement and quartile performance and patient experience, organizations in the top quartile for workforce engagement are most likely three times likely to be in the top quartile for patient experience, it's almost a perfect stair step from lowest quartile to top quartile.

00:02:14:03 - 00:02:29:09
Chris DeRienzo, M.D.
Now, I've looked at those graphs more times than I can count, and it's the one that about safety culture that always sticks with me because you've got you got this one visual that, like the arrows diverge and isn't it like a delta between the 97th and the second percentile?

00:02:29:09 - 00:02:50:29
Nell Buhlman
You got a great memory. Better than I do, I'd say. Yeah, that's exactly right. Which, you know, you bring up a really important point there, Chris, which is if you think about a couple of things - the component parts of workforce experience, like engagement is one of them, but it's how the organization is thinking about engaging their people, what matters to their people, what matters to people at the frontline versus a little bit further back?

00:02:51:04 - 00:03:20:04
Nell Buhlman
Safety is essential. Clinicians, everybody in health care, they want to know the care is safe. They want to know the organization is committed to high quality care. We have this sort of visual concept that we lay out when we're talking about the relationship between these domains that I referred to as sort of the flywheel, the flywheel effect of employee experience, which component parts of that, of course, engagement of the workforce, and also the degree to which they feel safe themselves and that the care is safe.

00:03:20:11 - 00:03:48:22
Nell Buhlman
And I call that the mini flywheel. And when you get momentum with that mini flywheel, people feeling set up for success and engaged in their work, it powers the larger flywheel of patient outcomes. So safety outcomes, quality outcomes, patient experience outcomes, and business outcomes on that big flywheel of, you know, is the care being delivered efficiently? Are organizations able to be profitable so they can plow those profits back into augmenting the services they provide to their communities?

00:03:48:29 - 00:04:07:21
Elisa Arespacochaga
I mean, it's at its heart, basic human nature, right? If other people care about things, then suddenly more people want to care about those things, and the more you can get that momentum going of just engagement and wanting to care about it. Because every clinician I know, you know, mortgage some part of their 20s to really focus on

00:04:07:21 - 00:04:08:24
Nell Buhlman
100%.

00:04:09:01 - 00:04:20:20
Elisa Arespacochaga
providing that care to others. So having a cohort of people, a team you're working with that cares about what they're doing and wants it to be the best possible, it just inspires you to do more.

00:04:20:22 - 00:04:24:21
Chris DeRienzo, M.D.
22 to 33. That's my mortgage.

00:04:24:23 - 00:04:27:21
Nell Buhlman
An extended mortgage!

00:04:27:24 - 00:04:50:21
Elisa Arespacochaga
So let's talk about one of the things that to me is really key to doing this well. Because you can have a charismatic leader, you can have an inspired team. But if it isn't easy to do the right thing, if you don't have that infrastructure in the organization that supports engagement...if you make it hard for people to do that right thing, it makes it that much harder to keep it up, to keep that enthusiasm going.

00:04:50:26 - 00:04:57:26
Elisa Arespacochaga
So what are some of the things you all are seeing that are helping support everybody rowing in the same direction?

00:04:57:28 - 00:05:29:28
Nell Buhlman
I'd say one of the most important elements is identifying the goal. What is it that we are trying to do? How does it align to organizational strategy? And does it factor in what matters to the people who are doing the work, the people who are delivering the care, whether they are right at the bedside or they're further away from the bedside, those at the bedside standing on their shoulders, so to speak. Aligning to strategy, making clear how it aligns to strategy, and anchoring it in the values of the organization, and making sure that the behaviors that are expected are aligned to those values.

00:05:30:04 - 00:05:50:12
Nell Buhlman
That there's accountability to those behaviors. So, those are some of the foundational sort of strategic elements of it. And then the rest of the infrastructure, I think, you know, is aligned around do people know what they're supposed to do? Have they been trained? Are we measuring things appropriately? What are the different facets, the different components of the strategy that are going to enable success?

00:05:50:12 - 00:05:54:27
Nell Buhlman
And how do we hardwire those things so that we're delivering reliably on them?

00:05:54:29 - 00:06:27:25
Chris DeRienzo, M.D.
One thing, Nell, that I would add, is we've been lucky to work together since at least December. And I remember we had an opportunity to bring several hospitals and health systems into a room, all of whom were really showing top level performance, top box performance for both their workforce experience and their patient experience. And it struck me that this kind of infrastructure that didn't require you to be a very large, multi-state, you know, multi-system entity down to a single hospital in Appalachian Ohio, up to those sizes -

00:06:27:25 - 00:06:33:24
Chris DeRienzo, M.D.
they were kinds of infrastructure that worked. And Elisa, you tell a story of one of those that I just always love to hear.

00:06:33:27 - 00:06:57:09
Elisa Arespacochaga
Now have to remember which story that is. But yeah, there's a lot of underlying infrastructure of making sure that everyone is on the same page. There are a couple of everything from the very simple to from a CEO whose name was Cliff and felt moved to tell his team what he was thinking about on the regular and writing this newsletter

00:06:57:09 - 00:07:25:21
Elisa Arespacochaga
that was both very personal, but also very connecting to the community and calling it Cliff Notes, which to me is just one of the most heartwarming opportunities. Obviously, not every CEO is going to be named Cliff. You have to come up with the individual connection, but looking for opportunities to truly and authentically connect with everyone on the team, whether you're in the same building with them or whether you're across states from them looking for those opportunities that give you that authentic voice

00:07:25:21 - 00:07:56:25
Elisa Arespacochaga
I think and that authentic connection to your team. Because everyone really does want the same things, and identifying what that road looks like and where you want to go and where you are today are so important to that. So just to dig in a little bit more on some of those top performers and our conversations to really understand what they do differently. It was interesting to me that as we went through those conversations with them, there were some sort of key approaches that they all had that, as I described, are very tactical.

00:07:56:25 - 00:08:09:06
Elisa Arespacochaga
Everything from making sure they're communicating in different ways and very authentically. But what were some of the ones that struck you all as really neat tactics to make that engagement hit home?

00:08:09:09 - 00:08:45:08
Chris DeRienzo, M.D.
Yeah, Alyssa, I'll lead with one. And it's about connect to purpose. You know, I've heard experience described as how we deliver on our brand. And I'm a doctor, not a marketing person. But I've also heard brand described as the promise that we make, the reason that people come to see us and drive past other places. When I heard that, I thought back to the first health system I worked at outside of fellowship over ten years ago, and during orientation, our chief operating officer told every single person who worked for this health system, you have two jobs. And job number one is to do whatever it is we hired you to do, be it as a

00:08:45:08 - 00:09:06:23
Chris DeRienzo, M.D.
neonatologist or as an EVS technician or revenue cycle employee, and do it as well as you possibly can. Job number two is help us figure out how to make it better. And our purpose, our core brand was improvement. That we knew we were doing well but our commitment to the community was we are always working to get better and that had to be ingrained in our DNA.

00:09:06:23 - 00:09:30:13
Chris DeRienzo, M.D.
So she did a spectacular job, starting with orientation and even before orientation in terms of hiring the right people for whom that purpose really connected, that helped then build an infrastructure that we can rely on. But connect to purpose was the one that really resonated loudest with me and again, that works just as well for a critical access hospital in Oklahoma as it does for large multi-state systems here in Tennessee.

00:09:30:20 - 00:09:44:09
Nell Buhlman
Chris, that's really interesting because she's actually when I hear you tell that story, and it's not the first time I've heard it's such a good story, she's doing a couple of things there, maybe three good things there, and I'm sure she does lots of great things. But, one of them is - with the idea of connecting to purpose

00:09:44:09 - 00:10:07:06
Nell Buhlman
so first, like articulating what the purpose is. Everyone understood because she said the same thing to everyone. So everyone understood. So having that narrative, expressing it in a way that transcends all roles in the organization is essential. That's how you connect to purpose. And then the other thing is there's another element we saw among those organizations that we brought together in December is the idea of two way communication.

00:10:07:06 - 00:10:26:24
Nell Buhlman
Right off the bat, that CEO was opening up the door to two way communication, not just this is how you're going to do it. I'm going to tell you how you're going to do it, but I want to hear from you how to make it better. So that two way communication was there. There's no better way to show respect to people than by inviting them to contribute to adding additional value.

00:10:27:00 - 00:10:47:14
Nell Buhlman
Finding improvement and respect is the number one driver of engagement nationally, at every organization locally. It's not one of those things that sometimes shows up as a key driver and sometimes shows up as like the third driver, it's always the number one key driver. So she was doing that too. And then this idea of the work mattering is really essential as well.

00:10:47:16 - 00:11:07:14
Elisa Arespacochaga
And I love that. One of the other examples that stuck with me was this one organization that created what they referred to as transformation teams, where they went to the frontline because it was closest to the problem or probably closest to the solution, and pulled together frontline teams on focused priorities that they all had agreed upon as an organization

00:11:07:14 - 00:11:24:29
Elisa Arespacochaga
that led directly to their strategy. But then they went to the people doing the work and said, be part of our transformation team. Help us make this change. So that communication was just reinforced between leadership and the frontline, but also was giving this group both the respect and a voice in how their work was going to move forward.

00:11:24:29 - 00:11:48:18
Nell Buhlman
And building trust, and building trust so essential. And the idea of teams is also essential. Individual contributors can only create so much value. When you have people working together in teams, you have this exponentially greater value because it's a flywheel unto itself. It gets momentum, it's self-reinforcing. And we talk a lot about the idea of in health care

00:11:48:18 - 00:11:57:16
Nell Buhlman
it's not just a team sport, it's a team of team sport. And you have to have intersections and collaboration and coordination across multiple teams to really get it right.

00:11:57:18 - 00:12:22:04
Elisa Arespacochaga
And Chris has heard this, but I still quote it quite often. The first day of one of my calculus classes in college, professor came in and wrote on the board, two plus two equals five and asked us to prove it. And I said, well, for sufficiently large values of two, that's accurate. So, I think that's entirely what we're trying to build in health care is where it's sufficiently large values of two to be able to be five.

00:12:22:04 - 00:12:22:24
Elisa Arespacochaga
when we're two plus two.

00:12:22:24 - 00:12:45:14
Nell Buhlman
Exactly right. Exactly right. And to make the connection back to patient experience: Among the key drivers for patients to give highest marks for likelihood to recommend or overall rating of care is their perception of the degree to which teams worked well together to care for them. It is the number one key driver for achieving high performance and likelihood to recommend across all settings of care.

00:12:45:16 - 00:13:01:05
Nell Buhlman
Did the care team work well together to care for me? Which is interesting because it shows that patients are alert to team dynamics and interpersonal competencies in ways that maybe we didn't imagine previously, or maybe weren't even really true previously, but it certainly is today.

00:13:01:07 - 00:13:15:10
Elisa Arespacochaga
Well, I just want to thank you, Chris and Nell, for joining me on for this brief conversation. I look forward to so much more work together, because this intersection is one that both I'm passionate about, and I think we can really help the field move forward.

00:13:15:12 - 00:13:23:22
Tom Haederle
Thanks for listening to Advancing Health. Please subscribe and rate us five stars on Apple Podcasts, Spotify or wherever you get your podcasts.