Culture Doesn’t Eat Strategy. It Digests It.

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Melissa Gilkes-Smith: You’ve heard the quote. Everyone in healthcare has heard the quote: Culture Eats Strategy for Breakfast, Peter Drucker, referenced at every healthcare retreat, leadership retreat, printed on every culture deck, repeated until it stopped meaning anything. Here’s what I want to offer today that framing is incomplete. And in healthcare, incomplete thinking about culture is costing us. In performance, in staff retention, and most importantly, in the patient experience we’re trying to deliver. Culture doesn’t eat strategy, it digests it. And whether your culture turns that strategy into fuel or waste, that’s the question we’re trying to answer here today. I’m Melissa Jules Smith, and this is Touch Points, Moments That Matter.

So welcome back to Touch Points, Moments That Matter, the podcast dedicated to the practical side of patient experience, operational excellence, and the moments that shape how patients feel about their care. Today we are talking about culture, not in the abstract vision statement sense, but in the real, lived what actually happens on Monday morning sense. Because here’s what I believe deeply. You cannot build a remarkable patient experience on a broken employee experience, and you cannot sustain either one without a culture that is genuinely aligned with your strategy. My guest today has spent his career at the intersection of exactly these things. Andy Clark is a patient experience expert and coach who focuses on helping healthcare leaders shape healthy cultures and get results.

And I mean results, not just better scores, but real shifts in how teams operate, how leaders lead, and how patients feel. Andy, welcome to Touch Points. I’m really glad you’re here.

Andy Clark: Thank you. Glad to be here.

Melissa Gilkes-Smith: So before we get into the meat of the conversation, I always like to ask guests to set the stage a little. So tell us who you are in your own words, what you do, and what got you here.

Andy Clark: Yeah, so um thanks for the intro. Um, you know, uh I’ve been in the patient experience world since uh, gosh, 2013. So quite a good bit um over time, you know, that that experience has helped mature to, you know, viewpoints and and stances. And uh it’s been a fun journey. I enjoy it. And the more I did patient experience, the more I realized how important leadership is and and taking care of your employees and your staff and um managing your organization in a way to get the results that you’re looking for. Um, so that’s been a lot of fun. It’s been a very rewarding experience. It’s something I love to do. It’s one of the reasons I got into healthcare, you know. Um, I’m on the administrative side, but uh when I got into healthcare administration, I did it because I wanted to help others, right?

Um and uh just to digress for just a half second, I had a back in college in undergrad, I had a fun interview where we were doing a day in a life of, and uh I chose a hospital administrator and we went and did an interview with him, and his whole attitude towards work was infectious um and influential for me because he’s like, I get to do this. Like this is a fun job. And you know, I might not be the one at the bedside taking care of a patient, but I am taking those, taking care of those who are taking care of patients. Um, and so that was something that really resonated with me and gave a sense of purpose. And so that that’s kind of what what drives me and and why I do this. Um beyond that, you know, I’m a dad, got three kids, 16, 14, and nine.

They all keep me busy, two boys, one girl. The girl is the youngest, so she does kind of rule the house, and um that’s okay. She’s uh she’s a sweet one, she’s uh precious. But uh yeah. Uh hobbies, love college football, University of Alabama is my team. Um, oddly enough, being here in Birmingham, um, I am a hockey fan as well, and so love the Florida Panthers and uh just uh yeah, that’s me.

Melissa Gilkes-Smith: Fantastic. I love that. And that’s actually a perfect setup for where I want to start today. Um, because the work that you do, it really lives right at the intersection of culture and results. And I want to challenge a framework that a lot of listeners have been handed. So let’s start with a quote: culture eats strategy for breakfast. It’s everywhere, it’s on posters, it gets nodded at in boardrooms. The conclusion of a lot of leaders draw from that is that strategy is the lesser priority that if you get the culture right, everything else follows. But my pushback is this it’s two-sided. A bad strategy executed by a great culture still loses, and vice versa, a great strategy by a poor culture still loses.

And so culture doesn’t replace strategy, it either compounds it or corrupts it. And Andy, where do you land on this?

Andy Clark: Yeah, I I think it’s a very interesting way of framing it, um, the way that you’re articulating it. And yeah, I I think that, you know, as I as I thought about this podcast and our discussion, and I was thinking about um the the framing of this discussion, one of the thoughts that occurred to me is that culture is a vehicle that takes you from strategy to results. And that’s exceptionally important when you’re looking at healthcare and trying to drive patient experience as an example. Um, because healthcare at the end of the day, if you want to boil it down to something very, very simple, is it’s a human interacting with another human. Right. And so when you’re looking at trying to deliver a positive experience with a high rate of consistency that’s predictable over and over and over again, the way you’re going to be able to do that is through a strong culture, which incorporates strong leadership, also incorporates strong core values as an institution and living out those values.

And those things create your culture. And that’s what’s going to enable your employees to deliver quality patient experience and quality outcomes.

Melissa Gilkes-Smith: I agree. And I think I think more of like a useful question is not is our culture strong, but is our culture aligned with what our strategy actually demands? Because you can have an incredibly cohesive culture that’s pulling in the wrong direction. So, what does that misalignment look like when you walk into an organization?

Andy Clark: Yeah, so I think, you know, if you wanted to zoom way out, um, yeah, your core values need to match your top leadership team, your senior leadership executives, right? Because the thing is, is if they are misaligned, everyone in the organization knows it. It it shows in the way you make decisions and it shows in the way that you talk about different initiatives and the way you support things and where those resources go. So there needs to be alignment with those values in that senior leadership team. And when it works well, everybody can feel it. You know, some of the classic examples are Chick-fil-A, for example. Um, you know, you go in, it’s clean, right? They got fresh flowers, it’s fully staffed.

Even if it weren’t and they were short-staffed, you would never know it. Everyone is sweet, everyone is kind, they have all these viral moments of, you know, there’s their staff handling these really crazed um, you know, customers that are being very unreasonable and they handle it with grace and compassion and love. And you only can do that if you’ve developed a culture that fosters that. Um, where it doesn’t work is when you’ve put people in a situation to try to manage a positive experience, and you are not aligned with the way that you’re operating. You have not given their proper resources, you have not given people, you know, um alternate avenues to help. You haven’t empowered those employees, those frontline staff.

I remember talking to some check-in staff at a clinic uh a couple of years ago, and they were very, very frustrated because they wanted to do a good job, but they didn’t have the resources, they didn’t have the time, they didn’t have the structure around them. No one had built an environment for them to be successful, right? And so what you got was apathy, you got burnout and and disengagement because they’re like, look, we noticed these problems, we tried to do the whole patient experience thing, we told our supervisor, and we told our supervisor’s boss, and someone from Cedar Senior Leadership came and did routing, and we told them, but nothing ever changed. Right? And that’s where that misalignment is, and and so you can see it in your interactions with people because um, you know, and juxtaposed to like Chick-fil-A, for example, you go somewhere else, name your other fast food restaurant, you don’t really get the same attention and care and timeliness.

It is just not there because, you know, the culture isn’t there to support it.

Melissa Gilkes-Smith: I hear that in so many healthcare organizations. The strategy says patient first, but the culture rewards speed, throughput, and not rocking the boat. And then leaders are surprised when a patient experience initiative doesn’t take hold. So before an organization can even start fixing the culture, they have to do that diagnostic work. What does our strategy actually require of our culture specifically? And Andy, how do you walk a leadership team through that? How do you fix it at a leadership level?

Andy Clark: Yeah, so I think so much of it is related to your core values and making sure that you live out your core values and that you make your decisions based off of those core values. And as I mentioned before, you need to have the right leadership team that matches and mirrors those core values. Umce you’ve done that, I would say you want to make sure that your team has healthy dynamics, a senior leadership team. Um, I’m a big fan of assessments like the disc, for example, um, where you can show different communication and behavioral styles. And what I love about assessments like that is it gives a vernacular for the team to use and kind of understand themselves, but also understand their peers. And one of the things that whenever I do disk assessments is I stress that each different personality, or not personality, communication style, um, is important.

Those behavior characteristics complete a full circle, right? You have a full team. And they’re helpful to see if maybe you’re overloaded on um, you know, the task um uh driven individuals versus those that are more relationship driven or you know, those that just um you know are all logical but no feel, right? So being able to kind of map out where everyone is and make sure that there’s a certain amount of appreciation for what everyone brings to the table. And then you can also take different initiatives and divide them up among those that have those natural strengths. So leveraging the strengths that those individuals have. And then I would say you want to be honest with yourself about your organization and what their capabilities are and what are their limitations.

Um, I remember talking to a senior leader, this is probably eight or nine years ago, um, where kind of to what you said earlier and your question of you know, volume, volume, volume. And um, this organization was pushing volume, and they were also saying patient experience matters. And I I told this individual, I was like, do you realize that every time you address the staff, your your organization, you’re saying volume, growth, throughput at about a rate of four to one to patient experience. And you’re you’re telling people patient experience matters, but what they’re actually hearing is volume and throughput, just because you’re drowning it out with how often you’re communicating it. So, you know, you have to have a strong communication plan as well, um, and making sure that you’re hitting on those initiatives, backing it up with your core values, making sure that you’re properly resourcing those things, um, and that you’re setting up for an environment to work.

And then after that, I would say, once you’ve done that, you’ve done your big launch, you’ve done your communication plan, go back and inspect what you expect. Make sure it’s being done, but not only being done, but done in a way that is meaningful, particularly if you’re looking at patient experience initiatives. A lot of times I would tell people, it’s not what you do that matters, but how you do what you do that matters. Right. Um, and reinforcing those positive behaviors and giving coaching, giving feedback in the moment, helping create clarity around what you’re trying to do and what those outcomes are and how to get there. Um, and then, you know, also looking for accountability. You know, over time, if you’ve done these observations, you’ve come back and you know, you’ve been really looking at it and coaching it for you know a month or two and you’re still not seeing the change, then you do need to start applying accountability, um, assuming you’ve already taken care of all the other environmental factors, like I said, being properly resourced and putting them in a in a position to succeed with training, et cetera.

Um, and then I would say harvest stories as much as you positively can, and then sharing those stories and sharing the results, sharing your scores, showing your your measurements along with those stories so people can see, okay, we’re getting this outcome and we’re getting these great stories. Um, and I like to think of people as being data driven, but also being emotionally driven. So I can show you data, but then I can also share with you a heartfelt story. I’m getting a broader audience and I’m I’m articulating why this matters and why we’re doing what we’re doing, and you can tie that back to that core value again. And that starts creating, you know, a system of psychological safety, empowered leadership.

It creates that prism for people to look through and know in any given situation. Um, you know, if these are our values and I’ve heard the stories and you know, we’ve gotten the feedback, and I’ve seen people being praised and recognized, but also others being held accountable for not following through. Whatever the situation is, I look through that prism and now I know what to do. And that kind of gets us back to where we started, which is that’s the culture that you’ve created that helps you get your strategy to your outcomes.

Melissa Gilkes-Smith: Those uh disc profiles, those assessments are really helpful, I think. So I was in an organization previously. I mean, I’ve I’ve taken several of those assessments, of course, uh across my career, but it really helps to understand how to communicate better with different people, meeting people, meeting your team where they are, not just um those that report to you, but also your colleagues and you know, asking and understanding what motivates employees, what motivates your team, because it’s not the same for everybody. So the question, what motivates you, what matters to you? And all of this, of course, is just setting the foundation and the connection of the employee experience to the patient experience and not providing that that why we’re doing something.

So why we do what we do is for the patient experience. Um, you can end up creating some disengaged employees, you know, if you don’t understand their motivation and, you know, their why, like why they are here, you know, on your team, why, why did they take a position in healthcare? What motivates them in their position? So let’s go to the disengaged employee. So, what does a disengaged employee really look like to a patient? Because I think like sometimes leaders, they they think disengagement is just invisible, but that staff member just goes quiet or slows down. But patients, they they pick up on it.

Andy Clark: They do. Um, and you know the the thing with patients and patient experience that there’s been plenty of studies that show that patients can accurately reflect through the cap scores if they’re getting quality care or not. Right. Whether they’re they’re they know medicine or they’re just a complete layperson that really doesn’t understand understand our system, they they are accurate predictors of quality of care. Um and and you can feel it. And some of it comes through, especially in a healthcare setting, where you see the level of care, level of time, attention, the willingness to maybe find a solution. Right. A lot of times going back to that volume, people are like, well, this is the standard thing we do, whether you’re a square peg or and this is a round hole, it doesn’t really matter.

We’re going to try and jam you through this system anyways, um, which happens quite a lot. Um and and they stop seeing the patient. Um, yeah, they they stop seeing the problems, and they’re not asked to be a part of the solution. And I think that’s part of it. If you have a strong culture um and you got engaged staff, they’re being asked routinely, how could this be better? And they’re being listened to on top of that, right? So they they give a suggestion and you act on that suggestion. Now you’ve just reinforced it. Okay, they actually care. This actually means something. Um they’re serious about making change and and making it better. If you can’t do whatever the suggestion was, then you follow back up with that individual or or groups of individuals and you let them know why you can’t do it or why you can’t do it right now.

But maybe in the next budget cycle, we can prepare for this, we can plan for it, and we can execute it the way that we like to execute on things, right? So I I think when you do those things, you create engaged employees. If you don’t, then they just kind of do the bare minimum. And I think that’s what most people, when they’re having a bad patient experience, that’s what they feel, that’s what they see is the bare minimum. They’re they’re doing the task and they’re not thinking about that patient as an individual, they’re thinking of them as a task. Um, and and that happens a lot in healthcare, unfortunately. And what I would tell people is you need to start remembering and being cognizant that those tasks represent the patient’s quality of life.

You know, lab results, for example, you know, you think you got cancer, you’re sitting there. Okay, we’ll follow up with you. If you don’t hear from us, no news is good news is something you hear all the time. Yes, yes. And when I would do orientation um for for new hires, um, you know, I’d ask them like, well, what’s a what’s a good time frame to to hear back on on labs, especially if it’s cancer? And I’d have the whole group and I’d say, Raise your hand if you think a day or two. Right. And without fail, the majority of the class, healthcare employees, I think I want to hear about it within a day or two. And that’s just not the case. Right. And but that’s a task. You go through it, hey, my job’s done, I move on as an employee.

And I could spend a lot of time on this one because I’m really passionate about it. But what I’ll say is that’s just doing the bare minimum. You know, same thing with rooming a patient and putting them in an exam room. Doctor will be in in just a minute. No, he won’t. He’s 45 minutes behind, right? I I could tell you he’s 45 minutes behind. I could offer to let you go to the restroom. Yeah, I could bring you a drink. There’s things that I could do to make your weight a little bit more pleasant if I actually am engaged. If I’m not, I’m just on to the next thing, doing the bare minimum.

Melissa Gilkes-Smith: And that’s a great point. I think this is actually where a lot of healthcare organizations are underinvesting. They take the time to do the employee surveys. Where can we do better? You know, what issues do you see that we’re having, you know, with our patient care, with our patient experience, what workflow flow issues? And then they take the time to do the survey. And then they’re like, okay, so we check that box, done. And then they don’t actually don’t follow up with the recommendations and suggestions. And so that right there immediately causes that disengagement. It’s kind of like, yeah, here’s the survey again, the annual survey, you know, that does nothing. So what do you so what does it look like when you have a When you have a healthcare organization that tries to launch a patient experience initiative into a misaligned culture.

So, like what what what does that look like?

Andy Clark: Uh the the phrasing I like to use is like it becomes flavor of the month, kind of like what you just said. It’s like, okay, here’s that, you know, here’s that patient experience thing. Yeah, we’re gonna have a a big, you know, focus for a month and a half, and then it’s on to the next thing. You know, it it’s not who we are, it’s not what we are, it’s not why we do what we do. It’s something that we we pay homage and lip service to for a short period of time, and then we’re on to something else.

Melissa Gilkes-Smith: The change initiative graveyard.

Andy Clark: Correct. Correct. I like that term.

Melissa Gilkes-Smith: Yeah.

Andy Clark: I want to keep it.

Melissa Gilkes-Smith: It is yours. You can have that. So let’s talk about how you actually fix it. So you are walking into your first day, brand new organization. You’re gonna do an audit, you’ve been invited in. Hey, Andy, we really need to, you know, figure out what’s going on here with our patient experience. Um, you know, our employees just don’t seem to be into this initiative, and we really need to launch it. We were told by corporate we have to make it happen. Where do you start?

Andy Clark: Um, well, uh I like to look at the the scores and the data, obviously. Um, but what’s the most important thing um that I would do is I would talk to the staff. I would go around on them and I’d observe them doing what they’re doing and watching them interact with with the patients. Um yeah, I’m a big believer that the people who have the best solutions to your problem are the ones closest to it. Agreed. So spending time with that frontline staff asking them, you know, why can’t you do this? What’s wrong? What’s preventing you? One of my favorite questions to ask frontline staff is if I had a magic lamp and this genie could give you, grant three wishes, and they’re only good inside the work environment to improve your working uh situation, what would they be?

And the reason why I like to ask that question is because it it takes them out of a frame of thinking where there’s limitations, right? Oh, well, I would love to have more staff, but you know, we’ve been told 500 times that’s not going to happen, so I’m not gonna say it. It’s like, well, no, tell me, you three wishes, they could fix it. You know, what would they be and why do you pick those three things above anything else? And you ask enough patient or enough uh staff, uh frontline staff, they’ll give you the roadmap.

Melissa Gilkes-Smith: They will. I asked the same, it’s it’s so funny that you actually said that because when I first go in to an organization, I sit with each of the team members and I just sit there and have a conversation. I just I kind of observe and um I ask the same question. And the thing is, it’s interesting, they they usually start small. They’re like, oh, well, you know, it’d be nice. I’m like, no, no, no, no, no, no, no, no. You have a gene. Like, go, like, huge. What just like your wildest dreams, anything that you could have in your position, like, what would you ask for? I could make it happen right now. What would you ask for? And it’s it’s interesting the things that they the answers I get because a lot of them are very similar.

Andy Clark: Mm-hmm. Yeah, you get themes, and from those themes, you you can come up with a good strategy and you can find out where the gaps are in your culture.

Melissa Gilkes-Smith: So I want to touch on recognition because I think it’s sometimes one of the most underutilized culture levers in healthcare. What gets celebrated gets repeated. So but most organizations’ recognition programs, they kind of feel performative. What does genuine recognition look like in a patient-centered culture?

Andy Clark: Yeah, you know, I think people look at these recognition programs and they tend to over-complicate them or over-engranize. You know, they think, oh, okay, I gotta go find the, you know, the story of someone that, you know, on their off day went and they, you know, donated 12 hours of their time doing this and this, and you know, they’re above and beyond, and that’s what they need to look for to celebrate. And that’s not necessarily true. And then they try to come up with these big programs where we do points and and things of that nature. And those can work, but I don’t think it’s as meaningful as just going and rounding on staff and and asking them, like, you know, who could I recognize? You know, who’s who’s helped you out today that you would just like to say thank you to?

And you know, I I can tell you how many times I’ve had someone say, Oh, you know what, you know, so and so, they stayed late yesterday because I was behind, and and they helped me finish up on documentation or doing whatever it was that they needed to do. Um, and it was just so helpful and you know it meant a lot to me because I was able to get to my my child’s baseball game in time. And now I can take that and I can go back to this this employee who stayed and helped us, hey, you know, employee A over here, they just told me a great story and they just wanted to recognize you for you helping them out. Well, what have I just done right there? I have made someone feel good about doing something extra that they didn’t have to do, which means they’re more than likely going to repeat it because now someone’s noticed, and it wasn’t just that one individual, someone else in the organization has noticed that and and recognized it.

But I’ve also created a stronger knit connection with those two employees, right? Like I know you were grateful. Not only that, you were grateful enough to let someone else know. So the next time you need me, I’m your man, right? Like because it it’s appreciated. And that’s really the core is true appreciation. Even for the little things, it doesn’t have to be something large. And and sharing those stories, I think that’s huge. And and and showing, hey, it can be something little, and and you you you focus on those things, those little tiny points, which are more numerous, and I think will have more impact over time than the the story you hear about someone braving, you know, the blizzard to make sure someone didn’t go without kind of thing.

Those are great, you know, but they’re not easily replicatable.

Melissa Gilkes-Smith: It’s in the moments, those little moments. Which leads us into my my next topic. Um, I want to talk about leaders’ roles specifically, because I believe this is where a culture lives or dies. You cannot hire or train your way to culture change. Leadership behavior, it is the culture. The team watches everything. And so, what does it look like when a leader is genuinely modeling the culture they say that they want?

Andy Clark: Yeah, I mean, I I think it’s like I said before, um they they mirror those core values, right? They they live them out and and people see those core values in that individual. Um, Andy Stanley, I’m not sure if you’re familiar with him or not, but um he did a a talk uh on Leadercast years and years ago. And he he basically said, Don’t don’t kid yourself that people don’t see your own shortcomings or or that you’re you don’t that you have it all figured out because if you have an executive assistant, for example, just ask them where you fail, and they can give you a list, you know, 10 things deep, you know, with without even thinking. Same thing if you’re a doctor, go ask your nurses or your medical assistants.

They’ll tell you really quick where you’re you’re falling short and and working on them. So I guess what I’m trying to say is you need to be very intentional, you need to be reflective as a leader in what you’re doing, why you’re doing it, how you’re doing it, making sure that those core values are in place and that you’re living them out and people see it. If they don’t see it, then there’s a problem, right? You either got to do a better job of communicating what you’re doing while you’re doing it, or you need to modify your behavior to mirror those core values.

Melissa Gilkes-Smith: And one of the things that I I’ve seen in a couple of healthcore organizations is that you have one team member or a couple, but usually it’s one team member that they’re really good at their job. They’re they’re great at their job. So leadership doesn’t want to rock the boat. They might not necessarily be nice to their team members. Um, and it’s toxic, it they create a toxic environment, but they’re so good at their job. And so you have these specific, you know, behaviors which it goes going against the organization’s culture. What happens to the team when when that type of behavior goes unaddressed?

Andy Clark: Well, you’re you’re going to disengage your staff, right? It’s well, these values do not matter. The organization says that they care about these things, but you know, when the rubber hits the road, they really don’t because my boss is terrible in you know, domain A, B, and C, and no one ever does anything about it because what they really value is this. And so they they get that message really quickly, and they will turn cold to you know those initiatives and to those values and to the culture because we haven’t made the hard decisions. Yeah, healthcare, for example, um, you know, doctors. Um, you know, you can have some doctors that are yeah, really good, have a great reputation, bring in a lot of patients, but they aren’t easy to work with.

Um, they don’t follow policy, they don’t follow procedure, they have workarounds, they make their team do workarounds, they berate the staff. Like there’s a lot of negative behaviors that you can’t see from a physician. Um, and a lot of times an organization won’t do anything because, well, that physician brings in you know a lot of revenue through procedures or um, you know, consults or what have you. So um those type of things are not easy, right, as a leadership um team to make those decisions sometimes. And there are reluctance, but if you don’t, you’re you’re causing far greater harm in the long run. Um the other thing I’ll say a lot of people in healthcare, they’re nice, right? Like they just they it’s easier to kind of bury your head in the sand, overlook the negative behavior, and just pretend it doesn’t exist and move on because, like you said, somebody’s getting results.

The problem is that not addressing that negative behavior, someone else is picking up the slack because of it, or someone else is taking the brunt of the dysfunction. And it’s not fair to that individual that’s taking the brunt of the dysfunction. Um, and that person will leave you. And what I have found when you have disruptive leaders or individuals that are high performers with negative behaviors, once you’ve addressed it and either coached out those negative behaviors or that individual leaves the organization, you find that they were consuming way more resources, way more time and attention than any value they were giving you. You’re much better off without that individual if they don’t change those behaviors.

Melissa Gilkes-Smith: Agreed. Agreed. So going to culture initiatives, you have a lot of, you know, larger healthcare organizations, they always have these grand initiatives, launch events and everything, but that’s not necessarily practical for small and medium-sized practices who have, you know, limited staffing, limited funding. What would you recommend if a healthcare practice manager or a leader of a small to medium-sized practice wanted to make one change when they walked into their office tomorrow? What would that recommendation be?

Andy Clark: Some of that goes back to what we were talking about earlier and you know, getting frontline engagement, you know, um, and and finding out what they um see and what they think is wrong and what they think solutions are. Uh and then I would also say, of course, you need to do a full stakeholder analysis, right? Um, if you’re in a small practice and you’re an office manager, you do want the front step front office staff, but you’re going to need, you know, the physicians that are all partners in this practice to also have a say-so and in this and and be able to kind of shape that outcome. Um, but I’ll also go back to what I was saying a second ago of being honest about where you are and what you can do and can’t do.

Um, you don’t have to do great big initiatives. Pick one thing, two things, and really understand it and then go forward. I’ll give you an example. Um, I was with an exam uh organization that uh was doing the um medical practice caps. And um there was a domain question uh for stewardship of patient resources, which basically was one question, and it asked, how often did the staff talk to you about the price of your medications or the cost of your medications? All right. That’s a loaded question, right? Because if you are a medical assistant or nurse, are you going to want to talk to that patient about the cost of your medications? Probably not, because there’s going to be a baked-in fear. One, I don’t know what all medications cost.

I don’t know what’s on your formulary, I don’t know what’s not on your formulary, I don’t know how to spell all of them. I don’t know what all of them do. I don’t know what the alternatives are. Yeah. So there’s a lot of reasons why. On top of that, I might be scared that you sit there and you have a 30-minute conversation with me and my doctor’s mad at me knocking on the door while I haven’t finished triaging yet. So if you’re going to change that, you need to be honest with that challenge. And so what we did is like, okay, well, those are problems. How do we fix those and address those problems before I ever put that nurse or MA in a position that they can’t really win and they’re going to be afraid, and so they’re just not going to do the behavior.

And long story short, um, this organization had social workers, so it’s like, let’s use social work. And they had a pharmacist. Like, let’s use the pharmacy system, right? So we changed the focus of that domain and for that MA and nurse to only identify a problem. We’re not asking you to have the answer. Identify the problem. We’re going to pass that on to social work in the pharmacy. Behind the scenes, they’re going to find out, you know, how to fix your the cost of your meds. Do we need alternatives? Is it just a prior authorization issue? You know, are there programs that you can take advantage of, et cetera? And they will take the next steps with a patient. So all I want you to do is identify the problem.

And I also measured the time in the exam room and before we made the initiative change. And we we started small, we piloted it, and then we measured the time in the exam room after, because if I was going to roll this out long term, I knew I had to overcome the the time in the room challenge. And what I was able to show and demonstrate through doing this is there was no real statistical change in the wait times in that exam room. Right. So anticipate the pushback, why people aren’t going to want to do it, what those barriers are, and have a plan that you’re going to execute to overcome those. And then adding into that is following through, as I said earlier, inspect what you expect. So we’re going to have this new initiative.

We’re going to roll it out. We want good results. I’m going to circle back. I want to watch. I want to see how that’s playing out in the real world. I want to fine-tune that message and give you coaching and give you feedback to land where we want to land. And then in the process, I want to ask you, like, hey, was there a great story with this? So, like with the patient uh stewardship of patient resources, you know, that’s what we did. We went back. We we asked, like, you know, how did it go? We gave them feedback, we watched interactions and gave them coaching. And then I’d ask, like, hey, any cool stories with this? And you’d be surprised. It’s like, yes, we had a patient in here yesterday, and he was, you know, on five different meds.

He’s uninsured. So all he was doing every single month was filling one prescription. He was just pick one and then didn’t have the other four. Well, that’s not good quality care at all. You’re not going to get quality outcomes. And so it’s like, with this program, we were able to connect him with social uh social uh services, and they were able to get him on you know discount programs through the pharmacy, um, not pharmacy, through the uh pharmaceutical companies. They were able to sign him up on Medicaid, they were able to get him a cell phone. Like there are several programs that this patient qualified for that if it weren’t for being intentional and asking that one question and having a structure in place for that to be a successful interaction, yeah, that would have never happened.

So you take those stories and you you create a positive feeling and tell people like this is the change you can have. You can really impact someone’s life by asking this one question. Don’t be afraid. We’ve got all the expertise over here and others to help you. We’ll we’ll accomplish this as a team. Don’t be afraid. We’ve already shown it’s not going to take more time in your day. You’re still gonna be able to do everything you need to do, right? Those are the types of things that you need to do if you’re gonna make an initiative change and try to drive patient experience and create the consistency with the quality patient outcomes that you want. I’ll stop there and let you I love that.

Melissa Gilkes-Smith: It’s uh it’s connected the employee experience with the patient experience right there. It’s just that that simple culture shift, empowering the team to feel comfortable to ask those questions. I love that. You know, this is exactly the kind of the conversation that I wanted. Um, it was honest, practical, and genuinely useful. Is there anything that you want to leave our listeners with?

Andy Clark: Um I think if if you haven’t learned, the you know, the way I look at this is it’s it’s all about being intentional, being methodical, um not trying to change at a pace faster than what your team or organization can change, and being honest about that. You may, as a leader, want to accomplish you know, five initiatives this year, but your organization is only capable of accomplishing three. Be honest with yourself and say, all right, let’s let’s dig in deep, let’s get these three. Maybe we’ll surprise ourselves and we can take on another initiative and add that on. But we’re not at a place right now where we can do all five. And if we do all five, all we’re gonna do is burn people out. And healthcare is really bad about burning people out.

Um and as I said, inspecting what you expect is is key. Um if you want to deliver a high quality patient experience and you’re trying to activate patients, you know, I I don’t like the term patient experience. I like patient engagement, right? Because you could be happy with your care, but which is part of it, but if I engage you and activate you as a patient, as a part of that care team, you are going to be satisfied as a result because you are empowered and you’re going to get better outcomes as a result, versus you know, okay, nothing went bad, so I guess I’m satisfied. Um it’s a it’s a deeper look at things. And to to boil it back down, I guess, is that intentionality. And then I’ll say one other thing, which we barely touched on, is that accountability piece.

Um you know, you have to hold people accountable. The the kind thing is accountability, not holding people accountable is unkind, um, as we kind of touched on before. But those would be kind of like the parting thoughts or some summaries that I would give.

Melissa Gilkes-Smith: All right. Well, thank you so much. I appreciate you bringing your expertise and your candor to touch points today. So here’s what I want to leave uh the audience with today. Uh, culture does not eat strategy, it digests it. And the question is never whether your culture is strong, it’s whether your culture is aligned with what you’re actually trying to achieve. If you’re listening to this and something landed, share it with a colleague, leave a review. And if you want to go deeper, reach out to Andy directly. His information will be in the show notes. I’m Melissa Jill Smith. This is Touch Points Moments That Matter. Thank you for being here.