About the Expert

Julie Rish, Ph.D. is a Clinical Psychologist, Director of Design and Best Practice in the Office of Patient Experience at the Cleveland Clinic. Dr. Rish is also the Director of Communication Skills Training and an Assistant Professor of Medicine at the Cleveland Clinic.

Julie Rish, Ph.D., MA, Role at The Cleveland Clinic

I have spent most of my professional career helping people with health behavior change. That blends nicely with the work that I do in, patient experience because it is about how do we change and adapt our behaviors to best support our mission and cause in the organization and come together. As the director of communication skills training for a medical school, I’m active in teaching our students what communication with patients and each other could look like and potentially should look like in bringing in that next generation to health care.

Most of my life is in, patient experience, in leading efforts in one; how do we partner with patients, their family, and their support persons to improve care and to reimagine what that partnership looks like so that we can be very strategic to maximize the full potential of partnership and to manage the complexities of health care together as a community.

The other part of my life is complimentary as applying plain design thinking to our work. So, in a variety of settings having great collaborations across the Cleveland Clinic. Questioning, how do we do that in a way that brings together all the stakeholders to design something better for patients and our people.

Discussing Patient Experience & Humanism in Medicine

I think medicine is inherently human. The art of medicine without relationships—We’re not just technicians. Similarly, providing an excellent patient experience is about meeting people in a very relational human way. I think that you can’t disconnect those two things. Optimal healing can’t occur without the humanity of medicine and true understanding of another person sitting in front of you, without being able to empathize with your experience.

Relationships are healing in and of themselves. When we’re connecting as people it’s healing to me as a clinician but it’s also healing to the person that’s sitting in front of me. We have to think about going above and beyond what we can do medically for someone.

Achieving excellence in Patient Experience at the Cleveland Clinic

What we’ve done so beautifully is put some stake in that, that we are going to care about our patients, we’re going to care about our people and we’re going to invest a lot of energy in both. Trying to understand one another, trying to appreciate each other’s perspective, see things through different lenses, and design them together. That’s a beautiful model that will help us improve as a system but also help us improve and transform health care.

Barriers to achieving humanism in medicine

There are a lot of barriers to being human in medicine we know about widely publicized, burnout in clinicians. The detrimental effect that has on them individually but also on patient care. It’s double-edged and it’s complex to solve. Also, add the burden of documentation. Providers spend more time in documentation than they are in front of the patient. 

Trying to find meaning and purpose in their work and the complexity of trying to solve that. The knowledge and the explosion of that is another barrier in some ways. Trying to stay current when they’re so much information is hard. How many hours a day can one possibly invest, then how are they finding balance in their lives and spending time outside of the walls of the system that you work?

There are a lot of barriers that equal time and task pressure. How can I be present at this moment and not thinking, three steps ahead or three steps behind but just to be present at the moment? When you do that you can find meaning and purpose in your work. The barrier is how do we overcome those obstacles to create moments of presence? Being mindful and truly connecting a human level. In doing so, that’s where we can find restoration and purpose and get back to why you chose this profession, this career, this entity in the first place. That’s our greatest opportunity right now is to try to navigate those barriers in a way that is optimizing the human connection.

The importance of Humanism in medicine

The importance of clear. I talked about how relationships are healing and that it’s hard to create a relationship without being present and authentically yourself. Therefore, if you’re struggling with burnout and it’s easy to depersonalize a situation and it creates some distance between you and the person sitting in front of you, it’s also hard to create meaningful moments. That equals satisfaction with your career, with your experience at that moment, and with the quality of care.

A Barrier Free Healthcare Delivery System

Navigating the system in a way that we are creating is our greatest imperative. We have to think bigger than clinicians. We have to continue to invest in our people, that’s clinicians but I think that’s other members of our clinical teams and our staff in a health care system that we see burnout in many different places.

Being thoughtful about what we’re doing and how we’re investing in our people was important. Thinking bigger than just the people, that it’s systemic and if we’re asking people to spend half of their day in the documentation and the evenings and all hours of the night then how can we possibly expect them to overcome these barriers.

Thinking systemically, what does healthcare need to do to better support our clinicians. The burden of documentation, policy, and the pressures that we’re placing on top of them. While also thinking, how do we change the top-down but also how do we support from the bottom up. In addition, equipping people with the skills to communicate effectively to connect to meaning and purpose in their clinical encounters. In some ways, that’s by just teaching someone how to listen and to empathize with someone’s experience and perspective and connect to that as a human.

Again, I would transcend more than just our clinicians. I think it is our nurses, it’s the other people that are touching our patients. From the person that checks you in, to the person that you speak to on the phone when you’re trying to navigate and make an appointment, to the information that you get when you leave the hospital. There are so many different touchpoints that we have to connect to.

Technology & Healthcare

These types of solutions have to be co-designed. Oftentimes it feels like we are pushing solutions out and those solutions need to be brought together from the people most intimately affected. So our patients, our people, our clinical staff, our non-clinical staff. Those people need to come together to define what that solution looks like and what the need is.

Oftentimes, I feel like we’re just creating solutions or “hey great lets give you some communication training”, but is that the training that you need is that what’s going to solve the problem and is this actually the problem to solve or the opportunity to innovate around. I think if we are not talking to those people most intimately affected at the beginning and throughout, I’m not certain that our solutions are going to work and that we’re actually going to be transformational.

Patient Experience In Its Current State & Future Outlook

In the future our patient experience relies on meaningful partnerships and collaborations. Intimately integrating our patients, their family and support persons into our work and having them help us co-design care, from the beginning and all phases and all levels of the organization. If we’re not doing that then we run the risk that we’re not providing the care, the needs, the solutions that are patients need.

Bringing them in and sharing that space with them in true partnership, not in a focus group setting. The true partnership where we are identifying the problems to working alongside, to creating solutions together and testing them out. The patient experience relies on our willingness and openness to do that together. The future of patient experience relies on meaningful strategic (maybe) relationships with each other. Where we’re talking together, and where we’re coming together to solve these problems.

Meaningful Integration Of Technology

I would suggest that technology needs to be seamless, in that it affects both of our patients and our clinicians. It needs to solve for the tremendous burden of documentation and the non face to face time that our clinicians are struggling with. It needs to facilitate making health care more simple for patients.

If you think about we what exists right now there are thousands of apps and thousands of different platforms that someone could go to. How do you know what’s the right app to download or how to even find the right one the problem that you’re trying to solve. We in health care need to streamline those applications in a way that’s meaningful to our patients. That’s going to help them navigate the system and connect them in seamless ways.

I would say the same for our clinicians. Technology needs to create the moments of connection. The human moments and take the burden out of some of the non-human moments for clinicians. It needs to solve for both ends of that spectrum to simplify the experience of health care. Otherwise, you need an app to navigate the apps.

The most important thing is being willing to be vulnerable, humble and to learn from each other. To be thoughtful about how we partner with the people around us, how we learn from each other, etc. All of that takes deep understanding, empathy and trying to appreciate someone else’s experience and perspective.

If we’re not doing that we’re not solving at that intersect, that’s really where we need to be. What are the solutions that make the most sense for the most people, at the right time? To me that’s transformational! So, we could setup great population health efforts, but if it’s not the practice, the services or the values of the community that it serves, then what have we done.

Being thoughtful to first understand the people that are out there. Empathizing with that, then solve those problems together and create those opportunities together. That’s what’s exciting about health care is the great potential of what you can do together and in a collaboration. I’m excited to be a part of that!