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A Q&A with Thomas Howell, Medical Director for Patient Experience at the Mayo Clinic

March 25, 2019 - by Talya Meyers

Dr. Thomas Howell is just a regular doc. Or so he says. For the last 5 years, he’s been the medical director of patient experience for the Mayo Clinic Health System. He’s also on his 28th year as an ob/gyn and currently practices in a small town in rural Minnesota. “Although I work for an organization as well-respected as the Mayo Clinic, my practice is still very similar to what most folks in medicine are doing,” he said.

WELL sat down with Dr. Howell to find out more about what he does, his patient engagement philosophy, and how health systems can craft an extraordinary patient experience strategy.

Tell me a little bit about what your work involves right now?

My role is really to help coordinate our patient experience strategy and tactics. We’re working on three main goals: One, inspire and unleash the creative potential of our staff. Two, build trusted and loyal relationships with patients and their families. Three, elevate and engage the voice of the patient.

Those are pretty high-level ideas, but we’re really trying to focus whatever work we’re doing around those three ideas.

For a long time patient experience in the industry really was about “What are your HCAHPS scores?” or “What are your patient satisfaction survey scores?” I think that we used data as an end result and we wanted to just move [our metrics] to a specific number, so that we could get our value-based purchasing money from the government.

Now, we’re really focusing on data as a tool. We’re starting with the question of why we’re in healthcare in the first place and why we care about this, then thinking about what things we should be doing to help with patients and staff. Then, last, how do we know that we’re successful? That’s where the data comes in.

As well as being an officer, you have an active ob/gyn practice. How does your work as a clinician inform your administrative role?

I think my work as a clinician is why I’m in this administrative role. I’ve always just felt that this really matters, and that it’s what intrinsically makes me happy in that role as a clinician. When a new patient comes in, I always ask “How did you end up seeing me?” The best answer is “Well, my sister is your patient, and she said I had to come see her doctor.” When somebody recommends you, it just makes your week.

So I think trying to help other providers have that same experience, and being able to maybe have a bigger sphere of influence, is really what got me doing this.

What are the keys to providing a wonderful patient experience?

When interacting with providers, you have to always consider what it is that they care about. What three things do you want patients to say about you?

Daniel Pink wrote a book called Drive, about how to challenge what we think about motivation, and it’s very good. There are three basic components: Am I competent at what I’m doing? Do I have a meaningful purpose? And do I have some autonomy?

When providers and nurses are with a patient, in that moment, you have all three of those things. I think it’s really about tying that into whatever the individual physician’s or provider’s values and priorities are.

In that conversation, there are going to be consistencies, largely, but there will be something that’s unique to them, and you want to say, “Take that and really authentically leverage it, and get really good at that, because that’s something that you care about.”

What assumptions do doctors and health systems make about patients that need to be rethought?

I have a list of things I have sometimes heard about patient experience: “I didn’t get into this to be nice.” “Only crabby people return surveys anyway.” “If I can’t spend enough time with patients, nobody’s ever going to be happy.” “If I just give everybody narcotics who wants them, everybody will be happy.” (The data actually says the opposite of that is true.)

Thomas Lee, the medical director for Press Ganey, says—I’m paraphrasing—the irony is that physicians all think that we’re compassionate and the differentiator is technical expertise. Patients assume that we’re technically excellent and the differentiator is compassion.

So if you ask patients what a quality experience is, what’s quality in healthcare, they’ll talk about access, relationships, shared decision-making. They don’t think about door-to-balloon time for angioplasty, or infection rates. They assume that we know what we’re doing or we wouldn’t be allowed to do it.

How is our definition or understanding of “patient engagement” evolving over time? How does it look different than it did a few years ago?

I think it’s going toward understanding the totality of the patient journey. It’s not just about the few minutes that I’m with them. It’s also going toward understanding that the interaction with the family and the caregivers is incredibly important. So overall, it’s becoming much more holistic than it was.

And I think it’s moving away from “This is about a metric” to “This is about improving an experience.” I believe many thought leaders in this space are all thinking the same thing. I was in a meeting, an innovation group [at HIMSS] that had leaders from Brigham [and Women’s Hospital], Yale, Cleveland Clinic, UCLA, and University of Utah, among others, and everybody really was saying that.

One of the other really key concepts that came out [of the discussion] was that getting experience right isn’t complicated. It’s just difficult to do because you’ve got to do it all the time, not 75% of the time.

What advice would you give to other health systems who are trying to craft a great system for patient engagement?

A lot of the time, people think about patient experience in terms of “We have a problem with courtesy, so let’s just fix courtesy.” This isn’t just about fixing stuff; it’s about a lot of sometimes competing priorities. For example, we want to see enough patients to keep the finances good, but that requires us to be a little bit more efficient, so how do we do that?

The second thing is, you’ve got to tie it to your values as an organization, whatever they are. You have to ask yourself the big “Why?” question first, then get your staff to buy into that. Then you focus on key things that are going to make the experience better, and find metrics that help you track that. Don’t find a metric to work on and then try to build a program around that. That’s doing it backwards.

What do you think patient engagement is going to look like five or ten years from now?

I think nobody knows the answer to that. There are so many technological innovations, but I would say that the answer is not technology. A lot of cool stuff and apps aren’t going to solve [the patient engagement issue], but there are a lot of cool stuff and apps that are going to help that and make it easier.

I think it’s going to be largely about fundamental, core things: patients having their anxiety alleviated, feeling like we care about them and we’re functional as a team, having confidence in us. How that’s done logistically, and what tools we have, will certainly be very different. But [the question of] why we exist is still going to be the same. ♥

This interview has been edited and condensed for clarity.

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