To Move Health Care to Health Caring: A Conversation with Julie Kennedy Oehlert,DNP,RN

Teddie Potter: I am honored to have an opportunity to interview Julie Kennedy Oehlert, an inspirational nursing leader. Julie has been a nationally recognized executive coach for years, but her new role requires her to move beyond coaching executives to coaching entire organizations toward healthier cultures. I'll be using some of the same interview questions used by Wolf and Prince (2014) in their paper, “The Chief Experience Officer: An Emerging and Critical Role.”

Julie, your role as patient experience officer is definitely an emerging role, and all of us will benefit from your expertise. To begin, what is your professional title, and why was that title selected for your role?

Julie Kennedy Oehlert: My title is vice president (VP) of Patient Experience at the University of Arizona Health Network (UAHN). That title had already been chosen at UAHN, so it was the title I was hired into. Unlike some of the people in Wolf and Prince's (2014) article, who chose their titles, this is the title I applied for. I believe the title was chosen because UAHN wanted to be very intentional about the level at which this executive worked; they were very thoughtful about making sure that this position was high enough up in the organization to represent the importance they felt their patients deserved, and that the person who fills the role is able to make the changes he or she wants to make in regard to safety, quality, and patient experience. The VP of patient experience role, like the VP of nursing role, is a high-level system role.

Potter: For those who may not be familiar with the organization of acute care facilities, where would the VP role be, compared to the other chief roles (the C-Suite)?

Kennedy Oehlert: I report directly to the CEO of the hospital. I work collaboratively with the CEO of the medical practice and the CEO of the health plan. My role is a system role—I work across the system, in line with other VPs who have system responsibilities.

Potter: How did you prepare for this role? Did your professional background help you attain it?

Kennedy Oehlert: The best preparation I had for this role was to be a nurse. This is a role of boundary spanning leadership because I work with all disciplines that touch the patient. Nursing is known for that—for being collaborators and for being a profession that speaks for the patient. That was my best preparation—my years of working as a nurse.

Also, I have spent time in my career as a consultant. I have worked with physicians all over the country in academic health centers. It is very important that our physician colleagues are on this journey with us, to make health care more health caring. I think sometimes (I don't know why) they are siloed or excluded. I've also spent time as an executive leadership coach.

Another thing that prepared me is that I chose to get a doctor of nursing practice degree in health innovation and leadership. If nothing else, the role of VP of Patient Experience has to be innovative because there is no map of where we are trying to go in regard to health care and patient experience. We literally have to innovate all of it. Those three things contributed to my feeling that I could step into this role and contribute to the work that UAHN wanted done.

Potter: I want to take a moment to salute your heart as your work in interprofessionality helps you champion the needs of patients while respecting other professions. I heard you clearly say that this is a time to gather allies from all the various professions to work together on behalf of the patient to create a healthy system. D'Amour and Oandasan (2005) have described interprofessionality as the “development of a cohesive practice among different professionals from the same organization or from different organizations and the factors influencing it” (p. 8). Can you tell us more about interprofessionality, as this is your area of scholarly expertise?

Kennedy Oehlert: Interprofessionality is near and dear to my heart. I believe that unless we are a team that has the patient as a respected member, health care will be fractured. The only way to have true interprofessionality is to have each member of the health care team value what the others bring to make the health care experience whole. If we don't include certain colleagues or certain disciplines, we remain fractured. If we work toward having a team of people—providers, leaders, ancillary staff, and volunteers—working with the patient, and if we believe that what we bring is valuable, we are bound to be successful, and to contribute to that patient in a positive way.

I spend a lot of time coaching on interprofessional practices. Plenty of people think they are interprofessional because they work together. Interprofessionality is more of a mind-set—a value—than people just collaborating. It's about professionals who really respect each other's work and have the patient on the team as a respected member of the team.

The role of VP of Patient Experience has to be innovative because there is no map of where we are trying to go.

Potter: This is a radical shift from the way things have traditionally been done in health care. How are you making this live in your own organization?

Kennedy Oehlert: Operationalizing interprofessionality, or a culture of patient-centered care, some would call it, is a journey. It's challenging because health care and the institutions that train our health care providers—physicians, nurses, radiology techs, lab techs, pharmacists—are all hierarchical. So disassembling that story and helping people actualize interprofessional work takes a lot of intentional leadership decisions, including how we set goals. Do we set organizational goals in which people can succeed without working together? Do we set goals that don't include patient goals? Do we set financial goals higher than we set our safety, quality, and patient experience goals? Do we create silos through that work?

A fascinating thing about this work is that a lot of policies and procedures in health care contribute to a domination model—to a lack of interprofessionality. We have to go through and weed those out and challenge people to realize that some of the foundation of their daily work has to be torn down and rebuilt with a more interprofessional feel. I did a lot of work with our policies, procedures, and practices, looking at how we set goals, looking at the words we use to talk about patients and about each other, whittling away at what is, and challenging how people think and act and work, in a way that is enlightening to them and respects where they are in the work that they are doing.

Potter: So you're going far beyond a new set of policies and procedures and strategies. You're really shifting the culture.

Kennedy Oehlert: I think people understand the work of changing goals and policies and procedures, but a lot of this work is relational work. I meet with the patient care managers and talk about how it would look if the patient is a valued member of their team during bedside shift report. It's about building relationships with the medical assistants in the clinic such that I can ask them, “What can you do to help the provider see the number of patients he or she needs to see while still making sure that the patients feel cared about?”

There's a lot of relational work in the hard work of culture change. Even if you change goals and policies and procedures, it's hard work to explore and ask, “Why do you do what you do?”

Potter: There are so many things in our work that are unconscious, or they're old, habitual patterns that we've practiced for so long, we don't even see them anymore.

Kennedy Oehlert: Recently, I was talking to a group of chief residents—they are the ones in charge of all the other residents, and we do an orientation with them. I asked them how they can make sure that the patient who is lying in bed, who doesn't feel well, who is basically naked inside a gown—how can we make that person feel like a valued member of the team?

They all just looked at me like, “What is she talking about? How can that patient become a member of the team? He's sick.” This was a shift in their thinking; a new way to consider the patient.

Potter: This speaks to how we need to start educating our nurses and physicians. If we don't start with empathy, we're missing what the person needs; we're missing the key to the whole process. How do we call the question to encourage them to get back to the roots of empathy? For example, “Why did you become a physician?”

Because you cared about making the world a better place. “Why did you become a nurse?” Because you cared about people who are ill.

Kennedy Oehlert: Yes, and I am very cautious of blanket solutions. I think in health care, we have painted ourselves into a corner where the expectation is, “Do this sequence of tasks in every single patient encounter, or risk being punished.” That is not netting us the caring partnership environment that we wished for. So I am very careful, in my mentoring and coaching, to allow people to redevelop relationships, with each other and with the patient, that are not too structured.

Potter: Not formula-driven. Not, “Enter the room and say these same four statements to everyone you care for.” That approach is not going to build trusting relationships.

Kennedy Oehlert: It's a hard topic to discuss because we all want the easy solutions. Executives and health care workers want “fairy dust” sprinkled on their organization to solve the problems in their culture. They want to be able to say, “Our patient experience scores are really high. We don't want to work on it too much— don't fix what isn't broken. We want the health care experience to be fantastic for our patients.” They don't realize that it takes a lot of hard cultural work to make that real. We have to help our health care workers connect to their patients and to each other and avoid edicts and heavy-handed recommendations.

I want to be really clear that my work as VP of Patient Experience has just as much to do with the providers of health care as it does the patients. It's wrong thinking to focus exclusively on the patient experience because you actually have to work on the experience of the physicians, nurses, environmental services workers, food service workers—everyone. Their experience—how they experience each other—is also how the patients experience them. It's no different, really.

Potter: It's all connected.

Kennedy Oehlert: It's very connected, and it's fascinating. The thing I'm most proud of since I've been at UAHN is the work we've done with the patient relations department. Most organizations that have a patient relations department house it in the legal department or the compliance department. In these settings, the voices of those patients who believe they need advocacy because they aren't getting the help they need from their caregivers are remote and not attended to. That information often is not even reported along with the data that is collected about the patient experience.

When I got to UAHN, the patient relations department was structured just like that: Some of the people were in compliance, some were in quality, some were in the medical practice side. I put them together in a group. Then we began to reimagine: If we wanted to put patients on our team, what would Patient Relations do? So, we created an amazing department of people whose main function is to build bridges between patients and their care providers and mend those relationships that have been stressed or broken.

We use words very intentionally in our reports and responses to grievances and complaints. We say, “We disappointed this patient. We want to work with you as the health care provider to learn from this failure—this disappointment—and help the patient understand what we're doing to improve the care.” We intentionally don't choose words that say, “You are bad. You are wrong. We blame you. We side with the patient.”

The only way to have true interprofessionality is to have each member of the health care team value what the others bring to make the health care experience whole.

Operationalizing interprofessionality (a culture of patient-centered care) is challenging because health care and the institutions that train our health care providers are all hierarchical.

This has been a journey because we had to create new templates and new procedures. And we had to hire some new people for this department who had a new mind-set. We had to interact with our health care providers in a way that let them see that we care about them just as we care about the patients.

Probably the best thing about our reimagined patient relations department is that if a patient has a complaint anywhere on our campus, we call a care conference. So we don't say, “We're going to take it on as patient advocates,” but “We're going to involve the care team and we're going to listen to you as part of the care team. Together we're going to come up with a solution.” This approach has decreased a lot of the anxiety for people who receive complaints logged by patients; it has stopped the perception of the “we/they story.” We say, “We're calling a care conference. Get the doctors. Get the residents. Get the nurses. Get physical therapy. Get social work. Get the patient advocate. Everybody get in a room. We disappointed you, patient and family. Tell us what we can do different or better.”

For me, this has been a joyful change because I think that in the past, when patients complained, it was wrapped up in “blame.” There was the component (perceived or real) of “he said/she said,” and it didn't change the culture. We now distribute information about patient grievances and complaints widely. We share it with everyone; we start meetings with it. And now—it's really interesting— people call the patient relations department to tell us we're doing a good job. It's truly becoming a relations department, not a blame department.

I'm really proud of that work, and it's something other organizations could easily look at by considering some of these questions: What does our patient relations department do? How can we bring patient voices forward? How can we make those grievances relevant to our work?

We have a template that we use when we respond to a patient complaint or grievance. It's got great wording. It says, “Here's what we're going to do going forward, to make sure that what happened to you doesn't happen again. Here's what we're going to do on your behalf. Thank you for sharing this. We want to get better.” It probably took the most work of all our rewordings because there was a lot of cultural negativism around how people responded to the patient advocate that is counterintuitive to the role. Building the patient experience in positive ways through the work we did with the patient relations department is one of the things I'm most proud of.

Potter: This is such a beautiful example of what is possible when you have a strong leader in the patient experience role really looking at it from start to finish.

You called the question, “What is the experience of the patient through the system?” Then you created a culture shift. You invited everyone to be at the table as full partners. So instead of the patient relations folks being on the periphery, they are at now part of the healing team. It wasn't a top-down, heavy-handed, shaming, blaming process. You've done that with every single employee in your organization. Facilities management people, dietary, security—they're all part of the team. But the challenge is, there are some folks who don't like to be team players. So can you mention some challenges you still face?

Kennedy Oehlert: I watch the interprofessional dynamics pretty closely and I work very hard to coach on those dynamics. For example, if we have something bubble to the surface about a security officer who was threatening in demeanor toward a patient or a coworker, we address that transparently and point out what that could have felt like: “That's not part of our culture. We don't tolerate incivility, bullying, or intimidating behavior—we just won't have it.” We give people an opportunity to reflect on that.

The other thing that has been a beautiful “win” to the work I do is bringing awareness of this work to the executive teams. For example, on Monday, I brought some patient grievances to our leadership meeting and we talked about being able to coach and respond to them. We actually have these discussions: How do you coach about and respond to issues of power? How do you coach and mentor on other ways people can interact, so that they can experience us and each other in a partnership way, and make sure we are not sliding back to the mentality of punishing when we see these behaviors.

Potter: I've heard you mention partnership and domination, and I know that you are strongly influenced by the work of Riane Eisler. Do you want to say more about that?

Kennedy Oehlert: When I was getting my doctorate, I had the opportunity to hear Dr. Eisler speak. I had been very worried, on a visceral level, about what was going on in health care. I didn't really have the words or the theory to understand—I was just worried. I was worried that patients didn't have a voice. I was worried that nurses “ate their young” instead of mentoring and coaching them. I was worried that doctors were mean to the residents and “beat empathy out of them” if they brought it to the table. I just had this worry in my heart about health care.

The best preparation I had for this role was to be a nurse.

Dr. Eisler talked about cultural transformation theory (Eisler, 1987). For me, it was like waking up from a sleep: Now I had a theory and words to describe what I felt was going on in health care. She said that on a continuum of culture, from domination to partnership, a culture can move. So not only did this theory give me words and understanding—it gave me hope, that we can operationalize a partnership culture, even though people believe (and maybe I believed it too) that we are like fish in a bowl, swimming in a culture we can have no impact on. It was so empowering to learn about cultural transformation theory and to reflect on everyone's ability to move to a partnership model.

So I became very interested in applying Dr. Eisler's theory to health care, and it has been transformational for me. Because it gives me and everyone I work with the understanding of what is good or bad about this cultural situation in which patients and students are at the bottom, and how to move to a partnership culture in which patients are active members of the health care team and students are valued and nurtured. I guess that's where cultural transformation theory really taught and empowered me. I can look at that continuum and say, “We can do that.” I have used Dr. Eisler's theory in my interprofessional work, in my coaching, in my mentorship. I believe that it resonates with people because they can understand what they can do to move the culture toward partnership. They feel empowered by it. You can empower with theory.

Potter: As your role grows, as your specialty grows in the field of nursing (VP for Patient Experience or whatever the title happens to be), it sounds like you feel empowered by having a theoretical base. Would you say that this might be true for your colleagues out in the field who are stepping into this emerging role?

Kennedy Oehlert: I hope that the nursing professor who taught me basic theory gets to read this article, because she'll be proud. When I started my doctoral work, I didn't see the value of nursing theory, but now, I believe it's completely relevant to the work we are doing. If we don't have theory—if we don't have an anchor—we move forward in such an erratic way. So I believe that coming home to some of our theories—the one I used is on culture change, but there are others—is critical for what we are trying to achieve: to move health care to health caring. I think theory is critical.

There's a lot of relational work in the hard work of culture change. Even if you change goals and policies and procedures, it's hard work to explore and ask, “Why do you do what you do?”

Potter: Julie, one thing I hear in the way you speak that is so impressive—and it's so very hard to do in our culture—is to consider the patient a full partner in his or her health care experience. Do you have any suggestions to help us move further along that path?

Kennedy Oehlert: Some of the work I do now is about how you have to be very intentional if you want to put the patient on the health care team as an active member. Sometimes when people talk about patient-centered care, I share the example given by a very insightful physician I met one day, who said, “I think our idea of patient-centered health care is plunking patients in the middle of all of us and talking over their heads.” His statement made me realize that we have to be very intentional to make sure the patients have a voice, that their input is relevant and valuable, and that they will have a better health care outcome if they are involved and engaged in their care. We must ask them whether they feel they can do what is suggested in the care plan or, if not, what they suggest.

It's more cultural than tactical. We have to intentionally say, “If these patients were acting members of a working team, how would we treat them? Would we talk over their heads? Would we not introduce ourselves? Would we make them sit for hours in a clinic? Would we not call them and check on them?”

It's a slow process back to making sure that patients are heard and that they are empowered to be members of the health care team. It's a very interesting journey because I don't believe that people see how often the patients are not considered a part of our team. I read the comments and grievances we receive and I see it. I see it when a patient says, “The doctor told me my goals that I brought to the visit weren't his goals, so he doesn't want to see me anymore.” “The doctor told me I didn't have a choice—I have to take these meds.” “The nurse told me my sister couldn't visit me.” “The food service worker who brought my tray said, 'Oh well, this isn't what you ordered, but this is what you get.”’ These are all indicators that the patient isn't considered an important part of that team. It's out there if we care to look, and if we do, I think we'll be sad to see that that aspect of our interprofessional work is really broken.

Potter: As I listen to you, I'm thinking that at this point in this article, our readers will be wishing that they could clone you and send you all over the country to work in their organizations. Since that's not possible, what can nursing do to make sure that somebody who has a strong commitment to empathy—to the patient's story—is hired into the role of the patient experience officer? Is there anything you can put out there for organizations that are hiring patient experience officers to consider?

Kennedy Oehlert: Interesting that you ask because one of the things I did when I got to UAHN was to look at our behavioral-based interviewing—the questions we were using to interview staff. I threw out some, changed some, and added some. I did it with our nursing prescreening, to screen for interprofessionalism. For example, “If you have seen a peer yelling at or intimidating another peer, what did you do? What was the outcome? How did you feel?” Or, “A patient asks to see a different doctor because she doesn't have a therapeutic relationship with her current one. What do you do?” We ask questions to screen for the culture that we're looking for.

So if I were hiring a patient experience officer, I would screen for empathy, interprofessionality, and collegiality with all elements of the health care team. I would make sure the candidate cared just as much about employee culture and engagement, and physician culture and engagement, as about patient engagement. I don't think we can afford to silo the patient experience—I don't think that works.

Potter: This is a wonderful place to conclude our interview! The message is that patient experience is a systemwide process. By lifting this up and being concerned about the experience of all of us, the patient will ultimately benefit. It's a lovely message and so appropriate that you are being interviewed for Creative Nursing because every element of what you have done in your organization has been a creative process. Thank you for sharing that message with us today.

Kennedy Oehlert: Thanks. I appreciate the opportunity to share what I am doing because I think that nursing can be a catalyst to make health care what we wish it to be—for our practice, for our colleagues’ practice, and for our patients. Nursing can do this work. We are suited to do this work if we choose to do it.

It's wrong thinking to focus exclusively on the patient experience because you actually have to work on the experience of the physicians, nurses, environmental services workers, food service workers—everyone.