The Exec: Communication Key to Patient Experience in the Inpatient Setting

Inpatients benefit from good communication with doctors and nurses, and they want to know the clinical staff is communicating and coordinating care.

In general, the primary elements of patient experience include healthcare access and treating patients as people rather than consumers, says David Williams, MD, chief clinical officer and senior vice president at UnityPoint Health.

Williams has been the top clinical executive at UnityPoint since May 2020. Prior to working in his current role, he was president and CEO of UnityPoint Clinic and UnityPoint at Home. Before joining UnityPoint more than two decades ago, his work experience included serving as regional medical director for Iowa Health Physicians.

HealthLeaders recently talked with Williams about a range of topics, including the primary challenges of serving as chief clinical officer at UnityPoint, home healthcare services, and how clinicians are involved in administrative leadership at UnityPoint. The following transcript of that conversation has been lightly edited for clarity and brevity.

HealthLeaders: What are the primary challenges of serving as chief clinical officer of UnityPoint?

David Williams: My mind goes right to COVID. We are more than three years into the pandemic, and it has taken a toll on our caregivers—doctors, nurses, and advanced practice providers. Specifically, you see COVID fatigue in the general public and in our workforce. It has led to significant workforce challenges. We have doctors and nurses who have been on the brink for a long time, and several are choosing to leave the profession.

In addition to the impact of COVID is workplace violence. I have been in healthcare for well over 25 years, and I have never experienced the incivility that we are seeing toward our caregivers. This puzzles me, and we are working to keep our team members safe.

HL: How are you rising to these challenges?

Williams: For the workforce challenges, I have to give credit to our chief nursing officer, Dr. D'Andre Carpenter, who is my dyad partner. We are looking at nursing workforce differently. We do not think the traditional nursing staffing model is going to come back. We do not think we are going to have enough staff for that model. So, we are developing a collaborative care model to have nurses work together to take care of populations of patients. We want to use our resources to the best of our ability.

We are using technology with both the nursing and physician workforce. One example is telehospitalists. During the pandemic and to the present time, I do not think we would have had enough hospitalists across our three states and nine regions to take adequate care of patients without telehospitalists. By using telehospitalists, we have been able to unlock resources particularly in some of our rural communities that we would not have been able to serve otherwise.

With workplace violence, we have taken a unified approach. We have three states and nine regions, and workplace safety has traditionally been handled at the local level. We now have a systemwide task force with clinical leaders as well as public safety leaders to come up with solutions. Some of it is limiting access points to our facilities. The other piece is training our staff with de-escalation training to recognize patients and family members who may be in an agitated state and de-escalate potentially violent situations. We are taking a multi-pronged approach.

HL: You previously served as president and CEO of UnityPoint at Home. For health systems, what are the main opportunities in home health care services?

Williams: Home health care is kind of a hidden gem. We spend a lot of time as health system leaders talking about our hospitals and clinics—we do not spend enough time talking about what we can do in the home. People define home health traditionally—they think of things like durable medical equipment and traditional home-based services.

What we have been able to do is expand the scope of home health. We have a suite of care-at-home services now, including hospital at home, palliative care at home, skilled nursing at home, and primary care at home. When you think about home health, patients want to be taken care of as close to home as possible. They are going to have the best care experience at home surrounded by loved ones, and it is also going to be a setting with the lowest cost of care.

We not only provide traditional home care services but also think about what else we can do in the home. That is where people want to be.

David Williams, MD, chief clinical officer and senior vice president at UnityPoint Health. Photo courtesy of UnityPoint Health.

HL: You have played a patient experience leadership role in the past. What are the keys to success in achieving a positive patient experience?

Williams: In our industry, there is a big debate about whether we should call people patients or consumers. I do not think either term works—we should call people as people. They want to be treated as people. They want us to treat them the way they treat their family members and loved ones.

Access is huge—we must focus on access. Virtual access is becoming crucial. For example, we are focusing on ways people can access us through their cellphones.

One example of boosting patient experience is at UnityPoint Clinic, where our front desk staff has been rebranded. We had a contract signing ceremony for all of them. Their new title is experience specialist, so they know the No. 1 thing we need them to do is to show people who come to our clinics how much they matter.

In the inpatient setting, the key to patient experience is communication—not just communication with nurses, not just communication with doctors. It is very easy for patients and family members to feel the difference between care on a weekday and care on a weekend. Showing them that our teams are talking and collaborating with each other is the key to patient experience in the inpatient setting.

HL: What are the main clinical care challenges in rural health?

Williams: Staffing problems are throughout the industry, but they are exacerbated in rural health. I live in the state of Iowa, and we also serve the states of Illinois and Wisconsin, and all three states are very rural. We have problems recruiting providers, particularly in obstetrics and behavioral health. We have problems with recruiting nursing staff. We have problems in recruiting for sub-specialties. We must do the best we can to stretch those resources.

We have a tendency to have one specialist such as an obstetrician in a small town in Iowa. What we are trying to do is at least provide them virtual groups because what tends to happen is you have one doctor in a specialty, and they are on call 365 days a year. They do not get a break. We try to team them up with doctors who might work a couple of towns away to form a virtual group to provide some coverage and collegiality. We have found this to be effective in extending careers in some of our small towns.

Telehealth is part of the answer to rising to rural health challenges. We have expanded sub-specialty care in rural areas via telehealth.

HL: How is UnityPoint staffing clinicians at rural hospitals?

Williams: In addition to forming virtual groups, we are utilizing to the best of our ability advanced practice providers in our rural hospitals. We also have several residencies at rural hospitals and that is key. If you can get young doctors in training to work in these communities, many of them fall in love with their towns. They decide they want to practice in a rural setting.

HL: How are clinicians involved in administrative leadership at UnityPoint?

Williams: We have a dyad leadership model throughout our organization in the clinic setting, the hospital setting, and the home care setting. We pair clinical leaders such as doctors, nurses, and advanced practice providers with operational leaders.

One thing we have done that is unique is we realized we needed additional training for our physician leaders. About 10 years ago, we started a physician leadership academy in partnership with the American Association for Physician Leadership. We bring in their faculty and train cohorts of our promising physician leaders. We have trained more than 100 doctors in this program, and I am one of them. I was in the first cohort. Some of these doctors go on to receive master's level training. Many of these doctors move into leadership roles throughout our institution. I am proud of how physicians are engaged directly in leadership at our health system.

Our hospitals have traditional medical executive committees and medical staff leadership. In UnityPoint Clinic, we have a group that is called the Physician Governance Council. It is a group of mainly physicians and some advanced practice providers in all of our regions that are our highest physician governance body. They are instrumental in not only clinical operations but also in strategy.

We also have physicians on the health system's board of directors and regional boards of directors. So, clinicians are involved in governance throughout our health system.

Related: The Exec: Physicians Play Key Role in Healthcare Administration