Feature | October 03, 2014 | Williette Nyanue

CXO: Perfecting Patient Experience

Healthcare facilities across the nation employ a chief experience officer to help focus on patient experience

With information just a click away, the widespread use of the Internet has given rise to a more educated consumer. It is no surprise then, that this increase in consumer education has permeated the healthcare industry. No longer are patients arbitrarily accepting referrals from one physician to another. Rather, they are using all available information to decide what healthcare facility to visit or which healthcare professional to see. Patients are also using their experiences, through reviews, to help others make similar decisions.

This trend, along with a growing link between patient experience and reimbursements, has encouraged healthcare facilities around the country to take a look at organizational practices from a patient and employee standpoint to identify where upgrades can be made. Within the past seven years, many healthcare facilities have employed a chief experience officer (CXO) to focus on patient experience. 

Defining the Role

Although the exact title differs across institutions — director of patient experience, vice president of hospitality and service culture, and director of office experience are a few variations — the focus of the position remains the same. According to a white paper from the Beryl Institute, which explores the role of the CXO, “The chief experience officer — or variations thereof — generally connotes an individual operating at or directly reporting to the C-suite level of the organization, with the requisite level of authority and accountability […as] part of a broader strategic commitment to improving the patient
experiences being provided by the organization.”1 

Traditionally, each employee was responsible for his own contribution to the patient experience. Today, however, having a specific position is vital. “We recognized that our hospital employees were increasingly engaged with our mission to improve the patient experience, but that many of our physicians were not aware of the numerous initiatives employed to accomplish our goals,” said Yale-New Haven Hospital’s first Medical Director of the Patient Experience, Michael C. Bennick, M.D., M.A., FACP.  “This served as the impetus to create my role.”1

In essence, the role of CXO was created to assess how an organization is performing, discover how it can improve the patient experience, and effectively communicate these results and data to educate providers and staff and mobilize them to implement necessary changes. 

Seeking the Perfect Candidate

Like the title, educational and professional qualifications for the role also vary across institutions. The Beryl Institute’s white paper, which surveyed 14 CXOs from across the country, reported backgrounds in patient advocacy and nursing, medicine, business and marketing, and consulting and hospitality.1

Each academic and professional background cultivates unique skills that can be beneficial to the role. Before becoming the executive director of patient experience at Yale-New Haven Hospital in New Haven, Conn., Jeannette Hodge worked as a director and executive director in church and non-profit settings. “My professional life (and my personal life as well) has been grounded in relationship building, and I would say that has been most important in preparing me for this role,” said Hodge.1

Christine Holt was director of marketing for the Rothman Institute & Nazareth Hospital prior to joining the Holy Redeemer Health System in Meadowbrook, Pa., as its vice president of marketing and chief experience officer. She stated, “Because of my time in marketing and the perspective that I bring, I like to think of the experience as an extension of the brand, and expression of our mission and who we are.”1

The white paper found that regardless of educational and professional background, the common quality uniting all CXOs was a desire to promote excellent service and care, and knowledge of the impact of positive patient experience on satisfaction.1

Where to Look

Many institutions have found success filling the position from within. “I’ve actually seen more of this go inside, where they first identify if there is somebody within the staff that has very good political credibility and can get stuff done,” said Donna Padilla, senior partner at executive search firm Witt/Kieffer, who has tracked the CXO trend. Padilla said this could be a physician leader or a non-physician depending on the desires of the institution. The Beryl Institute paper also recorded this trend, stating, “Most of the individuals were ‘internal hires,’ steeped in the culture of the organization they now serve as a CXO, but viewed by themselves and others in the organization as agents for positive change.”1

There have been cases where organizations have externally recruited someone with a fresh perspective and the necessary skills and experience. While this is a possibility, Padilla said this approach might be more difficult because many applicants will not have the title CXO already listed on their resume, and there are a wide range of acceptable qualifications and experiences. 

Benefits of Employing a CXO

However organizations choose to fill the position, having a CXO to ensure patients have a positive experience helps to protect brand integrity. “One bad patient experience lives forever in the technology,” Padilla said. “Being able to avoid the easy pitfalls really propels an organization forward.” 

Having a CXO to evaluate where and how an organization can provide more prompt, efficient service, and help guide the implementation process, lessens the chances of dissatisfied patients providing unfavorable reviews both online and to prospective patients. A CXO who can conceive and execute a strategy to improve communication between staff, healthcare professionals and patients can help avoid unnecessary readmissions and save organizations time and money in the long run. 

Patient Satisfaction and Reimbursements

Organizations that choose to instate this role can reap more immediate financial benefits. Today, healthcare reimbursements are tied to high-quality patient experiences. In 2002, the Centers for Medicare & Medicaid Services (CMS) and the Agency of Healthcare Research & Quality (AHRQ) developed Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS), “the first national, standardized, publicly reported survey of patients’ perspectives of hospital care.”2 The 27-question patient discharge survey was implemented in 2006 to provide data for hospital comparison, create incentives to improve quality of care and increase transparency.2

Not only are the results of HCAHPS published on the Medicare Hospital Compare website, the Deficit Reduction Act of 2005 provided financial incentive for those hospitals that implement HCAHPS.2,3 In 2010, the Affordable Care Act further increased the financial incentive, linking Medicare reimbursement to an improvement in HCAHPS score.

“It is important to have a CXO or similar position to ensure organizations remain focused on the culture and initiatives that support that culture,” said Lynn Skoczelas, BSN, MBA, chief experience officer, Sharp Healthcare, San Diego, Calif. “Since we began our Sharp Experience journey over 12 years go, we’ve increased our market share every year, increased our net revenue, increased our bond rating, increased our philanthropic support, driven down turnover and driven up employee, physician and patient satisfaction.”1

Moving Forward

As organizations across the country look to improve patient culture at their facilities by employing their own version of the CXO, there are several factors that administrators need to consider. The implementation of this position, which often includes the development of a corresponding team or committee, requires the organization have the financial resources and manpower.

Instating a CXO will also require that all individuals be open and flexible as the position takes the necessary shape in each institution. “It all depends completely on the structure, the evolution of the system and the person that holds the position. There’s not a one-size-fits-all form in this one. Everybody is making it work for themselves,” said Padilla.

Nevertheless, as the rise of consumerism in healthcare increases competition, many healthcare facilities will be faced with the decision to employ a CXO in the near future. Paul Westbrook, vice president, patient experience, Inova Health System, Fairfax, Va., said, “In an ever-increasing competitive environment, where differentiation is the competitive advantage, how can you expect to build your reputation within your community without a dedicated resource?”1 


1. J. Wolf, D. Prince. “The Chief Experience Officer — An Emerging & Critical Role.” The Beryl Institute.  

http://www.cms.gov/Medicare/Quality-Initiatives-Patient-Assessment-Instruments/HospitalQualityInits/HospitalHCAHPS.html. Accessed Sept. 11, 2014.

3. R. Stiegrist. Virtual Mentor. American Medical Association Journal of Ethics. November 2013 http://virtualmentor.ama-assn.org/2013/11/pdf/mhst1-1311.pdf. Accessed Sept. 11, 2014.

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