NRC Health investigated drivers of experience perceptions following clinical encounters.

The Human Understanding Metric (HU^me) — “Did everyone treat you as a unique person?”— is a powerful indicator of patient experience in the clinical setting. Research conducted by NRC Health’s Human Understanding Institute revealed that, at a behavioral level, Human Understanding boils down to these three things: Connect with me, Listen to me, and Partner with me.

Why does this matter? Data from NRC Health’s experience feedback surveys, most of which are gathered within 48 hours of a clinical encounter, demonstrate that the extent to which people feel that everyone treated them as unique during an encounter is the #1 driver of Net Promoter Score (NPS)*.  National data from NRC Health’s ongoing Market Insights study shows that the odds of a patient being a Promoter are 12 times higher when that patient reports that everyone treated them as unique. And there is a powerful relationship between Human Understanding and loyalty, which has clear implications for the financial health of health organizations.

*NPS measures patients’ likelihood to recommend by subtracting the percentage of detractors (0-6 on a 10-point scale) from the percentage of promoters (9-10).

“Human Understanding prioritizes human connection and health equity,” says Dr. Gregory Makoul, Chief Transformation Officer at NRC Health. “It supports a broad view of experience and puts ‘How are you doing?’ on equal footing with ‘How did we do?’ The logic extends from patients and families to the frontline: Focusing on what matters to each person is important on both sides of the stethoscope.”

“Focusing on what matters to each person is important on both sides of the stethoscope.”

-Dr. Gregory Makoul, Chief Transformation Officer at NRC Health

Gundersen Health System and M Health Fairview are among the NRC Health partners that have implemented the HU^me into their patient experience surveys. Supporting this effort with intentional strategies to engage leaders and teams, these systems are now enjoying unprecedented increases in NPS. After implementing the HU^me as part of a field test in January 2022, Gundersen Health System’s NPS score grew by 3 points. M Health Fairview implemented the HU^me in December 2022 and saw an NPS increase of 4 points—among the largest growth so far of all the partners using the measure.

While these results are impressive, they did not magically appear upon addition of the HU^me. Both Gundersen and M Health Fairview rallied around the larger idea and importance of person-centered care, creating strategic processes around a Human Understanding movement. While these organizations are very different, there are common themes around intentional effort and alignment, process improvement, and building the infrastructure it takes to bring Human Understanding into the heartbeat of their culture.

Here’s a summary of how these exceptional health systems embrace Human Understanding as a culture and generate tangible improvement.

Delivering Love + Medicine is not just a slogan at Gundersen Health System. It’s a whole-hearted philosophy and way of life to deliver world-class medical care mixed with the right amount of love. Gundersen aims to elevate the voices of individuals served and provide exceptional care experiences. They do this by shaping a culture of compassionate, personalized experiences fueled by love, trust, and connection.

In late 2022, Gundersen and Bellin Health merged to offer patients access to more integrated resources and a broader network of services. The collective system, serving Wisconsin and portions of Michigan, Minnesota, and Iowa, has 11 hospitals and over 100+ local clinics, with more than 1,400 clinicians. A year earlier, Gundersen and Bellin were two of the first organizations to field-test the HU^me during the scale development phase.

Gundersen has long been engaged with NRC Health to improve service excellence, patient experience, and Human Understanding. Staff and volunteers routinely create special experiences for patients, and the organization’s leaders intend to expand on that as they improve so they can offer services at an even higher level.

In the last year, patient experience leaders worked across the organization to build awareness of the power of human connection as it aligned with its own research and systemwide goals, including Diversity, Equity, and Inclusion efforts. With strategic attention and resources, Gundersen aimed to deliver enhanced focus, alignment, resources, and efficiency, because human connection relates to many organizational priorities, and the organization invests in relentlessly caring for patients and families.

Over the years, Gundersen has leveraged the power of storytelling and sharing and honoring patients’ stories, laying a foundation for the importance of listening and providing individual personalized care.

“What’s really important is leveraging a patient’s story—holding it as something really delicate, special, and important.”

-Shannon Hulett, DNP, RN, CNL, Director of Gundersen Patient Experience

“I think so much of the care we give is special,” says Shannon Hulett, DNP, RN, CNL, Director of Gundersen Patient Experience. “What’s really important is leveraging a patient’s story, whether it comes out in their comments or other ways—holding it as something really delicate, special, and important and doing something with it, including being honest with ourselves when we have improvements to make on aspects of stories where we may be falling short.”

“It’s less about ‘Here’s what we think is best for you,’ and it’s more ‘How can we work with you to understand what you need?’” says Adam Hatfield, Director of Gundersen Media and Communications. “When you look at the new Bellin and Gundersen Health System mission statement, it says ‘Inspire your best life.’ It’s about partnership, and it’s about understanding.”

To do that, it’s important that Gundersen sees people as unique individuals with diverse experiences and perspectives, says Mai Chao Duddeck, EdD, Solution Owner, Gundersen Diversity, Equity, & Inclusion. Duddeck also believes that compassionate listening has been critical for employees to improve how they serve patients. She says that speaking softly and respectfully (especially to those with limited English proficiency) asking for understanding, and remembering that healthcare can be a scary place, are all part of the organization’s responsibility to ensure that every individual feels that their needs are being taken care of.

“Our approach is that Human Understanding is everyone’s responsibility, and we work together to build and deliver the best care to meet our diverse populations,” Duddeck says. “Creating those spaces where all of us belong is really critical to our DEI vision of closing the health-disparities gap and fostering a sense of belonging for all.” She says Gundersen has been developing and equipping staff with tools, resources, and training around fostering healthy relationships, combating unconscious bias, engaging in community partnerships, and identifying cultural opportunities to meet the care needs of diverse populations—all of which contribute to being human.

“Our approach is that Human Understanding is everyone’s responsibility, and we work together to build and deliver the best care to meet our diverse populations.”

-Mai Chao Duddeck, EdD, Solution Owner, Gundersen Diversity, Equity, & Inclusion

Gundersen is committed to strategically creating elevated experiences through human connection and relationship building, cultural enhancement, and the provision of supporting resources. Hulett explains that the organization’s leaders are focusing on the power of relationships and working to get to the heart of positive and negative patient comments, and insists that good experiences affect quality, safety, and outcomes as much as experience metrics.

“It’s important to see this value-added work as two-dimensional and three-dimensional,” says Duddeck. “Two-dimensional is more the quantitative side, the numbers, and the measures in concrete forms. It’s imperative for us to recognize the three-dimensional measurements in the form of qualitative storytelling and the values that the Human Understanding Metric is adding.”

Themes from both NRC Health survey data and unsolicited patient responses are included in system- and department-level strategic efforts.

Gundersen leaders also ensure that every employee shares in the organization’s mission and vision that personal connection, partnership, and compassion are expectations. Leaders round at employee forums, discussing what exceptional care delivery looks like for patients and learning from staff in how they accomplish it.

“It’s not just a job. We need to treat our patients as family, friends, and neighbors.”

-Theresa Braudt, MSN, RN, Administrator for Gundersen Boscobel Area Hospital and Clinics

“It’s not just a job,” says Theresa Braudt, MSN, RN, Administrator for Gundersen Boscobel Area Hospital and Clinics. “We need to treat our patients as family, friends, and neighbors. And we have many stories where patients are choosing to come here because it’s different—because they are unique, and their needs are met here.”

“We know that we are part of every single person’s journey, whether short or long,” says Hulett. “It could be just a Tuesday to us, but it might be one of the most important Tuesdays of their lived experience. We strive for our initiatives, and individual pieces come together like a beautiful quilt for people to experience. It’s not just leading human connection and working to improve our metrics together. It’s serving a greater purpose and delivering on our mission and vision—and our strategies and tactics help to get us there.”

“It has to be intentional,” Hatfield says. “It can’t just be some buzzword or something you do because you think it might be right. It has to be an organizational commitment from the top to the bottom and everywhere in between. It has to be embedded within everything you do, and that takes time.”

“It can’t just be some buzzword or something you do because you think it might be right. It has to be an organizational commitment.”

-Adam Hatfield, Director of Gundersen Media and Communications

M Health Fairview is an academic health system that was developed in collaboration with the University of Minnesota, University of Minnesota Physicians, and Fairview Health Services to deliver breakthrough care closer to patients’ homes. Their partnership combines the university’s deep history of clinical innovation and training with Fairview’s extensive roots in community medicine. Together, they are expanding access to world-class, patient-centered care through the health system’s 10 hospitals and 60 clinics.

In 2022, M Health Fairview began refreshing its customer experience service standards: a set of ideal behaviors that support the key elements of an interaction from the perspective of patients and their families. This involved interviewing patients and family members, frontline staff, and leaders to identify and understand the most important or impactful elements of their experiences. The organization then used that feedback and other research—including academic journals—to develop simplified service standards that could be applied to all interactions, not just clinical care.

The rollout this year includes a comprehensive communications plan leveraging the organization’s broadest-reaching publications and channels, centered around a series of professionally produced videos that introduce each service standard with patient stories that exemplify that standard. A robust intranet section with links to resources like team discussion guides is a crucial component of getting employees across the system familiar with the service standards and equipped to live them out.

The CX team ensured that each of the questions on their NRC Health patient experience survey maps to a service standard. “Human Understanding is connected directly to one of our refreshed service standards,” says Casey Arends, M Health Fairview Customer Experience Manager. “This helps teams have a barometer for how they’re performing on that service standard and helps connect a wealth of resources and best practices.

“For us, it was intentional to add the Human Understanding Metric, because it helps us directly measure how we’re living out our service standards,” he adds. “All the supporting skills and all the behaviors behind that directly align with Human Understanding. Human Understanding is compelling and easy to add, because it connects the people’s passion and purpose for working in healthcare, not some tactic or checkbox item on an encounter.”

“Human Understanding is compelling and easy to add, because it connects the people’s passion and purpose…”

-Casey Arends, M Health Fairview Customer Experience Manager

Further connecting service and compassion, M Health Fairview tied the focus on Human Understanding back to DEI initiatives and health equity using NRC Health patient experience data to better understand how well diverse communities they care for are represented in the results. Based on that, they’ve identified opportunities for improvement in representation and their experiences.

Amy Feeder, M Health Fairview Customer Experience Program Manager, says the focus group material NRC Health published was helpful because Human Understanding represents everything that her organization cares about.

“We’re doing all these other things that clearly support Human Understanding and make a difference.”

-Amy Feeder, M Health Fairview Customer Experience Program Manager

“‘You listened to me, you focused on what’s important to me’—it’s all personalizing care,” she says. “It was easy to see why it’s important and why we needed to add it. I’ve been pleasantly surprised that our scores are so great and continue to go up. We’re doing all these other things that clearly support Human Understanding and make a difference.”

M Health Fairview scores have continued to increase following an initial jump after going live with the HU^me, improving by another 2.9 percentage points in the following months.

“I believe this is due to the efforts over a long period to help the organization view experience through the impact on individual patients, in terms of people’s passion for working in healthcare versus a number to improve on,” Arends says. “What makes me proud is that the Human Understanding Metric has also increased significantly over the same time. Our environment, attitude, and engagement have driven that outcome.”

“I believe this is due to the efforts over a long period to help the organization view experience through the impact on individual patients…”

-Casey Arends, M Health Fairview Customer Experience Manager

Besides tapping into the commonly held, broad values and beliefs that Arends mentions, the CX team has driven results over the past several years by building process and resources to help individual departments review their NPS and key driver results as well as patient feedback. Site and functional teams follow a weekly cadence of reviewing key metrics, progressing on experiments and projects, and reflecting on results.

CX has also employed specific tactics to empower leaders, such as leveraging the organization’s annual goal-setting process. “A recent improvement that coincided with launching the Human Understanding Metric was an improved process of directly engaging each frontline leader to ensure they understood the improvement target, their top key drivers, and how to access resources in best practices to improve,” Arends says.

Another example is the development of a key driver tactic grid that links best-practice resources (one-point lessons, discussion guides, etc.) to each service standard and questions from patient experience surveys. Understanding these connections and having a self-service menu of support allows frontline leaders to help their team act on data insights. The CX team has received positive feedback from partners who appreciate the ability to choose from options for a given situation rather than having to brainstorm what “good” looks like.

“One of our CX leaders described it as the difference between saying, ‘What are you going to do to improve your scores?’ and offering a multiple-choice menu with the question, ‘Which option would you like to work on to improve this opportunity?’” Arends says. “It’s a very different emotional and cognitive load for an operational leader than, ‘You need to improve your scores.’”

There is tremendous value in the simplicity of demonstrating Human Understanding through connection, listening, and partnership. The key is authenticity. “It’s important to remember that clinicians are experts on clinical care, and patients are experts on their lives,” says Dr. Makoul. “Care works best when they take good advantage of each other’s expertise.”