Why Health Systems Keep Getting Patient Experience Wrong | Amanda Brummitt, FACHE

Patient experience gets treated as a soft metric. Amanda Brummitt, FACHE, has spent 25+ years in health system operations proving it is a margin lever, a retention lever, and the first thing most AI rollouts ignore.\n\nIn this episode of The Clinical Realist, Dr. Sarah Matt sits down with Amanda Brummitt, Principal of Brummitt Group, to unpack why patient experience is strategy, not sentiment, and what health system leaders get wrong when they bolt AI onto a broken experience.\n\nGuest: Amanda Brummitt, FACHE, Principal, Brummitt Group\nHost: Dr. Sarah Matt, MD, MBA, surgery-trained physician-executive\n\ndrsarahmatt.com | https://calendly.com/sarahmattmd

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Transcript

SPEAKER_00 0:00

Asian experience is one of those terms that gets thrown around a lot in healthcare administration. But what does it actually mean on the receiving end? Today I'm talking with Amanda Brumitt, a healthcare operations veteran with more than 25 years in the field. She's run operations at HCA and the largest private anesthesia practice in Texas, before finding the Brumitt Group, which now works with healthcare organizations and ops growth and specifically the patient experience. So Amanda's framework is simple. In competitive markets, patients have choices. They're shopping and they're usually doing it on their worst days. So let's get into it. Amanda, thanks so much for being here. I'm so excited to finally see you.

SPEAKER_02 0:37

Yeah, thank you for having me, Sarah. It's always a good day when I get to chat with you.

SPEAKER_00 0:41

Absolutely. So for those who don't know, me and Amanda got to meet in person a couple months ago and absolutely had tacos in Austin, which was the best. Always good when you can have tacos. I know, right? So, Amanda, tell me a little bit about the Bromet group and what you folks are actually solving for organizations today.

SPEAKER_02 0:58

Sure. So our main areas of expertise are strategy, business development, and patient experience. And those all come through an operations lens. As a background, as a chief operating officer, that hat never comes off. So, you know, if you call me the marketing girl, I'm Matt Gitcha. We do do marketing strategies, but we do it all through an operational lens. So what can we promise out in the field and in our speaking points to patients that we can actually deliver on on the back end in a clinic, in a hospital, in ASC.

SPEAKER_00 1:30

I like that. So I've often heard you say that in competitive markets that patients are shopping and they're doing it on their worst days, which I I love that framing really stuck with me. So walk me through what that really means operationally. What's the patient actually evaluating when they're trying to decide where to go?

SPEAKER_02 1:46

Yeah, definitely. And I'll I'll give the disclaimer here that if you are some highly specialized clinician, like maybe a pediatric kidney transplant surgeon, you can move on. You don't have to do any of these things because people will find you. They will pick you based on your expertise. But most clinical specialties don't have that. Uh pediatricians, orthopedists, OBGYNs, they are competing for patients, at least in all the markets that I work in. So what that looks like on a day-to-day basis is removing any friction points from the patient potentially landing in that room, actually having a one-on-one encounter with that clinician. And essentially it's making sure the digital footprint externally makes it very easy to know who that clinician is, what they do, what they offer. When that patient calls, that that person at the front desk is warm, welcoming, inviting. I don't care how good Dr. Matt is, if I love her, but consistently Jo L that works at the front desk is mean to me. If it's any specialty where I've got options, patient's going to move on. And then yeah. And then making sure that anything that we we promise, we follow through with, because at the end of the day, we eventually want that patient to get that one-on-one time with that clinician. But there's about 60 different things that can happen before they get there to make them bounce, call the next office and just move on.

SPEAKER_00 3:18

Definitely. So I have a feeling there's tons of places and decision points where the patient's making choices and the practice has no idea. Is there one major area you think we should all highlight about the patients evaluating us now that should be really focused on?

SPEAKER_02 3:34

Yeah, I'll say that first phone call, and here's why I say it, because intuitively it feels right, but I've also got data to back it up. I've worked with enough plastic surgeons over the years who obsessively follow call conversions, click conversions, all of those different metrics that we look at in marketing, abandoned phone calls, number of patients that make it through to number of patients that actually schedule. And so from their data, knowing those patients are shopping, the interaction with that first human is a game changer. And a warm human answering helps. And I am all for technology, but this is one of those things that get to the human as quick as you can. That human being empathetic, calm, kind, anticipating needs, letting them ask questions, even if they're annoying, even if it's the sixth time you've answered it. That's the biggest point I see where a patient is deciding whether or not they want to schedule that appointment, give that insurance information, or if they want to say, yeah, I'm gonna do my homework and I'll call you back. If they say that, they're probably not gonna call back.

SPEAKER_00 4:44

I like that. I think it has to do kind of back to hospitality. And when we think about customer service, oftentimes we don't think about hospitality in healthcare setting, but it's a difference between calling a motel over there or the Ritz. There's gonna be a difference in your experience when you call or have a problem.

SPEAKER_02 5:02

Absolutely. And you know, it's funny you say that because I think I got tapped in the patient experience space early on because I had retail experience. I worked retail for a decade. And my opinion, even as a young person, was I get paid the same either way. So I have to be here. I might as well be nice to these people and try to sell something. It's not different in healthcare, at least for the front office.

SPEAKER_00 5:26

No, that's true. I like that. Now, you've worked with health systems, private practices, both. How does an organization get to the point where becoming a patient is really hard? You know, like how does that friction accumulate without anyone noticing?

SPEAKER_02 5:42

Sure. Well, I I think it's an accident. I don't think there's a soul out there that sets it up to make it hard for patients to find us. And a lot of times it's people like me, it's operators. We want one more form for the person to sign. We want one more digital wall put up to keep patients from accidentally landing in the wrong spot. We want to protect those appointment slots too much. I can't tell you how many times I've seen this, especially in surgical practices where staff is they're protecting their surgeon, but ultimately they're keeping patients from getting in the door. So they're all well-intentioned things. And I think the way to undo it, which you didn't ask that, but I have to tell you, the way to undo it is take off your stethoscope, take off your white coat, call your office, not from your cell phone, because your team knows your phone number, see what happens, be annoying, be needy, drive to your office. Don't park in your parking spot, park at the front. Imagine you've got an injury. How long does it take you to get there? How do people treat you? You gotta both the clinicians, the operators, anybody in that process have gotta pull themselves out of it and walk through the lens of a patient and see what it feels like.

SPEAKER_00 6:58

I love that mystery shopper thought process. That's a good one.

SPEAKER_01 7:01

Mm-hmm.

SPEAKER_00 7:02

Now, I know you spent a ton of time at HCA and then at the largest private anesthesia group in Texas. When you're at that scale, what does that teach you about patient experience? What might be surprising to someone like me that you learned while you're in those large environments?

SPEAKER_02 7:17

Sure. So I'd say at HCA, it's all about the top. And I worked in multiple facilities. And if you've been in one HCA hospital, you've been in one HCA hospital. They all have their own culture. It starts at the top. However, that CEO treats the rest of the C-suite, how they treat their VPs, their directors, how they treat their team, that's how those people are going to treat patients. And how those executive level people interact with patients. We've all seen it. We've seen the hospital CEO in line at the cafeteria that's talking to patients. We've also seen the hospital CEO walk down the hall and not look at anybody and not smile. They're gonna emulate whatever leadership does. So I think when the leaders take amazing care of their team and the leaders make it clear that we take amazing care of our patients, that sets everything up for success. And I started with takes good care of their team, because if you take crappy care of your people, don't expect them to take great care of your patients. And then on the anesthesia side, you know, it's it's a peculiar specialty because you have just a couple of minutes to build some rapport with a patient. If you do your job well, they forget that you existed, and then all they remember later is maybe I don't feel great, maybe I have a scratchy throat. Whoa, what is this massive bill? So it's an interesting specialty. And I would say for them, it's all about building rapport in those couple of minutes that they have, maybe longer when they have the luxury, to really get to know that patient and get to know their caregivers, manage any expectations, and then also critical that if there is an interaction outside of that pre-op immediate post-op period, that it's really good. That they've got to call the office. The office has to do an amazing job because it's not like primary care where you've got an established relationship. You're looking for a reason not to pay the bill.

SPEAKER_01 9:17

That's a good point.

SPEAKER_00 9:18

I like that. Now, you know, we think about a lot of the work I do in the tech space. There's health systems buying a ton of tech right now with patient experience as the pitch attached to it. So we have ambient listening, we have patient portals, apps for everything. Well, when you think about the organizations on the ground, how do you separate the tech that actually serves patients and just the tech that serves the organization and kind of calls it patient engagement?

SPEAKER_02 9:44

Yeah. Well, so I think most of it in my experience as a patient has been that it serves the organization. If um, Dr. Matt sends me a message to remind me to get my flu shot and I have to log into a portal and I've wasted 45 seconds of my life, I am pissed. I didn't need an encrypted message to a good reminder for a flu shot. So I always want people to be thoughtful about what they're trying to deliver and what they're trying to achieve. And so when they're looking at all of those different technologies, and a lot of them can improve a patient experience. You know, it makes my experience better as a patient, being able to reschedule an appointment online at 10 o'clock at night and not have to bother the office, especially if I'm an established patient and I've got a certain slot. Let me reschedule my own appointment. Two-way communication. If I get a text or a phone call or a portal message, let me respond to it. Ooh, you want to see me get mad? Send me a text message and ask me to call your office at 5 01 p.m. and then don't answer the phone.

SPEAKER_00 10:50

Literally got one of those today and I was like, low accountability, just lazy.

SPEAKER_02 10:57

Yeah. Bad. Totally bad. That said, there's also a ton of technology that can make our lives so much easier. Having a robust and meaningful patient portal where I can download simple things like vaccine records, imaging records, patient encounters, all of that makes my life easier and is less taxing on the staff because I'm not calling the office and bugging them for it. Those are all amazing. I am actually really excited about ambient listening with, especially with aging parents. I'd love to know what exactly she told the doctor to get the advice that she got. But I'd also like to know what the doctor said so that we can then help with that. I also have a mom and a baby sister that are nurses, so it'd be great to be able to take that and be like, hey, here's what happened with my mother-in-law today. Can you help her understand this? So I think that's all good and well, but I want to be really clear that if we're calling it for patient experience, make it for patient experience. Test it on patients, see if it made their life easier. If it didn't, call it what it is.

SPEAKER_00 12:07

Agreed. So you just brought up ambient listening. I think that was interesting because the practice today is recording and transcribing every visit, it's probably going through their electronic medical record. But I don't think the patient usually gets a copy. I mean, sometimes you might get a more robust um, you know, action and plan at the end of the paper that they sometimes hand to you and sometimes you don't. Yeah. But what's the right answer there? Should patients be getting a copy of that as well?

SPEAKER_02 12:34

Yeah, you know, I'm obviously not the compliance officer or a clinician, but if you're gonna record a conversation with me and you're gonna save it, then I absolutely want a recording of it as well. And as a former practice administrator, it makes me really nervous that it's gonna end up in court, it's gonna end up used against us, end up on the internet. But at the end of the day, if we're doing this to make things better for healthcare, let patients have it. And I do worry, even in my own experience, there's times that I'm like, hey, don't put this in the record. I'm gonna tell you the truth, but don't throw it in there. That goes away with ambient listening. And so I think there's some trade-offs, and I will let the clinicians of the world make those decisions, you know, on how that happens. But yeah, we've got to let patients access it. And I know I've been on lots of FaceTime visits with other people, and it helps. It adds to it. The other thing is, just as an aside, if you've got patients that want to sue you, they're probably recording the visits anyhow. So I think you might be making it easier for people to hold things against you, but you're not completely protecting yourself from that.

SPEAKER_00 13:48

It's an interesting thought process. You know, as a provider, I've heard a lot of provider pushback, like, I don't want my words to be taken against me and this, that, and the other thing. But you do have a point there, you know, it didn't happen unless it's written down. And to have only one part of that relationship have the information and the other not seems maybe not great in both directions.

SPEAKER_02 14:09

Right. And I'm a highly resourced, highly knowledgeable patient. And I can't tell you how often I get back home and go, wait a minute, what did Dr. Lal say? And then I log into the portal. Luckily, my PCP is a beautiful documenter, and I see it. And then I don't have to call her and bother her. We none of us need more calls to our clinics. None of us do. So anything we can do to reduce that is gonna help.

SPEAKER_00 14:32

So I admit back in the day, I absolutely was in charge of building a patient portal for an EMR I will not discuss or mention because I I'm the problem here, right? Um, but there's basically a version of innovation where every interaction has an app. There's a portal, and the patients are getting exhausted. I know for me, I have a ton of kids, and I literally have so many portals for so many doctors and all this stuff that I don't even have all the logins. I'm like, okay, husband, you're in charge of this one. Get me those immunization records because I want nothing to do with it. Yeah. So where's that line between digital convenience and digital friction?

SPEAKER_02 15:08

Ooh, that is a great question. And so I'm a geriatric millennial. So, you know, I like technology, but also I'm gonna be quick to pick up the phone and call you if I don't understand something.

SPEAKER_00 15:20

All right. Don't you dare call me, Amanda. Don't you be calling me? Someone's gonna be dead if you call me.

SPEAKER_02 15:25

Don't call one of my friends and they'll go, Are you okay? Exactly. So I'm with you. I actually I I won't download anybody's app. I don't want anybody else's app. Now, if you want to live in an ecosystem that I already live in, spruce, uh what is the my patient passport, any of those that already exist, maybe. But the better practices better cross-share information. You know, from a patient perspective, it's gotta make my life better. And if it makes my life harder, it's not any good. For your point on all of those passwords. So we live in the one password world, which helps a little bit, but also gets really, really complicated when you have multiple providers that use the same EMR and it's terrible. We got to figure that out. But really, where that intersection, I think, happens, where we actually make things better, reduce the phone calls to our offices, is when it's meaningful. So whatever is in there is meaningful and we can access it easily. And, you know, you're the you're the technologist here, so you've got to figure this out. But I'm thinking it's something simple like my fingerprint.

SPEAKER_00 16:42

I'm thinking it's something simple like text messages or WhatsApp or whatever. I mean, it needs to be something simpler. Because again, like as a product person through and through, I think we often don't ask, do the patients even want this technology we're deploying? But, you know, in the past, we've had so many regulations that required us to have certain functionality that made sense in a portal. Oh, we have to be able to give them their record. They have to be able to view, download, and transmit. We have to have this, we have to have that. And it wasn't because there was a problem that needed solving, it was because the regulations required it. And so now we're just kind of building on top of that, which is really tough.

SPEAKER_02 17:19

Yeah, I'm excited about the things we've been hearing about for gosh, what, 20 years now, where we're all gonna own our own digital health record eventually and be able to stay in that for like 30 years ago, right? When's it when's it coming? Because it sounds amazing. And also as an administrator, patients aren't great historians. And so I would have loved to have had all the actual information about the patients. That's a good point. Yeah.

SPEAKER_00 17:46

Can you go fix that? I don't know that I can. Because the thing is, like everyone's historical records are now in so many siloed places that we could probably just burn all down and start from scratch here, but I don't know that we could get all that information back. Yeah, that is true. That's tough. Now, we think about AI, we know that patients and doctors are all using it. And, you know, as a provider, I still see patients in a charity setting. And back in the day, people come with their laundry list of stuff that they're like, okay, I have all these gazillion things. And then all of a sudden they're bringing it with Google information with it. Dr. Google is very pervasive and persistent. And now it's Dr. Claude or Dr. Gemini or Dr. ChatGBT. And so when we have our patients using AI, how do you think practices should react to that? How providers should kind of recognize that and then make it okay so that the patients who are educating themselves in whatever manner possible can be supported more by the healthcare system?

unknown 18:50

Yeah.

SPEAKER_02 18:51

I I think we've got to embrace it. And here's why. So, you know, my work spans anywhere from free charity clinics to, you know, high-end infusion centers to med spas, way different patient demographics, and they are all running into that. Every patient subset is using it. And I think people have to embrace it because patients are gonna use it either way. And it's almost, I feel this way, I'm gonna really oversimplify it, but it's the way I feel about like supplements and holistic medicine. If you shame your patients for using it, they're just gonna lie to you about using it or not tell you. So if you make the AI thing more approachable, then they start to have a dialogue with you so that you can actually manage that conversation. And so I would say step one is just be open to it. Okay, Sarah, did you look up anything ahead of time online? Did you have any questions that Claude told you to ask me? Like, let's talk about it. I'd rather we have the conversation than you and AI. And I realize that's hard in a very time-limited span. But opening that conversation one, and then I'd say step two, like get get funky with it. Come up with your own prompts that you can give patients and say, okay, here's three different things. You know, maybe it's a new diagnosis of rosacea. Here's three things you should no, I yeah, don't be asking about crazy things, but common things. Here's three prompts, go put them in and then give them the resources. American Academy of Dermatology, the places where you trust and respect. And then I would say, you know, sort of the the last version, at least in my head, is letting patients know what not to believe. You guys are rapidly amassing information. Like I guarantee you there's topics you already know that chat, Jim, and I, Claude, whoever is giving bad advice on. I mean, we're constantly telling people they don't have brain tumors.

SPEAKER_00 21:02

That's all I can say. Yes. Constantly are.

SPEAKER_02 21:05

So going ahead and working that into your patient handouts, and I say handouts because we only have so much time rather than speaking points on, hey, by the way, AI may tell you this, don't believe it.

SPEAKER_00 21:17

I like that. I think that um that proactive approach of providing good resource, not just the patient education and the portal, sorry, patient education, sorry, portal, not sorry. Um, you know, what are the sites that you would trust for your patients? How can you make sure they understand what those sites are? Um and then I do think that's interesting to be able to provide your own prompts. Because again, I could see that on the back door of a of a waiting room or something like that, where it's like, hey, you got diagnosed with risation today or whatever. Here's how you can find out more about it in a different fashion.

SPEAKER_02 21:51

Yeah. And it only works if we tell them some trusted resources like ACOG.

SPEAKER_00 21:56

I like that. It's a nice way to think about it. So So if you're a physician or a practice admin that's listening to this talk right now, and you know your patient experience is terrible, what's the first thing you should do?

SPEAKER_01 22:11

Be honest about it.

SPEAKER_02 22:13

Have a conversation with your clinical team and your staff and say, hey, our patient experience sucks. I know you're taxed. I know you're doing the best you can. I know this is one additional stressor. My job is to keep the doors of this practice open. And in order to make that happen, we have to fix these perceived realities about our practice and let your team be part of the conversation. Don't dictate it. It's not going to feel good. And take time to listen and really hear what your physicians and nurses and front office staff feel, because their feelings are all real. We got to move past them so that we can keep the doors open and keep patients getting in the door, but we shouldn't dismiss them. And while we're having the conversation of all these things we're going to do to make patients happy, on the flip side, build in some protections for your team. Okay, we're going to do, you know, all these things to improve patient experience, but also if we have badly behaving patients, we're not going to tolerate it. And here's the line there. So yeah, I'm going to ask you to be 20% warmer and fuzzier, but I'm also going to do a better job of protecting you. And if we've got a patient that's consistently abusive or consistently late or whatever disruption is, we're going to dismiss them. So give your staff something back.

SPEAKER_00 23:37

I like it. I think the other piece too, especially in private practices or PE back practices, putting that economic argument on it too. So patient experience is hard sometimes to put as a line item, but no show rate, that means something. All the different pieces of, oh, now I'm an hour behind schedule, that means something. And so I think that sometimes that economic argument can help from a funding perspective, from a practice perspective. And then finding ways to help the staff understand why that's actually better for them.

SPEAKER_02 24:11

Yes. I absolutely agree. And I would add to your metrics, patient attrition. Oh, yes. And figuring out why at a granular level, I think a lot of times we just, oh, they must have moved. Oh, they must have found somebody else. When you've got a really good relationship with your patients and they're going to leave, they tell you, I'm moving to Ohio. I'm not going to see you anymore. It takes some time, but yeah, invest in that.

SPEAKER_00 24:38

So what's the biggest pushback you get? You go into an organization, you say, hey, your patient engagement, your experience, terrible. Where do people usually push back? What's their excuse?

SPEAKER_01 24:48

So there's two. One is we don't have time for that. Okay. Fine. The other is, nah, let's just do some marketing.

SPEAKER_02 25:00

And so they'll throw 10, 20, 30, $40,000 at marketing for people to come in and have a bad experience while they're losing patients. And they've just thrown that money in the trash.

SPEAKER_00 25:11

Amanda, you call them back up. You and I'll do it for half.

SPEAKER_02 25:14

We got it. It's easier to throw money at a problem than it is to fix it. But I would argue it's cheaper to keep the patients you have happy.

SPEAKER_00 25:25

I would agree with that. I would agree with that. Well, this has been a wonderful conversation. So for people who want to learn more about the Brumit group and what you guys are doing, how should they get in touch with you?

SPEAKER_02 25:36

Sure. So website is a great option. B-R-U-M-M-I-T-Tgroup.com. They can also follow me on LinkedIn. And I'll be honest, both my website and my LinkedIn, they have all the recipes. They have all the answers to all of that. So if people are self-starters, just go take it, dig through it, and go fix things. And then if they need help, I'm here.

SPEAKER_00 25:58

I love it. Well, that's Amanda Brewitt, Operations vet, patient experience strategist, and someone who spent a long time watching the gap between what healthcare organizations say about patient experience and what patients actually feel when they show up. So the framework I'm taking from this one is patients are shopping on their worst days. Everything about how a practice operates is either making that easier or harder. And focus on the patient experience. If they did not have a good experience, they're not coming back. So if this episode was useful, share it with one person in your organization who needs to hear it and subscribe wherever you listen. This is the Clinical Realist. We'll see you next week.