Insights Series Issue 22: "Patient Trust, why it matters for Covid-19 and beyond"

A thought leadership paper on “Improving patient experience” co-authored with Adrienne Boissy, MD, MA Chief Experience Officer of Cleveland Clinic Health System.

Insights Series Issue 22 improving-patient-experience The New Normal Patient trust Why it matters for COVID-19 and beyond A thought leadership paper on “Improving patient experience” co-authored with Adrienne Boissy, MD, MA Chief Experience Officer of Cleveland Clinic Health System SIEMENS Healthineers Preface The Insights Series The Siemens Healthineers Insights Series is our preeminent thought leadership platform, drawing on the knowledge and experience of some of the world’s most respected healthcare leaders and innovators. The Series explores emerging issues and provides you with practical solutions to today’s most pressing healthcare challenges. We believe that increasing value in healthcare – delivering better outcomes at lower cost – rests on four strategies. These four principles serve as the cornerstones of the Insights Series. Expanding Transforming Improving Digitalizing precision care patient healthcare medicine delivery experience The New Normal The New Normal is a special edition of our Insights Series focusing on the COVID-19 pandemic. This series provides recommendations on how to confront the current SARS-CoV-2 outbreak and its implications, as well as strategies and ideas on how to emerge from the current crisis stronger, more resilient, and better prepared to address the healthcare challenges that lie ahead. Please visit Executive summary In addition to inflicting the most widespread and devastating The U.S.-based Cleveland Clinic was one of the first major medical harm of the past century, the COVID-19 pandemic academic medical centers to make patient experience a has also damaged a less tangible aspect of our well-being: strategic priority, to appoint a Chief Experience Officer, our trust. Trust in institutions and their leaders, trust Adrienne Boissy, MD, MA, and to create a new role known as in strangers we meet, trust in healthcare providers – all the Chief Caregiver Officer, led by Dr. Kelly Hancock. The have been challenged. COVID-19 pandemic has been a grueling test for healthcare systems, including the Cleveland Clinic. Looking back Restoring and strengthening this trust is essential for on the early months of the pandemic, Dr. Boissy published healthcare professionals, from small rural doctors’ offices a groundbreaking article in the New England Journal of to the largest healthcare systems. When trust is weakened, Medicine Catalyst entitled “Getting to Patient Centered Care every step along the patient’s pathway is affected. Trust in a Post COVID-19 Digital World: A Proposal for Novel is not only vital for delivering quality patient care, it is Surveys, Methodology, and Patient Experience Maturity also an essential business priority. Customers demand trust Assessment.”1 Many of the concepts captured herein from every enterprise with which they do business, but are reflections of that manuscript, in which Dr. Boissy it is absolutely vital for those to whom they entrust their contemplates on what Cleveland Clinic did well, and to health and their lives. At its core, patient trust is intimately offer honest and insightful recommendations on how connected to whether promises to patients are kept. trust might be built and grown moving ahead. In healthcare, this is about safety, empathy, teamwork and ease. Siemens Healthineers Insights Series · Issue 22 3 Introduction Facts and figures About the Cleveland Clinic The U.S.-based Cleveland Clinic has a well-earned reputation as one of the world’s foremost healthcare organizations. The Cleveland Clinic is a nonprofit, multi-specialty academic Cleveland Clinic2 medical center that integrates clinical and hospital care with research and education. Today, the Cleveland Clinic 8.7 million Outpatient visits in 2020 operates close to 1,300 beds at its main location and more than 6,000 beds throughout its entire system, which includes 273,000 18 hospitals worldwide. Hospital admissions and observations in 2020 >220 The Cleveland Clinic employs more than 67,000 caregivers, Outpatient locations more than 4,000 physicians and scientists, and has close 19 to 2,000 residents and fellows in training. Its annual operating Hospitals worldwide revenue is more than $10 billion. 68,700 Healthcare professionals In addition to its leading-edge medical work, the Cleveland Clinic was also one of the first large hospitals to actively make patient experience a strategic goal – embracing a mission of providing care that addresses every aspect of a patient’s encounter with the clinic including the patient’s physical, emotional, spiritual and educational needs. This same commitment also extends to the care teams who treat patients; without them, a high level of patient care would not be possible. The Office of Patient Experience identifies best practices and analyzes how top performing hospitals discern and maintain success. At the same time, the Office drives improvements across the enterprise, and performs unit observations that will sustain these best practices. Their leadership in this area has been recognized internationally. 4 Issue 22 · Siemens Healthineers Insights Series The challenge During the current pandemic, patients around the world During the COVID-19 pandemic people have been confronted with frightening new realities. They have been uncertain to seek care3 were threatened by a new virus about which little was known; information about appropriate hygiene and safety protocols was inconsistent; even the safety of hospitals and medical facilities was unclear. In the U.S., a majority of people expressed concerns about feeling “safe” in medical facilities. During the acute phase of the first wave of the pandemic, in May 2020, a survey in the U.S. indicated that 45% of the population would be uncomfortable seeking care in an emergency room setting, about 30% in the hospital, and 37% in a walk-in clinic.3 The same study also revealed that more than a third of American adults would delay a return to a hospital or outpatient care site for a non-urgent procedure by at least seven months. Later in the year it was estimated that 41% of U.S. adults had delayed or avoided 45% medical care including urgent or emergency care (12%) and routine care (32%). In the U.S., avoidance of urgent or have been uncomfortable seeking emergency care was most prevalent among unpaid careers, care in the emergency room persons with underlying medical conditions, Black adults, Hispanic adults, young adults, and persons with disabilities.4 A recent study in the U.K. has reported that in 2020, a 30% million women missed their vital breast screening as result of lockdown measures.5 have avoided a hospital In addition to fears about their own safety and well-being, some patients were potentially concerned about the 37% ability of healthcare teams to provide adequate care. Could they still be trusted to deliver quality medical care when have evaded a walk-in clinic they had their own personal challenges to deal with? As Chief Experience Officer Adrienne Boissy, MD, MA, has observed, “COVID-19 has challenged nearly everything about healthcare delivery, including the experiences of patients and families. Although the ‘how’ of delivery has changed, the timeless and universal commitment to patient - centered care has not. We will continue to keep patients safe, we will care for them as people, we will partner with them, and we will make it easier.”1 Trust builds when we * Early survey among patients from U.S. keep these promises. Siemens Healthineers Insights Series · Issue 22 5 Factors influencing patients’ decisions There are numerous explanations for this cautious behavior on the part of patients. Psychology suggest that people Factors that influence overestimate perceived threats, which in turn, likely patients’ healthcare reinforces their underestimation of the need for medical decision-making1 care. Furthermore, human brain is also emotional, and fear being one of the most powerful emotions , it may steer • Cautious behavior many patients away from the care they need. This was • Limited knowledge evident during the COVID-19 pandemic, however, such • Concern about costs behavior is not unique to crisis situations like the current • pandemic. Additional worries: need to take time off work or tend to other’s care A second reason for patients delaying needed care is limited knowledge. Many healthcare consumers get their health information primarily from their local news or, in the case of younger people, online or from social media. Approximately 16% of people received health information from their own employers. Only 14% of healthcare consumers received any information directly from health systems.6 Patients typically get information A final, and pervasive, factor influencing patients’ decision- from these sources1 making is concern about costs. For patients who are considering skipping a routine medical visit, the COVID-19 pandemic created an additional reason to forego treatment, elective procedures, or testing. Furthermore, the landscape of 73% layoffs, closure of small businesses, and being forced to Family member take time off work, for example because of home-schooling, 45% loss of childcare, or to care for sick family members, created Friend additional financial pressures for healthcare professionals and patients alike. Socio-economic disparities must also 42% be recognized and acted upon as they are associated with Online physician reviews health outcomes. 30% Traditional marketing campaigns 6 Issue 22 · Siemens Healthineers Insights Series Adrienne Boissy, MD, MA “People who have the luxury of choice walk with their feet and with their wallets. The decision to come back to our clinics and offices is about whether they trust us to keep them safe.” The impact For healthcare providers these patient worries represented a significant concern. By delaying or foregoing hospital visits, many patients would not receive the care they need, + Impact on workflow The trust and confidence between patients when they need it, thereby compromising their own health and the healthcare system is essential not and often requiring treatment for more serious conditions only for the health of an individual patient, at a later point in time. On a more practical level, this but also for the functioning of healthcare systems. decline in patient volumes also represented a serious business challenge. Despite this, the Cleveland Clinic ramped up caregiver support programs and committed to no furloughs. Patient trust is the essential ingredient that ensures the stability and efficacy of a healthcare system. An absence of trust is harmful to patients as well as to healthcare teams, Over the course of the COVID-19 pandemic, the Cleveland contributing to burnout,7 less professional satisfaction, Clinic was confronted with challenges they had never and greater risk of errors and malpractice suits.8, 9, 10 encountered before. Yet, the work they had done in the Patients delaying their own care affect healthcare practices preceding years proved to be valuable. As Dr. Boissy notes, financially, impacting reimbursement and forcing them “It was a very dynamic environment, changing rapidly to incur far greater costs in the long term. A simple on a daily basis. We'd never seen anything like it. The infection or illness that could be treated easily, if diagnosed good news is, we had a running start given our history of early, can turn into a serious medical condition requiring teamwork and operating as a unit.” expensive treatment and hospitalization. In addition to patients, caregivers were also affected. During the early months of the pandemic, many caregivers were exposed and became infected. At one point, more than a thousand employees of the Cleveland Clinic were sick with COVID-19. Like others, the Cleveland Clinic adopted a variety of practices to provide bedside care and protect employees, including screening services, developing home monitoring programs, mobilizing retirees to support care, bringing outpatient clinicians into the hospital, and building temporary hospitals. Siemens Healthineers Insights Series · Issue 22 7 The solution Gather quantitative evidence, pay attention to qualitative feedback, and apply what you learn According to Dr. Boissy, shaping trustful interaction must • Navigating the billing experience: research led by both begin with patient – and caregiver – centeredness. She the billing department and the Insights Studio, a Cleve- references the Institute of Medicine's (IOM) definition from land Clinic design team, identified five reasons why the Crossing the Quality Chasm report from 2001: “providing those patients who fail to pay their medical bill don’t care that is respectful of and responsive to individual pay: skepticism of accuracy, confusion, searching for patient preferences, needs, and values and ensuring that information about the bill, struggling to pay, and patient values guide all care decisions.”11 Various definitions prioritizing their spend. have been provided over the years, yet this definition remains the gold standard for patient centeredness.12, 13 Dr. Boissy went on to propose evolving metrics and a maturity framework for organizations that more accurately The Cleveland Clinic proactively and systematically reflect patient journeys across a lifetime. These metrics categorized all patient comments from their patient go beyond traditionally mandated surveys like HCAHPS*. satisfaction surveys over a nine month time frame They include, for example, the patient activation measure pre-COVID-19 pandemic. In the New England Journal of (PAM), patient reported outcomes, time-to-treatment and Medicine (NEJM) Catalyst paper,1 Dr Boissy noted that customer ease score, many of which focus over a lifetime positive experiences are associated with: communication relationship rather than a single event. Metrics like customer with patients, their inclusion into care teams, and their lifetime value, retention rates, and share of wallet, in which sense of being cared for, by doctors, staff, and in particular the subjective reports are paired with objective quantitative nurses. The reported pain points across all settings were: measurements, provide evidence to support processes and operations. The COVID-19 pandemic has accelerated • A lack of ease: administrative burdens create more the need to include measures, such as safety and empathy inconveniences for patients as do unexplained waits in patient experience measurement, and this change for test results, appointments, and transfers. The result, will require commitment and courage from healthcare unfortunately, is a patient narrative of being disrespected organizations. and feeling ignored. • An absence of timely responsiveness: most people expect to receive their diagnostic results as soon as they are available, not depending on the clinician's time. • Insufficient communication or empathy: patients often don't feel part of the care decisions and need to operationally become the center. * Hospital Consumer Assessment of Healthcare Providers and Systems U.S. national survey. 8 Issue 22 · Siemens Healthineers Insights Series Adrienne Boissy, MD, MA “The starting point is for organizations to have: 1) subjective and quantified objective data on patient experience, 2) leadership commitment with patient-centered metrics on CEO scorecards, and 3) active board member and patient engagement.” Benchmark metrics for organizations that reflect patient journeys across a lifetime Patient experience and Patient activation Timely Communication and satisfaction measures measures responsiveness empathy measures + i + Siemens Healthineers Insights Series · Issue 22 9 Ensure safety The Hippocratic Oath clinicians take to “do no harm” is an anchoring principle of medicine. Dr. Boissy believes Embedding empathy that “Pandemic or not, patients will never choose to in operations interact with any healthcare provider if they aren't sure we can keep them, and their loved ones, safe.” Cleveland Clinic created Hero Huddles within larger meetings to tell the story of exceptional actions by individuals and teams, who During the COVID-19 pandemic, concerns about their own then received a personal phone call from an safety were often only one dimension of the anxiety executive leader thanking them. patients had. Many were equally concerned about the risk of being isolated, separated from their friends and loved ones, while grappling with a serious health crisis. also need to include experience. Adding questions about safety to experience surveys is a first step. Furthermore, patients – at least historically – assume high quality and safety in healthcare. Addressing safety concerns As Dr. Boissy points out, “That's a whole new element of cannot be treated as a one-dimensional undertaking. It messaging and operations that organizations need to must be part of a broader effort to fully understand a manage. How do we ensure that loved ones are always patient’s concerns, wishes and needs. Many organizations part of the healing process for patients, whether they are focus on high reliability principles to drive safety, these there in person or not?” Safety Empathetic interactions Adapted technology to enhance trust 10 Issue 22 · Siemens Healthineers Insights Series Enhance empathetic interactions How does one operationalize empathy? As Dr. Boissy Furthermore, it is known that teamwork is a top driver of admits, finding ways to promote empathy on an operational likelihood for patients and family to recommend. Multiple level really is the central challenge facing organizations domains of patient experience improve significantly when as large as the Cleveland Clinic. “We cannot approach patient rounds are performed as teams at the bedside. it with flowers and hope that things change. We have to Led by Dr. Silvia Perez Protto, the Director of the End of Life weave empathy in at every level within our organization, Program at Cleveland Clinic, a team drafted a guide in to change our processes and operations. This requires an Electronic Health Record (EHR) on how to have conversations awareness of what is important to patients.” about advance care planning using national standards. The team also implemented a standard process for advance Several great examples exist of where organizations can directive capture and documentation, and added language get started. To address ease of access, the Cleveland Clinic to the system for the moment of passing which considers pioneered same-day-access and more recently introduced patients’ wishes. time-to-treat as a metric for teams in cancer care led by Dr. Brian Bolwell. Additional examples of easing access are The question Dr. Boissy asks is, “How do we anticipate the auto release of lab data and results, and working with our patients’ needs and know them better? Two ways patients to draft communication practices to proactively to operationalize partnering with patients are including address fears. As Dr. Boissy has observed on numerous patients in the discussion of daily plans of care, even occasions, patients spend a large amount of time waiting – through virtual interfaces, and using care team meetings for an appointment, in waiting rooms, for test results. to discuss experience issues in the hospital.”15 While their care may then be a high level of quality, it’s the long waits that patients remember. Her teams are designing a predictive model of wait times to communicate to patients and keep them updated. Billing is another source of frustration for many patients. To help address this, the finance teams have had a single unified bill for patients in place for several years, designed together with patients. Virtual visits for billing questions are now being introduced. Siemens Healthineers Insights Series · Issue 22 11 Adapting technology to enhance trust A question that healthcare organizations worldwide have In order to accurately assess the impact of the move to been struggling with is, how do you maintain a human virtual care, the Cleveland Clinic and other care organizations connection, loyalty and trust in an increasingly digital gathered patient information through surveys. The world? general feedback was exceptionally positive, with close to 90% positive ratings, including the “likelihood to One of the positive outcomes of the current pandemic, in recommend” ranking. Ease of use, and feeling empathy Dr. Boissy’s view, has been a relaxing of regulations also scored very highly.17 The most crucial lesson, that govern clinicians’ interactions with patients. They have according to Dr. Boissy, is that “the technology should moved from being able to use one or two platforms into support the relationship, not the other way around.” essentially anything that allows a high-quality audio-visual connection.15 The development of a COVID-19 home monitoring program with phone calls and virtual check-ins used information about stressors as well as advance directives to address patient concerns. One particular breakthrough has been in the area of mental health, where these new platforms provided new ways of communication and learning about patients, often while they were at home in a more relaxed and natural setting than in a doctor’s office. In Dr. Boissy’s own practice, treating Multiple Sclerosis patients, she noticed some remarkable differences: “For example, a patient I've been taking care of for ten years, I get to see him on video and then say, ‘Hey, I'm noticing that behind you, you have a huge array of cooking pans. Are you a good cook?’ It enables a whole new window into the lives of the people that I'm trying to connect with.” Empathy and relationship-centered communication training for care teams is already a part of each employee’s onboarding at the Cleveland Clinic.16 The program now has been expanded to provide training on communication skills while using virtual platforms. 12 Issue 22 · Siemens Healthineers Insights Series Adrienne Boissy, MD, MA “Every human is amazing and special and messy and fragile – all the things that make us human. Whether in person or on a phone or virtually, we need to endlessly seek that humanity in one another.” Technology should support the relationship between patient and healthcare professionals O c H+D Siemens Healthineers Insights Series · Issue 22 13 Recommendations moving forward Maintaining patient trust has always been essential for healthcare providers. As we emerge from the COVID-19 Make access to care easier. Meet pandemic, strengthening this trust will be particularly patients where they are. important. Listen intently to the pain points In order to create a foundation to re-establish patient of patients, healthcare professionals trust, Dr. Boissy identifies five key focus areas: and teams. 1. Make access to care easier. This requires a combination of having the availability, using technology where it Embrace tools and technology that makes sense, meeting people where they are, and enable effective virtual experiences messaging safety at every opportunity. for both patients and caregivers. 2. Listen intently to the pain points of patients, healthcare Offer training for clinicians on virtual professionals and teams. Be visible within the units, best practices in communication. even it is through virtual rounds. 3. Tools and technology that enable hospitals and caregivers Place the patient as the center – to design effective virtual experiences for both, patients the actual functional center – and caregivers, should be embraced. Communicate of the team. their value for patients, including saving time, effort, and money. 4. Offer training for clinicians on virtual best-practices in communication and make them aware of the flexibility and effectiveness of virtual interactions. 5. Place the patient as the center – the actual functional center – of the team. Encourage patients to share positive comments with staff, deliver letters to other patients, and include them in events like hackathons at which tough topics are debated. Include patients through whatever means possible and engage them. Be creative. 14 Issue 22 · Siemens Healthineers Insights Series Conclusion The COVID-19 pandemic has altered our world in countless ways, many of which we have not yet fully understood. The entire healthcare sector has felt the full force of these changes and has been on the frontlines of this epic challenge. In addition to managing the spread and impact of the COVID-19 pandemic, maintaining patient trust during such an unprecedented crisis was a further element of this challenge. Patient – and caregiver, employee and staff – trust is essential for maintaining the ability to deliver effective care and for keeping individual hospitals, as well as the entire healthcare system, functioning. Recent efforts to strengthen patient trust at the Cleveland Clinic and elsewhere have taken many forms, including deep listening to patients’ comments; more proactive outreach; more active engagement with patients’ families; more attention paid to patients’ wishes and preferences; increased efforts to ease the burden of the entire experience; and a clear commitment to the care of healthcare professionals. Trust is, of course, intangible. It is difficult to measure or quantify. Yet there are things caregivers can do individually, and there are measures that can be undertaken on a system- wide level, to maintain and enhance trust. Dr. Boissy considers that “while we continue to work on the perfect measurement of trust, in its simplest of terms, we need to keep our promises of safety, of inclusion, of caring, and of ease to our patients. That's the start of something beautiful.” Siemens Healthineers Insights Series · Issue 22 15 About the authors Adrienne Boissy, MD, MA Chief Experience Officer Cleveland Clinic Health System Adrienne Boissy, MD, MA, is Chief Experience Officer of the Dr. Boissy co-chairs the Empathy and Innovation Summit, Cleveland Clinic Health System and a staff neurologist the largest independent summit on patient experience at the Cleveland Clinic Mellen Center for Multiple Sclerosis. in the world. She serves as Editor Emeritus of the Journal of Dr. Boissy leads initiatives to address and improve every Patient Experience and serves on the advisory board for aspect of a patient’s encounter with the Cleveland Clinic Option B. She has published extensively about relationships, Health System – from their physical comfort to their burnout, digital design, and empathy in healthcare, educational, emotional and spiritual needs. The Office of and advocates for major operational changes in healthcare Patient Experience is responsible for a range of programs systems for a more humane experience, noted in her TED and services across the enterprise, including service talk “Can empathy help heal healthcare?”. In a comprehensive excellence, communication skills training, spiritual care, NEJM Catalyst piece, she has proposed a comprehensive data intelligence, volunteer services, and the ombudsman’s overhaul of experience measurement in a post-COVID office. Her recent work has focused on patient engagement digital world. She has been featured in The Wall Street and the digital experience of the future. Journal, NPR, The Washington Post, Forbes, and The Atlantic, among others. A Harvard Macy scholar, she has been internationally recognized as a leading physician executive and industry pioneer. 16 Issue 22 · Siemens Healthineers Insights Series Christina Triantafyllou, PhD Isabel Nieto Alvarez, MSc Vice President Head of Improving Senior Key Expert on Improving Patient Patient Experience at Siemens Healthineers Experience at Siemens Healthineers Christina Triantafyllou, Ph.D. is Siemens Healthineers’ Isabel Nieto Alvarez, MSc. is passionate about innovating Head of Improving Patient Experience, where she explores and transforming the experience of care to be human- ways in which this field can be enhanced and made more centered. She is an expert of the Siemens Healthineers accessible to healthcare providers. She develops strategic Global Innovation Network on mental and physical stressors approaches to deliver high value care by providing in the experience of care. Isabel leads cross-functional patient experience focused solutions, best practices and teams in innovative projects on patient experience. Prior thought leadership content. Christina began her healthcare to her current role, she has served as a marketing manager career at Harvard Medical School, Boston, U.S., where and business developer for the company, and as Professor at she worked as a medical physicist and advanced to a faculty the Universidad Anáhuac, México focused on sustainability position focusing on developing innovative imaging in healthcare for medical students and psychology. Passionate technology and studying the human brain. Her scientific about improving the patient and care team experience, career continued at Massachusetts Institute of Technology she presents and writes globally on the subject. (MIT), Boston, U.S., at the Brain and Cognitive Sciences department. She is a biomedical engineer from Universidad Iberoamericana in Mexico, holds a Master in Science on Mind and Body At Siemens Healthineers, she served as the Director of Global Medicine from Saybrook University in California, U.S. and Ultra High Field MR Solutions, focusing on business strategy, Certifications on Leadership in Healthcare without Harm KOL-based collaborations in innovation/clinical translation, and Design Thinking. Her scientific background on mind and and product management for the first worldwide clinical 7T body health and neuroscience, combined with experience MR system. Christina studied Physics and holds a Ph.D. in in medical technology innovation are cornerstones of her Medical Physics from Kings College, University of London, U.K. expertise and passion. Siemens Healthineers Insights Series · Issue 22 17 References 1. Boissy A. Getting to Patient-Centered 7. Ranjbar N. Burn Bright I: Reflections on 13. Greene S.M., Tuzzio L., Cherkin D. A Care in a Post-Covid-19 Digital World: A the Burnout Epidemic (Part One of a framework for making patient-centered Proposal for Novel Surveys, Methodology, Two-Part Series) [Internet]. The American care front and center [Internet]. and Patient Experience Maturity Journal of Medicine. 2019. The Permanente Journal. 2012. Assessment [Internet]. Nejm Catalyst Available from: Available from: Innovations in Care Delivery. 2020. j.amjmed.2018.09.036 Available from: PMC3442762/#!po=76.5625.10.7812/ TPP/12-025 9343(18)31151-3/fulltext CAT.19.1106 14. Protto S.P. Why "the pause" is important 8. Sutcliffe K.M., Lewton E., Rosenthal for patients at the end of life [Internet]. 2. Cleveland Clinic. Cleveland Clinic by the M.M. Communication failures: Cleveland Clinic. 2017. Numbers [Internet]. Newsroom. 2021. an insidious contributor to medical Available from: Available from: mishaps [Internet]. Acad Med. 2004. Available from: the-pause-is-important-for-patients- facts-figures/ at-the-end-of-life/#:~:text=One%20 of%20the%20activities%20 3. KaufmannHall. COVID-19 [Internet]. 9. Chipidza F.E., Wallwork R.S., Stern T.A. implemented,the%20efforts%20 Consumer Survey. 2020. Available from: Impact of the doctor-patient of%20the%20team relationship [Internet]. Prim Care article/whenwillpatients-return Companion CNS Disord. 2015. 15. Medina M., Babiuch C., Card M., et al. Available from: Home monitoring for COVID-19 [Internet]. Cleveland Clinic Journal of article/new-survey-consumers-growing- Medicine. 2021. more-comfortable-returning-hospitals 10. Baker R., Mainous A.G., Gray D.P., Love Available from: M.M. Exploration of the relationship 4. DAIC. SCAI Study Shows COVID Fears between continuity, trust in regular ccjm.87a.ccc028?cct=2319 Continue to Cause Americans to Avoid doctors and patient satisfaction with Doctor Visits [Internet]. 2021. consultations with family doctors 16. Boissy A., Windover A.K., Bokar D., et al. Available from: [Internet]. Scan J Prim Health Care. 2021. Communication Skills Training for Available from: Physicians Improves Patient Satisfaction shows-covidfears-continue-causeam- [Internet]. Journal of General Internal ericans-avoid-doctor-visits Medicine. 2016. 11. IOM (Institute of Medicine). Crossing Available from: 5. Breast Cancer Now. Almost one million the Quality Chasm: A New Health System women in UK miss vital breast screening for the 21st Century [Internet]. 2021. due to COVID-19 [Internet]. 2020. Available from: Available from: %2Fs11606-016-3597-2 press-releases/almost-one-million- 12. Shaller D. Patient-Centered Care: 17. Cleveland Clinic. Cleveland clinics digital women-in-uk-miss-vital-breast-screening- What Does It Take [Internet]? health playbook [Internet]. 2021. due-covid-19 The Commonwealth Fund. 2007. Available from: Available from: 6. Lagasse J. Coronavirus Pandemic land-clinics-digital-health-playbook/ influencing consumer healthcare behavior fund-reports/2007/oct/patient- [Internet]. Healthcare Finance. 2021. centered-care-what-does-it-take covid-19-coronavirus-pandemic-influ- encing-consumer-healthcare- behavior-and-some-changes-may 18 Issue 22 · Siemens Healthineers Insights Series Suggested follow-up on Improving Patient Experience • Siemens Healthineers Insights Series, issue 3: What has real impact on the patient experience, and what doesn't? Available at: insights/news/insights-series-issue-3.html • Siemens Healthineers Insights Series, issue 5: Reducing fear and anxiety by re-designing the patient experience. Available at: news/redesigning-patient-experience.html • Siemens Healthineers Insights Series, issue 9: Managing the impact of caregiver stress and trauma in the COVID-19 era: a strategy toward resilience-building. Available at: news/managing-the-impact-of-caregiver-stress- and-trauma.html • Siemens Healthineers Talks with Jason A. Wolf, President of the Beryl Institute: How can we improve the patient experience in healthcare? Available at: news/shs-talks-wolf.html • Boissy A. (2020). Getting to Patient-Centered Care in a Post– Covid-19 Digital World: A Proposal for Novel Surveys, Methodology, and Patient Experience Maturity Assessment. Nejm Catalyst Innovations in Care Delivery, full/10.1056/CAT.19.1106 Information: H. The Siemens Healthineers Insights Series is our preeminent thought leadership platform, drawing on the knowledge and experience of some of the world’s most respected healthcare leaders and innovators. It explores emerging issues and provides practical solutions to today’s most pressing healthcare challenges. All issues of the Insights Series can be found here: Contact: For further information on this topic, or to contact the authors directly: Christina Triantafyllou, PhD Vice President Head of Improving Patient Experience [email protected] Siemens Healthineers Insights Series · Issue 22 19 At Siemens Healthineers, our purpose is to enable healthcare providers to increase value by empowering them on their journey towards expanding precision medicine, transforming care delivery, and improving patient experience, all enabled by digitalizing healthcare. An estimated five million patients worldwide everyday benefit from our innovative technologies and services in the areas of diagnostic and therapeutic imaging, laboratory diagnostics and molecular medicine as well as digital health and enterprise services. We are a leading medical technology company with over 120 years of experience and 18,500 patents globally. With about 50,000 dedicated colleagues in over 70 countries, we will continue to innovate and shape the future of healthcare. Siemens Healthineers Headquarters Siemens Healthcare GmbH Henkestr. 127 91052 Erlangen, Germany Phone: +49 9131 84-0 Published by Siemens Healthcare GmbH · HOOD05162003193453 · online · 9945 0621 · ©Siemens Healthcare GmbH, 2021

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