Yuna Lee grew up in Perth, Australia, watching her family run a line of nursing homes. She learned how even the smallest actions on the part of staff could make worthwhile differences in patient care. When she later worked at the New York City Health Department, she often consulted frontline staff to improve care in the clinics.
These experiences helped lead Lee to the Yale School of Public Health, where she is a fourth-year Ph.D. candidate working on a dissertation on how to foster creativity and innovation in health care organizations to improve the patient experience.
Lee, who spoke about making health care organizations more patient centered at the Association of Yale Alumni meeting late last year, said that creativity is needed to improve health care organizations and the quality of care they offer. Good ideas for improvement arise every day and health care organizations need to learn how to recognize and implement them.
Even small and inexpensive changes can have big impacts, Lee said. For example, when staff members bend their knees to speak with wheelchair-bound patients at eye level, rather than literally looking down on them, it engages the patient and shows respect.
Lee also believes that frontline care staff, such as nurses, should be encouraged to speak up to overcome the culture of standardization and professional hierarchies. “Whether it’s a doctor or someone preparing food, staff that interact with patients and have an idea to improve their care experience should feel comfortable speaking,” she said. “We need organizational cultures where creative and useful ideas stand a chance of surviving and becoming sustained innovations.”
For her dissertation, Lee spent the past four years collecting data from a group of primary care clinics in Connecticut where the staff met weekly to discuss ways to improve the patient experience. Lee tracked the ideas generated by these teams and collected data on staff work experience and social networks. She found that approximately half of the ideas generated failed.
“I’m trying to understand what the creative process looks like in health care, and in many ways it looks different from other industries” said Lee, who is in the school’s Department of Health Policy and Management. “What ideas take hold and which ones fail, and what can leaders and managers do to nurture the most promising ideas?”
We need organizational cultures where creative and useful ideas stand a chance of surviving and becoming sustained innovations.
Yuna Lee
Improving the patient experience is not just a compassionate response to suffering or the right thing to do. The Affordable Care Act has made changes to Medicare reimbursement so it is linked to patient experience. The goal is to realign incentives within the health system so providers who deliver high-value patient-centered primary care are rewarded.
“Ensuring that health care is patient centered is an increasingly important focus of efforts to improve the quality of care in the United States,” said Dean Paul Cleary, who is Lee’s adviser. “Yuna’s work will be the first to study systematically the process through which creative ideas are developed, nurtured, and implemented.”
Lee said improving health care tends to focus on technological upgrades that don’t directly affect the patient experience. “Empathy, compassion and trust are things we don’t tend to talk about, but that’s what makes the difference when a patient is in pain or is feeling scared,” she said. “We need to get the human element back to working in health care, so staff are empowered and connect with what they do.”
Creativity in health care organizations, Lee has concluded, is a social and political process, one that brings medicine and management together.
“Creative ideas have the potential to improve care in nursing homes, hospitals, doctors offices or on the field. But it doesn’t happen by itself,” she said. “We need to create an environment and culture that encourages creativity and speaking up.”