Clock vs. Cloud Problems

When caregivers move from clinical to patient experience roles


We recently had a conversation with a fellow Beryl Institute member, a former PT practitioner that went back to school and got a bachelor’s degree in Organizational Leadership. Now, she serves her health system’s Patient Experience department with process improvement, bringing both a clinical and OL perspective to the service mapping that she leads within the organization. But even with this training, she acknowledges that service mapping is very different than working in the realm of culture change.

According to an informal survey of other PX professionals at the recent 2018 Beryl Institute conference, she’s not alone in this thinking.

Caregivers have a job to do, and do it well.

Having been trained in a traditionally linear thinking approach (A leads to B results in C), you and your colleagues have a very low tolerance for errors in process and outcome, as it should be when the health of others is at stake. As complex and interconnected as most healthcare interactions can be, we’d refer to your work as solving “Clock Problems.” 

Those who move from clinical practice into the world of Patient Experience, with its impact on staff culture and service delivery, may find it’s a “Cloud Problem” that can’t be so easily quantified. So many elements impact culture, and this is where, through combined efforts, you learn, adapt and work primarily to improve the health of the system that supports Patient Experience every day.

Philosopher Karl Popper noted the difference between the two:

“… clouds are intended to represent physical systems which, like gases, are highly irregular, disorderly, and more or less unpredictable. On the other extreme of our arrangement, we [have] a very reliable pendulum clock, intended to represent physical systems which are regular, orderly, and highly predictable in their behavior.”

To those who’ve accepted this responsibility, congratulations! You’re moving into a realm that will allow you to exponentially impact every human within your organization, as well as those that interact with you from the outside. How you frame this new challenge may help define the ways you bring your expertise to this role (there’s a whole world of Systems Thinking that describes this much more completely than we have space for here).

In an established organization, working across silos is obviously difficult. But fostering a desire for change, and an openness to new approaches, will be brought about when you build trust by enlisting caregivers in the design of your PX infrastructure. 

Consider these high-level needs as you approach PX:

  • Commitment, both personally and financially, from the top tier of management.
  • Persistence in the vision that drives your initiative: if successful, what will this organization look and feel like in 3 years?
  • A clear communications strategy that defines the purpose of each initiative, how changes will be implemented, what accountability looks like, and how individuals at all levels might be involved and impacted.
  • Diplomacy when working with managers or front-line staff who are stressed out and have a lot on their plates; understand that they need to be approached carefully, using your clinical background to gauge that approach.
  • Patience to allow it to “seep through” the organization, so that each individual can buy into the future vision you’ve established.
  • Co-design initiatives to allow the individuals actually delivering the experience to create the change themselves. Tools and strategies can be built to work for them and for patients and families as well.
  • Build trust and nurture relationships: work every day to turn gatekeepers into gate openers.
  • Incorporate the mantra “Never a failure, always a lesson” into how you speak to your initiatives. Building a culture of forgiveness among leadership and staff is key to the success of any PX effort, no matter how small.

Working to change your workplace culture, those linear processes that result in successful healthcare outcomes, is only one part of the challenge you’ve accepted. Working to change your “emotional culture” is like holding a bird: hold too tight and you crush it, too loose and it may fly away.