|Member Spotlight - January 2011|
JANUARY 2011 MEMBER SPOTLIGHT
WHAT ARE YOUR KEY RESPONSIBILITIES?
WHAT HAS BEEN YOUR MOST SIGNIFICANT ACCOMPLISHMENT IN YOUR CURRENT ROLE?
I have held the position of Director of Service Excellence since its inception in April 2009. The role was created to provide focus and resources for improving patient satisfaction and HCAHPS scores. A major accomplishment has been to change Inova's performance and accountability model to one that will create a positive culture and alignment to improve the patient experience.
Eighteen months ago, accountability for patient satisfaction outcomes was held at the department director level (for those departments that discharged patients who received surveys). Each department had a goal that was derived by moving their scores from a current level to the 90th percentile within a three-year period. Scorecards were created that highlighted performance in red if the actual score was less than 95% of the stated goal, yellow if the actual score was between 95% and 100% of goal and green if the actual score equaled or exceeded the goal. The challenge with this approach was that it didn't acknowledge that it takes more resources to improve the patient experience. One poor encounter and one not necessarily within the department being measured could actually negatively impact that department’s scores. This measurement model did not create alignment across departments or ensure that all leaders were incented to improve the patient experience. In addition, high performing units were locked into extremely high goals, while lower performing units had much lower hurdles. For example, one unit might have a goal of 85th percentile, while another unit's goal might be in the 50th percentile. Goals that were missed were highlighted in red (regardless of the percentile targets). We discovered that there was an immediate and visceral response to red. Because units missing their targets were highlighted in red, conversations were no different for high performers (who may have achieved the 70th percentile instead of > the 80th percentile) than for lower performing units (that missed their 50th percentile goals). Consequently, performance improvement around the patient experience was viewed as punitive and unfair.
In order to change these dynamics, we did two things. We aligned incentives by developing goals at the facility and system level and held all leaders accountable for achieving those goals. For example, housekeeping, dietary, physical therapy, etc. were held accountable to the same goal as their counterparts who were running the clinical departments from which the patients were discharged. This goal structure incented high performing leaders to share best practices with their colleagues who were struggling. We also changed the scorecard. We no longer show the actual percentile ranking as compared to a goal ranking at the individual department level. Instead, we highlight the actual performance based on what quartile and decile has been achieved. Units who achieved the top docile are highlighted in green, units highlighted in deep blue have achieved the upper quartile, units highlighted in light blue have achieved between the 50th and 75th percentiles, units highlighted in pink are performing in the 25th to 50th percentile, and those units operating in the bottom quartile are reserved for red. Seeing the units stratified in this manner help senior leadership prioritize their efforts for moving units along the continuum. More importantly, conversations immediately changed with those leaders who had high performing units but performance hadn't yet climbed into the top decile. The changes that were implemented have improved our culture around service performance improvement, leadership is now more engaged, and conversations are more focused around affecting positive change instead of the scorecard itself.
WHAT IS THE BIGGEST CHALLENGE YOU ARE CURRENTLY FACING?
Improving the patient experience requires a heavy dose of change management as we must alter cultural beliefs within healthcare, as well as make changes to long-standing processes. Changing human behavior is always hard. Inova has been on this journey since 2005 when we engaged the Studer Group to help us implement evidence based practices for driving improvement in the patients’ perception of their overall quality of care. Those tactics were then taught to leaders who were responsible in turn for teaching their staff. We collected process metrics to ensure that the tactics were implemented. While compliance stood at 85% - 95%, we saw little change in scores. This situation led leaders to assume that these tactics did not drive performance, and with middle leadership under pressure to produce results, our units began to try other creative ways to drive scores. This frenetic activity did little to improve the patient experience, but demonstrated to their leadership that action plans were being implemented.
Over the past eighteen months, I have spent time observing and drilling into the root cause of why we have not achieved what we expected. I knew from networking with other organizations that the Studer tactics could drive performance. Two issues emerged. We never explained the "why" only the "what." Service can have a negative connotation with clinical staff. When you say service, they perceive that you are comparing their jobs to entertainment and retail, and they are stretched to understand how a patient would ever view their experience as excellent. After all, who enjoys going to the hospital? Because we did not connect the dots for the staff, that we really were talking about reducing the patient’s anxiety, ensuring their safety, and communicating with them in a way they could understand, they did not fully engage. Furthermore, we did not provide adequate training with deliberate practice in a safe environment. Many leaders and staff lacked the necessary skill to execute the tactics with intention in a memorable way. We are now going back to the basics. We plan to create a vision for the patient experience and to communicate that vision through stories. Leaders and staff will attend intensive training utilizing skills labs to test their competencies. My biggest challenge will be to keep the organization focused and to execute on the plan in the face of a number of facility and system level initiatives that could distract from our efforts. We also need to convince staff that our renewed focus is not simply another "flavor of the month."
WHAT ARE YOUR VIEWS OF THE FUTURE IN ADDRESSING PATIENT EXPERIENCE?
To date, most of the improvement around the patient experience has focused on building a culture that supports a service orientation, creating a healing environment and offering additional amenities such as valet parking and dining-on-call. Our next foray of activity will focus on our processes. For the most part, healthcare processes are built for our organization and the physicians' convenience, not necessarily for the patients’. Furthermore, as an industry, we are so fractured that delivering seamless care seems almost impossible at times. If we want the patient to have an excellent experience, we must begin to design that experience to focus on how we can build services around the patients' wants and needs instead of ours. While this approach sounds easy, it is actually quite difficult, as we must change our interaction with our patients from "let us take care of you" to partnering with our patients in their care. Patient experience design will require investments in infrastructure, including mechanisms to harvest the voice of the customer and information and technology to facilitate processes and information exchange. Furthermore, we will need to develop partnerships with physicians and other stakeholders in the community. This work dovetails nicely with the advent of accountable healthcare organizations that will emerge as a result of the enactment of healthcare reform.
WHAT DO YOU DO FOR FUN WHEN NOT FOCUSING ON THE PATIENT EXPERIENCE?
When I am not working on patient experience initiatives, I am acting as concierge for my three children; all are heavily involved in sports and require limousine service around Northern Virginia. I am actively involved with my daughters' sports clubs, including fundraising efforts and acting as treasurer of the travel soccer team. When I have time, I enjoy participating in the church choir, and I love to read novels about political intrigue.
WHY DID YOU CHOOSE TO BECOME A MEMBER OF THE BERYL INSTITUTE?
I became a member of the Institute because I wanted to network with other professionals that are similarly engaged in efforts to improve the patient experience. I don't believe in reinventing the wheel, so I look for avenues to learn best practices from others. I am really looking forward to the conference in April as an opportunity to share ideas and to learn from others who may have faced the same challenges as me.