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The Beryl Institute invites members to submit posts on patient experience related topics. For guidelines and information on submitting a post for consideration, contact michelle.garrison@theberylinstitute.org.

 

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Top tags: patient experience  healthcare  communication  culture  patient  HCAHPS  Leadership  patient engagement  empathy  physician  survey  compassion  perception  physicians  caregiver  data  employee engagement  family engagement  healing  Hospital  improving patient experience  technology  collaboration  community  Consumerism  Expectations  interactions  patient and family engagement  pediatric  person-centered care 

Helping People Understand the Most Appropriate Radiological Imaging and Test Procedures for Their Condition

Posted By Andrea Borondy Kitts MS, MPH, Friday, May 24, 2019
Updated: 14 hours ago

It all started when I got my September 2016 issue of the Journal of the American College of Radiology (JACR). As a non-radiologist associate editor for the journal, I focus on providing the patient perspective on radiology to the readers of the journal. When I read my September issue, I came across the Appropriateness Criteria (AC) document for low back pain. The AC’s are guidelines based on evidence developed by expert panels from the American College of Radiology (ACR) membership and are published to help referring clinicians and other medical professionals decide on the most appropriate imaging and treatment options for their patients.

At the time I was trying to get a diagnosis for my low back pain and was surprised to read an MRI is not usually an appropriate imaging test for low back pain that is not a result of an obvious injury or does not have any concerning neurological symptoms. I thought this would be important information for patients to know as it may help lessen anxiety for some patients anticipating needing this uncomfortable and expensive test. It may also help patients understand why the test may not be needed, especially patients that may insist on an MRI based on advice from family and friends or from Dr. “Google.”

I discovered that there are 233 AC topics covering over 1,570 clinical scenarios. These topics covered a wide range. Examples include imaging for headaches, imaging for suspected pulmonary embolism, criteria for routine chest x-rays, imaging for head trauma in children, for asymptomatic patient at risk for coronary artery disease, for staging and follow-up for ovarian cancer and for acute onset flank pain with suspected stone disease (urolithiasis - kidney stones). I thought having patient friendly summaries on all of the AC topics would provide a valuable resource to help patients become more engaged in their health and healthcare. I approached my editor about my idea. He liked it and the JACR Editorial Board agreed to the project.

JACR staff then met with ACR Quality and Safety personnel and the ACR AC Committee Chair for guidance on ensuring the quality and technical accuracy of the summaries. It was decided that the AC Committee would provide oversight for the technical accuracy of the patient summaries. To that end, a patient engagement subcommittee was formed comprised of 10 technical experts from the ACR AC Committee and a patient advocate. Patient friendly summaries are 250-word abstracts summarizing the AC’s written in patient-friendly language. They are written by layperson authors and checked for technical accuracy by radiologist co-authors from the AC patient engagement subcommittee.

The summaries are published on JACR.org and are cited in PubMed. The summaries are also available in both English and Spanish on the RadiologyInfo.Org website, a website dedicated to providing radiology information to patients. 28 patient friendly summaries have been published to date. We anticipate a continued upward trend in downloads/views on all platforms as more summaries are published and more healthcare professionals and patients become aware of this resource. To that end, the project team is working on raising awareness and getting broader distribution of the summaries to patients, referring clinicians and radiologists.

The value of the summaries for all individuals was reinforced for me when a close friend of mine, a thoracic surgeon, told me about his trip to the emergency room with acute pain from kidney stones. Although he had a history of kidney stones and did not want any imaging tests, he was essentially held hostage with refusal of pain medication unless he agreed to a CT scan. He subsequently got a very large bill for the imaging test. I sent him the patient friendly summary of the acute onset flank pain AC, and he successfully used it to get the charges reversed. Each of us will be a patient at some point in our lives and likely to need some type of imaging or other radiological intervention. An easy to understand resource summarizing the recommendations for the clinical situations we are likely to encounter will be helpful in guiding our treatment options.

Andrea Borondy Kitts is a retired engineering executive with 32 years of experience in Aerospace. She lost her husband to lung cancer in April 2013 and is now a lung cancer and patient advocate and consultant. She works part time as a patient outreach and research specialist at Lahey Hospital & Medical Center in the lung cancer screening program where she assists with research and helps provide a patient perspective to the program. Andrea is also an Associate Editor for the Journal of the American College of Radiology (JACR), a member of the American College of Radiology Patient and Family Centered Care Commission, the Massachusetts Comprehensive Cancer Prevention & Control Network’s secondary prevention subcommittee focused on lung screening, the National Lung Cancer Round Table, the American Association of Medical Colleges Telehealth Advisory Committee and the NAM Action Collaborative on Clinician Well Being and Resilience. She is the COO of Prosumer Health, a start-up company that is developing a smartphone accessible, AI-driven, evidenced-based health maintenance and improvement platform for consumers. She volunteers for the American Lung Association and is a technical community member of the Hartford Healthcare IRB. Andrea has a BS in Mechanical Engineering from UVM, a MS in Management from MIT and a Master’s in Public Health degree from the University of Connecticut. Andrea tweets as @findlungcancer and can be reached at borondy@msn.com.

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Creating Organizational Change: A 1-Word Solution for Improvement

Posted By Greta Rosler MSN RN NEA-BC CPXP , Tuesday, May 21, 2019

During my 22 years in the professional space of caring for humans – both patients and professionals – there have been many words or phrases that have been abandoned in our ever-changing environment. Safety and the need for transformational change have taken us away from labels such as MSO4, compliant, discipline and satisfaction and that nomenclature has been replaced with terms that are more suited to a high reliability and just culture, such as morphine, adherence, coaching, and experience. And as the language of healthcare evolves, PX leaders focused on perpetual improvement and culture change often still cling to one word in particular – a word that if replaced, could advance our improvement efforts and the experience they create.

Ask yourself: The last time someone felt uncomfortable with communicating about a shifting expectation within the organization (or perhaps you yourself felt uncomfortable delivering that message), what pronoun was used? Or, the last time you delivered a difficult message about PX improvement, what pronoun did others use as they tested this information? The pronoun often used in these scenarios is “they,” though when you dissect what is meant by they, you have found one of the fundamental keys to your organization’s improvement culture.

My experience as a PX leader has taught me that the word they is often a reflection of a lack of ownership on our part or a sense of mistrust when it is used in a reverberation back to us. It is easy to dismiss ownership as a PX leader, who often serves to consult or support, though may have no authority. It comes naturally to note that “they” have not done whatever prescriptive measure we’ve recommended. Yet as you shift that internal and external narrative to we, your hand is forced to own, improve, and influence in an amplified fashion. It is in those moments of discomfort – of “we” statements – when our position pivots from one of minimal authority and helplessness to one of ownership, influence, and true partnership.

When physicians, nurses or fellow leaders challenge me with a “they” statement as a result of their mounting uneasiness with change, I gently ask them if they can clarify who they mean by "they". And when they respond in a way to suggest that other leaders made a difficult decision or were endorsing a challenging improvement, I gently say, “So I think what you mean by they is me,” followed by a simple description of my work in partnership with their leaders. We’ve now shifted from they, or even me, to “we.” Though it isn’t always a decision or change for me to own, in most cases, the trusting relationships with the leaders who have made the decisions are. It is in these moments that leaders also see the power of removing “they” from their dialogue. This shift creates sustainable improvements, one relationship at a time.

To immerse yourself in this thinking, consider a recent time and a specific issue in which you used a they statement, perhaps to assign ownership to others or attribute a failed initiative elsewhere. Now consider how you would feel about that problem if you replaced the pronoun they with we and were truly responsible for it. For me, the idea that these problems or lack of momentum represented me and my ability to influence change shifted my thinking into a new level of strategic leadership.

Building collaborative relationships as mentioned above is not often easy, as sometimes, our ability to share perspective with other leaders is minimal. To accomplish this, here is your step-by-step guide that can bring forth new levels of ownership and improvement for you and those around you: 

  1. Name an improvement that has not gained any traction or has failed. Or, name a department that is pivotal to the overall PX success of your organization.
  2. Make a list of key leaders and/or stakeholders who are essential to that improvement or department.
  3. Identify 2-3 ways that you can build a relationship with those leaders and influence improvement: consider setting a bi-weekly meeting for coffee so you can hear their perspective and challenges, offer to come to a departmental meeting to lend support, or invite them to lunch while naming that you recognize the duress they are under.
  4. Use those efforts of building a relationship with that person to turn "they" statements into we dialogue whenever possible, naming yourself and the other stakeholder as key collaborators in this improvement.

As a PX leader, I care deeply about the improvements that happen within organizations to promote the most compassionate care. And as PX leaders, each of us has a commitment to not only empathy, but strategy, achieved through intense collaboration. Our roles often require us to own and disrupt an environment in order to create the best experience, even when uncertainty or apprehension pervades. And if we are feeling trepidation about facets of a change, we can be certain that the leaders responsible are as well. When you replace they with we, you have doubled your ability to shift an organizational culture.

Greta Rosler MSN RN NEA-BC CPXP is a health care leader and patient experience optimist who is passionate about influencing organizational change and supporting leaders to implement best practice experience improvements. Greta has worked for the Geisinger Health System as a patient experience leader and currently works for the Academy of Communication in Healthcare supporting relationship-centered communication programs in organizations across the U.S.A.

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The Benefit of Purposeful Hourly Rounding

Posted By Brian Bustoz and Alicia Hernandez, Thursday, April 25, 2019

One day during a leadership round at Harris Health System’s Lyndon B. Johnson Hospital in Houston, Texas; I visited with a patient and asked if her nurse or patient care assistant was visiting her every hour.

The patient seemed a bit confused with the question. She then responded, “Well if you mean is someone checking on me, I guess so.” The patient explained that during a visit with her pastor, “Someone popped their head in and asked me, ‘Baby are you ok?’ and then walked out.”

The patient’s pastor asked her if she knew the individual who had just appeared. When the patient said, “no,” the pastor became concerned for the patient’s safety.

An Aha Moment

When this story was shared with nursing leadership it was apparent that our nursing hourly rounding needed improvement. This began our journey to master purposeful hourly rounding (PHR) on all units. We began with a pilot program on a medical surgical unit. The patient satisfaction project manager collaborated with nursing leadership to create a purposeful rounding program that would help improve efficiency, decrease nurse fatigue, and also improve the patient experience.

Since the introduction of the PHR program in the summer of 2018, our nursing units have seen an increase in their Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) measure of “Responsiveness of Hospital Staff.” In fact, there has been a significant decrease in patients using the call light system and now a typical comment from patients is, “I never have to use the call light because someone is always checking on me!”

An Evidence-Based Approach

Nurses always want to meet the demands of their patients and deliver high quality exceptional care. However, their list of required daily tasks can present a real challenge. In 2012, a study conducted by Stimpfel, Sloane, and Aiken associated a correlation to nurses who work shifts of 10 hours or more with a higher level of burnout and patient dissatisfaction. The impact of those long work hours can result in increased fatigue and a focused effort should be spent on strategies to maximize efficient use of time by providing clustered care and purposeful rounding (Kelley, 2017).

Our Recipe for Successful Purposeful Hourly Rounding: The Six P's

During hourly rounds with patients, our nursing and support staff ask about the standard 5 Ps: potty, pain, position, possessions and peaceful environment. When our team members ask about these five areas, it gives them the opportunity to proactively address the most common patient needs. A sixth P was recently added as a reminder to look around and “pick up” any trash near the patient’s bed or bedside tray. We found that the six Ps have been influential in helping us improve the HCAHPS dimension scores for Quietness and Cleanliness.

Practice of Presence

The unstated, but most powerful, “P” used by the nursing staff is presence. Before our nurses enter a room, they are told to to pause to take a minute to clear their mind and focus their attention solely on the patient. This allows them to use their time with their patients more effectively and the patients receive full attention. The art of presence enhances the nurse-patient interaction and draws on a model of true patient-centered caring (Sutterfield & Stern, 2002).

A Continuous Effort

Our nursing team rounds on patients every hour during the day and every two hours at night. The Responder 5 Nurse Call system is used and features a green, yellow, or red light in the hallway outside a patient’s room. The green light defines an hourly round has been completed within the hour, yellow identifies the round occurred within the last 45 minutes, and a red light appears if the patient has not been rounded on in over an hour. With an update to the call system and a change in the rounding process this has been influential in helping to ensure rounding is effective. In addition, the health unit coordinator on each unit is also a partner in this and makes an announcement at the top of each hour as a reminder for nurses to complete their hourly rounds.

Benefits

In the short time since the implementation of purposeful hourly rounding, we have seen improvement in the majority of the HCAHPS dimensions scores. Many of the patient care units have met or exceeded the goal—and most importantly, they sustained it. Percentile rankings have also increased. In fact, some units have reached the 82nd percentile, while others have reached up to the 99th percentile. Alicia Hernandez, administrative director of nursing, Acute Care, states, “Our purposeful hourly rounding program combines great communication skills with a few simple, but very impactful actions that greatly improve the patient experience.”

1. Kelley, C. (2017). Time management strategies: purposeful rounding and clustering care. MedSurg Nursing, 26(1).
2. Stimpfel, A., Sloane, D., Aiken, L., & Stimpfel, A. (2012). The longer the shifts for hospital nurses, the higher the levels of burnout and patient dissatisfaction. Health Affairs (Project Hope), 31(11), 2501–2509. https://doi.org/10.1377/hlthaff.2011.1377
3. Sutterfield, R., & Stern, L. (2002). Nursing Presence. The American Journal of Nursing, 102(12), 13–13.

Brian Bustoz, serves as the project manager of patient satisfaction at Harris Health System’s LBJ Hospital. In this role, he works as a patient experience consultant and strategic partner to executive, nursing, operational, and physician leadership teams. His focus is to be a strong advocate in helping to enhance the patient experience by utilizing resources for all hospital and clinic services which will support attaining and sustaining performance goals.

 

Alicia Hernandez, MSN, RN, serves as the administrative director of nursing, acute care services at Harris Health System’s LBJ Hospital. She has more than 20 years of nursing experience in operations, education, and nursing administration. She has also previously served in a role as a nurse consultant for international countries focusing on improving healthcare globally. Alicia has played a strategic key role in role in LBJ Hospital’s progress toward the goal for magnet status.

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Leveraging Technology and Innovation to Improve the Patient Experience

Posted By Taylor Carol, Monday, April 22, 2019
Updated: Wednesday, April 24, 2019

I was given two weeks left to live after being diagnosed with a rare form of cancer. I had just turned 11 years old. After spending the next five years in a hospital, six months of which were spent in an isolation unit, my doctors finally delivered the news - the cancer was gone. Several years later I was fortunate enough to graduate from Harvard University, but my passion for improving the lives of hospital patients never faltered.

To say that my time spent in solitary confinement was difficult would be an understatement, but it caused me to realize the critical role that distraction therapy and social interaction play in treatment and recovery. Thankfully, my family was able to provide me with a laptop, textbooks, gaming consoles, and tutors during my time in the hospital, but many of my peers were relegated to 10+ hours of basic cable television per day. The social isolation and lack of accessible stimulating content in that environment have a detrimental impact on both the mental and physical recovery process.

According to a research study done by Johns Hopkins University, patients exposed to distraction therapy, in the form of nature scenes and relaxing music, experienced significantly less pain during their treatment process than those who were not. I observed a similar trend during my visits to over 20,000 hospital rooms with GameChanger Charity, a non-profit organization I built to support pediatric patients. Hospital patients who were able to consume engaging content reported pain scores that were as many as six points lower than average on a 10-point scale. When patients are experiencing less perceived pain they require less pain medication and less attention from the hospital staff.

Furthermore, focusing on distraction therapy and other methods of engaging patients also impacts patient satisfaction. This became clear after Georgia Health Sciences Medical Center implemented patient and family engagement strategies and saw an increase in patient satisfaction scores from the 10th to the 95th percentile. When patient satisfaction scores go up, hospital revenue tends to follow. According to NRC Health, while reimbursement can play a role in improving hospitals’ bottom lines, the real value is found in enhancing patient experience to increase customer loyalty. Estimates place the lifetime value of a patient at $1.4M and when patients have a bad experience and choose to go elsewhere, that money goes to competitors and negative reviews follow. On average, over 32% of people who visit a hospital website say reviews are the most important thing on the site. The Advisory Board Company states that a 10% increase in patient loyalty generates roughly $22M in revenue for the average hospital.

After realizing, through experience and extensive research, the significant impact that content, distraction therapy, and patient engagement strategies can have on patients, I sought out innovative and cost effective solutions for hospitals to empower their patients. For example, hospitals can leverage live streaming technology to interact with patients who are confined to their rooms and create a sense of community by allowing patients to communicate with each other during broadcasted events such as yoga, bingo, or art classes. Also, hospitals can decrease hardware expenses by utilizing cloud services to deliver content via a “bring-your-own-device” model that reduces reliance on TV monitors, server racks, and gaming systems. Finally, introducing educational and academic content to hospital patients can encourage them to focus on post-hospital life and allow them to leave the hospital with new intellectual pursuits. I am continually focused on increasing patient satisfaction, improving clinical outcomes, and decreasing hospital infrastructure costs and I welcome any and all opportunities to share my experiences with healthcare providers.

Takeaways for Healthcare Providers:

  1. Live streaming hospital events and experiences increases participation and accessibility, while furthering the sense of community amongst patients.
  2. Leveraging cloud-based and OTT content delivery through a “bring-your-own-device” model reduces hardware and infrastructure costs.
  3. Entertaining and relaxing content can be a quality source of distraction therapy, but educational and academic content allows patients to leave the hospital with newfound intellectual passions.

During his five-year battle with a -then- terminal cancer diagnosis, Taylor Carol witnessed the immense impact that video games and entertainment technology had on patients’ lives. Inspired, he resolved to build a company committed to leveraging live streaming, technology, and innovation to empower patients. Taylor founded ZOTT: a cloud-based content distribution platform designed to revolutionize the patient experience within hospitals while decreasing infrastructure costs. The ZOTT team is thrilled to reimagine the ways technology can be integrated into healthcare and change patients’ lives forever.

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Does Your Patient Experience Encompass All Patients?

Posted By Barb Davis, Monday, March 25, 2019

In January 2017 I received a call from my doctor’s office to schedule a routine check-up. I told the scheduler that I had recently experienced a life-altering event that prevented me from putting weight on my leg. She responded, “The doctor wants to see you.” I took a deep breath and planned out my visit, realizing I would have to use a wheelchair to get there.

This, then, is my story of seeing the world through the eyes of a wheelchair user and my realization that we in healthcare can do a better job of seeing the patient experience through a different lens.

From the moment I exited the car, I experienced barriers and challenges:

  • A gas guzzling car was idling in front of the ramp, blocking my ability to wheel up it.
  • Although I had other options, I automatically went to the registration kiosk which I have used many times for check-in. Although great when I was standing, it was impossible for me in a wheelchair. The screen was too high and I couldn’t see my selection options.
  • Getting into a busy elevator was another humbling experience. Before sitting in a wheelchair in an elevator, I had not realized how invisible a wheelchair-bound person is in a crowded space
  • The exam room was too small to accommodate a wheelchair, requiring the Medical Assistant to remove furniture, rearrange the exam table, and adjust the computer monitor.
  • When I told my physician about the scheduler’s insistence to see him, said: “oh, we could have put this off.”

Throughout my life, I have been fortunate to have not experienced any challenges with mobility. Although sensitive to the ADA and a proponent of individual rights in hospitals, I had not personally experienced what it is like to not be able to hear others speak,to see my pathway, or to able to walk to the next room. Throughout my work in patient experience, I realized that my organizations had not fully incorporated the needs of all types of patients in its design.

In hindsight, I wish my team and I had taken more time to see the barriers that different patients may experience. When we evaluate signage, could we have taken a more holistic approach? When implementing a new process, did we explore how it may impact different types of patients?

Once mobile, I recommended that the office undertake an “access” walk-through. They could ask people to assume roles in which one person would be in a wheelchair, another would be blindfolded and another had their hearing obstructed. In this challenge, the mock-patients travel from the parking lot to the diagnostic appointment and back again. The team would do a de-brief to identify the barriers and opportunities and discuss their observations on how the organization accommodates patients and family members with visual, auditory and physical challenges.

I urge you to consider how your organization addresses the challenges and opportunities of meeting patients and families where they are--in wheelchairs, unable to read signs, or unable to hear audible clues, or the variety of other differences that could alter their visit. We must consider these challenges in our important work to improve the experience of all patients.

Barb Davis has over 30 years of health care experience in quality, safety and patient experience. She currently works for CipherHealth as VP, Clinical Services.

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Providing an Exceptional Patient Experience Starts on the Phone

Posted By Sarah Suddreth, Monday, March 25, 2019
Updated: Tuesday, March 19, 2019

In just a few years, 89% of organizations will earn or lose business based on customer experience.1 Delivering exceptional patient experience is not optional and begins with a patient's first interaction with your health system. While demand for online booking options is on the incline, the phone is still the preferred first touch point for many patients.2 However, the most significant root cause of poor service is callers having to repeat themselves and being trapped in automated self-service. If the caller is routed incorrectly, sent to hold, treated rudely or not adequately helped, that can poorly affect his or her perception of the care they’ll receive. In many health systems, staffing challenges and inefficient phone processes are just two contributing factors to an overall poor first impression.

Let’s consider the following scenario: A patient calls your health system to book an appointment with a dermatologist. After reaching an operator, she is sent to another operator who immediately places her on hold for “just a moment.” More than three minutes pass, and she becomes increasingly impatient. The call reconnects with someone new, and she hears an abrupt “Hello?” and instantly feels her pre-existing anxiety grow for the anticipated consult. After providing specific details about what she’s looking for, she hesitantly asks to schedule an appointment, but wonders what kind of care she’ll receive if she arrives.

Even though the patient committed to an appointment, your office now faces an uphill battle to overcome the patient’s poor experience from that initial phone call. In fact, it takes 12 positive customer experiences to make up for one negative experience.3 This is just an example of one patient’s call journey. Poor routing, sending patients through loops or blindly to voicemail and untrained staff handling the phone decrease the likelihood of booking a happy patient. Here are two essential steps to improve patient phone experience and your staff’s ability to schedule.

Step One: Create a patient-centric mindset

Since a phone call is usually a new patient’s first interaction with your healthcare system, staff who handle phone calls should be prepared to confidently and knowledgeably answer questions and collect necessary information. In almost all cases, enhancing the skills and demeanor of your phone handlers is the first issue to tackle, because when staff doesn’t properly execute on every phone call, appointment conversions are directly impacted.

Coach them how to best handle scheduling conversations so new patients are fully helped. Phone handlers’ tone must also reflect the brand – so make sure they answer with a friendly hello, state their name and the health system’s name, and ask “How can I help you?” Hold them accountable and provide a suggested phone script to create consistency with patient conversations. With proper usage, it conveys professional and clear communication which puts patients at ease and strengthens provider-patient care.

Finally, make sure schedulers are inviting every new patient in to see a provider on the phone call. Our data shows that 90% of the time, the caller will say yes to scheduling if an appointment is extended. Once an appointment time is established and agreed upon, your staff should then set expectations for the visit by letting patients know the expected wait time, parking information and directions, and which documents and paperwork they will be asked to provide upon arrival.

Step Two: Evaluate your processes & simplify

Beyond just phone handling, understanding where callers are originating from and where they should go is extremely valuable to eliminating phone call transfers and hold times. The number one reason for caller dissatisfaction is waiting too long on hold.4 This means acquiring a detailed analysis of phone numbers dialed by patients, evaluating caller flow, and tracking ongoing trends are necessary to maximize call routing.

Evaluate the structure of your call flow and caller trends. Are there certain times of day or days of the week when call volume increases, total hold times are up, or callers are transferred more than once?

Leverage caller trends and call volume data to make staffing decisions and provide feedback on how to transfer callers. Optimize your FTEs (full-time employees) and strategically stagger schedules at identified peak hours and challenging times for getting patients quickly connected to someone who can help.

In the instance when transfers need to occur, there should be a clear process in place. Encourage a warm transfer process to avoid callers being blindly transferred to voicemail. Phone handlers should check the availability of the intended party before transferring the caller, so no patient is sent to voicemail unless specifically requested.

A proper phone configuration for efficient routing reduces hold time and increases the likelihood of scheduling a happy patient.

Long-Term Success

An exceptional phone experience can set you up for long-term success. The patient remembers the interaction with the exceptionally friendly and helpful phone handler he or she talked with. Before arriving, the patient feels prepared and is confident in the care you will provide. These two simple steps can positively improve your callers’ journey and build your reputation as a valued healthcare provider.

1. https://blog.sprinklr.com/big-list-customer-experience-statistics/
2. https://technologyadvice.com/blog/healthcare/study-patient-portal-communication-2014/
3. 
https://www.slideshare.net/MathewSweezey/the-future-of-marketing-2016-new-roles-tools-and-trends/35-It_takes_Understanding_Customers_by
4. "Consumer Survey Reveals the Customer Care Experiences That Most Impact the Relationship Between Cable Operator and Subscriber.” CSJ International Press Release. May 12, 2010.

Sarah Suddreth is a proud member of The Beryl Institute and Director of Business Development at Call Box, the leading telephony and artificial intelligence technology firm that works with health systems and providers to present more insight into their phone calls. Healthcare providers turn to Call Box when both internal and external patient experience issues continue to arise over the phone. Living in Dallas, Sarah works with healthcare executives across the nation to enhance Patient Access and Experience standards for patient interactions over the phone.

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How Personal Music Is Transforming the Patient Experience

Posted By Dan Cohen, Friday, February 22, 2019
Updated: Sunday, February 10, 2019

If a new drug was discovered that alleviated symptoms for people living with dementia, a pill that helped them to feel joyful and able to communicate again, why wouldn’t we rush to make it available to every person in our care? All the more so if that same medication reduced falls, delirium, and pain; if it improved post-surgical and rehab outcomes; and if it reduced reliance on antipsychotic medications.

Believe it or not, those outcomes are happening today in the largest public hospital systems in the U.S. and Australia. But no miracle pill is involved. Rather, the effective intervention of personal music, used according to evidence-based best practices, is proving how personalized playlists offer an effective, side-effect-free, non-pharmacological approach to improving the patient experience.

When I first started providing music, it was based on a hunch that re-connecting people with their favorite music would provide enjoyment and comfort. I didn't expect them to "light up" quite as much as they did. Whenever any of my friends or family members were hospitalized, I would offer to bring them their music. One 91 year-old friend was admitted to the hospital to address chest pains, so within 24 hours I dropped off an MP3 loaded with his favorite big band tunes. On day 3, when I entered his room, he was out of bed with his headphones on dancing to the music with a big grin on his face. Until he passed away two years later, he'd always refer to the "great time" he had in the hospital.

Little did I know that personalized music would become a standard of care. For example, hemodialysis, spinal cord injury, surgical intensive care, ventilator units all use M&M to improve the patient experience, according to Sui Unzelman DNP, RN, VHA-CM, Nurse Educator, South Texas Veterans Healthcare System, Audie L. Murphy VA Hospital. One patient's family, upon the passing of their loved one who listened to their favorite music, commented, "so grateful he was listening to music in his final moments, rather than listen to the hospital noise."

Observations about the power of personal music are backed by extensive research. Recent studies include:

  • In Scottsdale, Arizona, Dr. Kari Johnson, PhD, RN, with HonorHealth, examined the connection between listening to favorite music and delirium prevention in hospital trauma ICU settings. Her controlled study found that patients in the music intervention group experienced a statistically significant reduction in physiological measures of anxiety, a major factor in delirium onset.

  • The University of California-Davis School of Nursing is about to release results of the most comprehensive research to date involving the use of personalized playlist for 4,100 residents across 300 California nursing homes. Results reflect Music & Memory’s impact as a relatively low cost, non-pharmacological intervention that has a significant positive impact on elders with some form of dementia, behavior or mood issue. The report documents both a clinically and statistically significant reductions in aggressive behaviors, reliance on antipsychotic, anti-anxiety, and antidepressant drugs, as well as reductions in pain and falls.

  • Researchers at University of Utah Health in Salt Lake City used brain imaging to demonstrate that familiar music may facilitate attention, reward and motivation, which in turn makes it more possible to manage emotional distress for people with dementia.

  • A pilot study published in conjunction with Stephen Post, PhD, of Stony Brook University Hospital indicates that listening to personal music favorites improves swallowing in individuals with advanced dementia, making eating easier and potentially diminishing reliance on feeding tubes.

I'm so pleased that not only Music & Memory will be present at the Patient Experience Conference as the charity partner, but also that we'll be hosting a special screening of the Sundance audience-award winning documentary, Alive Inside: The Story of Music & Memory, Wednesday evening of the conference. Out of 4,000 US documentaries submitted to Sundance in 2014, the 50,000 attendees to the Park City, Utah festival voted "Alive Inside" their favorite.

Music & Memory is honored to be selected as The Beryl Institute Patient Experience Conference 2019 charity partner. We look forward to meeting you at the film screening or in the PX Collaborative.

Dan Cohen, MSW, is founder and Executive Director of Music & Memory, a nonprofit that promotes the use of personalized music to improve the lives of those in our care. “Alive Inside: A Story of Music & Memory,” a Sundance Audience Award-winning documentary, is its inspirational story. Music & Memory operates in thousands of long-term care communities, hospices, hospitals, and home care organizations internationally (musicandmemory.org).

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Employee Engagement and Leadership Rounding

Posted By Amy Vanderscheuren, MHA, Monday, February 18, 2019
Updated: Tuesday, December 18, 2018

In today’s highly competitive healthcare landscape, where health system leaders are challenged to achieve both clinical and operational excellence, while at the same time providing an exceptional patient experience, cultivating a decidedly engaged workforce has never been more important. Research shows that employee engagement directly impacts an organization’s bottom line: healthcare organizations with an engaged workforce – one that truly cares and consistently puts forth a discretionary effort – have fewer instances of hospital acquired conditions (HACs), better mortality rates, improved patient satisfaction scores and lower rates of turnover and absenteeism1. Inarguably, it behooves healthcare leaders to consciously invest in employee engagement.

Leadership Rounding, a structured activity, whereby executive, nurse and/or department leaders intentionally and purposefully engage with staff (and patients!) to collect firsthand, actionable insights, is an important and effective strategy for cultivating and improving employee engagement. A proven technique for connecting with staff in a meaningful way, informing leaders across the organization about patient care and other work-related challenges and highlighting the extraordinary work performed by frontline staff and managers, Leadership Rounding has the potential to transform an organization.

The benefits of Leadership Rounding for an organization are many: improved clinical outcomes and patient experience; higher rates of employee satisfaction and loyalty; ability to attract and retain talent; a recognized culture of continuous improvement; and increased employee engagement (which differs from employee satisfaction). Following are four ways Leadership Rounding directly contributes to cultivating and improving employee engagement.

  • Build trust and accountability
    Some estimates suggest that managers are responsible for 60% of all the reasons people quit their jobs, which is one reason manager-employee relationships are so important2. Leadership Rounding demonstrates that leaders care about their employees as people and shows employees that their leaders are interested in day-to-day operations and quality of work performed. Further, Leadership Rounding gives employees a voice, allowing them to share ideas about what is going well in their workspaces, what tools they may need to be more productive, and what they are most proud of at work – important aspects of forging relationships that are grounded in trust and accountability.
  • Improve communication
    Leadership Rounding enables two-way communication between leaders and staff and serves as a platform for collecting information and then closing the feedback loop. During these rounds, leaders have an opportunity to enforce key strategic messages, explain decision-making processes, correct misinformation, and note key behaviors. At the same time, Leadership Rounds also provide a conduit for employees to express their opinions and share their ideas for improvement.
  • Boost morale
    When leaders consistently connect with employees and show genuine interest in and appreciation for their contributions to the organization, staff (and leaders alike!) are energized and motivated to excel. Leadership rounding presents a level playing field, where leaders and employees can connect over their shared purpose: achieving the organization’s mission.
  • Recognize staff
    According to Dale Carnegie: “Nothing else so inspires and heartens people as words of appreciation.” And he’s right. One of the most powerful benefits of leadership rounding, particularly in relation to improving staff engagement, is identifying and publicly acknowledging employees who deserve recognition. Recognizing and appreciating employees for their good work confirms their work is valued by others, which leads to higher rates of job satisfaction and increased productivity (a happy worker is as much as 12% more productive than his unhappy counterpart!3). The value of employee recognition cannot be underestimated.

Leadership Rounding is a proven, best-practice strategy to collect vital information, reward and recognize, build relationships and validate key behaviors. Ultimately, leader rounds improve engagement levels for all stakeholders, leaders and employees alike!

Sources:

1. Kruse, Kevin (2015). The ROI of employee engagement in hospitals. Forbes. Retrieved from: https://www.forbes.com/sites/kevinkruse/2015/02/26/the-roi-of-employee-engagement-in-hospitals/#6642044554ce
2. Schwantes, Marcel (2017). Why do employees really quit their jobs? Research says it comes down to these top 8 reasons. Inc. Retrieved from: https://www.inc.com/why-do-employees-really-quit-their-jobs-research-says-it-comes-down-to-these-top-8-reasons.html
3. Craig, William (2017). 3 reasons why employee recognition will always matter. Forbes. Retrieved from: https://www.forbes.com/sites/williamcraig/2017/07/17/3-reasons-why-employee-recognition-will-always-matter/#315c68463c93

Amy Vanderscheuren, MHA is a Performance Improvement Coach for TruthPoint. She has been partnering with clinical and administrative leaders, frontline staff, and patients and families to improve clinical outcomes, the quality and safety of healthcare, and the patient experience for more than a decade.

Tags:  accountability  communication  morale  relationships  rounding  trust 

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Impacting Service Culture When You're the New Kid on the Block

Posted By Nicole L. Cable, CPXP, Monday, January 28, 2019
Updated: Thursday, January 24, 2019

Service culture is defined as "organizational culture where there is a collective way employee think about providing outstanding service, act to provide it and understand how and why they do it" (Toister, 2017). Simply put every employee in your organization lives and breaths customer service. You may be wondering how do I create an environment in which service is a part of the DNA. You must first start with your employees.

In a modern healthcare context characterized by inclinations towards human-centered care, institutions have to pay attention to culture to meet their service excellence objectives. Author Simon Sinek captures the importance of culture in service excellence, observing that “customers will never love a company until the employees love it first.” Within such a reality of practice today, new employees or leaders also have to concern themselves with culture. Beyond just possessing the most proficient skills and qualifications in one’s field, I strongly believe that how one interacts with his or her new colleagues and the new workplace may determine success. New employees find themselves in not only a strategic position to influence culture, but also a sensitive situation in which the wrong approach could backfire. As a result, attaining the right balance between understanding the new place and introducing fresh ideas is pertinent.

The very first step through which the new kid on the block can influence culture is through leveraging universally desirable traits and qualities. These refer to attractive characteristics that would prove desirable across all settings of practice, pertaining to both people skills and being great at one’s role. It would be a mistake to imagine that one can impact culture positively when one’s new colleagues already feel that he or she is the weak link. As a result, consummate technical performance and exceptional people skills in aspects such as communication and teamwork provide a strong base upon which to win trust and establish professional camaraderie that then place one in a position to impact culture desirably.

It would also be foolhardy to attempt inspiring culture change before understanding the new organization’s existing culture, values, beliefs, vision, and other key aspects. The quickest way to lose favor and genuine attention is through being a smarty-pants who assumes the high ground and deems all pre-existing aspects of culture inferior. As a result, through employing discernment and mindfulness, one has to take his time to understand the organization and its people, ethos, and strategic direction, as well as the rationales behind different elements of culture. Such a respectful demeanor would provide a good base from which to then impact culture, whereas a dismissive or scornful attitude would have the opposite effect, especially considering the new employee may still not be part of the in-group.

The third step then concerns how to actually impact culture, having established the right workplace relationships and understood the organization. The work already done ensures that the ideas proposed on improving culture, however novel, build on the organization’s strengths and opportunities, which maximizes chances of success. Offering evidence of efficacy and positive outcomes on the shared goal of excellent service delivery, either through citing examples or best practice standards, provides a way through which to convince the executive leadership, change agents, and colleagues on the new ideas. At the same time, being the new kid on the block, one may need to champion a piecemeal, iterative approach that helps provide direct evidence of success while also ensuring organizational learning. Such an approach would foster the permeation of the new values or practices within the organization. Ultimately, to impact culture as a new leader, one has to convince others that he or she shares in the overarching organizational service delivery goals, and that his or her ideas serve such goals.

References:
Delight at Work article. http://www.delightatwork.com/delight-at-work/customers-will-never-love-a-company-until-the-employees-love-it-first Toister, J. (2017). The Service culture handbook: A step-by-step guide to getting your employers obsessed with customer service. Toister Performance Solutions.

Nicole Cable is currently the Chief Experience Officer at InnovaCare Health – a company offering population health management services by creating and implementing innovative solutions for value-based healthcare.

Nicole has been a strong advocate of patient experience in healthcare. She has played a pivotal role in designing patient experience practices as a panelist and keynote speaker at several healthcare forums and conferences.

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Managing Multiple Chronic Conditions During Care Transitions of Older Adults

Posted By Chantal Backman INF./RN, MHA, PhD, Monday, December 10, 2018
Updated: Friday, December 7, 2018

Older adults with multiple chronic conditions typically have more complex care needs that require multiple transitions between healthcare settings. Poor care transitions often lead to fragmentation in care, decreased quality of care, and increased adverse events. Emerging research recommends the strong need to engage patients and families to improve the quality of their care. However, there are gaps in evidence on the most effective approaches for fully engaging patients and families in their transitional care.

As part of The Beryl Institute’s 2015 Patient Experience Grant Program, our organization looked to use participatory visual narrative methods to explore older adults’ experiences of managing multiple chronic conditions during care transitions. By engaging older adults with multiple chronic conditions and their family members in the detailed exploration of their experiences during transitions across health care settings, we hoped to identify potential areas for future interventions.

Based on the study results, three areas for improvement specific to older adults managing chronic conditions during care transitions emerged:

  1. Strengthening support for person- and family-centered integrated care
    Older adults and families in our study described the nurse as the central hub that links them to healthcare providers and community resources. In addition to the medical needs of this population, it was clear that appropriate assessment and mechanisms to support patients in the broader context of health, which includes economic, access, and social issues/barriers are needed. Older adults and families often do not know who to contact to obtain support. As one participant mentioned, the care is often focused on the medical issue, and thus providing a very “siloed” system. One consideration to facilitate better integration is assigning a primary provider as the central hub to be the link during the patient’s transitions across the health care system. Previous studies show that such system navigator roles have reduced readmissions to the hospital and return visits to the emergency department.

  2. Engaging older adults and families in their care management and care transitions in meaningful ways
    Our study indicated that older adults and family members who were actively involved in their care were better able to navigate their journey through the health care system. This is consistent with other studies. Emerging research is focused on further engaging patients and families in their care. Further work is needed to develop personalized care which provides individualized access to relevant resources in order to better manage not only single but also multiple chronic conditions. One promising option would be to explore the use of technology to provide a personalized care plan approach to ensure safe, effective and person- and family-centered care transitions. The development of new technologies for personalized care could potentially help to facilitate and to manage multiple chronic conditions while navigating our complex healthcare system, thereby better empowering the patient and their families.

  3. Providing adequate support/resources for family members and informal caregivers
    It is clear from this research and from other studies that family members and informal caregivers take an active role in helping patients during their care transition experiences. Further resources are needed to better support family members who play an active role in care. However, it is also important to assess a patient’s social context to determine if further support is needed, and whether or not there is the presence of informal caregivers and family members who can help to support the patient.

Our study reinforced the importance of active involvement in managing care transitions, positive experiences during care transitions, accessing community services and resources, challenges with follow-up care, lack of meaningful engagement during discharge planning as well as the presence of systemic barriers in care transitions. The results contribute to our understanding that person- and family-centered care transitions should focus on the need for active involvement of older adults and their families in managing care transitions.

To learn more about the study methodology and findings, visit: https://bmchealthservres.biomedcentral.com/articles/10.1186/s12913-018-3292-6

Dr. Chantal Backman RN, MHA, PhD is an Assistant Professor at the School of Nursing at University of Ottawa in Ottawa, Ontario, Canada

Tags:  care transition  chronic  engage  grant program  integrated care  support 

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