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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, please contact us at info@theberylinstitute.org.

 

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Sacred Ground

Posted By Dr. Bryan K. Williams, Friday, January 22, 2016
Updated: Thursday, January 21, 2016

There are certain places in this world that I truly consider to be sacred. One of those places is a healthcare facility. Whether it is called a hospital, doctor’s office, nursing home, or hospice is irrelevant. In that moment, when someone needs to be cared for and healed, it is a sacred one. One that healthcare providers should never take for granted.

As a patient, I am annoyed that I don’t feel well, and I’m even more annoyed that I have to go visit a healthcare provider. My schedule has been disrupted. I have anxiety about the diagnosis. I might even have more anxiety about how much the medication will cost. The one thing I don’t need, however, is to feel like I am a bother to those I am seeking help from. The healing truly begins way before patients actually meet the provider. It begins with the warm smile from the person at the registration/admissions desk. Or perhaps it begins with whoever answers the phone when the patient calls seeking answers.

Recently, I was facilitating a training session at a healthcare organization. The attendees were comprised of senior and mid-level leaders. Towards the end of the session, one leader asked me, "Under what circumstances should the leader not tolerate negativity from the staff?” At first, I thought the leader meant it as a rhetorical question, but then I realized that she was completely serious. In fact, as I looked around the room, EVERY leader was leaning forward and eagerly awaiting a response. I realized that it was a much more common issue than I previously thought.

After thinking for a moment, I told her that no negativity should be tolerated. Ever. In fact, the healthcare environment is sacred ground, and it should be considered sacred in every way. Especially by those who work there. On the way home, that leader’s question lingered in my mind. Early the next morning, I wrote the following:

Sacred Ground

This is where healing takes place.
This is where caring takes place.
This is where the ultimate expression of hospitality takes place.
Everything I say and do should declare that "I see you...I honor you...and you have unconditional worthiness".
Let there be no gossip.
Let there be no negativity.
Let us only lift each other up, as we lift up those we take care of.
Let us be grateful that there are people who entrust us with their health.
People who need us and depend on us.
May we never take that for granted or grow complacent.
This ground is not sacred because of my degrees, or certifications, or expertise.
It is sacred because "caring" happens here. Healing happens here. Love happens here.
From this day forward, I will consistently put the "care" in healthcare, as I care for my patients, care for my colleagues, and care for myself.
As long as I have breath, I will do everything I can to keep this ground sacred.
-Bryan K. Williams

 


Dr. Bryan K. Williams is a keynote speaker, consultant, and author who champions service excellence and organizational effectiveness. His clients include Baldrige-winning hospitals, award-winning school systems, and Forbes 5-Star Luxury Hotels worldwide. Bryan’s passion is to serve others so they may better serve the world.

Tags:  culture  Leadership  patient advocacy  patient engagement 

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Navigating the Path Ahead: A Roadmap for Patient and Family Engagement

Posted By Ushma A. Patel, MSPH, Thursday, November 12, 2015

To patients. For patients. With patients. This is how the healthcare system has evolved in how we interact with and engage patients and families in their care. As a healthcare researcher, I was always drawn to the patient and family engagement field. However it wasn’t until recently that my passion for improving the healthcare system deepened. In 2014, I survived preeclampsia, HELLP syndrome and a subarachnoid brain hemorrhage after my daughter’s birth. Luckily I am doing just fine now, but my daughter went on to face multiple health challenges, including open heart surgery at 7 months, eye surgery at 15 months and a suspected genetic condition that will have lifelong implications. As a mom and patient advocate, I know firsthand how important it is to stay engaged with her providers and healthcare – not just for improving her health but also for other children who may face similar battles.

There are many perspectives of what patient and family engagement is, and despite the variations, I think we can all agree that it is critical. The more important question is exactly how we engage patients and families in meaningful ways.

Based on Carman et. al’s Framework for Patient and Family Engagement, the American Institutes for Research developed the Roadmap for Patient and Family Engagement in Healthcare Practice and Research with funding from the Gordon and Betty Moore Foundation. The Roadmap reflects collective input from over 70 stakeholders who represented a variety of perspectives - clinicians, healthcare leaders, patients, families, insurers, payers, and researchers. It includes a vision for patient and family engagement in healthcare, and 8 change strategies to drive action towards increased patient and family engagement: 

  1. Patient and Family Preparation. Educate, prepare and empower patients and families to engage effectively in their health and healthcare 
  2. Clinician and Leadership Preparation. Educate, prepare and empower clinicians and healthcare leaders to partner effectively with patients and families
  3. Care and System Redesign. Redesign care to support partnerships between patients, families, and the healthcare team
  4. Organizational Partnership. Redesign healthcare organizations to make patients and families part of the governance structure
  5. Measurement and Research. Create measures and conduct research to improve care, facilitate changes, and understand outcomes
  6. Transparency and Accountability. Make data and information transparent to promote accountability and enable action
  7. Legislation and Regulation. Encourage patient and family engagement through regulation and legislation
  8. Partnership in Public Policy. Identify and provide opportunities to integrate patient and family perspectives into public policy

These change strategies occur across the 3 levels of engagement – (1) direct care, (2) organizational design and governance, and (3) policy. Within each of these 3 levels, there are opportunities for engagement across a continuum, ranging from consultation to partnership and shared leadership. At the consultation end of the continuum, patients are involved but have limited power and decision-making authority. At the partnership and shared leadership end of the continuum, patients have shared power and responsibility and are active partners in defining agendas, co-creating materials, contributing information, and making decisions. And it’s at this end of the continuum where there’s an opportunity for real change to occur.

Adopting these change strategies can take time, and therefore, the Roadmap also includes 5 simple actions that different stakeholder groups can take immediately such as preparing for their healthcare appointment or inviting patients and family members to share their experience.

There may not be a clear path to how we improve population health and the patient experience or reduce health care costs, but the Roadmap provides a solid starting point to navigate the way. Click here to read more about the Roadmap and Framework.

 

Since 2009, Ushma Patel has worked as a health services researcher at the American Institutes for Research in their Chapel Hill, NC office. Prior to AIR, she worked for the Lewin Group. In her spare time, Ushma is an avid DIY crafter, and also volunteers as a member of the Patient Advisory Council for the Preeclampsia Foundation and for the Duke Pediatric Cardiac Surgery Center.

Tags:  family  measurement  patient  research 

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Universal Children’s Day Reminds Us of Our Impact on Pediatric Patient Experience

Posted By Martie L. Moore, Sunday, November 1, 2015
Updated: Monday, November 2, 2015

"The one thing all children have in common is their rights. Every child has the right to survive and thrive, to be educated, to be free from violence and abuse, to participate and to be heard.”1 - Secretary-General Ban Ki-moon

As a former pediatric nurse and expert witness for child protection services, I’ve spent a lot of time caring for children in the hospital and home setting. I know one of the greatest things I’ve learned is that we as caregivers can empower children during difficult situations. The need to support the wellbeing of children extends beyond healthcare: It is a universal initiative.

Universal Children’s Day on Nov. 20—unlike the traditional Mother’s Day or Father’s Day recognized in the United States— was established by the United Nations General Assembly in 1954. All countries are encouraged to promote not only mutual exchange and understanding among children, but also to initiate action to benefit and uphold the wellbeing of children around the world.

Children in the U.S. may not always face the same frightening conditions as elsewhere in the world. But this day helps us to remember that we as clinicians still have a responsibility to create an atmosphere that supports the children under our care. We know that the less stress and anxiety a child has, the better their ability to cope in a stressful situation. Hospitalization is one of the stressful situations that we can do something about.

Improving patient experience is already a major target for hospitals, and hospitals are measured and paid based on HCAHPS surveys completed by adult patients. In October 2014, the Agency for Healthcare Research and Quality posted a pediatric version of the HCAHPS survey. This pediatric survey is under review this year as a possible benchmark on which to base hospitals’ Medicaid and Children’s Health Insurance Program reimbursements, leading to the expectation that this pediatric HCAHPS survey will ultimately factor into reimbursement as the adult equivalent does now for Medicare.2

Now is the time to be thinking about how to address this special population. The ways you care for children in your facility can go a long way toward producing a positive experience for both the patient and their loved ones.

Make the Hospital A Safe Place for Children

We all know hospitals can be a very scary place for anyone, let alone children. A child doesn’t know what to expect, and is constantly meeting new strangers. He or she may not understand what’s happening to them. They could be experiencing pain from their illness, the treatment, or both.

So how do we make the hospital a place where a child can feel safe, participate, and be heard? You can make a big impact with small changes: Start with what they’re wearing. Pajamas are a great source of comfort, and while the child’s personal pajamas may not be an option, your facility can still stock pediatric gowns that promote comfort and modesty, have kid-friendly prints, and feel soft like the pajamas they may wear at home. Consider pediatric gowns with MRI-safe plastic snaps that negate multiple gown changes.

While using pediatric gowns that evoke the comforts of home, also be sure that a child’s hospital bed is a safe place. Avoid performing any painful treatments while they are in their hospital beds so that it remains a haven that they can trust.

You can also help by communicating directly with your patients. Talk to them, not at or above them, so they understand what is happening. Speak at their level, both intellectually and physically, crouching or sitting down to look them in the eye.

You may even choose to draw pictures to help demonstrate what is going on inside their bodies or a treatment they are about to experience. Many children "play nurse or doctor” at home; offer to let them participate in their care by holding the stethoscope, counting with you for their pulse or heartbeat, or perhaps picking a favorite color for a bandage or cast. Your conversation may also help distract them from their pain. The fun prints on their gown featuring friendly animals or characters could be a conversation starter in itself. Ask them about pets, sports, movies, or their funniest joke. A good belly laugh does wonders for the soul!

Good communication involves good listening. Take the time to hear what a child says to you. You could learn that something as simple as a special toy or a quick trip outside for some fresh air could make him or her feel better.

Listening and observing may also help you uncover any signs of abuse. If you observe these signs, stay calm and report the suspected abuse immediately per your facility protocols.

You Make a Difference

Every day, clinicians make a big difference in the lives of the children they care for. Make yours a good difference. Delivering extraordinary care to our children can change lives, helping them grow up to be healthy and successful adults who can protect the next generation of youth around the world.

Sources
1. Universal Children’s Day. Available at: http://www.un.org/en/events/childrenday/. Accessed October 15, 2015.
2. CMS may use new child HCAHPS to adjust Medicaid hospital pay. Available at: http://www.modernhealthcare.com/article/20150108/NEWS/301089948. Accessed October 15, 2015.

Martie L. Moore is chief nursing officer of Medline Industries, Inc. based in Mundelein, Ill, a leading provider of medical products and clinical solutions across the continuum of care. In this role, Moore provides nursing leadership for solution-driven clinical programs, delivers product development to enhance bedside practice and launches quality initiatives across the continuum of care. With what she learned during the nearly 30 years of clinical experience and extensive executive leadership, Moore now develops forward-thinking solutions and programs for those in the field today.

Tags:  HCAHPS  Hospital  patient experience  patient safety  pediatric 

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Rare Care – The Specialty Pharmacy Patient Experience

Posted By Christopher W. Kennedy, MSM, Tuesday, October 13, 2015

Nearly 7,000 diseases are classified as rare in the United States. These disease states require some of the most cutting-edge and technologically advanced therapeutics. Patients with chronic rare diseases will often require long-term medications throughout their lives. The management of a rare disease requires a multidisciplinary approach to healthcare. Continuity of care is front and center as patients are transitioned from inpatient hospital settings or outpatient clinics to their homes. Many will require frequent treatments, nursing visits, on-going monitoring, medication adherence plans and disease state education.

The Patient Experience drastically changes for patients after they are discharged from traditional care settings. Advancements in the Patient Experience movement within inpatient hospital settings has set an example for specialty and home infusion pharmacies to follow. While some hospitals have found it difficult to determine where their inpatient pharmacies fit into the Patient Experience movement, other leading health systems have fully recognized pharmacy as the medium that crosses all levels of the healthcare continuum.

Regardless of the progress being made in the hospital setting, the Patient Experience has stalled on the doorstep of the specialty and infusion pharmacy industry. This challenge requires organizations to redesign their "customer service” models. Heritage Biologics is a specialty pharmacy providing nationwide infusion and rare therapeutic services. The pharmacy was founded by a rare disease patient who asked a really BIG question: How do we improve care for people like me?

We have established Four Fundamentals that guide the organization’s framework for creating a successful Patient Experience platform:

  • PARTNERSHIP: Customized solutions are designed to ensure the continuity of care between providers and all healthcare stakeholders.
  • COLLABORATION: Insights are captured and shared with healthcare partners to allow for better outcomes management.
  • EXPERIENCE: A new standard in pharmacy patient care is being established with our patient-centered solutions.
  • GUARANTEE: A clearly defined emphasis on placing the patient before the business allows for a commitment to rare care that is unmatched.

The complexities of the evolving healthcare system in the U.S. have posed significant challenges for rare disease patients. Pharmacies must team with healthcare providers, payers and manufacturers to coordinate care efforts. This creates an environment where therapeutic health outcomes become the common denominator for everyone involved. Collaboration is critical for patient healthcare, and we hope other pharmacies will join the Patient Experience movement.

 

Christopher Kennedy is Vice President of Business Development at Heritage Biologics. He has spent the last 14 years as an executive leader and innovator in the healthcare space. His background includes launching several entrepreneurial start-up ventures designed to help advance patient care.

Tags:  collaboration  environment  healthcare  patient experience  pharmacy 

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The Fine Art of Healing

Posted By Bruce W. Heinemann , Thursday, October 1, 2015
Updated: Thursday, October 1, 2015

It’s now been fourteen years since I had surgery for prostate cancer at the very dangerous age of 49. Like all who experience cancer, this period in my life has been a journey of fear, uncertainty, hope, but ultimately a realization of an opportunity that in illness often lies the very seeds of our own healing. But even more importantly an opportunity to heal the greater dimensions of our whole being. Much attention has been given to the concept of Wellness in healthcare in the recent decades. And that concept has been front and center in my consciousness in my years long journey of insight, understanding, and ultimately, transformation.

I have come to understand wellness is a way of living, a way of being. It is a way of understanding ourselves and our place in the world. Above all it is the profoundest realization of the inseparable oneness of mind, body and spirit. To this point I think of how the term "mind/body” connection is currently used in medicine and healing. To me, this very term is in itself highly descriptive of what has long been the perception that there would be a separation of the mind and body in the first place. My experience has taught me that there is no "connection” because there is no separation, all are but one. And as such, from my cancer experience, I have come to firmly believe that the patient experience that produces the best healing outcomes are ultimately rooted in the nurturing of our whole being.

Most illnesses, but cancer particularly, seem to most often illicit the immediate response: "Am I going to die”? I found that working through this fear was key to moving forward into healing. I consider myself most lucky because, as a fine art nature photographer, in my art there was an enormous cathartic opportunity to face this fear with not only courage, but unexpected insight. It has now become an endeavor of mine to share with others those insights and feelings that helped me through that process.

Toward that end, I have developed a series of short multimedia inspirational videos entitled: The Fine Art of Healing. Also as a musician who has throughout my career presented my images with music and words in concert, I am keenly aware of the profound power of these three components of our sensory awareness when experienced in consort. In my first video, Imagination Inspired, I encourage the patient to imagine their life beyond today and into a future healed, to understand that what we can imagine already exists. We need not assume that what we experience today is what we must experience tomorrow.

In the second video: Love and Gratitude Are The Fairest Blossoms Which Spring From The Soul, I explore the profound healing power of loving and being loved, for there is nothing more powerful in the healing process than this.

I have begun placing them in healthcare facilities for their broadcast on monitors and for use on iPads for patients to watch when undergoing treatments such as chemo or rehab. The value of inducing a state of relaxation and pleasure in these settings towards creating better patient experiences and resulting outcomes can hardly be overstated.

Connecting with a patient at the deepest emotional level during the healing process with images of beauty, inspiration, and yes, even thought provoking ideas, ideas to help them see themselves in their world as healed, and in a state of wellness, is to help them access the power of their own life force, from which ultimately, I believe, all healing comes.

My journey from cancer to healing has lead me to the realization that what we think, believe and feel, largely determines the conditions present in the state of our wellness. Thus, with this understanding, the providers of patient experience have the opportunity to create an environment in which these essential elements of our very being, are understood and nurtured, with the ultimate goal of producing the very best outcomes.

Lastly, it has been this realization that has made the last fourteen years, truly the transformational journey of my life. And as such, it is my desire to share this powerful and uplifting healing process with others, that they may find their own transformation in it as well.

Bruce W. Heinemann is a fine art nature photographer, writer, publisher and speaker. His speaking presentation includes his four videos and is entitled: The Fine Art of Healing: A Journey of Personal Transformation.

Tags:  healing  patient  patient experience  video 

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Making a Difference – Working as a Medical Interpreter

Posted By Jane Blackburn, Friday, September 11, 2015
Updated: Monday, September 14, 2015

The phone rings. The interpreter answers the phone knowing they may be moments away from changing someone’s life.

That’s a thought that goes through the mind of thousands of over-the-phone medical interpreters. These professional interpreters field the urgent calls—from doctors, nurses, paramedics, and even patients themselves—where time and accuracy are often the difference between a spiraling crisis and comforting relief.

In order to comprehend life as a a medical interpreter, we have to begin at the other end of the line, with the limited-English speaking patients. Life for them is trying enough. Add to it the pressure of an imminent baby delivery, a late-night medical emergency, or understanding complex insurance forms, and you begin to see the difficulties they face and the emotions they encounter ranging from exasperation to depression to outright panic. That’s where professional over-the-phone and video interpreters work their wonderful magic.

For instance, interpreter Ayan A. received a call from a terrified, sobbing mother who dialed 9-1-1 because her child was injured and having difficulty breathing. Hearing Ayan’s voice on the line helped to calm the mother so that she could understand and follow the CPR and first aid instructions needed to stabilize her child until the ambulance arrived. Fortunately, by the end of the call, the child had opened his eyes and the bleeding had stopped. Before hanging up, the 9-1-1 operator commented to Ayan that together they had saved a life.

And then there’s Ashi F. He received a call from a nurse who along with a doctor was helping a young woman in labor with her first child. With a calm voice, Ashi helped the medical team through the epidural and delivery of the baby girl. Before the call ended, Ashi heard the sweet cries of the newborn baby as she was placed into her mother’s arms.

A third interpreter, Firas A., was speaking on the phone with a nurse and her cancer patient while they waited for the doctor to arrive with test results. The wait seemed like an eternity, the patient wasn’t optimistic, and Firas began to expect the worst. The doctor finally appeared and declared that the patient was cancer-free. Overwhelmed by his own joy, Firas had to compose himself before interpreting the good news.

And there are countless other stories just like these.

However, these compassionate professionals do much more than interpret words from one language into another. It’s essential that medical interpreters receive specialized training and testing in order to practice their trade. That means they must be intimately familiar with medical terminology and protocols, trained to remain calm during a crisis, and schooled in cultural sensitivity. All of which helps prepare them for any situation that might arise. The use of professional medical interpreters enables accurate diagnosis, reducing unnecessary testing, increasing efficiencies and lowering the cost of patient care.

In addition to the many benefits of interpreting, what most interpreters value about their work is hearing the gratitude expressed by patients. Mario C. summed it up this way, "I have helped with transplants and delivering children, all using my voice. Interpreting makes a difference. I make a difference.”

Read the stories of patient encounters, in the words of professional interpreters, at Real Life Interpreter Stories.

Jane Blackburn joined LanguageLine Solutions in 2001 as a Customer Service Manager. Since 2013, Jane has been the Director of Interpreter Services with responsibility for managing the 8000+ LanguageLine Solutions Interpreter workforce. Jane has a Bachelors degree from California State University.

Tags:  language  medical interpreter  patient  patient experience 

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Be a Change Agent and Shift the Culture of Dementia Care

Posted By Kristen Cribbs, Wednesday, August 19, 2015
Updated: Wednesday, August 19, 2015

As healthcare providers working with individuals who are living with dementia, we have a lot on our plates. It’s easy to get caught up in the busy day to day and to lose patience when Mr. Jones is "just being difficult.” The Alzheimer’s Foundation of America (AFA) seeks to cultivate a more skilled and empathetic dementia care workforce by teaching professionals to look beyond behaviors and to be curious: What might Mr. Jones need? What is he trying to communicate?

Putting ourselves in the shoes of individuals living with dementia who are confused and experiencing communication challenges helps us to provide dementia care that is truly person-centered. Through setting aside our biases and agendas and being attuned to individuals in the moment, we are better able to offer the support that they need to be healthy, fulfilled and safe. Taking a "one size fits all” approach to care can limit a positive patient experience and impact an individual’s ability to make his own decisions and maintain a meaningful life with dementia. We suggest taking the time to get to know a person, their family, history, preferences and goals. Building a relationship forms the basis for effective communication – by gaining insight into the person, you are better able to understand how they convey their needs and desires.

Reflecting the mission of AFA, the Foundation’s training and education division, Dementia Care Professionals of America (DCPA), works to ensure that dementia care is person-centered, valuing the uniqueness of each individual. DCPA’s philosophy encourages interdisciplinary collaboration among care providers, care facilities, families and individuals living with dementia and ensures decision-making processes and care plans reflect an individual’s needs and desires. This approach is of the utmost importance in promoting wellness and health while improving both delivery of services and the experience of the individual who has with dementia and his family.

It is this shift in thinking that leads to an increased ability to build positive relationships and improve the experience of the individuals and families with whom we work. We are proud of all of our programming, including our new training video, which goes beyond the basics and encourages participants to think critically about their work. Emphasizing relationship-building as the cornerstone of high quality dementia care will cultivate a more skilled and empathetic workforce that is prepared to meet the unique needs of this growing population.

Although individuals with dementia may experience certain challenges as a result of the condition, this does not negate their right to lifelong learning and meaningful living. We encourage you, your staff, and your organizations to take the time to focus on the abilities, stories, and knowledge within this incredible group of people the individuals with dementia with whom you work. The relationships built in the process will be enriching not only for the people you serve, but you, as well.

Kristen Cribbs, M.P.H., is Deputy Director of Educational Services at the Alzheimer’s Foundation of America (AFA), where she oversees AFA’s Dementia Care Professionals of America and Excellence in Care programs. Her efforts focus on establishing and promoting best practices in dementia care across sectors and care settings and she is deeply committed to improving the health and quality of life of older persons. AFA is a national nonprofit dedicated to providing optimal care and services to people with dementia and their families, ultimately improving quality of life through support and education that elevates care.

Tags:  dementia  healthcare  long term care  person-centered care 

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‘Sometimes’ is the Enemy of ALWAYS

Posted By Jake Poore, Friday, July 24, 2015

In Jim Collins’ famous book "Good to Great”, he says ‘good is the enemy of great’. His premise is that we often settle or become comfortable with good or good enough instead of striving for more... reaching for the last inch that drives great experiences.

Great companies not only create experiences that reach more heights (or go the extra mile), they also seem to get everyone in the organization to deliver it, consistently... creating a culture of always.

If good is the enemy of great in business, then ’sometimes’ is the enemy of ALWAYS in healthcare.

  1. If we say, "we’re always going to knock on the patient’s door, wait for their reply, enter, make eye contact, smile, wash hands and introduce ourselves”, and we do this often, sometimes or even most times... we fall short of a culture of always.
  2. Imagine seven nurses care for a patient of over a three-day stay. If five nurses do these behaviors always and two don’t feel this is important and skip it, we’ve created a culture of sometimes – and again, we’ve fallen short on the journey to become a culture of always.

Unintentionally, I believe, we’re creating a silo mentality where everyone does their own thing. That’s a fragmented way to lead any organization. It creates chaos, dissatisfied patients (and employees) and ultimately, low patient satisfaction scores.

For today’s healthcare administrators, this isn’t just something that’s nice to do; it’s a must-do. Federal financial reimbursement is tied to CMS surveys. And these surveys only give credit for "always” answers. If your facility scores a 0 to 8 (never to sometimes), you get zero credit. Clearly, a culture of always means survival.

The popular phrase "culture eats strategy for lunch” rings true. If your culture is weak, how your employees perform their daily job tasks will trump any corporate strategy. You may have good intentions, but they’re only as effective as the integrity of your organization’s culture.

Consider:

  • Some doctors shake hands with patients; some don’t.
  • Some sit and listen to the patient’s story before diagnosing; some interrupt within 18 seconds to "move along.”
  • Some nurses introduce themselves; some don’t.
  • Some offer to close your door for quiet from noise; most don’t.
  • Some food service workers offer to help elderly patients open plasticware and milk cartons; others drop and run.

Besides doctors and nurses, the average patient interacts with more than 100 care team members along their healthcare journey including call center employees, front desk reception, volunteers, transporters, security, food service, housekeepers, etc.

If culture is what we do every day, and we aim to create consistency to survive and thrive in healthcare, then we must create new daily habits as a team so everyone is on the same page. The key is redesigning the culture with input from every employee group.

It seems everyone is admiring this problem, but nobody has a clear solution. The real problem is we’re throwing spaghetti at the wall and hoping it will stick. The solution is to no longer teach to the test as a long-term strategy. To get to a culture of always, we have to change our culture.

Patients are like the canary in the coal mine. They’re sending up warning signals of a flawed culture because, just like the canary, they’re most susceptible in a toxic environment. And make no mistake - they’re calling us out on things that poison the patient experience.

How?
Through patient satisfaction surveys.
By telling friends and family about the level of care they received.
And by taking their business and their loyalties elsewhere.

 *Hear more from Jake Poore about patient loyalty and creating exceptional patient experiences at the upcoming San Francisco Regional Roundtable.

As Founder and President of Integrated Loyalty Systems, a company on a mission to help elevate the human side of healthcare, Jake (@jakepoore) knows what it takes to create and maintain a world-class service organization. He spent nearly two decades at the Walt Disney World Company in Florida helping to recruit, hire, train and align their 65,000 employees toward one end in mind: creating memorable experiences for individuals, not transactions for the masses. In 1996, Jake helped launch the Disney Institute, the external training arm of Disney that sold its business secrets to the world.

Tags:  culture  patient experience  patient loyalty  service excellence  team 

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Social Media and the Patient Experience

Posted By Andy Roller, Thursday, July 9, 2015
Updated: Tuesday, July 7, 2015

The patient journey is rapidly changing. The old patient journey went something like this:

  • Scenario 1: You got a referral from your primary care doctor and unquestioningly followed the directive. Based on your experience, you became a loyal patient, advocate (for better or worse), or indifferent.
  • Scenario 2: You asked a trusted friend or utilized some form of word of mouth. Based on your experience, you became a loyal patient, advocate (for better or worse), or indifferent.
  • Scenario 3: You became aware of a particular doctor, specialist, or practice – maybe through some form of traditional marketing (TV, Billboard, Newspaper, Direct Mail). You then considered and evaluated. You proceeded to set an appointment. You went through with the procedure or treatment. Again, based on your experience, you became a loyal patient, advocate (for better or worse), or indifferent.

Of course, every reputable practice will work to make the experience and the resulting word of mouth the best it can be. But my, how things have changed. With a rapidly increasing digital population, the patient experience starts much earlier. The journey-experience increasingly begins with online search. It continues through their experience with care they receive; then through online reviews and social media posts they publish.

According to 2014 Pew research, 86 percent of patients search online before booking a doctor’s appointment. And, as of 2013, 41 percent of patients were using social media to determine their choice of Healthcare Provider (HCP). 43 percent of medical visits originate from a search engine. These numbers are rising at a rapid pace.

A full 90 percent of patients 18-24 of age trust and make decisions based on what they find on social media. And over 25 percent of conversations on Facebook are about a health-related experience. Yet only 26 percent of hospitals in the US actively engage via social media. It's true that prospective patients don't often convert based on a single Facebook update. But the influence on patient decisions and advocacy is foolish to ignore. 

The new patient journey looks more like the following: 

The patient searches online related to symptoms, providers, reviews. They may share social updates and interact as they search. Keep in mind, what they're finding is largely the result of other patients who have posted about their experience. Marketers call this the the Zero Moment of Truth. 

 

 

 

 

 

 

Once the prospective patient finds what they are looking for, they make a decision to move forward. This is often called the First Moment of Truth. They may call or send an online form, make an appointment or schedule a consultation. Again, this moment may also be something they share with their social networks. 

The patient then attends their first appointment or procedure or hospital stay. This is their Second Moment of Truth. We most often think of this moment as the patient experience. It may be the core of their experience, but it's only part of the journey and experience. 

 

 

 

 

During and after the stay or procedure is when the majority of social sharing takes place. This sharing becomes the next prospective patient's Zero Moment of Truth. 

 

 

 

 

 

 

 


What will prospective patients find? How well are HCPs facilitating the patient experience along this journey?

At Expio, we teamed up with TCU's Neeley School of Business to create the following short report. We present the information in the context of a true story from the perspective of a Father dealing with his young son's medical care. View the full report here.

Andy Roller is the Founder and Owner of Expio. As a believer in the power of entrepreneurship for commerce and community development, he is also a community volunteer, board member of Panhandle Twenty/20 and part of Leadership Fort Worth. Andy was named one of Amarillo Chamber of Commerce’s Top 20 Under 40 Business Professionals in 2011. Andy is a fitness and health geek, guitar player, father to 5 super cool kids and husband of an Enchantress.

Tags:  Consumerism  patient experience  social media  voice 

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The Return on Improvement

Posted By Paul Westbrook, Wednesday, June 24, 2015

In this final article in our three-part series about the three-year patient experience transformation at Inova Health System, we present and examine the results of our efforts. In article one, "A Thin Line, The Nature of Care,” we spoke of adopting a "hospes” approach in healthcare, based on warmth, welcome and hospitality. In "Of Heads, Hearts and Hands,” we illustrated the transition from strategies to action, specifically by inculcating hospitality principles through five key work streams. Today, we must ask: What did we accomplish? What were the measureable results? How did we improve? What was the ROI, the Return… On Improvement?

Since objective and demonstrated numbers are visible evidence of improvement, let’s go there first. At Inova, while we established the foundations for change in the first 18 months of our effort, the latter part of the three-year period started yielding significant improvements across all of the HCAHPS domains. President/COO Mark Stauder reported, "In almost all of the significant areas, scores improved markedly. However there was more than metrics advancing. We were in, and continue to experience, a cultural transformation.” Domains such as, "Overall Rating of the Hospital,” "Nurse Communication,” "Doctor Communication” and "Responsiveness of Staff " scores each rose an average of 42 percentile points. The hospitality principles applied resulted in percentile rank growth from the ~30th percentile to the ~70th percentile in 8 of the 9 HCAHPS domains. Our largest hospital had its most success ever in Q2 of Calendar Year 2015, surpassing goals in 5 domains and being within 2 points of goal in the other three. "By unifying our efforts from the C-Suite to the bedside, we were fulfilling the Inova Promise. We were empowering intentional, genuine and sustainable change,” Stauder noted.

Two of the premises in the Inova approach are 1.) Patient Experience improvement is not a tactic, and 2.) Cultural transformation cannot be delegated. Sustainable performance improvement is a result of systematic inspiration and commitment at all levels of the organization. And it’s not merely about moving the numbers. By focusing on culture, communication, human resources, leadership development and service excellence, enterprise-wide improvement occurred concurrently on all levels as the organization took intentional and measureable steps in delivering the Inova Promise.

Among the learnings in this cultural transformation were the following:

  1. Culture, communication, human resources processes and leadership drive tactics
  2. Defining "Patient Experience” and repeating over and over "what success looks like” provides unifying focus
  3. Cultural transformation cannot be delegated
  4. Data vs. opinion changes behaviors and drives engagement
  5. Human Resource processes empower and sustain service excellence
  6. Leadership’s role is to enable service delivery by removing barriers
  7. Patients need to be part of every step of the process
  8. Clear expectations for improvement must be articulated
  9. Answers lie with those closest to the bedside
  10. Leaders ask great questions, listen intently and invite action

In the realm of patient experience, we speak about "cultural transformation.” Admittedly, it is somewhat nebulous, intrinsically qualitative and difficult to measure. In the same breath, we are also compelled and driven to deliver objectively verifiable and proven scores with the goal of mitigating financial and reputation loss. What a quandary. It is as though we are caught in the middle between the seemingly ambiguous and the fanatically measurable.

In embracing our first premise that 1.) Patient Experience is not a tactic, it seems that asking for a "Return on Investment” may be too narrow of a question, as if the result of our efforts is going to be the sum of multiple tactics. The traditional ROI question seems to head us in an almost transactional tactical approach of a "quid-pro-quod ethic” – do these things to get that result. Perhaps the more appropriate question to ask is rather, "What is the ‘Return on Improvement?’” At Inova Health System, by focusing on hospitality principles across five core work streams, and approaching patient experience as a collective commitment, we experienced transformative- rather than tactical-success.

As we move forward, the Inova Promise is being realized, the spirit of the organization is palpable and the numbers, well they speak for themselves. Three years ago, we returned to hospitality, to a service-discipline of relieving fear, anxiety and suffering. We embraced "hospes,” warmth and welcome – and are realizing each day, a more significant ROI, the transforming "Return on Improvement.”

*This is the final piece of a special three-part guest blog series focusing on various components of patient experience excellence, including patient and family care, culture and leadership and employee engagement. Read Part 1 and Part 2.

Paul is the Vice President of Patient Experience at Inova Health System. Prior to joining Inova, Paul began his service delivery consulting company, Westbrook Consulting, LLC, with the mission of transferring his 35 years of hospitality service in branding, strategic deployment, and operations to other service industries, to give back to his community and make a meaningful difference in peoples’ lives. Paul is also part of The Beryl Institute's Patient Experience Executive Board.

Tags:  culture  improvement  patient experience  return on service 

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