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The Multiplying Effect of Satisfaction and Dissatisfaction on Reputation and the Bottom Line

Posted By Aaron Campbell, CPXP, Wednesday, August 28, 2019
Updated: Wednesday, August 21, 2019

“The most important figures are unknown and unknowable… One, for example, is the multiplying effect of a happy customer that brings business into the company. Another one is the multiplying effect of an unhappy customer that warns his friends and some of his enemies about his experience.” – Dr. W. Edwards Deming

Even after seven months, I can still hear my aunt’s screams of pain. Just 30 minutes earlier, I had been at my grandmother’s beside at one hospital when I got a call saying my aunt was unresponsive and being rushed to the ED at another.

I gave my grandmother a hug and headed to the car. As I sped down the interstate, I called the ED, identified myself as my aunt’s power of attorney and begged to speak with someone. My aunt had been ravaged by debilitating and deforming arthritis, along with congestive heart failure. They needed to know that she was a DNR, and her advanced directive had been sent with her in the ambulance.

To my dismay, the callous employee responded, “I’m sorry, but you can’t speak with anyone until she is registered in our computer—that’s our policy.”

When I arrived, the ED staff, unaware that I had called, had ignored her advance directive and administered Narcan to revive her. She was awake, dying and in the worst pain of her life because of “policy.” To make matters worse, the nurse sitting with her shamed me when I expressed anger over their actions and demanded they call hospice. It took nearly seven hours of suffering before the morphine hospice had ordered finally began to ease my aunt’s pain.

Just a few hours later, back at her little apartment, I held her hands as she took her final breath.

Taking Into Account the Unknown and Unknowable

In my professional role, I have the privilege of working with health systems across the country to improve the patient experience and strengthen (and often repair) their reputations. While I’ve helped design PX strategies for systems with 30,000+ employees, I felt completely powerless to help my own family. No HCAHPS survey, online review or formal grievance could capture the true depth of my feelings or the potential impact sharing my story could have on that hospital’s reputation and, therefore, bottom line.

Healthcare organizations make daily miracles and messes on the grandest scale. In a world of social media, positive and negative posts can be halfway around the world in a matter of hours. While most consumers think about a healthcare organization’s reputation and take seriously what friends have to say about their experiences, many providers continue to make investments in experience based on potential impact to reimbursement and by reviewing one-dimensional metrics, such as the overall hospital score from HCAHPS. They look at the obvious numbers and fail to consider the unknown or unknowable “multiplying effect” of patient satisfaction levels on an organization’s reputation.

Dr. Edwards Deming, an early leader in the management and LEAN movements, said “No one can guess the future loss of business from a dissatisfied customer.” He also said, “It will not suffice to have customers that are merely satisfied. Customers that are unhappy and some that are merely satisfied switch. Profit comes from repeat customers—those that boast about the product or service.”

Every decision and investment you make – or don’t make – towards a better, safer, more compassionate and convenient healthcare experience raises the stakes. And, the decisions you make not only affect your organization but your competition, too. This is why it is so important to look beyond the numbers and to take every opportunity to truly listen to your patients, their family members and to your employees. Internal policy and regulation, while crucial to a safe and organized healthcare organization, must be built with patients and their caregivers in mind.

“The most important figures that one needs for management are unknown or unknowable (Lloyd S. Nelson, director of statistical methods for the Nashua Corporation), but successful management must nevertheless take account of them.”  -- Dr. W Edwards Deming

Opening the door to dialogue and empowering and equipping your people to respond proactively and with authenticity to any situation is one of the only ways to change the story people will tell, and therefore take account of the unknown and unknowable.

Aaron Campbell, CPXP guides healthcare leaders on patient, employee and community engagement and experience in his role as senior managing advisor at Jarrard Phillips Cate & Hancock. The firm is a U.S. top 10 ranked healthcare communications consultancy specializing in change management, crisis/issue navigation, strategic positioning and M&A exclusively for providers. A social worker by training, Aaron has spent nearly 15 years working with diverse stakeholders in the public, not-for-profit and private sectors to improve health and social welfare policy and the delivery of care through strategy development, strategic communications, grassroots engagement and advocacy. Inspired by his personal experience caring for his aging grandmother and disabled aunt, Aaron leverages his passion, expertise and experience to help healthcare leaders develop strategies and buy-in to create and sustain change.

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Play as an Integral Part of Pediatric Patient Experience

Posted By Christina York, Monday, August 26, 2019

Within each child is a deep, intrinsic love for play—and not only is it something that they love, it’s something that they need. Play is how children of all ages discover, learn, and engage with the big world around them. The creator of the Montessori education approach, Maria Montessori, once said that “play is the work of the child.”

This reality does not change when children are at the doctor’s office or are hospitalized. In fact, in healthcare settings, play becomes even more essential. Play is the way kids prepare for procedures and cope with the pain and anxiety that come with treatment. Play normalizes the unfamiliar hospital environment that has many scary sights and sounds. Play is also a motivator for patients undergoing difficult rehabilitation therapy and recovery. As an occupational therapist once told me, “When you do pediatric therapy, you have to play games. Kids don’t care about your goals.”

Ultimately, incorporating play into the hospital is synonymous with improving pediatric patient experience and the experience of their caregivers. That's why there are so many tools, activities, and spaces to encourage play in hospitals. From simple distraction tools like bubbles to entire concourse remodels to innovative technologies like augmented and virtual reality, these methods all share the ultimate goal of helping kids focus on play and not on the negative aspects of hospitalization or treatment. It's also why hospitals have dedicated staff like child life specialists to provide support for patients.

Here are some ways to incorporate play for pediatric patients:

  • Create a welcoming space: Upon walking into a doctor’s office or hospital, the physical environment is the first thing patients experience. Needless to say, it makes a big impact on how patients experience their healthcare. A bland and sterile waiting area feels cold and uninviting in comparison to a space with lots of natural light, color, and activities for patients to engage in. Including artwork, plants, snacks, interactive games, and even space transformation are ways to create more interest in patient areas. Designated play areas or rooms are also helpful for providing more welcoming spaces for children.
  • Incorporate medical play, modules, and simulations: Incorporating age-appropriate medical play prepares patients before procedures in a way that helps them understand what is about to happen. This not only decreases anxiety for patients, procedures are done faster, and less unnecessary sedation is required. For certain procedures like MRI's, engaging patient education simulations can be used to prepare patients.
  • Use distraction therapy frequently: Whether during simple needle-related medical procedures or longer hospital stays, distraction therapy can be used throughout the healthcare experience. From traditional toys and sensory equipment to technology like augmented reality, distraction is a great way to help patients perceive less pain and anxiety during procedures as well as alleviate boredom. Find distraction tools that are appropriate and engaging for every age group, like video games, stuffed animals, virtual reality headsets, scavenger hunts, and more. 

Christina York is a user experience guru, technology visionary, and Founder/CEO of SpellBound, a company that creates therapeutic augmented reality tools to help children cope and engage with medical treatment. She can be reached on LinkedIn or at

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Caregiving in Alzheimer’s Disease

Posted By John A. Galdo, Pharm.D., M.B.A., BCPS, BCGP, Tuesday, July 23, 2019

My mom was diagnosed with Alzheimer’s Disease in January 2019. Despite living with the diagnosis for only a few months, the time has felt like a lifetime. However, the most unfortunate aspect to our story isn’t the various barriers in healthcare from lack of provider support or hurdles in health information exchange, but the fact that Alzheimer’s Disease is a terminal illness with no cure. We are never going to get lost time back, and, at a point in the disease journey, medications are less effective. This is why it is so important for family members to be a part of the healthcare conversation.


We were concerned about Mom’s deteriorating memory and social skills for a few years but didn’t react until safety became a concern (she became lost while driving, emotional outbursts from ‘missing’ items). My dad and I sent a letter to Mom’s primary care provider (PCP) stating our concern regarding Alzheimer’s Disease/dementia, and we requested a screening be conducted during her annual wellness visit. There are a variety of objective screening tools available to providers to assess for the risk of dementia and Alzheimer’s Disease. Yet, Mom’s PCP opted to go in a different direction. She asked Mom, “are you having any memory issues?” Of course, Mom answered no.


Even us finding out the ‘screening’ was simply ‘are you having any memory issues’ was an ordeal in and of itself. Mom, given her medical condition, is not a reliable historian, nor at the time, apt to include other people in the healthcare conversation. Mom needed an advocate and her care team (aka us) with her at appointments (we weren’t); so, we had to take matters into our own hands. However, for any of us to have a conversation with the PCP, we had to be co-signed on Mom’s medical records. I understand the value, but a simple signature became another barrier - multiple phone calls and an eventual trip across state lines to sign a piece of paper, so I could have a conversation with the PCP. And we did all of this just to find out a standardized assessment never occurred.


And this is why creating the proverbial ‘village’ is so important within healthcare. Mom was unable to advocate for herself, and Dad and I were barred. But once we created our support system and care team, our journey truly started. Through voicing our concerns to the PCP in a regular cadence, we were able to get an appointment with a neuropsychologist, who did conduct those objective screening tools. After the neuropsychologist’s four-hour exam (which no one told us the duration of this appointment), we were informed of a “probable” Alzheimer’s Disease diagnosis (a psychologist is unable to diagnosis based on scope of licensure in the state) and referred to a neurologist. However, the neurologist refused to see us until baseline imagine and laboratory work was complete – as a healthcare provider, I understand the clinical evidence behind this ‘checklist’ – but it was only with my background that I was able to navigate the system with any sense of urgency. My favorite system failure was when the neurology office sent my dad the medical referral paperwork, which is supposed to be filled out by the PCP referring to care! And bless his heart, dad tried to fill it out. We then had to wait a few more months to get an appointment with a neurologist who finally confirmed and started treatment for Alzheimer’s Disease. The entire process took over half a year.


Needless to say, we only ‘achieved’ a diagnosis because my dad and I became involved in Mom’s care. The best time to become an advocate and caregiver is now. And it can start with simply speaking up when concerned.


John A. Galdo, Pharm.D., M.B.A., BCPS, BCGP (Jake) is a caregiver and pharmacist in Alabama. He currently works developing and educating on healthcare quality measures and is a member of the board of directors for the Alabama chapters of the Alzheimer’s Association and American Diabetes Association. He can be found on LinkedIn.

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This Isn’t Rocket Science. In fact, It’s Harder.

Posted By Mark VanderKlipp, EDAC, Wednesday, July 3, 2019

Come on, you guys, this isn’t rocket science.” - said everyone ever

People glibly toss this statement off when they attempt to take the reductionist high ground, to speak of the simplicity of the task before them. They hold out rocket science as a discipline that’s almost impossibly complex, knowable to only a select few.

Rocket scientists have the luxury to focus for a period of time on delivering a payload through the atmosphere and into outer space. But as complicated as this problem may be, it is a definable problem, with physical laws that determine constraints, that has a defined beginning and a definite end.

On the other hand, moving a complex healthcare culture forward is a daily task that requires a broad definition of goals, barriers and opportunities (which vary for each individual over time), with only the murky boundaries of understanding to determine constraints, with no definable beginning and certainly no end. In our realm, individual behavior is situational, truth is subjective and emotion and urgency trump all.

To the extent that there’s an answer for our industry, it’s in defining human-centered processes that honor the lived experience of individuals in the system, and forward their expertise as shared learning occurs. This excellent article by Laura Hoppa lays out a great process for doing so: Activating Strategy through Experience Design.

I serve as a volunteer on a PFAC for Munson Medical Center in my hometown of Traverse City, MI. We recently heard a presentation from the Director of Facilities for a new surgical tower that will completely change the front door of the Medical Center: it moves an existing city street to the north and creates new connections to the building that alter pathways and process significantly.

As we were reviewing the goals for the project that the architect had written, the single word that kept coming back to me was “hygiene.” Mirriam-Webster defines this as “a science of the establishment and maintenance of health, or conditions/practices conducive to health.”

When I think of health in this context, I think of informational health, brought about by consistent informational hygiene.

As Jason Wolf so often says, “we are people serving people” and nowhere is the correct exchange of information more critical than in the world of healthcare. Good informational hygiene does not have an end point - it’s a practice that we must make a part of every day, if we wish to continually maintain and improve the health of our cultures and environments.

Thinking of the major changes about to occur here in Traverse City, our goal will be to maximize the exchange of information in order to meaningfully impact mindsets in ways that improve both staff and patient/family experiences. Here’s how I would define good “informational hygiene”:

  • Increase awareness
    • Lay the groundwork that necessary change is underway, well in advance of any “ask” or intervention
    • Build momentum in clear, consistent communications across media
    • Create avenues for conversation among diverse individuals that help frame the issue

  • Interrupt with novelty
    • Once defined, use metaphor/story to describe aspects of the issue as you see it
    • Create “landmark” informational experiences to establish the issue as one needing resolution
    • Design avenues for conversation to hypothesize potential solutions

  • Convince with facts
    • Cement the challenges with relevant, “sticky” facts
    • Support those with quantifiable information and stories to clarify, add shape to the issue
    • Communicate clearly and often

  • Change long-held assumptions
    • Name them as a way to frame the challenge
    • Acknowledge their value in the past, and the original thinking/necessity that brought them about
    • Contrast those with new information, and illustrate changes that might result with new assumptions

  • Build trust
    • Tell the truth as you see it
    • Be open to receiving critique and having your mind convincingly changed
    • Encourage co-design of solutions with humans on all sides of the experience

Once mindset change has opened the door, we can begin to communicate all the ways in which behaviors can change to support the greater good.

So when you hear someone say ‘Come on you guys, this isn’t rocket science!’, remember that convincingly altering mindsets to change behavior isn’t rocket science; it’s much harder than that. Kudos to all members of this organization, and the entire healthcare system, who bring their best to this challenge every day.

Mark VanderKlipp is an experience and systems designer, working in human-centered graphic design for over 30 years. He helps clients visualize the systems within which they function, empowering staff to deliver an experience that’s clear, relevant and human. He previously spent 24 years with a world-class wayfinding design firm, 13 as its president, where he was the lead strategist for diverse assignments in healthcare, higher education, civic, corporate, trails and tourism throughout North America. Mark is a 1987 graduate of the University of Michigan. In 2012 he earned his evidence-based design certification (EDAC) through the Center for Health Design, and in 2017 became certified in Systems Practice through +Acumen. He is also a founding partner of the customer experience consulting firm Connect_CX.

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What Can Hotels and Healthcare Providers Learn from Each Other?

Posted By Denise Durgin, Sunday, June 23, 2019

When I was diagnosed with breast cancer last year, my world was shattered. Once the diagnosis settled in, I knew I needed to reframe my journey so that this cancer didn’t define me and I could remain strong, positive and focused on healing. As my appointments quickly unfolded, I knew I wanted to be heard as a human, even a guest in the customer journey; one that has a voice, that has a choice and one that was expecting a short stay in this human experience.

Because I spent 25 years at Marriott and The Ritz-Carlton in sales and marketing leadership, I walked into each guest touch point observing it from a customer service perspective. Each phone call, medical test, appointment, online interaction and even on the day of my surgery until now, I engaged with each service provider looking at it from this lens. I found being a guest in the cancer journey was similar to being a guest in a hotel. When the healthcare provider’s expertise, knowledge, online reviews and service were excellent and human, it made me feel confident, comforted and impacted my healing. From the Beryl Institute’s Experience Ecosystem, here are four of the eight strategic lenses that positively impacted my guest experience in the cancer journey.

Quality and Clinical Excellence

Ask five people to describe their favorite hotel stay, they’ll probably share a story about an emotional connection made during their stay. As a guest in the cancer journey, I felt the same way about my service experiences. I expected clinical excellence, just like hotel guests expect service excellence. After the shock of the diagnosis and my surgeries, my next guest experience focused on radiation treatment. The moment I walked into the Maryland Proton Treatment Center I felt like a VIP (very important person) guest. I had an excellent experience from the scheduling, to the valet parking, welcome desk, concierge, integrative wellness center, waiting rooms, radiation technicians, weekly scans and physician appointments; the people were amazing. The end – to - end experience reminded me of being in a luxury hotel as the service and care was top notch. We drove an hour each day to my 5 ½ week plan of treatments and this team got it right on every single guest touch point-every day. I was so happy that I wasn’t referred to as a patient. Except for my burns at the end of treatment, I didn’t feel like a patient. Each day I walked into MPTC, Ms. Roberta had a genuine and caring smile; “Welcome back Ms. Durgin, it’s wonderful to see you today” just like a hotel stay; not a stop in the cancer journey.

Staff & Provider Engagement

When people book a hotel stay they typically expect a clean and safe experience. But subconsciously they’re expecting a memorable experience which I believe is a level above a satisfied customer experience. How do these memories get created? Through the staff’s engagement at each customer touch point. The same can be said about being a guest in the cancer journey. When safe high quality clinical outcomes are evident, staff and provider engagement can be the tipping point to select a service provider; at least it was for me.

Culture & Leadership

Recently I had another minor surgery. My surgery was delayed three hours into the afternoon so my pre-op nurse offered to braid my hair to keep me focused on other things besides surgery and the lack of food and water. Each time I left to use the restroom, Belinda brought me a fresh warm blanket from the warmer. She was compassionate and empowered herself to take care of me. I had the most memorable experience despite a three hour delay. Belinda knew what was expected of her and worked within a culture that was extremely patient/guest focused. The medical team even gave me a signed thank you note when leaving the hospital-just like meeting planners receive after concluding a conference. I completed the customer survey with a perfect score of excellence.

Policy & Measurement

Hotels and healthcare providers are driven by organizational, federal and state policies that are lived by the guests and patients each day. How these policies are performed in hospitals is measured by the HCAHPS surveys administered by CMS while many hotel brands survey their guests using software from companies like Medallia. Both hotels and healthcare providers have online reviews as additional measurements of success.

As a guest in the cancer journey, I needed two surgeons. When I was referred to a few surgeons by my physician, I immediately went to the online reviews. Just like booking a hotel stay, these reviews were like my TripAdvisor of my healthcare journey. Two of the recommended surgeons were through Fairfax INOVA hospital – a 5 star rated hospital by CMS. One of my recommended surgeons was a 5 star surgeon and the online review that helped me decide: “I have never met such a compassionate and caring human being.” The other surgeon was also referred to me by a friend and my physician and is a 4.9 star surgeon. The review that stood out for me: “Dr. Edmiston showed great compassion toward me and it's clear that she is highly committed to the well-being of her patients.” I knew Dr. Rad and Dr. Edmiston were the surgeons for me.

Denise Durgin, is a certified executive coach at Back Bay Leadership where she works one on one with clients and organizations who want to improve their leadership and service cultures. Denise began her 28+ year career at Marriott International, The Ritz-Carlton and Host Hotels & Resorts in the Back Bay of Boston. She’s currently co-chair of The Beryl Institute Global Patient and Family Advisory Board.

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Do You Really See Me? Or Just My Disability…

Posted By Cheryl Shearer, MBA , Thursday, June 6, 2019
Updated: Thursday, June 6, 2019

No matter what we do as healthcare professionals, we cannot ever fully understand how it feels for the patient and their family. Their reality will only ever be our perception because we are not experiencing this for ourselves, we are not sitting on the other side of the desk at the consultation, we are not seeing with the patient or their family member’s eyes, we are not listening with their ears, and we are not sitting there being administered to by someone who is, most often, a stranger.

While this allows us to be objective and that is good for the clinical care of the patient, the success or failure of the patient’s journey will, to a certain extent, rely entirely on how we engage with them so they feel safe to interact with us.

There are touchpoints in every patient's journey that influence how we, as healthcare professionals, make them feel. How we greet them, how we talk with them, what promises we make, and what information we provide them with – all are important parts of the communication with the patient and their family. Talking over the patient or about the patient to other colleagues, making promises that cannot then be fulfilled and not fully answering their questions all have negative consequences - whether it is a kind word, a friendly gesture, a failure to introduce yourself, not answering questions, being rushed and rushing your patient, everything has either a positive or a negative impact and, unfortunately, the negative impact stays with the patient much longer.

I had the privilege of sitting and listening to patients living with disabilities tell me about their experiences. These people have very different life experiences but what ties their stories together is a desire to be treated with dignity and respect. Seemingly simple things like greeting them first and asking them if they need assistance, before doing anything else, are really important to them.

The information provided by these people who shared their stories identified themes that we can all learn from, so the attached resource was put together as an education tool for staff across the healthcare sector in hospitals, aged residential care, and primary healthcare.

The intent of the resource, with these very personal stories, is to help anyone working in healthcare to better understand the importance of communicating with patients and their families in a way that is best suited to the individual patient. The patients and the families of the two patients who are deceased have consented to their stories being shared wherever their stories may make a difference.

Please download and share these stories.

Cheryl Shearer MBA, Coordinator – Health Quality &Patient Safety Service, has been a member of the Quality & Patient Safety Team at the Bay of Plenty District Health Board, New Zealand since 2006.

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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: Friday, May 24, 2019

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 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

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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.


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.
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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