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

 

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Positively Impacting Staff Engagement and the Patient Experience with Community Giving

Posted By Magali Tranié, Wednesday, November 14, 2018
Updated: Wednesday, November 14, 2018

As one of the eight active lenses of the healthcare experience framework1, staff engagement is recognized as fundamental to the successful realization of a positive patient experience2.

An organization’s staff engagement strategy should comprise of numerous elements3, and some form of community giving activity should be one. It’s the holiday season after all, a wonderful time to remember the importance of helping others! Yes, it’s something close to my heart so I’ll admit I’m a bit biased, but there’s actual some science behind the benefits too.

According to research, giving back benefits not just the recipient(s), but your health and happiness and communities by creating social connections. Talk about a win-win-win!

So, if you’re ready to implement community giving as one of your staff engagement initiatives, here are four things to consider for maximum impact:

  1. Get Senior Leadership Support
    The first step should be ensuring leadership buy-in, which should seem obvious since “culture & leadership” is another active lens of the experience framework1. For example, we list “community” as one of our company’s purpose along with associates, customers and their patients. We post this purpose all over our offices’ walls and desks as a way of making that commitment public!

  2. Leverage Your Field – or Simply Your Neighborhood
    Your facility’s discipline can help guide you towards charities that are within your space. It makes sense for an imaging center to rally around breast cancer awareness, or for a cardiologist to support the American Heart Association, to point out the obvious. There are many healthcare-related non-profits to pick from – as well as many healthcare recognition days to leverage.

    For instance, since we provide linen rental and laundry services to healthcare, we partner with some local chapters of Ronald McDonald Houses to clean their linen at no charge, and we donate to St. Jude Children's Research Hospital through payroll deductions, to name a few.

    Alternatively, you can decide to support your local community too, directly impacting your staff and perhaps even patients. Is there a park nearby that needs a little TLC? A charity close to a staff member’s heart? Our ImageFIRST Fort Myers team had planned a Habitat for Humanity volunteering event only to find out one of their recent hire had been a beneficiary of Habitat!

    Your patients may also be a great inspiration for ideas. In May 2018, we partnered with one of our customers Surgery Care Affiliates and nonprofit One World Surgery, which they are foundational corporate partner of. Our entire leadership team got to work to donate and assemble 250 backpacks of school supplies for young students in Honduras who cannot afford these basic necessities.

  3. Involve and Empower Staff
    Once you get leadership buy-in, you’ll need a small committee. Build a team made up of positive and passionate “locker room leaders” who can spread the enthusiasm and create energy around the activities you decide on. Ensure their managers is on-board with their participation and commitment.

    This team can help execute, gather ideas, give you a pulse of what’s important to your staff (so you can bring community giving activities that matter to them), and gather feedback after each event. For example, we found out some of our associates have difficulty leaving the office to participate due to recurring weekly work. We’ve modified our community giving activities to include events both outside and inside the office walls.

  4. Integrate Community Giving Activities Within Staff Engagement Calendar
    After a kick-off meeting, set recurring quarterly meetings to plan the next three to six months. Work with your committee to develop a calendar of activities that you can integrate within your (hopefully) pre-existing staff engagement calendar.

Community giving is a wonderful way to engage your staff, so long as you plan ahead and dovetail it into your existing activities. Here’s a checklist and calendar to help you plan!

1. Wolf, J. A. (2018) Introducing a Framework for Experience in Healthcare. The Beryl Institute. https://www.theberylinstitute.org/blogpost/593434/308047/Introducing-a-Framework-for-Experience-in-Healthcare
2. 
Wolf, J.A. (2017) The State of Patient Experience: A Return to Purpose. The Beryl Institute. https://www.theberylinstitute.org/page/PXBENCHMARKING
3. 
Gallup Q12 Survey https://q12.gallup.com/Public/en-us/Features

Magali Tranié is the Director of Marketing for ImageFIRST Healthcare Laundry Specialists. She has 20 years of experience working in various marketing disciplines, leading teams and contributing to employee engagement strategies. She is passionate about community giving, being an active weekly volunteer for a local animal shelter since 2006, giving annually to a variety of non-profits, participating to one-off volunteering opportunities throughout the year, and sponsoring a child in Rwanda since 2017.

Tags:  community giving  culture  staff engagement  volunteerism 

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The Evolution of Patient Experience with Design Thinking

Posted By Kelly Makino, Thursday, October 25, 2018
Updated: Tuesday, October 23, 2018

One framework that is beginning to demonstrate considerable value as a resource for innovation in patient experience is design thinking, an approach that leverages the creative process to craft solutions for ambiguous challenges and has recently been gaining steam at a global level with proven success in a wide range of industries. This perspective has quite a bit to offer healthcare as well, and it’s easy to find some great literature on the innovative partnerships, impactful accomplishments and deeply empathetic moments that design thinking and healthcare have created together for patients.

Design thinking often brings to mind revolutionary leaps, but it also carries practical value for day-to-day PX innovation. By infusing the principles of design thinking into our daily work, we are able to create a culture that is ripe for wide scale innovation, and build a healthcare practice that is at home with ongoing evolution. To create some inspiration, here are some concrete examples of simple ways that one could put some of these principles into practice.

Empathy

Walk through your health center and look at things like a patient. Focus less on what they are doing, more on what they are feeling at each step. How much thought has been given to designing their emotional journey through your system? What do the directional signs look like? Are they welcoming, or do they look like warning signs? Are they outdated? What message are they sending?

Also, look up. Staff rarely look at the ceiling, but patients do. How are those ceiling tiles doing? Where in your health center will your patients learn – without talking to anyone - the story of why your staff come to work every day? That they are your priority? That you will offer them the compassionate care they are seeking? Do they learn that when you want them to?

Lastly, how inclusive are the messages in your health center? Who is being left out of the welcome?

Mindful of Process

Do your employees know the full process of the patient experience or just the sliver they interact with? Carve out 30 minutes at your next staff meeting and do a Patient Journey Map with front line staff. It’s a great opportunity for them not only to showcase their knowledge but also to find places they can improve the system, support patients and have empathy for the humans in front of them.

It only takes a whiteboard, markers and supportive, thoughtful questions that challenge thinking, like: “What situation do you think a patient is in when they’re trying to make an appointment?” Or “Ok, now that they’ve taken their clothing off, how cold is the room? The floor?”

Radical Collaboration

There is assumption in design thinking that the solutions to problems of an industry often can often be inspired by studying and collaborating with other fields. What fields have mastered your biggest challenges and have you really looked hard to find the answers to your problems outside medicine? Did you know that Formula 1 pit crews have helped medical teams improve the way they resuscitate newborns? However, the day Doug Dietz lost his MRI scanner to pirates is probably my favorite design thinking PX stories; and so, I will leave you with it as my closer. If you haven’t heard this story yet, please check out his TED talk.

Doug Dietz’s MRI scanner was the most effective he’d ever designed. But children were frightened of the dark, intimidating machine - they were so worried they couldn’t even lay still without “sleepy drops.” When he found this out Doug was upset - he didn’t get into product design to scare kids. And so, one day not long after, his MRI scanner was hijacked by some pirates at IDEO who turned it into a ship – complete with a gangplank. The problem didn’t stop at pirates, either. Another machine sank into the ocean, a third was lost in the woods on the way to the hospital, one accidentally launched into space.

Yet somehow, the staff of University of Pittsburg Hospital didn’t seem upset at all this chaos with their MRI machines, instead encouraging mischief, cranking up music, turning on a bubble-making disco ball, making the place smell like lavender and telling fantastical adventure stories that their littlest patients couldn't help but lie still and listen in fascination to. According to legend, if a patient is completely motionless for a certain time, fish will start to swim by in the magic adventure machine. Underneath all this pretend play, MRI scans are more effective, more accurate and need to be repeated less often than back in the old days when children had to be sedated to undergo these potentially life-saving scans because they so scared of the loud, terrifying MRI machines and gloomy UV lighting.

If that’s not PX innovation, I don’t know what is!

Kelly Makino, MSW is the director of Training and OD with Planned Parenthood of Orange & San Bernardino, based in the greater Los Angeles area. As a former LSW from the New York area, she is passionate about infusing person-centered approaches into healthcare that holistically advance the patient experience, support clinicians in their craft, and improve the systems that support them both. She is a graduate of Georgia State University, University of Pennsylvania, and is working on a doctorate at University of Southern California researching ways to improve communication training outcomes for people in clinical settings.

Tags:  collaboration  culture  design thinking  empathy  innovation  mindful  partnerships 

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When Hospitality Meets Healthcare: A Personal Reflection

Posted By Sven Gierlinger, Thursday, November 9, 2017

It happened to me - first came a tingling in my fingers and toes; and within days, I was paralyzed. A husband and father of two young children at the start of a new assignment with The Ritz-Carlton Hotel Company - I was diagnosed with Guillain-Barré syndrome, a rare condition in which a rapid-onset muscle weakness caused by the immune system attacks and temporarily damages the peripheral nervous system. Suddenly, and for 90 days and nights, I was 100% dependent on my doctors, nurses and therapists.

Believe it or not, I’m actually grateful for this experience, as it showed me that as a patient, you are challenged to heal in many ways – physically, mentally, and emotionally. My experience in these moments helped me understand the power of embedding both service and empathy into the clinical processes that truly can make or break a patient or family experience. Every moment counts. 

My years at The Ritz-Carlton opened my perspective to what guests really want – and it’s much more than crystal chandeliers, marble floors and fancy ocean views. The Ritz-Carlton takes culture very seriously and believes it should be fully ingrained in all its employees, even by memorization. This credo provided the gold standards of service that were the focus of my everyday work, and until this day I can recite each word.

The Ritz-Carlton Credo:  The Ritz-Carlton is a place where the genuine care and comfort of our guests is our highest mission. We pledge to provide the finest personal service and facilities for our guests who will always enjoy a warm, relaxed, yet refined ambience. The Ritz-Carlton experience enlivens the senses, instills well-being, and fulfills even the unexpressed wishes and needs of our guests.

Based on my own professional and personal healthcare experiences, and as the Chief Experience Officer at Northwell Health, I knew I had to look at the experience through a very different lens. We have seen that the hospitality industry has established a precedent of best practices that can directly correlate to the healthcare industry. Let’s take the crossover themes from this credo for example: providing genuine care and comfort, personalization, a warm yet refined environment, and delivering on unexpressed wishes. I often wondered what this same credo would look like if ‘Ritz-Carlton’ was replaced with ‘Healthcare’, and if ‘guests’ were replaced with ‘patients’. 

Let’s read the credo again…

The Healthcare Credo:  Healthcare is a place where the genuine care and comfort of our patients is our highest mission. We pledge to provide the finest personal service and facilities for our patients who will always enjoy a warm, relaxed, yet refined ambience. The Healthcare experience enlivens the senses, instills well-being, and fulfills even the unexpressed wishes and needs of our patients.

Now, isn’t this what we all want and deserve from our own healthcare experience? It’s not only about first impressions; it’s about lasting impressions and creating that consistency in the patient experience. As experience leaders, it is imperative we understand how to enliven all the senses – what patients see, hear, touch, taste and feel. This understanding can greatly affect the patient experience, as well as the overall healing process.

At the end of the day, I think we can all agree that healthcare is about helping people through their most vulnerable time, and there is no greater honor.  So, I challenge each of you to think about healthcare differently. Reflect on this healthcare credo and ask how you can translate these concepts into practice to truly make every moment matter.

Sven Gierlinger serves as the VP, Chief Experience Officer at Northwell Health. With a focus on providing exceptional customer service and delivering the highest quality care, Mr. Gierlinger is responsible for building an engaging, innovative and collaborative culture that drives organizational growth and customer loyalty through the patient/customer experience. He is also an Executive Board Member for the Beryl Institute and a member of the Institute for Innovation, Founding Executive Council. Northwell Health, headquartered in New Hyde Park, New York, is the largest healthcare provider and private employer in New York State. The system serves over 8 million patients in metro New York and the surrounding areas with its 22 hospitals and more than 550 outpatient practices.

Tags:  culture  hospitality  impression  patient experience  personalization 

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Empathy as an Office Culture

Posted By Erin K. Brandt, Monday, August 21, 2017
Updated: Wednesday, August 16, 2017

The patient experience movement is one of astounding energy, driven in large part by the realization that fellow humans respond positively when empathy and partnership are at the forefront of care decisions. The majority of those employed in healthcare are not working tirelessly to manufacture a product; their purpose lies in improving the human condition. Sure, there are thousands of innovations marketed every day with the goal of providing solutions to our health problems, but it’s the human connection that has such a monumental impact on how patients respond to our efforts. Human connectedness builds trust, opens lines of communication and creates an environment capable of health and healing. While our hospitals and health systems have made significant gains, I must ask where independent medical practices stand in this storm of pressing innovation.

I consider my work with small medical practices a grassroots effort to inspire empathy as an office culture. How many providers or staff members have taken time to sit in the waiting room or exam room? I believe it’s imperative to consider what message we are sending through our actions and our environment. Are the chairs uncomfortable, the floor dirty, reading material outdated and torn? When the MA calls you back does she smile and call you by your preferred name? Do we have policies that build barriers instead of bridges between our patients and providers?

Today’s medical landscape is crowded with challenges related to payment models, quality metrics and frustrating non-compliance. How can we help patients who don’t appear to want to help themselves? In my experience, the answer lies in a culture of empathy. Understanding the broader scope of social health determinants and their impact on a patient’s ability to follow through can mean the difference in treating a patient with apathy versus compassion. Make no mistake; patients read body language, tone and other social cues while visiting their providers. These impact their decision-making and behavioral attitude towards where they will go to receive care. This, in turn may determine a patient’s follow through with filling prescriptions, imaging, labs or referrals to specialists. 

While we have done extensive work in the hospital and outpatient setting related to patient experience. We also see that primary care clinics and specialty offices remain the frontline of a fragmented system in rural America. Visit on a typical business day and you’ll observe massive stacks of facsimiles, incessant phones ringing, paperwork shuffled and names being called. The medical assistants, schedulers and receptionists I work with admit they become incensed by the lack of understanding on behalf of the patient. They forget they are experts in their role and patients are navigating foreign territory, sometimes scared or too embarrassed to ask further questions. Add the ever evolving changes for the latest software update and every one is confused and less than patient. 

Many small medical practices continue to work under fee-for-service payment models. Many I speak with are put off by the pressures to utilize EHRs and perceive value-based payment systems as another way for payers to gain control over their quest to do what is best for the individual patient. They feel many of the technology solutions are beyond their reach due to issues of interoperability and gaps in IT prowess and staffing.  

While I have a healthy appreciation for the innovation entering the healthcare space, I would like to point out this is not an “all or nothing” ultimatum. My vision includes guiding small and mid-size practices to understand the value of adopting small changes to achieve empathy as an office culture. If we make a commitment to weave compassion and understanding into our communication, our policies and our daily decisions, we position ourselves to help patients in a way indifference cannot. Practices I speak with often feel discouraged by the barrage of high tech investments pitched to them as the sole pathway toward improving patient experience. No amount of technology can replace humanness. So while I dream of large-scale changes to the systems of heath care, I am encouraged by the efforts of independent practice managers working low-tech solutions to create a much needed culture of empathy.  

 

Erin K. Brandt is a public health advocate, facilitator and passionate patient experience leader. Her start as a grassroots health educator working with inmates, the homeless and those suffering from addiction ignited a deep passion for facilitating change through the human connection. Erin currently works with organizations developing leadership pathways, coaching and supporting the patient experience movement. Along with her role as a Patient Experience and Care Advocate at Yuma Regional Medical Center, Erin teaches courses for Arizona Western College Community Health Worker program and designs custom training content for local businesses and healthcare practices. 

 

Tags:  culture  empathy  human experience  medical office 

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The Importance of Culture Building

Posted By Magali Tranié, Thursday, June 1, 2017
Updated: Tuesday, May 30, 2017

I graduated college with the unbridled optimism and sense of invincibility of youth, only caring about completing tasks and my salary. I never considered a company’s culture or my “engagement” level.

Until I was wrong.

Sometime after graduation, feeling underappreciated, I took an “exciting” opportunity with a great salary that was too good to be true – and it was. Thus began a very rough few months: cultures clashed, and I became highly disengaged. The overachiever that I am turned into a low performer. My friendly personality turned sullen.

Yes, culture matters. Much more than completing tasks, and certainly more than a salary.

So it was not surprising to me that recent patient experience research unveiled the growing focus of employee engagement in a comprehensive approach to patient experience improvements efforts. Not that it’s a new concept; many industries – including healthcare – have been struggling to define and embrace employee engagement initiatives for years.

No industry can benefit from employee engagement more than healthcare. In fact, a Gallup study of 200 hospitals found that nurse engagement was the number one variable correlating to mortality, beating out number of nurses per patient per day! 1

So, where do you begin?

Tackling employee engagement starts with a strong foundation: a well-defined culture. Writing down who you are, how you want to behave, and what your goals are the first steps.

Who you are starts by going deep to the core of why your organization exists. When we developed my company’s purpose, the question “Why do we go to work each day?” guided us. We knew that our associates – which is what we call our employees – were instrumental.

Our purpose reads: “To build a great company by positively impacting the lives of our associates, our communities, our customers, and their patients.” We intentionally selected words like “positively” and “impacting,” (indicating action vs. being passive). Note that associates are listed first – that was not accidental!  And we include patients – because they are ultimately the ones we impact.

Next, we wanted to provide a roadmap for the behaviors we expect from our associates; the “how we do our work”. So we developed our Values, which are “Be respectful. Be Remarkable. Be safe. Be honest.”

We then determined our goals: Associates, Customers, Growth and Profits. If you’re wondering why a business would put associates first and profits last, well, it’s deliberate! After all, how can you expect profits (a.k.a. business viability) without great people? Notice what else comes before profits? Customers, of course!

And these aren’t just words on paper, we made these public, including posting them on our website: www.imagefirst.com/Our-Values.

Once you have your culture defined and communicated, the second step is bringing it to life. And that’s not a once and done thing; this is something you do every day, week, month, quarter – methodically and intentionally. We hold daily or weekly huddles during which we discuss our purpose, values and goals – and how it ties back to our customers or their patients. Our leaders put associates first: whether it’s through one of the many established recognition programs, providing community giving opportunities for associates, celebrating birthdays every month, or the many fun team building activities.

It’s the mix of formalized ongoing programs and recognition as well as the regular fun activities that work. Providing flexibility to customize these events (we have numerous offices throughout the country) empowers associates at each office to “make it their own.”

Ultimately, great cultures and staff engagement do not happen by accident. But the good news is that with discipline and intent, any organization can drive improvements!

1. http://www.gallup.com/poll/20629/nurse-engagement-key-reducing-medical-errors.aspx

Magali Tranié is the Director of Marketing for ImageFIRST Healthcare Laundry Specialists. She has 19 years of experience working primarily in business-to-business in various marketing disciplines, leading teams and driving or contributing to employee engagement activities.

Tags:  culture  employee engagement  goals  values 

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How Much Does Culture Matter in Today’s Healthcare Environment?

Posted By Katie Owens, Monday, April 17, 2017
Updated: Wednesday, April 12, 2017

What is culture? Culture can consist of many different elements in healthcare. From the way things are done in the organization. The shared relationships among people which dictate how they behave. To a set of shared beliefs and values. Each belief (while uniquely described by many) universally acknowledges that culture is an important part of the fabric of their organization.

Despite the fact that many people have conviction that organizational culture will either enable an organization’s success or serve as a barrier to achieving outcomes, sometimes broaching the subject of Culture can cause leaders or front line team members to shy away. Culture can feel messy, hard and inconvenient. We may be proud of some aspects of our culture but disappointed in others. Our team sought to find evidence outside of anecdote and theory to help leaders understand the role culture plays in creating excellence. That query led us to conduct our recent study demonstrated that culture does impact outcomes. The two big learnings we had conducting our study published in the Journal of Healthcare Leadership is that:

First, high performing cultures are more likely to do better than low performing cultures on key balanced scorecard metrics: Employee and Physician Engagement, Patient Experience, Value-Based Purchasing and Turnover. These cultures did not outperform by a small margin but a margin of magnitude and statistical significance (see Video on Culture Imperative). In other words, our team found that culture is not “nice to have” but critical to create demonstrable outcomes.

Second, engaging your employees in your culture is the most powerful step to create positive results. Your workforce is the lifeblood of your organizational culture: their engagement, relationships with leadership and each other and commitment to your mission. We found four key levers that are more likely to support achievement of outcomes:

  • The extent to which patients are treated as valued customers.
  • You find that your values are very similar to the values of this organization.
  • You feel that being a member of this organization is very rewarding.
  • You are proud to be a part of this organization.

There is no question healthcare leaders, staff and physicians are perservering day in and day out to provide the very best care to patients despite a myriad of challenges. Our teams are craving cultures that give them a sense of purpose and joy. As we work to create a “new normal” that equips our organization to provide person-centered excellence across the continuum of care, our findings indicate that leaders should pay attention to culture and actively steer workforce engagement to create employee pride, a focus on the customer and shared values.

Katie Owens, MHA is Vice President of HealthStream Engagement Institute, a HealthStream Company. Katie is a highly regarded thought leader in the healthcare industry who is a national speaker, executive coach and facilitator of leadership. Katie is founder of Lumen, a monthly podcast dedicated to shining a light on the bright spots where excellence happens in healthcare. KatieOwens.org

Tags:  culture  employee engagement  improving patient experience  metrics  physician engagement 

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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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‘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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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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Of Heads, Hearts and Hands

Posted By Paul Westbrook, Friday, June 12, 2015

In the first article of this series entitled, "A Thin Line, The Nature of Care,” we discussed the inherent challenges discovered in our three-year patient experience transformation at Inova Health System. Our commitment to addressing those challenges, by focusing on hospitality principles was addressed. In the third and final section, we will present, "The Return on Hospitality,” indicating the objective and measurable success we’re achieving. Today, in this second installment, "Of Heads, Hearts and Hands,” the call of moving from the head – to our hearts and hands, from plans and strategies to actions and tactics is examined. As we get started, enjoy this quote:

"A person's most useful asset is not a head full of knowledge, but a heart full of love… and a hand willing to help.” – Anonymous

As we commenced our journey of patient experience transformation at Inova Health System, our first objective was to re-examine strategies and tactics, of uniting heads, hearts and hands in fulfilling the Inova Promise. The initial SWOT analysis revealed sobering realities and opportunities for growth. Through the valuable introspection of the newly formed Patient Experience Transformation Team, it was determined that the most effective channels for change would be to re-inspire five core work streams. This system-wide evolution across core work systems continues today at Inova as we embrace and fulfill our promise:

"We seek every opportunity to meet the unique needs of each person we are privileged to serve – every time, every touch.” Inova Promise

The Five Core Work Streams

  1. Culture.The heart of the matter of service excellence in healthcare is creating a culture that endures across all care areas and locations. With a passionate commitment to our promise, we embody a culture of making emotional connections. Where service is individualized. Where every action is built on intentionality and purpose – in an atmosphere of mutual respect.
  2. Communication.Information is power. Through open communication about mission and vision, staff members are empowered, have a sense of pride and see their roles as critical in the delivery of care. Leaders convey inclusion and respect by sharing insights through multiple channels such as recognition meetings, huddles, executive rounding, newsletters, blogs and other media. Consistent and cohesive communication is foundational to building a culture of shared values.
  3. HR Processes.To be the best, we strive to attract and retain the best. Through a combination of behavioral interviewing and setting the expectation early, we commit to attracting, selecting, orienting, on-boarding, rewarding/recognizing and nurturing the best people we can find, keeping a constant focus on the balance between talent and cultural fit.
  4. Leadership Development. Healthcare leadership requires clinical excellence coupled with interpersonal and administrative acumen. We foster well-rounded excellence in medical competence and leadership that invites and inspires and that is engaging, efficient and effective.
  5. Service Excellence. Our day-to-day engagements include developing champions and driving service essentials like rounding, white board completion and shift-to-shift handoffs. Moreover, we consider one another as internal customers and endeavor to pleasantly surprise each other and our patients with the unexpected anticipation of needs and desires.

The patient experience at Inova Health System embodies a three-stage effort of 1.) Approach 2.) Deployment and 3.) Results. As I’ve discussed the deployment of action through these five core work streams, the next blog post of this three-part series will present the results – results that illustrate a system’s integration of "heads full of knowledge,” and "hearts full of love and hands willing to help.” I will share results that show the impact of a system-wide transformation of service to those "we are privileged to serve – every time, every touch.”

*This is the second 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 3 here.

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:  communication  culture  Leadership  patient experience  team 

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