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

 

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Re-centering Our Attention on Clinical Excellence

Posted By Kelly Parent, Wednesday, June 20, 2018
Updated: Tuesday, June 19, 2018

“Unless someone like you cares a whole awful lot, Nothing is going to get better. It's not.” - Dr. Seuss

If your health care organization is anything like the ones for which I have worked, you have been exposed to a myriad of philosophies, principles, and tactics (i.e., service excellence, patient/person and family centered care, patient and family engagement, relationship-centered care) that seek to define a culture that achieves optimal patient and family outcomes and experiences through the creation of trusting and empathic relationships, effective communication tactics, and patient and family engagement and activation. There is compelling evidence for the value of such efforts, for they have been shown to improve clinical outcomes, decrease harm events, reduce litigation, and save health care dollars.

However somewhere along the way, the health care industry has become a bit preoccupied by “the test,” viewing the patient experience largely through the lens of patient satisfaction scores. Somewhere along the way, we have allowed ourselves to transpose the patient experience with the customer experience as incongruously defined by hotel standards. We are spending large amounts of time (and money) focusing on a number instead of a person, reacting to mismanaged expectations, and trying to surpass our competition by offering gourmet food, fancy wait space amenities, and concierge services. It is time to get back on track re-centering our attention on clinical excellence. We must re-focus by respecting the needs and perspectives that patients and families bring to the table, communicating with them in ways that are understandable and affirming, welcoming and encouraging their participation in care planning and decision making, and evaluating success in meeting goals of care.

“It's not about what it is, it's about what it can become.” - Dr. Seuss

Fifteen years ago, my family was thrust into the world of doctors, hospitals, fear, and pain when our daughter was diagnosed with a serious illness. Being health literate, we were relatively well positioned to navigate this complex world, for we understood medical jargon, knew how to get answers to our questions, and most importantly, grasped the importance of becoming an active member of her health care team. However despite our confidence, knowledge, and skills, at times we were too vulnerable, too intimidated, and too exhausted to comprehend every conversation, engage in every discussion, and speak up every time that we were unsure. We learned to appreciate the staff who took the time to see where we were (sometimes with needs changing from shift-to-shift) and adapt care tactics accordingly. During highly emotional and difficult times, we needed staff to take care of us and do things “to and for” us. At other times, we needed to be fully present, engaged, and activated to partner “with” our daughter’s providers to make decisions and learn how to manage her care at home, and we always needed staff to know our daughter, the little girl, and not just our daughter, the illness.

My daughter’s illness turned out to be my training ground to become an advocate for patient and family centered philosophy and culture and create institutional readiness for patient and family partnerships. Over these past twelve years, I have learned that patient and family centered care is the way to achieve optimal outcomes and experiences, but to accomplish culture change it takes all of us:

  • We must commit to finding our passion to care for those who come to us at their most vulnerable needing us to provide emotional, spiritual, and physical support.
  • We must remember that unless you ask, you have no idea what patients and families fear most.
  • We must commit to creating and sustaining a culture of teamwork, trust, and compassion welcoming our patients and families as full members of their health care team.
  • We must remember that no one knows more about our patients than the patients themselves and their families.
  • We must commit to welcoming family presence and participation across the care continuum.
  • We must remember to acknowledge family expertise and point out strengths.
  • We must commit to providing transparent, understandable, and timely access to medical information and coordinating care and communication across all settings.
  • We must remember to explain “why” and teach “how”.
  • We must commit to respecting and encouraging patients and families to speak up if something does not feel right.
  • We must remember that what is routine for you is far from routine for patients and families.
  • We must commit learning what matters most to patients/families.
  • We must remember to truly listen.

“Today I shall behave, as if this is the day I will be remembered.” ― Dr. Seuss

Kelly Parent has twelve years’ experience leading patient and family engagement efforts across clinical, education, research, and quality/safety initiatives. Kelly started as a Family Advisor, served as PFCC Program Manager at a large academic medical center, worked as a PFCC educator and consultant, and is currently the Vice President for the Patient and Family Experience at Beaumont Health System.

Tags:  patient and family engagement  patient centered care  patient experience  service excellence 

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Why Your Hospital is Competing with the Apple Store

Posted By Julian Hutton , Monday, January 9, 2017

At a recent patient experience leadership forum, the question was posed “Who is your competition?” Predictably the initial discussion revolved around the merits and reputations of other local or specialist hospitals and how their patient experience was judged to compare. But who else is the patient comparing your hospital to when they give a verdict on the service they have received? What other experiences form the benchmark when evaluating how highly they should rate their hospital experience?

The United States is now a service economy in which we are spoilt for choice on which stores, malls, restaurants, supermarkets, automobiles, hotels and electronics to spend our time and money. As products and services, at all levels of cost and quality, have proliferated, one of the major differentiators has become the customer service experience both at point of sale and for as long as we own the product. Although it is an investment, training staff in the skills to make customers feel valued and respected is a great deal more cost effective than slashing prices. It also has swift return with minimal impact to the bottom line and, if you get it right, earns you enduring customer loyalty. When you buy a $4 Big Mac, you can be fairly certain that somebody will greet you (occasionally with a smile), ask what they can do for you, take your order and deliver the right product. From that standard, the bar for customer service keeps getting higher – for less than $100 a night, a limited service hotel receptionist will welcome you warmly, inquire as to how your journey was, efficiently check you in and show you to a room with clean sheets and small, tastefully designed, bottles of gold, frankincense, and myrrh in the bathroom. (Coming soon to a chain hotel near you.)

When you go into an Apple store, you’ll be greeted by somebody who seems genuinely pleased to see you. They are friendly and professional. They give every impression of being sincerely interested in helping you. They listen attentively, they make sure they have understood what you have told them, and they then tell you who is going to be helping you. They introduce that person and hand off to them by repeating what you have said to them and inquiring if, before they go, there is anything else that they can do for you. During your whole experience with Apple, whether you are buying something, or getting help with an existing Apple product you already own, you are kept informed of the process, how long it is estimated to take, what is going on behind the scenes that you may not know about and when the person helping you will be back. At every stage, there is a handover from one person to the next. If the person helping you needs to go somewhere and you are by yourself, it is only a matter of minutes before an Apple employee asks you if you are being helped and if there is anything they can do for you. You are never left wondering if anyone has forgotten you or what is going on. And however intractable your issue is, you are never made to feel you are being a burden.

Can hospitals ever operate as smoothly as an Apple store? No. But can hospitals learn from the kind of customer service culture that companies like Apple have trained their staff on? That has set them apart from their competition, earned the loyalty of their customers and set a standard of customer experience that other services are judged by? Fairly or unfairly, hospitals are being judged by patients on the constantly improving standards set by the service culture they experience in their everyday lives.

Julian Hutton studied leadership at Britain’s Royal Military Academy Sandhurst and was an officer in the Scots Guards. From there he went into the hotel and hospitality industry, working all over the world for some of the industry’s best known names. For the last 10 years, he has been increasingly involved in developing leadership and hospitality service training programs providing the highest standards of guest and patient experience.

Tags:  competition  customer experience  Customer Service  Hospitality  Leadership  service excellence 

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Patient and Family Engagement to Improve Patient Safety

Posted By Tejal K. Gandhi, MD, MPH, CPPS, Monday, March 7, 2016
Updated: Monday, March 7, 2016

Patient engagement is an essential component of safe, appropriate, high quality healthcare. But what do we mean by patient engagement and how does it relate to patients’ experience of care?

A recent report published by the National Patient Safety Foundation (NPSF) notes that most definitions of patient engagement include the common themes of "partnership, communication, information exchange and respect.”

The Beryl Institute defines patient experience as "the sum of all interactions, shaped by an organization’s culture, that influence patient perceptions across the continuum of care.”

There are overlaps between patient experience of care and patient engagement. If patients are not respected as partners in their care and if clinicians do communicate with patients effectively, then it is highly unlikely that the patient’s experience will be a positive one. Moreover, research has linked patient experience to clinical outcomes, with a 2013 paper finding "patient experience is positively associated with clinical effectiveness and patient safety and [data] support the case for the inclusion of patient experience as one of the central pillars of quality in healthcare.”

The NPSF report, Free from Harm: Accelerating Patient Safety Improvement Fifteen Years after To Err Is Human, makes a number of recommendations for improving patient engagement to improve patient safety:

  • Training and education: Clinicians and health professionals need to be educated about concepts such as shared decision making, health literacy, cultural sensitivity and respect.
  • Ease of access to information: Patients and families need timely access to medical records, test results and tools and resources that help them understand complex medical information.
  • Patient representation: Members of the community served by a healthcare organization should be represented on the governing bodies and committees of those organizations. Only by such representation can we ensure that safety and quality initiatives and care processes that affect patient experience are designed with patients in mind.
  • Tools and strategies: From including families in bedside rounding to the use of tools like the Ask Me 3 program, which encourages patients to ask key questions about their health and care plans, there are tools and strategies that can help engage patients and improve their experience of care.
  • Reporting and measuring: The Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) serves to measure, to a degree, a patient’s experience of care while hospitalized. We also need ways to measure patient engagement, including ways to capture patient reports of safety lapses.

Arguing for greater patient and family engagement is not new to NPSF, and is in fact an issue that we and others have been advocating for some time now. While educational efforts such as the Agency for Healthcare Research and Quality’s Questions are the Answer campaign are useful for patients and consumers, we also know that even experienced health professionals sometimes have trouble speaking up when put in the vulnerable position of patient.

While patients should be encouraged to be full partners in their care, their clinicians are the ones who really hold the key to making that possible.

Improving patient and family engagement is one of eight recommendations in the new NPSF report, which is a focal point of Patient Safety Awareness Week, March 13-19, 2016. The theme of the week this year is United for Patient Safety, a reflection of the belief that clinicians, patients, policy makers, researchers and everyone involved in healthcare must be part of making care safer for everyone.

 

Tejal K. Gandhi, MD, MPH, CPPS, is President and Chief Executive Officer of the National Patient Safety Foundation, the NPSF Lucian Leape Institute and the Certification Board for Professionals in Patient Safety. She is advocating for patient safety at the national level, driving educational and professional certification efforts, and helping to create and spread innovative new safety ideas.

Tags:  healthcare  patient and family engagement  patient engagement  patient safety  research  service excellence 

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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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