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Case Studies provide real stories of current efforts, including programs being initiated, practices being implemented, and outcomes being targeted and/or achieved. Case studies are presented as both an opportunity for learning from others as well as a spark for further ideas on how we work to improve the patient experience.
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A Journey of Cultural Transformation:
Engaging the Hearts of Teams and Leaders to Elevate the Experience
What was the challenge, opportunity or issue faced?
The following case study from The University of Chicago Medicine (UChicago Medicine) illustrates how this institution capitalized on their people as their biggest asset. Valuing their people (clinical and non-clinical alike), engaging them in experiences that reconnects them to purposeful and meaningful interactions, identifying and leveraging their strengths and acknowledging their capacity to change a world is the catalyst which fuels transformational change to cultivate a palpable culture of caring. Grounded in this notion of changing a world, not the world, UChicago Medicine set out to change - a world of one person, one colleague, one team, and one patient at a time.
At UChicago Medicine, this bold decision to invest efforts to find joy and meaningfulness in the work we do, was realized with invitations to clinical and non-clinical teams to participate in a program called The hArt of Medicine®. This case study will highlight how this appreciative, strengths-based approach, engaged, encouraged and enabled individuals to not only appreciate their individual magnificence and impact in caring for others, but cultivated a culture where caring, exceptional experiences occur for patients and families.
UChicago Medicine has a reputation as a leading institution in innovative research and science and recognized a distinct opportunity to elevate the quality of the care experience to the caliber of our research and scientific discoveries. The patient voice captured through patient satisfaction surveys indicated significant opportunities to enhance the experience for our patients and families. A common thread of top correlators to overall rating of care was how staff worked well together. With a focus on this indicator, the UChicago Medicine's Patient Experience and Engagement Program (PEEP) team, and with strong support from executive leadership, shifted their attention to engaging clinical and non-clinical staff into meaningful care experiences and positively reinforcing individual strengths as a key driver of exceptional patient experiences.
What did you do to address it?
Energized to leverage individual and teams' strengths, caregivers and non-clinical staff were invited to participate in The hArt of Medicine Program. Grounded in evidence based research, the program provides a practical approach to bringing awareness and meaning to the individual's actions, attitudes and behaviors that promote consistent, respectful, trusting, empathic, therapeutic encounters and cultivate a caring culture.
Moving beyond the conventional practices of training and auditing communication skills, UChicago Medicine embarked on a three-phased approach to continuously evolve and engage leaders and teams.
The first phase, Connect and Equip, connects participants to what is meaningful and purposeful to them in caring for others. Much time is taken to explore why they went into healthcare and what brings them joy. This exercise begins to put meaning back into their clinical lives and day to day activities. It begins the awareness that leads to shifting from a task driven environment to one that is meaningful and fulfilling to them. As the participants share together, expert hArt Hug Coaches are 'holding up the mirror' to them - highlighting their most magnificent, unselfish choice they make in caring for others, connecting them back to what they imagined when they made the choice to be a doctor, nurse, tech, medical assistant, etc.
This search for meaningfulness continues as the coach asks staff, providers and leaders to collectively draw what a positive patient experience looks like. Drawing the picture ignites their emotions and causes them to create a story together. This magical exercise brings clarity to not only what the patient experience looks like, but how they create it. Because they do it together, the teams feel connected, and discover that they are more alike than they are unalike.
Skills in empathy, communication and building therapeutic relationships are also reviewed and developed to equip each participant in understanding and adopting effective communication practices. The coaches observe individuals at the bedside, and play a key role in bringing awareness to and positively reinforcing those actions, attitudes and behaviors that support consistent, positive human experiences.
Operationalize and Perform, the second phase of the program, is crucial to integrating these practices and way of BEING into the day to day operations. Huddles, Rounding and Leadership Forums begin to shift from drawing attention to what's not working, to acknowledging and positively reinforcing those behaviors that support a caring culture. At the core of this phase is a unique track for leaders to 'Lead hArtfully'. Leaders are invited to cultivate a caring culture by discovering the best in people. Leaders begin exploring what caring leaders 'look like', and are enlightened in their discovery that these same actions, qualities and strengths are those we are asking of staff and providers in caring for patients. They are then invited to set an intention to 'turn their observers on' to notice and acknowledge those specific actions, attitudes and behaviors that positively impact patients and reinforce these using a strengths-based framework.
hArt Hug coaches, again play a critical role in operationalizing and cultivating these actions, attitudes and behaviors, supporting and developing leaders to bring awareness of the presence of these to their staff and reinforcing the positive impact they have in creating meaningful caring interactions.
Culturalize and Evolve is the third phase and is essential to weaving actions, attitudes and behaviors into the fabric of the culture. Purposeful partnerships within Operational Excellence and Talent & Organizational Capabilities (e.g. Lean Management Principles, Standardized Work and New Hire Orientations) helped to create a scalable, integrated and consistent deployment across UChicago Medicine's E3 Leadership model (Engage, Evolve, Excel).
Crucial to the effectiveness of this endeavor, and to support the momentum and growth of the program, UChicago Medicine developed an internal coaches program. Coaches not only deliver the workshops and provide internal coaching support, but expand the knowledge, expertise and coaching competencies across the enterprise. The coaches program has over 20 coaches, skilled in coaching principles and practices, observational coaching, and bringing awareness to individual strengths to support, develop and encourage the integration of those actions, attitudes, and behaviors into the fabric of the organization.
What outcomes were achieved?
Two years from the introduction of this program, more than 25 departments are engaged in the phased-approach. Executive leaders have participated together and with their individual teams in Leading hArtfully™ workshops. Most notably is that many of the departments engaged in this cultural transformation have asked the PEEPs team to bring the program to their departments (vs. mandating participation) echoing the value and organizational readiness of this cultural shift. 'Turn Your Observer On', 'Change a World Moments', 'Leading hArtfully' and new 'Ways of BEING', are now part of the lexicon and language within UChicago Medicine.
Increases in patient experience scores are seen across most departments, substantiating the importance of cultivating a caring culture alongside specific process and performance patient experience initiatives. In particular, the Adult Emergency department witnessed a statistically significant increase in the composite score of courtesy of the nurses, when the patient has been seen by at least one nurse who has completed the program.
Directly related to the workshops themselves, we see statistically significant increases in the Pre and Post Surveys that are distributed. Surveys are taken to gauge the shifts in both skill development and cultural change. Within the skill development area, participants 'know what communication techniques help to create positive patient experiences', and understand that 'empathy is a skill'. Post workshop culture shifts are seen in the participants' awareness of and participation in, creating their current work environment, noting that their 'attitude and conversation is generally positive', they 'have a sense of personal accomplishment', and most notably, they 'have the time needed to create positive experiences'.
Employee engagement scores have also improved. Lastly, what we believe to be an essential ingredient to this improvement, is the enlightened awareness our leaders (now) have in their ability to create and influence caring cultures that create exceptional experiences for everyone - one person, one colleague, one team and one patient at a time.
"… now I see that I can influence patient care by caring for my staff… I take notice of the exceptional work that we do, the powerful impact that we have on our patients and the change a world moments happening every day"
- Nurse Manager
"I realized that as a leader that I couldn't continue to 'wish' for these changes to emerge, but that I had to adopt and practice a new way of leading"
- Department Director
"We are now a unified team that trusts each other with improved engagement and satisfaction at all levels."
- Physician Leader
"The adoption of the program shined a light on where we need to focus on our culture to create change a world moments for both patients and our caregivers. This is truly reflected in not what we do, but WHO we are BEING."
- Chief Experience Officer
About UChicago Medicine
More than a century of groundbreaking research and innovation, UChicago Medicine is embedded in the University of Chicago campus in Chicago's Hyde Park neighborhood. UChicago Medicine is a private, not for profit academic health system with 4 inpatient facilities, over 1200 licensed beds, 43 operating rooms and 8 ambulatory care facilities serves patients worldwide. All of these contributions work to bring life to our mission, which is to provide superior health care in a compassionate manner, ever mindful of each patient's dignity and individuality. To accomplish our mission, we call upon the skills and expertise of all who work together to advance medical innovation, serve the health needs of the community, and further the knowledge of those dedicated to caring.
About The hArt of Medicine®
The hArt of Medicine® is designed to create personal, human and effective interactions that foster an organizational culture where exceptional experiences occur. Grounded in evidence based research, The hArt of Medicine®, utilizes an appreciative, strengths-based coaching approach to facilitating change. The program framework provides a methodology and practical approach which brings awareness and meaning to the individual's actions, attitudes and behaviors that promote consistent, respectful, trusting, empathic, therapeutic encounters, and cultivate a caring culture. The program begins by re-connecting participants to what is meaningful and purposeful to them, and equipping them with tools, skills and experiences that support positive therapeutic interactions. Workshops, observational coaching and operational integration strategies are structured to draw attention to the participant's personal strengths and unique qualities that support caring human experiences. For more information visit www.hartofmedicine.com