Katie Owens - Healthcare Speaker and Executive Coach

Lead Author, The HCAHPS Imperative for Patient-Centered Excellence

What are your patient experience superpowers?

In Healthcare, we are braver, stronger, smarter, and more resilient than we give ourselves credit for being. Each day patients are counting on us across the continuum of care not just to deliver exceptional care but also to create a patient experience filled with compassion, dignity, and respect. Some days we may wish we had superpowers.

As caregivers, we do possess some essential superpowers:

To heal

To comfort

To empathize

To inspire hope

To give confidence

Sometimes our superpowers are temporarily hidden by negativity, self-doubt, or sheer distraction. Yet, they exist deep within us as caregivers and can return at any time, given supportive conditions. On the other hand, sometimes our superpowers come so naturally to us we don’t realize our own gifts, or we discredit the magnitude of our strengths.

The reality is that most people do not have the same superpowers as you do, which makes you uniquely qualified to deliver exceptional patient experiences.

New research indicates we need to put these superpowers to good work. According to an article written by Austin Frakt from the New York Times, “A hospital with patient experience scores that are 10 percentage points higher (e.g., 70 percent of patients satisfied vs 60 percent) has a mortality rate that is 2.8% lower and a 30-day readmission rate that is 1.9 percentage points lower”.

Let’s take a pause and reflect on your gifts and find ways to feed your energy:

  • When was a time you interacted with a patient, a family member, or a colleague when you felt amazing?
  • What personal attributes have set the stage for your greatest successes in life to date?
  • How do you pull yourself back up again after a disappointment or a setback?
  • Who in your circle builds your confidence and reinforces your greatness?
  • Who can be your mentor to increase your confidence in areas where you feel timid?

Let’s be those superhero agents of change to combat anything that gets in the way of our efforts and to build up ours’ and each other’s superpowers every day!

Culture Matters in Today’s Healthcare Environment

When talking about healthcare, what is culture? It can consist of many different elements in healthcare. From the way things are done in the organization to relationships among people that dictate how they behave. It also includes 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 any organization.

Despite the fact that many people have the conviction that organizational culture will either enable an organization’s success or serve as a barrier to achieving outcomes, broaching the subject can cause leaders or frontline team members to shy away. Culture can feel messy, hard, and inconvenient. We may be proud of some aspects of our it 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 demonstrating that culture does impact outcomes. The two big learnings we had are:

1. 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. In other words, culture is not “nice to have” but critical to create demonstrable outcomes.

2. 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 likely to support achievement of outcomes:

  • Employees who treat patients as valued customers
  • Employees whose values are very similar to the values of the organization
  • Employees who feel that being a member of the organization is very rewarding
  • Employees who are proud to be a part of the organization

There is no question healthcare leaders, staff, and physicians are persevering every day to provide the best care to patients despite myriad challenges. 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 their cultures and actively steer workforce engagement to create employee pride, a focus on the customer, and shared values.

Visit Katie’s blog on The Culture Imperative.

The Imperative of Culture

There is no doubt that we work in an industry filled with challenges to overcome. However, throughout my career working with America’s hospitals and health systems, I have found that organizations make the most progress focusing on building up strengths and then closing gaps with areas that are not working well. Time and time again, our culture can rise to the occasion to let our best and brightest team members bring our mission forward to assure patients receive the very best care possible.

Have you ever wondered how you can leverage your culture to achieve better results? Recently our team at HealthStream was inspired to conduct an empirical study of the impact of culture on key performance outcomes. With so much uncertainty in healthcare today, we wanted to test the value of high performing cultures create for their patients, employees, and providers. In particular, we wanted to assess the attributes of culture that equip organizations to achieve great outcomes. Our study was published this month in the Journal of Healthcare Leadership.  I hope you will take a moment to read about the study.

Four Lessons United Airlines Can Teach on the Importance of Person-Centered Communication in Healthcare

Effective communication is always determined in retrospect.

Communication is usually determined through the rear-view mirror. Did our town hall convey the tone and vision intended? Did the patient understand not only the importance of taking their medications but the instructions for following correct dosage? Did the employee hear the difficult feedback in a way that will lead to constructive outcomes? My belief is that every United Airlines team member had the best intentions when following their protocol. However, they missed the mark in that trust and relationships are the foundations of communication.

Despite our best intentions, good communication happens through the eyes of the beholder(s).

We may believe we are good communicators but do our recipients of the message agree? While Stephen Covey famously said, “We judge ourselves by our intentions and others by their behaviors,” we need to remember that United Airlines flipped this scenario. These employees and leaders, while following the integrity of their policy, neglected to account for how passengers, the media and consumers at large would judge their behaviors. Real-time video has allowed us to get a glimpse into a precarious situation. We need to remember that we are always on stage in this virtual age. Are our actions always displaying trust and respect for our patients, their loved ones and our visitors? While our missions should prohibit us from ever “re-accommodating” a patient, chances are we use words that could inadvertently leave a negative mark on the healthcare community.

We must pick ourselves back up off the floor (sometimes more often than we’d like to admit).

Even the pros mess up. United Airlines CEO, Oscar Munoz, has a reputation for being an effective communicator and feel confident their airline is made up of hard-working, well-intentioned employees. Negative things happen in travel and in healthcare. More important than the gaffe itself, are the demonstrable steps organizations and individuals take to persevere afterwards.

Think this can only happen to United Airlines? Think again.

We operate 24/7, every day of each year. Our patients and their loved ones can now share good, bad and shocking information with a snap of a mobile device. In our work, we have found it essential to establish person-centeredness as an integral value and a communication competency that needs to be cultivated by every individual who wears a badge in your organization. We recommend two proven models: Language of Caring’s Heart-Head-Heart for person-centered communication and HealthStream’s RELATE for person-centered behaviors. Seek out opportunities to institute deliberate practice and cultivate communication competencies for not just regular daily needs but simulate crisis scenarios.

Consider using two criteria: are my words and actions building trust? Am I displaying caring and compassion? At the end of the day, every person we encounter gives us the opportunity to display trust, respect, and compassion. We need to be ever more vigilant when we feel we are sliding into territory that could lead to irrevocable circumstances.

Creating Employee Joy: Best Practices for Employee Engagement

Jim Eggers and I have recently been immersed in uncovering findings for our HealthStream National Benchmarking Study on Healthcare Employee Engagement. We analyzed responses from over 250,000 leaders, staff, and physicians. In my last HealthStream blog titled, “Making a Difference in Healthcare Employee Engagement,” I shared results relative to the stagnation of employee engagement (e.g., no positive or negative progression with national norms), disparities between leadership and staff engagement, and strategies to create engagement based on our key drivers. As we look at the dynamics of healthcare, it can ask one to question, “Does joy still matter today?”

To me, the question comes back to, “Do our patients and their loved ones deserve to encounter employees and providers who are engaged and find meaning (dare I say joy) in their work?” The answer is yes. To that end, my goal is to focus on sharing learnings from our study that will help leaders change the status quo.

We know from our research that:

  • Daytime employees are more engaged than night and evening employees with their organization. (3.26 vs 3.21 and 3.10 respectively)
  • The first six months is the peak of employee engagement. Engagement falls steeply over the first five years of employment.
  • Groups that experience the lowest intent to stay include nurses and millennials.

I had the chance to present our findings to more than 150 attendees on a recent Healthstream webinar. Our goal was to discuss how we can create employee joy based on what we learned during our benchmarking study. Interestingly, when I asked respondents to share barriers to creating joy, I received some of the following responses summarized by this word cloud. Additionally, some of the direct feedback included:

  • Workload, stress level, and reward (is the pay adequate for the amount of work)
  • Staff burnout, uneven workload, and communication
  • Being so busy that there is never any downtime, having a supervisor who doesn’t acknowledge anything positive that you do, not allowing staff to pursue their special interests (as appropriate within the organization)
  • Negative attitudes and being short staffed
  • Distrust, negativity, fear, and lack of engagement

 

Employee Barriers

Webinar Poll: What are barriers to creating joy?

To be quite candid, I was heartbroken to see these responses. Healthcare leaders, employees, and providers are some of the most talented and hardworking individuals. Their skillsets and compassion literally save lives every day.

After we discussed the barriers, I shared strategies to turn the tables and create more joy. After all, there is no denying we work hard in healthcare. There are good days and bad days. We have to be emotionally honest about the demands of our careers. Yet, there are steps that leaders and individuals can take to make a positive difference. To that end, I closed out the webinar by asking participants to share one step they can take to create more joy. While I was clearly saddened by the barriers, I was beyond encouraged to see the takeaways of participants.

Responses to ways to create more joy included:

  • Follow up – let employees know you are listening to them.  Show empathy especially during stressful times.
  • Conduct town hall meetings and focus on answering the whys. Senior leadership — presenting achievements and the how/why it makes a difference for the employees and patients.
  • Utilize the RELATE model with managers and encourage them to use it with their staff.  Provide senior rounding more often including all departments.
  • Positive feedback.  Staying positive in spite of circumstances.  Thanking the staff for what they do. 
  • Personal accountability for creating daily joy… Be the reason someone smiles today.  It’s about the relationship!
Creating Employee Joy

Webinar Poll: What is one step you can take to create more workplace joy?

Recognition, Communication, Listening, Rounding and R.E.L.A.T.E. (HealthStream’s people-centered communication model) are all budget neutral items. You can appreciate someone despite being short staffed. We can encourage each other and listen when we are having a personal bad day. Let’s take a stand together to make a positive difference for ourselves and our colleagues. I am confident we can cultivate these steps and remember that through each of our hands, every patient is counting on us to be our best and engaged.

Download a copy of our Benchmark Report: 2016 Employee Engagement in Healthcare here.

 

Compassion is a Human Mandate

This week I had two humbling opportunities to contribute to the national patient experience dialogue and share deep convictions for compassion in health care. Gregg Loughman, General Manager & Vice President of PX Solutions at HealthStream, and I presented a webinar series, hosted by The Beryl Institute, on the CAHPS Imperative for Patient-Centered Care. I also had the honor to travel to New York City for an interview with CBS News to discuss the impact of surveys in improving the patient experience.

  1. By Establishing the Consumer Assessment of Healthcare Providers and Systems (CAHPS) Survey, Centers for Medicare and Medicaid Services (CMS) took bold and progressive steps to spark a conversation about the importance of every patient having a voice in the quality of care received. Until that point, the patient experience was considered a “nice to do” and now the patient experience is among the top priorities for healthcare executives, staff and providers.
  2. Whether you love or hate any patient experience survey, they have been designed by patients and their loved ones to convey the behaviors that reflect quality care. There is no doubt that working to achieve the level that “Always” or “Best Possible Hospital” requires; however most times we would want those same criteria for our loved ones. We cannot have two separate standards for what we would want and what we provide.
  3. The CAHPS Surveys were never designed for organizations and caregivers to chase scores or penalize. They were created to capture feedback on the total health care experience and give data to help develop competencies that lead to safer, higher quality care. The feedback creates opportunities to celebrate the best in our organizations and improve reliability at the bedside.

Recent research that I have had the opportunity to conduct has demonstrated that high performing cultures lead to a more engaged workforce, better patient experience performance, lower turnover rates and more favorable performance with value-based care measures. I encourage everyone to take the CAHPS Survey that most applies to their work area. Take the survey from the shoes, slippers and gowns of your patients. Use this as an opportunity to talk about why the patient experience matters in your organization. To me, the government never needed to mandate compassion but their progressive steps created recognition that compassion is a human imperative- every person, every time.

Surveys on patient experience

 

Urgency to repeal the Affordable Care Act: an amygdala hijack?

How healthcare leaders can stay focused

I have worked in healthcare for nearly 20 years, from the bedside to various leadership roles. Today, people are receiving care across America’s hospitals and health systems. They are going through the most gut-wrenching situations anyone can imagine or experiencing anxiety that can accompany even the most joyful circumstances. For these individual’s, their sole line of support are the nurses, physicians and staff treating and caring for them at the bedside (and by degrees of separation the leaders who guide the organization).

Repealing the Affordable Care Act without a better replacement feels like a decision driven by an amygdala hijack (when our caveman/woman brain takes over in an immediate visceral response that is blown out of proportion and we lose self-control) versus an approach that carefully and respectfully considers the impact on our citizens.

As JoAnn Volk so eloquently articulates in the January Health Affairs blog, an immediate repeal of the Affordable Care Act would impact immediately 22.5 million people (who are mothers, fathers, sons and daughters), jeopardize access to preventative services, ability for anyone who has a pre-existing condition to receive healthcare (e.g., you need to switch insurance and you have type 2 diabetes or persistent back pain and become out of luck), dependent coverage to age 26 (our children who are getting a start in life), the annual out of pocket and lifetime limits (that caps our risk and ability to secure our families economically) and external review for quality control.

It is undeniable that the task of reforming American healthcare is wrought with multiple stakeholder groups from insurers, providers, patients, pharmaceuticals and more. The writing is on the wall that we are heading into another round of significant industry changes. My hope is that we proceed with a thoughtful approach that acknowledges the complexity and magnitude of what is at stake. For leaders, as we head into uncertainty, it is more important than ever before to keep our teams focused on what they can make a direct impact on; the quality of care provided each day. It is so easy to become distracted when healthcare is the headline and the center of a political hurricane.

Healthcare employees want to make a difference. They have been called to our profession out of a sense of purpose. Each day we are fiercely working to improve quality and assure patients have the best experiences under our care. Much emphasis to improve has come from value-based purchasing and the HCAHPS program in particular. Yet, it occurred to me recently that government should have never had to enforce compassionate care. Yet, we still live in a country where only 71% of patients can say they received care at the best possible hospital. Seventy-one percent is not good enough. Every patient deserves the best care possible.

As we head into another round of legislative actions to create a next generation model, can we collectively hit the pause button and stop pointing fingers and start empathizing with one another? Put ourselves in the shoes of administrators and vice versa where administrators put themselves in the shoes of front line caregivers. And for goodness sake, let’s all put ourselves in the crutches, slippers and gowns of our patients. Maybe then we can step back and gain perspective that as human beings we all deserve compassion and care from our healthcare providers and each other. Let’s create more joy and connection to purpose each day. I bet we will all feel better when our day and shift ends.

To help your organization to remain focused and engaged, contact Katie to speak at your next event.

20 New Year Tips to Help You Elevate the Patient Experience in a More Efficient and Effective Manner

With 2016 coming to a close, I thought I would include 20 tips for 2017 to help elevate the patient experience in a more efficient and effective manner. I like to call it #PXHACKS!

Wishing you a happy New Year that will bring you greater heights of success and prosperity.  -Katie

  1. Ask your team what made them feel most reassured when they have been a patient. Rate your department on those criteria.
  2. Set a measurable, time-bound patient experience department goal. Strive to achieve a target that links to your organizational goal.
  3. Ask your staff to take Patient Experience Survey most related to their work environment. Educate how patients hold us accountable
  4. Create a list of Zero Tolerance words (short staffed). Engage your team to turn negative words into reassurance.
  5. Engage high achievers as champions in Patient Experience journey-those motivated & passionate- let them create momentum with you.
  6. We are always onstage with the Always Patient Experience-Compassion, Verbal, Non-verbal Cues.
  7. Upon visit, have admissions ask patients and families what is most important for their care. Use whiteboard to document.
  8. You are empowered. If you see trash pick it up, greet colleagues, patient and families with eye contact and a hello.
  9. Sit at eye level when communicating important information.
  10. Narrate your care and process. Never assume patients and families understand what you are doing and why.
  11. Always reinforce your patients and their families are in good hands with you and your organization.
  12. RELATE w/ every patient: Reassure, Explain, Listen, Answer, Take Action & Narrate Care, Express Appreciation.
  13. Block 30 minutes every week to walk in the shoes/crutches of your patients. See & feel patient experience from their perspective.
  14. Set Expectations early and often. Remember every person in your care is not used to the role of patient.
  15. Reward & recognize employees for going above & beyond for Patient Experience. No one ever feels over recognized at the end of each week.
  16. Give staff feedback about their performance. Share Survey results, patient experience comments and rounding feedback.
  17. Seek patient and family feedback when implementing programs. Let the voice of your healthcare community guide you.
  18. We miss the mark with Hourly Rounding & Bedside Report. It is not about the checklist or task but patient engagement and empowerment.
  19. Go on a ‘gurney journey’ to empathize with your patients and design improvements.
  20. Establish PX competencies for individuals who wear badges across the care Train and validate behavior.

What are your 2017 #PXHACKS (Patient Experience) Tips? Send me your feedback. If you enjoyed this post you may also like the article titled, “Can We Afford to Stay in Our Lanes to Achieve Patient Experience Excellence?”

 

Make Time to Stay Engaged this Holiday Season

It’s hard to believe that 2016 is almost over. With the holiday season upon us and the hustle and bustle of getting it “all done,” it’s easy to focus on the areas that aren’t working and the times we feel we are less than perfect. In our busyness, we can soon forget the moments that bring us joy. We should all be still for a moment and be reminded of why our professions in healthcare are so profound. Two influences impacted my focus for this November blog: a lunch outing with my family and a recent interview I had with Win Howard, CEO Asante Three Rivers Medical Center.

My family recently visited one of our favorite waterfront restaurants on Fort Walton Beach, The Gulf. While trying to enjoy my lunch I was also entertaining my rambunctious four-year-old son when suddenly I was captivated by a sign that steered my attention.

Win Howard

So many times, I hear leaders, staff, and providers experiencing burnout…overwhelmed with the “to do”s, frustrated by the growing documentation and protocols, the heightened emotions faced with the rising expectations of patient care. Yet, in my experience, the best days we have are when we can look back on any given day and see the good that happened and that we were able to share with those we touched. What I love about this message is we get to choose… We get to decide each day how we want to spend 1440 minutes in 24 hours. Do we want to spend it doing good for others or live in frustration and anguish? I bet for all of us who have been patients or loved ones of patients, we want every single person to be engaged and focused on making our experience one filled with compassion and high-quality care.

We found in our HealthStream Benchmarking Study on healthcare workforce engagement, that leaders are three times more engaged than their direct reports. We have to find ways to create daily inspiration and reconnect our teams to purpose. Here are a few ideas to create engagement despite our distractions.

Put excellence on a pedestal

Seek out what is working well. Begin each staff meeting with thanksgiving, reward, and recognition. Ask team members about moments made them proud. Ask patients what has made their visit or stay excellent. Get specific details so you can share with your team. There are plenty of times to address areas of improvement for quality, patient experience, and financial performance. Try your best to create environments where you build on your bright spots while you close gaps in other areas.

Obtain and share stories

In my interview with Win Howard, Win talks about the profound experiences that have impacted his leadership in creating a more patient-centered culture at Asante. Win is an accomplished CEO with high levels of employee engagement and patient experience outcomes, designations for patient quality, yet when he speaks about the moments that have created the most memorable experiences, they are ones of care and compassion- especially at the most difficult times.

Create visual cues and contagious experiences

Keeping focused amidst distraction requires attention, yet when you enlist others you get a contagious movement. Enlist your teams to have compassionate scavenger hunts. Take pictures using your mobile device to bring back examples from your daily activities or life outside of work (of course in compliance with your digital and social technology policies).

As we move into the last month of the year, let’s make demonstrable gains to restore engagement and put the culture we want at the forefront. There is no time to wait until this becomes a New Year’s resolution.

To request the full report of HealthStream’s Benchmarking Study please visit my contact page.

 

Can We Afford to Stay in Our Lanes to Achieve Patient Experience Excellence?

As I was driving to the Nashville airport after a successful week at HealthStream Summit I saw a traffic sign that read, “Stay in Your Lane.” It caused me to reflect on how often we inadvertently give messages to our best and brightest talent to keep their eyes focused on the road ahead and not to waver. Looking at my own career and experiences, the most memorable moments, achievements or sources of support came from those chances to go above and beyond or be on the receiving end of an individual willing to go the extra mile. Can we afford to stay in our lanes to achieve patient experience excellence?

The Patient Experience

When it comes to the patient experience, there is not a person in our care that wants us to deliver a checklist, only do our job. They want to know they are our biggest priority- they want to trust us that in their moment of need, we will not stay in our lanes- we will unapologetically go above and beyond for them. We will be brave to speak out in the event we see an error, pray with them when they are scared or losing hope, comfort their loved ones and sit at their bedside just a moment longer.

The realities we face in our day to day grind can sometimes cause us to lose perspective. My dear colleague Kathy Boswell, Director of Organizational Development at Brookwood Baptist Health, shared; as leaders if our employees do not see us at our best, how can we expect each patient to see us at our best. Kathy reminded me that we are always on stage.

I was asked to be the opening keynote at our Patient Experience Workshop (attended by a group of national leaders who are passionate about every patient receiving the best care possible) and decided to poll the standing room only crowd. I wanted to know what actions or behaviors made them feel most reassured when they were a patient. The results (below) were compelling… When we are a patient, we want confident employees, communication, and eye contact. None of these require a capital investment. We are all called to re-sensitize the powerful role we play each day as soon as we put on our badge. It’s time to take action! I challenge you to stand up and stand out among your colleagues. Lead by example and BE the difference in the lives of your patients.

Stay in Your Lane

Let us not get distracted by the grind, our glance time, our productivity and forget that every patient deserves our very best. We can’t have a different standard between what we would want for ourselves or our loved ones and what we want for our patients. Do you think we can afford to stay in our lanes to achieve patient experience excellence? Let me know your thoughts by leaving a comment.

If you enjoyed this article you may be interested in “20 Tips to Help Elevate the Patient  Experience in a More Efficient and Effective Manner.”

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