Katie Owens - Healthcare Speaker and Executive Coach

Lead Author, The HCAHPS Imperative for Patient-Centered Excellence

Category: Transforming Care

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.

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.

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.”

HCAHPS: An Asset or Liability for Recruiting and Retaining the Best Workforce?

HCAHPS scores are a recruitment issue, as well as a clinical issue.

At the heart of many healthcare organizations’ mission statements is an imperative to place the patient at the center of our work. Either directly or indirectly stated, the quality of the patient experience (both clinical quality and patient’s perceptions of care and service) is paramount to why many organizations exist. The Hospital Consumer Assessment of Healthcare Providers and Systems Survey (HCAHPS) has become the standard by which we evaluate excellence in the patient experience.

At face value, the HCAHPS survey is 32 questions measuring patient perceptions of care across seven dimensions, two individual items and two overall items (of which all are publicly reported on HospitalCompare.hss.gov). Each day, more than 8,400 patients complete the HCAHPS survey and give feedback on the quality of their experience (Lehrman & Goldstein, 2013). Our health systems and workforce are currently in the second year of accountability for performance, based on Value-based Purchasing where HCAHPS represents 30% of the Total Performance Score.

In April 2015, Centers for Medicare and Medicaid (CMS) will be adding a five-star rating to simplify consumer understanding of performance and “spotlight excellence in healthcare quality”(HCAHPS, 2015).

With growing simplicity in transparency, there is a heightened need for constant vigilance on HCAHPS as a magnet to attract and retain the very best. Our coaches work with hospitals and health systems to create cultures of excellence where everyone in the workforce is mission critical, from the boardroom to the bedside. This article will help you leverage HCAHPS to support attracting, selecting, and retaining talent.

FIRST IMPRESSIONS: ATTRACTING THE BEST POSSIBLE CANDIDATES

In a world where our patient experience scores are readily available and our applicant pools have myriad means to research our organizations to make their employment decisions, some key questions emerge, such as: Why should a candidate choose your organization over a competitor? And, do your HCAHPS scores tell a positive story about your commitment to patient-centered excellence or a negative one?

According to a 2013 CareerBuilders survey, reputation is incredibly important to job-seeking candidates. This study found that candidates would be willing to accept a lower salary if the employer made a great impression during the hiring process and that the employer’s brand plays an integral role in their decision (CareerBuilder, 2013).

It is important to evaluate your organization’s unique proposition of excellence, and HCAHPS data can be an incredibly valuable validation of your accomplishments. As a resource, how well are your recruitment assets aligned to tout your HCAHPS commitment?

chart-hcahps-an-asset-or-liability-for-recruiting-and-retaining

SELECTING THE RIGHT PLAYERS

While most would agree it is critical to select individuals that reflect the organization’s commitment to patient-centered excellence, all too often selection is rushed to fill vacancies. Anyone who has ever made a bad hire knows that the impact can be damaging on so many levels.

Selection should be rigorous, so each employee can be engaged and empowered to make a difference (and ultimately be set up for success in the organization). Your selection process determines the candidates and, ultimately, hires that will be entrusted to care for your patients. The goal should be to narrow your organizational “front door” so that only those who embody your values and commitment to excellence can walk through. The following are proven strategies to elevate your selection process:

Standards of Performance

Standards are the behavioral expectations for all leaders, staff, and physicians that demonstrate your organizational values in action. Creating emphasis on your standards is an integral link to the “Always” experience HCAHPS requires. Many of our clients require all applicants to sign a commitment statement to their Standards of Performance as a component of the job application.

Behavioral-Based Interviewing

Behavioral-based interview (BBI) questions are a powerful inquiry tool to allow the hiring manager to evaluate past behavior (successes and failures) of the interviewee. Our experience is that BBIs can be a powerful lever to ensure that new employees already possess the behaviors necessary to achieve HCAHPS goals, particularly the communication skills that are part of most of the HCAHPS dimensions. These examples from our HealthStream Coaching Library can be used to elevate selection techniques:
• Tell me how you help your patients understand your responsiveness to their needs (e.g., call-light response, bathroom, personal needs).
• Tell me about a time when you had to work with a team to improve your HCAHPS scores.
• Describe a challenge you have had to overcome with physician communication.
• Tell me how you have engaged your staff to improve nurse communication.
• Give me an example of how you have involved non-clinical teams in the patient experience.

It is so important for hiring managers to practice active listening during the interview process. BBIs will reveal rich background information on each candidate; however, the onus is on the interviewer to ask probing follow-up questions. Some commonly asked follow-up questions include:
• What was the first key thing that you did?
• How did you determine the strengths and weaknesses of that approach?
• What was the outcome of the situation?

Peer Interviewing

Peer Interviewing is a selection process where high-performing team members are allowed to evaluate job candidates and assist the manager in the candidate selection process. Involving peers creates further validation for the hiring manager, builds early rapport with candidates, and creates peer investment for a new hire’s success.

The most successful peer interviewing programs are planned and launched to equip the peer interviewers to successfully recommend the best candidates to hire. Peer interviewing can create an integral link to hiring those most aligned with your HCAHPS expectations and aspirations. Preparing peer interviewers to ask HCAHPS-related questions and to share the organization’s commitment to patient-centered excellence creates clear expectations to the job applicants.

ONBOARDING AND RETAINING YOUR TALENT

Now that they are hired, how do we garner their full engagement and get these employees to stay? Retention needs to be a constant focus that begins on day one. Every employee needs to know their contributions to the patient experience and how they can impact HCAHPS.

Orientation

Bringing new leaders, staff, and physicians up to speed on the organization’s commitment to service, HCAHPS, and the patient experience sets clear expectations and accountabilities from day one at orientation. Organizational and departmental orientation should include:
• education on the importance of HCAHPS,
• the survey tools used to measure the patient experience,
• how to access patient experience results and key reports,
• organizational and departmental goals for HCAHPS improvement, and
• tools and resources to improve HCAHPS scores.

The First 90 Days

Our coaching teams recommend adopting 30-, 60- and 90-day meetings as an integral onboarding process to engage new team members and validate their progress.

During 30/60/90-day meetings, leaders can engage their new hires to assure the promise of the job equated to the reality, solicit ideas for improvement, and further engagement and enthusiasm for the organization’s success. Maintaining congruency with HCAHPS is important during these discussions. The leader can (and should) reinforce commitment to the patient experience, maintain accountability for “Always,” share recognition, and ask for the employee’s fresh perspective to improve service and operations.

Equally important to layering learning for new team members is the team that will support successful onboarding. HCAHPS performance and patient comments can be a valuable lens to identify employees that can be role models and/or preceptors for other new leaders, employees, and physicians.

There are endless reasons to make HCAHPS a priority in your organization. In this churning and evolving healthcare environment, leaders are more challenged than ever before. We’re responsible for more lives at a time when the healthcare industry faces soaring costs, falling reimbursement rates, rigorous standards of quality, workforce shortages, and more informed patients.

HCAHPS as an enabler to your selection, onboarding, and retention systems is not a matter of luck, it is the intersection of process, expectations, and engagement.

30/60/90-Day Meetings
• 30 days: establish the relationship
• 60 days: ensure things are going well
• 90 days: get feedback from the 30/60-day discussions


References

CareerBuilder. (2013). New CareerBuilder study reveals nine lessons for job seekers and recruiters that may surprise you. Retrieved from http://www.careerbuilder.com/share/aboutus/ pressreleasesdetail. aspxsd=10%2F17%2F2013&id=pr785&ed=12%2F31%2F2013
HCAHPS. (2015). HCAHPS Star Ratings. Retrieved from http://www.hcahps.org/StarRatings.aspx
Lehrman, B., Goldstein, L. (Autumn, 2013). HCAHPS Executive Insight Letter. Centers for Medicare & Medicaid Services, Baltimore, MD. Accessed January, 2015. Retrieved from http://www.hcahps.org/executive_insight/default.aspx


Printed Winter 2015 Healthcare Workforce Advisor

http://www.healthstream.com/resources/px-advisor

Hospital 5 star rating system set to roll out in April: CMS

by John W. Mitchell , Senior Correspondent

The Center for Medicare & Medicaid Services (CMS) is ratcheting up accountability for hospitals with the rollout of a consumer overall 5- star single rating system in April.

CMS spokesperson Alper Ozinal told DOTmed News there is good reason to emphasize hospital scores through a single star rating in addition to category-by-category ratings.

“HCAHPS scores have been found to be positively related to other quality indicators, including process of care, outcomes, safety and readmissions.” He added that HCAHPS scores have been improving in hospitals since introduced in 2006.

“This is a big change,” said Katie Owens, Vice President of HealthStream Engagement Institute, a company that both surveys nearly 1.7 million patients a year about their hospital experience and coaches hospitals on how to improve scores by creating patient-centered service. “With consumers now so active on social media the use of 5 star ratings on such sites as Yelp, Trip Advisor and Consumer Report, it seems CMS is looking to follow suit to simplify things in the eyes of the consumer,” she told DOTmed News.

The American Hospital Association (AHA), which represents nearly 5,000 hospitals and health care systems, has concerns about this new single star rating system, officially titled HCAHPS (Hospital Consumer Assessment of Healthcare Providers and Systems) Star Ratings.

“The current hospital compare site [which was developed with help from American hospitals] was not designed for single star system rating from multiple scores for patient experience,” Akin Demehin, Senior Associate Director for Policy at the AHA explained to DOTmed News.

“Hospitals are committed to sharing quality data but we’re concerned the single star rating (for patient satisfaction) will not be particularly useful to consumers in making health care decisions. We think it might be more understandable for single star ratings planned in the future for clinical outcomes, such as heart attack.”

Owens, with HealthStream, noted that improving patient satisfaction requires a systemic effort to create a patient-centered culture.

“The Star System does not change anything as far as our work with hospitals. We work to place patients at the center of health care through a hospital leadership commitment to cultural change,” she said.

She noted the biggest barriers to improving hospital ratings are: lack of accountability; lack of skills to consistently deliver patient-centered staff behavior; and lack of buy-in from staff and physicians.

To Access Article:

http://www.dotmed.com/news/story/25325/

Common Sense for Improving the Patient Experience

Three proven techniques — “personnel” attention, setting expectations and accountability — can transform your hospital’s culture.

At the risk of stating the obvious, all health care begins and ends with the patient. Yet, we are falling short on instilling behaviors and systems centered on the patient. In fact, hospitals have a dismal disappointment rate of 29 percent: According to the most recent Centers for Medicare & Medicaid Services HCAHPS survey, American patients believe they were treated at the best possible hospital a mere 71 percent of the time.

If you consider how hospitals, physicians and the industry as a whole are judged, the patient experience can make or break your reputation as well as the bottom line. My challenge to you is simple: Use common sense to create a solvable scenario for our leaders, employees and physicians who care deeply about being successful.

Critical Questions
Patient surveys and the potential financial impact of value-based purchasing have elevated the patient experience to one of the most pressing issues currently facing health care organizations. The Beryl Institute’s 2013 benchmark study, “The State of Patient Experience in American Hospitals,” revealed that patients rank their care experience as one of their top priorities. Yet, a 2013 HealthLeaders Media study revealed that 58 percent of health care leaders have not made specific patient-experience investments.
In this time of unprecedented change, financial pressures and competing priorities, how will your hospital meet or exceed quality measures? How can you avoid the financial penalties associated with underperformance? How can you create systems of accountability and recognition to ensure that your culture achieves results?

Patient-centered excellence is the commonsense answer to these questions and more. Each patient is your hospital’s core responsibility, but are you committed to providing service excellence? Is your staff taking the time to remember that “the gall bladder in 205” is really a retiree named Miss Peggy who volunteers as a crossing guard in her neighborhood? Does Mrs. Jones know without a doubt that her care and needs are your priority on any given day, despite emergency department volumes greater than 100,000 visits per year? If not, patient-centered excellence is not a priority at your hospital.

I am going to outline three proven techniques that can put your hospital on the right track to improving the patient experience.

Cultural Transformation through “Personnel” Attention
HealthStream Engagement Institute poll given to 250 health care leaders ranked “people” last in their list of priorities. How can we ask our team to create exceptional quality, financial or experience outcomes if we are not developing and engaging the people who achieve our results?

What does it take to transform a culture? Unfortunately, it does not happen overnight. Cultural transformation is a journey that begins with “personnel” attention. It involves learning new skills and creating opportunities to mentor staff and leaders.

To put this into perspective, I have yet to find a hospital that excels in patient-centered excellence that does not value and nurture its own personnel. From senior leaders to physicians, and the environmental team to valet drivers, your personnel must take ownership in your hospital. They must feel heard and respected and ultimately be a part of the conversation.
Take a moment to rate your hospital’s commitment to patient-centered excellence. Answer the three challenge questions listed below.

patient-centered excellence

If you cannot rate your teams predominantly between fours and fives, chances are you are encountering one or more of nine common barriers to cultural transformation:

1. failure to set clear direction and mission;
2. lack of staff ownership and buy-in;
3. fragmented communication;
4. lack of recognition and rewards;
5. failure to hold staff accountable for performance;
6. inadequate data-collection and measurement process;
7. satisfaction with the status quo;
8. insufficient leadership commitment and visibility;
9. lack of an open and trusting environment.

I encourage you to review these barriers and then do the exact opposite.

Great Expectations
An easy-to-remember but tough-to-implement mantra is “every patient, every time, every interaction.”

Just as it is your leaders’ job to set expectations with your personnel, your personnel must strive to set proper expectations with patients. The first step for staff is to try to understand the patient experience from the patient’s perspective. The second step is to deliver a consistent experience to every patient, every time. Unless we understand the patient’s perspective, we will be unable to deliver the best experience possible.

Another key factor for staff is knowing that there’s a big difference between what’s important to the patient and what’s important to us as health care providers. Human beings are not used to being patients, so we have to help them know what to expect during their hospital stay. After all, they spend most of their lives outside the hospital. It is our role and privilege to understand and manage what the patient sees, feels and experiences.

An example of properly setting expectations is explaining what kind of noise a patient will hear at night, going so far as to illustrate that the patient might hear noises different from those in his or her home. Additionally, we need to tell the patient that “ultimately our job is to make you feel secure. We’ll respond 24/7 and take care of you during your stay.”

Accountability and the Patient Experience

Accountabilities predict the outcome. This is a fact that I have witnessed countless times. The challenge lies in properly evaluating behaviors and setting accountability measures. We are astute at holding people accountable for financial and quality measures, but the patient experience can be tricky. We need to establish, clarify and champion specific accountabilities for the patient experience.

Evaluation with consequence sustains results. The best way to illustrate this claim is to imagine the best nurse, physician and technician in your hospital. Now imagine the ones whom you would not want within 20 feet of your loved one. If you pulled annual performance evaluations from both, would there be a difference? If not, there is a lack of accountability and consequences. We need to remove this deficit to transform the patient experience.

Tools and tactics work best one at a time. The three I have outlined here — “personnel” attention, setting expectations and accountability — will get you on the right track. I guarantee that recognizing patient-centered behaviors will elevate your market position and financial performance. Patient-centered behaviors cost nothing, but they earn dividends. Are you prepared?

Katie Owens is the Vice President of HealthStream Engagement Institute based in Pensacola, Fla. She is the lead author of “The HCAHPS Imperative for Creating a Patient-Centered Experience.”

To Access Article:
http://www.hhnmag.com/display/HHN-news-article.dhtml?dcrPath=/templatedata/HF_Common/NewsArticle/data/HHN/Daily/2014/Sep/090414-owens-patientexperience

Creating a Culture of Accountability – Where Do You Stand?

accountability

If you want to achieve world-class levels of performance in the patient experience (or any other key performance measures) you must create a culture of accountability in leaders for achieving results and ultimately aligning the actions and behaviors of staff and physicians to help reach desired outcomes. HealthStream Engagement Institute has coached nearly 60,000 leaders, staff, and physicians over the last 12 months and, through that coaching, we have seen some interesting trends:

Yet, when we ask leaders if we could tell the difference between their high, solid, and under-achieving performers based on their annual evaluations, we overwhelmingly hear a common response: “No.” This problem is so pervasive that on our HEI patient-centered excellence survey of nearly 25,000 responses, the lowest scoring items include tolerance for poor performers and employee input leads to change. These gaps are magnified because organizations are allowing poor performers to continue undermining success. Meanwhile, leaders fail to engage and recognize their high performers. You can put any performance system in place. What is typically missing is how to establish the right accountability for outcomes. In our work with America’s hospitals and health systems, we find four crucial elements to understanding your strengths and gaps for creating a roadmap to sustainable accountability.

• Selection and Retention
• Workforce Development
• Performance Management
• Measurement

What is Your Snapshot?

The following items are a limited portion of the evaluation process that HEI uses to determine the state of organizational accountability. Take a look and see how your organization scores.

accountability

CLIENT SPOTLIGHT

Phelps Memorial Hospital CenterSleepy Hollow, NY

Phelps Memorial Hospital Center (PMHC) began a journey of transforming patient experience in February 2012, beginning with HEI’s Patient-Centered Excellence Assessment. That process provided them with a roadmap to improvement, part of which included enhancing their methods of leadership development and creating accountability for performance. Each level of leadership, from executives to frontline supervisors, has embraced their roles and responsibilities and committed to a long-term investment in their culture. As a result, PMHC has experienced drastically improved outcomes in employee engagement and the patient experience.

accountability

High-performing organizations create an environment of accountability where their top talent is aligned and engaged to produce the right results. This type of culture is pervasive throughout the continuum of employment, one which starts with the application and interview process and continues throughout the life cycle of an employee. An environment that is geared towards maximizing the potential of each member of its team and empowers them to improve things for themselves and those they serve will put your organization in the best position for success.

Printed Summer 2014, Healthcare Workforce Advisor

HealthStream.com/pxadvisor

The Role of Coaching in Patient-Centered Excellence

Article by Katie Owens and Kathleen Lynam, Executive Coach, HealthStream Engagement Institute

TODAY’S CHALLENGING HEALTHCARE ENVIRONMENT includes reconciling competing priorities and ensuring a culture of quality, safety, and continuous learning. Add the reams of data found in dashboards, Gantt charts, spreadsheets, and electronic reports for payroll, time off, compliance, and quality. It is easy to become distracted— especially with the realities of our economic climate and reform.

We believe that providing excellent patient experience is the foundation of competency in healthcare; yet, nationally only 70% of patients reported in 2013 that they received care at the “Best Possible Hospital” (HospitalCompare.gov, 2014). What can organizations do right now to support leaders, including frontline nurse managers, medical directors, and department directors, in their efforts to manage costs, direct resources, role model effective behaviors, and lead and inspire staff to provide the highest quality and cost-effective, patient-centered care?

It is imperative that organizations understand that embracing a culture of coaching is critical to ensuring patient-centered excellence. Coaching individuals on how to lead initiatives, deploy tactics, and give essential feedback to staff will help them be more successful sooner by creating a better path forward and avoiding common pitfalls to improving the patient experience. Whether your organization has a dedicated team for patient experience leadership or has a committed team of internal champions, this article is designed to support organization efforts to build the proficiency of coaching to overcome performance gaps and sustain progress.

WHAT GETS IN THE WAY OF SUCCESS?

The majority of the changes we see occurring in healthcare today are driven by a focus on a deficit or outcome that did not meet its target. It may sound contradictory, but with a sole focus on the “red” or “negative” performance, you miss the opportunity to develop, nurture, and invest in the bright spots, processes, or individuals who will ultimately achieve and replicate success for the organization. Without a culture of coaching, healthcare providers miss an approach that builds on strengths, promotes better outcomes, develops trust, and reinforces your most critical priority—the patient.

Many of the tools used to improve the patient experience are not new. Every leader and organization we encounter have already begun the journey to achieve patient-centered excellence. Many organizations have deployed proven techniques—hourly rounding, service recovery, communication models (such as HEI’s RELATE), and standards of performance. But if everyone is using them, why does achieving patient-centered excellence remain a challenge for so many?

Healthcare organizations expend significant effort with only limited success because they lack a culture of coaching. According to a 2014 BLG poll of nearly 200 leaders, only 12% of leaders reported use of transformation techniques to improve the patient experience are effective. These findings reveal that healthcare organizations have made significant efforts, but with limited success. Our data (Owens, 2011) shows that:

• Most organizations that embrace a new initiative, experience some improvement, but then regress back to their previous state.
• Managers in many healthcare facilities struggle with execution because they have too much on their plates for consistent focus.
• Underperforming leaders and staff don’t embrace change, naysay, and wait for initiatives to fail.
• Loss of discipline occurs because leaders are not equipped with new skills and accountability tools to sustain new behaviors and tactics.

In order for organizations to break through the challenges of the common scenario, coaching is critical to build on strengths, develop a plan to educate and reinforce patient-centered skills, and establish a platform for accountability. In our experience with assisting organizations through leadership development sessions, coaching roadmaps, and adoption of new or enhanced tactics and communication models, consistent feedback is that the most valued part of an engagement is one-to-one personal coaching.

For the leader and the department teams, obtaining validation that what he or she is doing in real time, the words and actions used, is a critical part of developing competencies and becoming expert in the realm of patient-centered excellence. A coach is in a unique position to observe, teach, mentor, give feedback, and in some cases, even to direct. A competent coach has the wider vision and is able to gain the trust and confidence of the leader, staff, or
physician who is coached; he or she is a great listener, an astute observer, and an effective communicator.

Use of PX Transformation Techniques

the-role-of-coaching-in-patient-centered-excellence-pdf

The Role of the Coach

Patient experience coaches and internal champions, when following a proven, executable blueprint, can accelerate an organization’s ability to achieve outcomes to support CAHPS, employee engagement, and physician loyalty successes. Coaching affords organizations the opportunity to hold up the mirror: they can praise what is working well and coach-up skills to take an individual or team to the next level. Coaching can create a platform to drive and support strategic initiatives to ensure a culture where every patient, every time has an excellent experience. We believe HealthStream Engagement Institute’s proven model that seeks to create alignment and develop internal coaches, leaders, staff, and physicians ensures development equates to successful execution and sustainability of gains achieved.

“I have spent many years of my career working towards a culture of ‘every patient, every interaction, every time’ and am passionate about improving the patient experience. But… it wasn’t until I had the opportunity to partner with HealthStream Engagement Institute and work directly with our coach that we realized a cultural transformation where we “always” place the patient first. Our patient experience scores continually improve and our patients keep coming back.” – Lynn Charbonneau, Director, Patient and Community Experience, Waterbury Hospital, Waterbury, Connecticut

 

HEALTHSTREAM ENGAGEMENT INSTITUTE’S  PATIENT-CENTERED EXCELLENCE

Keeping the patient at the center of everything we do— every patient, every time.  Assessing and developing the people who deliver care to understand and manage what the patient sees, feels, and experiences.

HealthStream Engagement Institute’s Coaching Model: Alignment – Development – Execution – Sustainability
Alignment

In leading change, an organization, department, or service line must have a clear vision of where it is going; creating the message to communicate the “why” to staff and leaders alike is a critical element. Employees must grab onto the “why” before we can begin to teach them the “how and what” that ensures leaders are progressing. Coaches can identify strengths and gaps in current performance, as well as accountability and engagement for the organization’s journey. This alignment creates a unique coaching plan to assure the best means to develop and reinforce the desired change.

Development

You cannot expect leaders, staff, and physicians to automatically have proficiency in patient-centered skills and behaviors. It can, however, be developed.

Execution

Ensure that skills and proficiencies are executed well and consistently. Coaching plays a powerful role in validating that skills are transferred.

Sustainability

Constantly monitor outcomes and execution—this is key to maintaining focus. However, coaches must make certain to engage new leaders, staff, and physicians and ensure the onboarding process is aligned and that cultural expectations for the patient experience are maintained.

The Coaching Model in Action: Teaching Hourly Rounding

Let’s take a practice that our coaches regularly address during client engagements: hourly rounding.

Alignment
• Build trust with the departments that need to adopt or improve hourly rounding.
• Discuss the benefits of hourly rounding and understand previous strengths or barriers to hourly rounding in the past.
• Agree to a policy and practice for executing hourly rounding and set non-negotiables (ex. No pass zones for call lights).
• Set time-bound goals for implementation and results monitoring.

Develop
• Work with department/division leadership to understand the skill of hourly rounding. Teach the leader how to validate hourly rounding through patient rounding, coach their staff on hourly rounding, and recognize great practice.
• Train the staff using evidence-based practice (HealthStream Engagement Institute recommends addressing 5 key patient needs: Pain, Positioning, Personal Needs, Potty/Bathroom, and Privacy) and use tools such as an hourly rounding log to visibly confirm hourly rounding with the patient.
• Work with the staff to develop Words That Work and the RELATE model for patient-centered communication to narrate their care and the hourly rounding process. Manage up the importance of hourly rounding to patients.

Execute
• As a coach, take the opportunity to let staff simulate hourly rounding.
• Use an hourly rounding competency tool to create development plans.
• Observe leaders validating hourly rounding and coaching their staff on hourly rounding.

Sustainability
• Use patient experience and quality outcomes as metrics of success.
• Leverage hourly rounding tools to ensure this evidence-based practice is occurring.
• Pair up high-achieving leaders and staff with team members who may be struggling.
• Celebrate, celebrate, celebrate successes.
• Integrate into new employee and leader orientation the skills necessary to adopt this practice.

The art of coaching can be applied to each and every technique you want to see adopted in your organization— and it produces results. Coaches trained in patient-centered excellence are in a unique position to see, assess, design, and tailor coaching to address an organizations’ challenges in providing not only clinical excellence but service excellence. Coaching supports developing your workforce and building your most critical assets—your people.


References

HospitalCompare.gov. Hospital Consumer Assessment of Healthcare Providers and Systems Survey (2014), Owens, K. The HCAHPS Imperative for Creating a Patient-Centered Experience. BLG, 2011.


Printed Summer 2014 PX Advisor

HealthStream.com/pxadvisor