Katie Owens - Healthcare Speaker and Executive Coach

Lead Author, The HCAHPS Imperative for Patient-Centered Excellence

Tag: Healthcare

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.

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.

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.

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/

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

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