Katie Owens - Healthcare Speaker and Executive Coach

Lead Author, The HCAHPS Imperative for Patient-Centered Excellence

Tag: Patient Centered

Person Centered Excellence – Compassion

Taking on the role of a patient is one commonality we all share. Whether we have been one at an urgent care, to have a child, to fix a broken bone, seek treatment for a chronic condition we are all a part of the healthcare ecosystem. I have the privilege to work with thousands of healthcare leaders, staff, and providers each year – it is one that I do not take lightly. I work hard to stay on top of industry trends and remain connected to the daily demands of patient care across the continuum. It is fair to say that Healthcare takes up the majority of my daylight hours (sound familiar?). And I feel compelled to play a positive role in making healthcare better because every patient is a person who wants the very best care possible. The human experience matters. Compassion matters.

The reality is that we spend more time at work and with our co-workers, patients, and visitors than our own families and loved ones. We are people taking care of other people – in their greatest time of need, where uncertainty and the need for reassurance peaks.

So many times, leaders ask me, “What matters most to drive outcomes; focusing on engaging your employees or patients?” I have given this question tremendous reflection over many site visits with hospitals and health systems, as well as my families own personal healthcare journeys over the years. I have come to the conclusion that as healthcare leaders, employees, and providers, we need to unapologetically establish and promote cultures of person-centered excellence. Cultures where each person is treated with respect, dignity, and accountability. At the heart of person-centered excellence is actively displaying compassion and empathy for each individual.

In thinking about times when I have personally been a patient (and researched my own symptoms online – to which I am not alone. It is estimated that over two-thirds percent of patients Google their symptoms prior to an office visit), every team member has made me feel that I am in good hands by demonstrating compassion (or made me feel uneasy by failing to demonstrate compassion).

Every interaction that you have is an opportunity to demonstrate person-centered excellence in action by displaying empathy and compassion or denigrate it. Your presence with your employees, providers, patients, visitors and community matters.

Honestly, nearly all of us strive to be empathetic and compassionate (granted there are some CAVE People – Citizens Against Virtually Everything), yet too often I see a disconnect between an individual’s intent and the perceptions of the recipient. There are three likely scenarios where we can close gaps (and the good news is that none of these require additional budgetary dollars).

Among leaders and employees

As a leader, do not assume your team knows all of the tremendous work you do behind the scenes. Communicate often and genuinely. Be visible, always make eye contact and engage your employees. If your team members do not feel and experience compassion from you, how can you expect them to give it to your patients?

With patients and their loved ones

As caregivers, we must recognize that every patient and loved one that comes through our doors (regardless of where – the Lab, Emergency Department, Imaging, Inpatient, Medical Office) sees themselves as the most important person. Healthcare is unfamiliar to them, they likely have fears/anxieties and want to be reassured they are going to receive quality, compassionate care. We need to set expectations early and often, display empathetic and compassionate behaviors and never assume patients understand what we are doing and why.

Among peers

Since we spend more time with our peers than our loved ones, we need to explore ways to empathize with one another. Sometimes this takes a degree of courage to confront matters of safety, avoid errors or hold people accountable. I was recently shadowing bedside shift reporting with an organization and noticed a pair of nurses doing their end of shift report outside of the room. The retiring nurse later shared with me that she “knows” they are supposed to do their shift report in the room with the patient but does not feel confident in speaking up with those who are not onboard with the initiative. Everyone loses when we miss opportunities to cultivate peer-to-peer empathy and compassion.

Let’s get excited to seek out opportunities to Cultivate Person-Centered Excellence by establishing essential appreciation of the human experience in key roles to walk in patient’s crutches or slippers, wear the employee badge or the leadership hat. I can promise you, it will be a more rewarding voyage than focusing on what is not working in healthcare today.

Patient-Centered Communication: Verbalizing while using EHRs

Effective patient-centered communication is the foundation of high-quality healthcare. Nearly all healthcare interactions — from making appointments and registering to discussing medical symptoms, treatments and care options — rely on effective communication. Technology, in particular, electronic health records (EHRs), holds the power to improve our communication with our fellow healthcare providers and our communication with patients and their loved ones or denigrate it.

While electronic health records can create the opportunity for real-time documentation and information sharing, we must leverage this tool to enhance our interactions with patients. At HealthStream Engagement Institute, we recommend three important tools to support the intersection of EHRs and patient-centered communication:

1. Use “words that work,” ban “words that don’t work” and take advantage of your investments in leading technology to provide the best patient care possible.
Words

patient-centered communication

Words that work are designed to create a positive impression of your organization; however, words that don’t work are likely embedded in your organization as well (especially when it comes to EHR technology). By working with and engaging your teams, you can identify the words that don’t work, create crosswalks to words that do work and have fun in the process.

2. Narrate your care and process: Explain every step. Whether you are entering demographic information at admission, conducting bedside shift reports or validating medications, we cannot assume patients understand the intricacies of care delivery.

3. Use RELATE, our patient-centered communication model, to engage patients while documenting their care electronically.

Reassure: Discuss the importance of bedside documentation to assure the highest quality care. Verbalize your commitment to quality. Acknowledge any fear or anxiety a patient or their loved ones may be feeling.

Explain: Explain the process for documentation and how the information will be used.

Listen: Listen for any questions the patient may have about charting, care delivery.

Answer: Answer their questions in easy to understand terms. If possible, use techniques like “teach back” to validate the patient’s understanding of your explanations.

Take action: Narrate your care and process every step of the way.

Express appreciation: Thank the patient for the opportunity to participate in their care.

 

Katie Owens is Vice President at HealthStream Engagement Institute. She works with senior teams to front line staff to establish alignment and engagement and coaches how measurement and data influence behaviors and drive outcomes for patients and their families.

Published in EHR Intelligence, 2014

https://ehrintelligence.com/news/patient-centered-communication-verbalizing-while-using-ehrs/

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