Be fo re we sta rt Re minde rs: L e tte rs o f c o mmitme nt - - PowerPoint PPT Presentation

E nsur ing L e ade r ship E ngage me nt

Be fo re we sta rt…

• Re minde rs:
• L

e tte rs o f c o mmitme nt

• I

HI Ope n Sc ho o l

• Yo ur fe e db a c k is ve ry impo rta nt fo r us. So ple a se

c o ntinue to sha re it with us. We truly a ppre c ia te the time yo u ta ke to g ive us yo ur tho ug hts a nd input.

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I mpo rta nt no te s

• Within3 Co mmunity

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I mpo rta nt no te s

• HCAHPS Ye a r 2 Re fe re nc e L

ist

http:/ / tc .nphhi.o rg / L e a rn/ HCAHPS-Be yo nd-T he -Ba sic s.a spx

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SOS L e ade r ship to Impr

• ve Patie nt

E xpe r ie nc e

Bianc a Pe r e z, PhD

Se nior Re se ar c h Sc ie ntist 5

Obje c tive s

• 1. Re vie w “e vide nc e b a se d” le a de rship pra c tic e s

to impro ve Pa tie nt E xpe rie nc e

• 2. SOS L

e a de rship: Se e the pro b le m, Own the pro b le m, So lve the pro b le m 1,2

• 3. Disc uss c o mmo n b a rrie rs a nd po ssib le so lutio ns

6

• 7/ 8 hig h pe rfo rming o rg a niza tio ns re pe a te dly ide ntifie d stro ng CE

O a nd g o ve rna nc e suppo rt fo r a c hie ving pa tie nt c e nte re d c a re a s a c ritic a l fa c ilita to r

3

• 6/ 6 hig h pe rfo rming ho spita ls a re c ha ra c te rize d a s ha ving stro ng , visio na ry

le a de rship c o mmitte d to pa tie nt a nd fa mily c e nte re d c a re 4

• I

n a surve y o f 800 US ho spita l e xe c utive s, 72% a g re e tha t stro ng , visib le suppo rt fro m the to p is a ke y to impro ving Pa tie nt E xpe rie nc e 5

• “T

he sing le mo st impo rta nt fa c to r c o ntrib uting to pa tie nt-c e nte re d c a re … is the c o mmitme nt a nd e ng a g e me nt o f se nio r le a de rship a t the le ve l o f the CE O o r b o a rd o f dire c to rs”. “I n the wo rds o f o ne o b se rve r, the re is no c hanc e to suc c e e d witho ut it, and mayb e no t e ve n with it.” 6

L E ADE RSHIP MAT T E RS… A L OT !

7

SE

E OWN SOL VE

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Se e the Pr

• ble m:

E xamine your Cultur e with Re spe c t to Patie nt E xpe r ie nc e

• Suc c e ssful o rg a niza tio ns c o nside r the mse lve s to b e pa tie nt-c e nte re d ra the r

tha n pro vide r c e nte re d 7

• T
• p pe rfo rme rs we re mo re like ly to fo c us o n o ve ra ll o rg a niza tio na l c ulture ,

ve rsus trying to simply a ddre ss Pa tie nt E xpe rie nc e a s a se pa ra te initia tive 8

• “Patie nt E

xpe rie nc e is o ur strate g y. So , it’ s no t ano the r strate g y. T he y ke y is to unde rstanding ho w e ve rything e lse fits in.” 8

• David F

e inb e rg , Pre side nt UCL A He alth Syste m

• “We do n’ t fo c us a s muc h o n sc o re s a s we do o n wha t a ffe c ts the sc o re s” 9
• 7/ 8 hig h pe rfo rming o rg a niza tio ns sa y susta ine d fo c us o n e mplo ye e sa tisfa c tio n is

a fa c ilita to r fo r b uilding a pa tie nt c e nte re d o rg a niza tio n9

9

Se e the Pr

• ble m:

E xamine your Cultur e with Re spe c t to Patie nt E xpe r ie nc e

• Culture is stro ng ly suppo rtive o f le a rning a nd c ha ng e .

“Part o f o ur c ulture is that we ’ re ne ve r happy with the status q uo . Ne ve r… We ask patie nts, what wo uld we ne e d to do in

• rde r to b e a 10/10.” 3
• Chie f Nursing Offic e r
• T
• p pe rfo rming o rg a niza tio ns ha d a mo re ske ptic a l se lf-a sse ssme nt
• f se rvic e e xc e lle nc e 9
• 80% o f b o tto m pe rfo rme rs ra te d the mse lve s 4 o r hig he r, whe re a s 80%
• f to p pe rfo rme rs ra te d the mse lve s 3 o r lo we r (1 is no t a t a ll

suc c e ssful a nd 5 is ve ry suc c e ssful)

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SE E T HE PROBL E M: E xamine your Hospital’s Pe r for manc e

• 6/ 6 hig h pe rfo rme rs sa y tha t the c a pa c ity to syste ma tic a lly me a sure a nd

mo nito r pe rfo rma nc e thro ug h a b a la nc e d sc o re c a rd is ke y to impro ve me nt4

• Hig h pe rfo rming o rg a niza tio ns me a sure ho spita l pe rfo rma nc e a nd unit le ve l

pe rfo rma nc e 3

• Hig h pe rfo rming o rg a niza tio ns va lue na rra tive fe e db a c k fro m pa tie nts8
• Be tra nspa re nt: Pub lish Pa tie nt E

xpe rie nc e da shb o a rds fo r e ve ryo ne to se e , inc luding pub lic !8

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OWN T HE PROBL E M:

Hold E ve r y Staff Me mbe r Ac c ountable to Patie nt E xpe r ie nc e

• 8/ 8 hig h pe rfo rming o rg a niza tio ns sa y pro viding fro ntline sta ff,

ma na g e me nt, a nd g o ve rna nc e with spe c ific fe e db a c k o n Pa tie nt E xpe rie nc e is c ritic a l3

• L
• w pe rfo rme rs ha d the ir Pa tie nt E

xpe rie nc e sta ff fo c use d o n o the r jo b re spo nsib ilitie s, e .g ., ma rke ting , HI M; whe re a s hig h pe rfo rme rs we re mo re like ly to b e de sig na te d Chie f Pa tie nt E xpe rie nc e Offic e r, Ma na g e r o f Se rvic e E xc e lle nc e , Dire c to r o f Pa tie nt Re la tio ns, Se rvic e E xc e lle nc e Co o rdina to r

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• Ask e ve ry me mb e r o f the se nio r te a m to c le a rly e xpla in the ir ro le s

a nd re spo nsib ilitie s to wa rds Pa tie nt E xpe rie nc e 9

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Solve the Pr

• ble m:

Be a Visible L e ade r

• T
• p pe rfo rme rs c o mmit sig nific a nt le a de rship time to the Pa tie nt

E xpe rie nc e 9

• Se rvic e le a de rs a t to p pe rfo rming o rg a niza tio ns spe nt a n a ve ra g e
• f 85% o f the ir wo rk time fo c use d o n impro ving Pa tie nt E

xpe rie nc e , c o mpa re d to 35% fo r lo w pe rfo rme rs9

• Suc c e ssful ho spita ls c o nduc t le a de rship ro unding . Builds

re la tio nships with fro ntline sta ff, e ng a g e d e mplo ye e s a re re c o g nize d, a nd re mo ve s b a rrie rs to g o o d Pa tie nt E xpe rie nc e 9

• Wha te ve r the CE

O pro mo te s a s impro ving Pa tie nt E xpe rie nc e is ho w the o rg a niza tio n will a ppro a c h Pa tie nt E xpe rie nc e 8

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Solve the Pr

• ble m:

Be a Visible L e a de r

14

Solve the pr

• ble m:

E ng a g e Sta ff, Pa tie nts a nd F a milie s

• T
• p pe rfo rme rs ha d a n a ve ra g e o f 80% o f a ll e mplo ye e s c o mmitte d to

de live ring c o nsiste ntly po sitive Pa tie nt E xpe rie nc e ; b o tto m pe rfo rme rs ha d 63% o f sta ff o n b o a rd with se rvic e e ffo rts9

• 5/ 8 hig h pe rfo rming ho spita ls sa id tha t e ng a g ing pa tie nts a nd fa milie s

is a c ritic a l stra te g y3

• 6/ 6 hig h pe rfo rme rs sa y the y pa rtne r with pa tie nts a nd fa milie s a t 3

le ve ls: Po int o f c a re de live ry, pla nning a nd po lic y de ve lo pme nt, a nd me dic a l e duc a tio n4

We do n’ t have any c linic al me e ting , re tre at, e t c e te ra, witho ut patie nts the re . So we traine d a g ro up o f patie nts to b e ab le to sit with us, and b asic ally just ke e p us ho ne st. I f yo u ac tually liste n to o ur c o nve rsatio ns so me time s, we stray fro m b e ing patie nt c e nte re d. Having the patie nt the re – it b ring s it b ac k.

• Da vid F

e inb e rg , Pre side nt o f UCL A He a lth Syste m

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Common Ba rrie rs (a nd possible solutions)

Bar r ie r : F

a ilure to de fine Pa tie nt E xpe rie nc e o b je c tive s5

Solution: Unde rsta nd the c urre nt sta te o f the Pa tie nt E

xpe rie nc e pe rfo rma nc e – ho spita l wide a nd unit-spe c ific 5

Bar r ie r : Co mpe ting prio ritie s/ time c o nstra ints5 Solution: I

t ta ke s a n inte ntio na l de c isio n to fo c us o n Pa tie nt E xpe rie nc e a nd re c o g nize tha t it c a n in fa c t tie ma ny o the r prio ritie s to g e the r

5

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Common Ba rrie rs (a nd possible solutions)

Bar r ie r: L

a c k o f physic ia n e ng a g e me nt5

Solutions:

• 1. L

e a de rs sho uld ma ke it e a sy fo r physic ia ns to a b so rb the Pa tie nt E xpe rie nc e me ssa g e a nd re info rc e b e ha vio ra l e xpe c ta tio ns fo r a ll te a m me mb e rs5

• 2. De ve lo p physic ia n-spe c ific fe e db a c k/ g o a ls
• 3. Assig n e ng a g e d physic ia ns to spe a k with physic ia ns a b o ut why
• rg a niza tio n is c o mmitte d to Pa tie nt E

xpe rie nc e . Do c to rs liste n to do c to rs!3

Bar r ie r: I

nsuffic ie nt re so urc e s to suppo rt impro ve me nts5

Solution: Re c o g nize tha t no t e ve ry so lutio n is c o stly. Cha ng e s in c a re

de live ry b a se d o n pa tie nt fe e db a c k a re o fte n surprising ly simple a nd ine xpe nsive 3

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Common Ba rrie rs (a nd possible solutions)

Bar r ie r: Cha ng ing mindse t o f e mplo ye e s fro m pro vide r-fo c use d to

pa tie nt-fo c use d 3

Solution: Ma ke Pa tie nt E

xpe rie nc e pe rso na l, e .g . L iste n to pa tie nt sto rie s, ma ke it a n a g e nda ite m a t sta ff me e ting s3

Bar r ie r : Cha ng ing the mindse t to a pa tie nt-fo c use d o rg a niza tio n is

ta king lo ng e r tha n e xpe c te d 3

Solutions:

• 1. Be re spo nsive to pa tie nt fe e db a c k, de a l with ne g a tive sto rie s

imme dia te ly, a nd le t sta ff kno w yo u ha ve a ddre sse d the pro b le m 3

• 2. Ce le b ra te suc c e ss, a c kno wle dg e c o nsiste nc y, a nd a ddre ss

pro b le ms10

• 3. Se e Pa tie nt E

xpe rie nc e a s a jo urne y, no t a n initia tive 9

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Summa ry

Se e the proble m

E xa mine yo ur c ulture with re spe c t to Pa tie nt E xpe rie nc e E xa mine yo ur ho spita l’ s pe rfo rma nc e

Own the proble m

Ho ld e ve ry sta ff me mb e r a c c o unta b le to Pa tie nt E xpe rie nc e

Solve the proble m

Be a visib le le a de r E ng a g e sta ff, pa tie nts, a nd fa milie s

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Re fe re nc e s:

• 1. Co nne rs, R., Smith, T

., & Hic kma n, C. (1998). T he Oz princ iple : Ge tting re sults thro ug h individual and

• rg anizatio nal ac c o untab ility. Po rtfo lio .
• 2. Orliko ff Re ine rtse n Bo a rd wo rks: E

d uc a ting the Ho spita l Bo a rd o n Qua lity a nd Sa fe ty (n. d .). Re trie ve d fro m: http :/ / www.o rb o a rd wo rks.c o m/ ind e x.html

• 3. L

uxfo rd , K ., Sa fra n, D. G., & De lb a nc o , T . (2011). Pro mo ting pa tie nt-c e nte re d c a re : a q ua lita tive stud y

• f fa c ilita to rs a nd b a rrie rs in he a lthc a re o rg a niza tio ns with a re puta tio n fo r impro ving the pa tie nt

e xpe rie nc e . I nte rnatio nal Jo urnal fo r Quality in He alth Care , 23(5), 510-515.

• 4. Sha lle r, D., & Da rb y,. C. (2009). Hig h Pe rfo rming Pa tie nt a nd F

a mily-Ce nte re d Ac a d e mic Me d ic a l Ce nte rs. T he Pic ke r I nstitute . Re trie ve d fro m: http :/ / www.upsta te .e d u/ g c h/ a b o ut/ spe c ia l/ pic ke r_re po rt_7_09.pd f

• 5. Wo lf, J. (2011). T

he Sta te o f Pa tie nt E xpe rie nc e in Ame ric a n Ho spita ls - 2011 Be nc hma rking Stud y. T he Be ryl I nstitute . Re trie ve d fro m: https:/ / the b e rylinstitute .site -ym.c o m/ sto re / vie w_pro d uc t.a sp? id =769470

• 6. Co nsulting , S. (2007). Pa tie nt-Ce nte re d Ca re : Wha t Do e s It T

a ke ? .

• 7. Ba lik, B., Co nwa y, J., Zippe re r, L

., Wa tso n, J., (2011). Ac hie ving a n E xc e ptio na l Pa tie nt a nd F a mily E xpe rie nc e o f Inpa tie nt Ho spita l Ca re . I HI I nno vatio n Se rie s white pape r. Ca mb rid g e , Ma ssa c huse tts: Institute fo r He a lthc a re Impro ve me nt.

• 8. Wo lf, J. (2013). Vo ic e s fro m the C-Suite : Pe rspe c tive s o n the Pa tie nt E

xpe rie nc e . T he Be ryl I nstitute . Re trie ve d fro m https:/ / the b e rylinstitute .site -ym.c o m/ sto re / vie w_pro d uc t.a sp? id =1510539

• 9. Ba ird , K

., Wo lf, J. (2010). T he F

• ur Co rne rsto ne s o f a n E

xc e ptio na l Pa tie nt E xpe rie nc e : F

• c us,

Ac c o unta b ility, E ng a g e me nt, a nd Co mmitme nt. T he Be ryl I nstitute . Re trie ve d fro m: http :/ / c .ymc d n.c o m/ site s/ www.the b e rylinstitute .o rg / re so urc e / re smg r/ White _Pa pe r_E xe c _Summ/ T he _B e ryl_I nstitute _-_4_Co rn.pd f 10.He a lth Ca re L e a d e r Ac tio n Guid e to E ffe c tive ly Using HCAHPS (2012). He a lth Re se a rc h & E d uc a tio na l T

• rust. Chic a g o . Re trie ve d fro m: http :/ / www.hpo e .o rg / re so urc e s-a nd -

to o ls/ re so urc e s/ HCAHPS%20e ffe c tive %20use .pd f

Ne xt Ste ps

• Ple a se lo o k fo rwa rd to o ur ne xt We b ina r o n April

24th: Manage me nt Co nside r

atio ns fo r Impr

• ve d

Patie nt E xpe r ie nc e

• Pre -wo rk:

T a ke c o mplime nta ry I HI Ope n Sc ho o l Co urse o n Dig nity a nd Re spe c t (Co ntac t yo ur T e am L e ade r fo r re g istratio n info rmatio n re g arding c o mplime ntary I HI Ope n Sc ho o l re g istratio n) – An I ntro duc tio n to Patie nt & F amily Ce nte re d Care – F irst I mpre ssio ns – Privac y and Co nfide ntiality – Culture and Be lie f Syste ms – Cre ating a Re stful and He aling E nviro nme nt

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Ne xt Ste ps

• Wha t to pic s wo uld yo u like to re a d a b o ut o n o ur

c o mmunity? He lp us pro vide yo u with wha t yo u wa nt.

• Sho uld yo u ha ve a ny furthe r q ue stio ns, ple a se

c o nta c t:

• Ma i AlSo ka ir
• E

ma il: ma lso ka ir@ na ph.o rg

• Pho ne : (202) 495-3350
• Ja ne Ho o ke r
• E

ma il: jho o ke r@ na ph.o rg

• Pho ne : (202) 585-0134

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WVU Healthcare

• 531-bed AMC; 113 ICU beds.
• 450 clinical faculty, 380 residents.
• 34,000 admissions; 48,000 ED visits; 800,000

physician office visits; 4,000 trauma patients.

• Payor mix – Medicare (33%), Medicaid (22%),

uninsured (7%).

• Safety net and tertiary care services – only

significant services not available are major organ transplantation and burn care.

• 6,500 employees; partially unionized.

Cultural Change

History:

• Non-confrontational; conflict avoidance.
• Low patient satisfaction scores.
• Resistance to change.
• Not transparent and not accountable.

Creation of WVU Healthcare (July 2010):

• Joint Operating Agreement (JOA).
• Management integration.
• Change in funds flow / shared operating margin.
• Single point of decision-making.

JOA Implications

• New faculty compensation plan – productivity

and other performance metrics.

• Realigned medical director structure.
• Financial management – single budget, shared
• perating margin, excess margin share with the

SoM.

• Single employer.
• Collective accountability to an annual

Performance Improvement Plan.

• Single strategic plan for the clinical enterprise.

Cultural Change Process

• Goals: transparency, accountability, expecting

excellence.

• Outside help – Studer.
• Our code words: Journey to Excellence.
• Structure, accountability, leading by example –

all matter.

Key Process Steps

• Communication.
• Reward and recognition.
• Rounding – senior leader, departmental, nurse

leader, one-hour, customer service.

• Performance development: We’re only going

to achieve our goals, if the 7,500 employees of WVU Healthcare are better; that’s only going to happen if we as leaders make it happen.

COMPOSITES/ HCAHPS MEASURES

FLOOR

Q4 2011 PG HCAHPS DATA Q1 2012 PG HCAHPS DATA Q2 2012 PG HCAHPS DATA Q3 2012 PG HCAHPS DATA Q4 2012 PG HCAHPS DATA ACHIEVEMENT (50th percentile) BENCHMARK (mean of top decile)

Nurses always communicated well

38.98 74 79 80 81.3 81.8 75.18 84.70

Doctors always communicated well

51.51 74 78 79 82.3 81.4 79.42 88.95

Patients always received help quickly

30.25 58 61 66 65.5 70.4 61.82 77.69

Pain was always well controlled

34.76 64 67 69 73.5 69.2 68.75 77.90

Staff always explained about medicines

29.27 62 72 63 68 67.1 59.28 70.42

Rooms and bathrooms were always kept clean

36.88 51 49 55 57.8 57 62.80 77.64

Area around room was always quiet at night Yes patients given info about DC/recovery

50.47 79 86 84 85.7 85.7 81.93 89.09

Patient’s overall rating of hospital (9 & 10)

29.32 66 68 71 74.6 79.3 66.02 82.52

ED Standard Overall Percentile Rank

PG Large Database

50 100 150 200 250 300 5 10 15 20 25 30 35 40 45 50

Q4 2011 Q1 2012 Q2 2012 Q3 2012 Q4 2012

“n” size Overall Percentile Rank

Overall Percentile Rank n size Linear ( Overall Percentile Rank) Note decline in sample size quarter to quarter— data is not representative

Outpatient Monthly Capacity

Specialty Exam Rooms % Capacity Total Capacity ENT 19 77% 1,732 Pediatrics 40 76% 3,800 Orthopaedics 18 102% 2,120 Medical Specialties 45 68% 4,275 Internal Medicine 18 101% 1,642 OB/GYN 17 95% 1,615 Surgical Specialties 21 94% 1,995 Neurology 12 94% 1,140 Neurosurgery 10 60% 950 Ophthalmology 40 76% 3,496 Family Medicine 33 71% 3,385 Totals 273 26,150

8 Locations: Family Medicine, POC, Eye Center UHC benchmarks used for ENT, Ortho, Int Med, Ophth, Fam

• Med. 2.5 pts/session used for all others

We’re Not “There” Yet

• “Plateauing” of results; 7 of 8 HCAHPS measures

are above the 50th percentile, but none are above the 90th.

• Consistency matters – all units/departments, all

shifts, all the time.

• New employees – too much turnover, inadequate
• rientation.
• Performance development and management.
• Biggest inpatient issue: noise at night.
• Biggest outpatient issue: access.

CEO Engagement

• Believe the data and decide that it’s

important.

• Cultural change can’t happen overnight – and

it needs to be led from the top.

• Consistency and visibility are critical –

definitely my biggest challenges.

• Transparency – current performance,

expectations/goals, implications.

CEO Engagement

• Structure matters – accountability, leadership,

communication.

• Leadership team is key – meet with the 335

leaders of WVU Healthcare (70 are physicians)

• ne or two days every quarter.
• Celebrate “wins”; be clear about

challenges/shortcomings.