What to Do If Your Boss Is A Low Performer

One of the most frequently asked questions that I receive—the one that’s at the top of everyone’s list—is: “What can I do if my boss is a low performer?”

It’s tough enough to confront someone who we supervise about job performance issues…even tougher to have that difficult conversation with a peer, but taking on the boss may seem impossible and even career threatening. Yet, if you’re working for a low performer, you likely feel disillusioned and discouraged. Plus you aren’t being mentored and developed in the ways you desire. As a result, you pay the price. Your department struggles. The organization may not achieve its goals. And yes, even your boss loses out.

After talking with hundreds of staff and leaders who want to push through this barrier, I have some suggestions on what you can do if you feel your boss is a low performer. Try these:

1. Take a look at yourself first. This means holding up the mirror. Make sure you are doing all you can to run a great department to achieve the desired results. Bosses appreciate someone who provides solutions. Find ways to take things off your bosses’ desk rather than piling new things on by pointing out problems with no solutions or ownership. While your boss may not perform the way you wish, you will have a much better discussion about these issues if you are performing well yourself. Reaching out to your employee assistance program is also a good way to make sure other issues are not clouding your perception of the situation.
2. Start with identifying what your boss does that you feel is helpful. Ask yourself: Does your boss do many things well and a few things poorly? It’s easy for a few frustrating behaviors to cloud our judgment and overall view of our boss, in spite of some redeeming qualities. Let your boss know what is working for you first. Remember, recognized behavior gets repeated. An example: “Larry, I appreciate the time you spent with me this morning going over the project list. Your time on this very much helps me prioritize next steps, move more quickly, and achieve outcomes.” By telling Larry that you appreciate his time and why, it becomes much more likely that Larry will make time for you next time you ask. Another example: “Larry, I do appreciate your candid feedback on my performance and suggestions for managing expenses better. I’m grateful that you’re willing to invest in my professional development by pointing out what I can improve on.” Here, we let Larry know we can take candid feedback.
3. Confront the problem. If you’ve already looked in the mirror, believe your own performance is consistently strong, and have shown maturity by welcoming potentially negative feedback yourself, you’re ready to take the next step with your still low-performing boss. I recommend using a “support-confront-support” technique. Basically, you combine what is working well with what is not. Be sure to emphasize that this is your perception of things. This will help your boss to be a more receptive listener who is less defensive.

   Example: “Larry, I want to thank you for sharing the strategic plan with me. Your suggestion that I focus on expense management and the implementation tips you offered are really helpful to me. We’ve already seen a lot of improvement. In fact, department expenses are under budget year-to-date. I also appreciate your support in allowing me to attend the recent conference. I found it very helpful in improving operations. (Get ready. Here’s comes the “confront” part…) “You know, this is just my own perception—you may not even realize it—but you just asked me a question and before I had even finished answering, you cut me off rather abruptly. It disappointed me and frankly, I was a little embarrassed. Larry, I believe you genuinely do want to hear what I have to say, so I’d appreciate it if you would take time to listen. As I said, I do very much appreciate the investment you’re making in me. It’s clear your suggestions are helping me lead change that will allow us to meet our department and organizational goals.”

   Typically, he or she will respond well to this kind of approach. The key is to start and end with the positives. Always use the words “It’s my perception” when you have this kind of discussion. Also, try not to judge your boss too harshly. In my experience, most of the time, your boss is not aware of the full impact of his or her actions on you. This is because all too often, we don’t take ownership for having these direct conversations. Instead we vent our frustrations with others who can’t really help us in side conversations.

4. Move to DESK. Okay, so you’ve tried tips one through three and haven’t gotten anywhere. What next? Meet with the boss using the Describe—Evaluate—Show—Know approach. Begin by D-describing what actions you have observed that are problematic. “Larry,” you say. “Thank you for your time. I would like to share my perception with you about the meeting yesterday. Please listen until I finish what I have to say. Yesterday at the division meeting, you asked me a question, but did not allow me to complete my answer before you said, ‘Sounds like we don’t know what is going on.’

   Next, move to E-evaluate. Evaluate how you feel or how your organization’s policy, standard, or value is not being lived by your boss’ behavior. “Larry, when this happened, I was hurt and embarrassed. I also believe that making that comment and cutting me off mid-sentence is not consistent with our organizational standards regarding respect. Then move to S-show. “My goal is to do well here, so I want you to know I can accept negative feedback if it is offered in a professional manner. Since I know we both want to achieve the same goals, I’d like to describe the best way to provide feedback to me. If you have concerns about what I’m saying, for example, just speak to me privately after the meeting and we can address them together then.”

   Finally, K-know the consequences. You might say, “Larry, if we cannot work out a way to communicate in a more productive manner, (then lay out what you are willing to do). This may not be the right place for me to work right now, and it saddens me for I very much would like it to work out.” Remember, you don’t have to follow through on quitting, but perhaps you have signaled the importance of resolving this issue. I understand that using the DESK approach is not easy. It takes a lot of courage and persistence. However, I urge you to be brave. Working for someone who drains your energy will impact your health, create issues with your staff, compromise your personal values and high standards, and eventually impact those you love when you take your frustrations home day after day. Life is too short to spend so much time with a boss or an organization where the fit is not right.

5. Get support when you need it. It’s also true that some behavior crosses the line when it’s abusive, harassment, or too volatile to handle alone. In those cases, do reach out to the system your organization has in place and report such actions. Remember to access your company’s employee assistance program. They can help you make sure that your perception is accurate and also provide key tips for managing the problem during this stressful time.

In conclusion, my experience is that being a supervisor isn’t easy. I just don’t think that leaders come to work with hopes of ticking off a few employees and creating conflict with patients and physicians. By taking the lead in resolving conflicts, you demonstrate healthy adult behavior to yourself, your boss, and your organization. If, in the unlikely event that the above tips do not create the right environment, remember that in the long run you will be happier and more successful in a place with a better fit. I suspect though, that in many cases, you might be surprised that your boss is receptive and appreciative of the honest feedback you offer when you address concerns directly. Typically, your working relationship will improve.

What’s Right in Health Care Conference and HCAHPS

Is there a day on the calendar that you look forward to every year as it gets closer? Maybe it’s a birthday. Maybe an annual reunion with old friends. As the date gets closer, your anticipation builds because you will be able to celebrate something important to you with people you care about. For me, one of my favorite days on the 2008 calendar is just five weeks away, so I’m feeling that same sense of excitement. Why? Because on June 18-20 I get to meet with and learn from the largest and most passionate group of healthcare leaders in the world, all in one place.

Our registration already includes more than 1,300 individuals from around the world committed to passionately implementing the same set of evidence-based tactics proven to save lives; to make healthcare better for employees; and to reinvigorate physicians in the practice of medicine the way it was intended. If you count yourself among the leaders committed to making healthcare better, I hope you are able to join us and experience the excitement and learning that takes place each year.

Over the three days we will be together, we will hear stories of what’s working well in healthcare organizations across the world, and leave with practical ideas we can put into action when we return back to our own organizations. While all three days will be solid with content, let me focus on just one of the educational sessions.

On Wednesday June 18th from 3:00-5:15, one of the six breakout sessions at that time will focus on HCAHPS. This intensive workshop is being led by two of our most senior coaches, who have worked with organizations in the HCAHPS pilot project, as well as a leader from Hackensack University Medical Center in New Jersey, one of the best performing organizations nationwide according to the initial HCAHPS results. Between their direct experience, and that of the organizations we have coached, Studer Group has more experience improving performance on HCAHPS than just about anyone else. In fact, whether you look at likelihood to recommend or a specific measure like pain control, 3 out of 4 Studer Group partners outperform the national HCAHPS database.

Why is this session important? Because HCAHPS is arguably the most powerful transformation for U.S. healthcare since President Lyndon Johnson signed Medicare and Medicaid into law as part of his “Great Society” plan in 1965. That’s a bold statement. But I believe it is also a fact, because for the first time since we, the people, were given these essential insurance plans, our voice now counts. As part of CMS’s ever-evolving Value Based Purchasing plan, the voice of the patient is now being heard through HCAHPS, and will soon help steer payments toward those providers whose customers perceive that they provide better care. As such it is absolutely critical that your organization understand and focus on the underlying issues that will shape the perception of your organization in the eyes of the patients for which you care.

Whether you plan to attend the HCAHPS breakout session or not, we strongly encourage you to take a moment and complete the following brief online survey. This three-part survey asks you to complete the HCAHPS questions just as a patient would; to list the single most important tactic that could improve the scores you gave; and any one question you would like the presenters of this session to answer. This anonymous survey results will be used in the actual presentation and will help customize the content to information you value. For your voice to be included in this survey, please click the following link before next Friday, May 23:

http://www.zoomerang.com/Survey/?p=WEB227SD2CAL42

This is just one of the 33 breakout sessions offered during the event. The other 32 breakouts each address a specific tactic, such as physician communication, service recovery, developing nurse leaders, rounding on employees, employee selection and retention, pain management, interdepartmental surveys, etc. Presenting organizations include winners of the Malcolm Baldrige National Quality Award, large academic medical centers and small hospitals serving rural America. In addition, we have 6 hours of plenary keynote sessions that will leave you talking; an awards event to celebrate together our shared successes in improving healthcare; and the world’s first concert specifically designed for healthcare leaders.

On June 18-20 I hope you will be able to join with hundreds and hundreds of leaders just like you – committed to making a difference. I hope to see you there.

Quint

Hourly Rounding

When we begin working with new organizations, one of the most important things we do is help them appropriately sequence how, when, and why they rollout the tactics proven to get results. Just like courses in school, there are some foundational pieces that need to be in place before more advanced techniques are attempted. One of the best examples of this is when organizations jump to advanced rounding techniques, such as hourly rounding on patients, before hardwiring the foundational rounding technique of rounding on employees.

In this blog I’d like to give some tips for sequencing tactics, as well as a perspective on why hourly rounding is such a powerful tool and worth waiting for.

An important early step toward hardwiring clinical, service, and operational excellence is all about engaging employees. Get your workforce on board and everything else falls into place. The most powerful tool at this stage is for the leaders of the organization to round on employees. That’s why when we coach organizations we ensure this step is happening with consistency before moving on. To learn more about how to round effectively, you can read more on our website. When done right, you will uncover mountains of knowledge currently lying hidden in the minds of your employees. However, the real benefit comes not from uncovering new information but from the wins you get with employees when you fix the issues that they have shared.

Once leaders are effectively rounding on employees, some organizations decide to adjust the focus of the rounding conversations to address specific pressing issues. For example, in their efforts to hardwire a culture of safety, hospitals across the country are incorporating some of the following questions into their rounding:

• Were you able to care for your patients this week as safely as possible? If not, why not?
• Can you describe how communication between caregivers either enhances or inhibits safe care on your unit?
• Do you know how to report an adverse incident?
• Can you describe the unit’s ability to work as a team?
• Have there been any “near misses” that almost caused patient harm but didn’t?

Fast forward. A few months of effective rounding conversations between leaders and employees have resulted in a culture of accountability, trust and open dialogue. Now is the time to rollout the powerful tactics like hourly rounding that have been proven to get the incredible results we’ll discuss in a moment. Why is this the right time? Any earlier and the employee rounds on patients would fade away over time. The discipline, the trust, and the accountability that are generated by leader rounding and objective accountability systems are critical for rounding to happen with every patient, every hour . . . and that’s the only way the results improve to the extent research has shown is attainable.

So what’s the big deal about hourly rounding? Why all of the effort? Because of the powerful impact this single tactic can have across your organization; and more importantly, its impact on the lives of thousands of patients and their families. For example:

• Inpatient Setting
  • Our study published in the September 2006 American Journal of Nursing proved that hourly rounding cuts patient falls in half, reduces pressure ulcers 14%, increases patient satisfaction 12 points and decreases call light usage 38%. In summary, results across the board . . . better outcomes for patients, employees, and budgets.
• Emergency Department Setting
  • We are delighted to announce that our recent research on the effectiveness of rounding in the ED setting has been accepted for publication by the Journal of Emergency Medicine. The results were very similar to the inpatient results. With just slight adaptation, rounding works everywhere. To share these adjustments we have produced a video-based tool that shows how to effectively round in the ED.
• National Acclaim
  • During the Institute for Healthcare Improvement’s December 2007 Annual Forum, hourly rounding was described as one of the most powerful ways to redesign patient care, in addition to helping “restore sanity and joy to our workforce.”
  • Let’s put that 50% reduction in patient falls in perspective. At a time when numerous proposals are floating around aimed at saving money or improving quality in US healthcare, if every hospital in the United States implemented hourly rounding it would prevent a quarter million falls, 75,000 injuries, and more than $2 billion. At the same time, patients perceive their care as better and safer and nurses work more efficiently. I don’t see the same side benefits from most of the legislative proposals for reforming healthcare.

To learn more about how to implement leader rounding on staff or the many different forms of hourly rounding I’ve discussed, consider attending our annual conference, What’s Right in Health Care^SM June 18-20 in Atlanta. You’ll hear more than 30 best practice sessions specifically designed to help you implement these and other evidence-based tactics. Here are just a few sessions related to rounding:

• Learn how one organization used hourly rounding in both inpatient units and their ED to generate more than $1 million in additional revenue and cost savings.
• Learn how another organization used both leader rounding and hourly rounding to raise its Emergency Department from the 4th percentile in patient satisfaction to the 92nd percentile in less than one year.
• Learn how another organization implemented hourly rounding on nursing units to improve their patient’s perception of care from the 32nd percentile to the 96th percentile while decreasing patient falls with injury by 43%.
• Learn how a hospice care provider implemented leader rounds on staff to obtain consistency in practice, approach, and clinical results.
• Learn how to implement leader rounding in physician practices.
• Learn how to combine leader rounding on employees with pulse surveys to improve employee engagement and lower turnover.

I hope to see you in Atlanta.

Practicing Excellence

I have the great fortune to speak with physicians nationwide about the passion they have for making a difference, especially in the lives of their patients. With Doctor’s Day approaching on March 30, I have asked Dr. Stephen Beeson, Studer Group physician coach and author of Practicing Excellence, to share some thoughts…

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Over the past eight years I have had the amazing opportunity and privilege to coach and train thousands of physicians from all over the country. Over the course of these years others and I have worked to distill and refine what works best to engage physicians and improve performance. We have had good results working with health care leaders and physician medical staffs around the country to improve the patient perception of care provided by physicians.It is clear now that performance reigns in health care. HCAHPS, Pay for Performance, and Medicare Reform are now regulating and rewarding organizational performance. Those systems that do better will win. Unfortunately, health care leaders struggle with organizational improvement if systems and leadership are not in place to create vision, measurement, training, and accountability to assemble a culture of performance.

With all this in mind, another challenge is answering the question, “What do we do with our docs?”

Here are suggestions:

• Align physicians to a Culture of Excellence. Before physicians will change their behavior they must believe the decision to do things differently is based upon logic and evidence. Physician engagement must begin with creating and communicating the case for service as a pathway to improved clinical outcomes, marketplace reputation, malpractice risk reduction, and the quality of his or her own work life.
• Train physicians using evidence-based behaviors. Evidence-based behaviors are behaviors that predictably improve patient perceptions based on historical health system evidence. Excellence-driven organizations invest in the improvement and development of their physicians using these behaviors that drive outcomes. This tactical training improves physicians’ ability to create patient loyalty, drive compliance with medication regimens and raise the performance of the clinical staff who look to them for leadership. (Click here to access a tool on establishing a first impression with physicians.)
• Select physicians that fit the culture. You can train and develop a physician to become great, or you can select high performing physicians who match your culture. (The latter is far easier.) Physician selection has historically been an ad hoc process, creating variability and unpredictability of physician performance. Behavior-based interviewing is a mechanism to select for the important physician characteristics that will position your group for success. Behavioral interviewing uses scripted questions that assess physician competencies including teamwork, compassion, clinical judgment and problem solving, communication, and leadership.

Practicing Excellence has always been about providing physicians evidence-based behaviors and guidance that have created results in every environment where they have been implemented. It is important to train physicians not only in how to treat patients, but equally important, how to treat colleagues and staff to develop an environment of teamwork, respect, collegiaty to create and sustain measurable organizational outcomes.

Stephen C. Beeson, MD is a nationally recognized presenter, practicing physician, and author of Practicing Excellence, A Physicians Manual To Exceptional Health Care. Visit www.studergroup.com/beeson.

Work-Life Blend Among Women Employed in the Healthcare Industry

As I travel the country and meet women who work in healthcare, the ever-increasing demands that women have in both their personal and professional lives is apparent. There are 10.7 million females employed in the healthcare industry. These women are making a difference at work, at home, and in the community. They shoulder tremendous responsibilities. It is time to better understand the unique and delicate issues of professional/personal blend facing the women who work in healthcare.

I invite you and/or your female colleagues to take part in a groundbreaking study to find solutions to work/life blend among women employed within the healthcare industry.

• Go to www.studergroup.com/womensstudy and complete the survey.
  The fifteen minutes of your time needed to complete the survey will impact the future of healthcare.

The knowledge gained from the study will uncover new and different opportunities that employers can execute for greater recruitment and retention of female employees. This will enhance the work life environment for women and, through an enhanced work environment, we will produce improved patient care.

Every day we all have the ability to make a difference. This is an opportunity to directly touch the lives of the women you work side by side with. Again, I ask you and/or your female coworkers to be a part of developing solutions regarding the importance of females in healthcare.

Leadership Resolution 2008

Want to make a New Year’s Resolution that not only improves your bottom line but actually has staying power? Here are five simple tips for turning it all around…fast.

Are you looking for a way to make 2008 the best year ever? Here’s my suggestion: spend the next 12 months (well, eleven and a half at this point) focusing on leadership. Not leaders, mind you—leadership.

Solid results that stand the test of time do so for one reason and one reason only: consistently excellent leadership. Products and services change with the demands of the market. Individual leaders come and go. The key is to create an organizational culture that ensures great leadership today and tomorrow.

In other words, you need a long-term fix, not a magic bullet or a trendy program du jour or a charismatic leader. You need a culture built on good, solid, time-tested leadership principles. Organizations should institute proven across-the-board behaviors that don’t depend on particular individuals. In the book Results That Last, I reveal some tried and true “best practices” in leadership—also known as Evidence Based Leadership^SM (EBL)—that enable organizations of all types to hardwire excellence into their very DNA. Simply put, EBL will help you get the results you’re seeking. The “evidence,” in this context, is the reams of data collected from study after study that aim to determine what people really want and need from their leaders, and what actions help them see the results that last and lead to their personal peak performance. Apply these proven tactics to every corner of your organization and you’ll achieve consistent excellence. Your success is no longer dependent on individuals. No matter who leaves, the excellence remains. These practices are not complicated. They’re simple, commonsense tactics that leaders can get their hands around and start doing right away.

In fact, implement these five “biggies” and you’ll see dramatic changes by the end of 2008:

• Nurture your winners. It’s just good math! Want to spend 92% of your time retaining the 92% of employees who really want to be on board—and 8% of your time on the 8% who don’t? Of course you do! Your high performers and middle performers are your company’s future, so it doesn’t make sense to spend the vast majority of your supervisory time on those few employees who simply aren’t going to change.

Here’s the solution: implement highmiddlelow® performer conversations. They’ll help you re-recruit your great employees, make good employees even better, and move those few problematic employees up or out. You’ll be amazed by the boost you’ll see in morale—and profitability!

• Accentuate the positive. Managing up means positioning your people, products, or organization in a positive light. Managing up doesn’t just happen; you have to make it happen in a systematic way. Help employees understand what can happen when negativity is allowed to breed (good people quit and customers leave) and they’ll be more likely to look for ways to be more positive.

Managing up makes people feel appreciated and reinforces desirable behaviors. For example, teach your frontline supervisors to let their leader know who does a great job. That way, she can thank these employees personally. Employees can manage up their boss and the company to other employees, customer service reps can manage up employees to customers, coworkers can manage up each other…See how it works?

• Make a real connection with employees—every day. As many of you know, I am a big proponent of “Rounding For Outcomes.” (Think of a doctor making her daily rounds to check on patients.) Rounding helps you communicate openly with your employees, allowing you to regularly find out what is going well and what isn’t going well for them at the company. But remember, it’s not just empty “face time”—it’s rounding for outcomes, which means the process has a serious purpose.

Basically, you take an hour a day to touch base with employees, make a personal connection, recognize success, find out what’s going well, and determine what improvements can be made. Rounding is the heart and soul of building an emotional bank account with your employees, because it shows them day in and day out that you care and are committed to improvements.

• Say thanks. In fact, put it in writing. I am a big advocate of sending thank you notes to employees who do an excellent job. But that doesn’t mean just sending the occasional note when someone goes far above the call of duty. Thank you notes don’t just happen. If they aren’t hardwired into an organization, they don’t get written. And a thank-you note is just too powerful a tool not to use. People love receiving thank you notes. They cherish them.

The best thank you notes are:

• Specific, not general. A thank-you note that focuses on something specific the recipient has done is far more effective than one that reads, “Hey, nice job!”
• Handwritten, if possible. Most people would rather receive a three-sentence handwritten note than a two-page typed letter. It’s more authentic and special.
• Sent to the employee’s home. When an employee receives a thank you note at home, it feels more personal than one laid on her desk along with a stack of reports and memos.

• Don’t just recruit great employees. Re-recruit them. If you plan to hire in 2008, here’s a relatively easy step you can take that will pay off in a big way. We all know employee turnover is expensive. But did you know that more than 25 percent of employees who leave positions do so in the first 90 days of employment? To retain a new team member, the leader needs to build a relationship. Studer Group has found that scheduling two one-on-one meetings, the first at 30 days and the second at 90 days, has an enormous impact on retention that directly turns into savings for your organization.

If these meetings are handled successfully, new employee turnover is reduced by 66 percent. I suggest using a structured list of questions to discover not only what’s not going well, but also what is going well. You can be certain that your new employee is comparing her first few weeks of work with your company to her last week at her previous job—which was filled with well wishes, tearful good-byes, and probably a going-away party. Clearly, your company will get the short end of an unfavorable comparison. These meetings will help you shore up an otherwise tenuous relationship.

Once you start implementing these tactics, results quickly follow. People will see that you care about them, which boosts morale, which improves performance, which leads to happier customers, which leads to higher profits.

Your job, and that of your leaders, is to create happy, loyal, productive employees. They, in turn, will create happy, loyal, profitable customers. They are two sides of the same coin—and that coin is the currency that buys you results that last.

Aligning Goals to Outcomes

A watershed question on whether your organization has an effective evaluation system is this: Is it possible for a leader to not perform well and still receive a good evaluation? If the answer is yes, one of the main challenges is setting measurable objective goals. Below one of our experts offers some help.

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Aligning Goals to Outcomes

- by Penelope Tucker

The most common questions we get from leaders are related to metrics and setting objective goals. Evaluations are top of mind as we enter a new year and create new goals. Leader accountability is the first thing we implement with any organization we coach. Why? If you first align the outcomes across your organization, you can then more simply align the behaviors. In Quint’s new book, Results That Last, he explains that if there is only one thing you can do aimed at taking your department or entire organization to the top, it should be to establish an objective evaluation system to hold leaders accountable.

So, how do you know what to measure in your organization, and how do those measures cascade and align to individual leader evaluations? Our partners now have the answer to this common question. Studer Group coaches this accountability methodology across the country, resulting in 38,615 leaders using our automated tool. Our national goal expert, Bill Bielenda, has created a full library of objective goals and metrics based on national standards and what we see measured in other organizations we coach. Organizations that have active coaching partnerships with Studer Group have full access to this library of resources. If your organization is not currently a partner, we have tools to help you in developing goals as well.

Studer Group has now maximized the ability to share successful leader goals and metrics, in addition to populating these into the Leader Evaluation Manager^SM software. If you want to closely track a particular goal or metric in your organization, I recommend placing that goal on one or more leader evaluations. And for those departments that need to move the most, I recommend assigning high weights to these goals. You will see the move in results when evaluations are tied to leader performance.

This is what we see in high performing organizations that have sustained results. With this level of objectivity, there are no surprises at the end of the year when you tie evaluations to results and further help your leaders prioritize.

I hope this will be helpful to you as you align evaluations to outcomes to drive sustainable results. Please contact me to access these resources or visit our website at www.studergroup.com.

Penelope Tucker
penelope.tucker@studergroup.com

Volunteers

Volunteers are such a vital part of healthcare and the success of many organizations. I asked one of our Studer Group experts, Lynne Cunningham, to share her suggestions on how to integrate volunteers into the organization.

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Maximizing the potential of your volunteers as your organization continues its service and operational excellence journey

- by Lynne Cunningham

Years ago, I chaired the Board of a volunteer organization in my community. Our executive director told us that everyone was “staff” – some were paid and some were volunteer, but there was no difference in the importance of the role each person had. Do you have that same philosophy when it comes to the volunteers in your hospital?

“If you are going to realize the potential of the women, men and teenagers who volunteer in your hospital, they need the same service excellence training that you are providing for your staff,” says Dian Hartmann, a Director of Volunteers for 12 years and now a hospital volunteer herself for 2 ½ years since her retirement.

Initial training and periodic training updates need to be designed and targeted for your volunteers. The training needs to be required for all volunteers. Validation that volunteers are using their service excellence skills needs to be the responsibility not only of the Director of Volunteers, but also of each leader in the areas where volunteers are providing service. The range of duties that volunteers can provide will vary but may include Information Desk, delivery of flowers and mail to patients, providing information in the Surgery Waiting Room, serving coffee to visitors, visiting patients, assembling packets, running errands for patients, or just listening and talking to patients when the volunteer has had similar experiences.

Hartmann recommends two hours of initial training for all new volunteers and two hours for training updates at least annually. “Training needs to be required for all volunteers so the sessions need to be offered at a variety of times.”

So how can you apply the Must Haves® to your volunteers?

• The Director of Volunteers, as well as other leaders, need to Round for Outcomes on volunteers to ensure they are rewarding and recognizing efforts, solving problems, and being open to questions the volunteers are afraid to ask of professional staff.
• Thank You Notes are an excellent way to recognize special efforts of volunteers and should be initiated by the Director of Volunteers and any leader or group of staff where the volunteers work.
• Key Words, especially AIDET^SM, are also important for volunteers. Volunteers should be using your organization’s standard Key Words like “Is there anything else I can do for you?” and wayfinding. Volunteers who are interacting with patients and family members can help reduce anxiety when they use AIDET skills and Acknowledge the patient, Introduce themselves with their role and experience, discuss the Duration or time they will be with the patient or when they will provide the next surgical update, Explain what they will be doing while with the patient, and Thank the patient for choosing the facility.
• Selection skills also apply to recruitment and interviewing volunteers. Volunteers should be trained to conduct peer interviews and then welcome their new colleagues when they first start their volunteer assignment. 30 and 90 Day Meetings can also be done by the Director of Volunteers and other leaders in areas where volunteers are assigned to minimize turnover.
• It may not be a Must Have, but Employee Forums are a key opportunity for the CEO to communicate with all staff – whether they are paid or volunteer. A special session may be offered to the Board of your volunteer organization, but all volunteers should be encouraged to attend an employee session and their attendance tracked just as you do for your paid employees.

Hartmann acknowledges that it takes more than coffee and cookies to get volunteers to training today. “There needs to be mutual respect from the hospital staff and leaders. Volunteers need to feel they are part of the team.”

What’s the Return on Investment (ROI) for this additional training and ongoing partnership with your volunteers?

• Applying the recommended Must Haves of Rounding, Thank You Notes and Selection to volunteer recruitment and selection will result in less turnover of volunteers. That saves time and money for interviewing, training and testing.
• Training volunteers to use AIDET and other Key Words will support your efforts to decrease patient anxiety and improve compliance.
• Ensuring volunteers listen for Service Recovery opportunities will help identify patient and family concerns at the earliest point before the patient leaves the hospital.

I hope these tips will be helpful to you as you work with your Director of Volunteers and the leadership of your volunteer organization to maximize the potential of this critical part of your work force.

Lynne Cunningham
Studer Group Coach

Passion

Passion — it keeps on going even when it is uncomfortable.

As I ended the November “Taking You and Your Organization to the Next Level” in Denver, I reviewed with the participants the items we had discussed: increased accountability, standardizing best practices, staff and physician engagement, post-calls, physician preference cards, addressing performance issues, Key Words at Key Times — just to name a few.

I shared that none of these were easy for me at the start. Some still cause anxiety. So, why would one do difficult things that are not easy and are uncomfortable? Because the passion to make health care better fuels us to do things that are not easy. Passion keeps us moving even when it is difficult and uncomfortable.

The week ended with me spending the day with over 100 physicians who practice in Centura Hospitals in Colorado. These physicians took the day away from their practice. I was once again struck with their passion for health care. What keeps a person going with the challenge of medical school, residency, the challenges of working long hours, and, at times, telling patients and their families information they wish that they did not have to share? It’s passion.

At 56 years of age, I continue to be in awe of health care difference makers. Yes, tools, techniques, medications, and training are wonderful and a necessity. But, passion is the constant that keeps our souls alive to continue to serve others.
In the end, I believe that we did not choose health care. Health care chose us.

Quint

HCAHPS

This past week Results That Last reached number 12 on the Wall Street Journal’s Business Best Sellers List. This means that when many non-health care leaders are reading Results That Last, they are seeing that there is much to be learned from leaders in health care. We have learned a lot from non-health care leaders—it’s nice to see it works the other way also. To those who have purchased Results That Last and given it to leaders you know, thank you.

This week’s blog is on HCAHPS. This is another opportunity to use transparency to show others the best of health care. Studer Group had the first Toolkit on HCAHPS. We have just released the third edition. Karen Cook is one of our experts in HCAHPS. She has over twenty-five years of nursing experience and was one of our first Studer Group employees. She and her partners have been working with the HCAHPS tool since the very early pilot stages in 2005. She has put together this blog on HCAHPS as well as a Webinar and the third edition of the Toolkit. Known for her passion in focusing on the patient, you will see in this blog that it is about “always.”

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“Usually isn’t good enough“

Early in my 26 years of marriage I received some advice to “never go to bed mad.” I even have a picture that serves as a visual reminder of that great advice—it says ” Always remember to kiss me goodnight.” But how often do I do it? I can honestly say that I usually do; but usually isn’t good enough. I invite you to think about a similar setting in your everyday life. For example, can you honestly say you brush your teeth every night?

“Always” is an interesting word—defined by Webster’s dictionary as “at all times.” This is a high standard to attain, yet that is exactly how we want the patients to view their hospital care. With the new Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) survey tool, the patients are asked to rate their hospital experience. Measured in frequencies, patients will be asked about their perception regarding how often they received particular aspects of care. Hardwiring processes to “always” deliver quality care means providing the best care to every patient, every time and with every interaction. Usually isn’t good enough.

Previously sheltered from public reporting of clinical quality data, hospitals have entered a new era of transparency. As part of a larger movement to help inform consumers, the patient perception of their experience with a hospital will now be reported with other quality metrics. The tool is a standardized, national patient survey, allowing public sharing of comparable data across acute care hospitals. While many facilities have been interested in their patient’s perception of care for a very long time, I have found that the potential for public reporting is a very powerful motivator to become even better.

In our national lab of more than 500 hospitals, executives are asking “how can we prepare for public reporting of the HCAHPS survey results?” Studer Group has created two new tools to help hospitals achieve their desired outcomes in clinical, operational and service excellence. Aligned to the survey questions, both the HCAHPS Webinar and a new Toolkit are available now. Here are a few tactics described in these new offerings.

Key Words at Key Times
The survey questions focus on communication with doctors and nurses, responsiveness of staff, cleanliness and quietness of the environment, pain control, discharge information, and communication about medications. One of the most challenging questions on the HCAHPS survey asks the patient how often “did the staff describe medication side effects in a way you could understand?” We’ve seen several organizations improve their results just by incorporating key words to directly address this question. For example, when administering a pain medication, a nurse would commonly have said “this medication will help manage your pain but you might have some nausea - make sure and let me know if you do.” When the nurse adds the key words, “this is a common side effect,” this connects the dots for the patients and helps keep them fully informed. To verify this occurs with every patient, the nurse manager can ask the patient on rounds, “have your nurses explained your medications and helped you understand any side effects to look out for?” When the patient is preparing for discharge, the nurses can ask open-ended questions for patients to review their medications and any potential side effects. Key words are important to deliver a consistent message and keep patients informed, and they play a vital role in impacting this particular question and the medication reconciliation process. They should be integrated into daily care conversations in multiple avenues and not just when the medication is actually being given.

AIDET
The new HCAHPS survey asks the patients about how often the staff explained things in ways they can understand and how often they were treated with courtesy and respect. Our AIDET communication format is a great tactic to implement immediately to impact our communication with patients. Evidence shows us that if every employee would focus on Acknowledging patients, Introducing themselves and the anticipated Duration, Explaining things in ways patients can understand, and Thanking the patients, it would help reduce patient anxiety. To close the interaction, each staff member can ask the patient, “do you have any questions I can answer before I leave?” This will help impact the patient perception of listening carefully and explaining things in ways they can understand.

While we want to achieve excellent results on the patient perception of care survey, I think it is sometimes easy to lose sight of why we’re doing this. It is not about looking good on the survey. It’s about always providing the best care to our patients. This survey tool allows us to know what patients think about the elements of care that are most important to them and helps us understand if they would recommend our hospital to their family and friends.

If that is not motivation enough, the Centers for Medicare and Medicare Services (CMS) issued a final rule for hospitals paid under the Inpatient Prospective Payment System. Those hospitals eligible for the annual payment update must submit their HCAHPS data or forfeit 2% of the annual payment update. This is part of the quality measures required in the Reporting Hospital Quality Data for Annual Payment Update (RHQDAPU) and is required as of July, 2007. The financial penalty varies from hospital to hospital, based on a number of factors including average daily census, but could be substantial. This requirement puts in motion the pay-for-participation concept and there seems to be a clear movement to eventually tie reimbursement to performance on quality metrics, including the patient perception of quality.

The HCAHPS toolkit provides more than 40 ideas to impact these questions. The ideas have been generated from hospitals already focusing on improving their patient, physician and employee loyalty. In the era of public reporting, this strategy takes on a whole new meaning and is key to long-term success. As leaders, we have the exciting opportunity to guide our organizations to a culture of “always.” Easier said than done, a culture of “usually” isn’t good enough.