The Power of the “Why” behind the “What”

Often after I do a speaking presentation, people will come up to me to ask questions and share steps they are taking to improve performance. Some of the saddest moments are when it’s evident that someone is working very hard to serve patients and it appears many of the right steps are being taken—but the objective results are not there.

I’ve identified a common theme in these situations. Even when many of the correct steps are being implemented, one critical step often is not: explaining the why. Sometimes explanations have more impact than behaviors.

Here are several examples:

Example 1: A hospital wanted to improve the patient’s perception of speed of direct admissions. Through process improvement it had reduced the average time to around 20 minutes from a previous average of over 40 minutes. Yet, patient perception of the speed of admission process stayed the same. The issue was that the change was not explained to patients—so they had no basis for comparison. It simply seemed slow.

The recommendation was to say to each patient: “The admission process you are going to go through used to take an average of 47 minutes. However, we’ve worked hard to speed up the process and now it should take less than 25 minutes. When you’ve completed the process, we’d like your feedback on it.” The hospital implemented these key words and ratings went up.

Example 2: An Emergency physician told me the story that while he tried to make all the patients comfortable he was not explaining the actions he was taking. For example, “I want you to be as comfortable as possible—would you like a blanket?” or “I have ordered pain medication to make you more comfortable.”

While he and the other physicians had always done these behaviors, they had not connected the dots for the patient. Once they started doing so, the patient perception of care (satisfaction results) improved.

Example 3: A hospital’s HCAHPS result on noise was not good. To remedy the problem, the organization had put softer wheels on carts, eliminated paging, and even purchased quieter keyboards and put up signs asking people to keep noise levels down. Unfortunately, no improvement was experienced in the HCAHPS.

Here is what took place next. The staff explained to the patients and family members that they wanted the unit to be as quiet as possible so the patient could get rest. They even explained the steps they had taken, such as the softer wheels and the elimination of paging. They added: “While we do all we can, we are a hospital and some noise is inevitable as we’re caring for patients. Still, if it’s too noisy, please let the staff know and we will do all we can to keep things as quiet as possible.”

Guess what? Perception of quietness went up and noise went down.

I see healthcare professionals working very hard, taking many of the right steps, and I see their disappointment when those results are not there. Often, they end up trying even more actions—which may still not make a difference.

My suggestion is this: before you make even more changes, first take the time to better explain the why of the current actions. The patient’s perception of care will improve. Sometimes, words actually do speak louder than actions.

Sincerely,

Quint Studer, CEO
Studer Group
http://www.studergroup.com/

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“I won’t say I’m sorry if it’s not my fault.” (“And by the way, don’t script me!”)

The other day I received a note from someone with a copy of a letter sent to him by a staff member regarding a conversation with a patient who was upset with the care she had received. The note basically read, “I won’t say I’m sorry if I didn’t do anything wrong. And I won’t use tools that have been provided because I don’t want to be scripted.”

I am sure many of you are thinking of some “key words” you would like to use right now! But instead, let’s attempt to help this person see the value of handling a complaint in a value-driven manner. I’ll address his concerns one point at a time:

Point #1: “I won’t say I’m sorry if I’m not at fault.” Saying you are sorry does not have to mean you’re admitting a mistake. It is fine to say, “I am sorry we are not meeting your expectations.” This does not mean that you or anyone else did something wrong.

The Fire Starter Publishing book “I’m Sorry to Hear That…” Real-Life Responses to Patients’ 101 Most Common Complaints About Health Care (by Susan Keane Baker and Leslie Bank) offers numerous examples of ways to say you’re sorry. The main goal is to get patient care back on track.

When I was president of a hospital, I wanted to help the patients and families get to the point in which they followed the treatment plan and worked with the staff, not against them. So when a patient complained, I would say, for example, “I am sorry you are disappointed,” or, “I am sorry we’re not meeting your expectations.” I followed this up with, “What would you like us to do?” Probably 95 percent of the time, it was something that could be done.

Sure, there were times when an issue was not able to be resolved. But most of the time things got back on track. In fact, our litigation all but disappeared—and much of the credit was due to those simple words.

Point #2: “I will not be scripted.” We prefer to use the term “key words” instead of “script.” (It seems healthcare people can be so upset with the word “script” that they miss the outcome.) Whatever you call it, scripting works. The goal is to use words, phrases, actions, tools, and techniques to help the situation and to achieve the best possible outcome.

Parents love scripting: “Say please,” “Say excuse me,” “Say thank you.” Spouses also use key words: “I love you,” “Thank you,” and “Let me get that.”

In healthcare we use scripts—or key words—with patients all the time. “Press this button if you need anything,” “Tell me if this hurts,” and “Let me know if you have questions.”

During each patient visit, physicians use the phrase, “Can I answer any questions?” When I ask them why, they say that it lets patients know they are interested and that there is time to ask questions. It also reduces calls back to the office. I believe that when the reasons why are correctly explained to them—and when they understand there’s a way to do it without admitting error—people don’t have a problem with saying sorry. (Of course, if it is an error, we need to say it is and fix it as best we can.) I also feel most people understand that key words can reduce anxiety, improve compliance with the treatment plan, and offer many positive benefits.

As for the person who inspired this blog post, let’s hope he did not understand the why of saying “I’m sorry” and of using a script. If he said these things out of his own discomfort, let’s hope that once training is provided, he will come to understand the why of de-escalating the situation. Patients, families, physicians, and employees have enough stress in their roles without letting situations that can be calmed down get heated up.

And if after learning the benefits of saying “I’m sorry” and putting powerful key words into practice, the person still can’t get it, he just may not be right for healthcare.

Sincerely,

Quint Studer, CEO

Studer Group

http://www.studergroup.com/

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Is respect given or earned? (How to not be micro managed)

In a meeting I recently attended, a leader shared that she felt her department was not respected. Her statement led me to look into the department in question. What I found was the department had poor results in expense management and physician satisfaction—and it also had low patient satisfaction.

Perhaps the lack of respect is not surprising.

Real respect is earned. And the best way to earn respect is through good results. Don’t get me wrong: the role of the department and the duties of the individuals that work there are always respected. But if the department as a whole is not respected, chances are the reason has to do with performance.

Liz Jazwiec’s book, Eat THAT Cookie, points out how easy it is to fall into victim thinking, and how easy it is to reinforce that kind of thinking when it develops in an organization.

When someone comes up to you and says he feels his department is not respected, or is being bashed or is not being treated well in some other way, he is exhibiting victim thinking. Here are a few suggestions on what to say:

• Ask the person to share specifically why he feels that way.
• Ask him what he is looking for.
• Then, close in on performance.

My experience is that good leaders do not make “victim” statements about not being respected. Generally, it is the leaders whose results are lagging who voice these complaints.

Often, these low performing leaders will report that they are “micromanaged.”

This reminds of me of another story. I was meeting with 12 hospital administrators and some key senior leaders from the system’s corporate office.

At the first break one of the hospital leaders came up to me and said he was pleased the system was moving in this direction. He also asked if perhaps I could influence the corporate leaders to stop micromanaging him.

Later on, right before lunch, I went up to another hospital leader at the session and asked if he felt corporate micromanaged him. No, he replied. In fact, he added, the main thing he liked about the system was that they did not micro manage him and that he liked the autonomy he was given.

Now, these two leaders worked in the same system. They had identical roles inside the organization. Yet, they had two very different perceptions.

I had lunch with the corporate leaders. During lunch I brought up both individuals, without making any specific comments about them. When I mentioned the first one, the immediate response was, “We are concerned about this leader. He is not meeting goals.” When I mentioned the second one, they said, “We never have to worry about Tom. He hits the goals every year.”

In summary, the better leaders achieve their goals, the more respect they and their area will have and the more autonomy they will receive.

Sincerely,

Quint Studer, CEO

Studer Group

http://www.studergroup.com/

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The Grateful Workplace: Six Ways to Create a Culture of Gratitude in Your Organization

Author and Speaker Liz Jazwiec explains how anyone at any level can infuse gratitude into their organizational culture.

Here’s a question just in time for Thanksgiving: Does your organization encourage a culture of gratitude? Not in an obligatory, “Gee, I really appreciate my coworkers and the feeling is mutual!” way? Chances are the answer is no. According to a recent Gallup poll, 65 percent of people say they don’t feel appreciated at work. And, that feeling can lead to pervasive negativity, low morale, and (worst of all) decreased productivity.

It doesn’t have to be this way. Organizations can deliberately infuse their cultures, from top to bottom, with the proverbial “attitude of gratitude.” Workplace gratitude is often passed from the boss to the employee. To have a real impact on workplace positivity, employees should show it to one another and to their bosses. And leaders and employees should show it to their customers.

It’s obvious when you are in a workplace where people value gratitude and graciousness. There is a really great vibe in those places. And when gratitude and graciousness are missing, it is equally evident. People in those environments seem to have a sense of entitlement. Coworkers who come into contact with them might say, “There is just no pleasing those people!” Customers might say, “They just don’t care about me!” Neither reaction is good for business.

The great thing about infusing gratitude into the workplace is that it can come from anyone, regardless of position. If you are a leader, you can infuse gratitude from the top down, perhaps by making it a required standard of behavior for employees. And if you are an employee, you can start your own grassroots gratitude movement by expressing gratitude yourself and encouraging your coworkers to do so as well. Everyone—and I mean everyone—can show gratitude in a workplace and influence others to do so.

If you want to make this the season of gratitude at your organization, read on for a few tips on how to hardwire workplace gratitude from the ground up.

Say thanks. When someone does something kind for you, whether it’s your boss, your coworker, or a stranger, recognize it! A simple “thanks” will do. You can’t expect people to appreciate you if you don’t receive their kindnesses and compliments with thankfulness. Sure, you might be skeptical if your boss goes to a leadership conference, and upon his return starts handing out compliments left and right. But just stop and think. Are those compliments making people happy? When you are recognized, does it give you even just the tiniest little twinge of happiness?

If so, then you’d better meet the gratitude your boss is showing with a little gratitude in return. Otherwise he will start thinking that his recognition doesn’t really mean anything to anyone, and his exercise in gratitude will be short-lived. And leaders, give your employees a chance to jump on the gratitude bandwagon. It may take a couple of compliments from you before they realize what this new positivity movement is all about. You may get a few skeptical looks after the first few compliments, but eventually they will warm up to the idea and be thankful—there’s that word again—that you are making the effort.

Adopt an “it’s the thought that counts” attitude. Consider this scenario: A new VP at a hospital wants to do something special for her hardworking, overworked staff. It’s decided that pizza will be provided for the entire hospital staff, rolling out over a Sunday, Monday, and Tuesday to ensure that every person on every shift can take a pizza break. The pizza plan goes into effect and the VP, who arranged everything, walks around the departments, expecting to be welcomed with open arms by an appreciative staff. Instead she finds that many of the teams taking care of patients are upset because they can’t leave their patients to go down to the cafeteria where the pizzas are located. Meanwhile (they complain), the business office and IT staffs are able to go to the cafeteria as they please.

In the interest of full disclosure, I must admit that I was that VP. And I was devastated. I had tried so hard to get it right. Now, I did learn from that experience. I knew that the next time I should have the pizzas delivered directly to the units. But had I been someone with a different personality, I might have just decided never to order pizzas, or do anything else special ever again. My point is that sometimes you have to take into account the intentions of your boss or your coworkers. If it is clear that they meant for something to be a way of thanking you or helping you, don’t complain about how they missed the mark. Thank them for thinking of you and move on!

Communicate openly and honestly. If it’s gratitude you need, tell someone! Often your leaders or coworkers can be so tied up in their own tasks that they forget about those working around them. The natural reaction when this happens is to either hold in your negative feelings or complain to another coworker. But a more proactive stance might be to opt for open and honest communication.

Now, I am not suggesting you go around asking people to thank you for what you are doing. That would be pretty obnoxious. But what you might do is ask your boss or coworkers if you are giving them everything they need from you. And you might also start showing them some appreciation. Gratitude is a two-way street. If you start making other people feel appreciated, nine times out of ten they will not be able to hold in their appreciation for you. You don’t have to wait for one of your leaders from on high to implement a gratitude initiative. It will be just as effective if it starts with you!

And leaders, if you feel your lack of gratitude is justified because your staff isn’t living up to their potential, communicate what’s missing. If this is the case, it’s likely that you are all stuck in a negativity cycle. You are unhappy with them. They sense that and become unhappy with you. Their unhappiness leads them to give less than 100 percent on the job…and you become even less happy with them. Get the picture?! If you aren’t getting what you need from them, let them know. And when they start delivering, thank them for their efforts.

Be prepared for some kind words. If you are unaccustomed to getting compliments, it may take some time for you to feel comfortable receiving them. Just practice and be prepared for some kind words! When I first started speaking, I had no idea what to say to people when they told me they liked my presentation. I had to rehearse being gracious and grateful. Can you imagine if someone came up to me and said, “I just loved your speech!” and I responded with, “Whatever?” Yikes and double yikes! It seems so funny we should have to practice saying “thank you,” but many of us just don’t know how to process gratitude. So start practicing!

It is just as important for leaders to practice this skill. It isn’t easy for many employees to approach their bosses—even when it is with a compliment—so make sure you give them the attention they deserve. Truly listen to them. Take a second, no matter what you are doing, to engage with them. And afterwards shoot them a quick email or send them a note thanking them for their kind words.

Thank those you serve. Once you have mastered the gratitude thing with your bosses and your coworkers, you need to move on to the people you serve. When I first told my staff that we ought to be thanking our patients, one of them replied, “What are we supposed to say? Thank you for breaking your leg?” Obviously not! I suggested they say, “Thank you for putting your trust in us today.”

You can do it with a simple, “Thank you for giving us your business.” Or you can thank them by providing other special incentives or coupons. It doesn’t really matter how you do it, just make sure they know you are grateful that they are choosing to do business with you over your competition.

Know that gratitude encourages repeat performances. Leaders, remember the behavior you recognize will be repeated. If you think an employee handled a disgruntled customer well or showed great proficiency in managing a group project, let her know about it and she’ll work hard to do the same, or even better, next time. And employees, if you acknowledge your boss’s efforts to show gratitude, she will keep doing it. Thank her for going to bat for you and your coworkers over a new piece of equipment you need or a pay raise dispute, and she’ll be more likely to do it again in the future.

I think it’s important to recognize the fact that no one has any obligation to show gratitude to anyone else. You don’t have to thank your boss, your boss doesn’t have to thank you, and neither of you have to thank your customers. But what I think you will all quickly find is that if you do take the time to say “thanks” your whole organization will improve. You’ll like each other more. You’ll want to go the extra mile for one another. And your customers will be happier.

I know from experience that the best places to work are places where teams are grate­ful for what is given to them and aren’t afraid to express sincere ap­preciation whenever it is merited. The best places to work are those where individuals, regardless of their position, accept compliments and praise with grace and don’t second-guess the intention. Even in these tough times, most of us have a lot to be grateful for every day. It’s important to recognize that. When you seek to expand both team and individual gratitude and graciousness, your work environment will be even healthier. You will see negativity slip away, and I can almost guarantee it: You’ll see your efforts reflected in the bottom line and most importantly happier employees and patients.

In gratitude,

Liz Jazwiec
Studer Group National Speaker
www.studergroup.com

For more information on Liz and her book, Eat That Cookie!, please visit www.studergroup.com/EatThatCookie.

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Own Your Leaders’ Development…not Their Symptoms

Are the leaders you supervise growing and developing?
Are they taking ownership of the challenges they face, or are they laying the burden on you?

There are certain statements you might hear from leaders or staff that raise a red flag. Often, these statements are symptoms of a larger problem. They indicate that it’s time for a leader to take a personal inventory and for you to help him or her develop.

Five of them are listed below, along with my suggested responses to each. In the past week I have heard all of these except for number five, which I typically hear from departments located off-site from the main campus.

1. From a leader: “The staff does not feel appreciated.”
   Ask the leader, “What do you feel you need to do for the staff to feel appreciated?” Help her own the situation. If she doesn’t own the situation, she won’t own a solution. Ask her, based on the feedback she receives when rounding on support staff or patients, “How much recognition have you harvested and shared with your staff? How often have you managed up staff to me as your leader?” Have your leaders ask each staff person what they are looking for in terms of appreciation. They can share a time when they felt appreciated so the leaders have a clear example to follow. I find leaders may feel they are showing appreciation, but staff may not see it that way. Tell them: “Don’t guess; ask. Don’t fall into the trap of feeding victim behavior. Finally, let staff also know what you are looking for in performance so that you’ll have the opportunity to show appreciation.”
2. From a staff member: “I like my leader because he protects me.” Or, “My leader stands up for us!”
   Ask the staff member, “Protects you from what? Why do you feel you need protection? What, specifically, is your leader standing up for?” I guarantee you will hear comments that indicate the leader may not have the skill to explain things or handle tough questions without putting others in a negative light. The better leaders see themselves as leaders in the organization first, then as leaders of their department.
3. From a staff member: “I want my leader to be on equal footing with other leaders so she can go toe-to-toe with them.”
   This statement was made regarding a situation in which some staff members felt that if their leader was at the same level as the leader’s supervisor or another leader then things would be better. This is usually a skill issue. In other words, the leader does not have the skill to communicate why certain decisions were made and that she supports the decision.
4. From a staff member when her boss is present: “I don’t feel that I’m getting the professional development I need, and my supervisor agrees.”
   Ask the staff member and leader how often they meet to discuss development. Ask to see the plan. Most likely there is not one. Again, the leader may not have the skill to create the plan or the organizational ability to make it happen. He might also be telling staff that he can’t give them the development they want because of the budget, the policy, or because, “You know how Tom is….” He is not owning the department. Also ask the staff person what actions she is taking for her development. Too often in healthcare, people exhibit “adult child” actions. Here the staff member is not owning her own development. I have even seen leaders invite their leaders or other C-Suite people to the department so staff can ask questions directly. If you are in this situation, ask the department leader to answer any questions about professional development first, before you answer them.
5. From a leader: “My area feels like the red-headed stepchild.”
   When I heard this statement, I asked the leader why the staff felt that way. She said it was because they were not located on the main campus and no one came to see them. They were left out at times. They didn’t feel included. I asked what she was doing to address these things, and I got a blank stare. I asked her how often staff members invited others to the department and how often she invited senior leaders over. I noticed they had a nice large room. I asked her if she ever suggested they move a department meeting from across the street to their meeting room. If she did that, I pointed out, with one action all of the department directors would now be over here. I asked her whether she interacted with other leaders, or whether she stayed in this off-site building all the time. By now you can guess the response I received. My main message to her was to integrate herself first, and then integrate the department. Don’t be a victim. To her credit she quickly did those things and more. Things got better.

The leaders of the leaders in these five scenarios were taking too much responsibility on themselves. My advice: Own what you feel you need to own, but give the rest right back to the leaders you supervise.

As a leader it’s natural to want to take ownership. But take ownership of how you are developing those who report to you, not ownership of their problems.

Don’t fall victim to the symptoms of an under-developed, under-skilled leader. If you fix the symptoms, those reporting to you will actually think it is your job and will not learn to take ownership. By empowering them to attack the symptoms at the source, you’ll ultimately help create happier, healthier leaders—and a happier, healthier organization.

Sincerely,

Quint Studer, CEO
Studer Group
http://www.studergroup.com

 

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It’s the Bounce Back that’s Crucial

Setbacks are universal. Every person, department, and organization experiences them. As long as the external environment is in a state of change, setbacks are inevitable. Also, completely unexpected occurrences will cause disruptions from time to time.

While the movement downward is significant, it’s an organization’s ability to bounce back—and bounce back quickly—that separates the best performers from the rest.

Clark Memorial Hospital in Jeffersonville, Indiana, is such an example. The organization has been recognized for excellence many times. Solucient listed it as a top 100 hospital. Studer Group has twice recognized it as Fire Starter of the Month. Other accolades include Best Places to Work, Kentucky Quality Award, and Economic Impact Award. It was an Indiana Excellence Award finalist. It received a Baldrige site visit in 2009.

Plus, the hospital’s results in Service, Quality, Finance, People, Growth, and Community have been solid for years.

So what happened? In the first quarter of this year, Clark had everything in place for an increase in patient care volume. But it did not come. A hospital that had always made money found itself, suddenly, in the red.

Here is what its leadership did, and they did it quickly: Senior leaders reduced their pay by 12 percent, and all other leaders reduced theirs by 10 percent until the organization was back on track. Not one leader left.

Staff focused tighter on all operations to improve productivity. In just one quarter they were back on track. During this time, staff turnover went down, productivity went up, and patient satisfaction stayed above the 90th percentile.

The organization is very transparent. It has been developing leaders for years and conducting employee forums. Leaders used their current methods to communicate all this information, the needed changes, and the “why” behind them. Their efforts paid off.

In summary, no one is immune to tough times. It’s how agile the organization is that counts. Having a strong foundation in place—one characterized by transparency, measurement, communication, hardwiring actions, and accountability—allows for quick action. Senior leaders lead the way with role model behavior.

In his newest book, Bounce, author Keith McFarland describes that every great organization faces adversity and setbacks—it’s how the organization bounces back that is the key. I agree. Over the years, I’ve seen his message played out by the organizations I serve…and I expect to see it proven again and again as we head into the future.

Sincerely,

Quint Studer, CEO

Studer Group

http://www.studergroup.com/

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The Top Ten Mistakes in Setting Goals

For years, healthcare leaders have been evaluated by means of a “Does Not Meet/Meets/Exceeds” scale. The problem with this is that it doesn’t really tell you what the leader accomplished. I believe a far more fair method is the use of a clear, objective, and weighted evaluation based on specific goal achievement.

The evaluation makes use of a one-to-five rating system for each goal, with the leader who exceeds expectations earning a five. And every goal is assigned a weight – a percentage – based on its importance so that leaders know where to put the most energy. However, my work with hospitals across the country has taught me that implementation of this leader evaluation system can be challenging for some. The good news is that missteps can be fixed with an understanding of what went wrong.

Here are the top ten, most common mistakes made during the first year of rollout and how they can be avoided:

1. Inappropriately assigning organization-wide goals to middle managers. For instance, it’s not uncommon for a hospital to assign its overall patient satisfaction goal to middle managers who have nothing to do with direct patient care. Instead, these individuals should have goals relevant to their position in the organization.
2. Goals are over- or under-valued in their assigned weight. Make sure you assign weights according to the goal’s importance and impact on the organization. The more significant the goal is to the organization’s success, the higher its weight should be.
3. All leaders share the same weights for a goal, even when their responsibilities don’t impact the weights. Leader’s goals should be weighted according to what they’re directly accountable for. Why should a person with minimal financial oversight, for example, be given a budgetary goal weighted at 50%? Yet I’ve seen it happen.
4. Instead of the outcomes, tactics such as projects or processes are used as goals. Don’t confuse the two – a tactic is the process/project used to reach a goal.
5. Designating healthcare regulations as goals when they’re really expectations. Regulatory standards should be a presupposed life style in the healthcare world.
6. Leaders fail to accept responsibility for far-reaching organizational goals they directly impact. Any leader who has influence over whether or not an organization-wide objective is achieved should own that goal.
7. Lack of uniformity in measurement. Define the measurement criteria for achieving a goal and what success will look like. Otherwise, leaders will invent their own definitions, targets or metrics …which results in confusion and inconsistency across the organization.
8. Leaders are allowed to “cherry pick” the easiest goals to meet instead of the most important. Cherry picking the undemanding targets gives staff the opportunity to achieve its goals, the leader looks good, and there is cause for celebration. However, in the long run, the organization suffers when a leader fails to concentrate on the important goals, the ones that will make the most difference.
9. Setting numerical targets where all leaders move up at the same rate. For instance, an organization wanting to move patient satisfaction results upward asks every leader to be responsible for increasing the scores by ten points. One manager is at the bottom of the barrel with patient satisfaction at 5 percent, while another one has achieved an 85 percent approval rate. Yet both are expected to improve at the same rate. This puts the first manager shooting for 15 percent, hardly much of an upgrade. But the second one will have to hit 95 percent, a very difficult thing to do – plus it’s hardly fair. The organization needs to consider rate of improvement instead of targets founded on the baseline when setting goals.
10. The goal is achieving a prestigious reward as opposed to the outcomes themselves. Don’t put the cart before the horse: Outcomes and results should be the priority – the awards will come. Remember, it’s the journey which warrants a Malcolm Baldrige National Quality award or Magnet status…that takes the organization to a whole new place.

If you have any questions or suggestions on how to implement goals in your organization please feel free to email me at bill.bielenda@studergroup.com.
Yours in service,

Bill Bielenda, Studer Group Coach
Studer Group
http://www.studergroup.com

For more information on Studer Group’s Leader Evaluation Manager™ software tool that automates the goal setting and performance review process for all leaders, and to review sample leader goals visit http://www.studergroup.com/lem.

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How Much Evidence is Enough?

If it doesn’t directly impact clinical care, is it still worth doing? That’s the question I was recently asked while speaking to a physician group.

(Before I go any further, let me say that I welcome having my beliefs questioned. It’s one of the benefits of being able to travel all around the country and interact with so many wonderful people. I have many opportunities to learn and to become better.)

Anyway, a physician in the room stated that he did not believe the patient satisfaction survey was of much value due to the fact that it does not impact clinical outcomes. He also felt that a patient could be very satisfied, yet not receive good clinical care.

Let me address the second comment first. I agree. It is possible for patients to rate their care high in a survey and still not receive great clinical care. This is where an organization’s values come in. I don’t know of any organization that feels good if patient satisfaction is high and quality is not.

The inverse is also true. Many times an organization’s clinical quality can be excellent but other issues can lead patients to feel they did not receive excellent clinical care.

My comment the other day to a group of physicians in an academic medical center was, "Let’s have the patient’s perception of care match the clinical quality you are providing."

Now, let’s go back to the challenge that started this blog entry: My first attempt to link the survey to the issue of clinical care was to read the questions. How well was your pain managed? How well were your needs responded to? How well were your questions answered? How well were things explained to you? How well were your home care instructions explained? I explained that I feel each of these can impact clinical care.

The physician disagreed, stating that these issues still may not change the clinical outcome. I then said, "So if a patient’s clinical outcome will not be impacted, then you don’t want your patient’s pain managed? Nor call lights answered?" The physician answered that of course he would want these steps to be taken.

That’s when it hit me. While I can connect the dots and also show more research that indicates a connection between patient satisfaction and clinical outcomes, the evidence really isn’t the point. There are times when even if actions do not impact the clinical outcome, certain behaviors and actions still need to be done.

Hospice caregivers do great work. Do their efforts change the clinical outcome? My first grandchild was stillborn. While the care and support given to my son and daughter-in-law did not change the clinical outcome, were they worthwhile? Yes, without a doubt.

Why do some people fight making some basic changes? I can’t take inventory for others, but based on years of experience, I do have some observations of my own.

For some people, it has to do with not being comfortable. If I am asked to do something that I am not comfortable doing and can come up with a reason not to do it, I have found a way to stay in my comfort zone. For others, I believe it is the fear of failure. They would rather not try at all than try and fail. I believe this is one reason best practices are hard to transfer in healthcare.

Some people may feel they are the voice for others. Have you ever noticed when someone is pushing back, he or she may often say, "Everyone," "Most people," or "Others," rather than coming out and saying, "Here is how I feel." Still others may feel they need more data before they can make a change.

It’s that last group of people, the data-seekers, who bring me back to the point. How much evidence is enough to make a change worthwhile?

I have come to this conclusion: There are times in life when we do the behavior even though there is not overwhelming research data to support it. We do it because it is the right thing to do. I can think of no reason more powerful than that one.

Sincerely,

Quint Studer

Transferring Best Practices

It is not finding best practices – it is transferring them.

Recently I attended a think tank meeting in Washington, D.C. At the meeting a well-known political leader, who was very engaging, said that if hospitals learned from non-healthcare companies how to improve process, healthcare would be much better.

He passed out a whitepaper with regards to funding a study which combined 5 top healthcare systems with top academia experts in areas such as process improvement. The paper went on to show how implementing the processes used in academia would help improve healthcare. They show how a physician, in streamlining processes, improved clinical care and reduced cost. It is a paper that is hard to disagree with in its intent.

I have great respect for this person and agree that there is solid room for improvement in both quality and cost regarding healthcare performance. I just don’t think we need another study on what to do to improve or create high performing organizations. We see high performance firsthand and read about it all the time.

As we seek to improve quality and access and reduce cost nationwide, to me the real question is not finding new best practices. The critical issue is how to transfer already existing best practices.

Why has this been so hard to accomplish in healthcare? There are areas in which high performance is transferred quickly. This is particularly true on the supply side. When a technology or pharmaceutical vendor has new software, equipment or medication they are quick to push the product into the healthcare arena. The challenge is not in purchasing such items, for the vendor will show the return on investment, the challenge is maximizing the value of this product in the organization. So the supply side of healthcare pushes what they feel are improvements into organizations and spends millions of dollars to make organizations aware of items and the value of each.

Often, the best practices related to demand, efficiency and effectiveness may actually require less expenditure, not more. They likely don’t have millions of dollars in advertising or sales tied to them. In reading an example of a physician best practice outlined in the white paper, if all physicians implemented, some on the supply side would do worse financially. So for some best practices there may not be an avenue to promote them by private companies. I am sure suppliers are looking to improve healthcare, and I do not fault them for doing what they feel is right, which is to have the organization purchase their solutions. My point is many improvements in healthcare are around people, systems, processes and execution; these most always require behavioral change. It’s not in the use of a new tool or medication. Substituting one medication for another is not a new behavior. It’s not a new generation of technology or software but many basic behaviors that need to change.

In order to implement the changes that we identify a need for through TQM, CQI, Six Sigma and Lean, it will come down to the organization’s leaders’ ability to align behavior, drive or entice actions and to hold people accountable. There is not a shortage of sound examples in healthcare. It is the inability of an organization to transfer these examples within their own organization, or even harder, to transfer from other organizations to their own.

For the past 6 months we have conducted a survey with many healthcare organizations. One of the questions we ask leaders is to rate their ability to transfer best practices within their own organization. On a 1 to 10 scale, with 1 being the lowest and 10 the highest, less than 10 percent of the senior leaders rate their organization’s ability to transfer best practices a 9 or 10. The average rating is a 5.

In my new book, Straight A Leadership: Alignment, Action and Accountability, which will be out shortly, I address the challenging issue of moving best practices. There are some obvious points and some below the surface issues.

Here are a few we have learned:

Issues below the surface:

1. Leaders want their autonomy. By implementing some other way of doing something the leader will give up a bit of their autonomy.
2. Leaders fear that if someone shows a particular method to work and they fail to successfully implement it, that this will be a bad reflection on their leadership. We can learn a great deal from physicians here. They are quick to duplicate others processes if they feel it will improve patient outcomes.
3. Some feel they are different or suffer from the disease of being terminally unique. We are so much more alike in healthcare than different. This can also come across as rationalization.
4. Ego. By the time some people get to the C-suite they are better leaders than followers, thus to copy or duplicate another leader or organization is hard.
5. Too much change. There is so much change in so little time that the new way is not mastered and this feels like the practice did not live up to expectations or, because the execution was not crisp, it led to desired results not being achieved.

Other issues:

1. Leaders who have best results and best practices are reluctant to promote them. The majority of leaders in healthcare are humble individuals who will say they are just doing their job and do not see what they are doing as special. So they do not promote them. Due to little money budgeted for a vendor the leader does not have a public relations and research arm with a sales force to take their practices elsewhere. Thus, best practices can be missed in an organization.
2. Some may feel it is the leader and not the process. Often, leaders who discover, create and or implement best practices are high performers in an organization so the focus is on their skill and not the practice. This is many times part of the equation so the actual practice is missed or underestimated.
3. The leader downplays what they are accomplishing. In healthcare I find that leaders are reluctant to take the spotlight and will downplay what they are doing. I have example after example of this. When I go to an organization I review data. I then visit a leader with outstanding results. When I ask them what they are doing, the first response is “nothing different from anyone else.” I then dig deeper with more specific questions and then I hear, "Well, we are doing this . . . " This then starts to identify processes, tools and techniques contributing to the high performance.
4. The leader is reluctant to teach others. When the high performing leader is asked to present what they are doing to others in the organization, they are reluctant. They often say they don’t want their peers to feel they are saying they are better or they don’t want others to feel bad. If they do present they tend to hold back and even give reasons why they can do it but it may be hard for others to do. They feel uncomfortable separating themselves from others. In fact, they will do a better job explaining what they are doing to people from another organization versus their own.
5. The leader fears they cannot sustain the success if word gets out.

Tips:

1. When a leader’s results starts to separate into better or high performance take time to view and diagnose what is being done. This needs to encompass any change in process, tools or techniques. Just as important, diagnose any change in the leader’s behavior.
2. Take time to document the findings in Tip 1.
3. Create on paper a best practice transfer system that outlines outcomes, process and answers to any push back that will come from others. This is why best practices in one organization are so important. This takes away geographic and demographic excuses or items like staffing, pay, benefits, physicians and corporate. If this leader can do it here so can others.
4. Assess needed skills to implement best practices: The person who created or implemented the best practice first has some skills that others may not. Assess what skills a leader must have in order to implement the practice successfully. They do not likely have an early adopter personality so skills that are there with the early adoptor are not there and must be acquired. If the leader does not have these skills, you may have to change the leader.
5. Accountability: The best practice is meant to improve performance.  Are the desired outcomes included in the leader evaluation that monitors and evaluates performance? If not then the best practice becomes an option and will likely not be optimized.
6. Are behaviors spelled out and sequenced for success? This will avoid making changes too much and too fast which leads to transfer failure.
7. Put in validation systems. Tools that validate implementation are critical to measure implementation. Trust but verify.
8. Spotlight with recognition those areas that are doing well in implementation. Ninety-two percent of people will move to what is being recognized. Use meetings, emails, letters and other avenues to spotlight those areas that are implemented well as milestones are reached. If you wait until you achieve the ultimate goal before acknowledging, you may never reach it. Those areas being recognized feel good and others who are not will notice and most likely move to the desired behavior.
9. Identify the why and keep in front of the organization. In healthcare, when changes are being made, there are valid reasons and plenty of why. Make sure the why is communicated often; such as improved care to save more lives, better access to help more people, lower expenses that provide better organizations and staff security. In healthcare the “why” drives the “what.”
10. Have a firm plan in place for those who do not have the will, the skill or both. If a leader has the skill to implement a best practice then the question is does the leader have the will. If they have the will, the question is do they have the skill. If they have both will and skill, success will be there. If they have one and not the other, ask yourself whether they can acquire the other, how fast and at what cost. Decide if the time and cost are worth the investment. If you feel it is not, then move quickly to remove the leader from this position. Over the years many best practices have taken a bad rap for lack of leadership.
11. Standardize the steps and learn from your organization’s experience. Make sure you have in place the best technique to transfer best practices generated within your own organization and also those you learn from others.
12. Relate, don’t compare. There is not a shortage of better ways to do things in healthcare, nor is there a lack of desire to share. A great characteristic in healthcare is the willingness for organizations to teach and learn from each other. While there will always be differences, the similarities will outweigh them. Relate on how to transfer.

Healthcare can spend lots of money to study non-healthcare organizations (who by the way are also not doing that well), to bring outside learning into healthcare (already done), or they can solve the real issue: how to transfer high performing leadership characteristics, tools, processes and techniques that increase access, achieve high clinical outcomes and lower cost throughout all healthcare organizations. There is not a magic pill or process. It is an organization’s ability to standardize high performance into their daily operations.

Sincerely,

Quint Studer, CEO
Studer Group
http://www.studergroup.com/

Preventing Patient Readmissions Improves Bottom Line Results

Organizations that make discharge phone calls reduce non-reimbursable readmissions between 20-30%. Research shows that patient/family likelihood to recommend a hospital is above the 90th percentile when they receive a discharge call. Research shows litigation goes down when a patient receives a phone call after discharge.

So how do organizations execute discharge phone calls?

Who to call:

• Studies show that unplanned readmissions rank the highest among patients who are suffering from congestive heart failure, pneumonia, and complications from surgical procedures such as heart stents and major hip and knee replacements. As organizations make phone calls to discharged patients, this high-risk group should be the first priority.

When to call:

• Hospitals see maximum results when calling discharged patients within 24-72 hours of going home. They catch early signs of adverse events, misunderstanding side effects of medication, therapeutic questions, and nosocomial infections.

Who calls:

• Trained healthcare personnel. The Discharge Call Manager™ software makes it possible to provide high quality calls from non-RN’s, allowing RN’s to provide direct patient care and save organizational dollars. Questions asked during discharge calls can be developed that align with HCAHPS requirements.

What to say:

• Studer Group recommends including quality-focused questions, such as:
  • Do you have any questions about your discharge (home care) instructions?
  • Do you have any questions about your medications? Are you aware of side-effects? (Mayo Clinic Proceedings study: Only 14% of patients knew medication side effects, 28% knew medication names and 37% knew purpose of medications, August 2005)
  • Do you have your follow-up appointment scheduled?
• Many organizations ask Unit Specific questions dependent on where the patient received their care. Studer Group will be happy to share successful questions by unit, in addition to populating these into the Discharge Call Manager. Click here to access our Discharge Call resource page and Question Library.

Why:

Discharge calls produce better clinical outcomes and are the right thing to do for patients and families. It’s a great way to verify that patients understand post-care instructions which reduce preventable readmissions. Most importantly, lives are enhanced and saved.

For best practices and frequently asked questions about discharge phone calls, contact Rachael Johnson.