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.

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…

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.

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.

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.

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.

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 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.

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 — 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

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.”

“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.

One of the most requested slides that we use in our presentations is one with two intertwined circles. One circle represents passion, and the other represents prescriptives.

I find these two elements are a powerful combination to attain and sustain results. If we try to achieve results with passion alone, we start to lose our passion when results are not attained or are attained for only a brief time. Gradually our energy starts to fade.

When we only use prescriptives without passion we get some quick results, but those stop when barriers come up. Why? Because it is passion that gets us through the barriers. Of course some days we will lead more with passion. Some days we will lead with prescriptives. But most of time we will have a combination of both.

This blog is in the passion circle.

Liz Jazwiec, who I have worked with since 1993 and is one of our Studer Group speakers, forwarded me a note that she recently received after a presentation at one of Studer Group’s partner organizations, Community Healthcare System (Munster, IN). The note reminded me of one sent out several months ago from a new nurse grad at Sacred Heart Hospital in Pensacola, FL. That letter describing the hopes and beliefs of a new nurse was warmly received. This note is about those moments when our internal flame is low, but then at just the right time we hear the right message.

My thanks to Jana for allowing her letter to be shared. Jana is a difference maker.

Dear Liz,

I recently heard you speak at our LDI for Community Healthcare System. Not only did I enjoy your presentation, I took home your message and could relate as a “seasoned” ICU nurse with “attitude.”You spoke about the importance of feeling like you make a difference. I need to share a story. People often asked me how I survived over 25 years in Intensive Care and did not become “burned out.” My standard answer is that burn out is something that is entirely avoidable. I wake up every morning knowing in my heart that I would make a difference somehow, some way and going to bed reviewing how I made a difference that day. I would tell my staff that it may not always be the burning bush in your face difference, but that they made a difference.

One day, forgetting my own advice, I did not feel like I was making a difference as a leader or a nurse. I was full of self doubt and self pity…a lethal combination. Just then, one of my fellow nurses stood at my door and asked to speak to me. She had been with me for over 10 years and started as a unit secretary. I had worked with her schedule so that she could attend school. As she stood there, all I could think of was that I was a failure at this leader thing and did not want to deal with any staff issue. Tina reminded me that she would be graduating in a few weeks, and the school had told the graduates that they could have one of their family members “pin” them during the ceremony. Since her mother had died recently, she was asking me to do the honors because she felt that she would never had completed her education if I had not worked with her schedule and given her constant encouragement. AHA! The wakeup call…this was something that I saw as part of my job and never realized what an impact it had on this individual.

Recently, I had forgotten to wake up to my mantra of making a difference since becoming the director of the IRB/Bio-Ethics department. Thank you for reminding me (and the rest of the audience) that it is our legacy as the healthcare team to make a difference and that we are all in this together.

Warm regards,

Jana Lacera

Community Healthcare System (Munster, IN)

Please add your comments to this blog by visiting Quint’s Interactive Blog and share your thoughts with our readers. We can all benefit from each other’s experiences.

Is it time to review your organization’s standards of behavior? 

Standards of behavior are developed with the goal that, if followed, several critical results will follow: 

• Patients will perceive excellent care
• Staff will feel positive about organization
• Physicians will find the practice of medicine efficient and effective

Given the importance of having standards that directly support your organizational goals, is it time to take your standards to the next level?  To update them?  In organizations across the nation we are beginning to see the next generation of standards of behavior.  

At Delray Medical Center in Florida, some of the units have reviewed the organization’s standards and made commitments on how to implement them within their unit. For example, their Med/Tele unit has such commitments as, “I will take responsibility for hourly rounds to assess my patients’ needs” and “I will round with the attending physician when requested.” 

Standards are put in place so staff can have input into the type of work environment in which they work best. Thereby, expectations are clear.   There is consistency in performance so patients receive better care, and departments and staff work well together. 

When standards are used well, patients, their families, physicians and the staff benefit. When written but not followed, the standards become one of those ideas that made sense, took time and effort to write, had promise, but are sitting in the program/buzzword graveyard. 

If your organization is not achieving your goals in these areas, it is a strong possibility that the standards are not being followed by some within your organization. To see if this is the case, have Human Resources audit the departments that are not achieving positive staff, patient and physician satisfaction. 

Oftentimes these audits will find that the standards are not being addressed.  Staff is either not being written up for not following standards, or not being recognized for following them.  There is usually little proof that the standards are being emphasized by the leader at all, which means that there could be a leadership problem in a low performing department. 

What is permitted is promoted. You may have a leader who needs more mentoring, coaching or, in some cases, removal. 

In summary, we all get off track. This may be a great time to assess how well your organization is using the standards of behavior. The insight you gain may help you take your standards to the next level.

If you are using standards well, please let me know. There are always organizations looking for better or best practices.  If you have a success story, please share.  If you need advice or have a question, please ask. 

Thank you for your commitment to making health care even better.

Quint

P.S. I know that many readers of this blog are concerned about whether their organization is ready for the increased transparency of information that will be available to the public through the HCAHPS survey. We recently taped a webinar on this topic that shows how to use specific, field tested tools to increase patients’ perception of care in your organization and how to impact HCAHPS with evidence based practices.  You can learn more here HCAHPS Update 2007 Webinar.

Please add your comments to this blog and share your thoughts with our readers. We can all benefit from each other’s experiences.