Archive for May, 2007

Hardwiring those powerful letters we receive

May 22, 2007

We all need those letters.

In a recent survey of leaders we asked the question, “When was the last time you shared a patient letter in your department meetings with staff?” It turns out 60 percent of leaders had not done so in the past 6 months. Why? We can come up with a variety of reasons, but I find the two most often given are, “I don’t get copies of patient/family letters” and “I did not know I was supposed to, or could.”

Let’s hit the first reason. In our work we find almost all health care workers, whether they provide direct patient care, support services or any number of roles, went into and stay in health care for the same reason – they like what it represents. What is that? Their organization makes a difference in people’s lives. Employees love to hear about the impact their organization is having, the lives saved, and the end-of-life care that, while not saving a life, made such a positive impact. There are differences made in so many ways. We work in organizations surrounded by miracles.

Positive letters are printed in newsletters (after taking legal steps to protect writers or obtaining permission to use), which is good, but we can do more. Take time to send letters to all leaders. Even staff that don’t provide direct patient care enjoy the letters and feel good about the impact their organization makes. It also provides leaders the chance to connect staff back to the difference they make through their roles. When rounding on staff, have leaders show the letters and read them to staff. Ask leaders to read the letters at their own department meetings, too.

This hits point two. Most administrators read positive letters at department head meetings. But are we sure those leaders bring the letters and messages back to their staff? Most employee forums (town hall meetings) include letters from patients/family members thanking the organization, specific people and departments. This does not ensure that all staff hear these great letters for only those that attend the meeting receive the message.

I encourage organizations to hardwire the practice of leaders taking positive messages/letters back to their units from department meetings and employee forums as well as reading them out of the newsletter.

It’s easy to tell when the staff feels good about where they work. You see staff wearing the hats, shirts and buttons with your organization’s logo on them when you’re around the community. Heck, they even keep their name badge on when stopping at the grocery store on the way home.

This past year we have collected many stories about the difference makers in health care. These are now in a book, which contains a health care story for every day of the year. We will be providing this book complimentary to all people at the June 11-13, What’s RIGHT In Health Care conference. As I read the stories it reinforced how fortunate I am to be on this journey with you. Thank you.



It’s All about Always, part one

May 15, 2007

My “ah ha!” these last several months is the different impact the words always, most of the time, and sometimes have when it comes to performance.   We now have H-CAHPS, which will create the healthcare language of always, usually, sometimes, never.

Over the years, in many areas we have hardwired always.  If you are a member of a purchasing group, leaders always buy from a specific menu.   If you have a budget due, it is always done by the start of the new fiscal year.

In operations, the elusive ingredient which separates the perennial high performing leaders and organizations is consistency.  Consistency for patient experiences, employee work environment and physicians’ practice of medicine.  Many feel we run four organizations: the day, night, weekend and holiday organizations.

The implementation tools and techniques backed by evidence that achieve and sustain high performance results are what we at Studer Group call “evidence-based leadership.”  Evidence-based leadership helps create an always organization.  The foundation of evidence-based leadership is to begin with aligned goals, which are created by effective leader evaluations and a leadership development process that links to desired organizational outcomes.

Prior to visiting an organization I have leaders complete a survey.  It asks leaders to evaluate the effectiveness of these foundational aspects of evidence-based leadership.  The survey covers such things as, “Do you have a formal meeting with new employees on their 30th and 90th day?  If you are an inpatient nurse leader, what percent of patients do you visit (round on) each day? What percent of patients receive a discharge phone call?”

There are questions on the healthcare environment, too, so it gauges understanding of the leaders on the current and future healthcare environment and their readiness for success.   

We use this data combined with the organization’s results to implement the next steps to either achieve excellence and/or to sustain excellence.   After reviewing the results of these surveys from hundreds of organizations, we have learned a lot. 

When it comes to patients’ perception of care, it is all about always.  That is the topic of this blog.

When I review survey results, I ask the top leaders of the organization “Are the nurse leaders rounding on patients?  Are discharge phone calls being made? Are outpatients being contacted to remind them of their appointment to reduce patient no-show rate?”

The answer I get is “yes.”  It is a true answer.  It is what they hear when they ask leaders these questions.

So what separates the high performing leader and organization from the middle performing leader and organization from the low performer leader and organization? It is the impact of always.

High performing leaders and organizations have hardwired the tools and or techniques so they are always done.

The middle performing leader is a most of the time leader in using effective tools and techniques. 

The low performing leader is sometimes.

When the question is asked the answer is, “Yes, I round. Yes, 30- and 90-day meetings on new hires.  Yes, discharge phone calls.”

It is not until the verification of frequency system is put in place does it come to light that the difference is not who does the behavior, for almost all leaders or organizations can say they do it.  It is the hardwiring of the tool and technique so it is an always behavior; not a most of the time or sometimes behavior.

The other confusing issue is a leader who says they always do it. We find that this means it may take place five out of seven days.  For example, consider leader rounding on patients.  We find that patients’ and physicians’ experiences at the hospital during the weekday are much different than the weekends. So, for some practices, the hardwiring needs to be for seven days, not five.

Measuring “always”.  How can leaders assess whether they are an always organization?  One great way to find out is to ask your patients.  For the more than 3,000 organizations using the H-CAHPS survey, patients are already telling them.  The H-CAHPS instrument asks patients to describe their perception of the quality of their care by rating the frequency of events during their care (never, sometimes, usually, always).

By asking patients if they always see key events, leaders can quantify how hardwired those behaviors are from the perspective of the most important person in their organization . . . the patient.

Less is more.  Today, we know that doing more may get you less and doing less will get you more.  Our experience has taught us that it is better to have a leader implement one new tool or an adjusted technique until they achieve always, rather than doing more than one tool or technique most of the time or sometimes.  Then the leader, unit, department and division experiences success, the tool or technique is hardwired, and the maximum impact is gained so the leader can see if more has to be done.  And, if more needs to be done, the leader can choose the next step much more wisely.

At our June 11-13 What’s RIGHT in Health Care conference, organizations who are successfully building a culture of always will be presenting. Hope you can join us.


Celebrating National Hospital Week & National Nurses Week

May 8, 2007

I have learned much these past years in health care. The privilege of being in many organizations convinces me that we in health care share many common characteristics. One characteristic is that health care is more than a job. It is a calling.

In just one day last week I heard the same message from two people who were in very different situations and times in their careers. Kevin Lofton, the new chairman of the AHA, spoke of this calling in his talk on Sunday, May 6th when he assumed the chairmanship of AHA. On that day I also received the letter below written by a nursing student at Sacred Heart Hospital in Pensacola, Florida:

“I have no career experience in the field of nursing. This is just something I know I want to do. I would like to say that my goals are to gain tons of experience and working knowledge for the job, learn multiple areas and fields until I find the one that makes me the happiest. I would like to say just that. Because of a recent experience in my life, I have learned a valuable lesson. These things I have mentioned are not my goals at all. Yes they are important, but they are only necessities. My true goals are to care for those in need, to be compassionate and supportive, to provide comfort and treatment. For someone who is injured, frightened or confused I want to be that person who provides a safe and comforting environment, a way to ease their suffering and the knowledge and strength for them to carry on. If someone is alone and in their final hours I want them to know someone cares even if that person is a stranger who is fortunate enough to be their nurse. Of all the little things and big things that go on in a healthcare environment, I have recognized two things that happen constantly. One, people get sick, injured, suffer and die every minute of every hour. Two, they turn to a nurse for help in hopes that, that nurse is there just for them. I want to be that nurse and that’s my goal!!.”

The words from the nursing student brought me back to the beginning: purpose, worthwhile work and making a difference. Kevin’s talk keeps me there. It is our time and our responsibility to fulfill our social contract with those we serve. If not us . . . who? If not now . . . when?

I am an optimist in health care. Are there challenges? You bet. Can we be better? We have to be. So why am I optimistic? I see difference makers everyday. So do you. It starts when you look in the mirror. Never underestimate the difference one person can make.