Archive for November, 2007


November 19, 2007

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.

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.


Leading With Passion

November 6, 2007

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)

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