Archive for February, 2009

The RN Renewal Plan: Why It’s So Important To Help Nurses Reignite Their Passion for Helping Others.

February 26, 2009

All nurses are inspired at the start of their career, but over time, the stresses of the job can overwhelm their sense of purpose. Leaders that help nurses re-connect—in turn, see their organizations thrive.

Anyone who works with nurses knows the profession is a double-edged sword: the very qualities that attract caring, compassionate people to the field also burn them out. It’s true. Impacting lives on such a profound level, not only physically but emotionally and spiritually, can be exhausting beyond words. And because the energy and passion of nurses is so intricately connected to a healthcare organization’s bottom line, leaders must take steps to sustain these elusive qualities.

It’s this simple: nurses who find their work rewarding provide better clinical care. Plus, their happiness and fulfillment positively impact other nurses and the workplace as a whole. An organization staffed by nurses who feel a sense of purpose, who engage with their patients on a real, human level, is a healthy hospital in every sense of the word. So helping them re-ignite their passion for their work is a critical business goal.

So, how can leaders help nurses know their impact? Click here to access three “Spiritual Stretches” to help nurses stay connected to the difference they make, excerpted from Inspired Nurse, by Rich Bluni, RN.

It’s no wonder nurses are so inspired at the beginning of their career. They get to share in some of the most joyful times in people’s lives and ease their pain in the toughest times. It’s a privilege. And it’s as important for nurses to nurture themselves as it is to nurture their patients. Taking the time to tap back into this calling will help nurses give the best care possible.

Just envision a hospital filled with inspired nurses working to execute common goals. It’s easy to see why it’s worthwhile to do so: better clinical outcomes, less employee turnover and all the other results of employee motivation equal a healthy bottom line.

Click here to view a free 30 minute webinar on how to create a culture of work-life blend in your organization that will improve employee turnover and satisfaction.

The work we do in healthcare is very powerful. We change lives and bring comfort, joy and healing to each patient we meet.

Physician Engagement and Collaboration: The importance of aligning physicians with organizational goals to achieve and sustain service excellence

February 9, 2009

Medicine is in the midst of a new era. An era that redefines the influence that patient perception of care is having on market share, reimbursement, and the doctor-patient relationship. Patient-centric care founded on trust and communication has taken on a new priority in healthcare, replacing technology as a driver in the public’s perception of quality. Now more than ever, hospitals recognize the need to work with their medical staffs to develop and execute a service excellence strategy that drives patient satisfaction. Here’s why.

Today, patients are much more savvy in their desire to understand their diagnosis and plan of care. With the Internet age upon us, patients often come to physicians’ clinics, hospitals, or emergency departments informed with ideas on what their diagnosis may be, what tests need to be ordered, and what treatment they feel is necessary. Additionally, the age of transparency has made it possible for patients to differentiate average care from great care. This places a greater burden on us to deliver care that is perceived by patients as meeting their expectations as well as achieving desired clinical outcomes. Our failure to meet patient expectations adversely impacts patient loyalty.

Medicine is undergoing a transformation like none other in its history. We are moving from a pay for service to a pay for performance model. For the first time, reimbursement will be directly tied to patient perception of care. HCAHPS is just the beginning. In the near future, CMS and third party reimbursement will be directly linked to patient satisfaction metrics that will inevitably impact both inpatient and outpatient practices. Given the unsustainable medical inflation rate and continued rising medical costs in the US, a system to reward organizations for delivery of great and cost-effective care from those who deliver anything else but that, is long overdue. The pay for performance concept will drive competition and give consumers greater decision-making ability on where they want to receive care. Organizations that fail to effectively prepare themselves, and execute a successful strategy for the evolving pay for performance initiative will have a hard time surviving.

The common theme that ties together the above discussion points is the concept of patient perception of care. And what drives that more than anything else? Effective communication. Chang’s study as published in the Annals of Internal Medicine in May of 2006 clearly showed that patient’s global ratings of their health care are not tied to the technical quality of their care, but rather, to the quality of provider communication (Volume 144, Issue 9, pages 665-672). Effective physician communication is the key driver of overall patient satisfaction. Resnick’s recently published study in the Journal of Surgical Education (2008;65;243-252) showed that 61% of the variability in patient satisfaction is tied to physician behaviors. The remaining 39% was linked to nursing behaviors. Physicians more than any other group influence patient perception of care the most.

It is critical then, for healthcare organizations that want to effectively compete and survive the tumultuous economic uncertainties facing us today, to engage and collaborate with physicians to create an aligned strategy on the delivery of patient-centric care that promotes effective communication at all levels. Healthcare systems recognize the importance that physicians have on an organization’s ability to effectively compete and financially succeed. The problem is, hospitals and physicians don’t always think alike. There is often distrust, misalignment, and differing opinions between the two sides. This was again demonstrated in the recently released Press-Ganey 2008 Check-Up Report on physician perspectives on American hospitals. Three of the top five listed physician priorities on what impacts the physician-hospital relationship the most dealt with how well hospital administration communicates, responds, and collaborates with physicians to meet their practice needs.

In the evolving pay for performance initiative, physician behaviors will not only influence their own reimbursement, but hospitals’ as well. It is imperative that healthcare systems recognize the importance of collaborating with their medical staffs to create an aligned platform that promotes patient care quality and safety as well as drives patient perception of care, and executes an effective reimbursement and growth strategy that is mutually beneficial. Studer Group recognizes how critical this has become for physicians and hospitals.

Studer Group is creating a physician specific service line for 2009. The physician service line will help organizations engage and collaborate with their physicians. From an initial survey and analysis of an organization’s situation and specific needs, a comprehensive physician coaching plan and strategy will be formulated and executed to drive patient perception of care and satisfaction results. Paralleling the success of Studer Group’s inpatient coaching service line, the physician service line will utilize the evidence-based tools and coaching tactics that Studer Group has developed to achieve successful outcomes for the hundreds of clients that we have partnered with in the past.

This is an exciting yet uncertain time in medicine. There is real potential to significantly impact nationwide patient care quality and raise it to a level never before seen. Pay for performance will drive that. Many organizations face financial constraints never before experienced prior to the recent economic downturn. One thing is clear. Implementing a successful patient perception of care strategy and creating a culture of excellence is not only the right thing to do, but necessary for organizations to survive and thrive in the today’s economic uncertainty. The return on investment for engaging and collaborating with physicians is enormous. It is physician behaviors that ultimately drive patient satisfaction, impact loyalty, and create trust. Studer Group’s physician service line will help physician groups and healthcare organizations achieve their desired outcomes.

If you are interested in learning more about Studer Group’s physician service line, please contact me at wolf.schynoll@studergroup.com, or visit http://www.studergroup.com/physicians.

Yours in Service,

Wolfram Schynoll, M.D., FACEP
Studer Group Medical Director and Physician Coach

“But we’re already doing it!”: Why Validation Is the Key to Effective Hourly Rounds

February 9, 2009

No doubt about it: Hourly rounding is hot. And no wonder. In 2006 Studer Group’s Alliance for Health Care Research initiated a call light study—whose findings were published in the American Journal of Nursing—which proves how well it works. In addition, 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.”

Since then, the tactic has been implemented in hundreds of organizations across the country. So it’s no surprise that at conferences I attend, discussion invariably turns to this subject. When leaders are asked whether they are doing hourly rounds, many of them will reply that, yes, they are. And when you ask staff if they are doing hourly rounds, they will also tell you, “We’re doing it.”

So why don’t all organizations experience fantastic results from hourly rounding? First of all, some organizations have been known to deviate from the original formula we set forth. It is critical to follow the eight behaviors of hourly rounding, which you will find explained in detail in the Hourly Rounding DVD and implementation guide available on the Studer Group website at www.studergroup.com.

The eight behaviors of hourly rounding are:

  1. Use opening Key Words.
  2. Accomplish scheduled tasks.
  3. Address the “Three Ps”pain, potty, position.
  4. Address additional comfort needs.
  5. Conduct environmental assessment.
  6. Ask, “Is there anything else I can do for you? I have time.”
  7. Tell each patient when you will be back.
  8. Document the round.

In our experience, the main difference between those that are successful and those that are struggling to achieve results is validation—or, said another way, lack of validation. If you want to drive the results described above, you have to Validate, Validate, Validate.

The most often heard excuse from staff regarding hourly rounds is, “We are already in the room that much anyway,” or “I am already doing those things.” Certainly this is the perception that many staff have; however, it is often not the reality. If it were, we would not hear so many patient complaints like, “I don’t see my nurse enough,” or “The staff seems so busy.”

Done right and properly validated, hourly rounding will improve your patient care and satisfaction. Here are just a few principles to keep in mind:

Face time is not enough. Staff must understand that hourly rounding is not about getting in the room every hour. It is about doing the eight behaviors every hour—which just happen to require us to be in the room to do them.

Nurse leaders, it’s your job to validate. It’s the nurse leader’s task to validate that the eight behaviors of hourly rounding are being implemented with enough consistency to achieve results. The key? Rounding logs. I have yet to see an organization be successful in getting the level of results we mentioned above without using them. I also advocate for the use of an annual competency that will add credibility to this skill and make it as important as all the other skills we validate annually. But even annual validation is not enough in the early phases of implementation, which can last sixth months or more. Nurse leaders need to continue frequent validation long enough to ensure that the staff’s initials on the log truly represents that all eight behaviors were accomplished.

Yes, validation takes time—but it’s worth it. If the validation is so critical—why do we have such a hard time doing it? The most obvious answer is time. Validating skills directly by observation is certainly an investment in time, but those organizations that bite the bullet and get it done will tell you the results they get far outweigh the time spent.

Trust, but verify. Many nurse leaders will tell me, “When I verify rounding, the staff feels like I don’t trust them. They think I am checking up on them.” Well…that’s because you are—but it’s the right thing to do. At Studer Group we call it trust but verify. After all, we trust that a physician will do a history and physical on every patient, but we still verify that he has done it. And we trust that a pilot will do his pre-flight checklist, but, again, we verify. As a leader on your unit, you have the ultimate responsibility for the competency of your staff. For critical skills a “trust but verify” approach is necessary—and hourly rounding does qualify.

“Soft” validation doesn’t work. I sometimes see nurse leaders invest the time in doing the validation but use too soft of an approach to get the real value. For instance: “Sara, I appreciate being able to shadow you and validate your hourly rounding skills. I think you did a great job. The only thing I didn’t hear was you using the closing key words. I’ll go ahead and check you off but please be sure to do them next time.” In this case, we have left open the door for Sara to continue to forget to use one of the eight behaviors of hourly rounds—Use closing key words.

Take the ACLS approach. I recommend you use an approach most clinicians are very accustomed to if they have ever tested for ACLS or similar certifications. That is, you need to be 100 percent correct to pass certification. You would never be ACLS certified and have them say, “You were pretty close on that dose of medication; just be sure to check closer next time.” If you are validating skills, take an ACLS approach and give specific and immediate feedback on each of the eight behaviors. This way the staff will know what they are doing well and what they need to do differently.

With diligence in validating skills, a tighter discipline to get all eight behaviors done well, and verification that they are actually occurring with every patient…the results will come.

For more information on tools that are available to help you implement hourly rounding in your organization please click here, or feel free to contact George Scarborough with questions.

Yours in service,

Lyn Ketelsen, RN, MBA

Studer Group Coach Leader