Archive for December, 2009

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

December 16, 2009

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.


Quint Studer

Quint Studer, CEO
Studer Group

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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!”)

December 9, 2009

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.


Quint Studer

Quint Studer, CEO

Studer Group


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

December 2, 2009

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.


Quint Studer

Quint Studer, CEO

Studer Group

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