Archive for April, 2011

Narrating Care: Why the Words You Say Maximize the Impact of the Care You Provide

April 6, 2011

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 what you’re doing and why you’re doing it. Sometimes explanations have more impact than behaviors. That’s why narrating care is so powerful. 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 patient perception of care 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 what you’re doing and why. The patient’s perception of care will improve and you’ll have a new appreciation for the true power of words.


Quint Studer

Quint Studer, CEO
Studer Group

The Art of Physician Courtship: Five Things Healthcare Leaders Can Do to Lay the Groundwork for Physician Integration

April 4, 2011

Click the link for a video going into more detail on this topic. Blog Response

It seems we in the healthcare industry constantly hear about the upcoming “marriage” between hospitals and physicians. And while it’s not yet clear exactly what form this partnership is going to take—ACOs, physician employment, or something else entirely—the people in suits and the people in white coats are about to get a whole lot closer.

This raises a very logical question: How can you ever get married when you’ve never enjoyed dating?

No one knows what will happen as pay-for-performance really gets rolling, but it doesn’t matter. Organizations need to get focused on building strong, healthy relationships with their physicians, however they work together right now. (If you don’t lay the groundwork for a solid partnership, can you imagine how unhappy the marriage will be—and how much the divorce will cost?)

The idea is to become the kind of organization that physicians want to partner with. Even if the “marriage” ends up not happening, everyone will be a lot happier in the present.

At Studer Group®, we work with plenty of organizations that get physician integration right. These organizations do very specific things that set them apart:

They understand that, in the hierarchy of physician needs, great patient care comes first. Physicians care about clinical outcomes. Other things matter, too (workload, reward & recognition, the ability to make a living), but knowing patients are well taken care of has to come first. Providing exceptional quality care—every patient in every department every time—can happen only when you have the right culture. And that “culture of always” can happen only when you get the foundation right.

It’s Evidence-Based LeadershipSM—a foundation that gets their goals, behaviors, and processes aligned and working together—that allows them to reduce variances in leadership skills and processes and helps organizations achieve predictable, positive patient outcomes.

They measure physician satisfaction. It’s very simple: If you want to know whether your physicians are happy with your relationship, ask them. It’s amazing how many organizations don’t take the obvious step of diagnosing physician satisfaction. And what’s even more amazing is how many do diagnose it but then fail to act on the results—or even switch vendors rather than look for ways to improve the situation.

If it’s really important to you, you measure it. You diagnose. And you don’t run from the answer.

Once they’ve measured it, they take action to improve it. Rochester General Health System in Rochester, NY, is a great example of physician integration. RGHS took its physician satisfaction results from the 11th percentile to the 90th percentile in a very short amount of time. It did so by measuring one domain at a time—administrative response time, communication, tools and equipment, ease of practicing medicine—and by working with physicians to create a game plan on improving each one.

Their leaders keep in close touch with physicians. Leaders cannot engage their medical staff from an office. To build solid relationships, they need to establish sincere, face-to-face, two-way communication with physicians. This doesn’t just happen. Leaders have to make it happen. That’s why we recommend that leaders build time into their schedules to round on physicians.

We’ve found that when leaders round on physicians once a month, satisfaction results will be in the 87th percentile for likelihood of recommending the hospital to a colleague or patient. If you round quarterly, satisfaction is in the 75th percentile. If you round every six months, or never, it’s in the 50th percentile. So if you’re going to round, you have to do so at least once a quarter to make an impact.

They look for ways to make physicians’ lives easier. Two simple tools we recommend are Got Chart and physician preference cards. The first is a checklist nurses use when they need to call a physician about a patient. It lays out the information the physician wants to know (and in what order) and makes these interactions more efficient (and safer for the patient, too). The second is just what it sounds like: a card the organization creates for each physician to let staff members know which rounding time he prefers, how he prefers to be contacted, and so forth.

As you can see, both tools are very low-tech and easy to use, but they make a big difference in physician satisfaction.

Physician integration isn’t really about ACOs or any other financial structure. It’s about making sure hospitals run well. It’s about making sure patients are given exceptional care, not just some of the time but every time. It’s about creating solid relationships with physicians, so that they want to join forces with you in whatever form the partnership takes.


Quint Studer

Quint Studer, CEO

Studer Group