Archive for the 'Communication' Category

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


MORE Skills for a New Economy: A Message to All Employees

March 2, 2011

(Part Two of Two)

In Part One, we discussed the need for employees to take ownership of their roles and the organization’s mission for all to gain sustainable excellence in the challenging times ahead. We explored ways employees at all levels can show their value across the organization and own their own development.

Here are a few more tips for leaders to share with staff members as they strive to become more valuable (and valued) in today’s tough new economy:

Understand the Connection between Time and Money.

Think about ways to be more effective and help others. When building a budget, consider all factors—including salary (often the biggest expense in a project) and time to complete. Be aware that as a project drags past its deadline, the chance it will go over budget increases.

Here are a few ways to be a good steward of your organization’s resources:

  • Get in the habit of quantifying. Avoid words like “a lot” and other generalizations. Get very specific and require others to do the same. Countless hours (and endless money) can be spent on activities because of reports that there were “a lot” of requests. When we take time to quantify the requests, we often find that “a lot” really means just a few people.
  • Keep things simple. When projects get too complicated, they either don’t get completed, or they result in considerable overruns on budget and missed deadlines.
  • Get the to-do list reviewed regularly. Focus on tasks that connect to the organization’s business goals; reduce the busywork.
  • Get timelines, a deliverables schedule, and a budget on everything you do. This is step one on any project. Creating a framework in the beginning forces an employee to think things through and often eliminates READY, FIRE, AIM problems. Report back regularly as to whether the project is on time and on budget.
  • Learn to ask, “How will we measure results?” Asking this question in the beginning allows us to really evaluate whether the project is worthwhile. It keeps employees from starting dead-end projects with no value…and allows us to showcase successful projects for a nice win.
  • Don’t confuse activity with progress. Focus on what matters. Twenty percent of the work creates 80 percent of the results. Can you move that number?
  • Give regular updates on ongoing projects. Something may have changed, or someone may have a new idea to make it better. Be proactive to stay on course.
  • Review processes regularly to make sure they don’t need updating. Continue to re-evaluate the way things are done and search for improvements. Don’t fall into habits.
  • Ask, “Is there something I do that could be outsourced?” An employee should let leadership know if there is a part of his or her job that the company could do more quickly, more efficiently, or less expensively by outsourcing. In the long run, an employee who thinks like this will show more value to the organization and will soon be on his or her way to bigger and better things.
  • Learn to put the well-being of your team over your own comfort. Think, If it were my money on the line, my future at stake, what would I do?

Remember, Communication Is Everything!

Work to create an infrastructure whereby information can flow. Then, do everything possible to help effectively move that information through the process.

Here’s how:

  • Communicate early and often. It will increase the odds of success exponentially.
  • Be more than an e-mailer. Sometimes it’s best to pick up the phone. It builds relationships. Plus, real conversations spark new ideas, and too much back and forth over e-mail may slow down the process.
  • Share information anytime you can. Ask yourself, What do I know and who else can benefit from it?
  • Think strategically about your e-mail CC line. There’s a delicate balance between keeping busy people in the loop and overwhelming them with too much (unnecessary) information. When copying someone on an email, be sure to let the recipient know what is expected. 
  • Reach out to others. Set aside a few minutes each week to reach out to people you don’t see that often. It creates goodwill and is the first step in collaborating in a meaningful way.
  • When asking for help, give a timeline. It helps busy people know how to sequence their projects.
  • Be clear. It eases anxiety. Before hitting “send” on an e-mail correspondence, review the note to make sure all the questions are answered and there is clarity in the letter.
  • Report the good and the bad. We can learn so much from mistakes. Mistakes help pinpoint areas where we need to get better and create an internal sense of urgency.

Tough times are ahead, and we need to be owners of ourselves and our organization, not renters. Show value. Actively seek personal development opportunities. Maximize profitability. Communicate. Standards have never been higher—and more public—so now is the time for employees to strive for excellence at every level, every time.

Emergency Room Nurses Have the Best Stories

October 8, 2009

It’s true. If you ever want to laugh until you cry ask an ER nurse to tell you a story. If you ever want to be stopped in your tracks with your eyes welling up with tears ask an ER nurse to tell you a story. I worked as an ER nurse for awhile, as did my wife, so I have a great love and admiration for what ER nurses do.

We’re coming up on ER Nurse’s Day (October 14th) so I have been thinking a lot about ER nurses and their stories. Isn’t it amazing how stories, in general, can move us? If you think about it stories are how we learn. Probably your favorite teachers were those that told great stories and didn’t just read from a book.

What can we learn from ER nurse’s stories? First of all we can learn that within those stories there is much inspiration. I spend a lot of time encouraging people in healthcare to share their stories as I speak around the country and I talk about stories a lot in my book Inspired Nurse as well as in my blogs and on the Inspired Nurse Facebook page. I do this because I have learned the power of our stories. They connect us back to who we are, where we’ve come from and what we are “made of” as nurses.

So…how can we make the best use of the amazing stories that live in our ER? Wouldn’t it be amazing to have a few of the ER nurses in your organization write their stories, their greatest moments in the ER and perhaps even their funniest ones? After they’ve done this perhaps post them in your newsletter, highlight them at a celebration, have them read these stories at a board meeting or even post them in the ER for all to see? Why? Because these stories will inspire. They will remind us why we do what we do. They will bring us back to the foundation of what we are as nurses.

As I always say when I speak at hospitals across the country, our stories are our “bricks.” They are what built us. Often, we don’t focus on these “greatest moment stories” though do we? Usually we tend to share more of the most recent and negative stories. After awhile, it seems as if those inspirational moments are few and far between. But they’re not. It’s just a matter of focus and attention. When you focus your attention on the negative, well, that becomes our perceived reality. Maybe it’s time we focus on some of the other stories?

So, dust off those amazing ER stories. Find some creative ways to get them out there and share them with your team. It’s often said that great organizations are known by the stories that they tell. So are great ER Nurses. Honor your ER nurses this year by laughing and crying along with their stories. I promise you two things about those ER stories. They’re never boring and they’re always inspirational.

One more tip. If you are a senior leader, another great way to honor your ER nurses would be to make rounds in the ER on ER Nurse’s Day to thank the nursing staff for the great work they do every day.

Be Well. Stay Inspired.

Rich Bluni, RN

Rich Bluni, RN, Studer Group National Speaker

If you are looking for ways to celebrate this special day, seats are still available for the Nuts and Bolts of Service and Operational Excellence in the Emergency Department on October 14 – 15, in Phoenix, Arizona. You may also consider presenting staff a copy of Inspired Nurse by Rich Bluni or Excellence in the Emergency Department, which was just published by Studer Group coach Stephanie Baker.

Celebrating Doctors

March 30, 2009

“More than the application of science and technology, medicine is a special calling, and those who have chosen this vocation in order to serve their fellowman understand the tremendous responsibility it entails.” With these words spoken 18 years ago, President George H. W. Bush proclaimed March 30th as the annual date to celebrate National Doctor’s Day.  Today, hospitals and patients across the nation will thank their doctors for answering the call to practice medicine. One of the best ways to say “thank you” today is to commit year-round to providing a great place for physicians to practice medicine.

Fundamentally, physicians want four things from the place where they choose to practice medicine:

  • Quality – Physicians want to know their patients are receiving quality care and very good service even when they’re not around.
  • Efficiency – Physicians want a friction-free place to practice medicine where delays, waste and frustration are minimized
  • Input – Ask physicians where they feel the organization should focus to make things run better; fix what can be fixed; and then follow-up to let them know what has been addressed.
  • Appreciation – Physicians value a “thank you” and acknowledgment when things are going well.

Most of our efforts in healthcare to engage physicians center on the first two items: quality and efficiency. This makes good sense – they’re the most tangible and have the most ability to quickly impact outcomes for physicians, patients and the hospital. However, too often we neglect the last two: input and appreciation. That’s unfortunate, since these are the lowest cost, quickest to implement and most sincere ways to demonstrate professional respect and involve physicians in the hospital enterprise. Here are a few tips to get started:

  • Focus, fix, and follow-up. All three are key steps to providing physicians a great place to practice medicine, but failure to follow-up is perhaps the fastest way to breakdown the relationship physicians have with the organization. Here are two examples of how to provide physicians opportunities for input that lend themselves to quick follow-up.
    • Ask physicians to list three issues that act as barriers in the delivery of care for their patients at the hospital. Be sure to also ask them for a potential solution to the problem. Based on the information you collect, publish a simple one-page flyer that lists the issue raised and the action taken.
    • You can create even faster follow-up by using a simple tool like a flipchart or a whiteboard posted in a common area. For example, the OR manager could post a flipchart on a door leading out of the OR with a marker attached by a string. In one column provide a place for physicians to list their barriers, and in the other column the OR manager writes what has been/will be done to address the barrier.
  • Round on physicians. By rounding on physicians, leaders demonstrate care and concern. They will also harvest what’s working well, people to recognize, systems to improve, and tools and equipment that need to be addressed. Here are some questions to ask physicians during rounds:
    • Focus on the Positive: “What is going well today?”
    • Harvest Wins: “Are there any hospital staff or other physicians you feel deserve to be complimented or recognized?”
    • Identify Process Improvement Areas: “What systems can be working better?”
    • Repair and Monitor Systems: “Do you have the help and equipment that you need to care for your patients?”
  • Send thank-you notes. In a study of the top workplace incentives, the number one strategy was handwritten thank-you notes. There’s nothing difficult about the act of writing a thank-you note, but there are better ways to make them effective for physicians and to hardwire them. For example, ask each nurse leader or unit nurse to send one handwritten thank-you note to a physician’s home on a regular basis. Physicians who receive such a note typically seek out the nurse who sent it. In addition to delighting the physicians and strengthening their connection with the nurse who wrote the note, the specific behaviors mentioned in the note will be reinforced. Let the CEO know who is being thanked and why so she can extend her appreciation the next time she sees the physician.
  • Pass along compliments to employees on behalf of physicians. Ask physicians “What is going well?” When Dr. Johnson mentions how much he appreciated the timely lab results in recent weeks, tell the lab manager, “Dr. Johnson wanted you to know how much he appreciates your staff’s on-time lab results over the last month. Please let them know what a difference they are making for physicians.”
  • Spotlight physicians who are making a difference at board meetings. For example, the CEO might say, “Dr. Rivera came in during a day off to work with the OR team to develop surgical preference cards for physicians. This has increased efficiency and reduced costs. As the board chair, I recommend the board write a letter of appreciation to Dr. Rivera.”

In the hallways today, take a moment to say “thank you” to the physicians who practice medicine in your organization. Also commit to implementing one new behavior, perhaps one of the ideas above, that you can hardwire so that physicians know how much they are appreciated all year long.

Our mission at Studer Group is to help make health care a better place for employees to work, physicians to practice medicine and patients to receive care. The tips above come from a physician collaboration toolkit available free of charge to partner organizations on our website.  You can find the toolkit and learn more about what we’re doing to help create better places to practice medicine on this resource page:

Yours in service,


What to Do If Your Boss Is A Low Performer

June 13, 2008

One of the most frequently asked questions that I receive—the one that’s at the top of everyone’s list—is: “What can I do if my boss is a low performer?”

It’s tough enough to confront someone who we supervise about job performance issues…even tougher to have that difficult conversation with a peer, but taking on the boss may seem impossible and even career threatening. Yet, if you’re working for a low performer, you likely feel disillusioned and discouraged. Plus you aren’t being mentored and developed in the ways you desire. As a result, you pay the price. Your department struggles. The organization may not achieve its goals. And yes, even your boss loses out.

After talking with hundreds of staff and leaders who want to push through this barrier, I have some suggestions on what you can do if you feel your boss is a low performer. Try these:

  1. Take a look at yourself first. This means holding up the mirror. Make sure you are doing all you can to run a great department to achieve the desired results. Bosses appreciate someone who provides solutions. Find ways to take things off your bosses’ desk rather than piling new things on by pointing out problems with no solutions or ownership. While your boss may not perform the way you wish, you will have a much better discussion about these issues if you are performing well yourself. Reaching out to your employee assistance program is also a good way to make sure other issues are not clouding your perception of the situation.
  2. Start with identifying what your boss does that you feel is helpful. Ask yourself: Does your boss do many things well and a few things poorly? It’s easy for a few frustrating behaviors to cloud our judgment and overall view of our boss, in spite of some redeeming qualities. Let your boss know what is working for you first. Remember, recognized behavior gets repeated. An example: “Larry, I appreciate the time you spent with me this morning going over the project list. Your time on this very much helps me prioritize next steps, move more quickly, and achieve outcomes.” By telling Larry that you appreciate his time and why, it becomes much more likely that Larry will make time for you next time you ask. Another example: “Larry, I do appreciate your candid feedback on my performance and suggestions for managing expenses better. I’m grateful that you’re willing to invest in my professional development by pointing out what I can improve on.” Here, we let Larry know we can take candid feedback.
  3. Confront the problem. If you’ve already looked in the mirror, believe your own performance is consistently strong, and have shown maturity by welcoming potentially negative feedback yourself, you’re ready to take the next step with your still low-performing boss. I recommend using a “support-confront-support” technique. Basically, you combine what is working well with what is not. Be sure to emphasize that this is your perception of things. This will help your boss to be a more receptive listener who is less defensive.Example: “Larry, I want to thank you for sharing the strategic plan with me. Your suggestion that I focus on expense management and the implementation tips you offered are really helpful to me. We’ve already seen a lot of improvement. In fact, department expenses are under budget year-to-date. I also appreciate your support in allowing me to attend the recent conference. I found it very helpful in improving operations. (Get ready. Here’s comes the “confront” part…) “You know, this is just my own perception—you may not even realize it—but you just asked me a question and before I had even finished answering, you cut me off rather abruptly. It disappointed me and frankly, I was a little embarrassed. Larry, I believe you genuinely do want to hear what I have to say, so I’d appreciate it if you would take time to listen. As I said, I do very much appreciate the investment you’re making in me. It’s clear your suggestions are helping me lead change that will allow us to meet our department and organizational goals.”

    Typically, he or she will respond well to this kind of approach. The key is to start and end with the positives. Always use the words “It’s my perception” when you have this kind of discussion. Also, try not to judge your boss too harshly. In my experience, most of the time, your boss is not aware of the full impact of his or her actions on you. This is because all too often, we don’t take ownership for having these direct conversations. Instead we vent our frustrations with others who can’t really help us in side conversations.

  4. Move to DESK. Okay, so you’ve tried tips one through three and haven’t gotten anywhere. What next? Meet with the boss using the Describe—Evaluate—Show—Know approach. Begin by D-describing what actions you have observed that are problematic. “Larry,” you say. “Thank you for your time. I would like to share my perception with you about the meeting yesterday. Please listen until I finish what I have to say. Yesterday at the division meeting, you asked me a question, but did not allow me to complete my answer before you said, ‘Sounds like we don’t know what is going on.’Next, move to E-evaluate. Evaluate how you feel or how your organization’s policy, standard, or value is not being lived by your boss’ behavior. “Larry, when this happened, I was hurt and embarrassed. I also believe that making that comment and cutting me off mid-sentence is not consistent with our organizational standards regarding respect. Then move to S-show. “My goal is to do well here, so I want you to know I can accept negative feedback if it is offered in a professional manner. Since I know we both want to achieve the same goals, I’d like to describe the best way to provide feedback to me. If you have concerns about what I’m saying, for example, just speak to me privately after the meeting and we can address them together then.”

    Finally, K-know the consequences. You might say, “Larry, if we cannot work out a way to communicate in a more productive manner, (then lay out what you are willing to do). This may not be the right place for me to work right now, and it saddens me for I very much would like it to work out.” Remember, you don’t have to follow through on quitting, but perhaps you have signaled the importance of resolving this issue. I understand that using the DESK approach is not easy. It takes a lot of courage and persistence. However, I urge you to be brave. Working for someone who drains your energy will impact your health, create issues with your staff, compromise your personal values and high standards, and eventually impact those you love when you take your frustrations home day after day. Life is too short to spend so much time with a boss or an organization where the fit is not right.

  5. Get support when you need it. It’s also true that some behavior crosses the line when it’s abusive, harassment, or too volatile to handle alone. In those cases, do reach out to the system your organization has in place and report such actions. Remember to access your company’s employee assistance program. They can help you make sure that your perception is accurate and also provide key tips for managing the problem during this stressful time.

In conclusion, my experience is that being a supervisor isn’t easy. I just don’t think that leaders come to work with hopes of ticking off a few employees and creating conflict with patients and physicians. By taking the lead in resolving conflicts, you demonstrate healthy adult behavior to yourself, your boss, and your organization. If, in the unlikely event that the above tips do not create the right environment, remember that in the long run you will be happier and more successful in a place with a better fit. I suspect though, that in many cases, you might be surprised that your boss is receptive and appreciative of the honest feedback you offer when you address concerns directly. Typically, your working relationship will improve.

What’s Right in Health Care Conference and HCAHPS

May 20, 2008

Is there a day on the calendar that you look forward to every year as it gets closer? Maybe it’s a birthday. Maybe an annual reunion with old friends. As the date gets closer, your anticipation builds because you will be able to celebrate something important to you with people you care about. For me, one of my favorite days on the 2008 calendar is just five weeks away, so I’m feeling that same sense of excitement. Why? Because on June 18-20 I get to meet with and learn from the largest and most passionate group of healthcare leaders in the world, all in one place.

Our registration already includes more than 1,300 individuals from around the world committed to passionately implementing the same set of evidence-based tactics proven to save lives; to make healthcare better for employees; and to reinvigorate physicians in the practice of medicine the way it was intended. If you count yourself among the leaders committed to making healthcare better, I hope you are able to join us and experience the excitement and learning that takes place each year.

Over the three days we will be together, we will hear stories of what’s working well in healthcare organizations across the world, and leave with practical ideas we can put into action when we return back to our own organizations. While all three days will be solid with content, let me focus on just one of the educational sessions.

On Wednesday June 18th from 3:00-5:15, one of the six breakout sessions at that time will focus on HCAHPS. This intensive workshop is being led by two of our most senior coaches, who have worked with organizations in the HCAHPS pilot project, as well as a leader from Hackensack University Medical Center in New Jersey, one of the best performing organizations nationwide according to the initial HCAHPS results. Between their direct experience, and that of the organizations we have coached, Studer Group has more experience improving performance on HCAHPS than just about anyone else. In fact, whether you look at likelihood to recommend or a specific measure like pain control, 3 out of 4 Studer Group partners outperform the national HCAHPS database.

Why is this session important? Because HCAHPS is arguably the most powerful transformation for U.S. healthcare since President Lyndon Johnson signed Medicare and Medicaid into law as part of his “Great Society” plan in 1965. That’s a bold statement. But I believe it is also a fact, because for the first time since we, the people, were given these essential insurance plans, our voice now counts. As part of CMS’s ever-evolving Value Based Purchasing plan, the voice of the patient is now being heard through HCAHPS, and will soon help steer payments toward those providers whose customers perceive that they provide better care. As such it is absolutely critical that your organization understand and focus on the underlying issues that will shape the perception of your organization in the eyes of the patients for which you care.

Whether you plan to attend the HCAHPS breakout session or not, we strongly encourage you to take a moment and complete the following brief online survey. This three-part survey asks you to complete the HCAHPS questions just as a patient would; to list the single most important tactic that could improve the scores you gave; and any one question you would like the presenters of this session to answer. This anonymous survey results will be used in the actual presentation and will help customize the content to information you value. For your voice to be included in this survey, please click the following link before next Friday, May 23:

This is just one of the 33 breakout sessions offered during the event. The other 32 breakouts each address a specific tactic, such as physician communication, service recovery, developing nurse leaders, rounding on employees, employee selection and retention, pain management, interdepartmental surveys, etc. Presenting organizations include winners of the Malcolm Baldrige National Quality Award, large academic medical centers and small hospitals serving rural America. In addition, we have 6 hours of plenary keynote sessions that will leave you talking; an awards event to celebrate together our shared successes in improving healthcare; and the world’s first concert specifically designed for healthcare leaders.

On June 18-20 I hope you will be able to join with hundreds and hundreds of leaders just like you – committed to making a difference. I hope to see you there.


Hourly Rounding

April 15, 2008

When we begin working with new organizations, one of the most important things we do is help them appropriately sequence how, when, and why they rollout the tactics proven to get results. Just like courses in school, there are some foundational pieces that need to be in place before more advanced techniques are attempted. One of the best examples of this is when organizations jump to advanced rounding techniques, such as hourly rounding on patients, before hardwiring the foundational rounding technique of rounding on employees.

In this blog I’d like to give some tips for sequencing tactics, as well as a perspective on why hourly rounding is such a powerful tool and worth waiting for.

An important early step toward hardwiring clinical, service, and operational excellence is all about engaging employees. Get your workforce on board and everything else falls into place. The most powerful tool at this stage is for the leaders of the organization to round on employees. That’s why when we coach organizations we ensure this step is happening with consistency before moving on. To learn more about how to round effectively, you can read more on our website. When done right, you will uncover mountains of knowledge currently lying hidden in the minds of your employees. However, the real benefit comes not from uncovering new information but from the wins you get with employees when you fix the issues that they have shared.

Once leaders are effectively rounding on employees, some organizations decide to adjust the focus of the rounding conversations to address specific pressing issues. For example, in their efforts to hardwire a culture of safety, hospitals across the country are incorporating some of the following questions into their rounding:

  • Were you able to care for your patients this week as safely as possible? If not, why not?
  • Can you describe how communication between caregivers either enhances or inhibits safe care on your unit?
  • Do you know how to report an adverse incident?
  • Can you describe the unit’s ability to work as a team?
  • Have there been any “near misses” that almost caused patient harm but didn’t?

Fast forward. A few months of effective rounding conversations between leaders and employees have resulted in a culture of accountability, trust and open dialogue. Now is the time to rollout the powerful tactics like hourly rounding that have been proven to get the incredible results we’ll discuss in a moment. Why is this the right time? Any earlier and the employee rounds on patients would fade away over time. The discipline, the trust, and the accountability that are generated by leader rounding and objective accountability systems are critical for rounding to happen with every patient, every hour . . . and that’s the only way the results improve to the extent research has shown is attainable.

So what’s the big deal about hourly rounding? Why all of the effort? Because of the powerful impact this single tactic can have across your organization; and more importantly, its impact on the lives of thousands of patients and their families. For example:

  • Inpatient Setting
    • Our study published in the September 2006 American Journal of Nursing proved that hourly rounding cuts patient falls in half, reduces pressure ulcers 14%, increases patient satisfaction 12 points and decreases call light usage 38%. In summary, results across the board . . . better outcomes for patients, employees, and budgets.
  • Emergency Department Setting
    • We are delighted to announce that our recent research on the effectiveness of rounding in the ED setting has been accepted for publication by the Journal of Emergency Medicine. The results were very similar to the inpatient results. With just slight adaptation, rounding works everywhere. To share these adjustments we have produced a video-based tool that shows how to effectively round in the ED.
  • National Acclaim
    • 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.”
    • Let’s put that 50% reduction in patient falls in perspective. At a time when numerous proposals are floating around aimed at saving money or improving quality in US healthcare, if every hospital in the United States implemented hourly rounding it would prevent a quarter million falls, 75,000 injuries, and more than $2 billion. At the same time, patients perceive their care as better and safer and nurses work more efficiently. I don’t see the same side benefits from most of the legislative proposals for reforming healthcare.

To learn more about how to implement leader rounding on staff or the many different forms of hourly rounding I’ve discussed, consider attending our annual conference, What’s Right in Health CareSM June 18-20 in Atlanta. You’ll hear more than 30 best practice sessions specifically designed to help you implement these and other evidence-based tactics. Here are just a few sessions related to rounding:

  • Learn how one organization used hourly rounding in both inpatient units and their ED to generate more than $1 million in additional revenue and cost savings.
  • Learn how another organization used both leader rounding and hourly rounding to raise its Emergency Department from the 4th percentile in patient satisfaction to the 92nd percentile in less than one year.
  • Learn how another organization implemented hourly rounding on nursing units to improve their patient’s perception of care from the 32nd percentile to the 96th percentile while decreasing patient falls with injury by 43%.
  • Learn how a hospice care provider implemented leader rounds on staff to obtain consistency in practice, approach, and clinical results.
  • Learn how to implement leader rounding in physician practices.
  • Learn how to combine leader rounding on employees with pulse surveys to improve employee engagement and lower turnover.

I hope to see you in Atlanta.


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.

“Always” Leadership

September 19, 2007

Consistency seems to be an elusive item in health care. Some shifts, some days, weeks, or months run well. Then issues arise that negate the gains. These methods to create and sustain those gains so interested Wiley publishing that they led to the publishing of my new book, “Results That Last.” In this article, Bob Murphy of the Studer Group has written excellent recommendations for how to become an “Always” leader.

We appreciate your feedback. I am so pleased many of you wrote regarding how helpful Debbie Cardello’s article on butterfly leadership was. Enjoy Bob’s article.

As I travel around the country, it constantly amazes me how much the same we are, how similar the issues are that we face. Right now, whether you are a leader in a hospital, health system, or medical practice you are facing the realities of financial pressures, competition, quality and service mandates, and labor shortages in critical positions.

When I ask leaders whether they think that health care will be more difficult in five years, everyone’s hands go up. Leaders know that if we do the same things we are doing now, in five years our results will be less than they are now. Just like when you’re promoted to a new role, the skills that helped you be successful to this point might not be the same ones you need to be successful going forward. For health care leaders looking to make an impact over the next five years, they need to become “always” leaders.

A recent challenge introduced by the Centers for Medicare and Medicaid Services (CMS), is destined to change the way we think about our roles as leaders. The Hospital Consumer Assessment of Health Care Providers and Systems (HCAHPS) “voluntary” survey of patients changes our fundamental language and attitude of leadership. The HCAHPS survey asks patients to rate us on the frequency of how often we do certain things. This is an important distinction from previous patient surveys which asked about satisfaction. Asking how often they saw certain things is very different than asking how satisfied they were with the same things.

Patients are asked: How often did nurses treat you with courtesy and respect? How often did doctors explain things in a way you could understand? How often were your room and bathroom kept clean?

The possible responses are “Never”, “Sometimes”, “Usually” and “ALWAYS.” When the results are  compiled and published on the CMS website, the only results we will see is the percent of “Always.” When CMS uses the data in its calculation of our reimbursement, they will likely use the percent of “Always” to reward high performing organizations.

Because of these external pressures, we are being pushed from being “Sometimes” organizations to being “Always” organizations. That means we likely have to move from being “Sometimes” leaders to “Always” leaders.

What does an “Always” leader look like?

  1. An “Always” leader has a plan! High performing organizations and their leaders have leader performance evaluations that are measurable, specific, objective, weighted and time-sensitive. The goals set forth in the individual leader’s evaluation are linked to the organization’s overall goals. A good, measurable, specific goal aligns the leader’s behavior to the expectations of the organization. Most leaders really appreciate an evaluation like this because it helps set priorities and tells them in advance what is necessary for success. Leaders have told me that they want to know how they are doing and what else to do to succeed. High performing organizations use monthly report cards and 90-day plans to help a leader with all that is on their plate. A good evaluation provides a prioritization roadmap for the leader and keeps leaders focused on what is important. As a leader, I am pulled in many directions at the same time. A good evaluation tells me where to focus my time and helps when I am asked to do “other” work. I can bring my annual evaluation, monthly report card and 90-day plan to my boss and ask them to help me prioritize the new work. If it does not fit into my annual evaluation, I will likely not waste my time and energy. A good evaluation system allows senior leaders to continuously monitor eader performance and provides for organizational agility.
  2. An “Always” leader takes accountability for their own development. If we agree that health care is getting harder and we need to continue to grow our leadership muscle, an “Always” leader does not wait for their boss to tell them to get training. An “Always” leader evaluates their skills and seeks out new ways to learn. An “Always” leader asks their supervisor if they are on track, what are they doing well, and what could they do better.
  3. An “Always” leader uses evidence-based leadership (EBL) tactics when appropriate . An “Always” leader follows best practices in hiring,
    retention, communication, reward/recognition, re-recruiting high and middle performers and dealing with low performers.
  4. An “Always” leader has a balanced approach. Many organizations balance priorities and activities between the focus areas of Service, Quality, People, Financial Performance, Growth and Community. All too often our staff thinks that all we are concerned about as leaders are financial results.
  5. An “Always” leader connects the dots consistently to purpose, worthwhile work and making a difference. Many of the staff we work with have a calling. They choose to come to work every day because of the special feeling they get while taking are of patients or taking care of those who take care of patients. An “Always” leader taps into that core feeling of making a difference by the way we communicate, what we reward and how we lead by example. Methods include sharing stories from other parts of the organization that demonstrate worthwhile work, recognizing staff members when they demonstrate the behaviors we know make a difference to our patients. “Always” leaders use every opportunity to connect to the hearts of their staff. What we do is special. Our patients entrust us with their lives and that is special. We should take every opportunity to tell and show our staff that what they do is important.
  6. An “Always” leader follows a sequenced approach to improvement. Most everyone reading this article is familiar with CPR (Cardio-Pulmonary Resuscitation). If you were faced with a situation where CPR was necessary, you would follow the ABCs of CPR right? First is airway, then breathing, then circulation or compressions. It is understood that you may never get to compressions if you cannot open the airway. Why? Because the compression would not be as effective. The same thing applies to leadership in many ways. Some of the tactics we teach at the Studer Group are advanced techniques and require some foundations or basics in place first. Now, you can skip steps, but the likely outcome is that you will not be as effective, nor will you be as effective for long. We know that Hourly Rounding is a wonderful tool to implement to reduce decubitus ulcers, falls, call lights and the distance nurses travel during a shift, but we usually do not recommend it be the first tactic you employ. We usually first recommend Rounding for Outcomes on your staff and nurse leader rounding on patients before hourly rounding. Why? Rounding on staff and patients by the leader first role models the desired behavior. It helps the leader show that they are aware of the issues on the unit and what patients want before asking staff to do that. Rounding on staff helps improve the personal relationship between the staff and leader. Leaders find out what tools and equipment needs there are on the unit. Leaders find out what is going well and can reward and recognize staff for demonstrating desired behaviors. When rounding is done consistently by leaders, staff are less likely to push back.
  7. “Always” leaders take best practices and standardize across the organization. An “Always” leader is trying to find a way to do their job better and get great outcomes. We find in many organizations there are leaders already getting the desired results such as low turnover, great productivity, high service, but, for some reason, it is not well known throughout the organization. Sometimes other leaders in the organization are aware that there is a leader internally getting great results, but there is a reluctance to do what they are doing. An “Always” leader breaks down those silos and barriers and duplicates what is working well.
  8. Failure to always do desired behaviors. As organizations move to improve results, we commonly find that changing the behavior of hundreds of thousands of staff members is very hard to do. The easiest thing we can do is change our own behaviors first. That requires a good long look in the mirror. I’ve had to do that so many times in my career, and still do since I still make mistakes.

As health care leaders, it is our responsibility to move our organizations from “Sometimes” to “Always.” The journey will be hard work, but one that is achievable if we use proven tools and techniques to guide us.

Please add your comments to this blog and share your thoughts with our readers. We can all benefit from each other’s experiences.

Butterfly Leadership. Does It Keep You From Achieving Desired Results?

September 11, 2007

Debbie Cardello of the Studer Group, former COO of Baldrige winner Robert Wood Johnson University Hospital Hamilton (NJ), recently used the term “butterfly leadership.”  I asked her to write more on this important topic.  I hope you find her article interesting and helpful.  Your comments are appreciated. 

You are probably wondering, what is butterfly leadership?  And what does it have to do with achieving results?  Picture a butterfly as it flies from flower to flower, tree to tree, then quickly flutters away in search of sweeter nectar.  As healthcare leaders, we face similar temptations.


I think back to days (I should say years) gone by when I was very frustrated that quarter after quarter, patient satisfaction scores stayed the same.  Sometimes they even got worse, despite how hard we were working to improve.  What I ultimately realized was that the team’s actions weren’t always aligned with goals and the “flurry” of activities prevented us from focusing on what mattered most . . . patients, employees, and physicians.


Good leaders in good hospitals experience these challenges every day. We also know that there is no magic bullet; and as caregivers, we will always find problems to solve and systems to improve.  On the other hand, if our energy is consistently diffused, our ability to be an effective leader is at risk.  We could experience a decline in performance, burnout, or worse yet – leader turnover.


What can we learn from the example above to help us focus and align our priorities, accelerate our performance, and avoid “butterfly leadership?”


Use the 90-Day Plan to identify what matters most.  We’ve all heard this great advice: don’t confuse activity with results. It’s so easy to do in the busy world of healthcare. Begin by identifying what’s most important. This is where a good 90-day plan can help.


A 90-day plan that outlines three to four action steps is manageable and helps us focus on next steps that will move us closer to desired results. Review the plan monthly with your supervisor to ensure you stay on track, and to get and give feedback on how to best spend your time.  Ask yourself on a regular basis, am I spending my time on value-added action steps, or is activity simply finding its way on my calendar?


Use Rounding to hardwire behaviors that matter most.  We know that changing behavior is one of the most challenging aspects of being a leader.  Behavior rarely changes by writing an email, sending a memo, implementing a policy, posting a flier on the bulletin board, or communicating it once at a staff meeting.


It is a process that happens one day at a time, and one person at a time through our rounding on staff and helping them connect their work to the mission and goals of the organization.  Praise staff in the presence of others when you see them doing the behaviors that you are trying to hardwire. By doing so, you communicate what behaviors are most valued and important to patient care on our unit, and in our organization.


In order to reduce variation, we must manage performance.  Most likely, you’ve already recognized your high and some middle performers for using desired behaviors.  You also have a pretty good idea of who is not.

Next is a most important step if you are challenged by consistency issues.  This is the time when many of us get frustrated and are tempted to “flutter” away, try something new, move on to another initiative, or throw up our arms in defeat and accept average results. Average results in healthcare could mean that a number of patients could still contract an infection in the hospital or be harmed by a medication error which consistent improvement efforts could have prevented.

Circle back and visit staff members individually to clarify that using the desired behaviors is not an option, it is a requirement.  Give your staff an opportunity to discuss why he or she hasn’t complied – it may be due to a lack of understanding or training.

End the meeting with the understanding that the behaviors will need to become a regular practice to avoid further action.  In my experience, a leader would have to do this with only a few staff – the rest figure out how serious you are, what’s negotiable, and what’s not negotiable.

Use Reward and Recognition to communicate what matters most.  A simple rule to remember in communication is that once is never enough.  We all need to hear information multiple times and in a variety of ways in order to truly understand.


Reinforce desired results with fun and interactive exercises that reward and recognize key behaviors.  Share the top three organizational or department priorities at employee forums or department meetings.  Ask employees to talk about one action they could take in their department to get the desired result.  Encourage staff to share success stories.  Give out fun prizes to volunteer participants.  Employees are more likely to relate to important information when they can apply it to their own job.


While butterflies are most productive when they are “fluttering” from activity to activity, healthcare leaders could benefit from focusing their actions on identifying, rewarding, hardwiring and communicating what matters most. The result is so much more than meeting a goal or a score – it’s making a difference in the lives of those we serve.


Please add your comments to this blog and share your thoughts with our readers. We can all benefit from each other’s experiences.