Archive for the 'Leadership' Category

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.


Eight Roadblocks to Moving Best Practices

January 20, 2010

Have you ever noticed certain leaders or departments in your organization are really, really good at doing one specific thing? Maybe they consistently get great patient satisfaction scores, or their employees have very low levels of absenteeism, or their infection levels are consistently lower than those of similar areas.

It’s clear that these high performers are doing something different, something that sets them apart. And whatever “magic touch” they have, you’d love to bottle it and distribute it to other areas of your organization. In fact, you may have done some digging and figured out what they’re doing right. But when you tried to get others to follow their lead, there’s a good chance you fell short of the goal.

Harvesting “best practices” and transferring them to other leaders and departments is a wonderful way to achieve organizational consistency. And yet, many organizations just can’t seem to get it done. Have you ever wondered why?

We have discovered there are eight common “roadblocks” that keep organizations from identifying and moving best practices. They are:

  1. High performers can be modest. They minimize what they do. “Oh, it’s no big deal,” they’ll say. To figure out what they’re doing that’s different, you need to dig deep. In fact, digging deep with a high performer is how we initially discovered the impact of hourly rounding—which was later found to reduce call lights, falls, and skin breakdowns and to increase patient satisfaction.

  2. A leader may fear losing his edge. If he tells everyone about his best practice, he will be unable to keep up his success. This does not happen frequently, but it does come up.

  3. Sometimes the high-performing leader balks at taking on a “teaching role.” Maybe she doesn’t want others in the organization to think she is showing off or that she is the boss’s favorite. And when she does present, she will even give reasons for why she could successfully implement the best practice but it may be hard for others.

  4. Success is attributed to the leader and not the best practice. People think it’s the leadership and not the practice itself that’s getting the great results—so the actual best practice is missed or underestimated.

  5. Leaders want to keep their autonomy. Implementing someone else’s way of doing something makes them feel they are giving it up. It moves them out of their comfort zone. (This is especially true in the C-suite.)

  6. “Terminal uniqueness” can hamper moving best practices. Leaders are quick to point out how they are just a little bit different and that’s why a certain best practice won’t work for them.

  7. Egos get in the way. By the time some people get to the C-suite, they are better leaders than followers. Or at least they think they are!

  8. There is too much change and not enough time. There simply isn’t enough time for a best practice to be mastered—and it’s dropped before it’s given a fair chance.

The good news, of course, is that there are solutions to all of these roadblocks. Smart organizations will work to overcome them. Best practices are the ticket to great results—and isn’t that what we’re all looking for?


Quint Studer

Quint Studer, CEO

Studer Group

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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.

Do We Change Goals or Change Actions?

September 8, 2009

I was reading a story in a book about a person who turned his life around. One sentence just jumped out at me. The person said he used to reduce his goals to fit his behavior. His life turned around when he changed his behavior to fit his goals.

Right away I thought of healthcare. Over the years I have met thousands of people in healthcare, been in hundreds of organizations, and spent countless hours with senior leadership teams. I reflected on what I had read; do we change the goal or the performance? To me, this is one of the key characteristics that separates high performing organizations and individuals from those that are not high performing.

High performing organizations do not lower the goal; they increase their performance. They understand this will mean changing actions (behavior).

Other organizations spend their time discussing why they are different and lowering goals to fit their performance.

Which type of organization do you work for? What do you do? Do you change the goal or change your behavior?

I found these to be real gut check questions.

Announcing the Largest Ever Study on Health Care Leadership Skills

March 25, 2009

I’m writing to ask for your participation in an important research project within the healthcare industry. We anticipate that the findings of this study will impact how we train future health care leaders, just as the previous studies you helped us with proved the dramatic benefits of hourly rounding, identified characteristics of high performing organizations and shed light on issues of work-life blend among women in healthcare.

We are conducting what we hope will be the largest study ever of health care leadership skills. Our goal is to ensure that the next generation of leaders has the skills required to make healthcare even better. Conducted in partnership with The George Washington University, this study seeks to better understand the skills you had as an early careerist, the skills you think are most important for new leaders to possess and skills you believe will be needed in the future.

If you hold a leadership, management, or supervisory position in healthcare organizations, I invite you and/or your colleagues to take part in this study to create recommendations for actions and policies to enhance the skill sets of new healthcare leaders.

Go to and complete the survey by April 10th. The fifteen minutes of your time needed to complete the survey will impact the future of healthcare. We commit to sharing the results broadly and free of charge this summer.

The knowledge gained from the study will help schools and employers better train and retain healthcare leaders, two critical steps toward creating better places to work, practice medicine and receive care.

Every day we all have the ability to make a difference. Here’s an opportunity that will only take you 15 minutes today for results that will last generations.

Yours in service,


Good Behavior by Decree?

August 12, 2008

How A Simple Contract Can Motivate Employees to Create a Kinder, Gentler (More Prosperous) Workplace

Consider the things your employees do that you wish they wouldn’t. Allison, for instance, chews gum—loudly—when she’s on the phone with customers. Calvin consistently forgets to turn off his cell phone at critical times. (Last week it burst into a rousing chorus of “It’s a Small World” during an important meeting) These are not bad employees, but they do have bad habits that irritate customers and coworkers alike.

If you assume there’s nothing you can do about such all-too-human flaws and foibles, think again. You can legislate good behavior—and what’s more, the vast majority of employees will be glad you did.

Don’t assume people will feel that you’re infringing on their rights when you create a set of behavioral rules. Most of them are as irritated by the offenders as you and your customers are. Besides, most people appreciate ‘official guidelines’—it eliminates their own confusion as well as that of their coworkers.

You might assume that, say, knocking before entering someone’s office is a “common sense” behavior. But it’s not always. Common sense is a subjective concept, depending in part on an individual’s background. Still, it’s very important that every employee display behavior that’s consistent with company standards and aligned with desired outcomes.

Obviously, you want employees to leave a positive impression on customers. And it’s also important for morale to have everyone behaving in appropriate ways. Employees who frequently behave in ways that their coworkers deem inappropriate are certainly not contributing to a happy, unified, productive team. And here’s the real bottom line: if you don’t spell out which behaviors are acceptable and which are not, you can’t hold people accountable for them.

The solution is simple and amazingly effective…develop a “Standards of Behavior” contract and have everyone, from CEO to receptionist, sign it. This document can address any and all aspects of behavior at work: from interaction with clients to phone etiquette to “good manners” (knocking on doors) to “positive attitude” markers (smiling or saying thank you).

Often, just knowing that a Standards of Behavior document exists creates an extra boost of awareness that really does affect day-to-day behavior. It creates the same behavior expectations for the entire team. Best of all, it functions as a tidal pull on problem employees, bringing them up to a higher level of performance.

You may worry that enforcing Standards of Behavior will create a company of robots—a company in which human differences are discouraged in favor of mindless conformity. It won’t! An office unified by agreed-upon standards is a far more pleasant place to work. Plus, individual responsibility flourishes, because it’s clear what everyone’s responsibilities are. That contributes to an environment of fairness, cleanliness, and good manners—and happy customers who keep coming back for more.”

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.

Practicing Excellence

March 18, 2008

I have the great fortune to speak with physicians nationwide about the passion they have for making a difference, especially in the lives of their patients. With Doctor’s Day approaching on March 30, I have asked Dr. Stephen Beeson, Studer Group physician coach and author of Practicing Excellence, to share some thoughts…

Over the past eight years I have had the amazing opportunity and privilege to coach and train thousands of physicians from all over the country. Over the course of these years others and I have worked to distill and refine what works best to engage physicians and improve performance. We have had good results working with health care leaders and physician medical staffs around the country to improve the patient perception of care provided by physicians.It is clear now that performance reigns in health care. HCAHPS, Pay for Performance, and Medicare Reform are now regulating and rewarding organizational performance. Those systems that do better will win. Unfortunately, health care leaders struggle with organizational improvement if systems and leadership are not in place to create vision, measurement, training, and accountability to assemble a culture of performance.

With all this in mind, another challenge is answering the question, “What do we do with our docs?”

Here are suggestions:

  • Align physicians to a Culture of Excellence. Before physicians will change their behavior they must believe the decision to do things differently is based upon logic and evidence. Physician engagement must begin with creating and communicating the case for service as a pathway to improved clinical outcomes, marketplace reputation, malpractice risk reduction, and the quality of his or her own work life.
  • Train physicians using evidence-based behaviors. Evidence-based behaviors are behaviors that predictably improve patient perceptions based on historical health system evidence. Excellence-driven organizations invest in the improvement and development of their physicians using these behaviors that drive outcomes. This tactical training improves physicians’ ability to create patient loyalty, drive compliance with medication regimens and raise the performance of the clinical staff who look to them for leadership. (Click here to access a tool on establishing a first impression with physicians.)
  • Select physicians that fit the culture. You can train and develop a physician to become great, or you can select high performing physicians who match your culture. (The latter is far easier.) Physician selection has historically been an ad hoc process, creating variability and unpredictability of physician performance. Behavior-based interviewing is a mechanism to select for the important physician characteristics that will position your group for success. Behavioral interviewing uses scripted questions that assess physician competencies including teamwork, compassion, clinical judgment and problem solving, communication, and leadership.

Practicing Excellence has always been about providing physicians evidence-based behaviors and guidance that have created results in every environment where they have been implemented. It is important to train physicians not only in how to treat patients, but equally important, how to treat colleagues and staff to develop an environment of teamwork, respect, collegiaty to create and sustain measurable organizational outcomes.

Stephen C. Beeson, MD is a nationally recognized presenter, practicing physician, and author of Practicing Excellence, A Physicians Manual To Exceptional Health Care. Visit