Make Hospital Staff Accountable for Patient Experience

An organization's culture, despite what's written on its mission statement, is the collective body of its staff's behavior. Patients' ongoing interactions with hospital staff create hundreds of opportunities to leave impressions, both positive and negative. It's in these "moments of truth," that an organization's brand is forged.

In six out of ten "moments of truth" the attitude of healthcare staff defines the experiences—twice the amount of banking or hospitality, according to a PwC report (PDF).

"In some ways, it's an apples-to-oranges discussion because in hospitality and banking, I have an employee that is replaceable," says Paul D'Alessandro, a principal in PwC's Health Industries Advisory and the firm's U.S. customer impact leader.

Coach, Measure, and Hire Well
"We hold people's feet to the fire in all of those different industries. If they mess up, they are held accountable for it. But there needs to be more accountability in healthcare as well, but with a sensitivity to the fact that they aren't necessarily an interchangeable employee… There needs to be work put into place into the way our teams are coached, teams are measured, and the teams are hired quite frankly, as well."

In healthcare, the staff is on a stage, and the patients are the judging audience, armed with patient satisfaction surveys. According to the PwC report, 72% of consumers ranked provider reputation and personal experience as the top drivers of provider choice.

Physicians, nurses, medical technicians and other clinicians can become unaware that their level of compassion is waning when they're under pressure, but it's up to the organization to renew their awareness and hold them accountable.

"[Clinicians] end up focusing after months or years of doing things in a given way, numbing themselves to the fact that what they just did, hurts." says D'Alessandro.

Re-Sensitize the Staff
Shifting a culture at an organization, or changing the pattern of any person's behavior, takes time. Here's how one hospital is tackling the problem.

Last week, Cabell Huntington Hospital in Huntington, WV, launched an employee training session with the hospital's human resources department that focused on putting the 2,400 employees in the patient's shoes. The emphasis was on re-sensitizing the staff to the patient experience through simulation exercises. Cabell Huntington is a 303-bed academic medical center that serves a rural area of more than 29 counties, spanning West Virginia, Kentucky, and Ohio.

"We're in Appalachia, and we have a lot of folks who have less than a high school education, and there's significant poverty in our area. There's a lot of anxiety on the shoulders of our patients, and going into a healthcare environment really exacerbates that. So we really want our employees to think about the patient's clinical experience from their perspective," says Loree L. Holland, director of service excellence at Cabell Huntington.

Holland joined Cabell Huntington four months ago to lead the movement toward patient-centered care. Her first focus was to shift the hospital's culture by setting up expectations in terms of behavior, and holding people accountable. The hospital culture is now finding a balance between clinical excellence and patient satisfaction

"Some folks will say she's a really good nurse, but she has poor communication skills. Well, it takes both to be here because most of our patients aren't clinically oriented. They don't have a way to measure whether something is of clinical excellence," says Holland.

"What they can relate to is whether someone is caring or compassionate, communicating with the patient and being proactive about their needs. If you have someone with great interpersonal skills, but they're having significant issues with quality, that is also an issue. You have to have the whole package to be successful and to provide an exceptional patient experience."

Teach Management, Too
Holland says part of teaching employees to be reactive and patient-centered is teaching management to be reactive and employee-centered. At Cabell Huntington, the leadership team has gone through training that centers around accountability and being reactive to employee behavior, both positive and negative, to teach new habits and shift staff attitudes.

"It's not about waiting, but immediately having that difficult conversation. Sometimes you have to tell folks what they need to hear, not what they want to hear. And if you have folks who are not behaving appropriately, you need to train your management team to handle that situation and do the counseling," says Holland.

In a culture of new expectations, Holland says it's also important to not go straight to disciplinary action, but counsel the employee about their behavior.

"Sometimes the employee just doesn't understand, and we're here to develop and coach employees to be successful. It's not fair to all of a sudden to take very aggressive action with an employee when you haven't been coaching them. It's important to use daily coaching, so our leaders are now out and about, giving regular and immediate feedback. It is important to give employees continuous developmental opportunities rather than once a year in their review."

Set Expectations
When a system is broken, it's difficult for employees and managers to feel empowered about their work, but Holland says empowering managers to take ownership of their teams and change that culture on a daily basis is how to most directly impact the front lines of care.

 "Over these past couple weeks during our coaching sessions, managers have realized that you're not just managing people, you're leading them by establishing expectations and recognizing and rewarding behavior. You may be a good clinician, but if you're not stepping up as far as the other pieces go, then we have to have that conversation."

'This journey is not optional'
Empowering employees to be "owners and not runners" of the hospital's patient-centered mission, Holland says, leads to instances where coworkers have stepped up within their teams and held one another accountable.

"I make it very clear to them what our expectations are in terms of behavior, and [let] them know that the journey we're on—we're not turning back. This journey is non-negotiable and it's not optional. And I put it to them right then and there, 'Is this something you can be committed to, with a positive attitude, and work as a team to achieve?' And we'll make it clear from that point on that we're not going to tolerate negative attitudes or poor behavior, but we will work with them."