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Making Patient Experience Initiatives Stick

HealthLeaders magazine, November 13, 2009

NYSTROM: For nonemployed physicians, we hold orientation where they're walked through everything we do to improve the patient experience from our physician services team. Some buy in, some don't. Our physician services team works hard on this.

KEYSER: One core strategy is called the Distinctive Care Model. It has a host of knowledge changes, skill sets, behavioral changes, and systems and process changes that we believe lead to a remarkable experience. There is a lot to learn out there. Learning is often limited to the standard operations leadership team and not to doctors. Well, who influences more than they do? One event, "The Physician's Role in Service Excellence," teaches that the simplest behaviors can make a difference. Sitting down, making eye contact, and asking open questions—things that are so simple that some organizations won't teach them to their doctors because they think it would be rude. But physicians—although not all of them—will say, "That's a good idea. I can do that today."

GNIDA: It's rare that we present in front of a room of physician leaders and they say, "Oh, we've heard all this" or "That's not going to change anything I do." Mostly the reaction has been, "Now I understand what you're trying to do here." Physicians are skeptical of some of our programs because we change them often and we're not consistent with promoting and engaging with them. Someone new comes in and they take the hammer out and start swinging. That impacts the relationship between the physicians and the next group that tries to put in an experience program. We have to be consistent and build trust. Then they can be not just partners, but leaders.

KEYSER: One of our core values is compassion. People often worry compassion is not something you can teach. It absolutely is. We had a nurse say, "I'm not fuzzy-wuzzy. How can I be compassionate?" We asked her what she's good at. She said "I'm one of the nurses they call when they can't get the IV in the patient." I told her that her ability to prevent more pain is a very compassionate act.

The employee's role

HEALTHLEADERS: What is the role of employees in creating the patient experience?

NYSTROM: We created a selection process to ensure we were hiring people who can create excellent experiences for our patients. In every interview, regardless of whether the position is directly involved with patient care, we ask candidates what patient-centered care means to them. Even if they're in the finance department or in HR, they need to connect the dots to see how they can affect the patient's experience in their particular role. If a person cannot articulate how they affect the patient experience, it's probably not the right place for them.

KEYSER: Storytelling is really important to us and has been for a good time now. Two years ago we started a program called cascading. We taught every executive to tell their story—why they got into and remain in healthcare. Each told their personal story to their reports. Those reports created their story and told it to their reports. We are training leaders in the art of storytelling because your ability to tell the experience of your patients and of you as a staff member engaging those patients has a very strong impact in the organization. People remember stories. They don't remember bar charts and awards.

NYSTROM: We also rely on stories, and our employees are huge promoters of patient experiences. When Progress West opened, we heard people say, "Of course they're going to get great patient loyalty survey scores. They're a new facility. They've got top-of-the-line equipment." I told every single person I interviewed that we could have the best processes, the most beautiful facility, and the latest technology, but if we hire the wrong people we could fail.

GNIDA: There's this idea that a new hospital is going to be a savior for a patient satisfaction program or all of a sudden scores are going to go up. I always laugh, because when you look at the survey and what's important to patients, it's not about the waterfall in the atrium. We're asking, "Did your nurses connect with you, did they have compassion, did you understand what your physician was telling you?" Quality care comes from people.

KEYSER: One of our hospitals was intended to be different from the beginning. We brought staff in with significant lead time prior to opening and trained them. It was a big investment. But opening day went off pretty much without a hitch. It gets down to vision. The executives said this place is going to be different; it's going to feel right, people are going to be trained; they're going to understand what their responsibilities are; we're not going to spend our first six months figuring out what to fix. Well, if you're going to say that you better be ready to pony up, because traditional leaders may say, "I have to have people on the payroll way before we open? Are you kidding me?"

HEALTHLEADERS: How do you measure the impact of patient experience efforts?

KEYSER: We look at our service measurement as a story. We have a significant intentional effort around trying to humanize our data. When all leaders are talking about are scores and targets, they're blowing it. When they talk about what the data are trying to tell us about what patients are going through, then we're making progress. It would be easier just to spit out the data every week and post it and say, "Oh, bad dog, no biscuit," or, "Things are going really well." No. If there's a gap between where you are and where you want to be, talk to people and try to understand what's happening. Are their perceptions different? Are the drivers not what we thought they were? Are they having a rough day? Let's look into it.

GNIDA: The more we embrace measurement, the more we can use it to our advantage. One way to do that is to understand it better. Managers often underestimate the percentage of patients who score the hospital as "excellent" on surveys. I could be at the top hospital in the world or at a low performer. They all think the top answer is "very good" or "good." Yet "excellent" is by far the number one answer on patient surveys. If you collect data about problems, that's what you're going to see. That puts you in the mode of service recovery. Healthcare professionals are experts at diagnosing and fixing problems. From a patient experience point, that's not the best strategy. We need to figure how we make something that already works pretty well even better. That's harder.

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