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Society for Healthcare Consumer
Advocacy 2013 Annual Conference
April 5, 2013
Presented by
Michele
Weston, CSP
Mom & Dad
3rd Knee Replacement
Takes a Village of Caring People
Mayo Clinic Best Practices
What would it mean to you if your front
line were engaged and owned the
patient experience & HCAHPS Scores?
Business Impact of an Engaged Workforce
50% - lower turnover
56% - Higher than average
customer satisfaction
38% - Above average productivity
27% - Better bottom line
Source - Blanchard Seminars
“For HCAHPS patient experience
service delivery to work just fine,
it must be led from the top
and the frontline!”
– Brian Lee, CSP
The Vision:
“To become an
Employer and Provider
of Choice.”
Connecting & Inspiring
Patient Advocates
Today’s Mission
Transformational Strategies
to Create a World-Class
Patient Experience
PAGE 1
a 1% Change in Employee
Morale
a 2%
Change in
Customer
Satisfaction
=
The Engagement/Service Link
Source – Press Ganey
“Feedback is the breakfast of champions” – Ken Blanchard
PAGE 13
Loving
compassionate care
for every patient,
every time,
no exceptions
If our mission is to provide
Then there is only one answer
= engagement!
Healthcare is different!
“It doesn’t take
an instant more,
or cost a penny more,
to be empathetic than it does to be indifferent.”
– Brian Lee CSP
Engagement
Is no
Longer
An
Option!
Buddy Discussion…
What do you see is
the value of frontline
engagement and
ownership?
Without Staff Engagement
You won’t move the needle to improve
anything..
• Patient Experience
• Clinical outcomes
• Patient Safety
• Hospital readmission.
• Hospital Acquired Infections
• Compliance!
Transform
The 3 Cornerstones of a Culture of
Engagement
Empower
Engage
PAGE 3
Important
Note:
Not everyone
shares the same level
of positive attitude
and engagement as YOU!
PAGE 3
The Five Attitudes of
Engagement
PAGE 3
Where would your Patients and co-workers say you fit?
“Negativity is the single
most destructive
force in the work place
today.”
– David Rabiner Leading Age Florida,
July 22, 2012
Nobody’s Home – Thomas Edwards Gass
“Based upon
our attitude
we can either
bring Joy or
Misery”
“The problem may not be the
ones who quit and leave for
more pay,
it’s those who quit and stay.”
– Brian Lee CSP
National Norms/Engagement - Source HR Solutions
23% - Actively Engaged
61% - Ambivalent
16 % - Actively
Disengaged
= 77% - Need Leadership!
Recommendation #1
1. De-staff your chronically
unproductive employees, via
corrective action coaching.
Corrective
Discipline
Counselling
System
OPPORTUNITY
ISNOWHERE
Life is full of Choices
Recommendation #2
Utilize Service Standards/ “Care Promises” to
choose new staff via “peer hiring screens” &
evaluate everyone.
You Can’t Change Behavior by Memo!
Warm Greeting – greet patients with a smile and a welcoming attitude.
Eye Contact – make appropriate eye contact.
Plain, Non-Medical Language – use common words when speaking to patients.
Slow Down – speak clearly and at a moderate pace.
Limit Content – prioritize what needs to be discussed and limit information to 3-5 key points.
Repeat Key Points – be specific and concrete in your conversation and repeat key points.
Show or Draw Pictures – draw pictures, use illustrations, or demonstrate with 3-D models.
Patient Participation – encourage patients to ask questions and be involved in the conversation during visits and be proactive in their healthcare.
Encourage Questions – create a shame-free environment, make patients feel comfortable asking questions. Enlist the aid of others to promote understanding.
Teach Back – confirm patients understanding what they need to know and do by asking them to teach back your instructions.
Grow your “grinners” into “winners” through:
Positive peer influence
Accountability
Education
Communication
Empowerment
Leadership
Engagement!
= Culture change
K = The Key is Culture
E = Empowerment is the Way
E = Education & Engagement
P = Play and Make it Fun
KEEP
The Key is
Culture
PAGE 3
KEEP
Culture:
“An organization’s
way of life.”
“The way we do things
around here.”
“Unwritten rules.”
Improve and “change your
culture… or be doomed to
repeat the past.”
– Brian Lee, CSP
Conduct a Focus Group with
your staff to clarify your current
culture and share it with
everyone.
Recommendation #3
Our Culture Today Loyalty Culture we Need
The Need for Culture Shift:
Poor Communication
Financially Driven
Listen But No Follow Through
Command + Control
Silos
Stressful
Lean Staffing
Poor Accountability
Good Communication
Customer Driven
Follow Through + Results
Empowered Employees
Cooperative Care
Stress Managed Environment
Always Adequate Staffing
Deal with Non-Performers
EX
Utilize input from everyone
to identify your actual
culture and brainstorm
your preferred culture.
Jon R Katzenbach, Ilona
Steffen & Caroline Kronley,
Culture Changes that Stick,
Harvard Business Review
“A strategy that is at odds with
an organization’s culture is
doomed.
Culture trumps strategy
every time.”
–
Empowerment
is the Way
KEEP
Service Recovery
Implement a Critical
Best Practice:
Recommendation #4
Practice the Service Recovery Complaint Golden Rule:
“Mess up?
Fess up,
& Dress Up”
- Brian Lee CSP
48
Average Service Problems Per Inpatient
Source HCAB
Empower Everyone to:
“Solve a complaint
prevent a complaint,
or show human compassion”
The discretion
to spend up to $10 per person
or up to $50 per person/year
Authorize Everyone:
1. Author a Service Recovery Policy
2. Create Tool Kits
3. Initiate post-incident reporting for
Root cause analysis
4. Educate everyone in a classroom
Charter a performance improvement team to:
Recommendation #5
Question
“How many would like to know
What your staff like about you?”
Leadership
Empowerment
Retention
Survey
Measure employee engagement twice
a year and act on what you hear.
PAGE 4
Recommendation #6
PAGE 5
Communication
“To prevent your people’s
mood from turning blue,
give them a chance to let
you know what they do”
– Brian Lee, CSP
PAGE 5
Recommendation Recommendation #7
All Managers should do Intentional Rounding
…15% of your time!
Be aware of the 3 types of communicators:
“Egotist”
“Bore”
“Brilliant Conversationalist”
Ask Questions
Then zip your lips.
Ironically, people regard
someone who does more
listening than talking as a
“brilliant” conversationalist.”
(You’ll learn more too.)
Get in “sync” give each direct report “One
Hour of Active Listening”
Recommendation #8
Quality Active Listening
1. Establish rapport.
2. Get to know them.
3. What do you want to be doing
1, 2, 3 years from now?
What can I do to help?
4. “If you were me, what 3 changes
would you make to improve
customer satisfaction, team morale &
peer retention?”
PAGE 6
Quality Active Listening
5. Give out a copy of
My “LIST” (to follow)
6. “What are your training/education
needs?”
7. “Anything else you want me to
know?”
P.S. Don’t forget to ask: “If you were
going to leave… What would be
your #1 peeve?”
“The #1 reason people leave jobs
is because they don’t feel
appreciated.” – Gallup Poll, 2005
Get a “L.I.S.T.” from
every direct report.
L List of an
I Individual’s
S Special
T Things
PAGE 8
My L.I.S.T. Tool -
PAGE 9
“Walk the talk” when it comes to
Patient Satisfaction Survey Literacy?
Recommendation #9
Here’s a Pop-quiz for your peers…
1. Everyone please stand
2. Sit down if you can’t answer
YES to any of these 5
questions…
Pop Quiz:
Here’s a Pop-quiz for your peers… Pop Quiz Warm up:
A. How many of you
ever had a birthday?
Pop Quiz
B. How many of you
have pets?
Pop Quiz
Here’s a Pop-quiz for your peers… Now Here Are Your 5 Questions:
Informal Frontline Survey Understanding Validation Survey
1. Do you know your
latest Patient
Satisfaction scores?
What are they?
Pop Quiz
2. Do you know how
the scores have
changed since the
previous report?
How?
Pop Quiz
Informal Frontline Survey Understanding Validation Survey
3. What are the top 2
things your Patients
say that you do
best?
Pop Quiz
Informal Frontline Survey Understanding Validation Survey
4. What are your top 2
Patients dis-satisfiers?
Pop Quiz
Informal Frontline Survey Understanding Validation Survey
5. Which dis-satisfier
are all your people
working to eliminate?
Pop Quiz
Informal Frontline Survey Understanding Validation Survey
“Your people can’t care about what they don’t know about.”
Brian Lee, CSP
What’s the Point?
“The speed of the Leader
is the speed of the team.”
– Arabic Saying
Inside of A Dog
“My goal in life is to be as good of a person
as my dog already thinks I am.” – Author Unknown
Bailey’s 5th Birthday
Implement a pet-visitation/therapy program
Recommendation #10
Thanks to Darla Van Essen - “The Stink Bug Project”
What is the Stink Bug
Project?
Supports families who have a child
diagnosed with a life-threatening
illness. We provide well-trained, loving
companion dogs from the Prison-
Trained K-9 Program at Colorado
Correctional Industries.
Jon & Jett Making the Rounds
Education &
Engagement
PAGE 7
KEEP
“When your people are learning
they’re not leaving.”
– Brian Lee, CSP
PAGE 7
“Give me a lever long enough…
and single handed, I can move
the world.”
– Archimedes
Lever = Education
What was Domino’s Pizza Famous for?
“You’ll never solve your
patient/family satisfaction
problems until your
frontline is educated
& owns them.”
– Brian Lee CSP
90
Where are your people learning Service Communication Skills?
Question-
Question-
Where are your people learning
HCAHPS Competencies & Skills?
“I get my HCAHPS scores & I have no idea how to fix them”
– Hospital Manager,
Utah
The HCAHPS Wack-a-Mole Factor
Utilize our HCAHPS HOPE™ Plan
Hardwiring
Outstanding
Patient
Experience
The HCAHPS
Performance
Improvement
Series 1. Communication with Doctors
2. Communication with Nurses
3. Responsiveness of Hospital Staff
4. Pain Management
5. Communication about Medicines
6. Cleanliness and Quietness
7. Discharge Information
8. Overall Rating
9. Recommendation to others
Shameless Self Promotion!
HCAHPS Domain Specific Factors
1. Specific Best Practices Required
2. Tools, Equipment, & Resources Required
3. Staff: Skills/Behaviours Requires
4. Staff (Scripting) “Key Words at Key Times”
5. Collaboration: Required from other
Leaders/Departments
“During this hospital
stay, how often was the
area around your room quiet at night?”
Domain Administrative Owners: CEO, CNO,
COO, Chief Plant Engineer, Environmental
Services, Nurse Leaders & Supervisors, & CNAs
and everyone else.
HCAHPS Domain:
A Quiet at Night Checklist:
Here’s the reality:
The only reference a patient has for
“Quiet at Night” is the
solitude of how quiet it is at home
Quiet at Night:
Staff need to Define ‘quiet’
in the hospital setting.
Help patients relate to ‘quiet’ in terms of
rest and well-being,
not in terms of extraneous noise levels.
& Educate patients that many of the sounds
are due to the efficient delivery of care.
Quiet at Night:
The key is to manage patient expectations
about “quiet” by asking them
to ‘judge’ the sounds
that disturb them as ‘sounds of care’
instead of “It’s too noisy!”
Traditional “Hush” Campaign
or Yakker Tracker
The Magic of Frontline
Engagement, Ownership
& Accountability Engage
“For culture change to work
just fine, it must be led from the
top, and the frontline.”
– Brian Lee, CSP
What would it mean to you…
if your staff ‘owned’ and felt
accountable for your patient
experience/ HCAHPS scores?
… and experienced
an Explosion of
personal and
professional
growth!
“The only thing worse than training your employees and losing them, is not training them and keeping them.”
- Zig Ziglar
The Culture Change “Tipping Point” Formula
The Goal =
20% influence 80%
5% Leadership
+ Front Line 5% x 3 years =
20%
Recruit and engage the “Best of your Best” frontline stars
Recommendation #12
Empowered Frontline Leaders Can be Called…
“Service Champions”
“Value Added Service Providers”
“Ambassadors”
“Service Advocates”
“P.A.L.’s”
“Service Excellence Advisors” (SEAs)
SEA Selection Criteria
1. Frontline/Non-Management
2. Terrific Attitude
3. Demonstrate Commitment to
Patient Satisfaction
Appointed for a one-year term
Girard Medical Center SEAs
SEAs are recruited at a ratio of 1 for 10-20 staff & volunteers
The Service Excellence Advisor Creed
Peer Influence... the ultimate
“power-tool” in culture change.
“We must become the change we
want to see in the world.”
– Gandhi
Buddy Discussion…
What Service Skills do you
want Everyone to have?
Medicine of Compassion
Train the SEAs to teach an annual 3 hour HACHPS based Patient Experience Workshop to everyone…
Recommendation #13
SEA Teaching Teams of 4 Peers
SIH System Soul Sisters
SEAs participate in a
2-day Train-the-Trainer Course
+ First Half Day
3-hour Service
Excellence
Workshop
Remaining Day
& a Half Day
Train the
Trainer
The Service Engagement Advisor Train-the-Trainer Course Graduation Celebration
“Why would you reinvent the
wheel,
when you can steal it
from someone! – Jack Welch Author
Find & utilize experienced and talented Consultants:
Recommendation #14
Insanity
Doing the same
thing over and
over again, yet
expecting
different
results!
The Service Excellence Initiative™ Roadmap
“Git-R-Done!”
– Larry the Cable Guy
Schedule monthly department “DO IT” Meetings
Recommendation #15
DO IT
Daily
Ongoing
Improvement
Tactics
…that engage everyone
to eliminate priority dissatisfiers.
Listening Posts-
Patient Surveys
Discharge Calls
Letters
Leader Rounding
Hourly Rounding
Family Comments
DO IT Meeting AGENDA,
Schedule a weekly 15 minute team Service Huddle
Recommendation #16
Service Huddle AGENDA
- Share Good News/Feedback - Identify Concerns/Complaints - Refresh Service Behavior - Have some fun!
1. Annual - 2 Day train the trainer
course
2. Annual - 3 hour Service Skills
Workshop
3. Monthly - 1 hour DO IT Meeting
4. Weekly - 15 min. Service Huddle
4 Ongoing Components to Frontline Engagement:
See your front line education
process as both your;
Service Excellence process
& your Retention and
Engagement system
“You Just Can’t Do It Your Way” – Brian Lee, CSP
You cannot force someone to care.
You cannot drive lasting change by
telling people what to do.
Or by issuing a memo and expect
people to conform or change by decree.
You cannot order someone to go the extra
mile because they will not go that extra mile
unless they really want to.
You cannot cause people to alter their
attitude or behavior or beliefs just because
you are their boss and you issue their
paycheck.
You Just Can’t Do It Your Way (continued)
While vision and accountability must
begin at the top, change will only really
take place when there is buy-in and
ownership and commitment and passion
from those people who must deliver on
your promises.
You Just Can’t Do It Your Way (continued)
For culture change to work just fine,
it must be led from the top and the frontline.
You Just Can’t Do It Your Way (continued)
Recognition/Feedback
PAGE 8
“What gets recognized and
rewarded gets repeated.”
– Michael LeBoeuf
Introducing Post It Therapy…
Service Provider’s
Thank You Card
Recommendation #17
1. Where should you use it?
2. What would be the value of
sending it to the staff
member’s home?
3. What comments should you
write?
4. What would you like the
card (& envelope) to look like
and say?
5. Deadline for production?
:
PAGE 9
KEEP
PAGE 9
Creating “Sticky” Relationships
Do not underestimate
the significant role
personal friendships
play in employee
loyalty.
“Loyalty at work hasn’t
come to an end…
It’s been replaced with
loyalty to one’s friends.”
– Brian Lee, CSP
“I like everything about working
here, except the company!”
– Manager in Focus Group
Fun/Friendly
“The team that plays together
stays together.”
– Brian Lee, CSP
Schedule creative quarterly
appropriate social opportunities
to break down barriers and let
people have fun!
Recommendation #18
Engagement = Hokey Pokey!
PAGE 10
Two Critical Questions
1. Is the need for World Class
Patient Satisfaction ever
going to go away?
2. Is the need to get and keep
engaged patient driven staff
ever going to go away?
“If you have a problem,
make it a procedure,
and it won’t be a problem
anymore.”
– Wayne Cotton
The Checklist
By Dr. Atul Gawande
Airline Six Sigma Safety “1,000,001”
Transform
The Culture of Engagement Model will enable you to…
Empower
Engage Total
Management
Engagement
&
Accountability
Continually
Improving the
Patient
Experience
Enthusiastic,
Empowered
Frontline
Leadership
DO IT
Implementation
Train & Engage Staff Annually
Systematically
Train & Engage New Hires
Systematically
Reduce Staff Turnover
& Increase Morale
Systematically
Improve Patient and
Family Satisfaction
Systematically
Create a Culture of Continuous
Quality Improvement
Systematically
Increase Census
Systematically
Create a Powerful Community
Based Brand of Excellence
Systematically
Improve the Bottom Line
“No Margin,
No Mission”
- Catholic Nun Saying
Systematically
PAGE 11
Today’s Mission
Implement Strategies to Create a
World-Class
Patient Experience
My DO IT! Plan
Daily
Ongoing
Improvement
Tactics
PAGE 11
Who will do What by
When & How
The Accountability First Step…
A quick social experiment...
“TRY”
to stand up
So who’s it up to
To Make a
Difference?
Recommendation…
If you’re going to Act,
Act With
Urgency!
Reflect & Record….
The BEST Idea
you’ve heard that
you intend to use
now!
“Feedback is the breakfast of champions” – Ken Blanchard
PAGE 13
A Brian’s e-books “Keep Your Nurses for Life”
“Satisfaction Guaranteed”
B PowerPoint of this Seminar (Digital)
C May be interested in a Coaching Call
D Sample Service Recovery Policy
E Enter my hospitals Name for a Complimentary
2 Day HCAHPS Bootcamp
Implementation Tools #5
Thank You
Liz Urban
and the 2013 SHCA
Conference Committee
Lamplighter Club
A Special Thanks to you for your:
Participation
Leadership
Above all your
commitment to
Changing Lives
Life is a GARDEN
Plant
Good
Seeds!
You MAKE the Difference…
with an
engaging
attitude!
Please Turn in Your Evaluation Form
PAGE 13
Have a
safe
journey
home.
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