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Lessons on the Importance of Healthcare Employee Engagement


This blog post concludes our 3-part series focused on employee engagement in healthcare, a vital component of every complete workforce development initiative. Here we are excerpting an article by Bo Hansen, Employee Engagement Consultant, in the current issue of Healthcare Workforce Advisor, HealthStream's quarterly magazine designed to bring you thought leadership and best practices for developing the healthcare workforce. Subscribe to HW Advisor.

Bo Hansen, Consultant, HealthStreamAfter graduating from nursing school, I began working in the emergency room of a busy 300-bed hospital. What I didn’t realize when I accepted the job was not only would I get to practice what I loved, but I would be observing some important lessons in leadership that I would remember throughout my career. My manager in the ER practiced nearly all the traits that
fill leadership books today. She was an effective leader and communicator, and her boss, the chief nursing officer (CNO), practiced similar traits. The CNO also was a regular sight around the hospital; she attended our weekly department meetings at least once a month to communicate plans for the hospital, bring us news, and ask how we were doing and what we needed.

Leadership Should Embody the Organization’s Mission

This was a faith-based hospital in Southeast Ontario, where nuns were actively involved in the mission of the hospital and in administrative decisions. For example, Sister Helen was a strong presence in the ER and our constant reminder of the mission of the hospital and the standards of behavior expected of everyone toward anyone who entered the hospital doors; that included patients, employees, physicians, visitors, and guests. The petite nun in her white habit was a fixture in the waiting room, rounding on patients and families and reassuring and comforting anxious family members.

Great Leadership Improves Staff Retention

HealthStream Employee Engagement Consulting and TrainingStaff turnover in our department was low, and we had a list of RNs waiting for the next job opening; other hospitals in the area had a list of positions waiting to be filled. We were invested in our hospital, took pride in being part of it, and we had no intentions of leaving an organization that valued our opinions. Decisions that affected staff and patients were made as a team. As an example, a physician donated a sum of money to our department to use any way we wanted. After every employee in the ER had weighed in with ideas and a vote was taken, it was decided to install a sound system in the waiting room. When the volume in patient visits to the ER steadily increased it was staff that came together to produce a staffing plan and a change in processes that would meet the demands. We were valued personally and professionally. The values and beliefs modeled by my manager, the CNO, and senior leaders set the tone for everyone else. I didn’t share the same faith as the founders of the hospital, but I shared their values. Nearly four decades later I think about how fortunate I was to land that job and to be exposed to the benefits of great leadership so early in my career. I experienced job and organizational engagement even before the terms were coined.

It’s Important to Assess Employee Engagement

As a Talent Management Consultant, I meet with hospital leaders all over the country to discuss their employees’ survey results and to discuss best practice ideas for sustaining and improving staff engagement. In a recent meeting with a successful ER manager, I asked to what practices she would attribute the high scores in her department. Without hesitation she began outlining what she called fundamental practices, such as:

  • Collaborating with staff about any decision made around equipment, processes, or policies. According to her, they are the ones that have to do the work, and they should make the decisions.
  • One-on-one meetings with staff to discuss their performance, their value, learning opportunities, and their professional opportunities.
  • Self-scheduling. Staff schedules should meet historical demands and incorporate personal preferences, when possible.
  • Continuing education. Continuing education for credits and certifications is a priority.

It was interesting to observe in her both an attitude of confidence and at the same time an unassuming, almost humble manner. She has been the manager of her department for 12 years, and employee engagement has been high every year during that time. The department also has the lowest turnover rate in the hospital, below 5%. 

Where to Start Improving Employee Engagement

In a separate meeting with the director of a medical/ surgical unit, the majority of employees ranged from being mostly dissatisfied to barely satisfied in every category of the same survey. When I presented the data and asked the manager what she thought might be solutions, her attitude was one of feeling powerless and defeated. She revealed a series of conflicts among staff in the unit and how dissatisfied the employees were with the hospital’s efforts to keep staff and to hire the right people. According to the survey data, the biggest concern to the staff was the manager’s inability to communicate and share important information. They wanted her to set expectations, to recognize staff for jobs well done, and were dissatisfied with her unwillingness to act when employees were not meeting standards of behavior. This is a tough report card for any manager to receive but a wake-up call to act on the data.

Organizational culture is influenced significantly by the attitude of senior management, their selection and training of middle managers, and their tolerance of low performers. In this example, not only is staff in the med/surg department disengaged, but the manager is disengaged. Comments and data revealed hostility among staff members with a manager who does not have the skills to solve conflict. Senior leaders should consider if this manager would be a better fit in another area of the hospital or if she simply has not been given the tools and the training she needs to lead this department. The reality is that healthcare managers need training and expertise in management and human resources to successfully manage, motivate, and inspire people. The cost of neglecting this type of training is higher than making it available to all managers with disengaged staff who do not share the values of the organization.

What are the Benefits of a Highly Engaged Workforce?

In summary, an organization with a highly engaged workforce will often experience the following associated benefits:

  • Low staff turnover rates that can range between 8% to 12%.
    Being considered the employer of choice in the community.
  • Staff who are willing to recommend the organization as the best place to work in the community.
  • High patient-experience scores (HCAHPS). Staff has to be emotionally engaged in their jobs to provide excellent patient care.
  • Exceptional quality and patient safety scores. A staff that is engaged and trusting of the organization and its values is more likely to report adverse or near-adverse events.
  • The reputation and financial consequences of the above.

Most importantly, you have to measure employee engagement to know how you are doing and to identify specific areas where you need to focus your improvement efforts. Everyone has the opportunity to make it better, and there are many tools at your disposal to apply to your
challenges. In the end, if employee engagement is one of the ways we can affect patient and business outcomes, how can we afford not to work on it?   

Reserve your copy of the HealthStream Employee Engagement National Benchmark Report releasing
this fall. 



Hiring the Right People in Healthcare


This blog post continues a 3-part series focused on employee engagement in healthcare, a vital component of every complete workforce development initiative. Here we are excerpting an article in the current issue of PX Alert, HealthStream's quarterly magazine devoted to the wide range of challenges, situations, and issues that have an impact on the patient experience. Subscribe to PX Alert.

Turnover and retention are a growing problem for healthcare talent management solutions from HealthStreamorganizations across the continuum of care. Increased volume demands on our healthcare system mean that organizations cannot afford to waste time hiring the wrong people. Two of our partners, Assess Systems and NurseCompetency, help care organizations improve their hiring processes and identify and assess better potential candidates. The excerpted Q&As below explain how human resources professionals can make better hiring choices using tools from two of our partners.

Hiring Healthcare Workers Who Are a Better Fit: A Q&A with Olivia Salas, Director, Talent Solutions, Assess Systems

Can you tell us about your company and its expertise with healthcare talent management practices?
Assess Systems ( provides talent selection and people development solutions to organizations worldwide. For more than 25 years, it has assessed millions of people in a broad spectrum of industries and positions spanning 42 countries and supporting 16 languages. Assess Systems partnered with HealthStream to help customers make better hiring, placement, and promotion decisions by using behavior-based, non-clinical assessments designed for the healthcare industry: Select for Healthcare™ and Assess for Healthcare™. With HealthStream, we have an important, unifying purpose—to help our customers improve healthcare.

What are some of the big challenges you help care organizations address?
Assess Systems is changing the patient experience through improved hiring. We help organizations reduce unwanted turnover and hire those with the best fit, driving productivity, improving hiring efficiencies, and standardizing and enhancing the decision-making process. We also improve interviews by providing dynamic interview guides with behaviorally-based interview questions and candidate-specific probes based on the assessment results. Assessment reports also provide development suggestions to support the new hire’s on-boarding and development.

Focusing on a candidate’s innate personality characteristics and natural abilities, the assessment platform can save hospitals time and money by providing a tool that evaluates the candidate’s natural fit with the competencies most important for job success and provide additional insight into the factors that may help or hinder the display of desired competencies and behaviors.

Our product allows organizations to hire patient contact employees who have a service orientation toward patients, remain composed under pressure, are energetic and productive, and who adapt to change and work cooperatively with other staff members. It will also help identify those applicants with low integrity and who are poorly suited for caregiver positions.

Can you share any specific stories about customer achievements using your solution?
A leading healthcare organization/university requested assistance to create a customized pre-employment assessment to help identify top candidates for their high volume, patient-facing Clinic Assistant role. A criterion-based, predictive validation was conducted to identify the traits which distinguished top performers.


Results from the study showed the assessment clearly predicted which employees were the most successful on the job:

  • 95% of those who were rated as star employees were recommended by the assessment.
  • Those who struggled in the role were three times more likely to be categorized as an “Avoid” on the assessment than those who were top performers.
  • Prior to the custom assessment with the tenure measure, the client reported that 13.9% of Clinic Assistants turned within the first 90 days. In a follow up analysis after the implementation of the custom assessment with Tenure Index, turnover for the role within the first 90 days was reduced to 7.5%. This equated to a 46% improvement in retention of hires.

Use NurseCompetency to Identify Candidates with the Right Clinical Skills: A Q&A with Elease Caracci, EVP, NurseCompetency

Can you tell us about your company and its expertise with healthcare talent management practices?
NurseCompetency ( is on a mission to create a safer healthcare environment for patients and healthcare workers through the use of current, clinically relevant education, assessments, and technology.  The core values that guide everything that we do include:

    • Patient Safety: by providing valid and reliable assessments, we help to ensure that healthcare workers are knowledgeable about providing safe patient care, which often results in increased HCAHPS scores and lower re-admission rates.
    • Healthcare Worker Safety: by providing education and assessments, we give healthcare workers the knowledge they need to remain safe from the hazards that exist in the workplace, which can have the added benefit of risk reduction and lower incidence of Worker's Compensation claims.
    • Professional Development: by providing meaningful feedback to healthcare workers, we help them to identify and remediate knowledge deficits which allow for on-going professional growth and safer patient care.

What are some of the big challenges you help care organizations address?
As a market leader in healthcare competency testing and technology, we are distinguished by our commitment to healthcare workplace safety and optimal patient outcomes.  All of our materials are compliant with industry and government standards (OSHA/HIPAA/TJC) and help our customers ensure that in turn, they are always operating in compliance with these same standards—resulting in a safer environment for both patients and the healthcare workers who serve them.

In addition, as many healthcare organizations struggle to find and retain qualified clinical staff, we provide an EEOC compliant way to be more effective in hiring practices and staff retention. Effective pre-hire testing can allow organizations to identify clinicians who are qualified, and then provide a means for the on-going evaluation and professional growth of those employees, once hired.  All of these factors can help to increase employee engagement, productivity, and reduce the rate of turnover. 

Can you share any specific stories about customer achievements using your solution?
We’ll let one of our customers speak on behalf of our solutions: Kellie Hodge RN, BSN, Director of Nursing at Omega Hospital, has said that,

“The clinical exams from NurseCompetency play a key role in our talent management program—as they are used to measure and ensure that our clinical personnel are knowledgeable and competent to perform the tasks associated with their respective positions.  The high level of authority among the subject matter experts consulted and the rigor in exam development both contribute to make NurseCompetency’s clinical exams among the best available anywhere for assessing competencies.”

Read the full article here.  

Reserve your copy of the HealthStream Employee Engagement National Benchmark Report releasing
this fall. 


Winning Over Resistant Employees to Patient Experience Improvement


This blog post continues our series of patient experience Best Practices from BLG, a HealthStream Company. Every week we will share information from BLG that demonstrates their expansive understanding of the challenges faced by healthcare organizations and the solutions BLG has identified for improving the patient experience and patient and business outcomes.

describe the imageNot everyone in your organization may feel comfortable with Words that Work. In our experience, we’ve encountered opposition from a few individuals who feel we’re forcing them to say things they feel are either unnatural or untrue. Here are a few tactics that help:

  • Reinforce the advantages of Words that Work at every opportunity
  • Reward employees who use Words that Work
  • Develop games and exercises that help employees become more comfortable with Words that Work

You will discover, as we have, that over time those who are the least comfortable with Words that Work become its strongest proponents. Once they realize the power and effectiveness of using key words and phrases, they embrace it and use it with great success.

How Important can Words that Work Be When It Becomes Part of Your Culture?

Here’s an example: 

An RN from another state had heard about Baptist Health Care through her previous employer. The hospital had benchmarked Baptist Health Care and attended a BLG conference. When she moved here, the RN applied to work at Baptist based on what she had heard. She also applied to work at the other hospitals in town. But she chose to work at Baptist because of her first impression on the campus. When she arrived and was obviously lost, a security officer approached her and said, “You look lost, can I take you somewhere?” It was at that point that she realized that all the things we say that we do at Baptist really happen.

Using Words that Work is effective if you really put the effort into it. Just as with all of the BLG Best Practices, we’ve learned success comes when you make it part of your culture. It’s up to you to make a commitment to use Words that Work – and all the other Best Practices – throughout your organization. 

A Recipe for Successful Engagement

Make sure leaders are trained and accountable. Inspire them to be dedicated. Make your overall strategy and intention known to them. Support them. Nurture their growth. And recognize merit not just in their successes but for the actual use of the Words that Work you have established. 

Why? You’ll be rewarded with higher patient satisfaction scores and synergy in your work environment. Finally, you’ll have discovered a path to follow that will help you achieve even greater success in the future, and keep the patient at the center of everything you do. 

Learn more about Words That Work and RELATE.

About BLG, a HealthStream Company 

BLG provides Patient-Centered Excellence Consulting, where the patient is at the center of
everything we do. Our tools, tactics, and best practices are evidence-based and outcomes driven.  We provide custom, individualized coaching that produces measurable, sustainable increases in patient satisfaction, employee engagement, quality outcomes, and profitability.

Learn more about BLG products and services.


Employee Engagement in Healthcare: An Insider's Look


This blog post begins a 3-part series focused on employee engagement in healthcare, a vital component of every complete workforce development initiative. Here we are excerpting an article in the current issue of PX Advisor, HealthStream's quarterly magazine devoted to the wide range of challenges, situations, and issues that have an impact on the patient experience. Subscribe to PX Advisor.

In this Q&A with Al Stubblefield, founder of Baptist Leadership Group (now BLG, a HealthStream Company) and president emeritus of Baptist Health Care in Pensacola, Florida, he stresses that maintaining a strong focus on employee engagement is the key to improving everything from patient experience scores and employee satisfaction to care quality and bottom line dollars. Here are two of his questions focused on employee engagement in healthcare.

Improve Healthcare Employee Engagement with HealthStreamQ: What specific steps can hospitals take to create a culture that boosts employee satisfaction and retention while meeting the new demands of healthcare?

Stubblefield: It may sound strange, but putting patients first actually affects how happy your employees are, not the other way around. Historically the healthcare industry and most of its processes were based around the comfort of the workforce instead of the patients. But when we do a top-to-bottom reorientation and ask people to understand that we are here to serve the patient first, most people get on board quickly. Initially at Baptist, we said, “If you are going to be a part of this organization, you are going to buy into these processes,” and we were tough about it. We fired some management and employees. Interestingly, our employee morale went through the roof.

Most people go into healthcare because they want to take care of others. It lights their fire then they see that their organization has the same desire. The morale is palpable, and the payback is calculable. At Baptist, our story is we were in the worst location of three hospitals in what should have been a two hospital market. Our competitors were part of two of the largest healthcare systems in the country. Over a 10-year period, they outspent us by pouring hundreds of millions of dollars into their facilities. Still, we gained in market share during that time, and I am convinced it is because we created a culture that engaged our workforce and knocked the socks off of our patients with service.

Q: The healthcare workforce encounters situations few others share, including working with patients who are experiencing extreme vulnerability. How do you develop the softer traits in staff, such as sensitivity and empathy?

Stubblefield: At BLG we stress that you start before a person ever applies for a position at your hospital. This involves two key processes:

1. Perform a Cultural Assessment Prior to Applying. Before prospects even fill out an application, give them a standards of behaviors book. Ask them to read it and acknowledge that they would be excited to follow the book’s guidelines.

2. Involve Peers Early On. No emplyee gets hired until the peers who are going to work alongside that employee have had the chance to interview the person and provide feedback on whether or not he/she has the skillset, the mindset, and the heart set that the organization needs to continue to honor its patient-centric culture.

Ultimately, this process instills an incredible sense of pride and ownership in the current workforce that they are helping maintain the culture. It also creates a situation in which a new employee has a network of supporters who are invested in the new employee’s success. 

Reserve your copy of the HealthStream Employee Engagement National Benchmark Report releasing
this fall. 


Patient Experience Best Practices: Words That Work for Specific Situations


This blog post continues our series of patient experience Best Practices from BLG, a HealthStream Company. Every week we will share information from BLG that demonstrates their expansive understanding of the challenges faced by healthcare organizations and the solutions BLG has identified for improving the patient experience and patient and business outcomes.

Since there are numerous healthcare related circumstances where specific Words that Work are valuable, we’re including several for your reference. You may decide to use them as they are or adapt them to your specific needs.

Words That Work For Service RecoveryImprove the Patient Experience with Words That Work.

When patients or other customers have had an unpleasant experience, Words that Work can change their attitude. 

Open your apology with:

  • “That is not the way we like for things to be here at          .”

Examples of ways to close your statement: 

  • “Here is my card. Please call me directly if you need anything at all.”
  • “I am so sorry you found your relative like this. We try to keep a close eye on our patients. Let’s talk about ways we can prevent this from occurring again.” 
  • “I am sorry for your experience. Rudeness is not acceptable from anyone. I will take care of this personally.” 
  • “We clearly did not meet your expectations. What food item would you like?” (Go get it.) “In the future if you are served something that you don’t like, please call this number  (direct line to kitchen) and request a substitution.” 

Phlebotomy Words that Work

Here's a detailed plan for interacting with a patient during a phlebotomy visit:

  1. Always knock before going into the room and enter with a smile on your face.
  2. Greet your patient by name. 
  3. Clearly state your name, the department (laboratory) and why you are there. 
  4. Don’t forget to check the armband, and follow all safety guidelines. 
  5. Explain step-by-step the procedure you’re doing and inform the patient that the stick may be painful.
  6. While drawing the patient’s blood or immediately after drawing the blood, the phlebotomist should ask questions about the service that the person has been experiencing.
  7. Give the patient the option of having his or her light left on or off. Return the tray table to within the patient’s reach. Place bed rails back in place.
  8. Thank the patient.  

Here’s an example of the greeting:

  • “Hello, Ms. Smith. I’m Joe Smith from the laboratory. Your doctor has ordered some blood tests, so I am here to draw your blood.”

…and the step-by-step procedure…

  • “Ms. Smith, I need to turn on your light, is that alright with you?” “I am going to place a tourniquet around your arm. If the tourniquet is too tight or painful, please let me know.”
  • “I am cleaning off your arm. Now I am going to draw your blood and you may feel a sharp stick.” (You may use big stick, a quick stick, whatever you are comfortable with as long as you emphasize that they may experience some pain.)
  • “I’m finished getting all the blood that is required for the blood test and I am now withdrawing the needle and placing a piece of gauze over the site. Will you please assist me by holding pressure on the site?” If the patient is unable to hold pressure on the site, you must apply the pressure. 
  • “I am going to place a bandage on the site. Are you allergic to any tape? You may take the tape off in five minutes.” 

…and the closing questions…

  • “Are you happy with the meals that you are being served?” “Is the cleanliness of the room up to your satisfaction?” “Are the television, remote, and bed functioning properly?”
  • “I have plenty of time to help you with anything that you need to make your time in the hospital as comfortable as possible. So is there anything else I can do for you?” 
  • If the patient answers any of the closing questions negatively, the phlebotomist should contact the appropriate person/department/ area and report the problem immediately.

Outpatient Surgery Words that Work 

Following discharge, patients are contacted at their homes by a member of the patient care staff. Using post-operative call sheets with information taken on the day of surgery, the staff is able to personalize post-operative calls.

Some of the questions asked during the phone conversation are:

  • “Did our nurses seem concerned for your comfort throughout your visit with us?”
  • “Do you feel that you had enough time to recover before being sent home?”
  • “What is your current pain level (on a scale of one to 10)?”
  • “Did you have any trouble understanding the discharge instructions for home care?”
  • “Did you experience any fever, nausea, or vomiting after discharge?”
  • “Did you have any redness or soreness at your IV site?”
  • “Is there anything we could have done better or differently?”
  • “Do you have any other concerns or problems that we need to address?”

Learn more about Words That Work and RELATE.

About BLG, a HealthStream Company 

BLG provides Patient-Centered Excellence Consulting, where the patient is at the center of
everything we do. Our tools, tactics, and best practices are evidence-based and outcomes driven.  We provide custom, individualized coaching that produces measurable, sustainable increases in patient satisfaction, employee engagement, quality outcomes, and profitability.

Learn more about BLG products and services.


Bridging the Continuum of Care Using Post-Discharge Calls: White Paper


Supporting and partnering with patients across the continuum of care is an essential element of patient-centered excellence and delivering quality outcomes for our patients. Now more than ever before, this partnership matters, as much for the care experience as for driving financial performance for our organizations. A critical component and best practice in the caregiver-patient partnership is how we manage the transition from hospital to home. We have all heard the adage—discharge planning begins at admission. Clearly, much emphasis and work has been placed on making sure we meet the clinical demands for each patient while also anticipating discharge planning requirements.

HealthStream Bridging the Continuum of Care White PaperDespite these efforts, many patients experience a disconcerting array of discharge reactions, including anxiety, uncertainty about their readiness to care for themselves, and confusion about medications following hospitalization, to name just a few. These factors, plus many others, can contribute to avoidable re-admissions and missed opportunities to give our patients proper clinical intervention when post-discharge problems arise.

Recognizing Our Glaring Gaps in Patient Care

The Discharge Instructions Dimension is the highest scoring dimension on the Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) Survey. According to Hospital Compare, 84 percent of the time patients report “Yes,” that they were given information about what to do during their recovery at home. So, from strictly a survey standpoint, it appears we have the discharge process mostly under control. Yet we know that patients actually do not receive discharge instructions 100% of the time! This contradiction becomes a very real quality and cost concern based on estimates that Medicare is spending an approximately $17 billion dollars on unplanned hospitalizations.

Given healthcare reform agendas, addressing unplanned and inappropriate hospitalizations is (for lack of a better term) “low hanging fruit.” Since October 1, 2012, all hospitals whose Medicare patients are discharged and subsequently readmitted within 30 days with Acute Myocardial Infarction (AMI), Heart Failure, and Pneumonia potentially are subject to reduced payments.

Based on these glaring gaps, we need to hold up the mirror and recognize that discharge planning is a hospital-centered, one directional process—from us as caregivers to the patient/family. We have to ask ourselves “Were patients given written discharge instructions? Did they get the opportunity to ask questions?” Yet, it is not until the patient gets home that we providers have the opportunity to complete the discharge as a patient-centered process. Once the patient gets home he/she begins to execute a “self-care” plan and run into real-life questions that a discharge checklist may or not address. Even when we perform discharge phone calls, many times the questions being asked by patients during the calls are very different from the issues addressed during the official hospital discharge process. Even more startling is that patients are not able to actively perform the self-care tasks described and assigned to them during discharge process.

This white paper includes: 

  • Closing the gap to ensure patient-centered excellence upon returning home
  • Ensure patient-centered communication
  • Adopt post-discharge phone calls
  • Creating more positive patient outcomes 

Complete the form below to download the white paper.

Online Learning Works for Staff in Senior Living and Other Areas


By Stella Hatcliffe, RN, MSc, CPHQ – Director of Professional Education, Mather LifeWays Institute on Aging

Stella Hatcliffe, Mather Lifeways Institute on AgingAs a nurse educator for many years I truly enjoy in-person presenting. Initially, as online learning evolved I was rather skeptical about embracing this new style of learning. I was concerned that participants would have less interaction with me and that this would reduce opportunities for integrative learning and sharing of stories. I also wondered if participants in online programs would find it challenging to put aside any distractions such as text messaging and talking with others whilst on mute on their computer. I wondered how, as an online presenter, I would be able to assess participants’ engagement with the presentation if I could not observe their facial expressions and use my emotional intelligence in delivering meaningful education. 

A Personal Test for Online Learning

However, two years ago I decided to test online learning personally. I participated in an online nurse certification course. This experience completely changed my perspective. This online course was very convenient as it enabled me to balance my family needs, career responsibilities, and other commitments. If I had completed this certification at a university, the distance and time to travel would have made this opportunity very challenging. Another benefit of online learning for me was the asynchronous environment. In an asynchronous learning environment I could participate according to my schedule instead of being limited to structured participation at the designated location.

HealthStream Online Learning for Post Acute OrganizationsNetworking and Interaction and Recruitment Success

Another positive experience was that the online course provided me with networking and interaction opportunities with nurses in other senior living communities. So while it was the case that face-to-face interaction was limited, I actually connected with a fellow participant who was relocating to Chicago. I linked her with my Human Resource manager, and she applied and was offered a position in my community. During the online program I also gained many helpful insights from the practical experience and knowledge shared by fellow participants in other locations and this helped guide my insights into senior living challenges and education priorities. For example, this environment is similar to what is available in HealthStream’s online community, the password-accessible networking site where HealthStream customer admins share their challenges, successes, and network with one another.

Learn more about HealthStream's workforce development solutions for post-acute care staff.

Potential for Greater Engagement with Online Learning

Having gained a positive experience as an online learner I also decided to embrace presenting online webinar educational programs. I discovered that as an online program presenter I could gain participants engagement and insights through poll questions and posting of participant’s thoughts and feedback. With online learning there is no back row. It has been my experience that online participants have time to reflect on the discussion, and be actively engaged. It has also been my experience as an educator that some participants may have a fear of public speaking and tend to stay quiet in class, whereas I learned that online education can help build confidence in shyer individuals or help those for whom English is a second language compose their thoughts before speaking.

After my webinar presentation, participants receive an online evaluation assessment form which I can immediately review. It has been very uplifting to see that online participants have gained new insights and positively report their experience which continues to support my new perception that online learning can be an impactful and positive learning experience.

Employer Benefits 

There is also positive evidence of employer benefits of embracing online learning. Rosalind Sloan, M.Ed., BSN, RN-BC, program manager/nurse planner for The Center for Continuing Education and Professional Development at the American Nurses Association (ANA) states that “Employers who invest in the professional development of their nurses by offering the time, resources, and funds for CE courses often see increased job satisfaction among their staff and lower turnover rates”  In addition, research by the Research Institute of America, suggests that organizations that invest in online training and education can increase employee retention rates between 25-60%.  By giving employees control of their learning process, they are able to review the material until they have mastered it, increasing both confidence and engagement. In summary, active engagement in online learning completely changed my perspective on the
power and impact of online learning and I now am a true advocate for online learning both as participant and as a presenter. 

To register for an upcoming webinar on HealthStream’s CE Starter Kit:  Education
Delivery, Tracking, and Reporting Made Easy, click here. 

About the Author

Stella Hatcliffe is responsible for professional education programs, certification programs, and educational products that create ways for older adults to Age Well, as well as for development of curriculum to support stimulating learning environments. Stella Hatcliffe is an experienced health care leader with progressive clinical and administrative experience in improving healthcare operations, quality indicators and evidence-based person centered care to residents and their families. She has extensive experience in hospitals and elder care settings in the United States and England. She has served as chief nursing officer, vice president of patient care, and clinical nurse specialist in Geriatrics. Her areas of expertise include staff development, enhancing resident experience, falls and pressure ulcer prevention, reducing hospital readmissions, and palliative and hospice care. She also collaborates with Mather LifeWays Institute on Aging researchers to support creation and evaluation of new educational programs. She is master’s-prepared in research and evaluation of health care services, and a certified professional in health care quality and nurse leadership.

About Mather LifeWays Institute on Aging

To learn more about HealthStream’s Turnover Solution, which will help you make hiring decisions with confidence, click here.

Make Words that Work a Routine to Improve Patient Experience


This blog post continues our series of patient experience Best Practices from BLG, a HealthStream Company. Every week we will share information from BLG that demonstrates their expansive understanding of the challenges faced by healthcare organizations and the solutions BLG has identified for improving the patient experience and patient and business outcomes.

After you’ve evaluated your customers, know the messages you want to convey and have the Words that Work ready, how do you begin putting those into action?

We’ve discovered interesting ways to make Words that Work a part of our daily lives at BLG and among our clients. You may want to use the following as starting points for initiating Words
that Work in your organization. 

  • Make it part of your daily communication (at BLG we have a daily huddle and Words that Work is a topic that is frequently featured)
  • Roll out Words that Work in department staff communication meetings
  • Have contests with prizes for improved Words that Work
  • Develop a reward system for employees who use Words that Work

Finally, use your own organization’s culture to stimulate ways to bring Words that Work into your business practices.

Restructuring Communication with Words that Work

Here are some examples of how a few changes in wording can help you turn negatives into positives and change the very nature of communication. 

Words That Work ExamplesSamples of Successful Words That Work Phrases  and the Situations Where They Are Appropriate


“Are you comfortable filling out your registration form here?” If not, respond, “As soon as I am able, I’ll take you to a private area to discuss it.”

“All our employees, including our physicians, wear a badge at all times. Please feel free to ask a staff member where his/her badge is if it is not visible. Your safety is important to us.” 


 “We have free parking assistance. If you pull your car under the covered entrance, we’ll park your car for you.” 

“We will be asking you throughout your stay how we can do things better – and let me remind you that we do have free valet parking for your visitor’s convenience.” 

Addressing Inconvenience

When you sense someone is ill at ease:

“I realize that being away from home is inconvenient. Is there something I can do to help, such as making a call for you or getting you a phone book, paper and pen?” 

“This must be a very upsetting (frightening) experience for you. What can I do to make you more comfortable?” 

When a patient has not had a chance to take care of things at home: 

“I realize that coming here today was not something you expected to happen. Is there something we can do to help make things go more smoothly at home? Do you need a phone or pen and paper?” 

Care Communication

Whenever an employee is with a patient:

If possible, sit down when you speak to a patient. Be on that individual’s level – literally and figuratively. It makes for better listening. 

Whenever an employee closes a door or pulls a curtain around a bed or cubicle: 

“I am closing this door/pulling this curtain because I am concerned about your privacy.”

Before leaving a patient’s room:

“Is there anything else I can do for you? I have the time to help you.”

When a unit coordinator answers a call light:

“How can your nurse help you?”

When there is an emotional or spiritual need:

“Being in the hospital can be tough emotionally and spiritually. We have chaplains in the hospital around the clock to talk with you about these issues. Would you like me to contact a chaplain for you?”

When a patient says “I’m sorry to bother you:”

“Of course you’re not a bother …”

When a patient says, “Oh, just one more thing ...:”

Take your hand off the door, step toward the patient and listen attentively.

When taking a blood sample early in the morning:

“Your physician cares about you very much. He has asked that we get a blood sample very
early so the results can be posted on the chart by the time he makes rounds in the morning.” 


“Have we explained your home instructions in a manner that you understand?” 

When a patient questions what will happen after discharge:  

“Has your doctor given you instructions?” If not, respond, “Let me have your nurse drop by to see you.” Follow up on that promise.  


When an employee in any area sees a visitor: 

“Good morning/good afternoon. May I take you to where you are going?” 

When a visitor asks directions:  

“I am going that way. I will walk with you and show you where to go.”  

When a staff member addresses a visitor on the elevator:

“Are you visiting family/a friend today? We want to provide very good care. Can we do anything for you?” 

Meal Time

“How is the quality of your food? Are your hot foods hot, and your cold foods cold enough?” 

If food has been delayed: 

“I am so sorry that you haven’t received your meal. I will call Dietary and re-order it. If for some reason they can’t bring it up, I’ll go get it for you.” 

Nurse Leadership


“Good morning, I am (name here), the nurse leader on your unit. Our goal here at     is to provide you with excellent care every time. Tell me about your care thus far.” 


“I need your help. This is my phone number (she writes the number on the communication board). Please call me the moment you see or find something that we can do better.” 

When nurse managers check on a patient: 

“How many times have you had to use your call light in the last 24 hours?” 

Nurse – Treatment

The admitting nurse asks:  

“Do you have any special/personal needs that we need to provide for you while you’re here?”

When shifts change, the oncoming nurse writes his/her name on
the communication board and says:

“I am (name here). I will be your nurse until (time stated here). Please let me know the moment we can do something for you or do something better. My goal is to provide you
with excellent care every time.” 


Administering medicine: 

“Before I give you this medication, may I check your ID/allergy bracelet? Thank you.” 

When in patient’s room:

“I am washing my hands to keep you safe.”

Service Recovery

When a patient’s item is lost:

“I’m sorry you’ve lost your (name item). Let me help you find it.” If you can’t find it, follow your organization’s prescribed service recovery procedures. 

When a patient is dissatisfied:

“I’m sorry. Is there anything I can do to help?”


“I am sorry this happened. I can see why you would be upset. This is what I am going to do about it ... I will check back with you in a little while to ensure that everything has been resolved. Thank you for sharing your experience.” 

Telephone Conversations

When placing a caller on hold:  

“Good morning, radiology department, Mary Smith. Are you able to hold for a moment? I am helping another person.” 

Then, “Thanks so much for waiting. Now how may I help you?”

Or, if the conversation is prolonged, go back to the customer: 

“I’m sorry that you have to wait. Are you still able to hold or would you like me to call you back?”

Test/Treatment Communication

Explaining during tests and treatments: 

“I’m glad you asked that.” Respond with information. The more knowledgeable the patient is, the more likely he or she will cooperate. 

“I realize that waiting for results can make you anxious. So I want you to know how long it takes to process this test and when your physician can expect the results ...”

When you sense a need  to comfort a patient during a test or treatment:

“For your comfort, I am giving you this warm blanket.”

“For your comfort, would you like some ice chips, juice or soda? You will be more comfortable if you sip slowly.” 


To a family member:  

“We want to make (name patient) as comfortable as possible. Please let us know if you observe that he or she is not.” 

When visitors arrive to see patients: 

“Do you know where the rest rooms, cafeteria, gift shop and chapel are? Is the temperature alright?” 

When the noise level is high in and around a room:

“Our patients are resting so quiet is very important. Thank you.”

When a patient is angry about a long wait:  

“I’m sorry your wait is long. Is there anything I can do to make you more comfortable? I appreciate your bringing it to my attention.” 

“I’m so sorry you’re still waiting. Here’s what’s causing the delay ...

I want you to know that you’re likely to be waiting for at least (time estimate). I apologize for the inconvenience.”

Learn more about Words That Work and RELATE.

About BLG, a HealthStream Company 

BLG provides Patient-Centered Excellence Consulting, where the patient is at the center of
everything we do. Our tools, tactics, and best practices are evidence-based and outcomes driven.  We provide custom, individualized coaching that produces measurable, sustainable increases in patient satisfaction, employee engagement, quality outcomes, and profitability.

Learn more about BLG products and services.

9 Healthcare Training Best Practices for EMR Adoption


With increasing frequency and impact, healthcare organizations are implementing EMR systems, such as Epic, to improve patient care and outcomes, drive standardization and reduce variability in clinical practice, accelerate adoption of evidence-based practices, optimize Meaningful Use Incentives, and reduce costs. For greatest success with these initiatives, many organizations are concluding that a successful organizational transformation requires
comprehensive adoption and a synchronized training plan—including training for awareness, super users, end users, and new hires—to ensure: 

  • HealthStream Training for EMR ImplementationOn-time implementation schedule
  • Awareness, momentum, and buy-in
  • Successful adoption
  • Competency and confidence
  • Timely, reliable, and meaningful analytics

Understand Your Epic/EMR Training Needs 

An Epic Enterprise initiative represents an enormous investment of time and resources to ultimately enable an organization to better serve patients. Every Epic Enterprise project requires a “workforce transformation” program that consists of communications, training, and formal adoption efforts. This solution must include:

  • A comprehensive adoption and training plan to ensure that the Epic Enterprise project will improve patient care, reduce costs, accelerate adoption of evidence based practice and consistent clinical guidelines, and ensure effective coordination of care across multiple care providers
  • A program that will allow the organization to hold to its Epic Enterprise timelines
  • A training strategy that provides early training to build awareness and momentum and proceeds with rollout training in lockstep with application rollout
  • A blended training program that relies on classroom instruction, coaching, mentoring, online courses, simulations, videos, community functionality, and a train-the-trainer methodology
  • Training strategy aligned with change management plans: plans to build momentum by helping staff envision the future. Boost buy-in by articulating the compelling rationale for change, personalize the “vision,” and obtain employee input to help refine and finalize implementation. Plans should be reinforced in training strategies and initiatives.
  • An approach to optimize Meaningful Use Incentives: The Medicare and Medicaid EHR Incentive Programs will provide incentive payments to eligible professionals, eligible hospitals, and critical access hospitals (CAHs) as they adopt, implement, upgrade, or demonstrate meaningful
    use of certified EHR technology. Training strategies should be designed to help healthcare providers meet and exceed Meaningful Use requirements.
  • Timely, reliable, and meaningful analytics: Reporting that is easy to generate, monitor, understand, and manipulate. Transparency, accountability, and executive-level insight are all requirements for a successful rollout.

Best Practices for an EMR TrainingRoll-Out

This white paper focuses on 9 Training Best Practices for an Enterprise-Wide EPIC/EMR Implementation. The components it describes in depth include: 

  1. Create Curricula based on Job Roles
  2. Upload Online Courseware
  3. Streamline Scheduling Process
  4. Track Attendance
  5. Build and Assign Tests
  6. Create an Accountability Plan with Reporting
  7. Develop a Learning Strategy
  8. Leverage Your LMS for Communications and Change Management
  9. Leverage Peer Best Practices


Complete the form below to download the white paper.

New PX Advisor Focuses on Talent Management in Healthcare


Welcome to the Summer 2014 issue of PX Advisor, our quarterly magazine dedicated to investigating healthcare topics and trends that impact the patient experience.

Improving Talent Management is Key to Improving Outcomes

One of the greatest challenges facing healthcare organizations today is talent management—and every aspect of the patient experience is touched by it. Attracting, developing, and retaining a high-performance workforce is critical to delivering excellent care and outcomes—and the stakes couldn’t be higher. As healthcare providers look toward comprehensive, efficient solutions to address talent management needs, we take an in-depth look at the components of effective talent management programs and their direct translation to an exceptional patient experience.

Subscribe to PX Advisor.

Success Formulas and Concrete Strategies for Improving Processes

In this issue, we offer success formulas andHealthStream PX Advisor concrete strategies for developing talent management in your organization. We explore the difference between talent management and workforce development, delineating how both are critical to success, and that the concept of talent management involves senior leadership commitment and strategy aimed at achieving an organization’s highest goals. You’ll learn how Al Stubblefield—former CEO and president emeritus of Baptist Health Care in Pensacola, Florida— transformed an organization with single-digit patient satisfaction scores into a Malcolm Baldrige National Quality Award winning facility through a focus on talent management and employee engagement.

The Importance of Accountability and Coaching

We’ve outlined four key steps to creating a culture of accountability—which our research has shown to be an important aspect of success in healthcare. Also discussed is the role of coaching in patient-centered excellence and how organizations that embrace coaching understand and benefit from its ability to identify weaknesses, build on strengths, and reinforce patient-centered skills. To assume that healthcare professionals at all levels intrinsically understand all that patient-centered excellence involves is to potentially miss the opportunity to excel at it.

Tools to Help Facilitate Organizational Change

Finally, we’ve assembled a talent management toolbox—explaining the five important questions you should be asking about your workforce. Further, you will learn how implementation of a cascading goals system can build alignment across your entire organization, creating  accountability and leading to measurable results.

We hope you’ll find that this collection of information, which was developed with healthcare leaders in mind, will support you in developing a culture of engagement and exceptional patient experience at your organization.

Complete the form below to download this issue of PX Advisor.

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