Apply Therapeutic Relationship Practices to Leadership in Healthcare

  

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By: Mary Griffin Strom, MSN, RN, Consultant, Creative Health Care Management

In the inspirational new book, See Me As A Person, authors Mary Koloroutis and Michael Trout define the practices that make up a truly authentic connection to patients and families. These practices are the essence of a therapeutic relationship. Koloroutis and Trout define a therapeutic relationship as one in which “the clinician offers care, touch, compassion, presence, and any other act or attitude that would foster healing, and expects nothing in return.” (Koloroutis & Trout, 2012.)

The “expects nothing in return” segment of that definition is what differentiates the therapeutic relationships we form with patients and their families from all other relationships. However, the elements that comprise the therapeutic relationship—presence through attunement, wondering, following, and holding—apply to all authentic relationships, personal or professional.

The therapeutic relationship practices that create authentic relationships with patients and families are something that we can think about, talk about, study, and DO. It takes intentionality, practice, reflection, and effort to move those practices from a way of thinking, to a way of doing, to a way of being.

The same holds true for servant leadership or caring leadership. We can talk about how important it is to be in service to those we lead or how important it is to be caring, but we seldom define those actions in a way that moves us to a new way of being a leader. Let’s explore what it looks like when we apply the therapeutic relationship practices to leadership.

Attunement

Presence through attunement is the container that holds the three essential practices. If we are not present and giving our undivided attention to the other, then wondering, following, and holding are not likely to be experienced by the receiver. First, we must be attuned.

As leaders, when we “round” on staff, are we attuned to them, focused on them, present for them, and with them? In other words, how do we show up? Are we working to meet our agenda or theirs? Are we with them to listen or to tell? If we are servant leaders, we might need to entertain how to set our agenda aside and be open to whatever their agenda is for that moment.

Wondering

Wondering begins then as soon as we are attuned. Wondering involves openness, curiosity, using wide eyes, and open ears. And perhaps most importantly, it means suspending conclusions. It means knowing that knowledge comes not from what we already know, but from what we might learn about our staff, the climate of the unit, and the staff response, as well as about the patients/families in our care that day on our unit.

Following

Following means we consciously decide to be guided in our discussions and our interactions with patients, families, and colleagues by whatever happens in the moment. It truly helps to know our staff as individuals, so that when they mention someone or something that has resonance to us, we pick up on that part of the dialogue and show respect and understanding of whatever conversation transpires. They are leading, and therefore, naturally you are the follower. This requires giving special attention to body language, tone of voice, choice of words.

Holding

Holding is the conscious decision to lift up, affirm, and dignify what you are hearing and learning from those who know the work the best: your team. Even if you encounter a strong emotional response in the moment, holding helps you as a leader to be a steady and nonjudgmental presence. Holding might mean that you convey that you have heard what was said, that you might need to get back to someone, and that you respect them enough to honor their concern. Holding also means that you keep your promise and return to them with an answer to their raised concern.

Just as these practices must be defined, practiced, and reflected on in order to be true elements of the therapeutic relationship with patients and families, the same holds true for these practices in our role as caring servant leaders. They do not come easily; they often come through trial and error and learning from our mistakes. Formal leaders would benefit from group/peer discussions centered on exploring these practices, putting them into practice, and then reflecting on how they worked and how it might become a way of leading. Staff will learn from you as they witness your steady intentional presence, your openness to their dialogue, your willingness to follow their train of thought and discussion threads, and your holding of their contribution as something valuable to you and to the organization.

I invite you to suggest at your next formal leadership meeting that you set aside some time to use See Me as a Person as part of your learning agenda for each of your meetings. As a leadership team, you will learn the language and definitions of its therapeutic practices and be able to role model the behaviors and practices such that caring servant leadership is demonstrated in actions more than words.

Learn about Leadership and Management Training Available Online Through HealthStream.

Throughout her career, both as a nurse at the point of care and as an administrator, Mary has seldom used the word “patient” without the word “family” following right behind it.  Currently, Mary is a consultant at Creative Health Care Management, where she partners with health care organizations on team building, patient safety and quality, leadership development at all levels, physician engagement, and patient experience. Mary can be contacted at mgriffinstrom@chcm.com

Leadership Development and Healthcare

  

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By Bob Ogden, Senior Director Consulting

(Bob is a West Point graduate and retired from the Army as a Lt. Col. after a 22 year military career) 

Lead and inspire people. Don’t try to manage and manipulate people. Inventories can be managed but people must be lead. —Ross Perot 

Over the last seven years I’ve had an opportunity to interact with hundreds of healthcare leaders, from board presidents, to CEOs, to front line nurse leaders.  During this time, I’ve been struck by the wide disparity in leadership skills; some “get it” and many clearly do not.  I remember a comment a CNO made to me several years ago when asked to what she attributed the improvement in their physician satisfaction scores.  She said “the new CEO is in the physician lounge every morning at 7:00 a.m. … he gets out of his office to meet the physicians and speak with them.”  It was as if she was surprised that a hospital CEO would leave his office to greet physicians on their turf. Sounds to me like that CEO was one of those leaders that “gets it.”  Unfortunately, though, I have met many leaders who do not. 

Be a yardstick of quality. Some people aren't used to an environment where excellence is expected. – Steve Jobs 

What is it that good leaders “get?”  What are the traits of successful leaders?  While there are many definitions and examples of good leaders, I like the five simple leadership elements of Paul “Buddy” Bucha, a 1965 West Point graduate and Medal of Honor recipient:  honor, confidence, competence, compassion, and humility. I’ve often wondered why I see so many leaders in healthcare that struggle with some of the basics of leadership.  Is it a lack of compassion or competency?  The vast majority of healthcare leaders I’ve encountered are extremely compassionate and highly competent in their fields, so that’s not it.  Is it because traits like honor, confidence and humility are missing, or is it something more fundamental?  Could it be that what’s missing is the process of developing healthcare leaders like we see in the military or other industries?  

Leaders aren’t born, they are made. And they are made just like anything else, through hard work. And that’s the price we’ll have to pay to achieve that goal, or any goal. – Vince Lombardi, legendary football coach 

I agree with Coach Lombardi that it takes hard work to mold someone into a leader.  As a graduate of the United States Military Academy at West Point, the foremost leader development institution in the world, and with 22 years as an Army officer, I have experienced leadership development up close.  What’s missing in healthcare is a framework similar to the West Point Leader Development System the USMA faculty uses to develop 18-22 year old cadets into leaders for our Army.  It is interesting to hear the insightful responses from a group of cadets when asked recently what leadership skills they had learned in their nearly four years at West Point.  From this group of young men and women came observations such as genuine concern for others, being personable, providing consistent and honest feedback, empowering subordinates, delegation, emotional intelligence, patience, resilience, trust, and reflection.  Do they “get it” already, even with their limited life experiences? 

Whatever you are, be a good one. —Abraham Lincoln 

Some may argue that developing an Army officer preparing to lead soldiers in combat is completely different than preparing a nurse manager or CEO for their leadership challenges.  However, if you look closely, there are a number of similarities between the two professions.  Combat and healthcare leaders work in an environment where ambiguity is the norm, the daily pace creates chronic stress leading to burn out, and decisions that impact life and death are made daily.  Technical competency is a requirement for both professions.  While nurses may not be ducking for cover or lifting heavy rucksacks, many lift obese patients and walk miles every day in the course of taking care of their patients.  We like to think the healthcare profession is unique, but I contend that there is a kinship with those protecting our freedom and there is much to learn about developing leaders from those in military uniforms. 

I start with the premise that the function of leadership is to produce more leaders, not more followers. —Ralph Nader 

A few healthcare organizations today have formal leadership development programs.  Some incorporate programs like HealthStream’s Frontline Nurse Leader program for charge nurses, team leaders, and assistant managers, or the American Association of Critical-Care Nurses’ Essentials of Nurse Manager Orientation.  For many organizations, however, leadership development consists of identifying the best clinician for the next open leadership position and then learning as you go.  If that describes your organization, you may want to consider creating a leadership development program or formalizing the program you have in place already.  A good place to start in creating a leader development program is to think what your end product should look like.  The ten desired outcomes of the West Point Leader Development System provides a good place to start. 

• Lead and inspire to complete the mission
• Embrace your role
• Demonstrate a broad perspective that is open to new ideas and experiences
• Understand ambiguous situations and solve complex problems
• Make sound and timely decisions under stress
• Communicate effectively with all audiences
• Demonstrate proficiency in (healthcare) skills required to succeed
• Demonstrate mental and physical toughness
• Demonstrate the respect for others and work effectively with different cultures and people
• Live the Army values 

While the last outcome is unique to West Point and its Army mission, the first nine relate well to the role of healthcare leader.  Whether you are developing charge nurses or future healthcare executives, the West Point Leadership Development System can be adopted and modified to provide a framework for a successful program. 

In today’s healthcare environment, where transformation has become the norm, strong leaders are needed now more than ever at every level within the organization.  It’s time to examine the process of creating leaders to ensure they will have the tools to face the challenges ahead of us.  Will your organization be ready to meet the challenge?

Learn more about HealthStream's Research Consulting Services.

Healthcare Talent Management: Use Competencies in Job Descriptions

  

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By Donna Wright, MS, RN; Consultant at Creative Health Care Management and author of Ultimate Guide to Competency Assessment in Healthcare

If you’re only using competency assessment just to assess skills, you have some missed opportunities. You can also use competencies as a way to articulate the current requirements of the job; it can be the second half of the job description. 

Here is how you do it:

Competency assessment should reflect the current competencies needed in the job. It is not a static list of skills you repeat over and over again each year. An effective competency assessment is a dynamic, changing list that reflects what is New, Changing, High Risk, and Problematic (Wright, 2005*): 

• New: new initiatives, procedures, technologies, policies, practices, patient/customer populations, etc.
• Changing: changes in procedures, technologies, policies, practices, patient/customer populations, etc.
• High Risk: High-risk job functions and accountabilities
• Problematic: problematic areas are identified by QI/PI data, patient surveys, staff surveys, incident reports, or any other formal evaluation process 

This dynamic competency identification process can help you create a list of competencies that will reflect the current nature of the job and the technologies, knowledge, and concepts needed to successfully complete the work competently to ensure that patient and their families have the best experience and care possible. 

When you have a dynamic system like this in place for your competency assessment, you also have achieved another aspect of performance management—articulating expectations. By stating what has changed and evolved in the job, you are explaining to an employee where their performance now needs to be. Our jobs are constantly changing; competency assessment can help leaders articulate these changes. 

So now, competency assessment begins to be part of the job description. It is the dynamic, changing part of the job. If you think about it, the traditional job description is the basic part of the job that does not change much. It includes things such as do your basic job, come to work on time, be able to lift 25 pounds or more, etc. The second half of the job description should be current competencies that reflect the dynamic, ever-changing part of the job. In a way you are saying to the employees, “Now your job looks like this. You now need to know this piece of equipment, here is some new research that needs to be integrated into our work, and here is an area that we need to improve our outcomes by changing our practices in this way.” 

When someone asks you if he/she can see a current job description, I recommend showing them two documents: the traditional job description and this year’s competencies. Next year if someone asks you the same thing, produce the traditional job description and that year’s identified competencies. 

By using a dynamic competency identification process, you are automatically updating your job descriptions every year. You have created a wonderful performance management system that assesses competencies and articulates expectations at the same time. 

Learn more about HealthStream's Competency Center and Performance Center.

A staff development specialist known for her irreverent wit, Donna brings a global perspective to her work. In this country and in the over two dozen others, Donna’s best known for the work she does based on two of her books, The Ultimate Guide to Competency Assessment and Relationship-Based Care (co-authored with several CHCM colleagues). The Ultimate Guide has become the industry standard for HR departments in establishing and assessing competency, and Donna specializes in setting up systems for organizations to ensure accountability and measure competency.

* Wright, D. (2005). The Ultimate Guide to Competency Assessment in Healthcare. Minneapolis, MN:  Creative Health Care Management.

Focus on CDI: Prep for ICD-10 AND Raise Documentation Quality-White Paper

  

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By Lee Ann Bryant, Associate Product Manager, HealthStream

Many think ICD-10 is only a coding problem, but the true challenge of ICD-10 is the need for increasing specificity and granularity in documentation in order to receive optimal reimbursement, meet all reporting requirements and most accurately reflect the level of care provided.

The term “Clinical Documentation Improvement (CDI)” has been used in the healthcare information management (HIM) industry for decades, yet never has it played a more crucial role than it does right now or that it will in years to come. The speed with which physicians adapt to reimbursement documentation requirements and guidelines has a direct impact on the rate of improvement of an organization’s overall workflow quality and productivity and also its ability to enhance cash flow and receive appropriate revenues for work performed. The upcoming conversion to ICD-10 makes this even more important. Improving CDI workflow processes to advance documentation quality and accuracy is of paramount importance as organizations prepare for the ICD-10 environment and the other challenges that lie ahead in the near future.

Documentation has always been necessary for the communication between the providers caring for a patient. But the need for increasing specificity has evolved along with industry trends.

Current Challenges and Trends

As the healthcare industry continues to evolve, there are global drivers and industry trends that are creating ongoing challenges:

• Increased government reform: With initiatives like the Accountable Care Act, Meaningful Use, Pay for Performance and National Agency Reporting, never before have healthcare providers been so exposed to the public on the quality of care they provide.
• Globalization: Travel and migration, prevention of epidemics and medical tourism are creating new challenges to the healthcare industry.
• Aging population: People are living longer and, as a result, more complex healthcare is needed, coupled with shrinking reimbursement.
• Economic recession: The healthcare industry is being asked to provide better quality but with less resources; facilities have less money to spend on innovation and providers continue to consolidate.
• Growth of data: The healthcare industry is rich in data but information poor; as medical knowledge grows, there is an increased need for comparative data, however EMRs are not built to analyze data. 

As a result of these trends, the challenge is to reduce costs while enhancing the quality of care. Specific challenges include: 

• Quality: Provide consistent and accurate documentation that provides the specificity necessary for ICD-10and reduces exposures for fraud and abuse.
• Financial: Reduce labor costs, denials and DNFB while optimizing reimbursements.
• Strategic: Create clinical data integration to support IT, HIM and financial goals.
• Human Resources: Resource management monitoring, outsourcing and role consolidation all create unique challenges, in addition to the need to educate employees not only on ICD-10 but on other initiatives like MU, value-based purchasing, etc. 

This white paper includes:

• The Evolution of CDI
• Current Healthcare Challenges and Trends
• The Need for Increased Specificity and Granularity in Documentation
• The 3 Main Groups affected by ICD-10: Physicians/Providers, CDI Specialists and Coders
• Key Processes Related to CDI
• The role Technology will play in supporting a successful CDI program of the future 

Download the White Paper Here.

The Impact of Emergency Department Experiences on HCAHPS Scores

  

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By Todd Sorenson, Consultant (HCAHPS & Other Surveys), HealthStream

Statistics provided by the Centers for Disease Control reveal that there were 136.1 million emergency department visits in the U. S. in 2009, with over 17 million of these visits resulting in inpatient hospitalizations.  Nationally, roughly 50% of all inpatient admissions come through the ED.  

Research performed during the HCAHPS testing period several years ago found that patients admitted through the Emergency Department rated care across all dimensions of care more negatively than those patients admitted through other avenues.  HealthStream has documented this occurrence as well, summarized by the results of a study done in 2012.    

This analysis revealed that inpatients who were admitted through the ED rated all HCAHPS Dimensions of Care lower than those who were not, most decidedly so for the Overall Rating of the Hospital, Communication about Medicines, Quietness of the Hospital Environment and Responsiveness of Hospital Staff.  Previous research conducted by HealthStream has also shown that hospitals scoring high on ED overall patient satisfaction tend to have high HCAHPS scores, while those with low ED overall patient satisfaction tend to have low HCAHPS scores.  These data imply that experiences in the ED have an impact, either positively or negatively, on inpatient HCAHPS scores. 

While hourly rounding on patients, post-discharge phone calls and numerous other strategies have been shown to improve HCAHPS scores, many hospitals can also benefit from improving patient satisfaction in the ED to drive improvement on HCAHPS as well.  Many of the same types of factors that drive the HCAHPS Overall Hospital Rating are also among the top drivers of the Overall Rating in the ED.  Querying the HealthStream Emergency Department Database reveals the following items are the most highly correlated to the Overall ED Rating: 

• How often did you feel that the care and services received during the visit were well coordinated?
• How often did the patient care staff do a good job of keeping you informed of delays in care or treatment?
• How often did you feel the doctor really cared about you as a person?
• How often did the nurses, doctors and other staff do a good job of working as a team?
• How often did the patient care staff do a good job of responding quickly to requests?
• During this hospital visit, how often did the hospital staff do everything they could with your pain?
• How satisfied were you with the amount of time the doctors spent with you?
• How satisfied were you with the total amount of time spent in the emergency department from arrival to discharge?
• How often did the patient care staff show the proper sense of urgency in treating your medical problem?
• How satisfied were you with how clearly and completely you were told what to do and what to expect after returning home?

From this list, the key drivers of the Overall ED rating include perceptions about the coordination of care, including teamwork and responsiveness of staff, the amount time spent waiting and keeping patients informed of delays, and the care provided by the ED doctors, in terms of time spent with patients and caring about patients as persons.  How is your emergency department performing on these important factors? 

With reimbursement dollars on the line, those involved in hospital quality and improving HCAHPS scores should not overlook the importance of the patient’s ED experience on  how they respond to the HCAHPS survey.

Learn About HealthStream Patient Insights/HCAHPS Surveys.

Read Consultant Bo Hansen's blog about HCAHPS and the Emergency Department, with prescriptive advice for hospitals.

New OSHA Compliance: Training Healthcare Staff on Hazardous Chemicals

  

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To better protect workers from hazardous chemicals, the U.S. Department of Labor’s OSHA has revised its Hazard Communication Standard to align with the United Nations’ Globally Harmonized System of Classification and Labeling of Chemicals (GHS). While the original Hazard Communication Standard, HCS 1983, was commonly referred to as the “Employee Right to Know,” the revised standard now provides for the “Employee Right to Understand.” With the goal of increasing worker comprehension about the hazards in their work environment, the revised standard requires companies to employ the use of a standardized format for Safety Data Sheets (SDSs), as well as new labeling elements for chemicals. OSHA is rolling out this change in phases over the next several years, culminating in a final deadline of June 1, 2016.

New Requirements Aimed at Healthcare Worker Safety

The first compliance deadline is December 1, 2013. By this time, all facilities must provide training on new chemical label elements and safety data sheets.  In response to this rule, HealthStream has teamed up with MAXCOM to offer 19 GHS specific training modules that focus on every class of chemical an employee might come across in their working environment.

To address the enormous amount of chemicals used in hospitals, OSHA amended the rule to allow chemical training to be provided by groups of chemicals. They write, “where there are large numbers of chemicals, or the chemicals change frequently, you will probably want to train generally based on the hazard categories.”

Hazardous Chemicals Are Common in Health Care Facilities

Chemicals in use in the healthcare environment may be hazardous due to potential for toxicity, corrosiveness, and reactivity.  In addition to the usual routes of exposure by inhalation, ingestion, skin and eye contacts, a health care provider can also inadvertently self-inject a toxic drug intended for a patient.

These groups of chemicals include:

• Chemical disinfectants commonly used in health care facilities are often corrosive and/or toxic.  Glutaraldehyde, sodium hypochlorite, iodine, phenols, formaldehyde, and quaternary ammonium compounds are all corrosive.  In addition to being corrosive and toxic, some disinfectants such as quaternary ammonium compounds (benzalkonium chloride, Zephiran chloride, Rodalon)  also cause contact dermatitis.  Glutaraldehyde solution has to be freshly prepared every 2 weeks, and due to its volatile characteristic employees often inhale its vapors.  Formaldehyde used for cold sterilization of instruments and as a disinfectant not only has noxious odor but also causes dermatitis and has been shown to cause nasal and other cancers in experimental animals.
• Freons such as Freon 12 (dichlorodifluoromethane), Freon 11 (fluorotrichloromethane), and Freon 22 (chlorodifluoromethane) are routinely used in pathology laboratories (to prepare frozen tissue sections), in aerosol cans as a propellant, as a refrigerant gas, and mixed with ethylene oxide (a sterilant).  Freons can freeze the skin and eyes and cause depression of the central nervous system resulting in dizziness, convulsions, and irregular heartbeat. 
• Methyl Methacrylate, commonly used in operating rooms for securing surgical prostheses to bone, has to be mixed just before a procedure often resulting in inhalation of the product.  Methyl methacrylate affects the central nervous system, is an irritant and may cause low blood pressure and cardiac arrest.  The product also has been linked to birth defects, though not cancer.
• Peracetic Acid (PAA) or Peroxyacetic Acid is used to sterilize medical instruments, and also present in laboratories, and patient care units.  PAA is a severe irritant, and have been linked to skin papillomas (wart-like tumors), and liver, kidney, and heart problems.
• Solvents (such as Dioxane, Xylene, and Benzene) used mostly as cleaning agents in housekeeping are central nervous system depressants and irritants.  Chronic exposure to solvents have been linked to effects on blood formation, kidneys, liver, birth defects, and cancer.
• Anesthetic Gases exposure usually occurs in operating rooms, labor, delivery and recovery rooms; and ER.  Gases often leak from the instruments, and in the recovery room are present due to the exhaled breath of post-operative patients.  Effects of anesthetic gases on health care employees are similar to the one experienced by patients.  Although short-term exposure only causes dizziness and disorientation, long term exposure may cause cancer, birth defects, and liver and kidney damage.
• Ethylene Oxide used to sterilize equipment also exposes employees in surgery units and central supply.  Ethylene oxide is a corrosive, causes destruction of red blood cells, and inflammation of lungs.  It is also a carcinogen and a fire hazard.
• Cytotoxic Drugs (such as cyclophosphamide, chlorambucil, and melphan) used for treatment of cancer, also cause cancer and damage to the reproductive system of health care employees.  Accidental injection of a drug such as mitomycin-C can cause loss of function of a hand; and drugs such as mustine hydrochloride and doxorubicin  are powerful vesicants (corrosives).  Exposure to the smallest amount of bleomycin can cause severe allergic reaction.
• Pesticides ( Mecoprop, Metolochlor), Rodenticide ( Bromaldiolane and Diphacinone) and Fungicide such as Mancozeb are routinely used by hospitals as a biocide.  Most are toxic to the nervous system, damage kidneys and liver, and cause allergic reactions.

Safer Substitutes

Less hazardous products can be substituted for many though not all hazardous chemical products in health care facilities. For example:

• For Ethylene oxide in most instances: safer hydrogen peroxide 7.5% solution, peracetic acid or a mixture of hydrogen peroxide and peracetic acid.  Even hypochlorite (bleach)is effective in some disinfection systems.  Please note that the substitutes are not suitable for flexible GI endoscopes.
• For Glutaraldehyde: Ortho-phthalaldehyde (OPA) in Cidex (contains only 0.55% glutaraldehyde)
• For common toxic chemicals such as chloroform: dimethoxyethane (DME), Ethyl lactate, methyl tert-butyl ether or methylene chloride; benzene can be replaced by benzotrifluoride (BTF), dimethoxyethane (DME);  acetone can be substituted by ethyl lactate, or N-methyl pyrrolidone (NMP) etc.
• For toxic chemicals such as formaldehyde: dimethoxymethane (DEM); Phenol  by polyethylene glycol (PEG), and pyridine by isopropyl alcohol.
• For flammable chemicals such as ethyl ether: methyl tert-butyl ether (MTBE), n-octyl tetrahydrofurfuryl ether (n-OTE)
• Waste anesthetic gases can be controlled by a scavenging system.
• For powerful pesticides containing pyrethroids: UV light traps; pheromone traps can be substituted for Cockroach pesticides etc.

Although heath care facilities will never be free of hazardous chemicals, it is increasingly possible to use safer alternatives and better procedures to prevent exposure.

MAXCOM’s GHS Training Library provides a basic overview of the hazards associated with every class of chemical a healthcare employee could typically be exposed to and how an exposure to these chemicals could affect him/her in the course of performing their everyday workplace duties. Additionally, this training provides valuable information about the degree of risks or hazard levels associated with chemicals specific to a healthcare environment, and finally employees are provided details about the information contained within each section of the new Safety Data Sheet, GHS label elements and the pictograms recently adopted by OSHA.

Learn more about Maxcom training here.

Focused on HCAHPS, Avera Sacred Heart Hospital Improves Its Scores

  

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By Nicholas Dowd, Senior Consultant (HCAHPs and other Surveys), HealthStream

The commitment to excellence is truly a team effort at Avera Sacred Heart Hospital (ASHH). They have been involved in – and seek out – opportunities to collaborate with facilities from across the nation to share best practices and processes to improve overall quality. For example, they were active participants in the CMS Demonstration Project and have proactively participated in programs such as the QUEST initiative, the IHI 100k Lives Campaign and the 5 Million Lives Campaign. They are also currently participating in the CMS initiative “Partnership for Patients. ASHH sees participating in each of these collaboratives as means to improve evidenced-based care, patient perceptions of care and enhanced patient safety.

Their deep level of commitment to continuously improving quality is a unifying thread that runs throughout the hospital, touching every employee. This team effort starts with transparency of performance data. Performance data at the unit level is posted on the hospital’s intranet enabling all employees to see results. Using the “push” feature of HealthStream’s Insights Online product, leaders can schedule and post results via e-mail to those front-line staff that need that information to manage more effectively. Those data are also an integral part of the work of ASHH Patient Services Council and a variety of performance improvement teams at work on a daily basis.

The current areas of focus for the hospital include:

• Decreasing overall readmissions
• Evaluating and implementing best practice solutions to reduce hospital harm
• Maximizing use of the electronic medical record

Read the full success story here.

Become a High-Performing Leader in Healthcare : White Paper

  

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(This white paper is posted on behalf of our parter, Baptist Leadership Group.)

In this churning and evolving healthcare environment, leaders are more challenged than ever before. We’re now responsible for more lives than ever at a time when the healthcare industry faces soaring costs, falling reimbursement rates, rigorous standards of quality, workforce shortages and more informed patients. While some kind of reform will be introduced, the “must” for care providers will continue to be to execute efficiencies that control cost while delivering patient-centered excellence. No matter how “reform” is presented to the healthcare industry in its final composition, as leaders we are still responsible for a successful delivery of care.

Our work is tough, but most of us are motivated because we have the privilege of helping people when they are at their most vulnerable, perhaps when they have even given up hope. Each patient experience is directly affected by the collective work that we do to deliver care.

A recent poll of healthcare leaders across the country revealed that the top two barriers to becoming a high performing leader are challenges with communication and accountability. These leaders want to focus on the skills needed to effectively develop themselves, and their employees, to have more meaningful, outcomes-based dialogue with senior executives. And why shouldn’t they?

Understanding organizational goals and translating them into meaningful targets for departments and staff is a significant, yet imperative, undertaking for leaders. When staff goals are aligned and measurable results are linked to improved patient outcomes, there is a quantifiable contribution to the patientcentered experience. Leaders have then enhanced their ability to take a seat at the decision-making table with senior leaders since their input directly contributes to safety, quality, cost-savings and the overall core business of the organization.

There are four key steps to becoming a high-performing leader.

• Make the connection

• Know “the whats”

• Enforce “the hows”

• Become indispensable

Learn more by filling out this form to download the white paper:

The Changing View of Talent in Healthcare--Taking a Holistic Approach

  

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By JoAnn McMillan, Ph.D., I/O Psychologist, Assess Systems

A few short weeks ago I received the type of call no one wants to receive, but for those of us with elderly relatives, we have come to expect. One of my aunts had been admitted into the ICU at a local hospital, and the prognosis was very poor. Like any of you would do, I dropped everything and raced across town to an unfamiliar hospital in search of my family. I entered a maze of buildings, corridors, and elevators and tried to navigate my way to her room. I finally gave up and stopped at the visitor desk to ask for directions. The transaction I expected to happen, that of someone politely pointing me toward the correct bank of elevators and giving me the floor to depart on, didn’t happen. Instead, a very gracious woman wrote the information down for me for future reference and then personally escorted me, not only to the proper bank of elevators, but up to the appropriate floor and into the arms of my family.  Even in the chaos of our personal crisis that moment stood out for me.

Hospitals are Being Compared to the Hospitality Industry

Since that day I have repeated the story several times, even as recently as HealthStream’s National Sales Meeting. Are you surprised by that? If I were repeating a story about how I received this kind of personal treatment at a high-end retailer, hotelier, or restaurant, you probably would not be. Those industries place a keen focus on the delivery of an exceptional customer experience to drive sales, repeat business, and referrals. My experience though is not unique. PWC’s “Customer Experience in Healthcare: The Moment of Truth” report underscores the importance of hospitals’ changing the way they interact with patients and adjusting their mindsets to view patients as customers and consumers. As an example, they even describe patients’ benchmarking service in areas such as housekeeping with those of hotels where they stay.

Improving Patient Experience is a Key Initiative for Many

Whether because of business intent, consumer demands, or government mandates, hospitals today are just as keenly focused on the patient experience. Examine the HCAHPS measures regarding patient perceptions, and you will find that almost all of them evaluate not only What was done, but How it was delivered. This was a key point of discussion among those of us that participated in a panel discussion regarding talent management initiatives at the HealthStream meeting. Healthcare like most industries is being asked to achieve more with less—smaller budgets, less resources, and fewer people. The impact of each individual for better or worse is greater. Human resources champions lose sleep at night wondering whether they have the right talent at every level to achieve business success in an environment changed by healthcare reform, consumer demands, and increasing competition.

Healthcare Human Resources Must Change and Add Focus

From a talent perspective hospitals today must not only select, train, and evaluate staff regarding technical skills and competencies, they must also look beyond the transaction and also evaluate whether the person has the aptitude and attitude to display the desired patient-focused behaviors and collaborative team behaviors to create an overall positive experience. This necessitates a critical evaluation and potential re-engineering of many HR processes. A quick checklist to get you started on a more holistic view of talent would include:

• Job Profiles – review and update your job descriptions to include robust competency content that supports both the What and the How of behavior. While technical skills remain absolutely necessary they alone are no longer sufficient. Profiles should include “softer” competencies such as influence, collaboration, resilience, change management, communication, etc. that facilitate positive outcomes.
• Selection Processes – update your interview protocol to probe more deeply into how the individual achieves positive results. Consider the use of broader assessment of personality, motivation and situational judgment as well as simulations to see both potential and demonstrated behavior.
• Training and Development – utilize 360-degree feedback to hold up a mirror that allows staff to see how others perceive them. Implement business-focused training in addition to technical training.
• Performance Management – include additional evaluation of How the person behaves in addition to What goals are achieved.

By taking a more holistic view of talent, similar to its application in medicine whereby the physician develops an understanding of the whole patient and how the systems of the body work together to achieve wellness, Human Resource initiatives can better leverage the broader capabilities of staff to achieve positive business and health outcomes.

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Candid Comments Make HCAHPS Results Even More Valuable

  

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By Robert J. Ogden, Senior Consultant (HCAHPS & Other Surveys), HealthStream

At the end of the HealthStream HCAHPS survey interview, patients have an opportunity to make a comment about their recent hospital experience, using our Voice of the Patient enhancement.  This feedback provides valuable qualitative information that supplements the quantitative data we gather. 

Why Aren’t Patient Comments More Common?

Recently, one of our clients asked a client services manager why don’t more patients, if they are unhappy, voice their concerns or issues when they have a chance to make a comment at the end of their HCAHPS survey? 

This is actually a very common question. If you are a hospital leader, nurse manager, service excellence coordinator, or someone else charged with improving your HCAHPS scores, you have probably heard that question before, or maybe asked it yourself.    

Most Patients are Happy

When answering this question, there are several things to consider.  First, it’s important to keep in mind that patients are very happy for the most part.  Consider that on a scale of 0-10, more than 70% of patients rate their overall experience either a 9 or 10, and another approximately 20% rate their experience a 7 or 8.  Less than 10% of patients rate their hospital experience a 6 or lower. So, while hospitals may be struggling to improve those last few points to differentiate themselves from the competition, the bar is set very high.

Unfortunately, it isn’t unusual to see some extreme responses to one end of the scale or the other, and then see the respondent indicate that they do not have an open-ended response.  Some respondents may have a difficult time putting into words their thoughts or may be reluctant to have their thoughts recorded.   Ultimately, I believe the reason most patients do not leave comments is because they are generally happy with the care they received and feel they have nothing outstanding to share.

We Wish We Could Ask for “Always.” We Can’t.

Another common question we get is why we can’t ask a patient why they did not give us an “always” or rate us a “9 or 10.”  If only patients would tell us exactly why they did not rate us an “always” or a “9 or 10,” then we would know more precisely what the patient expects, right?  While it would be nice if we could ask patients why they did not give us top box ratings, the CMS HCAHPS Quality Assurance Guidelines specifically prohibit asking patients questions like this to prevent introducing bias into the survey results.

Get More Comments by Explaining the Survey and Its Value

So what is a hospital to do to increase the number of comments from patients?  I encourage hospital staff to inform patients that HealthStream may contact them by telephone to complete a short survey about their hospital experience.  Your staff can inform patients of the survey upon admission, during discharge counseling with the patient and family, and prior to leaving the hospital.  Make patients aware that if they are selected to complete the survey, they will be given an opportunity to make comments at the end of the survey.  Encourage patients to make comments by letting them know how the hospital values their input.

What about your hospital?  How do you let patients know they may be called to share their hospital experience? Do you encourage feedback from your patients?

Learn More about HealthStream's Patient Insights Survey/HCAHPS Services.

Learn More about HealthStream's Voice of the Patient Survey Enhancement.