Today’s blog entry is one in
our “spotlight” series where we focus on a particular leading-edge thought
leadership topic. It's a bit longer than usual, and dives a bit more
deeply into an important and current topic.
Healthcare delivery is in a state of dramatic
change, driven by forces inside and outside of the industry. “The Affordable
Healthcare Act” is but one of the many new forces driving rapid and sweeping
One thing is certain – the changes are
inevitable and will result in winners and losers in the coming years.
What will define the winners? One factor we can be confident about is
“quality” and the many measures that define it, both from the patient
satisfaction standpoint and from the new types of objective “outcomes” and
“cost of service” measures.
This post discusses some of the concepts around
quality, accountability and some of the areas that healthcare delivery
organizations at all levels can take to measure and manage to this new quality
If you’re in a business relating to healthcare
this is familiar territory to you, although some of the new measures, metrics
and dynamics may be new. If you’re in another industry or another type of
business, this post can be helpful to you as both a cautionary tale (quality
and accountability will always win, and those that ignore it will pay dearly),
and also as an inspirational or visionary touch-point- in that quality and the
driving values around it will always win…
Like any business or process, healthcare has
it’s components of value and elements in the path to “deliver” these services
to customers. We call this the “Healthcare Profit Chain” or value
It’s not surprising that this involves the
sequence of experiences and person-to-person interactions around the holistic
or comprehensive experience patients have in receiving their care, treatment
and follow-up. What’s new and quite interesting is the “value-based-pricing”
that the Affordable HealthCare Act has set up around reimbursements.
The “bad apple” is only part of the problem
We see this in any other product or
service-based business. The quality of the apples leads us to examine the
source and handling of the apples on their way to the grocery store… Equally
so, the demeanor and response of the Produce Man at the grocery store (when
confronted with “bad apples”) really defines whether or not we forgive him and
the store for our bad experience (and whether it’s an opportunity to build
loyalty and trust, or to spread the word and “punish” the brand for their poor
process and bad outcomes).
For the first time the “patient experience”
(and related to that, the caregiver experience) is a measurable and measured
component of care ---and now payment. This is what one industry expert
calls a watershed moment for healthcare – a moment that demands huge cultural
change. Healthcare organizations can no longer measure themselves on
Today, the holistic patient experience matters
as much as outcomes (to the healthcare organizations). Perceptions matter
more than ever. Brand value and revenue now depend on it. And
now these perceptions have a direct and material impact on the money side of
But there is good news here: much of this
“healthcare profit chain” is well-understood (if not well-managed) and as a
result it’s going to be much simpler to succeed in the new world than was
perhaps once thought.
In this new reality, managers at every level
must manage all components of this profit or value chain in order to, as the
Kaiser Permanente ad campaign says, “thrive.” In your business or
industry you might consider how this is parallel to your way of driving quality
Introducing the Healthcare
The flow above is loosely inspired by the work
of the Service Profit Chain Institute,
except that in this view of the value or profit chain, we exchange the role of
“employee” with “caregiver” (reflecting healthcare).
In a recent discussion with a “Chief Patient
Experience Officer” at a leading healthcare organization, he asserted that
“…Everyone in the hospital is
now officially in the “field” of nursing because everyone must be focused on
the “experience” of those being cared-for...“
Given this, the most important component of
“quality” of each and every patient interaction is the overall satisfaction
relative to the caregiver. This is a groundbreaking recognition and one
that turns the traditional “respect” and “recognition” of nursing and caregiver
on its head, from a “rank” and “influence” standpoint in the industry.
We’re all “customers” and we’ve all been patients.
As patients ourselves we have long known this
and been aware of it. However if we’re honest with ourselves, we also
know that nurses and other caregivers are also historically some of the most
underpaid, under-recognized and overworked professionals we know. This has
unfortunately been a driving force behind the perceived necessity of nurses and
caregivers to seek unionization and collective bargaining protection.
Collective bargaining as the symptom, not the solution
Bank Tellers, transit workers, fast food workers and even theme
park workers have experienced this reality. Obviously whenever a group of
workers is forced to consider or implement unionization it’s a clear sign of a
catastrophic break between perceived value of their work and its impact on
quality and profitability of the organization. In healthcare it’s a bit
more frightening. Do you want the caregiver of your premature infant to
be brooding over an unfair shift change and a freeze on overtime? Would
you be happy about your surgical nurse worrying about longer hours and shortened
lunch breaks during your procedure?
This upside-down paradox is finally in the
open, as a new financial (reimbursement) connection is made at just this point
of “interaction and satisfaction.” As patients (“customers”) we should
Translating to the workers and the workplace
So how does this largely academic diagram
relate to the way we manage our organizations? In healthcare it’s not
particularly complicated. However it’s just as clear that these basic
management touch-points are being ignored or allowed to wither. Consider
these factors (and translate them to your industry if you’re outside of
healthcare by substituting “caregiver” for “employee” and “patient” for
-Caregiver job design
-Caregiver selection and development
-Caregiver rewards and recognition
-Caregiver tools for serving the patient
We asked the workers
We recently asked users at NursesCount whether
they felt that they were getting the training and help needed to succeed. Only
21% said this was frequently the case; and 58% said it was only occasionally
Great (healthcare) organizations assign a huge
value to this point of training and help. As an industry and as an
individual organization, it’s important to ask: “are we making it easier
or more difficult for our front-line patient (customer) care teams to deliver
A break in the value chain results in a cascading break in the
profit chain and introduces high risks
This leads to measurement (and now much more
effective understanding) of the drivers of caregiver (worker) satisfaction and
for that matter, caregiver retention. Notwithstanding the obvious primary
expense of experienced, skilled caregiver turnover, we now have direct
correlation to patient satisfaction, team cohesion and outcomes. This
cascades into a huge set of risks for healthcare delivery organizations and now
directly throws financial projections into question at all levels.
It’s also about brand risk and brand reputation
One aspect that is not lost on savvy healthcare
marketers is the concept of quality of care, patient-to-caregiver interaction
and satisfaction and loyalty or “preference” in a brand sense. In this
case it’s the brand of the hospital, healthcare organization or even a specific
“rock-star” anchor in a practice.
Yet the components of person-to-person
“quality” and loyalty are subtle and hard to pinpoint. It may be the sum
of 100 or 1000 special touches and empathy at each interaction. A few
words, or a lack of being rushed or harried. A simple smile and a gentle
act of reassurance. Taken together, these drive patient retention and
loyalty, CMS evaluations (ratings at hospitals that determine reimbursements)
and of course brand value by way of referrals and reputation. Connecting
the dots, this means revenue growth and increased profitability in the new
world order of satisfaction and quality-based reimbursements.
Leaders no longer able to just talk the
talk….New imperatives to walk the walk.
The tipping point has been reached. What
was once considered “nice to have” and “thought leadership” but still “soft
benefit” and marketing-speak has now become hardcore financial stewardship and
Top executives in these companies are not only
espousing, but are now expected to put solid policies and “mission-vision”
prescriptions into place to act on the age-old lesson from other service
industries: Your business results are directly determined by caregiver
(worker) satisfaction, as this is the most direct and manageable factor
relating to patient (customer) satisfaction and good outcomes.
How do you manage this so you
Clearly there is a lot already happening in the
effort to improve hospital and healthcare delivery processes. It’s a
red-ocean in many ways. Crowded with “experts” and fancy consultants
(with pretty graphs like the one above) and lots of measurement and
process. Yet the most important piece of this puzzle seems to be lost in
the furious effort to “control” the process. The missing piece is a
simple one, yet an elusive one for outsiders to “control” with rules and
It has been long said that you cannot “fake a
smile.” And what a difference it makes to every patient (and customer)
interaction! If we accept the equation that the sum of patient
interactions determines patient satisfaction, there are two simple and
easy-to-implement ways to get started.
Real-Time VS Stale data. Which would you rather use?
The first is to start to measure caregiver
satisfaction regularly. Just as the weatherman and economic advisors
forecast “early and often” so must healthcare workers’ satisfaction be
measured. This is the front-end of the value-chain or profit-chain we saw
at the beginning of this post.
Big Fix Projects VS Continual Improvement philosophy
The second is to move from periodic measurement
and “remediation” and drastic break-fix cycles to an approach of continual
improvement, feedback and small, frequent adjustments. If you are a
sailor you know this well. Small, frequent adjustments in the tiller and
the sail will always be better than once-a-day measurement and wide swings in
direction and remediation. People work that way too.
Annual, Quarterly or even Monthly surveys don’t
cut it. The data is stale and the working groups are scattered or
re-arranged by the time the “remediation” or “analyses” get to the right
place. It’s not a bad idea to do deep self-evaluations
periodically. It’s just impractical to try to manage something as subtle and
ever-shifting as caregiver and patient satisfaction that way. And now
it’s clear that it’s also financially reckless (if not derelict) to do so, as
these measures form the foundation of multi-billion dollar financial
projections and swings of millions of dollars in top-line reimbursement revenue
at any given facility. We need something that keeps satisfaction results
in front of the managers all time, because transparency makes improvement
Actionable data in a digestible format
Finally, we need a way to manage against
quality discrepancies as they happen. Depending on paper surveys that are weeks
or months old does not allow managers to find gaps and improve.
Caregiver satisfaction and patient quality of
care is not an exercise in history. It’s real-time. As real-time as
an EKG. History is nice, but in an “event” it’s irrelevant. Real
time is what matters to the patient.
We need to be able see daily how well are doing
and find gaps in performance and then be able drill into where the quality of
patient experience is succeeding or failing.
Correlating the two sets of data with ease
At same time, we need to have what we call
“temporal concurrence” between patient and caregiver data so leaders can
cross-reference between patient and caregiver data. This is the best way to
reveal the root causes and gaps that are doing damage in near real-time.
And by the same token, reveal the bright spots in the value chain where
everything is working brilliantly (and presumably what we want to replicate).
What are your thoughts on this? Join the discussion in our LinkedIn group.
NursesCount is leading the industry in this
practice of correlating these two sets of fresh data for the benefit of
organizations (including healthcare), workers (including healthcare caregivers
of all types) and the patients (customers) they serve.
To learn more about how to do this in your
organization, write to us at firstname.lastname@example.org and start following us at
@workerscount and @nursescount on twitter. WorkersCount is the provider of NursesCount, PatientCount and other healthcare industry services and platforms that help healthcare executives and their teams drive and sustain world-class service quality and engagement.