As a
follow-up to our previous post about "What keeps hospital CEOs awake at
night" we are focusing on quality, and what some people think-of as the
"X-Factor" in healthcare delivery today.
Let’s pose several questions:
-Do patients really determine the level of quality? (What is meant by “quality?”)
-Is there a link between patient experience, their perception of quality, and the level of your care team’s engagement?
We’re talking about the two-headed animal called “quality.” And this leads to the dominant revenue driver called “Brand.”
Yes, it’s marketing. And yet it’s much more than that. Brand is what matters most when “selecting” a healthcare organization. This applies to both patients and care teams. The best teams of physicians, nurses and administration leaders want to be affiliated with top “brands.”
The slick TV ads don’t matter to patients once they are inside of your organization. What matters is their own personal perception, imperfect as it may be. Every patient touch-point is an opportunity and a risk. And the best part of this? It’s all delivered by your people, and they have the power to make those touch-points all winning experiences.
CEOs do stay awake at night worrying about clinical care and containing
unnecessary expenses and reducing variability in the way care is delivered.
In many ways those objective measures of operational performance are
“easier” to box, than the “unstructured” perceptions of service quality of
patients. It can be very frustrating.
But it’s intertwined by that X-Factor that joins the clinical quality stats
with the patient perception of quality measures. That X-factor is the
care team.
Brand warfare today is happening all around us. Just turn on the radio or TV and see dueling healthcare advertisements. Expensive super-slick agency productions, they all talk about “we are more friendly” and “we know your name” and “we speak your language” and “we are in your local neighborhood.” What’s missing? “We deliver better medicine.” Because that’s not what Brand warfare is getting at. What drives the quality that is underlying this brand warfare? It’s our X-Factor— great care teams.
Getting
back to the interdependence of great care teams to great medicine, it’s also
essential to go back to the objective clinical stats and remember that highly
engaged care teams tend to make fewer mistakes, and tend to do a better job of
providing instructions at discharge, better follow-up post treatment and the
whole list of best practices that make patients “feel” more quality and love,
and also drive better medical outcomes. This is a known correlation, and
we are working to assist leaders measure and manage these connections.
But there is more.
Yes, billing is often the “last impression” a patient has with your healthcare organization. Now that’ alone is enough to keep many CEOs awake at night. Imagine this— a spectacular patient experience in both their objective clinical outcome to their true collaboration and participation in their ongoing care. But the last contact is with a cranky, ill-tempered billing department that is working on antiquated systems that make billing a nightmare for everyone. Result? Brand damage, and game-over. That patient will walk away with a huge negative and your brand is “cooked” - to paraphrase that CEO.
An
interesting study was conducted by BJC Healthcare and published in the Journal of Healthcare Management. Over 14,400 patients
were interviewed and three areas were explored that relate to Brand (and
revenue):
-Overall Quality of Care
-Willingness to Recommend
-Willingness to Return
In the study, staff responsiveness dominates the willingness to recommend and willingness to return followed by nursing care (which has big role to play in staff responsiveness as well).
Next - if you losing sleep about the size of your patient population focus less on marketing and more on creating experiences that will drive patients to recommend and return. Word of mouth has always been the most powerful marketing tool. One Hospital CEO said that every poor patient experience loses the hospital five new customers.
These seem like questions one would receive in a retail establishment or likely at a restaurant: “how is your meal? “Please recommend us on Yelp” and “here is a 10% off coupon for your next visit.” In Healthcare, brand is retail, because it is “consumer.” Patients are very sophisticated consumers, and as they gain more control over their healthcare dollars, they are moving quickly to measure value in terms of cost, quality of service and “brand” reputation as criteria, as they do in all other important areas of their lives.
Yes the world has changed. We think for the better. The top leaders we meet have long been advocates of patients as full participants and “engaged” in their treatment as well as arbiters of the “quality” of their experience, both clinically and overall.
Top leaders focus on this X-Factor of the care teams because it drives all of these operational statistics and patient quality perception measures.
What is your experience at your healthcare organization?
if you want to join the discussion on healthcare employee engagement and how to improve it, please join us at our LinkedIn group.
At a recent hospital CEO forum, speakers presented examples and ideas around innovation and shared their observations and prognostications about the rapidly changing U.S. Healthcare System. Here is a quick summary of the highlights of the evening.
The CEOs agreed that the U.S. needs to move from an episodic healthcare system to a healthcare system that is delivered in primary and ambulatory healthcare.
-Christopher McDougall, Born to Run: A Hidden Tribe, Superathletes and the Greatest Race the World Has Never Seen
As stated above, “the lack of teamwork and communication kills.” It kills profits, it kills service quality perception, it kills staff retention, it kills clinical care quality, it kills brand value and sadly, occasionally it also kills patients.
Today’s healthcare leaders are busy--perhaps busier than they have ever been. Top leaders (including CEOs) have many competing issues, risks and challenges that keep them up at night.
They are also less likely to boomerang back into the hospital as a re-admit or worse.
While CEOs have historically put their attention on other hospital practitioners and the latest state-of-the-art tools, the group that needs more leadership and CEO attention is Nursing.
When skilled nurses, nurses-aides, and support staff are not engaged, they cannot effectively engage patients. More importantly, as numerous studies affirm: “a lack of teamwork and communications kills.”
Meanwhile, perception matters because it determines whether doctors actively use a hospital, and how many patients select those affiliated or captive physicians. In a study by Otani, Waterman, Faulkner, Boslaugh, and Dunagan (Journal of Health Management, Jan 2010), three critical items for Hospital CEOs were examined—evaluation of overall quality of service, willingness to return, and willingness to recommend. One Director of Patient Experience said “every bad patient experience costs us 5 future customers.” Healthcare enterprises are recognizing the same consumer forces at work as impact other consumer brands: more power of choice, abundance of competitors, price, service and quality, and brand reputation.
Put simply- consumers are using the same quality, price and service criteria to spend their healthcare dollars that they use in all of their important buying decisions.
The Otani study looked at the drivers of each of these factors by looking at 14,432 case studies. They concluded that the first priority for hospital improvement should be nursing and support staff.
The reasoning is that nursing and support staff are the biggest drivers of quality of care, willingness to return, and willingness to recommend.
Physicians and the exam room were much further down the list. This is not surprising given the rapid shift in care to outpatient and ambulatory, where skilled nursing and staff provide the majority of face-time treatment, consultation and overall interaction.
Top leaders need to put their attention into the people, process, and technology of nursing. According to Sue Ehinger at Parkview Hospitals “the drivers that have patients rate us as excellent are time spent with the patient, control of pain, explanation of medications, tests and communication, and overall communications about the services being provided.” Understanding the patient’s perception of care has become for Sue a priority for achieving her hospital's success.
Given the importance of the nurse in this process, it is critical to bring the discussion of nursing and support care staff engagement to the forefront. This includes the ability to commit to building new types of processes and initiatives.
What's your view?
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Ten big ideas to engage, love and retain your nurses.
Insights and suggestions from nursing leaders
The lifeblood of any organization is its ability to attract great team members, including young, fresh-out-of-school beginners. What happens to the quality of care in healthcare, when that very group of new team members begins to feel alienated?
Recently we examined our aggregated data on nursing
engagement, and to our surprise we found that the least happy nurses with their
life at work were nurses with less than five years of service. This was by a very wide margin--greater than
15%. So we shared these results with a set of nursing leaders. We also asked them for a set of concrete strategies
that could be used to improve the engagement among the newest members of the healthcare
team. In this post, we will share why they believe this occurs and how you as a
nurse leader can combat it.
One Director of Nursing said that “they had seen more mature nurses really beat up on new nurses. More importantly, she had been asked not to hire new nurses onto the team. However, she said that “we have to remember that we were all were new nurses at one point”. And with the average age of nurses being in the 50s, clearly nursing leadership needs to figure out how to successfully and consistently retain and engage new nurses.
Another nursing leader told us about a University of West Texas study that said 14% of attrition among nurses is a direct result of poorly-engaging younger nurses. She continued that many studies have been published on the verbal abuse, hostility in the workplace, and the impact of this behavior on patient outcomes. She said “we know that the greatest attrition occurs among healthcare workers whose length of employment is less than 5 years.” The Joint Commission, the ISMP, the IHI have each spoken out on this subject.
Strategies
Our nursing leaders had ten ideas for improving things at your hospital. Here are just a few that they recommended.
1) Nuture young nurses. Make sure you take strong steps to nurture your young nurses. Teach new nurses and treat them as your own. This can include having veterans take new nurses under their wing. They often are a good judge of their co-workers and can help you figure out where the rookies’ strengths and shortcomings are. The fact is that most employees that are new to healthcare are seeking a mentor.
These are just 10 great ideas from healthcare leaders. You probably have 100 more. Please share in the comment section below and follow the conversation on twitter or Facebook.
Bonus: here's a link to the 10 perks nurses love most! How many does your healthcare organization offer? Enjoy!!
if you want to join the discussion on healthcare employee engagement and how to improve it, please join us at our LinkedIn group.
“Just The Facts” research insight series
"When that “million-dollar smile” from your nurse or healthcare worker can really mean a million dollars"
Is “attitude” and “engagement” and workplace happiness relevant to healthcare delivery quality?
But something else has happened in the last 18 months. It's all about the impact of quality on the “bottom line” in terms of finances.
Research clearly shows that workplace happiness can affect the bottom line of most enterprises. As we said, hospitals and healthcare delivery facilities are now large enterprises.
This is completely separate from what kind of policy an individual may purchase. It's all about the focus on the hospital, clinic, skilled nursing facility, long-term care or other "delivery" point in healthcare that touches patients. And the rules are already being enforced.
For the first time ever, patient care, and the level of quality they report (patients) will directly impact the reimbursement (payment) received by healthcare delivery organizations. This is such a dramatic change we’ll say it again: The healthcare organizations with above-average patient satisfaction and other quality scores will stand to earn more money, and those with below-average patient satisfaction scores will earn less. Much less.
A whole lot of healthcare industry administrators just got a new metric, and they now share it with their CEO, CFO and Board of Directors.
Through the Affordable Care Act that is now in force, Medicare’s reimbursements to hospitals will be partially dependent on patient satisfaction scores, including bonuses that will be paid to the hospitals that show the highest rates of patient satisfaction. The “winning” hospitals will be determined based on patient satisfaction surveys. Patients will rate how well their doctors and nurses communicated with them, how responsive hospital personnel were to the patients’ needs, how clean and quiet the hospital was, how well their pain was managed, even how accurate and easy-to understand the accounting and billing was.
Again, this component of healthcare reform is not subject to "repeal" or the area of controversy in the political arena. "Both sides" of the aisle have agreed to these terms. So it can't be "wished away" or "ignored."
So what this means is that every reimbursement from every patient interaction or treatment will be subject to an "adjustment" factor. This is an annual multi-billion dollar impact. Measurements (and adjustments) will be made annually.
Here is an example of a NursesCount check-in screen. Just 2 radio buttons and no typing. A simple “how do you feel about your life at work today?” and a single “question of the day.” That’s it.
How can we help healthcare delivery organizations manage this on a wide-scale basis? Simple again. We provide dashboards, alerts and reports that display just this type of “early warning” or “confirmation” of great results. It’s kind of like a blend between an “early warning system” and a “magic mirror into the future.”
Here is one look at a dashboard:
In the context of the new healthcare reform Act and the “carrot and stick” consequences, this kind of inexpensive, fun (did we mention games and rewards for participation etc?) and simple engagement measurement is a no-brainer, in terms of “diagnostics” and “prognosis” for a healthcare organization’s financial performance and worker happiness level.
What is your view on this topic?
Let us know what you think below:
Discuss this topic in depth by joining the conversation in our LinkedIn group!
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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.
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 imperative.
Let’s dig-in.
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 chain.
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).
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 this business.
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...“
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 celebrate it.
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 “customer”):
-Caregiver workplace
-Caregiver job design
-Caregiver selection and development
-Caregiver rewards and recognition
-Caregiver tools for serving the patient
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 the case.
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 great quality?”
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.
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.
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 risk management.
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.
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 requirements—Caregiver satisfaction.
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.
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.
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).
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 info@workerscount.com 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.
What if 85% of the time your primary physician got the “issue” (what was wrong) correct, but in only 65% of the situations, got the treatment right? The good news? There are new processes and ways to catch that 20% and fix it before it becomes a bad outcome, and they’re part of the move from volume-based medicine to value-based medicine. It’s more complicated than simple “quality vs quantity.” And it comes down to things like patient involvement and engagement, and proactive self-monitoring, as well as the new M-Health (mobile health) devices and smart systems.
Last week we were at a talk from C. Martin Harris, the CIO of Cleveland Clinic, a world leader in healthcare innovation and service quality. He was presenting a talk called “Reimagining Healthcare Delivery Models” at the UC Irvine Center for Digital Transformation.
Fundamentally, he said, “we need to move from paying for volume to paying for value.” According to Harris, paying for value shifts the focus to quality, safety, and reliability. And this is made even more important as more and more care moves from an inpatient experience to an ambulatory setting.
To make more tangible how big a change has occurred here, Cleveland Clinic has 250,000 inpatient visits a year but 5,000,000 ambulatory visits. That’s 20X. Harris says this movement means they need to be able to manage the patient quality of care whether the patient is visiting them in a bed, via ambulatory visits, a “minute clinic,” and even an outside provider.
These changes means that the information management infrastructure needs to enable an extended clinician care team to work closely together for best outcomes and to avoid duplicative costs.
Fundamental to making this reality at the Cleveland Clinic is the electronic medical record. It has become the “atomic entity” for everything that they do.
From an IT techie standpoint, Cleveland Clinic’s view of the EMR is very similar to a configuration item in a configuration management database. IN other words, it is the core or source reference data container for everything that the many systems and applications touching it.
Just like a CMDB in IT, every application and service in the healthcare system builds off the electronic medical record. At Cleveland Clinic, their applications send and receive information to the electronic medical record. While not novel in that aspect, the way Cleveland Clinic uses the EMR is a great example of the power and potential of an extensible system.
Not surprisingly, Cleveland Clinic is seeing its data size grow. They have 6.7 million patient records, 49 million encounters, 104 million prescriptions, and 330 million orders. And they need the system to work regardless of patient encounter type. As part of this, they have cut a deal with CVS where “Minute Clinic” nurse practitioners cannot only view Cleveland Clinic records but also append them for services that they provide. Harris believes that their EMR system needs to work both inside and outside their hospital and this is what they have built.
Here’s how “Second Opinions” works: A patient outside their system can go into the Cleveland Clinic Online System and register to get what they call the Second Opinions “pizza box” sent to them. They use it to send copies of everything about their medical condition. The patient pays for this service with a credit card and then an appointment gets scheduled for pizza box.
Afterwards, a “Second Opinion” is sent to the patient as well as their Doctor. Harris said that they serve more heart patients this way than anyone in the world.
Harris says that their data shows the most important factor in improving a condition is often simple behavior change. Harris says the reimbursement system needs to recognize this. “We need move from managing the procedure to managing the patient.” Harris says this is a key element of moving from a volume business to a value business. He says that it is essential that healthcare takes this step or it will suffer the fate of Kodak. “Making this real, we need to move the investment from volume to value.”
And as teased at the beginning of this blog post, their Second Opinion service has found that 85% of the time the initial physician gets the issue right but only 65% do they get the treatment right. Harris is clearly right here in saying that we are entering a new world of healthcare.
What do you think about the shift from Volume-based healthcare delivery to Value-based healthcare delivery?
Come join-in on the discussion over at our LinkedIn group.
Healthcare Executives
Emphasize the Importance of Caregiver Engagement
Recently we met with a group of healthcare executives and shared our results from a pilot that we had conducted with a leading university healthcare organization. The initial results validated the strength of the relationship between customer satisfaction and employee engagement. This was very encouraging, and clearly more work and exploration needs to be done to understand and document this link. Our experts were not surprised at all. In this post we share some insights from these experts, around driving better healthcare organizations for caregivers and their patients.
The Healthcare environment can be an intimidating or even frightening experience for patients. There is a lot going on for the patient and the scene can often be a “busy” one. The first interaction is critical to building a positive patient relationship. Courtesy and a calm, confident, welcoming presence on behalf of the first point of contact in the office is absolutely critical.
Wait-time is a good example of the impact of communication, respect and common sense. Every minute counts - whether the patient is in a chair in the waiting room or waiting for the nurse or doctor in the patient exam room. The goal is to minimize uncertainty, manage patient wait-time and be aware of when you are delivering above or below your goal. Big take-away—does your healthcare organization have a goal, standard or benchmark for wait-times and patient communications? If you don’t have a goal, you can’t measure your performance against it.
Part of doing this well is making sure you can capture the patients’ thoughts and feedback before they leave the hospital or office. This needs to be embraced by all staff. It is critical to getting a "real" picture of the patient experience.
The organizational culture needs to be designed to support the staff. Sometimes it seems as though it is the other way around—we ask our care and admin teams to adjust and adapt to the organization’s customs and pre-existing practices…even when some of these may be suboptimal or outright dysfunctional. People define the delivery of healthcare. Crafting a system that enables and empowers the people delivering service will help ensure quality, engagement and continual improvement.
An important factor in getting this right is to get constant feedback and input from the caregivers and teams that deliver service. Their perspective and ideas will be the most potent source of process improvement, and they are core to implementing changes and experimenting with new process. Key take-away—How are you gathering frequent (if not constant) feedback and suggestions from your front line teams? And what are you willing to unwind (disrupt) some longstanding customs, practices and policies in order to bring about real change and drive constant improvement of the service quality of your organization?
One of the biggest differences between healthcare and other industries is the unpredictable nature of everyday operations, and the extreme consequences of bad events or outcomes. Nobody works in isolation. Any day, any situation, any patient interaction can suddenly go sideways for a hundred different reasons. This is why a culture of collaboration is so vital. Though leadership and process roles and customs must be well-defined, it’s even more important to build a culture of empowerment, collaboration and respect for all participants’ feedback and ideas. These front-line service providers are the most well-qualified people to help improve and optimize quality of care and underlying processes that support them.
Measuring is the first step to managing. We have measured both caregiver and patient satisfaction and engagement simultaneously. It was exciting to see the relationship over time. One of our experts said that he had never doubted the connection between employee and patient engagement. The findings in the WorkersCount pilot are helpful for two key reasons, 1) they reinforce the need and value of frequent and timely feedback to drive meaningful and continued improvement and 2) it shows very high correlation between engagement and satisfaction.
Another of our experts discussed the “internal customers” (staff) and how their role and level of engagement was absolutely integral to patient/customer satisfaction. Clearly, all good organizations recognize the importance of retaining valuable employees. There is a clear connection between employee turnover and the bottom line financially. Nurses who love nursing need to be enabled by their organizations. Investing in training is one way to retain healthcare workers-it's a sign to their employees that they are valued. Winning organizations focus attention on both the internal and external customers.
Our experts not only validated the importance of the WorkersCount result set but ascribed importance to the ability to measure and manage healthcare employee and patient engagement. As one expert put it “the happier the employee, the happier the customer-this generally holds true for healthcare as well”. As healthcare leaders, we need to invest creativity and energy measuring and managing engagement of those that give care and then those that we serve.
What's your take on this subject? Join the discussion over at our LinkedIn group.
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A lot of ink has been spilled over the relationship between worker engagement and customer satisfaction. In some of the WorkersCount and NursesCount blogs we have touched on this (“the secret to driving service as a business differentiator” and “which comes first, customers or employees?”). In healthcare it is a widely accepted linkage, as it is also in retail and most personal-service industries. Yet it has been limited to “truisms, common sense, wisdom from experience and anecdotes.” It has indeed been an elusive connection to document. Until now.
WorkersCount and NursesCount (and PatientCount) simultaneously monitor both worker engagement and workplace satisfaction directly against customer (patient in healthcare) service satisfaction and outcomes. This is an industry-first in healthcare and all of general industry in terms of data modeling and actionable insights. And unlike any data service, this data is gathered is in real-time, on a daily basis.
A Case In Point
Warning signs and risk areas
In a healthcare client of WorkersCount, the challenges were several. The first challenge: Move the general customer engagement index from 4.6 (out of 5) upwards towards 5. Even a small increase in this index is very difficult, yet executive management felt strongly that this was a mediocre score, and signaled problems.
The next challenge: Address a recently exposed problem of engagement in a particular cohort (in this case, workers with over 5 years of tenure). There was a plateau and even a slide in job satisfaction. Executive management felt that this was a particularly high-risk item, as these workers represented key experience, expertise and were in leadership roles working on business-critical projects and programs. Turnover in this area would be particularly painful and potentially disastrous to the organization.
The WorkersCount (and NursesCount and PatientCount) process
The exec team implemented WorkersCount’s daily check-in service, which was done without the need to dig-into the HRIS system or any proprietary or sensitive system in the healthcare organization, including HIPAA or HCAHPS areas. It runs independently in the cloud and uses social sign-on to make daily check-ins (a hallmark of WorkersCount’s services) fast, fun and easy. It’s a daily reminder with a link, and a 30-second check-in process that’s anonymous. It asks workers only two questions: a baseline “how is your life at work today” question, and a second “question of the day” that rotates among a broad list. Only two questions are asked per daily check-in, so it’s fast and fresh every day.
A bit of fun on the way to 30-50% daily participation
Workers were encouraged to participate (voluntary), with the pledge from management that this was a safe, anonymous way to make their voices heard, and to help drive a better workplace for all (workers and “customers”). Using simple gamification to inject a bit of fun, and keep things interesting, individuals were rewarded with lunch, or cinema tickets, or dinner at random, or from groups that had high participation. The system does not link any particular user “votes” or input with a user identity. It is completely anonymous.
With a daily pulse on employee engagement, managers could actively manage employee engagement and make adjustments in days, not weeks or months. They could see where they were strong and where they were weak. They could see where they had engagement gaps, take actions, and actually see whether their actions resulted in real improvement. The system became a daily and weekly insight or “pulse” of the organization that could be used as a true management tool.
Startling results
By the end of the measurement period some startling discoveries were made, both from the raw data and more importantly from the interpretation and insights of the reports and data by the management team, working groups and nursing staff.
Here are some highlights:
Eliminating “hell days”
Wednesdays and Thursdays were particularly low days. Upon review of the data week-over-week and in context with benchmarks, the nurses council and the exec team hit upon an obvious, but hidden issue. Surgeons were scheduling elective procedures on Monday and Tuesday. Backlogged procedures were stuffed into Wednesdays and Thursdays because many surgeons had a habit of taking time off on Fridays.
Quick and effective adjustments
These are the simple and inexpensive fixes
that were able to be made immediately (not months after complex analysis): Manage overall scheduling more carefully to
spot “stuffing” trends like this, and manage doctors more closely to prevent
mass exodus on Friday (or any day) --
for whatever reason.
Cost- nil. Impact: Great. Timing: Immediate.
Diagnosing the “happiness plateau”
A completely hidden set of issues emerged with respect to the more experienced managers. These were the ones with over 5 years of tenure, and had the lowest scores around overall job satisfaction. In fact only 29% of this group reported being happy about work. This was a huge risk area. What the service quickly exposed were several gaps that executive management did not see coming:
· 40% had to work long hours to get things done
· 53% were not satisfied with the recognition they received
· 50% did not feel they had a positive work environment
and the most alarming bit of information that workers willingly shared:
· 43% were regularly taking calls from recruiters
These were the most experienced and seasoned managers in the organization. They had apparently been “suffering in silence” for some time—perhaps years. Yet the exec team had not been able to surface these straightforward management gaps until now. And it was done in weeks, not months.
Swift, simple and inexpensive solutions
Solutions were swift and obvious. Re-evaluate project timelines and expectations. Get more frequent feedback on staffing levels for projects and departments. Make it a formal priority to give recognition and credit for projects that may have been “invisible” to all but a few. Go deeper about ways of creating a more “positive” work environment. Track workers into career paths that were exciting and meaningful within the overall organization.
Cost: nil. Impact: Tremendous. Timing: immediate.
Update—this group posted an immediate 17 point gain in satisfaction, dropped their “willingness to take a recruiter’s call by over 50% and contributed greatly to the overall organization's 13 point overall general engagement improvement.
This was in just 120 days. The process is still accelerating and improving at this organization.
When the “standard” customer survey was tabulated, management was able to post the increase they were looking for and more. In just 120 days the 4.6 score jumped to 4.75, which was a very big single-period swing, and it continues to edge upwards.
What about customer satisfaction? Did the elimination of “hell days” (Wednesdays and Thursdays) and the other changes impact “customer” satisfaction as well? It did. The external customer satisfaction index climbed substantially during this period, after a pattern of decline. Here’s what it looked like when compared together:
Take-aways
We have mounting empirical evidence that links worker engagement to customer satisfaction. More importantly, using the WorkersCount methodology, reporting and check-in data, management has shown that hidden issues emerge quickly, causes are identified more rapidly and fixes or changes can be implemented (immediately in some cases) that are inexpensive and have high impact across the organization and customer base.
It doesn’t have to be hard, and the adjustments and "course corrections" need only be small, as long as they are part of a continuous improvement drive from good to great. All organizations need to do is decide, then make a commitment and then listen to workers and customers. It's astounding what your customers and workers will tell you ---if you only listen and give them a voice. The rest will quickly emerge from the talented and committed teams across the organization.
In the journey from good to great, this is one of the lasting lessons: listening works.
What's your view? Come join the conversation on this topic and many others at our LinkedIn Group.
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It is time to measure the pulse of the nursing
profession and healthcare organizations in general
Healthcare delivery is a complex and highly technical process but it is delivered 1:1 by people (primarily nurses) in an intimate setting. In fact, the people delivering this service matter more than the science, technology or equipment put together. It’s a startling realization that is just now starting to reverberate within the healthcare community.
“Bedside manner” is no joke. The state of mind, emotional focus and engagement of attending healthcare workers (again, predominantly nurses) is often the dominant factor in determining patient satisfaction and even patient outcomes. It is certainly cited as a major factor in medical errors (and in preventing them), according to JAMA and others.
According to Barbara Balik, RN, Ed.D, senior faculty member of the Institute for Healthcare Improvement (IHI), “We can only treat patients as well as we treat one another.” A 2009 Forum Group report titled “The Relationship Between Employee Satisfaction and Hospital Patient Experiences,” found that efforts to create higher employee satisfaction have a very desirable outcome on patients, including increased patient satisfaction, improved care quality, and increased patient loyalty.
Given this, the ANCC has made a survey of the nursing population part of the Magnet Recognition Program®. But how does one drive real improvement in nursing engagement from the perspective of a nursing manager ?
Shouldn’t it be as easy as what happens every time a nurse visits a patient? Simply put, why aren’t we regularly taking the pulse of the nursing profession, just like nurses do for their patients? A daily pulse would answer key questions about the state of the nursing profession. How engaged are nurses? What are the major issues and concerns for nurses? It would extend from measuring from the simpler things like personal recognition to the more complex topics including communications and rewards. It just makes sense to have more frequent, if not real-time information about how things are going for our healthcare professionals. We need them to perform at incredibly high levels of engagement and mental presence. And we also need to know (in real time) when there are roadblocks that my make this difficult for them.
In the WorkersCount service that engages at the general worker population across all industries, we have found that the dominant pain-points for employees are often the simple fundamentals. Feeling like you are part of the team? Only 38% said that co-workers get to know each other. Feeling recognized? Only 29% felt appreciated at work. And only 59% feel their accomplishments were consistently recognized. Knowing where their career is going? Only 36% claim to know where their career is going. There is a great deal of opportunity emerging for corporate leaders, and incredible insights happening daily for the participating workers as they gain perspective and context for their experience and quality of their lives at work.
In response to the needs of healthcare organizations and the fundamental importance of nurses to healthcare, we have created the first daily engagement service dedicated to the Nursing and allied healthcare provider population. NursesCount goes beyond basic worker engagement and dives deeper into the factors that drive world-class care, including industry-specific workplace and organizational barriers as well as bright spots. These workers are the best qualified to provide a self-reported daily pulse on the “health” of the healthcare delivery system.
The new NursesCount service is totally anonymous. Trended benchmark analytics is provided to hospitals wanting to go from good to great, and connect more effectively with their workers. Nurses that participate get a daily view into how other nurses at their hospitals answered sentiment and questions of the day by their hospital and their hospital unit. The longitudinal nature of the data creates new insights across organizations and departments, as well as in comparison to other healthcare organizations.
Everything happens in less than a minute, as
nurses check-into NursesCount using a mobile phone, tablet or a laptop—whichever
is easiest and most convenient for them.
The NursesCount service provides users and their healthcare organizations always-fresh data that enables them to drive real improvement and stay at the top of their game all the time. Because that’s what patients expect, and that’s what nurses and allied healthcare professionals demand of themselves and of their organizations.
Together with the companion service “PatientCount” (the new standard of patient service quality reporting) the healthcare organizations working with us are ready to leap ahead of competitors and blow-away expectations of patients. It’s like moving from a typewriter to a laser printer. And the metaphor is not that far away from what’s really happening in terms of speed and quality.
What’s your opinion about healthcare quality and engagement today? How will your organization take control of the process?
Come join the conversation at our LinkedIn Group today!
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