The X-Factor that can kill your hospital or make it thrive

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.

Because when the brand slips, the entire healthcare enterprise starts to unwind and spiral. It’s not pretty. As one CEO said “if the care teams stop favoring my hospitals and clinics, and move their procedures and patients away to competitors, as a CEO, I’m cooked.”

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.

Engaged care teams impact perception of quality from the moment patients come into contact with their healthcare provider at reception, to the last interaction with the billing department.  Think of the billing department as the poster-child for your brand’s great quality.

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

For quality of care (a major determinant of healthcare reimbursements), the highest influencing factor according to the study is nursing care, followed by staff responsiveness. The impact of the admissions process, physician care, and the treatment room experience was less than 20%. Message: If you are losing sleep over reimbursements take better care of your nursing team and staff.

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.

What does this have to do with our X-Factor?  Everything!  Healthcare CEOs are staying awake at night because they recognize the interdependence of having the top care teams and of providing the best working environment and best engagement.  It can be a matter of life and death for the patients and now it’s a matter of economic survival for the healthcare institutions. More than ever, it is the patients that are “defining” the quality as “customers” in a consumer model.

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.

What keeps Hospital CEOs awake at night?

What keeps Hospital CEOs awake at night?

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.

Healthcare delivery needs to change

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.

  • We need to meet more of our patients in the outpatient setting.
  • The emergency room can no longer be the first choice or “default” for access to healthcare    
  • We need to move from transactional care to more of a capitated system as quickly as possible.
  • We need to align the incentives to make “quality care” the way that we operate.

Healthcare must leverage technology to enable new mechanisms of care delivery

  • We must be more effective in our use of resources and technology to shorten each patient visit so that closer to 100% of the interaction is focused, high quality time with the caregiver, not the administrative, scheduling, billing or medical record retrieval infrastructure.
  • We need to have a real option for 5-minute WebEx type visits.                                                                                                                     (This should be a mindful complement to extended visits, not a blanket, blind replacement)
  • At the same time, we need intelligent systems and experience data we already possess to leverage temporal patient-provided data and smart alerting. This will enable us to detect patient problems and actionable risk conditions even before the patient is aware of an issue or symptom.

Healthcare organizations must specialize and partner more

  • We need to focus on establishing local centers of excellence
  • Healthcare is better the more frequently it is delivered
  • Every local organization cannot be good at every discipline
  • One major IDN described how they are using other major hospitals for their specialties that they do not have (by choice)

Hospitals must get better at what we do

  • Hospital leaders must realize that they cannot “make up cost on volume”
  • We must be effective and affordable
  • We need to reduce the variation in care in the healthcare system

High quality care is low cost care

  • We need to go after the causes of (avoidable) additional cost aggressively and creatively
  • Patients trying to stand up without assistance can increase treatment costs by $80K-$90K.
  • Hospital acquired infections are often attributable to simple failures of basic processes

To reduce infection and errors, we must ensure that we have well-functioning teams

  • To go after infections, we need nurses and doctors exhibiting best practices.
  • We must reduce the (up to) 20% readmit rate. Discharges resulting in readmission can wipe-out profit, and more importantly damage our brand and inconvenience (or harm) our patient. 
  • For example, we need ortho patients to go home understanding that they may not jump back on the treadmill immediately after a procedure.
  • Heart patients must understand clearly that their role in their recovery involves specific lifestyle changes (and why compliance is not optional)

We need to do a better job at patient experience

  • We need kind and compassionate nurses.  For the vast majority of hospitals, this is already being done very well.  However our patients need to feel our care more, and we need to increase our “frequency of touch.”  Consequently we are spending more time rounding.
  • We need to keep up our great patient satisfaction scores as well as the HCAHP levels. We certainly need to maintain our great brand and reputation. What has become clear to all CEOs is that these factors collectively impact our ability to continue to attract and retain top ranking doctors and caregiver teams.  This flows to our brand and our ability to continue to acquire new patients.

Conclusions: We need to move faster

  • Healthcare as an industry has moved relatively slowly in process and culture change, because we have always been cautious to “first do no harm.”
  • But we need to innovate and “iterate” rapidly today in order to survive in a fast-changing and highly competitive environment that is not tolerant of laggards. 
  • There is great disruption and innovation, and that is a great thing for our industry, our patients and our caregivers. 
  • By embracing innovation and “rapid iteration” in our use of technology, our experiments with new processes and approaches, we will all win. 
  • Failure to move ahead to innovate and “iterate” quickly is equivalent to placing ourselves at the end of the group or “the herd.”  As anyone who has ever visited a game preserve can attest, the rear of the herd is not the place one wants to find themselves in a competitive world.

What do you think about these ideas?

Please join in on the conversation!  You can find it at our LinkedIn discussion group:

“Every morning in Africa, a gazelle wakes up, it knows it must outrun the fastest lion or it will be killed.  Every morning in Africa, a lion wakes up.  It knows it must run faster than the slowest gazelle, or it will starve.  It doesn't matter whether you're the lion or a gazelle-when the sun comes up, you'd better be running.”

 -Christopher McDougall, Born to Run: A Hidden Tribe, Superathletes and the Greatest Race the World Has Never Seen


“Lack of teamwork and communication kills”

Announcing a LinkedIn group dedicated to engaging today’s nursing teams

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 have always been worried about patient satisfaction, avoidable clinical failures (hospital acquired infections, re-admits, falls), and growing their patient/customer base.  They also worry about nursing, physician and staff perceptions about their hospital as being a great place to refer patients and a great place to do their craft.  This goes to brand, work conditions and internal perceptions about quality of medicine and work environment.

Patient satisfaction and perception of quality is getting more attention because “patients who are satisfied (read “engaged”) tend to understand and comply with the treatment prescribed by the healthcare provider and are therefore, more likely not to go doctor-shopping (Eisenburg, 1997).

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. 

A culture of caring starts by caring for those that are giving care.

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.”

Revenue and Brand Impact in a competitive environment

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. 

Perception of quality of Care

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.

For these reasons, we have created a LinkedIn group focused on Nursing Engagement. We invite you to join and share your secrets to engaging the nursing and support staff as well as creating a true culture of caring. Here is a link to the Nursing Engagement group.

What's your view?

Nursing Leaders must engage the newest team members

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.

Newest member treatment: Do nurses really eat their young?

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.

Worse yet, the cost of RN turnover can have a profound and tracable direct impact on hospital margins. According to a March, 2013 NSI report, the average cost of turnover for a bedside RN ranges from $36,000 to $48,000 resulting in the average hospital losing $3.7 – $5M per year. Each 1 percent increase in RN turnover costs the average hospital $300k. While an overwhelming majority of organizations view retention as a “key strategic imperative” it is often not put into practice says one of our nursing leaders.  Hear that sucking sound?  It's the sound of care quality and revenue dollars going down the drain due to unnecessary RN turnover.

There clearly many factors that contribute to poor engagement of young nurses, but one healthcare leader said that one that is often overlooked is that healthcare is one of the most highly emotional industries and the people who are providing care don’t always know how to manage this factor.


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.

2)     Care for the whole person. Health care leaders should involve bedside nurses in models that focus on the mental, as well as the physical aspects of patient healing and employee care. Caring for the "whole-person" benefits nurses and patients alike, and health systems can ultimately improve efficiency, patient satisfaction, readmission rates, and cost savings if bedside nurses are involved in this type of dual mindfulness.

3)     Create a culture of safety. Use tools related to Culture of Safety to understand the issues impacting the patient.  Nurses (even the grouchy ones) are often startled when they begin to recognize how their nurse-to-nurse behaviors can create a negative outcome for the patient.

4)     Make new/existing people feel they part of the team. Make new people feel that they are a part of the healthcare team in a way that enables them to know their contribution is valued.

5)     Creating a supportive and just culture. Create a supportive and just culture, encouraging learning and ensuring Immediate inclusion into the social structure of the team.

6)     Make it okay to ask “stupid questions”. Any behavior not supportive of asking "stupid" questions, identifying and speaking out regarding risk in the environment, and not enforcing "see one, do one, teach one" , should be addressed immediately.

7)     Create standards of behavior. Create standards of behavior and a "commitment to coworkers” protocol. Embed this into orientation and performance evaluation tools. Do internal customer service surveys often to identify by department how you are doing in treating each other as important customers. Weed out detrimental behavior, similar to "hazing" in a frat house.

8)     Make it okay for nurses to seek care. All the "caring" is spent on the patients often leaves the individuals bereft of the ability to self-care and to care for each other. Even “Super-Nurse” isn't always truly caring for herself.  Make sure to be clear that "caring" doesn’t only apply to the patients and is imbedded into the total organizational culture.

9)     Managers protect employees from actions that don’t reflect a caring culture. Managers have to fiercely protect staff from any organizational behaviors that are not reflective of "caring". Your staff needs to know that you truly care for them.  The synergy of a caregiver team increases exponentially and patients know they are being cared for in a truly authentically caring environment.

10)  Creating an experience mix. The ideal experience mix is that of older RNs, medium-timers RNs and inexperienced RNs blended together. This sets up what Pat Benner describes a learning situation where the senior RNs have responsibility to share their knowledge with the younger RNs. The younger RNs can bring their enthusiasm and energy to the workplace and that with the sharing of experience will both benefit the team and it's growth and performance.

In summary, nursing leaders need to make sure that younger nurses are integrated into the team quickly and are treated in a supportive manner. Only in this way can nursing leaders make real progress to engage, grow and retain the next wave of caregiver team members.

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.

Is the system of patient feedback and caregiver engagement stuck in the horse-and-buggy era?

In 2014 are we using a horse-and-buggy system of caregiver team engagement and patient feedback?

Is it possible that living in the most highly connected, wired and always-on world, we persist with processes and business customs that were “current” at the turn of the last century?  (no, we mean 1900 not 2000). 

Those were the days when feedback and communication flew at the speed of horses or trains (feedback in weeks or months via letter and courier).  With secure mobility, real-time feedback and instantaneous results a reality (and not Dick Tracy or Flash Gordon-style fantasy), why would we ask less of ourselves in the most important industry and processes of all—keeping our loved ones healthy.

Geoffrey Moore used the term “Systems of engagement” to describe how employees communicate with one another, which he believes is driven by technology in new ways. Gary Hamel suggested that the industrial age has reached its limits of improvement. What does this mean for nursing and other healthcare leaders?

Just listen to several recent real-life discussions at a major hospital nursing counsel and with their executive team, on driving real improvement in engagement and quality:

Nursing Individual Contributor
“I don’t get to spend enough time with top leaders.  The organization has grown so large that I no longer have the access I had, and I feel I can’t share my big ideas about ways to improve.”

Nursing Unit Manager
“We have employee engagement surveys, but they’re too infrequent, the information is dated and the working groups change by the time we can see the results.  We want to work on “continual improvement” but our information won’t support this.  We’re stuck. “

Nursing Individual Contributor 2
“Why do we have to have infrequent surveys that have stale questions?  Why can’t we collaborate on the questions, conduct shorter surveys more often, and use technology more effectively?”
-And elsewhere in the healthcare organization:

Chief Patient Experience Officer:
“I want to know right away when my patients are thrilled and when they are angry, not two or three weeks later or months later when feedback trickles in via email or paper. And I can’t easily tie the response to a caregiver shift or team or set of circumstances.  There’s no context.  It’s very frustrating not to be able to address issues when they first pop up, and are simple to fix with a few adjustments or quick communications.”

“I can’t see what’s happening in real time below the first level of my management team.  I need something that gives me a daily pulse, both in patient feedback and in caregiver team engagement”
What are some of the take-aways from these discussions?
a)  Caregiver teams, managers and patients have a common interest in driving better quality, better employee engagement and better methods of feedback. They have just not had the tools to manage this process in real time (always “looking in the rear view mirror”) with a unified view of all factors.
b)  All parties recognize the value of more current, (optimally something closer to real-time) information to drive continual improvement efforts
c)  It is widely recognized that the current feedback “systems” are broken, outdated and provide stale and relatively non-actionable data.  Universal recognition that today’s feedback systems suffer from the “Yelp” effect (extremes), and at any rate are out-of-date and disjointed – all “looking in the rear view mirror.”
d)  Patient feedback coupled with caregiver team engagement level (in real time) is the last missing factor in service quality assurance in healthcare.  Until now, there has been no simple and “fun” solution to this vexing issue.  Everybody wants it—patients, caregiver teams, healthcare organizations and payers.  Now it is here.

It’s not all bad news.

WorkersCount real-time Patient feedback and caregiver team engagement services
What we call “the daily pulse of healthcare service quality and engagement” and WorkersCount is inside these meetings with daily feedback from caregiver teams and patients, using mobile technology and friendly, simple check-in style behavior.  Our real-time services including NursesCount, PatientCount, and others, provide this “daily pulse” that leadership is using to manage looking forward, not backwards, to drive and sustain quality and engagement excellence and world-class service.

Look out Geoffrey Moore, we’re about to leverage small technology (phones and tablets) to drive big changes in the “systems of engagement” across caregiver teams, managers and patients in real-time.  It’s about time we started acting like it’s 2014 and not 1914.  Fossils?  No more.
And for Gary Hamel and having reached the limits of the industrial age’s improvements?  We think he is spot-on.  We’re moving on to what’s possible with the tools and behavioral customs in our new digital and mobile age.  Lots of room here. 
More like a wide open road.
What do you think?

If you would like to discuss this further, come join us in our LinkedIn group and exchange ideas and experiences with others working to improve the patient experience and overall healthcare industry.

Is that "million dollar smile" really worth a million bucks? Now it may be.

 “Just The Facts” research insight series

From time to time we will use the "daily pulse” blog space to share insights about healthcare working and workplaces with our community.  Today’s post is dedicated to healthcare workers and how this impacts the quality of your care.  If you happen to land in the hospital or urgent care, these are workers upon whom you depend for treatment, care and handling and well-being.  Sometimes your very life depends on their care and their “engagement” with their work.

"When that “million-dollar smile” from your nurse or healthcare worker can really mean a million dollars"

Hospitals and healthcare delivery organizations have long since been “local” one-off affairs, with long-term workers and friendly, familiar workers (many of whom may have been your neighbors).  Sadly, these organizations have consolidated, the healthcare system has expanded, and these are now outposts of extremely large and complicated corporations. 

This is not to say that the great folks who dedicate their time to treatment and care of others are not wonderful.  This is simply to suggest that life “inside” of a huge healthcare organization is no longer simple, nor is it free from many conflicting priorities, complex paperwork procedures and legal mandates…. Which all contributes to a sometimes frustrating working environment, to say the least.   And this is what you walk-into when you are ill or injured.

Is “attitude” and “engagement” and workplace happiness relevant to healthcare delivery quality?

Yes it is.  That grumpy front desk receptionist, or that grouchy advice nurse can really do damage.  Similarly, that angelic nurse practitioner or on-duty physician’s assistant can turn disaster into “problem solved” for patients.  It’s that important.  Traditionally that has been the concern of marketing and "brand" chiefs at hospitals and healthcare organization.  It is still very important in the new hyper-competitive era.  Just listen to drive-time radio and you can hear at least two or three healthcare systems in your region battling it out for the loyalty and hearts and minds of consumers.  The "brand" war (for patient loyalty) has been raging for some time. 

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.

Until now, it has always been more anecdotal to say that engagement also affects the business top line or bottom line. Whether you agree or disagree with what is known as “healthcare reform” (The Affordable Care Act), there are new rules inside that act that have changed this equation forever for healthcare organizations.  

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.

Let’s now connect the dots.  Happy workers result in happier “customers” and a higher level of satisfaction.  Happy workers = happy customers (patients) = more revenue / earnings to healthcare organizations.  Unhappy workers = unhappy customers (patients) = less revenue/ earnings to healthcare organizations.  And this is more than pride.  This is a matter of millions of dollars per institution.

How this new “carrot and stick” concept works:

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." 

All of a sudden this “happy workers = happy patients” is of central focus.  While we suggest that most great healthcare organizations have always put “happy patients” and superior patient care at the top of their priority list, this gives the entire topic a new and super-charged level of importance.

Worker satisfaction and happiness is a leading indicator for patient satisfaction and thus a leading indicator for financial performance and reimbursement trends at these organizations.  It won't stop at Medicare reimbursements.  The industry's payer community (the organizations including HMOs, Insurance companies, et al) will shortly follow in lock-step, once the Medicare standards and metrics are in existence for a sufficient period that they can be referenced as defensible "government standards."  This may be only a matter of several years.  

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.

Can you “track” and “manage” worker happiness with an annual or Quarterly survey?  It’s possible, but as sailors know, making frequent, small adjustments to direction is much better than discovering you are hundreds of miles off-course after a few days or weeks between measurements.  The same applies to worker satisfaction and happiness measures.  Daily polling, using simple, short (and even fun) reporting experiences, will give everyone a much better read of (pardon the medical pun) the “pulse” of the organization’s happiness.  With such an early warning (or affirmation), it’s much simpler and easier to alter course, or do more of what’s working.  It’s just common sense.

WorkersCount's services called "NursesCount" and "PatientCount" (and others) are examples of such a daily service—and they provides the daily “pulse” of the organization’s worker satisfaction and happiness, as well as patient satisfaction.  Using a fun, simple mobile experience, the NursesCount service enables caregiver teams to “check-in” multiple times in a day (or just once if they wish), and make their voices heard.  If they’re excited about work, it shows.  If they’re frustrated, that also shows.  All anonymously and safely.  Games that reward users for prompt regular check-ins and other fun interactive features keep it light and engaging.  Users are in-and-out in under 30 seconds…. So they can get back to their work providing amazing care to patients!

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.

For patients, its just as simple.  During "rounding" (visits from caregiver teams), the patients are handed a tablet and provide feedback in a similar, 30-second experience with four simple questions.  A constant question ("how is your hospital stay going so far?") and three rotating questions below it (one about the caregiver team, the other about the environment, the other about their care plan).  Like NursesCount, it is private, anonymous and fun.  Patients love giving feedback this way.  For outpatient and ambulatory services (like urgent care and walk-in procedures) the patients use a tablet-based check-out podium that provides them the same level of feedback, anonymously and privately in 30 seconds on their way out the door.

This provides the first single view of service quality and engagement across the entire healthcare organization.  Most importantly it is the only real-time service of its kind.  This provides a unique daily view for leadership, that can be used as a real management system.

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:

All of this from two radio-button questions per day per caregiver, and four from patients.  

In summary, there is no better way to measure worker happiness and satisfaction than walking around and watching and listening and engaging with workers.  But this is difficult to do on a daily basis in today’s reality.  One tool to keep an eye on the “pulse” of the workforce is the NursesCount service.  And there's no better way to discover patient sentiment and satisfaction than while they're right in the hospital or clinic, and the experience is real-time.  This is what PatientCount is doing.

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.

The next time a healthcare worker gives you a million-dollar smile, a pat on the shoulder and a kind word, remember that, in fact, it could very well be a million-dollar smile if that’s what you walk away wearing as well.

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!  

Spotlight Blog: Healthcare and the “healthcare profit chain” – what it is and why it’s important

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 change. 

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. 

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… 

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).

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 outcomes alone. 

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. 

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 and accountability.

Introducing the Healthcare Profit Chain

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 celebrate it.

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 “customer”):

-Caregiver workplace

-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 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.

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 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.

How do you manage this so you can improve?

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. 

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 happen.

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 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.

Is the healthcare system prepared for the shift from “volume-based” to “value-based?” Are patients prepared?

The 85/65 dilemma:  The value of “Second Opinions” and the EMR

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.

Doctor Harris opened his talk by saying that healthcare has been a “volume business” for the last 250 years.  But with 10,000 Americans retiring every day, that delivery system will not continue to work.

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.

Cleveland Clinic’s basket of applications provides clinical, patient, scheduling, and analytical insights. They have names like My Chart, My Consult, and My Monitoring.  My Monitoring ingests and aggregates data to share with clinicians from all forms of intelligent monitoring devices and then detects issues and directly alerts a physician.  This includes implanted devices like pacemakers and increasingly the new class of mobile devices like glucose monitors and wearable blood pressure and heart monitors.  A rules-engine then helps them sort out what matters and what is actionable.  According to Harris, they want to be the “virtual On Star System for healthcare” and then turn all this data into healthcare informatics.

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.

Like many other EMR advocates, Harris sees mobility as the game changer. You should be able to make an appointment from wherever you are.  Mobility is about improving standard of care. In a short period of time they have grown to over 9,000,000 users of their mobile healthcare apps.  They are using Health Vault to create the inside/outside view.  Harris wants to create care teams that collaborate across different healthcare exchanges.  An example given was “Second Opinions.”

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. 

Caregiver Engagement- The most important component of service quality

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.

First impressions last a long time

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.

Organizational culture must support the staff in achieving excellence

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.

A single view of service quality and engagement

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.

Conclusions—Great customer service demands better, more frequent measurement and management everywhere

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.  

The proof is in the pudding

The proof is in the pudding

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:


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.