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.
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 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 firstname.lastname@example.org and start following us at @workerscount and @nursescount on twitter. WorkersCount is the provider of NursesCount, PatientCount and other healthcare industry services and platforms that help healthcare executives and their teams drive and sustain world-class service quality and engagement.