February 3, 2014
For the past several years, healthcare executives have ranked improving the patient experience among their top priorities. The Agency for Healthcare Research and Quality's Consumer Assessment of Healthcare Providers and Systems program has been a monumental game changer across the industry, bringing with it two unprecedented realities-transparency that places satisfaction scores squarely in the public domain and the impact the CAHPS program has made on reimbursement. These two elements have been pivotal in elevating patient experience from "nice to do" to "necessary." In order to build brand loyalty and consumer confidence, healthcare organizations must deliver consistently positive patient experiences.
As healthcare organizations strengthen their commitment to improving the patient experience, it becomes essential that managers are engaged in order to ensure consistency and accountability at all levels. The challenge for senior leaders is that engagement won't happen through policies, mandates or task lists. It happens through transformational leadership that helps each individual connect to the customer and to his or her sense of purpose, while maintaining focus and stringent accountability. It occurs through a passionate and persistent commitment on the part of the executive team.
Create a Framework for Success
Senior leadership, including leaders at the C-suite level, must create a foundation on which the patient experience at their organizations can flourish. Leaders must:
Create focus and define the strategy. This means including the patient experience as a strategic imperative, taking direction from the strategic planning process and tying patient experience back to business planning, right down to the service-line level. At Cooper University Health Care, the senior leadership team cascades the goals across their respective areas of responsibility. By cascading organizational goals for overall patient satisfaction to a department level, organizational targets are translated into more meaningful goals for front-line managers and their teams. Every department, unit and/or service line knows specifically how it impacts the overall organizational goal.
Activate the strategy-develop rigor and accountability. This is accomplished by prioritizing key events and defining clear expectations. In addition, you must create an operating work plan with clear goals and objectives cascaded across the organization and quantified through a balanced scorecard.
Engage the organization at all levels. You must tie service back to your organization's mission, vision and values and create nonnegotiable service standards. Providing leadership development encourages managers to hire, coach, mentor and model service behaviors. In addition, you must ensure a positive work environment and help remove barriers that impede service. You must also align incentives for both clinical and nonclinical staff members and be clear and consistent. It is imperative to connect the entire team to the patient experience-what we like to refer to as "the heart of healthcare."
Measure results. This involves conducting monthly and quarterly reviews of core measures to maintain focus. At Cooper University Health Care, a "stoplight" dashboard method is used to track performance. A monthly review is conducted at an administrative council meeting attended by manager-level leaders and above. Quarterly reviews are more detailed and include broader discussion about how adjustments are being made to move "yellow" and "red" performance to "green." Quarterly reviews include members of the senior leadership team and physician leaders.
Once the high-level framework is in place, senior leaders must focus on engaging managers, directors and supervisors. It's important to realize that fostering a culture of engaged leaders won't happen by chance, but it can be achieved by design.
Six essential steps for building an engaged culture
1. Get crystal clear on the current reality. As important as the survey data is for benchmarking and trending, the numbers do little to engage the heart. In fact, in many organizations, the data is merely an excuse to challenge the methodology or cite excuses for low patient satisfaction scores. It can sometimes be difficult to find the "voice" of the patient in quantitative data. That's why it's important to cull the surveys for comments and stories that will bring the data to life. In addition to the survey comments, look to qualitative data to find patient experience stories.
Some of the best qualitative methods for understanding the patient experience are mystery shopping with photo documentation, ethnography studies, in-depth interviews and focus groups. Each of these methods provides an opportunity for a deep dive into patient perceptions, expectations and emotions, painting a picture of the current reality. Once the current reality is revealed, senior leaders must map a clear course for improvement.
2. Raise service awareness. Raising service awareness takes more than posting quarterly satisfaction scores on a bulletin board. Leaders need to engage staff members in a dialogue that shares stories revealed through the various research methods. The dialogue can help staff members understand patient needs, expectations and perceptions. Storytelling and discussion help the data become a reality and move information from the head to the heart.
In addition, leaders can facilitate discussion with team members to identify the department's customers and their expectations. They can also chart a pathway to the patient, including key encounters, and set a clear expectation for management rounding.
Remember that not every department serves patients directly, so it's imperative to help employees working in those departments see that they are serving others who serve the patient. Raising awareness of service in nonpatient care areas may require interdepartmental surveys to learn how well support services are serving direct patient care areas.
3. Promote consistent service delivery. Once the leader has defined the customer and core expectations, it's time to drill down into how service is currently delivered to learn what is going well and what areas present opportunities for improvement. By engaging front-line staff members in discussions, leaders will be able to build buy-in for change.
The service delivery step is where you define clear behavioral standards and follow with staff member training and coaching. It's an ideal time to reinforce their ties to the mission, vision and values of the organization and to patient satisfaction scores. Clearly defined standards also help target ideal candidates for hire. Once you are clear what you are looking for, the search is easier.
4. Engage in service recovery. No matter how hard we try, things may still go wrong in care delivery. That's why having a clear service recovery structure in place can make a world of difference in satisfaction scores. This requires more than giving patients a basket of coupons for free coffee. Real service recovery starts at the senior leadership level where parameters are defined and efforts are rewarded. It includes training and ongoing coaching to help front-line staff apply critical thinking and expert communication skills.
5. Define the senior leader's role. The senior leader's role is defined in the C-suite framework above. The key elements are to tie the patient experience to strategy, define metrics, hold everyone accountable and maintain laser focus. Know the data and be a role model. When you waver off course, you send the message that the patient experience isn't an organizational priority. You may not only backslide but could lose personal credibility.
6. Define the director and manager roles. First and foremost, the director and manager must be role models who own their own behaviors and ensure they are aligned with core values and behavioral standards. Leaders must hire and coach for defined service behaviors. At the same time, it is vital they continually communicate organizational and departmental goals and know the data. In addition, they must conduct regular rounds on staff and customers to keep a finger on the pulse of operations and seize opportunities to recognize and coach during rounds. By doing so, they send a strong message that they are attentive, engaged and holding others accountable.
Creating outstanding patient experiences is a business imperative and can no longer be left to chance. It takes persistence, insistence and consistency on the part of leaders. When managers and staff see that the senior leaders remain focused on the patient experience and the resulting data over time, and when individuals realize the importance of their contributions toward achieving goals and seeing scores rise, employee pride will grow and ultimately patients will benefit.
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