The Healthcare Experience

“Signs, signs, everywhere signs

Blocking out the scenery, breaking my mind”

(Five Man Electrical Band (1971)

A few years ago I went to my primary care office for my annual check-up. When I walked into the waiting room there was a sign on the wall that read “If you haven’t been helped within 15 minutes, please check back with the front desk.” Overall the office had always been very efficient and helpful, and I rarely waited for more than a few minutes, so I certainly don’t have any complaints. But it did make me wonder why anyone would put up a sign like that.

Like most organizations the customer experience was of utmost importance to this organization. And I am guessing that the sign was well intended to hopefully prevent someone from “being forgotten” in the waiting room. But……shouldn’t we make sure our systems work well enough we don’t have to rely on our customers to fix our issues for us? The fact that sign needed to be there indicates that there are issues in the office with patient flow. I don’t think the best solution is to put up a sign and pretend we have solved the problem. The first step should be designing a system that ensures patients don’t have to wait long, and if there is an unforeseen circumstance that we know who we need to keep informed! 

Over the years I have observed many signs. For example in a bathroom I have seen signs that read, “If anything in this bathroom needs our attention, please call xxxx.” Again I believe this is well intentioned but I think it sends the wrong message. We should have a system in place to make sure our bathrooms are clean and in working order. Putting up a sign does not inspire confidence; it may be less labor intensive than other alternatives, but if we believe a great patient experience is paramount, that alone cannot be the decision point.

In another waiting room I observed multiple signs that said “We do not take xxxxx insurance.” I guess we expect our patients to read the sign, leave our facility and find someone who cares at that point. While I appreciate the fact that insurance and costs of care are pain points for our patients, we should be having conversations with these patients and help them find the nearest or most convenient place that would take their insurance. It allows us to engage with one of our customers and help them get what they need. There’s a chance they may come back for another service with us in the future!

Now, I do believe that there are good reasons to have signs in our facilities. Some may be required by law (“Employees must wash hands prior to returning to work”). Some might be helpful with way finding. Some may prevent people from doing something hazardous. All I am suggesting is we should think before we put up a sign that is convenient for us but sends an entirely different message to our customers. If I walk into an office and there are multiple signs plastered all over the place in my opinion the customer experience has taken a back seat to other objectives.

What do you think? Are there any signs that you think would be acceptable? What signs have you observed that have made you question the why?

Dennis Bruens
V.P. Regional Cancer Center

Some examples of complex issues include moving from volume to value payment models, patient flow, readmissions, hospital-acquired conditions and patient experience.

So how do you take any of these "big" and help make them "small"?

Start with understanding the position of "one," as this promotes the need for a more focused and disciplined approach. Let's take an example with a patient (n=1) at risk of readmission. She has congestive heart failure (n=1) which is one of the subset diagnoses with a higher risk of readmission.

Try this four-step approach to focus on the "n of 1" to see if you have a solid plan in place that can be managed every day:

Awareness: Ensure systems are in place to provide early identification that there is a patient you have to manage who has congestive heart failure. Do you know where all these patients are in your health system today? What tactics will ensure you do well and what obstacles get in your way to deliver consistent high performance?

Collaboration (Bridging Silos and Integrating: Who do you need to work with to coordinate the care of this patient while he or she is in your care and where will you transition this patient post-hospital stay? Do those post-acute locations know what they should be doing to continue the care you provided? How do you ensure you are all in sync with your efforts?

Intervention: How will you manage this patient while in the hospital? What are the patient risk factors and what is the plan of care and key care needs such as better nutrition, awareness of medications and potential side effects, and clear and understandable discharge plans?

Measured results and follow-up: Was this patient readmitted 30 days post hospital stay? If yes, why and how could it have been managed differently? If no, how was it managed so you could replicate with other similar patients and apply the same approach toward other "big" situations?

This approach will also help with the health and wellbeing of your team. With the rise in burnout along with the need to improve resiliency, these steps should help allow others to stay inspired and make a positive impact every day. 

Fun at Work...
I've heard the comments..."there should be no fun in the workplace" and "they call it job for a reason." However, since many of us spend 30%+ of our time at work and another 20-30% of our time sleeping, it is good to find those fun times at work...What's going on in your workplace to make it more enjoyable for you and your colleagues?

I was speaking to one of our Surgeons and we started to discuss the excitement and challenges in healthcare. He enjoys surgery, good dialogue, his colleagues and having fun while at work. He let me know he would not want to work in a place that was not enjoyable day in and day out. That would be a "dreaded place to be." This doesn't mean goofing off all day long. It does mean enjoying the time you spend in the workplace and helping to make it enjoyable for you and others. That creates a place for all of us to thrive.  And the other beneficiaries of this kind of place..our patients.

Forbes had an article reflecting on the benefits of fun in the workplace.

Also check out  these 8 tips from Tres Coaching:

1. Put fun first on your list of priorities, and the rest will fall into place. 
2. Laugh more. Laughter can be a great medicine for what ails you and your workplace. 
3. Be spontaneous with recognition, praise and a simple “thank you”. 
4. Schedule fun-based activities with employees, customers and suppliers. 
5. Find your inner child. Let others see the humorous side of your personality. 
6. Live with the 3E’s – Energy, Enthusiasm and Empathy. 
7. Take mental health breaks and/or extended lunches to refresh and re-energize. 
8. Keep things in perspective. Your work is a means to an end, not the end!

Regardless of where you are in your career, if you’re not having fun – what’s the point? Life is too short to not enjoy what you are doing, so find a way to put fun back into your work or do something else. The continuing negative trends in business as a result of downsizing, restructuring and the financial markets meltdown have taken a huge toll on the workplace, and the workforce tasked with doing more with less. We need to find ways to reduce stress, improve productivity, and keep our morale and energy levels up.

There are unlimited challenges and exciting times ahead in healthcare. Why not make the best of it and ensure we have some fun while constantly improving the healthcare experience.
 
What do you do to infuse fun into your work environment?

I'm one "click" away from a meltdown!

Recently, I was part of one of our clinical service line annual retreats. The focus was on several performance goals in support of our organization's strategic priorities.  The group's dialogue constantly moved us towards a shared vision. It was inspiring and refreshing to be part of this discussion.  

So many conversations in healthcare and around the nation are polarizing. An "all or none" or "a win or lose only scenario".  Even as health and well-being is discussed, many people want to stick with one view... People will share only one view..."it's all about lifestyle behaviors or the payment models/how and who gets paid or just take medications or just get the surgery or my patients will never comply".  Each view is a narrow lens of keeping our patient's overall care at the center of all our clinical decisions. There really needs to be a balance of all aspects of health to better meet our patients' needs. This includes clinician and staff's workplace wellbeing.  One example brought up in our retreat was around the electronic health record and the number of "clicks' to enter the necessary information. There is a delicate balance between ensuring high safe, quality care and exhausting those who are providing the care.

In the book, Mindful Healthcare: Healthy Team, Healthy Business, Dr. Wayne Jonas references the Quadruple Aim, focused on clinician's work life as well as the need to look at real ways to "transform" healthcare. He states, "as our policy leaders debate coverage, pre-existing conditions, central vs. local control, and the role of government in healthcare as it is, they will continue to miss healthcare as it needs to be and can become."  Our role in healthcare is to collaborate across our system and community, with patients and key partners in pursuit of an improved healthcare delivery system. 

What can you do to advance health in your organization?

We all know in order to take better care of our patients, you need to stay focused on the needs of your team.  Think about what is contributing to better clinician and staff work life and well-being. Also give thought to what takes away from this. If you are not sure, just ask your team and you will find out in 5 minutes! 

Try moving forward with small tests of change so you are better able to disrupt outdated care models and work processes. These steps could include:

1. Frame the vision and goals, facilitating the discussion and work towards a shared vision;

2. Understand your current outcomes and variances against national benchmark;

3. Review your work processes, work loads and work situations which contribute or reduce work place stressors;

4. Appreciate the need to reduce staff "burnout" and share stress management techniques to improve staff resiliency; and

5. Acknowledge that exceptional care can not be achieved consistently without the focusing on the wellbeing of your team.

Healthcare organizations need to learn from our health system as well as other industries.  Please share ways you are creating an optimal workplace environment in your organization. 

Game on!

In a recent post, I shared our health system’s four strategic priorities and how each facility and every department cascades these priorities to their respective areas and to every individual working in them.

Every week during orientation, I remind new and returning employees about 5 key things that are key to ensuring they could help us run our health system every day:

1. Know your own “purpose” and “why’ you chose to take this job. Was it because you had a calling to be a caregiver, because you get to impact the lives of others, because you could provide a livelihood for your family. Whatever the reason, everyone is excited when they receive the offer and yet sometimes these same employees forget why they were excited, their they forget their purpose and they start to negatively impact their colleagues, patients and families we serve.
2. Ensure you align with our mission, vision and values.
3. Learn our goals.
4. Understand how your role contributes to helping our health system achieve its achieve goals.
5. Learn how you help the organization improve every single day on every shift.

We count on our leaders to select for the “right fit”. After all, we have a community of nearly 20,000 employees, physicians and volunteers serving our patients, families and community.

In the 2/28 blog, “Industry Voices—The power of rounding to engage staff in your organization’s strategic priorities”, my co-author, Matt Walker shared how his Director was excellent at selecting the right individuals.

Kristi Cottrill, Lee Health - Healthpark Medical Center’s Director of Housekeeping and Transport Services shared the following about “hiring the right people”:

As we continue our journey toward excellence, finding and hiring the right people is crucial to our success. Without 5-Star employees, we cannot be a 5-Star organization. Interviewing and selecting the right talent is one of the most important jobs a department leader can do for the team. For large departments, the commitment is huge and the results are well worth the undertaking.

Who knows more about what you’re looking for than you?

My team recognizes that our responsibility goes beyond finding the right people to transport our patients. Many staff members use this entry level position as a stepping stone to other healthcare careers. With that in mind, we utilize the interview process to select those individuals we believe will become outstanding healthcare professionals for the larger team. It is a two-way street. What we are looking for and what the applicant wants as well.

1. It begins with the all-important first impression.
   Is the applicant neatly groomed? We don’t expect formal attire, as not everyone has the means to dress professionally. We do expect the applicant to be clean and neatly groomed.
   A warm, outgoing personality and an ever-present smile rank very high on our list of priorities. We try to look beyond the expected nervousness that goes along with an interview to determine if they possess the verbal communication skills that will “wow” our patients. Do they fit the image of a 5-star professional?
   
   
2. Short and long-term goals are discussed to help us determine if the applicant is focused on his/her future. Are they ambitious? College students studying health professions have an advantage, as we recognize our organization’s need for great nurses, Physician Assistants, Emergency Medical Technicians, etc. Additionally, it gives us an idea of how the applicant’s educational commitments will impact our department. If the applicant receives a job offer, we make every effort to assign a shift that will keep school related scheduling adjustments to a minimum.
   
   
3. While reviewing the work history, we focus on job stability. An unstable work history is an indication of “job hopping” and requires explanation. We want reasons why the applicant moved around so much. We also want to know what their past employers have to say about them. We check references!
   
   
4. Teamwork. In our department, the ability to work well on a team is important, as transporters often help each other with more difficult transports, and assist other departments during periods of lower activity. Often a team member will be routinely assigned to a high-volume area such as the Emergency Department. They become as much a part of that team, as they are a part of our team. For these reasons, we ask the applicant to share work and/or school examples of team projects, specifically, what they liked about working on the team and what challenged them.
   
   
5. Applicants are encouraged to share their customer service experiences; their greatest success stories and the ones they wish they could do over. They are asked to provide examples of how they handled certain situations such as: their most challenging customer, a time they disagreed with a policy, an example of when they went above and beyond, etc. This helps us evaluate their interpersonal skills and by their responses, we can determine if they are genuine and open in their communication. We listen intently as we evaluate their fitness for our team. Then, the applicant has an opportunity to convince us that extending a job offer would be the right decision for us, and for our patients.
   
   
6. The focus of the interview will then shift to what we have to offer.
   We build their excitement by sharing the great opportunities available for top performers within our health system, including tuition assistance and growth/advancement.
   We boldly declare that we are the best employer in the county and we are interested in hiring only the very best people. We paint a very clear picture of what that looks like such as; our very high standards for patient safety, dependability, compassionate behavior, and teamwork.
   Our team is especially proud of our commitment to “Patient Experience” and the opportunity we have not only to be one of the first people a patient sees, but also the last, as they are wheeled out upon discharge. We pride ourselves in providing both a great beginning and a warm, friendly end to their stay with us. While here, we strive to treat them like our most favorite relative.
   
   
7. While sharing what we’re passionate about, we watch their non-verbal communication to gage whether or not a fire has been ignited inside them.

The ultimate goal is to “hire tough,” so that leading the team will be easy.

Selecting the right candidates is only part of what makes a winning team. Setting the bar high and holding them accountable for the promises they made during the interview are key to the ongoing success of both the employee and Lee Health.

Be well. Stay inspired.

Scott

Scott's New Book: Mindful Healthcare: Healthy Team, Healthy Business

A healthcare organization needs to be more than capable nurses and doctors, sterile operating theaters, a business office, and an emergency room. Every successful medical organization should be an optimal healing environment. This holistic, person-centered approach to the business of medicine focuses on empowering the hospital and health system's working community. It reduces stress, eliminates burnout, and increases staff resiliency, helping your team to remember why they chose to pursue a career in healthcare. When your healers thrive, your hospital will flourish.