How Video Quick Learns and Other Multi-Modal Communication Strategies Can Fast Track the Success of Your Service Excellence Journey Carol Majewski, RN, MS, MHCDS, Jason Vallee, PhD & Jodi Stewart Beryl Institute Conference March 22, 2017
Excellence No people skills rushed Human Safe Exceptional Compassionate Kindness teamwork Professional disappointing bored Curt frustrating Choices Caring Sensitive respect Engaged Thoughtful Listening Not personable Always
D-H: An Academic Health System Serving NH, VT and Beyond
Quality & Safety Journey Shared Decision Making Legacy cultures across sites Achieving Excellence, PFCC, Patient Relations, Chaplaincy, Vol. Svs. Leadership Transitions Recruitment Challenges Entitlement Culture Where else would they go Consensus decision making It s the right thing to do We ve tried that before
Patient Experience Maturity Model Engaged Patient Experience is one of the core tenets of our strategy. Embedded Patient Experience is the fabric of our health system, not separately discussed. Interested Invested Patient Experience is important, but receives little funding and is not a strategic priority. Patient Experience is very important and formalized programs emerge. Committed Patient Experience is critical and executives are actively involved.
Office of Patient Experience Chaplaincy Volunteer Services Achieving Excellence Patient Relations PFCC
Quality Safety Staffing Budget Daily Crisis Personnel Appraisals Rounding P.I. Patients Vendors Education Compliance Reports Meetings
Keep it Simple Make it Memorable No Scripting, Authentic Empathy Readily Accessible Engage Multiple Roles Guide by our side, Not sage on a stage
Patient Experience Maturity Model Engaged Patient Experience is one of the core tenets of our strategy. Embedded Patient Experience is the fabric of our health system, not separately discussed. Interested Invested Patient Experience is important, but receives little funding and is not a strategic priority. Patient Experience is very important and formalized programs emerge. Committed Patient Experience is critical and executives are actively involved.
Let s Talk About Our Patients Journey
What drives patient experience? We asked 127 Leaders, Providers, Nurses and Staff Many had the same answer
Clinical Outcomes
Specific Drivers of Patient Satisfaction Scores For survey item: Rate all aspects of the outpatient visit the following 5 drivers determine whether or not a patient will respond favorably: 1. Sensitivity of all staff to your special needs and concerns 2. Overall care received from provider 3. Length of time waiting in the waiting room 4. Overall ease and convenience of making an appointment 5. Length of time waiting in the exam room 72% of the variation can be explained by the patients responses to these 5 driver items* *Listed in descending order of importance Mihevc, N. (2008). PSS Survey Analysis. The Research Group, Northhampton, Mass.
Defining the Experience The Transactional Patient Experience refers to entirety of the complex processes that the patient is subject to during their interactions within the D-H health system. TPX are the hard systems and processes. The Relational Patient Experience is the entirety of the complex human interactions during their relations within the D-H health system. RPX are the soft, or people skills, our patients experience.
What are some examples of each? Transactional PX: Making an appointment on the phone or online Conducting pre-visit paperwork Registration Waiting rooms (These are often the focus of process improvement methodologies (i.e. Six Sigma).) Relational PX: Showing care and concern Relating to the patient and showing rapport Introducing yourself and role Displaying excellent communication skills (These are the soft skills that accompany the transactional handoffs.)
The JUSST Model Needs vs. Expectations Justice My care team treats me with dignity and respect. S/he knows that I need to be treated fairly. Understanding two way listening for understanding & making sure you are understood. Security I believe my care team will take good care of me, will keep my interests in mind, and provide a safe environment in my time of need. Self-esteem My care team respects that when I am injured or hurt, it can also make me feel less than confident. S/he addresses my need to understand the process of healing. Trust My care team is genuine and speaks from a place of truth. S/he follows through with actions that support what they have said to me.
How do we sustain momentum and communicate all this work?
Acknowledge Current Environment Organizational leadership, people, priorities. Existing pressures, overload of information, mass of projects, and burnout.
Connect to Purpose Yearning to feel like you re a part of something and a desire to connect to your passion. Embedded into the fabric of who you are.
Communication Expectations Constant visible communication a priority Easily digestible (brief, powerful, to-the-point) Communication must be 2-way, not just pushing outward. Connect the dots so it s not perceived as flavor of the month. Create accountability and engagement cascade, cascade, cascade Get feedback--survey
Identify the Gaps in Your Patient Experience Efforts Evaluate metrics Round with patients, leaders & staff Identify learning needs Begin developing tools Develop structured dialogue Make it scalable
Why Video Became Our Magic Wand Scalable across multiple geographic areas Can motivate, engage, and educate Brief and high impact Initiates dialogue It s fun! And you can engage your staff in the process.
Patient Experience Video Quick Learns Identify Problem Determine learning format: Inspirational, learning, provocative Creative solution/storyboard Production Rollout/Learning Accountability & Engagement
Computer Use & Patient Perception National research, patient surveys/feedback and our own provider observational studies highlight that improper EHR and computer use in examination rooms and during the patient care continuum can inhibit providers and other staff from focusing on their patients and impact both the relationship with their care team and their overall experience of the visit.
Observational Study Overview & Results Ambassadors observed 61 providers on 196 scheduled outpatient office visits across D-H locations during June and July, 2014. The observed providers average percent excellent score (based on patient satisfaction surveys) was 71% at the time of this study (with a range of 40% to 93%). The observers used a simple observation protocol sheet to record whether providers employed seven key behaviors that are known to drive excellent patient satisfaction. Results indicated that while it was observed that providers do many of the behaviors associated with high levels of patient satisfaction (80.3% of the time), providers did not do all of the behaviors consistently. In fact, all seven behaviors were observed together only 7% of the time.
Study Results Patient Satisfier % observed Warm acknowledgement and introduction of them self 95 Asked open-end questions such as How are you feeling today? Addressed concern of patient and explained process of visit Explanation of care and confirmation of patient understanding Efficiency and good work flow/ technology & proper hand hygiene Closed the conversation with care and compassion 48 Created a pleasant environment with other team members 98 48 60 53 73
Patient Benefits of Effective Communication with Computer Exam Room Use Patients will experience computers as a valuable medical tool that can Enhance their confidence in care; Encourage adherence to medical regimens; and Invites their active participation in maintaining their health.
In fact, patients expect you to use a computer More than 80% of respondents indicated that they would not be bothered by use of a tablet, laptop or desktop during an exam and actually PREFERRED them to use of paper during a visit. Source: 2014 Survey of 4,500 U.S. Patients, The Profitable Practice
It s How the Computer Is Used That Impacts the Relationship with the Patient (The Perceptions that are Formed)
Discussion with Facilitator s Guide
Remember RESPECTS: Behaviors
RESPECTS: Communication Benefits
Expectations for Leaders. Your Role? Cascade to your departments. Discuss and share opportunities for improvement. Role model yourself. And remember, this can apply both in and outside of the exam room. Think about how this can connect for registration and other front desk staff when working with a computer screen in front of a patient.
Our Next Big Idea?
The 10-5 Rule Objectives? Explore the 10-5 rule as a behavior to break down barriers with one another and build relationships. Learn the specific techniques associated with the 10-5 rule. Identify and become aware of the surprising number of health benefits associated with smiling. Understand the impact communication has on our patients experience.
Discussion with Facilitator s Guide
But, there s much more needed to achieve and sustain patient experience excellence Examples of some patient experience tools that we use at Dartmouth-Hitchcock
Service Excellence Seminar Sessions with leaders Daily huddles with a focus on patient safety & experience Intranet knowledge capture Reward & Recognition for excellent service
More video quick learns ( PX Moments ) ie. Daily huddles, managing up, JUSST At Your Service enewsletter Monthly newsletter to leadership team Patient Experience Leadership Briefs White papers on various service excellence expectations
Provider Ambassador Team Peer-to-peer coaching for service excellence skills PX Week Recognition, thanks and celebration
Patient Experience Week April 24-28, 2017 Promotion and activities planned: Visual representation w/px messaging on banners, posters, digital signage, website, patient portal, messages-on-hold, etc. Employee Badge Ribbons, I am the patient experience Unveiling of PX video WOW Boards Patient Leader Greeter Day Employee Thank You Cards sent to Employee s Homes
So, what s next??
I love hearing and learning about opportunities where we are truly making a difference in the experience of our patients. Truly inspiring! The tools make it easy to do my job as a leader. It was a simple tweak that I never considered, which made such an impact on the relationship with my patients. Video has been an excellent tool to have conversations with my staff around specific topics. I ve been a doctor for 35 years and this is the first time since medical school, that someone has taken the time to observe and provide me with valuable feedback.
We are what we repeatedly do. Excellence, then, is not an act, but a habit. - Aristotle
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