PX Mastermind

This past week, I was invited to lead a Patient Experience Mastermind webinar on Best Practices and Lessons Learned.

I love that there is a vibrant and passionate community of PX professionals who are continuously learning and sharing their experiences with one another. I was honored to share what I know but even more excited at the idea of discussing and learning from the others on the call.

This was a huge topic so I broke it down into three major categories: Leadership, Data, and Originality. The first two are things I hear being brought up all the time. Culture change doesn’t happen without a firm commitment from leaders and a shared vision across the organization. And there are many more sources of data than simply the H-CAHPS scores. We spoke about all the ways patients and their families tell us about their experiences, yet we only seem to focus on a single number reported monthly.

That third category, originality, is where I spent the most time. There are all kinds of new innovations out there, new tech designed to deliver the ultimate patient experience, new philosophies about doing WITH our patients instead of doing TO or FOR them, and even a new money back guarantee if you’re unhappy with your service. There are new ways of executing old ideas: rounding with an iPad instead of paper and pen, putting your patient and family advisory council members on hospital committees, and moving physicians from ‘on-board’ to actively leading your PX efforts.

The other piece of originality is you. Your personal and professional experiences, along with your natural talents and abilities, all inform your approach to this kind of work. While I love that we can share and learn from each other, we need to bring our authentic selves and not rely on scripting or a cookie cutter formula to success.

Let’s continue to talk about best practices and share our ideas. Let’s talk about approaches that worked and those that didn’t work. And let’s not forget who we are, what we bring, how we feel, and why we do this. Our patients and their families will love us for it.

The Beauty of Making Mistakes

Last Sunday, the Grammy Awards show was on. I didn’t see the whole thing, but I did see pop superstar Adele begin a tribute to the late George Michael, stop her performance, and start over. Having worked as a singer myself for a number of years, I couldn’t imagine stopping in the middle of a song and asking everyone to please begin again. Lord knows I’ve wanted to.

This made me think about the tolerance we have for mistakes. In healthcare, it’s practically zero. When there’s a wrong-site surgery, an unexpected outcome, or even an unlikely but known risk factor, we do a root cause analysis, counsel those involved, suspend or even fire staff, and patients often sue.

I’ve worked in places where it wasn’t safe to make a mistake. You got yelled at, embarrassed in front of your peers, pulled off a project, or let go. Did that make us more careful? Did we perform better? Nope.

We threw each other under the bus. We didn’t contribute new ideas. We didn’t speak up if we saw something that didn’t look right. We worked long hours. We missed our kids’ concerts and soccer games. We took our stress out on our spouses. We didn’t sleep enough. We worked straight through lunch and came home too tired to eat dinner.

People will tell you they didn’t learn nearly as much from their successes as they did from their mistakes. So why do so many companies rush to assign blame instead of looking at ways to make improvements?

Well for one, it’s certainly easier to blame a person instead of a process. Holding the system accountable means that changes need to be made, often expensive ones, and many people don’t want to admit they may have made a mistake when they designed the system.  

Certainly, if there is a willful, deliberate action taken that causes harm, people need to be held accountable. But so often, mistakes are just that – mistakes. It makes sense to look at the bigger picture and see what could have been done differently both from an individual and systems perspective.

But it has to be safe, not punitive.

Adele felt safe enough in her star-power to stop an entire orchestra on live TV and ask them to start again. Whether the problem was in not getting her starting pitch because of a bad earpiece or simply due to nerves, she demonstrated that it’s better to speak up, go back and do the job right, even if it means suffering a little embarrassment. The public doesn’t seem to be holding it against her. Let’s hope more organizations take the same approach.

 

Going Platinum, part 2

Last week, I wrote about the Platinum Rule – doing to others as they want, not as we want. It’s not an easy thing; you have to invest a little energy and ask a person what he or she prefers. Many of us don’t feel we have the time, or we assume that others want the same as we do.

I had a friend in college who wanted to do something really wonderful for my birthday so she organized a surprise party for me; secretly invited all my friends, got a big cake, lots of balloons, and many of the foods she’d seen me enjoy. She really did surprise me, too. I had no idea any of it was going on. It was great to see so many people there, all having fun and celebrating. When it came time to blow out the candles, I couldn’t believe my eyes. My friend had gotten a chocolate cake. Everyone loves chocolate cake, right?

Not this girl.

I was gracious, smiled, and didn’t say anything about it except ‘Thank you’, but many of my friends gasped when they saw it. “Oh my God, Kate hates chocolate!”

The party went on; I wasn’t going to let a little thing like cake ruin it, but was a perfect example of how we make assumptions about all kinds of things.

We in healthcare do it all the time. This is especially troubling given all we know about a person’s ability to heal and get well.

If I were to ask 6 different people to tell me the three most important things during their hospital stay, I’d get many different answers. “Manage my pain” “Call me Bill, not William” “Call me Mr. Jones, not Bill” “Please leave the shades closed” “Please always open the shades” “Get me out of here as soon as possible.” “Don’t send me home before I’m ready” “Communicate with my primary care doctor” and on and on.

We have the perfect opportunity to collect that information. In fact, we have two. There’s the admission form when patients first arrive and the white board in their rooms. By simply taking a moment to ask, we can find out what matters most to them. By paying attention to it, we help them get better faster. What better way to demonstrate care and concern that to look at the white board and say, “How are we doing managing your pain today, Mr. Jones? Here, let me open those shades for you.”

That simple act, using the Platinum Rule, lets the patient know that we are taking his needs into account. We are personalizing his care. How he feels, what he wants, matters to us.

You don’t think you have the time? Believe me, the hospital on the other side of town has already figured this out. They’re doing it. They’ve hardwired it into the behaviors of all the employees who interact with their patients. And patients are noticing. More importantly, they’re noticing when it ISN’T happening at your hospital.

Take a few moments to use the Platinum Rule. And please don’t bake me a chocolate cake.

The Platinum Rule

I, like many of you, was brought up with the Golden Rule: Do unto others as you would have them do unto you or treat others as you would like to be treated.

There’s certainly a lot of good in that rule but I now try to do even better. I try to live by The Platinum Rule: Do unto others as they would like to have done unto them.

I’m not sure who coined the expression, but I first heard it when I was working in Physician Relations at a very large suburban Chicago hospital. None of us in the department was a physician, but we all worked very closely with them and had to continuously find ways to keep them happy, engaged, and admitting their patients to our hospital instead of our competitor down the street.

We all approached the task from our own perspective; what would I want, what would make me happy. A few times we got it right, but if we were going to truly be effective, we had to start seeing things from the physicians’ point of view. What would they want?

I didn’t realize it at the time, but it became a very valuable life lesson for me. I started approaching a lot of things with the Platinum Rule and it’s one of my key points when I’m delivering Patient Experience training.

One of my favorite examples is what to call people. My name, as it appears on my medical chart, is Katherine. But I’ve found that most people, for some reason, love to use nicknames when they see a long name like Katherine. They call me Kathy. It drives me crazy.

Don’t get me wrong, Kathy is a perfectly fine name, it’s just not my name and I hate when people assume it’s okay to call me that.

Funny thing is, there are Jennifers out there who don’t mind being called Jen or Jenny, and Margarets who take it in stride if someone calls them Maggie. These people can’t understand why I get so bent out of shape when someone calls me Kathy.

They don’t have to understand why. They just have to understand that it does.

So how are you supposed to know? Simple. Ask.

The key to connecting with patients isn’t in giving them everything that would make you happy and comfortable if you were in their shoes.  We need to ask them what they want.

How many of us actually have a question like that on our admission forms? Or our white boards in patient rooms? We have a perfect opportunity to find out exactly what we can do to make patients’ stays with us a little better (and improve our H-CAHPS scores, by the way) and we consistently miss it.

Individualized, personalized care matters. We can’t keep going with what we think is important. We have to ask our patients what matters to them and then do it.

It’s better than gold; it’s platinum.

Uhhhhmmmm Hello?

Shortly after I went to work for a large, multispecialty medical group, I did a little mystery shopping. This group had many locations around town and it was obvious that there was no organization-wide standard for service. Depending on which office you were in, you may be treated beautifully or like an annoyance.

There was one office in particular I’ll never forget. I walked up to the reception desk where a woman was sitting and looking down at some papers.  I got to the desk. She looked up at me and didn’t say anything. I smiled politely. She raised both eyebrows, made her eyes really big and stuck her neck out a little. I looked at her for another moment before I realized that this was her greeting. She wasn’t going to say hello or how can I help you today. Her idea of a proper greeting in a physician’s office was big eyes and a forward neck thrust.

As a perfectly healthy person who was just there to mystery shop and see what was what, I was completely put off. I can only imagine how someone who didn’t feel good and hates to go to doctors’ offices would react to that kind of first impression.

I don’t know what was going on in that woman’s life that day, if she’d had a really tough morning and just couldn’t force one more smile, if she’d gotten some horrible news, was battling some kind of illness, was thisclose to quitting…

And I didn’t care.

Whether we want to admit it or not, healthcare is a service industry. That person behind the desk is an ambassador, a greeter, a tone-setter, a first impression maker, and her personal life cannot affect her professional one.

One of the best offices I ever visited had a front desk person who looked genuinely delighted to see every person who came in. Her warm smile and an, “Oh good, it’s you!” kind of greeting made everyone feel truly welcome and comfortable. Whether she meant it or not didn’t matter. We all believed she did.

Wouldn’t you love to be greeted that way?

 

 

An Attitude of Gratitude with Your Coworkers

Something I’ve been reading a lot about lately is gratitude. Maybe the universe is trying to send me a message, because everywhere I look, I’m seeing something about having an attitude of gratitude.

I used to think gratitude was about being thankful for what you have. It is, of course, but I’ve come to think of it as much more. Instead of merely looking at it from a material possessions perspective, I’m starting to be grateful for all kinds of other things.

I’m grateful for the busy days when there are a million things to do; those days fly by quickly and before I know it, it’s time to go home. I’m grateful for the slow days when there isn’t a lot happening; I can get caught up on things I’d been meaning to do but never had the time.

I’m grateful for coworker who is supportive and upbeat; she makes me feel like I’m not alone in my work. I’m grateful for the coworker who is difficult and moody; she is teaching me how to be patient and she’s making me examine my own behavior and its impact on those around me.

I’m grateful for the patient who truly appreciates the work I do; he makes me feel like what I’m doing really makes a difference. I’m grateful for the patient who appears to be impossible to satisfy; he makes me step up my game, look harder for solutions, and not get complacent.

What I‘m finding is that I used to only be grateful when things were going my way, but anyone can be grateful under happy circumstances.  It’s the people who can be grateful under trying circumstances, difficult circumstances, even miserable circumstances – they’re the ones that truly inspire those around them.

That’s the kind of coworker I want around me. That’s the kind of coworker I want to be.

The next time things at work get a little tough, ask yourself how you can turn it into something to be grateful for. You might be surprised at the impact it has.

Final Impressions

You’ve got a pet peeve, right? That thing that really irritates you. Nothing huge, just something that gets under your skin.

When it comes to doctor appointments, I think my latest pet peeve is not knowing what to do when you think the visit is over.

It used to be (and maybe sometimes still is) that, once you saw the physician and he or she told you what the problem was, a nurse came in, answered any additional questions you might have, and told you to check out at the desk before you left the office.

These days, you see the physician, a nurse comes in afterwards to answer any additional questions and tells you to have a nice day. I always find myself stopping at the desk on my way out to be sure there isn’t something else I need to do before I go. Usually, the person at the desk is very sweet about it and says something like, “You’re all set. Take care!”

Sometimes, though, that person looks really annoyed and says, “Well, did the doctor say you needed something else?” in that condescending tone that screams “I hate my job”. “No,” I reply. “I just wanted to be sure we were good to go,” which is often met with a fake, dismissive smile.

And THAT will be my final – and lasting – impression about my visit.

As a Patient Experience trainer, I spend a lot of time talking about the greeting: that first impression that’s so important to people when they walk in the door. But lately, I’ve started spending just as much time on that final acknowledgment, the last thing patients see and hear before they walk out the door. You can undo a lot of good in those final moments, negate the things that had gone well up to that point. Or you can reaffirm your commitment to patient experience and continue to be helpful and kind, even after the visit is over.

The end is just as important as the beginning. Develop a good exit greeting and make a wonderful final – and lasting – impression.

The Story of Your Patient

We’re storytellers. With every human interaction, we’re telling a story about what we see and hear. Depending on the narrative that we create in our heads, the actions of others can be a mild annoyance or completely exasperating. 

Consider the patient who arrives late to an appointment. Do you immediately assume he is inconsiderate, unreliable, and just plain rude, or do you assume he made every effort to get there on time but circumstances beyond his control got in his way?

Maybe he was involved in an accident. Maybe he stopped to help someone in an accident. That little bit of narrative will absolutely affect your interactions with him and if you choose to be annoyed instead of gracious, he will sense it.

Consider, too, the patient that doesn’t lose any weight even after you’ve counseled her, told her that her health problems are only going to get worse. Every time she’s in your office, her test results are more and more of a concern. Blood pressure, cholesterol, kidney and liver function all headed in the wrong direction. She’s clearly not taking your advice. What story are you telling about her? She’s lazy? She doesn’t care about her health? She just won’t put down the bag of chips or box of cookies?

One or more of these may be true, but have you taken a few moments to find out anything about her living conditions, asked about any unresolved trauma, or learned of any family history of addiction?

It’s true we tend to be much more forgiving and gracious when we learn a little bit of the why, or the story behind the story. And although you may never know the actual truth, you can choose to like your patients more when you choose to tell a different story about their behavior.

They will be more likely to open up to you and be honest about their habits when they aren’t sensing your judgement and distain. And when patients like their doctors and feel that their doctors like them, they are more likely to comply with instructions and advice. They may even get healthier. 

If you want to change your patients, start by changing the story you tell yourself about them. Change you.

The Art Lesson

A few years ago, my department planned one of those bonding events in which employees are supposed to get together as a team outside of work hours and do something fun. Admittedly, I had my doubts about just how much fun it was going to be, but, in retrospect, I’m really glad I went.

We all gathered at a local place where a professional had paibottle_treented a beautiful picture and we each had an easel and some paint and a brush and, most importantly, wine.

There were a few in my group who were really quite good painters. They were incredibly focused on the task at hand and tried to make their painting as close to the original as they could, right down to the number of snowflakes and the exact placement of each.

I took a different approach.

I liked the picture the artist had painted but I didn’t want to create one that looked just like it. I remembered what I had told my daughter about art when she was in second grade, “Don’t ask what it is, ask how it makes you feel.”

I tapped into something deep inside and painted how the picture made me feel. It was a suggestion cropped-cropped-cropped-Kates_Tree.jpgof the original, different colors and a different feel. It was my version of the artist’s work.

At the end of the night, we all posed for a photo, each of us holding our works of art. Everyone in my group was holding a painting that looked very much like the original. Mine was decidedly different. And I was never more proud.

Okay, what does this have to do with patient experience?

It has everything to do with finding your voice in your approach to work. This is still an emerging field and while there are many best practices out there that we can learn from, there is still plenty of room for innovation, creativity, thinking differently about how to get to the heart of patient engagement.

In short, you don’t have to simply do what others are doing. You can be inspired by the work that’s being done and then tap into something inside of you and create something new. Test it, try it out, but never stop looking inside of you for answers. If there’s a voice in your head that’s telling you there’s a better way, listen to it! Design a pilot program around it and try it out!

There’s a reason you went into this field. You’re passionate about it. You know more than you think you do. Don’t be satisfied to simply copy and paste. Network. Discuss. Share. Create. Innovate. Do how it makes you feel.

Tactics vs. Culture

I had a conversation with a senior leader not long ago; we were talking about what kind of an organization we wanted to be, what kind of talent we wanted to draw, what we wanted patients to think of us. I mentioned that I’d worked for a hospital with many clearly defined expectations and standards that at first seemed uncomfortable but eventually became habits.

Certain things were so ingrained at that hospital that they became a natural part of me even in other places. For example, if we saw any kind of trash on the floor – paper, wrappers, anything – we were expected to pick it up instead of walk past it and hope that someone from environmental services came around soon. I haven’t worked for them for several years but I still can’t imagine walking past a piece of trash on the floor. I still pick it up when I see it.

The vice president I was speaking to said, “But does that really matter? If it doesn’t impact patient experience, I don’t want to waste any time training staff to do it.”

And that’s when I knew it was going to be an uphill struggle.

When we think of patient experience as a series of tactics designed to raise scores, we’ve not only missed the point, we’ve put the cart in front of the horse. We were trying to shape our organization’s future, define want we want to become. That can’t be expressed merely in a series of things you can measure, it’s more than that.

It starts by having employees take pride in where they work. Part of that means acting like an owner and taking action when you see something wrong, like trash on the floor. It may seem like a small thing but it’s those small things that add up to create your organization’s culture.

When you step outside of your expressed job responsibilities and take action when something is wrong, you’re more engaged, you’re part of something larger than yourself. That’s a big part in creating a positive, patient-centered culture with employees who feel connected to purpose.

The employees still walk past trash on the floor. Patient experience scores haven’t improved. Think there’s a connection?