Hansen talked about companies that beat the odds, even during times of uncertainty and chaos, to achieve exceptional growth and profits. In their research, they had identified key characteristics of those companies, one of which is fanatical discipline. They illustrate that fanatical discipline with the term, “20 mile march.” They say, “The 20 Mile March is more than a philosophy. It’s about having concrete, clear, intelligent and rigorously pursued performance mechanisms that keep you on track.”

As usual, I was thinking about how these lessons can be applied to healthcare organizations struggling to improve the patient experience. There is no doubt that patient experience goals can be overshadowed by other competing demands. With HCAHPS putting a very public spotlight on patient satisfaction scores, I frequently see leaders panicking and trying to attack every problem at once and expecting immediate results. At the same time, I’ve worked with a number of successful leaders who have made significant improvement in the patient experience without the panic. The difference? The successful leaders have made the patient experience a priority and never take their eye off the ball. They maintain a consistent pursuit of excellence, measuring and monitoring all along the way. They don’t try to sprint, exhausting all resources, but rather, maintain a steady course toward their goals.

Are you on a 20 mile march or a sprint to improve the patient experience?

As I have grown my consulting business over the past decade, I have sought out other like-minded organizations that I can trust, both as individuals and as service providers. The Baird Group’s quest to make healthcare better for patients and the people who serve them is closely aligned with BerylHealth. Over the years, I have come to respect BerylHealth for not only their marketing, call center services, and post-discharge calls, but as a company that strives for the highest level of employee engagement. I’m excited about our relationship because, as individual companies, we compliment each other’s services. When combined, we touch the patient experience across the entire continuum of care.

Improving HCAHPS is one of the driving forces behind our partnership. The Baird Group’s scope of services expands the full continuum of patient experience. We help our clients understand their current patient experience through culture assessment and mystery shopping. Once they have a clearer picture of the current culture, we guide them through the steps for a more positive, sustainable, patient-centered culture. That encompasses leadership development, process improvement, hiring practices, staff training, and employee engagement. While BerylHealth delivers the turnkey services to manage and direct customers’ first encounters with the healthcare organization by phone, Baird provides the strategies and tactics to manage the experience once the customer takes the next steps in the healthcare encounter. Keep in mind that the internal culture drives the patient experience. Our team works with leaders to build priorities, people, processes, purpose, and passion that will create and sustain a positive culture where the patient experience matters.

Our team does a significant number of culture assessments evaluating the patient experience across the continuum of care. There have been several occasions when we have been wowed by an initial phone encounter with an organization only to be gravely disappointed once we set foot on the campus. Why the disparity? In many cases, it was because BerylHealth was managing the great initial encounter, but, once the patient had the referral and arrived at the clinic or hospital, the experience wasn’t as friendly and customer focused. That’s where Baird Group comes in. We help the provider organizations understand what the experience is like for the consumer, and then we work with them to make improvements so it will be consistently positive from one person to the next and one day to the next. The Baird/Beryl combination is a powerful solution for managing the patient experience from the first encounter and throughout the continuum.

What surprises me most is that when reimbursement is on the line, I would expect healthcare leaders to do more to engage nurses in making improvements. Improving patient satisfaction takes more than just telling staff to be nice. They have to first understand the patient perspective and then become involved in finding what works.

I’m very encouraged with the work I’ve been doing on helping nurses improve HCAHPS scores. Many of the nurses I have worked with were very eager to learn more about the patient perspective and what actions can improve the dimensions of satisfaction. The profession as a whole is geared toward a holistic approach to care. Once on board and engaged, nurses make all the difference in the patient experience and resulting HCAHPS scores.

According to an article in The New York Times on April 13, medical school candidates will not only need to demonstrate proficiency in the hard sciences and math but also in behavioral sciences and critical analysis.

The article states:

In surveys, ‘the public had great confidence in doctors’ knowledge but much less in their bedside manner,’ said Darrell G. Kirch, president of the association, in announcing the change. ‘The goal is to improve the medical admissions process to find the people who you and I would want as our doctors. Being a good doctor isn’t just about understanding science, it’s about understanding people.’

Hats off to the AAMC for taking this position! We’ve known for a long time that the consumer expects clinical competence and will be much more likely to talk about and promote physicians who have a good bedside manner.

The other part of the equation is helping newly minted physicians who possess these skills thrive within a culture that supports them. Are you ready?

I was recently visiting a hospital during a patient experience consulting project. They had just completed an impressive renovation to the tune of $70 million and, although the architecture was as impressive as a 5-star hotel, the experience was more like the cattle call approach used in the DMV. When considering the patient and family experience, there are 3 “buckets” in which impressions fall. These include: people, process and place. Here are just a few examples from our assessment:

People
Directly under a beautiful waiting room poster promising patient- and family-centered care, we witnessed surgeons giving a families updates in the presence of other visitors. In the ER we saw entire exams conducted in the hallway right in front of other patients. In both cases, these were provider or organization-centered, not patient and family-centered.

Process
The family was not informed until the night before what time their infant’s surgery would take place. The young parents had limited resources for transportation and this process made it very difficult for them to make the necessary arrangements. Is this scheduling process made with the patient or family in mind? I doubt it. My guess it has more to do with the surgeon and the OR schedule.

Place
The employee-only cafeteria was located next to the family waiting area outside surgery. The smells were enticing. But when a father, who was waiting for his son in surgery tried to duck into the cafeteria for a quick bite, he was stopped by a security guard who directed him to a restaurant in the opposite end of the building. Families waiting outside surgery don’t want to leave their post for fear of missing an update. Patient- and family-centered? No.

My point is this: Everything about the patient and family experience must be seen through their eyes. Question every process, system, policy and facility change to make sure that you are delivering on your promise. Invite patients and families into the discussion early and often. You’ll see things in a whole new light.

Today, more than ever, healthcare needs engaged nurses to deliver the information and services that will create and sustain healthy populations. In my presentation, I reminded the nurses that it takes four things to be a great nurse. These are symbolized in The Wizard of Oz:

1. It takes courage to be a patient advocate and challenge the status quo.
2. It takes brains to continually monitor and manage vital processes for evidence-based nursing.
3. It takes heart to demonstrate compassion and empathy for others.
4. It takes a strong inner desire to want to make a difference.

And just as Dorothy realized that what she was seeking had been in her own backyard all along, these qualities reside within each of us and are there for the taking. Reach within and find the courage, brains, heart, and desire—for your patients, their families, and the community—and you will benefit.

It’s interesting that both the asker (in this case the wait staff) and the responder (in this case the customer) practice avoidance behaviors. What I’ve also noticed is that the wait staff often avoids issue by doing a “drive-by.” Without stopping to really listen, she asks how everything is but keeps walking knowing that the customer is probably going to say, “Fine.” The ugly truth is that a fine response is not a vote of confidence, nor is it a top rating. Fine can be anything from “It’s awful, but I don’t want to get into it with you” to “It’s just okay.” In either case, you won’t know what they really think until you get the survey results, and then you are shocked and disappointed.

What can healthcare leaders take away from the restaurant experience? That when making rounds on patients, remember “fine” is often a signal the patient could be avoiding confrontation. Be an astute observer during rounds and always seek suggestions for improvement. Don’t do drive-bys so that you can say you’ve made your rounds and check it off of your to-do list.

Engage and listen to your patients. Their opinions are rich with opportunity. And one more thing…practice being the type of consumer you’d like your patients to be. When things are less than expected at a restaurant, speak up and tell the waitress what you’d really like. Once you start to make these changes, you’ll be better at spotting opportunities with your patients.

For more information about better rounding practices and opportunities from the Baird Group, follow this video link.

First of all, let me say that this scheduling approach is not patient-centered. Not giving the patient any information about her scheduled time for surgery until the night before is strictly provider centered. If it was patient-centered, I would have been told days in advance. Instead, I was told that someone would call, and, if I wasn’t available, they would leave a message. I was also given a folder of printed documents, including my pre-operative and post-operative instructions, reiterating that I would be getting a call. The instructions stated that if I had not gotten a call, I should call a specific number before 7:00 p.m.

I received no call and no message. At 6:30 p.m. the night before my surgery, I called the number listed. After being transferred, the call was disconnected. Trying the number again, the attendant instructed me to call another number. When I asked if she could please transfer me, she said, “If we cut you off last time, we’ll cut you off this time. Good luck.” Not helpful. My next call resulted in the phone ringing thirty times before it was disconnected. This back and forth went on for nearly a half hour when finally someone took my number and said someone would call back.

At that point, I was not only irritated, but I had lost trust in the organization. After all, if it couldn’t answer a simple question, or even answer the phone number I was told to call, how reliable could its staff be in cutting me open and doing the right procedure on the right body part?

After six calls, I had made up my mind that I would cancel the surgery if I didn’t get an answer within the hour. This experience made me wonder just how many patients would continue calling to try to get answers and how many would just give up and wait until the next day to hear from someone. That would be costly for the organization as operating room time is a precious commodity.

By 9:00 that night, my question was answered when the department manager returned my call. I learned from her that I had been scheduled as the first patient in the morning and should arrive at 6:00. She was apologetic and said no one seemed to know why I hadn’t been called, but she was looking into it. I explained to her that this situation wasn’t just frustrating and time consuming; it caused me to question the competency of the team to whom I would trust my life in just nine hours.

I was surprised when the nurse who admitted me at 6:00 the next morning said, “I heard about the problem last night. I’m so sorry that happened.” In a way, it was good that she addressed the issue up front, but I also didn’t want my caregivers feeling like they were walking on eggshells. Fortunately, my surgery went well and the staff was thorough and confident.

But it reminded me that a patient experience is only as strong as the weakest link. Everything about the experience must be safeguarded in order to earn patient trust.

Today my scheduled was booked with back-to-back appointments leaving the remainder of the week reserved for cross country travel. Stuck in a snowstorm in bumper to bumper traffic was the first domino that fell for me today. That delay caused me to miss my 9:00 Doctors appointment which was 30 miles from my office. Rescheduling was not an option or it would cause me to have to cancel surgery for next week which had required that I eliminate travel completely for the following 3 weeks. So you can see how it goes.

1. I called the doctors office from the snowy highway. (Fear not, the traffic was moving at 2-5 mph and I have hands-free calling) I told the scheduler about my dilemma and explained that I could not reschedule to another day or it would mean cancelling surgery. I’ll admit that I was a bit amped up and expecting a roadblock. Instead, I got a sweet, empathetic response telling me that she would do whatever she could to help me get in today and that I should still proceed to the clinic. +
2. Within 5 minutes the nurse practitioner (Jane) with whom I was scheduled, called my cell phone to discuss scheduling options with the worst case scenario being a 3 hour wait. Not ideal, but I could live with it. (Have computer – will travel.) +
3. Arrived at the office building to find no parking available. Circled 3 times and went to a neighboring lot with no better results. Returned to the office building and “stalked” patients leaving the building to nab their parking spot. –
4. I had gotten specific check in instructions by both phone and mail so I knew exactly where to go when I arrived inside the building +
5. The registration attendant was immediately available, smiling and efficient. I was grumpy, but he was calm and professional. I told him that there is no parking. He thanked me and said he would make note of it and thanked me a second time for letting him know. +
6. Within 2 minutes of my arrival, Jane came out to greet me and updated me on an alternative plan that involved seeing a different provider but would cut my wait from 3 hours to 1. I could live with that. It made me feel like they really cared about my wait time even though it wasn’t their fault. +
7. Jane returned 5 minutes later and said she could further expedite my visit by at least completing my vital signs while she had a few free minutes. She completed these steps and I returned to the waiting area where I could have a cup of coffee or cappuccino in my favorite flavor. +
8. While I waited I watched how the staff handled other flustered patients. One registration agent came out to the line from another area and guided a waiting patient to another area where he could be served more promptly. +

My take on all of this is that I consistently observed frazzled patient being handled by calm, caring individuals who went above and beyond to keep things moving. Any one of these encounters, when viewed in isolation, may not seem to be a big deal. But when you put them all together, you have a positive experience.

This year, I wasted no time in setting clear and measurable goals for 2012 and communicating those goals to my team members. After all, if they all know the goals, they’ll be in a much better position to contribute to the achievements.

The year 2012 is pivotal in healthcare as value-based purchasing takes hold and incentive payments become a reality. I’m sensing a bit of panic as hospital leaders estimate what their HCAHPS patient satisfaction rates will mean in terms of reimbursement. We’re down to the 11^th hour and organizations that haven’t moved the HCAHPS bar are panicking.

This is the perfect time to re-evaluate goals and your strategies related to service excellence. For years, I have observed organizations that continue to measure satisfaction without taking real and sustainable actions. They hope that the scores will go up by paying attention to them. I can hope that my weight will go down just from stepping on the scale, but that little fantasy never comes true either. My weight on the scale is a reflection of my past decisions and behaviors. Your patient satisfaction scores are the same. They are a reflection of the past. They can tell you where you are today but won’t change by themselves. You need to take action and stay the course.

I recently asked senior leadership team members what their patient experience goals are and my question was met with silence and nervous glances. The CEO finally spoke up and said, “In the past, we’ve tried lots of different things and nothing sticks.” Did they try things, or did they implement them? Did they measure results and evaluate them? We can all set goals on paper, but the real winners are those that stay the course and cross the finish line.

What are your patient satisfaction goals for 2012? My advice is to set SMART goals (Specific, Measurable, Attainable, Relevant, and Time-bound) now, articulate your strategy, and gain the support of the movers and shakers who can help implement tactics and hold others accountable. From there, measure results, adjust as needed, and never take your eye off the ball. Don’t resolve to “hope” for the best or just “try.” Resolve to make it happen!

Here’s to a fabulous, productive 2012! Let’s get out there and make a real difference for our patients.