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.

When I reflect on the great influencers in my life, they are all people who were following their passion with clear values, and a desire to make a difference. In healthcare, when people are focused and driven by a passion to create a patient and family-centered experience, phenomenal things happen. One good example of this was a mentor I had while working in critical care. Paula wasn’t officially designated as my mentor (or even my preceptor for that matter), but she took me under her wing and showed me how a great nurse is a courageous patient advocate, an intelligent decision maker, and a tender, compassionate caregiver. It was many years after we had worked together that I told Paula she had made a real difference in my approach in nursing. She was shocked and said she didn’t think she had done anything out of the ordinary. That’s the beauty of it. She had used her gifts to make a difference–not only in the lives of her patients and their families, but in the lives and careers of other nurses she influenced.

We all have gifts to share. But when those gifts are combined with passion and a servant’s heart, great things happen. How did you share your gifts this past year? What gifts will you share in the year ahead?

I started the week working with a team of nurses, case managers, physicians, and other disciplines on improving their system for completing follow-up phone calls. It was clear that they are driven by what is best for the patient and the patient’s family. Their commitment and willingness to work together for a common goal is inspiring and reminds me that there are thousands of teams working around the country to make life better for their patients. That feeling was reinforced in the second half of my week’s travel.

I’m honored to have been invited to serve as the closing keynote for Inova Health System’s quarterly leadership Institute. Yesterday, I spent most of the day listening to their leaders tell stories and give awards for amazing accomplishments. The energy in the room and the spirit of service was infectious. What was evident to me was the alignment of their core values with their strategies and resulting actions. Some of their award-winning accomplishments were spearheaded in the trenches by front-line staff. Others were initiated by middle managers or senior leaders, but all were bound together by a common thread, a common message that fuels their actions. When I experience this level of alignment, I get the overwhelming sense that I’m at home. I’m with “my people.” That’s because I know beyond a shadow of a doubt we are all fueled by the same desire to shape a better experience for patients and for those who are serving the patients.

It’s important for all of us to find like-minded people on our journeys toward better healthcare. It reminds us that, although there is much work to be done, we’re not alone. Look around your organizations for “your people.” Find them and unite under a common vision for excellence. It will help lift you when the road seems long. I may be traveling and away from home, but I’m blessed to find my people in pockets from coast to coast.

We recently sent a number of mystery shoppers along with patients through their admission and fist days in a hospital to help a client gain a deeper understanding of the patient experience. These mystery shoppers went along as family members and had no idea about patient satisfaction scores or which categories of the HCAHPS survey were giving the leaders headaches. But their observations and documentation showed it wasn’t necessarily what the housekeepers did that caused patients to feel the hospital was unclean. It was the rest of the staff that contributed to making and ignoring clutter, which caused issues.

The patients’ comments and concerns about cleanliness in this case had more to do with clutter and staff habits than how housekeeping performed. In three of the four in-patient visits, patients were turned off by the clutter left on their bedside tables and the dirty linens left on the floor. In both examples, it was staff who dropped things on the floor, ignored empty containers on the bedside table, or left clutter behind.

In one situation it was the nursing assistant who helped a patient change his gown and then left the soiled one on the floor next to the bed. It was still there, along with another soiled one left on the bathroom floor, twelve hours later.

In two other situations, patients told the mystery shopper that they were bothered by empty juice containers, melted ice chips, and coffee cups left on their tables. They also noticed that, even though a number of staff members came in and out of the room for other reasons, they looked right past the mess and never straightened things up or offered to get rid of empty drink containers. Patients asked their family members to clean up.

Of course, meticulous housekeeping is essential for infection control and positive patient experiences. But in this assessment, our “AHA!” moment was in realizing that much of the patient perception about cleanliness was not about housekeeping, but rather staff habits and lack of attention to detail.

We all love stories of underdogs that rise to the top in the face of adversity, don’t we? What always resonates with me is that this type of success story often contains a common denominator beyond the triumphant outcome. That common denominator is, in this case and as in millions of other success stories, a visionary leader who, despite all obstacles, persevered in the face of resistance. Cathy Rush, the feisty, determined coach who led the team to several national championships, had the vision to see what was possible and the grit to persevere when most of us would have given up.

This story made me think about all the visionary champions who lead within the healthcare industry. They may not always be in the limelight, but they are there. They embrace their work every day with the belief that they can make a difference in the lives of the patients they serve and the staff who serve them. These visionary leaders can be CEOs of large systems, or managers of small departments in critical access hospitals, and everything in between. This movie reminded me that visionary leaders do three things:

• They truly believe that they can make a difference
• They articulate their vision in a compelling manner that helps others believe in their vision as well (after all, you aren’t really leading if others aren’t following)
• They stay the course in the face of adversity

Leading a culture of service excellence requires that you believe you can improve the status quo. It means you consistently think and talk about the vision and help others believe they contribute to that vision every day. And, lastly, it requires that you stay the course, even when you hit obstacles.

I frequently interact with people from organizations who share a litany of reasons that they cannot do any better. Understaffed, cramped, and aging facilities and time constraints are at the top of the list they share for not being able to create a better patient experience. These people need a champion of change. They need a visionary leader who helps them believe that their patients deserve better than what they are getting—that every encounter is an opportunity to make a difference, and they can trust one another to deliver on the promise.

When employees have the benefit of working for a visionary leader, chances are, their lives will be enriched forever. They’ll have a stronger connection to their mission and vision and be a daily contributor to the brand experience.

Remember—everyone wants to be on the winning team. Help them believe they have what it takes to be service champions.

Fortunately, there are some stellar exceptions. My team was recently invited into an organization to conduct a culture assessment. As part of our due diligence, we do mystery shopping and conduct in-depth interviews and a series of focus groups designed to identify the crucial elements of the culture. During the culture assessment, I had one of the best encounters with the senior leadership team that I have ever had. The CEO asked her senior leadership team if they were truly ready to hear the truth. She advised them, “If you are not ready to hear the truth and embrace the challenges before us, this is the time to speak up. We don’t have to conduct the assessment. But if we do, we must be ready to face the truth.” She went on to say that she is ready to take an honest look at the organization and is ready to do what it takes to improve the culture. This is exactly the type of leader I love working with. She is inspiring and gutsy enough to stand up and make some tough choices. Their organization sits at the 70^th percentile for satisfaction, but sees a need for improvement. My prognosis for their success? Excellent.

Compare that to another organization with whom we recently worked. Their patient satisfaction scores for “likelihood of recommending” slide between the 2^nd and 4^th percentile. When we presented our recommendations, the CEO led the senior leadership team in shooting holes in the findings and arguing that they needed more analytics to justify making any changes.

It doesn’t take a brain surgeon to see the problem. They want me to fix the scores, not help them deal with the underlying problems that lead to poor scores. I have visions of carrying the Jack Nicholson video clip around with me and, when the need arises, hit the button and let Jack tell them, “You can’t handle the truth!”