Ever since HCAHPS came into being, there has been greater concentration on creating an “Always” culture. Why? Because the word “always” is the top box choice on the HCAHPS survey. The good thing is that, by focusing on the word “always,” it helped healthcare organizations to set and uphold standards to drive the patient experience. But is it really consistent?
When we’re doing our culture assessments, we spend time looking at what things the organization currently has in place so that we can help them build on that, rather than completely starting from scratch. One thing I like to do when meeting with the executive team is to ask if they have standards in place. Many have created them. They often point to a nicely framed document on the wall and proudly confirm they done this very important task. Fabulous.
Then comes my big question to them. I ask, “How many of you would be willing to bet 10% of your salary on my experience. If I were to walk out into your hallways right now, would I experience everything that you have listed in your standards?” A few will give weak nods or shrugs. In some cases, no one moves or responds. Executive paralysis. Some brave soul might actually speak up and say, “It depends.” I’ll probe a little further by asking, “What does it depend on?” The response is usually, “The department, the person, or even the situation.” Bingo! That’s precisely why they are not achieving always.
Their admission of tolerance is usually the pivot point for most leadership teams. What you permit, you promote. By setting standards and then not holding staff accountable, the leaders have reframed the standards as “suggested behaviors.” There is no way any one of the executives would allow staff to avoid following infection control policy or spending policies. Why then, are the service standards less important?
Getting to always starts at the top in the C-suite. Although the HCAHPS questions pertain mainly to the clinical team interactions, an “always” culture must permeate the fabric of the entire organization. It must be a way of life.
P.S. I’ve never once had an executive willing to wager even 1% of their salary on consistency of the experience.