Breaking the Cycle of Denial: Responses to 3 common excuses

Falling back on tried and true excuses may be the comfortable thing to do when faced with the hard truths that surveys sometimes expose, but that denial trap isn’t helping you reach any of your patient satisfaction goals. I’m sure many of us have either heard (or perhaps uttered!) phrases such as, “One disgruntled patient is bringing us down,” or “The survey must be flawed,” ” Only the negative people bother filling out the surveys,” “Our patients aren’t like others,” or even just a plain catch-all: “It’s not our fault!”

Facing the truth is hard, and yet, when the evidence is staring at you in black and white, why not humble yourself and seek help? Burying yourself in a litany of excuses isn’t doing you, your staff, or your patients any good.

See if you recognize yourself (or your organization) in any of these common denial scenarios, and plot ways to break that cycle.

Excuse #1: The survey instrument is flawed

This excuse is usually heard when survey results are inconsistent from one reporting period to the next. When scores look good, everyone is celebrating and patting each other on the back. When the next period’s scores are significantly lower, the fingerpointing and excusemaking starts.

One of the easiest scapegoats is the survey instrument itself. In times when scores take a dip, the excusemongers may point out that perhaps the questions on the survey are worded in a way that patients can misconstrue. Or perhaps the survey is asking questions that are irrelevant to the services provided in your department. Or maybe the survey just isn’t asking the right questions at all.

That’s a lot of responsibility to heap on a piece of paper. But while it might be tempting to blame the survey, it’s just as easy to use the survey to combat this excuse. Start with education and transparency. Patient satisfaction surveys need to be transparent to all employees. That means employees should hear all of the comments and see all of the scores that make up their quarterly report. Sharing only the positive comments may give the impression that everything is going well. On the flip side, sharing only the negative paints a grim view of the patients’ experiences. Sharing all of the information is the best bet.

Many benchmarked survey instruments have online tools that leaders can use to get updates between official reporting periods. Make use of these tools to keep your staff updated in “real time” on their performance in the eyes of their patients. By keeping tabs on scores and comments as they come in, you have the opportunity to make minor adjustments to service behaviors as you go along. This also helps your team recognize inconsistencies in how they are delivering service.

In the same way that you make the survey results transparent’ your service improvement plan must be transparent to all staff as well. Ideally, all staff members should have input into your service improvement plan, and all should be able to see how that plan is clearly based on survey results.

Frequent and open communication about your patient satisfaction goals and survey results should help everyone see that the survey itself is not to blame for low or inconsistent scores.

Excuse #2: The patients are messing up the surveys

When a young child gets caught talking in class, he’s always quick to point a finger to his neighbor and declare, “It’s his fault, not mine!”

Sometimes as healthcare professionals, when we’re caught with less than desirable survey scores, we want to point that finger at our patients and say, “It’s their fault, not ours!”

Larry Beck, CEO of Good Samaritan Hospital in Baltimore, MD, was the guest CEO speaker at the January 27 installment of my webinar series, “Raising the Bar on Service Excellence: Step by Step.” For the past 10 years, Beck has taken Good Samaritan on a continuing journey to become an employer of choice.

Along the way, he and his teammates have faced many challenges, including the accountability challenge. “Healthcare is full of big-hearted people,” Beck says. “We want to think the best of our peers, and it’s a challenge for us to hold each other accountable.”

Beck’s team has recognized, though, that they are the only ones responsible for their outcomes. Charlene Foote, the outpatient rehab manager at Good Samaritan, was faced with lots of excuses for fluctuating patient survey scores. Like her CEO, Larry Beck, Foote also shared her experiences with our webinar audience.

In addition to continually keeping survey scores and comments out in front of her staff, Foote also worked to instill good habits into her staff members. “We worked on hardwiring discharge phone calls into their daily work,” she says. “We worked on making ourselves responsible for the patient’s satisfaction after they left our care.”

“Another habit we worked on was using keywords at key times,” says Foote. “We explained why we were doing something and made sure patients understood our instructions.”

These two habits–discharge phone calls and using keywords–helped make the staff understand that they were responsible for their patients’ satisfaction and, ultimately, how their patients filled out the satisfaction surveys.

This was further demonstrated by another habit that Foote instilled in her department: the sharing of narrative comments from the patients’ surveys so that staff could hear patients’ thoughts in their own words.

Excuse #3: It’s not us, it’s them

Again, it’s easy to want to pass the blame for a less than desirable score onto someone–anyone–else. The first-shift nurses blame the second-shift nurses. The second-shift nurses blame the ER staff. The ER staff blame the housekeepers or phlebotomists and so on. The buck doesn’t seem to stop anywhere. Foote understood that, in order to be an effective leader, she first had to model accountability. “I admit that when scores weren’t looking so good, it was easy to slip into the habit of finding someone else to blame,” she says. “But unless I let go of my own denial, there was no way I could lead my team through the changes we needed to make.”

Under Foote’s leadership, Good Samaritan’s outpatient rehab department went from struggling with inconsistent patient satisfaction scores to consistently scoring in the 99th percentile. Foote credits her staff with coming together for a common goal.

“When we started out trying to improve our scores, we looked to other departments within the hospital that had great scores. These were our mentors,” she says. “We visited these departments to see what they were doing well and how we could adapt that to our department.” Among the lessons learned from other departments was the fact that their leaders were vigilant about watching survey returns and not accepting excuses.

Foote set out to make service improvement fun in her department without taking her eye off of the goal. The department’s service goals were made visible on bulletin boards, in staff and patient activities, and even plastered to Foote’s office door. “I used the FISH philosophy to motivate staff members to take ownership of having fun at work,” she says. Each season or holiday ushered in a different theme for staff, and patients were even encouraged to participate in activities. In time, staff members began taking responsibility for coordinating department activities and bulletin boards. By keeping the scores and comments visible, people are less likely to deny the reality of the patient experiences.

Staff members were publicly recognized for their patient satisfaction achievements, and Foote found that the power of recognition motivated previously unenthusiastic staff members to get on board with the patient satisfaction initiative.

Foote’s staff members found that it’s easier to work together toward a common goal when they’re having fun at work. They’re also more likely to pull together as a team when faced with a challenge and less likely to pass the blame off on someone else.

When faced with less than desirable survey numbers, it may be human nature to find an excuse to explain them away. It’s harder to hold yourself accountable for those numbers, but, in the long run, eliminating excuses and doing away with the denial will bring you closer to your goal and increase both your staff and patient satisfaction.

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