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Exceptional Patient Experience. Leadership Development Session August 27 & 28, 2013 Beverly Begovich April Fairey Lara Burnside. Healthcare Today?. Positive Image or Negative Image? Trusted or Feared?. Objectives for Today. Review the impact of patient satisfaction

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Exceptional Patient Experience

  • Leadership Development Session
  • August 27 & 28, 2013
  • Beverly Begovich
  • April Fairey
  • Lara Burnside
healthcare today
Healthcare Today?
  • Positive Image or Negative Image?
  • Trusted or Feared?
objectives for today
Objectives for Today
  • Review the impact of patient satisfaction
  • Introduction to Words that Work that demonstrates patient focused care
  • Understand differences between traditional patient rounding and “focused” patient rounding
  • Next steps for creating Words that Work that demonstrates patient centered care and getting to the “wow” experience
patient expectations
Patient Expectations
  • Don’t harm me
  • Make me better
  • Be nice to me

Health Pulse of America Center for Survey Research – State University of New York, Stonybrook

Do you worry something might go wrong during your hospital stay?

55% somewhat worried or very worried of a wrong treatment or serious infection while in the hospital.

words that don t work
Words that Don’t Work
  • You picked the wrong hospital to come to…
  • They never know what to do when I come here.
  • I never heard of that. I don’t know what to do.
  • It’s change of shift; you have to wait.
  • Nothing happens from 6:45 to at least 7:30.
  • No family is allowed in our ED bays the fist half hours;you know that rule!
situations to use words that work
Situations to Use Words that Work
  • High Volume Cycles of Service
  • Greetings
  • Goodbyes
  • Transitions/Handoffs at change of shift
  • Service Recovery
  • Delays
  • Waiting Room Protocols
The Voice of Our Customer
  • Why does this matter?

I gave you “usually” on your survey. I am six times morelikely to go to your competitorin the future.


I gave you “Always” on your survey. I am six times lesslikely to go to your competitorin the future.

what s in the gap between the usually and the always
What’s in the gap between the “usually” and the “always”?
  • The “very goods” to the “excellents”
The Patient Experience: 3 Components
  • Loyalty
  • Emotional bonding
  • Psychological commitment
  • Likelihood to Recommend
  • Satisfaction
  • Meet/exceed expectations
  • Outcome delivered
  • How “Well”
  • Perceptions
  • Formed by experience
  • Perceptual quality
  • Behavior and consistency
  • How “Often”


Satisfaction Survey


impact of transparency
Impact of Transparency
  • Web traffic has increased 500% since Hospital Compare began publically reporting HCAHPS
  • Traditional vs.
  • Patient Rounding
  • Defined population daily
  • All new or All DC
  • Clinical Assessment
  • IP visit
  • Complaint Visit
  • Part of Interdepartmental Rounding
  • Problem disposition
  • Problem patient
  • Population is staff driven
  • Focus is derived from action plans your staff has committed to
  • Goal is listen and confirm that actions are consistent in all staff
  • Goal is setting expectation “our goal is excellent care…”
  • Goal is fix problem and seek recognition for staff
outcomes for patient family rounding
Outcomes for Patient/Family Rounding
  • Build relationships
  • Reward and recognize
  • Ensue patient safety
  • Ensure high quality of services provided
  • Identify opportunities for improvement
  • Remove barriers to a “WOW” experience
getting started
Getting Started
  • What is the goal? Overall satisfaction Percentile vs. Mean Percent?
  • What is the action plan decided on by the staff to address the priority items in the survey?
  • What questions might be asked that will validate consistency in following the action plan?
  • How frequently will rounding occur for patient/family?
preparing to round
Preparing to Round
  • Patient satisfaction surveys, comments, reports, censuses, and knowledge of services provided
  • Staff assignments
  • Business cards
  • Dry erase markers and/or pad and pencil
  • Ancillary department numbers and resource information
  • Items for “On the Spot” reward and recognition
step 1 build the relationship
Step 1: Build the Relationship
  • Provide an introduction
  • Maintain eye contact/smile
  • Put the person at ease
step 2 set expectations
Step 2: Set Expectations
  • Explain reason for rounding
  • Encourage open and honest communication
step 3 focus the inquiry
Step 3: Focus the Inquiry
  • Listen, learn, and share
  • Use specific language that will get to the goal of improvement
  • Focus on fact-finding, not fault-finding
  • Ask probing questions – high-gain, open-ended
  • Be persistent and consistent
step 4 close the encounter
Step 4: Close the Encounter
  • Offer to provide additional assistance/help
  • Tell them what you will do with the information and by when
  • Say “thank you” and leave your contact information
step 5 act on the information
Step 5: Act on the Information
  • Take notes and follow-up on actions
  • Act on opportunities for improvement
  • Under promise and over deliver
  • Reward, recognize, and celebrate!
  • Trend issues/opportunities for improvement
    • Share finding with the senior leaders, peers, and employees
using patient data to create action plan
Using Patient Data to Create Action Plan
  • Review Patient Measurement Report and identify the department’s top three priorities
  • Appoint one person in each group to act as the leader, the remainder of group are now staff members
  • Leadersfacilitate discussion with group to:
    • Identify the actions you will take to address top three priorities identified from sample Measurement Report
    • IE safety is top priority, action could be “This ID band is the first step in keeping you safe in our hospital”
action plan continued
Action Plan continued
  • Educate all staff to actions and advise effective date
  • Display agreed actions in common area on unit for visibility
  • Leaders document agreed actions on Pt. Rounding Log
  • Select patient population for rounding (consider staff assignment)
  • Begin rounding with focused questions
  • Document outcomes on rounding log
  • Share findings with staff and senior leaders
entry script to interact with patient s family
Entry Script To Interact with Patient’s Family
  • “I’m _______, the Director of _________. Our goal is that you receive Very Good care while you are a patient here.
  • Do you have time to answer a few questions for me?
discovery and apology scripts
Discovery and Apology Scripts
  • In the last 24 hours have you needed to use your call light? If so, what for? Were we timely in our response?
  • Describe your experience.
  • Tell me more.
  • Is there anyone I can recognize for providing you with “excellent” care? What exactly did they do?
  • I apologize for the delay in answering your call light. Tell me how I can make this better for you?
focus on the positives
Focus on the Positives
  • Manage up
  • Send “Thank You” notes to the employee’s home
  • During rounds, identify employees within your department, as well as employees from other departments, who should be recognized for consistently following the action plan
  • Recognize those employees mentioned by name
  • Involve employees in the decision making process
does focused patient rounding
Does Focused Patient Rounding
  • Really make a difference?
outcomes of leaders rounding on patients
Outcomes of Leaders Rounding on Patients
  • Patients rounded on by Nurse Leaders reported satisfaction levels on average 59 percentile points higher than patients not rounded on by nurse leaders
  • Decrease patient complaints by 66%
  • Reduce Emergency Department LWOT from 4.5% to 2%
all hospitals inpatient 2009































All Hospitals Inpatient - 2009
  • Percentile Ranking

Nurse Leader Rounded



Journey from the 24th to 99th percentile in 24 months

Implemented Monthly Patient Satisfaction Tracking and Reporting System: turning data into actionable knowledge and transparency, accountability, Rounding, Words that Work

likely barriers to effective focused rounding
Likely Barriers to Effective Focused Rounding:
  • Not prioritized as part of daily schedule
  • Distractions and called to fight “fires”
  • Accountability Gaps
  • Overall lack of belief in patient focused rounding as a critical management tool
  • Failure to act on the information