October 25, 2011

Improving Your Health System in 10 Minutes

Written by Lindsey Dunn

On Oct. 19, at the StuderGroup’s “What’s Right in Health Care” conference, five healthcare experts shared key takeaways for healthcare leaders in a session titled, “10 Minutes That Count.”
In the session, each speaker was given just 10 minutes to get across an important message that could be taken back to the healthcare leaders’ organizations and have a real impact.

First to take the stage was Bob Murphy, RN, Esq., FACHE, and international speaker and executive coach with StuderGroup. He shared lessons on “how to get people to do what you want them to do.” He left the audience with three key ways to achieve this:

  1. Find the few key critical behaviors that really drive results. According to Mr. Murphy, these are often small changes. “It’s usually just [changing] one or two key behaviors,” he said. For example, patient perception of care can be greatly improved by having leaders round on patients daily and providing each patient with a post-discharge phone call, he says.
  2. Use the right words. When asking employees to change behaviors, use the right words, says Mr. Murphy. StuderGroup research has found that if leaders use the word “mandatory,” 98 percent of people believe they must perform the behavior. If the word “required” is used, 67 percent believe they must perform the behavior; for the word “expected,” the percentage drops to 26 percent.
  3. Connect to the “why.” Finally, Mr. Murphy added leaders can drive behavior change by explaining the “why” — the reason behind the need for the behavior change.

Next, Beth Keane, MA, a national speaker and coach with Studer Group, discussed the importance of coaching and having hard conversations with employees to ultimately improve behavior and the overall organization. She started her presentation by asking, “Who tells us when we have spinach in our teeth?” Meaning, we all make mistakes, many times unintentionally, and we need people that care about us to alert us. Despite this need, many healthcare workers fear providing criticism or coaching because they worry it will be poorly received, when in fact, “coaching is caring,” said Mr. Keane.

She provided the following template to provide feedback through coaching:

  • “I see [this behavior] happening.”
  • “The result of this is…” (Mr. Keane noted this is when the employee provides “the why.”)
  • I want [this change of behavior].

“Consider training all your people on how to have hard conversations,” said Ms. Keane. “We have lives at stake and have to be able to coach one another.”

Jim W. Pichert, PhD, co-director of the Vanderbilt Center for Patient and Professional Advocacy, discussed how Vanderbilt has used a “tiered-intervention” approach to improving physician and other professional clinician behavior that may put quality and patient satisfaction at risk. At top of the tiered intervention pyramid are disciplinary interventions, followed by guided interventions — both of which Vanderbilt tries to prevent by intervening before behavior reaches this point. The health system does this by training clinicians on how to have prior conversations with each other about problematic behavior. At the most basic level are “coffee conversations,” which involve a clinician talking with another clinician over a cup of coffee about any concerning behavior observed. In the second level, trained clinicians have “awareness” conversations with physicians who stand out based on monthly data provided to each unit.

The results of Vanderbilt’s efforts have been impressive. The number of malpractice lawsuits per 100 physicians has “plummeted” over the last ten years, according to Dr. Pichert. Adherence to hand hygiene protocol among clinicians is now over 90 percent, which the health system hopes to increase to “every patient, every time,” he said.

Dr. Pichert believes other health systems can be similarly successful if leadership is committed to training physicians on the tiered interventions and a clear plan is put in place. Ultimately, clinicians want to provide quality care. “If you posed a risk to quality or safety would you want to know?” asked Dr. Pichert. “Of course you would.”

Next, Stephanie Baker, RN, CEN, MBA, a StuderGroup coach and former emergency room nurse, shared tips for ensuring “no ED [is] left behind.” ERs in the United States treat more than 124 million patients per year, and the CDC expects that to increase five percent for the next five years, says Ms. Baker. At the same time, more ERs close each year, putting further pressure on the ones that remain open. To deal with this, Ms. Baker encourages leaders to think of the “path of the patient.” That is, patients should be quickly triaged and seen by a physician within 30 minutes. Patient flow processes may need to be adjusted to improve efficiency. Ms. Baker also encourages ER staff to round hourly on the ER waiting room. “Hourly rounds saves lives and keeps people connected, ” she said.

She closed by saying that values should always be the guiding principles behind efficiency efforts. “There are no bad days; no ED can be left behind. Let’s lean forward,” Ms. Baker said.

Finally, Rich Bluni, RN, an international speaker affiliated with StuderGroup, talked about the importance of trust, communication and self-assessment in healthcare. In regards to trust, Mr. Bluni said healthcare workers often want to do everything themselves, to ensure it’s done right. This, he said, can be a mistake because it leads to burnout, which could result in errors. He recommends employees learn to trust their colleagues and encourage them to solve non-critical problems themselves, rather than bring them straight to a supervisor. Communication is also key as it is the number one cause of sentinel events, said Mr. Bluni. He encouraged leaders to ask their employees to rate them on their ability to communicate and to solicit ideas for improvement. Lastly, Mr. Bluni encouraged the healthcare leaders to self-assess both their work performance and their work-life balance and set goals for improvement in both work-related and personal arenas of life.

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