Cary Gutbezahl, MD

Cary Gutbezahl, MD, president of Compass Clinical Consulting, recently wrote an article published in Hospitals & Health Networks magazine on turning conflict into a positive force to create better American hospitals.

Here’s an excerpt:

Managing Hospital Conflict: Avoidance of conflict is neither healthy nor productive when the conflict is over sincere differences of opinion about solving problems. Instead, allowing team members to disagree often leads to the best solutions and the most productive work systems.

There are two types of conflict. The undesirable and too familiar type of conflict is called relationship or affective conflict, which is based in dislike and distrust. It has a strong emotional component and manifests itself in disrespectful behavior and speech, which result in nonproductive and disruptive interactions.

The other type of conflict is called task or cognitive conflict. This type of conflict originates from differences in perspective about how to perform a task. Studies show that groups that generate task conflict and manage it well perform better than do groups that have little task conflict.

The article then explains how to manage task conflict. Read the full story: The Benefits of Conflict.

The American Academy of Family Physicians predicts that the shortage of family doctors will soar to 40,000 within the next decade. Worse yet, the overall shortage of doctors is expected to climb to nearly 160,000 by 2025, according to the Association of American Medical Colleges.

“I don’t see anything in the legislation that will greatly increase the primary care pipeline,” said Dr. Russell Robertson, chair of the Council on Graduate Medical Education.

But when “reducing the cost of healthcare” by mandating lower fees to providers, this should be more carefully analyzed to prevent a future of continuous change. Best to get it right at the start instead of rushing to judgement. This will best be done if policymakers are using the right data to make wise decisions rather than picking a data point from one place and another datapoint from another place and yet another datapoint … searching for datapoints that support what they wanted to do anyway.

This excerpt from The Healthcare Value Blog indicates what I mean:

We are surprised and dismayed at how policymakers are using the findings as the map for healthcare reform in Washington, D.C. We are also frankly appalled at how The New Yorker article by Dr. Atul Gawande has seemingly become the guidepost of reform for policymakers. The reason is that the conclusions that The White House and much of Congress have drawn from The New Yorker article are, at best, suspect and, at worst, completely wrong. Reengineering 20% of the economy is a large task, in our view, and getting the facts straight is important.

So, what have we done? Instead of using an “Atlas” to analyze McAllen and El Paso, we suggest using a “GPS” to triangulate the position that hospitals played in overall excess cost and utilization. Doing so provides some critical facts that The New Yorker failed to report.

Check out the observations by Hal Andrews & John Morrow from The Healthcare Value Blog: Lost in D. C. with the Dartmouth Atlas.

That said, all of us can read enough of the crystal ball to realize that hospital leaders will need to carefully examine their own hospital systems for ways to eliminate non-value producing processes. The goal must be to reduce the cost of delivering safe, quality healthcare. As has happened at several clients we have worked with recently, hospital managers do have the potential to reduce labor cost without layoffs, and at the same time create a renewed, long term commitment by staff to achieve safer, quality healthcare for patients.

Hospitals are big, complex businesses — typically the largest employers in any city. Running such a business is no easy task. Taking cost out of such businesses must be done smartly less the wrong decision leads to patient safety issues or to unleash unintended consequences such as doctors, nurses and specially-trained staff voting with their feet and going elsewhere to make a living.

Where we might differ from some of the global directives coming from national policy is that these savings need to be delivered one hospital at a time, each with its own unique people, processes and culture. What we don’t want to see is our national system of healthcare providers flung into chaos without the time to get leaner and better.

We believe most healthcare providers understand the need to reduce the cost of delivering safe, quality healthcare and we see them already tackling this issue without being subjected to policies that might cause them to do this the wrong way.

The Journal of the Medical Library Association, Healthcare IT News reports on a study that indicates social networking tools are rapidly being added to the curricula in medical and nursing school. It should be noted that the study included a fairly small sampling and results may be non-projectable. We include this, however, because based on our experience (see last paragraphs of this posting), social media are gaining momentum.

Hopefully, this will be a trend because physicians, nurses and hospital administrators will gain by expanding their view of professional and patient discussions that should serve to improve care at lower cost.

The study cited:

• 53% of nursing schools and 45% of medical schools include Web 2.0 tools in their curricula.
• 58% of nursing schools plan to implement social networking tools in their curricula in the upcoming year, compared with 50% of medical schools.

Although a larger percentage of nursing schools report using or planning to use Web 2.0 tools in their curricula than medical schools, medical school respondents were more likely to report personal use of social networking tools than nursing school respondents.

Student, Practitioner Demand

A separate survey conducted in 2007 found that medical students and practitioners want more training to become better users of Web 2.0 tools.

Compass Clinical Consulting Using Social Media

Compass Clinical Consulting’s decision to reach out to the healthcare community through social media fits in with a growing trend of medical and nursing schools who are now teaching students how to be proficient in using social media.

Visit our website, our social media news room and our growing list of blogs and links to our Twitter, Facebook, LinkedIn, Flickr, YouTube, StumbleUpon, and other social media.

Over 300 hospitals are now following us on Twitter and in just three months nearly 20,000 pages have been viewed on our blogs.

The goal is to become an integral participant in the discussions that impact reducing the cost of delivering safe, quality healthcare.

When the order entry incumbent resigned without notice in November 2008, the management team began to seriously investigate the real sources of the high defect rate. A major insight was the realization that initial training of new employees was completely inadequate. Furthermore, many of the important aspects of the job were either undocumented or inadequately documented making effective training difficult.

In the first month after the new person was hired and trained the new way, the defect rate fell 72%. The next month it fell 17%. The defect rate has fallen by similar amounts each subsequent month, now five months running. As the defect rate falls to low levels, they have begun exploring the ideas behind a “zero-defect” program.

Read about their process improvement journey.

A hospital team can use this concept by combining labor cost management with case management. The two together become highly strategic multipliers. One plus one equals 3 or maybe even 10. The combination enables your team to lead transformational change faster.

Improving patient throughput with effective and aligned case management maximizes the use of hospital assets – time, space, capacity, equipment, and human assets. Maximizing those assets leads to significant productivity gains. When patient flow is increased, unnecessary work can be eliminated and existing staff can process added patient volume more effectively.

Flow improvement is especially effective for hospitals experiencing or anticipating substantial growth or for hospitals approaching the limits of their capacity.

Adding labor resource technology can also further multiply results, but only if social change is part of the technology implementation. The frequent lack of success experienced by management in using these systems usually results from the inability to generate “buy-in” as well as build the management and organizational capability to change culture and processes.

Without the required social change, technology alone is a force detractor. It takes your eye off the real problems while searching for magic bullets. Systems don’t produce results . . . people who know how and why to use systems produce results.

Growth of freestanding EDs, of course, are a threat to the back door of all acute care hospitals. It is another whittling of the full-service hospital. Does this mean such hospitals face the same demise as did department stores of the past that are now replaced by boutique retailers?

Modern Physician explores the dispute surrounding private, freestanding emergency departments. Private companies can operate their freestanding EDs without regulatory oversight. Hospitals argue this advantage compromises quality of care, while the Joint Commission says private EDs provide efficient and quality care. At least one private ED company welcomes more regulation, and one state is considering legislation this year that would increase oversight of all freestanding EDs.

Check out the video on The Doctor’s Channel to see further discussion via video.

One source attributes the following poem to a poet in Texas, who claims he wrote it 20 years ago. Recently it has made its way across the Internet as a story about a crabby old man who died in a hospital or nursing home and left this poem behind. That’s how some urban legends grow.

Wherever lies the truth, the poem should speak to all of us working in the healthcare industry — we impact the lives of real people and should be darned proud of reaching out and making life better for every patient.

There’s a real person inside each of us — even the crabby, feeble and sometimes irritating ones!

What do you see nurses?  What do you see?
What are you thinking  . . .  when you’re looking at me?
A crabby old man . . . not very wise,
Uncertain of habit . . . with faraway eyes?

Who dribbles his food . . . and makes no reply
When you say in a loud voice . . .  ‘I do wish you’d try!
Who seems not to notice . . .  the things that you do
And forever is losing . . . A sock or shoe?

Who, resisting or not   . . .  lets you do as you will
With bathing and feeding . . . The long day to fill?
Is that what you’re thinking? . . .   Is that what you see?
Then open your eyes, nurse . . . you’re not looking at me

I’ll tell you who I am . . .  As I sit here so still
As I do at your bidding  . . . as I eat at your will
I’m a small child of Ten . . . with a father and mother
Brothers and sisters . . .  who love one another

A young boy of Sixteen . . . with wings on his feet
Dreaming that soon now . . .  a lover he’ll meet
A groom soon at Twenty . . . my heart gives a leap
Remembering, the vows . . . that I promised to keep

At Twenty-Five, now . . .  I have young of my own
Who need me to guide . . . .And a secure happy home
A man of Thirty . . . My young now grown fast
Bound to each other . . . With ties that should last

At Forty, my young sons . . . have grown and are gone
But my woman’s beside me . . . to see I don’t mourn
At Fifty, once more . .  . Babies play ’round my knee
Again, we know children . . . My loved one and me .

Dark days are upon me . . . My wife is now dead
I look at the future . . .  I shudder with dread
For my young are all rearing . . . young of their own
And I think of the years . . . And the love that I’ve known

I’m now an old man . . . . . . . . . and nature is cruel
Tis jest to make old age . . . .. . . .look like a fool
The body, it crumbles . . . grace and vigor, depart
There is now a stone . . . where I once had a heart

But inside this old carcass . . . A young guy still dwells
And now and again . . . my battered heart swells
I remember the joys . .  . I remember the pain
And I’m loving and living . . . life over again

I think of the years . all too few . . . gone too fast
And accept the stark fact . . . that nothing can last
So open your eyes, people . . . open and see
Not a crabby old man . . .   Look closer . . . see ME!

Not to be outdone, The Cleveland Clinic has lent its name and backup services to a string of CVS drugstore clinics in northeastern Ohio. And the Mayo Clinic is in the game, operating one Express Care clinic at a supermarket in Rochester, Minn., and a second one across town at a shopping mall.

This is one more wave of competition, slicing off segments of the healthcare business. For hospitals, it is an enticing way of extending their local brand names into high traffic centers. For primary care doctors, it is chipping away at their business. Soon it might be a rare sighting to see frozen corn at the supermarket as the owners look for ways to add more profitable offerings and simply view their stores as a medium for selling more and more non-food merchandise.

Just one more sign that healthcare is changing faster than you can say PRESTO.

The intervention was associated with 29% fewer hospitalizations (95% CI 10% to 44%) and 24% fewer ER visits (95% CI 3% to 40%) compared with usual discharge planning for homeless patients.

In the United States, Google Trends has identified a remarkably close relationship between the number of people searching for flu-related topics and the number of people who actually have flu symptoms.

While not every person searching for “flu” is actually sick, a pattern apparently emerges when selected flu-related search queries from each state and region are added together.

For the United States, Google compared its query counts with data the U.S. Centers for Disease Control and Prevention (CDC). Some search queries tend to be popular exactly when flu season is happening. By counting how often these search queries occur, Google Trends has shown how much flu is circulating in various regions of the United States. Their results have been published in Nature.

Google is now running a similar project on Swine Flu (H1N1) to spot outbreak concentrations by state within Mexico. You can see the results in a graph on their website.

Significant Changes – 87 New Requirements

The Joint Commission has 87 new and revised requirements for 2009. Although some standards contain minimal changes, others create new expectations and documentation requirements. Last-minute additions in January will require additional resources to address compliance.

Searching for Flaws

The new survey philosophy (”searching for flaws rather than searching for validation”) also makes it likely that there will be more adverse findings during survey.

Makes Compliance More Difficult

Because the standards leave much to interpretation, hospitals are vulnerable to misunderstanding during survey, making compliance more difficult.

Practical Solutions – Immediate Actions

The “Practical Advice for Surviving the Joint Commission and Survey Process” advanced educational seminar explains how to prepare for the survey process, focusing on the issues that hold the greatest risk for hospitals in 2009.  It provides practical solutions for taking immediate action towards the best possible survey outcomes.

How to Survive the Joint Commission and CMS

Upon completion of the seminar, participants will be able to:

1. Discuss the elements behind the tougher survey process for 2009.
2. Discuss the impact that the January CMS-driven standard additions to the Joint Commission manual will have on organizational readiness.
3. Identify three requirements that must be documented for the survey of the leadership standards by the Joint Commission.
4. Differentiate between the standards and survey processes of The Joint Commission and CMS.
5. Identify three areas of compliance that could lead to an RFI in their organization.

Related Links:

For more information review the complete description of  “Practical Advice for Surviving the Joint Commission and CMS Survey Process”

Registration form for the “Practical Advice for  Surviving the Joint Commission and CMS Survey Process” seminar.

University of Cincinnati Medical School "Match Day"

I fully understand the goal of providing healthcare to all Americans who need it. I also clearly understand that the cost of  our healthcare system is one of the fast growing of all segments in our economy. And I see many politicians and lobbyists seeking to write or influence the coming healthcare reform activity now meandering through Washington.

What I don’t understand is how our policymakers make decisions without consideration of cause and effect.

We have a limited number of physicians, nurses and hospitals. Most are operating in the red. Some of the red ink can be avoided not so much by mandatory reform from Washington but by more efficient and effective process management by the leaders running our nation’s hospitals. These are complex organizations staffed with professionals who have agendas that do not always work for the good of the organization. That’s an area of reform that can bring about positive impact on our national cost of healthcare without the help of a single politician.

It does not address universal access which can happen most likely only with the support of some aspect of national healthcare reform. But it does run head into the notion that healthcare cost must be brought down. Most of the pay-go solutions to fund this are not going to be popular. Cutting back on healthcare services to those covered by Medicare or Medicaid (like withholding medication for macular degeneration until a patient is totally blind in one eye and then providing this medication to save the remaining eye) are brutal … who has the right to be so arbitrary?

And then there’s the issue of supply to meet demand. If universal access doubles the number of Americans seeking healthcare to a supply base that is fixed to meet the needs of the insured, who is going to provide care to all these new patients? With supply-demand issues, typically as supply is unable to meet demand, prices go up; not down.

So in our infinite wisdom, we also pass laws that limit the number of physicians coming through medical schools and academic (teaching) hospitals which exacerbates supply.

Medicare resident caps have been in place for more than 10 years while the nation is now facing a potential physician shortage. The caps have a chilling effect on the ability of teaching hospitals and medical schools to increase the nation’s physician workforce and meet the needs of local communities.

Given these times of increasing financial uncertainty for teaching hospitals, it is important that the Medicare program maintain its commitment made in 1965 to support the additional costs associated with the educating future physicians and beginning a move now to assure adequate numbers of providers as healthcare becomes the law.

If we are going to have healthcare reform, let’s hope the politicians consider carefully what they are doing. A failure to do this right will increase costs even faster than they are now. Politicians talk now about the expenditures in the current legislation (nearly $700 billion on some accounts and a trillion on some other accounts) as “spend now to save in the future.” Maybe instead, we have to accept the fact that healthcare will continue to be a costly and increasingly expanding segment of our national economy.

Perhaps, even broader, maybe we need a national referendum to give citizens of the U. S. a voice in what kind of healthcare system we want.

I would suggest it is also a good time for existing hospitals to consider changes that can make them into better hospitals. Bad economic times practically force change upon us. The immediate change many CEOs make is staff reduction and that might well be necessary. But stopping with staff cutbacks is only half the solution. The other half is looking closely at total hospital operations.

Based on your hospital’s vision and business strategy for differentiating your hospital from competitors, what changes can you make to bring vitality back to the organization?

When starting a new business, the author of leanblog.org suggests getting the right people on the team is the most critical element:

“It is very likely that you’ll need 3-4 key team members, your co-founders, to help you get this thing off the ground. Each will bring his or her specialty to the venture: a boss (CEO); an idea guy (R&D, technology); a bean-counter/administrator (CFO or controller); and a chief sales rep (VP/Director Sales/Marketing). If you get the right people in place things like “who is our customer, what are we going to sell them, and how will we make it” have a way of getting figured out. That’s what talented people do.”

The same is true of hospitals. Significant, deep and meaningful change is one of the hardest tasks that hospital leaders face. There is tremendous cultural drag. There are conflicting motivations to deal with. So getting the right people on the team to lead change is your most important decision. The second is dealing with those you know from the start are going to fight change to the death. You have to win these recalcitrants over before you get too far or they will submerge the best intended of plans. They need to see the personal value of change and how they will benefit. If they don’t go along, then their tenure may be questionable. The last thing you need is a mole undermining every advance your “change team” puts forth.

Because change during a recession is stimulated by revenue / profit concerns, part of the change must be aimed at improving productivity — the positive side of eliminating waste. We know from experience that when we are brought in on as part of the “change team” we have been able to put 3 to 5% on the bottom line while strengthening the hospital’s ability to deliver its vision and business strategy.

For a hospital in Texas, we were able to identify $23 million in savings opportunities during the 14-month target-setting process and $8 million was achieved upon completion of the assignment. But this kind of performance improvement is not possible unless the CEO assembles the right internal team to look freshly at the situation and have the courage of conviction to move forward.

You could find yourself in a very embarrassing spotlight that negates years of advertising, millions spent on upgraded facilities and more millions on attracting physicians, nurses and specialists to deliver care.

I just happens that we have a recent case history for how to destroy a hospital’s reputation.

Talk show host Glenn Beck was, according to his story, actually ignored by the front office staff when he came to the hospital in severe pain. He decided to do a short video about the way he was treated — not by the doctors but by the administrative staff. His video was picked up by the Drudge Report, posted on the front page of AOL.com, and now over 600,000 people have seen it on YouTube and CNN.

GLEN BECK VIDEO

Beck from the Dead

At the hospital, I was treated more like a number than a patient. At times, staff members literally turned their back on my cries of pain and pleas for help. In one case a nurse even stood by tapping his fingers as if he was bored while my tiny wife struggled to lift me off a waiting room couch.

I’ve now seen our system at its very best and I’ve also experienced it at its very worst. But in each case, the difference had nothing to do with whether the hospital had the latest equipment or whether it looked like the Taj Mahal. It had to do with compassion. It had to do with respect. It had to do with treating people the way you’d want to be treated when going through something unfamiliar and frightening.

That’s why I don’t want to hear anymore about universal health care or HMOs or the evils of insurance companies until each and every hospital in this country can look me in the eye and tell me that they their staff is full of truly compassionate people who treat their visitors like patients, not products. Hire and train the right people, and then and only then come talk to me about everything else you need.

Beck from the Dead is Not the Norm

Now, to be sure, most healthcare professionals do wonderful things, miraculous things every day. I’ve worked with many hospitals over my career in marketing and saw the compassion. I watched car accident victims who could not walk or talk brought back to life by compassionate people. I’ve watched burn victims, and leukemia victims, and crippled children all get incredible care. I hear the compassion in the voices of the nurses and therapists. I’ve even seen nurses cry at the plight of their patients and scream for joy at the birth of a new child. I believe in my heart that this is the way it is in most hospitals.

But it is the weakest link that will break any organization.

Kari Kemper’s experience in the blog posting just below this one is not as dramatic as Glenn Beck’s, but it is an example of a staff person just not centered in on the customer’s experience. There is an indifference exhibited in the way she was being admitted to receive care. Equally clear, this staff person was not equipped with the technology to deliver a great customer experience (or to accelerate the hospital’s cash flow). But she also may not have been trained and certainly did not show the compassion you would expect in a place of healing and care.

Glenn Beck’s rant started as he entered the hospital lobby and reached millions of people. Kari’s was not as dramatic and did not make YouTube. But neither example should have happened … not in a hospital.

Avoid the Rants and Complaints

So if you want to stay off national television with horror stories, there can be no weak links. Your patient access staff are the front door to your hospital. Yes, I know … it is hard just to keep these positions filled. I see the huge number of help wanted positions for patient access staff all over the Internet. But this position is in some ways, the most important at establishing from the get-go an experience that will cause each patient to brag about how well they were treated.

A Great Patient Experience …

… must be delivered consistently by every single person who touches the patient’s visit to the hospital.

Finding caring people to handle patient registration might be difficult. Training them should not be. And surrounding them with a culture that propels everyone to be compassionate and professional should be a priority. And equipping these people so that they can deliver a great experience during registration should be given serious consideration so that this great experience is done with speed and accuracy.

These are simple steps to keep your hospital off YouTube. More yet, they are at least one step to counter the negativity now being dredged up by the Glenn Beck’s of the world. This one experience at one hospital is all over the media … Beck’s saying from his sick bed that “I have stories that will melt your brain and it is a time for a wake up call.”

From the time I was an orderly (I think they’re called transporters these days) at a hospital while in college studying pre-med, to all the years spent with physicians and staff at hospitals in the midwest to help them with marketing and PR to tell their wonderful stories, I have seen the good and the bad … but mostly the good. That’s the story I want to see on YouTube. And it all starts when the patient is registering to get care. This should be a good experience, delivered with compassion.

She was astounded at apparent inept systems at the hospital where she was getting chemo. Mind you, she’s been in this routine for weeks but upon entering the hospital for the now-routine therapy, here’s what she experienced:

We were able to make it to the hospital which I was scheduled to get my chemo around 5 pm. First they made us wait at the lobby. Then I had to go and do the new patient registration .. oh c’mon I thought don’t you guys have a central database that they could pull from the oncologists office ? After all it is the same hospital !

The hospital had its rules and systems, even if they required the patient to register all over again due to the installation of the new registration system. That might be necessary. And the patient went along with the ordeal. But her blog shows just how far apart were her expectations from the actual experience.

It points to yet another opportunity for technology to do a better job of making the patient experience (read that as customer experience) more in line with expectations. Is it unreasonable to expect a doctor who works within the hospital to have his patient registration system aligned/integrated with the hospital’s patient access systems?

Toby Bloomberg at Diva Marketing has a great profile on why Windber Medical Center’s CEO Nicholas Jacob took the risk of blogging out in the public. What’s so remarkable to me is the honest candor that ripples through Nick’s postings … it almost makes me want to hug him for being so forthright.

Nick’s words about contextual relevance … what mattered most to patients:

“It was about transforming a hospital into the best of a hotel and the best of a spa. Our philosophy was not just to create something that people would like. We, in fact, were interested only in creating something that people would absolutely love.”

Read Nick’s Blog and you will see for yourself how this medium can transform communications and customer relationships.

Thanks, Toby for getting the bead on this great story.

Reported by Healthcare IT News

The Washington Hospital, a 265-bed hospital in western Pennsylvania, plans to install wireless public Internet service to enhance the patient and guest experience. The not-for-profit, community hospital has signed an agreement with Irving, Texas-based Wayport, Inc., for the technology services.

“We are truly excited about offering our patients and their guests this new service,” said Telford W. Thomas, president and CEO of The Washington Hospital. “Patients and their guests coming to our hospital want to stay connected to family, friends and work at all times. We are delighted that we can help them do so.”

Thomas said hospitals providing guest Internet service must ensure the connection process is fast and simple, yet highly secure. The Washington Hospital will run private side wireless applications and devices and provide guest access on the same Wi-Fi network, while maintaining HIPAA compliance and internal network security.

Wayport will provide 24-hour phone support for anyone who needs assistance connecting to the wireless network while at the hospital, said Kevin McKeand, Wayport‘s vice president and general manager for healthcare. ]]> http://www.better-hospitals.com/2009/02/enhanced-patient-experience-with-in-room-internet-2/feed/ 0 http://www.better-hospitals.com/2009/02/149/ http://www.better-hospitals.com/2009/02/149/#comments Fri, 27 Feb 2009 23:27:54 +0000 Dale Wolf http://www.better-hospitals.com/?p=149 By Dale Wolf

Hospitals are beginning to figure out what hotels have known all along – customer satisfaction is critical to market share and share of wallet. Yes there are nay-sayers who tell us that there is little evidence that customer satisfaction and creating customer advocates has a financial payoff. I see too many examples where companies that are dedicated to customer satisfaction are the best-in-class for growth.

Take Griffin Hospital that was once a struggling institution in the working-class Lower Naugatuck Valley of Connecticut. The board made a commitment to patient experience and now 20-years later – instead of closing their doors as was originally recommended – they are a shining light in the entire medical community. Griffin is financially successful, steadily expanding its programs, its buildings, and — a key metric for hospitals — its market share. It is the only hospital named by Fortune magazine as one of the “100 Best Companies to Work For” in America for seven consecutive years, ranking No. 4 in 2006.

Customer Satisfaction is ALWAYS Delivered by Employees

Research by Press Ganey shows a clear relationship between employee satisfaction, patient satisfaction, and quality of care as an interactive, reinforcing relationship. Not only do satisfied employees deliver better care—which results in better outcomes and higher patient satisfaction— but working for an organization that values patients and delivers quality drives employee satisfaction, retention, and loyalty.

Staff Interaction Leads to Patient Satisfaction

One such Press Ganey survey of 139,380 former patients of 225 hospitals revealed that none of the top 15 patient satisfaction factors had anything to do with the patient’s health outcome. Instead the main factor was staff interaction, and there was a strong correlation between staff interaction and employee satisfaction.

Four Drivers

Analysis of data in the Press Ganey Employee Perspectives database has identified four key drivers of employee satisfaction:

1. Overall organization impression
2. Participation
3. Senior leadership
4. Recognition

Facilities where employees evaluate these dimensions positively experience improvements in employee satisfaction, patient satisfaction, physician satisfaction, clinical quality, and other critical outcomes.

Putting Patients First

According to Susan Frampton, Laura Gilpin and Patrick Charmel in their book: Putting Patients First, listening to patients or answering their questions costs nothing. “It can be argued that negative interactions—alienating patients, being non-responsive to their needs or limiting their sense of control—can be very costly. Angry, frustrated or frightened patients may be combative, withdrawn and less cooperative—requiring far more time than it would have taken to interact with them initially in a positive way.”

What Makes this so Hard?

“Perhaps the simplest and most profound of all human interactions is KINDNESS. But if it is so simple, it is surprising how frequently it is absent from our healthcare environments. Many staff members report verbal ‘abuse’ by physicians, managers and coworkers.”

Griffin Hospital — The First Five-Star Hospital

As reported in “Strategy + Business” … While most hospitals are hacking and trimming in desperate efforts to survive, the executives at Griffin and other “five-star hospitals” have taken a different tack. They’re attempting to build health-care centers with the customer-friendliness of Nordstrom, the reliability of FedEx, and the transactional accuracy and simplicity of American Express. They believe that making hospital stays more pleasant will pump up market share and revenues, boost the quality of clinical care, create less stress for the staff, and generally turn their business around. They are transforming themselves to better serve the consumer.

Griffin Makes Radical Change

Griffin’s revolutionary childbirth center opened in 1987. Griffin’s maternity business — a profit center for any hospital — doubled in just four years from fewer than 500 births per year to more than 1,000. An extraordinary one-third of its “customers” came from outside the Naugatuck Valley. Patient and staff satisfaction surveys resulted in perfect scores. Then they rebuilt the medical/surgical patient facilities. They replaced the harsh fluorescent lights with indirect incandescent lamps, installed carpeting to absorb sound, and constructed family rooms and kitchens stocked with snacks. Volunteers came in to bake muffins and cookies for patients and staff, filling the corridors with comforting, homey smells. Musicians were brought in to play live music, and visiting hour restrictions were eliminated.

Griffin’s Efforts are Paying Off

In recent years, inpatient admissions have leaped 25 percent (from 5,866 in 1997 to 7,349 in 2004), and its outpatient services have grown even faster (from 94,567 in 1997 to 160,427 in 2004, an increase of 70 percent). This is three times the average growth rate for the state. Many of Griffin’s doctors have been able to expand their practices, bringing in other doctors.” At the same time, Griffin’s work-force turnover has dropped. “We under-compensate our employees,” CEO Patrick Charmel admits, “and we probably work them harder [than do other hospitals]. But they become much prouder of what they do.” Griffin has also become a model for other institutions. More than 500 medical centers — 10 percent of the hospitals in the U.S. — have sought out Griffin for benchmarking tours. Griffin is no longer everyone’s last choice in health care.

One Last Word from “Putting Patients First”

“There is a misconception that supportive interactions require more staff or more time and are therefore more costly. Although labor costs are a substantial part of any hospital budget, the interactions themselves add nothing to the budget. Kindness is free.   Listening to patients or answering their questions costs nothing. It can be argued that negative interactions—alienating patients, being non-responsive to their needs or limiting their sense of control—can be very costly. … Angry, frustrated or frightened patients may be combative, withdrawn and less cooperative—requiring far more time than it would have taken to interact with them initially in a positive way.”

Living Proof

Fortunately, for me, that’s exactly the kind of hospital I go to. So I am living proof that the research by Press and Ganey and the wisdom in “Putting Patients First” is legitimate. My hospital is Bethesda North in Cincinnati. Every time my family has needed lab work, outpatient services or ER … everytime, the registration process is compassionately handled with speed and accuracy. And the staff that have cared for us after the registration process was over all delivered the same level of kindness. Sure it takes outstanding doctors, nurses and specialists … sure it takes great front-office and clinical technology, but even more, it takes a caring culture.

Perhaps no industry should be more centered on improving customer experience than healthcare … where the experience has enormous personal implications and where buzz around experiences at hospitals can dramatically impact market share and revenue growth.

At a recent HealthLeaders Media event, it became apparent that C-level managers are catching on fast to the validity of patient experience as something that is directly affected by how management approaches its employee relations.

One example that you could be easily replicated in any organization came from keynote speaker Al Stubblefield, president and CEO of Florida’s Baptist Healthcare Corporation. He talked about the importance of sharing “feel-good moments” with employees. When a friend of a patient wrote to praise hospital employees and departments for the excellent care his friend received while hospitalized, the organization created a video of the man reading the letter and showed it to employees. Accompanying slides highlighted the individuals and departments he mentioned to show, as Stubblefeld noted, that “everybody makes a difference.”

Kate Fenner, CEO of healthcare consulting firm Compass Group, “There are a lot of factors that impact patient satisfaction, with outcomes being the obvious to top the list. But equally important in shaping the patient’s perception of one hospital compared to another include physician satisfaction and employee satisfaction since these drive clinical quality. Hospital leaders must set the environment for exceeding expectations for care outcomes, accessibility, waiting time and how well such factors align with the hospital’s brand promise.”

Fenner added, “In an era where maybe a third of hospitals lost money, patient happiness is crucial for gaining market share and with market share comes the ability to negotiate better payments from payers. Everyone in the organization from patient registration staff to surgeons and nurses to various clinicians and support staff to senior managers — everyone must see delighting the patient as Job One.”

“They borrow leftover prescription drugs from their friends, attempt to self-diagnose ailments online, stretch their diabetes and asthma medicines for as long as possible and set their own broken bones.”

A doctor was quoted: “We often see young people who have taken the wrong antibiotics borrowed from friends. We see urinary tract infections taking meds better suited for ear infections or pneumonia — the problem is, they haven’t really treated their illness and they’re breeding resistance.”

It is understandable when you see young adults trying to start a career making less a month than the health insurance would cost. It is understandable when a 2-day stay in the hospital costs a young adult more than a year’s college tuition.

It is understandable, but that does not make the problem go away. Where lies responsibility?  Hospitals already donate an average of 9% of their revenue to community health — much of it to provide care to the uninsured. Soon it’s like getting blood from a turnip.

Health care reform is in bad need for a fix. While we are bailing out car manufacturers and banks and launching heroic measures to bring our economy out of a near-depression, we wait for answers on healthcare.

In the meantime, young adults remain a population in peril.