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Improving Workforce Experience
Experience. Innovation. Outcomes.
San Francisco Health Plan| March 18, 2014
Quality Culture Series
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22
Examine and Build from:
• Drivers of an ideal healthcare workplace experience
• Using your organization’s Pulse Survey results to design high impact “always events” that return employees to purpose
• Proven practices and toolkits for improving staff empowerment, resilience, and relationships
• Strategies to minimize initiative fatigue and align improvement efforts
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Welcome and Program Objectives
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Your Sherpas
Ateret HaselkornSolutions Development Director
Kim PettyManaging Director
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Experience Innovation Network in Brief
Our Passion Humanize the Healthcare Experience.
About Us • Founded by Dr. Bridget Duffy, the first Chief Experience
Officer at the Cleveland Clinic and in the nation.
• ExperiaHealth accelerates the discovery and adoption of
innovations that restore the human connection in
healthcare.
Our Results
• Guided experience strategy, transformation and
improvements at more than 50 hospitals and health
systems, consistently delivering measureable results.
Select Partners on the Experience Journey
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Restoring Joy to Medicine
M. Bridget Duffy, MD
Chief Medical Officer, Vocera
Co-founder, Experience Innovation Network
“We must focus on
innovations that
improve humanity.”
– Earl BakkenFounder of Medtronic
Inventor of the Pacemaker
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“Entered to care,
lost my soul”
Frontline 6 Word Stories
Person-
Centered
CostQuality
Joy
Quadruple Aim
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Employee Wellbeing
The science
of finding
focus in a
stressed-out,
multitasking
culture
Mindfulness
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Impact of Burnout and Fatigue
“Primary care physician burnout threatens the quality of patient care, access, and cost containment within the U.S. health care system.”
In Search of Joy in Practice: A Report of 23 High-Functioning Primary Care Practices,”
Sinsky, CA, et al. (2013) Annals of Family Medicine, 11(3): 272-278.
In Search of Joy in Practice
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Medical
School
Adapted from Hojat, M., Mangione, S. Nasca, T.J. &. Gonnella, J.S. (2005). Empathy scores in medical school and ratings of
empathic behavior 3 years later. Journal of Social Psychology, 145 (6), 663-672.
Practicing
Nearing
Retirement
Medical
School
Practicing
Nearing
Retirement
Physician Empathy Curve
Exhaustion
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© 2011 Thomas G. Murphy, M.D.
Is Technology Making Us Less Human?
20 Day Stay 2001
212 Pages
14 Day Stay 2011
770 Pages
Meaningless Use
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“If the cows are happy,
the milk is supreme!”
Meaningful Relationships
Human
Experience=
Loyalty and
Growth
Empathy+
Communication,
Relationship,
Emotions
Experience Mapping
=Efficiency
Quality, Safety,
Flow
Lean
+
The Key to the Ideal Experience
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Reconnect people to purpose.
Improve physician and nurse communication.
Enable peak performance.
Create a relationship-based culture.
Address emotional and spiritual needs.
Wellbeing Checklist
Case Study 1: Sacred Moment
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Case Study 1: Sacred Moment
95th %
Physician Satisfaction
“We benefit from the Sacred
Moment as much as the patient.” -Twin Rivers Employee
117% Increase in
Patient Satisfaction
Case Study 2: Staff Resiliency
Chief Morale Officer
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Resiliency Program
� Assessment
- Self Awareness
- Mindfulness Based Stress
Reduction
- Practice of Gratitude
- Social Support
� Measured pre/post staff
emotional exhaustion.
� Chief Morale Officer
90% of program
participants saw
reduction in burnout
Case Study 2: Staff Resiliency
� “I enjoyed this and am looking
forward to bringing it to the clinic
and taking time to honor our
soul/spirit in our work.”
� “Thank you. This class is helping me
to relax a little bit and be more
accepting.”
� “I am very grateful that I attended
this workshop, it helps me to focus
to take care of myself.
Case Study 2: Staff Resiliency
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Case Study 3: Code Lavender™
• Percent of staff who
“do not feel supported”
decreased from 24% to 2.7%
• 163% increase in staff’s
likelihood to recommend
“The lavender alert has changed the energy on the unit in a huge way. Our
manager is more compassionate during stressful times, and we recognize each
others burdens better than we did before. The palliative care team, and others
that have supported us in various lavender alerts are wonderful and amazing!”
-ICU Employee
June 2013 December 2013
Case Study 3: Code Lavender™
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The secret to caring for the
patient and family
is in caring for the care
providers.
-Francis Peabody, 1925
“True Innovation Improves the Human Experience.”
– Alexander Blass
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Contact
M. Bridget Duffy, MD
Chief Medical Officer, Vocera
www.vocera.com
Twitter: @DuffyCXO
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Agenda – Experience Design and Mapping
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“For sale,
baby shoes,
never worn”
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Your 6-Word Stories
• “[Insert Stories]”
HOW WOULD YOU DESCRIBE THE CURRENT STAFF EXPERIENCE AT YOUR
ORGANIZATION?
SO, IN 6 WORDS…
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6 Word Stories
• “Who knows my dad’s whole story?”
• “Too many doctors, too little health.”
• “Needed hope, entered hospital, lost soul.”
• “I hear voices, never my own.”
• “Eyes averted, too busy, can wait.”
• “Discharged, that means I go home now?”
• “Where are you taking me? Will it Hurt?”
FROM PATIENTS & FAMILIES
• “Entered to care, lost my soul.”
• “Caring chaos, frustration, treadmill”
• “Tired of saying, ‘I am sorry.’”
• “Time constraints, few resources, still care.”
• “Organized chaos, with moments of caring”
• “Pulled by heart, pushed by utilization”
• “Throw them over the wall, splat.”
FROM THE FRONT LINES
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Restoring the Human Connection in Healthcare
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• Jessica McIninch, PsyD, Andersen Valley
Health Center
• Jessica Moore, FNP, Petaluma Health Center
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Guest Speakers
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“Together, We Create a Healthy Community”
Jessica McIninch, Psy. D.Mark Apfel, MD
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Our Journey
Connect with our
Team
Discuss Challenges
Identify Solutions
- Our Approach-
- The Outcomes-
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Our SolutionOur Clinic staff members have begun a daily practice of proven stress reducing methods to improve our health, well-being and happiness.
We hope to help staff members balance the stress, burnout, and emotional exhaustion that can come from the daily work of caring for the patients we serve.
We are emphasizing the use of mindfulness to skillfully focus our attention to our present moment experience in an open and nonjudgmental manner.
Assess
Explore
Restore
- Our Approach-
Step 1: Administer Self Assessment to establish baselineStep 2: Initiate 30 day Mindfulness/Gratitude program
• 2 Training Sessions• Weekly Homework• The Challenge: Share 1 gratitude each day via e-mail, picture, leaving a message on work-line
Step 3: Re-administer Self Assessment
- Project Goals -
- The Premise -
You’ll Never Guess What Happened
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Our Outcomes
- Our Wellness Room -- Pulse Survey Results-
“I really enjoy coming into workknowing that my colleagues appreciateme and the work I do.” – Staff Member
- Mindfulness Pilot-
89% Increase in Gratitude scores
81% Increase in “Observe” Scores
94% Increase in “Non React” Scores
100% Reduction in “Burnout” Scores
“You can really tell, there’s a difference,people are friendlier in the halls, it makes iteasier to work together and get things done.” - Staff Member
Place to Work Come for Care
12-May 63% 88%
13-Jan 70% 70%
0%10%20%30%40%50%60%70%80%90%
100%
Ne
t P
ro
mo
ter
Sc
or
e
AVHC Pulse Survey Summary
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Seeking Satisfaction:
PHC’s Journey Toward Improved Provider and Staff
Satisfaction
Identify the Problem
Annual Surveys: All StaffReviewsTeam MeetingsMonthly All Provider MeetingExit Interviews
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Major Drivers of Disatisfaction at PHC
Undefined WorkInadequate Support Poor Communication/Lack of FeedbackPoor CompensationDisconnect Between Personal Values and
Day-to-Day Work
Defined Work
Empaneled ProvidersStandard Hours for Providers & StaffClear Operational and Quality AimsConsistent Message around Strategic Goals
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Expanded Team ModelRobust HuddleSmaller PodsAccessible Leadership
Support To Accomplish Work
Monthly Team/Provider Clinical QualityWeekly Operational DataQuarterly Provider ReviewsWeekly Case Review and Mentorship for
New Providers
Frequent Feedback
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Compensation AnalysisTransparency around CompensationIncentive Pay Structure for ProvidersProvider Input around Incentive Structure
Fair Compensation
Lunch & Learn for Staff
Staff Massage
Staff Meditation
Fitness Class Discounts
Exclusive Fitness Offerings for Staff
Gym Membership Discounts
Annual Provider Camping Trip
Potlucks
Halloween Competition
Winter Gala
Summer Picnic
Monthly Finding Meaning In Medicine Support Group (FMM)
Community Building/Wellness
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● Find deeper satisfaction and meaning in day-to-day work lives
● Strengthen original sense of calling● Form Authentic Community with
colleagues● Learn tools of self care● Renew their commitment to themselves,
their patients, and medicine
FMM Objectives
● 5-10 Participants● Monthly meetings at a colleague’s home● 1 ½ Hours● Everyone comes prepared to share on the
month’s topic
Group Structure
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Improved provider retention/decreased turnover
Improved staff satisfactionImproved patient satisfactionImproved sense of meaning and community
among providers
Did it work?
• How has your journey impacted your
organization’s culture?
• What has been most eye-opening about your
experience?
Panel Discussion
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Relax, Restore, Re-caffeinate
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Idea
Exchange
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Speed Dating Format
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5 Conversations for 5 Minutes Each
Pick one or two questions below or create your own question to kick off your conversation:
To drive workforce experience:
• What’s the most exciting innovation you’ve seen?
• What program has been the most successful?
• What new approaches are you piloting or considering?
• How do you define success?
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Conversation Starter Questions
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TIME
REMAINING: 5:004:454:304:154:003:453:303:153:002:452:302:152:001:451:301:151:000:450:300:150:100:050:00Click Here to
Begin Timer
Experience Observation Simulation5 Minute Simulation
Idea Exchange Timer
5 Minute Countdown
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Building a Baseline
• Review of PULSE Survey Findings
• Preliminary Opportunity Identification
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Building A Baseline
Administer. Analyze. Communicate.Introduce.
Pulse Survey
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Growth Opportunity
Engaged
Employees
Enthusiasm, Creativity
Excellence, trust, value
Loyal
Patients
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Why Measure Staff Loyalty?
Profitable,
sustainable,
organic growth
• Are more enthusiastic about their work
• Provide better customer experiences
• Influence other employees
• Provide feedback and ideas
• Buy more
• Stay longer
• Refer friends
• Provide feedback and ideas
Engaged Employees = Loyal Patients
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• Survey designed to measure loyalty, by asking staff and providers to answer
questions on a 0-10 point scale (0-Highly Unlikely to 10-Extremely Likely)
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What is the Pulse survey?
Baseline Questions
• How likely are you to recommend this clinic as a place to work to a friend or relative?
– What would it take for you to rate us a “10” or to maintain your rating ?
• How likely are you to recommend this clinic as a place to come for care to a friend or relative?
– What would it take for you to rate us a “10” or to maintain your rating of “10”?
Optional Questions
• What would you do to improve the patient and family experience?
• What would you do to improve the provider and staff experience ?
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“Satisfaction” vs. “Loyalty”
Definitions from The American Heritage Dictionary of the English Language, New College Ed, Boston
Satisfaction (noun). The fulfillment or gratification of a
desire or need
“The patient
is always
right”
• Working Harder
• Not Correlated to Growth
“The patient
is our
partner”
• Working Smarter
• Correlated to GrowthLoyalty (noun). Feelings of devoted attachment
and affection
Focus of Net Promoter
Methodology
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6363
109876543210
Not at all
likely
Neutral Extremely
Likely
Detractors Passives Promoters
How likely are you to recommend a colleague or friend?
% Promoters
(9s and 10s)
% Detractors
(0 through 6)% Net
promoters= -
Calculating NPS
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What does NPS tell us?
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The Value of the Pulse Survey
Simple way to capture, analyze and act on staff voice.
Capture
Analyze
Act
� Heard
� Supported
� Engaged
� Activated
� Motivated
� Empowered
� Accountable
Leading to staff who feel:
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Demonstrated to Have an Impact
Center Q May-12 N Jan-13 N Change
West County Health Center Work 44% 16 59% 22 15%pt improvement
Care 81% 16 91% 22 10%pt improvement
Santa Rosa Community Health Centers Work 4% 68 25% 12 21%pt improvement
Care 24% 68 33% 12 10%pt improvement
Share Our Selves Work -10% 42 -4% 54 6%pt improvement
Care -2% 42 13% 54 15%pt improvement
Neighborhood Health Care (Elm) Work 9% 70 21% 42 13%pt Improvement
Care 23% 69 29% 41 6%pt improvement
Lake County Tribal Health Consortium Work 14% 58 43% 60 29%pt improvement
Care 34% 58 50% 60 16%pt improvement
Golden Valley Health Centers Work 7% 44 13% 40 6%pt improvement
Care 9% 44 15% 40 6%pt improvement
Axis Health Centers Work -3% 109 16% 106 19%pt improvement
Care 27% 109 27% 106 0%pt improvement
Anderson Valley Health Centers Work 63% 16 73% 11 10%pt improvement
Care 88% 16 73% 11 15%pt decrease
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Driving Improvement with the Pulse Survey
*NPS range across over 30 healthcare facilities (includes hospitals and clinics)
Category Average
Place to Work
NPS Place to Work Range -73% to 89%
Place to Work Average 7.84
Place to Work Range 4.04- 9.2
Come for Care
NPS Come for Care Range -58% to 88%
Come for Care Average 7.17
Come for Care Range 4.34 - 9.44
• Establish a Baseline – Create a measurable starting
point for improvement and an understanding of the
current employee experience and employee
perceptions of the patient and family experience.
• Identify Opportunities - Identify specific, actionable
improvement opportunities and potential solution
based on verbatim comments.
• Take Action – The greatest value in establishing a
baseline and collecting feedback is in the ability to act
on the feedback and communicate back to survey
participants what was done as a result their feedback.
• Measure Results – Organizations can administer the
“pulse survey” at the beginning and end of an
Experience Improvement project to gauge the impact
in improving the experience in their hospitals.
*Benchmarking
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Our Pulse Results
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From the front line…
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“Most people try to help
each other as much as
possible.”
Communication
“[There is a] bit of a disconnect
between different departments. Some
portions could benefit from better
communications from the other depts
to provide a better overall workflow for
the clinic.”
“Efficiency, stronger leader ship, TEAM
WORK...... management and staff all pulling
together to make it a better place "clinic"
Not only directing traffic but being in it to
help your team!... that way no one would
have resentments... working together....”
Camaraderie
“I feel fortunate in my life for the last 26 yrs.
that I've been working here. I'm happy with
myself I share these happiness with my co-
workers and our patients. When there are
turmoil’s I know they will pass. Nothing is
forever.…”
“More support and
communication”
“That individual
departments meet more
than once a month, even if it
is temporary. this may help
with the communication
issue that has been a
problem for a longtime.”
Teamwork
“More morale and
team-building
events.”
“More gathering outside of work with different
department.”
(with / from
leadership)
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Experience Hierarchy
Needs Met = Differentiation
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Pulse Survey Break-out
• Step 1 – 15 Mins: Team Pulse Survey Review
– What was your greatest insight while reviewing
the verbatims?
– What are your ‘quick wins’?
• Step 2 - 15 Mins: Report Out and Discussion
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Preparing to Prosper
• Creating a Culture of Experience Excellence
• ExperiaHealth’s Experience Improvement Framework
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The Key to the Optimal Experience
Efficiency
Remove Waste
Process Improvement
Empathy+
Human Connection
Experience Improvement
Healing
Experience=
Loyalty for Life
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6 Steps to Experience Transformation
1. Make Experience Transformation a Unifying, Strategic Priority
2. Engage Providers to Lead in Partnership with Administration
3. Engage Associates in Transforming Patient & Staff Experience
4. Design and Implement ‘Always Events’ that Improve Experience
5. Pilot and Spread Always Events (PDSA)
6. Measure and Monitor Results
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1. Experience = Top Strategic Priority
Strategy and Governance
Operational Excellence
Experience Innovation
Foundational Elements
Co
mp
etitiv
e D
iffere
ntia
tion
• Strategy: Clearly articulated; well
disseminated
• Governance: Well-defined chain of
command; integration between
experience, process, and
quality/safety improvement
• Culture: Alignment of hiring,
acculturation, and rewards
structures
� Voice of the Employee and Patient:
Qualitative and quantitative; action
focused
� Co-Design Processes: Frontline-led
adaptation and implementation of
known best practices; driving
towards sustainability and
accountability
� Measurement: Linking experience,
clinical, and quality outcomes
� Innovation: Designing new
models of care; identifying Always
Events; restoring human
connections and joy to medicine;
hardwiring change through
technology and process change
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2. Provider-Administration Partnership
1. Shared goals, vision and accountability
2. Collaborative decision making
3. Frequent and clear communication
4. May debate in private, but publically speaks with one voice
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3. Engage Team in Experience Transformation
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4. Design Always Events
Empathy Arrival (or Pre-Arrival)
The Four C’s
� CONNECT – “Hello Mr. Smith. I’m [Name]. Welcome to
the clinic. Are there any questions that I can answer
for you prior to your visit?” Or “Is there anything else
you would like me to share with your care team?”
� COMPASSION – “You must be frustrated.” “I can
imagine how that must be upsetting.” “You must be
worried.”
� COMMUNICATE – “[MA Name], your provider’s medical
assistant, will be out soon to escort you back to the
exam room.”
� COMFORT – “Please make yourself comfortable” –
offer water, coffee, or other comfort measures as
appropriate.
Note information to help the MA identify the patient in
the waiting area.
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5. PDSA Pilot, Refine, Improve
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6. Measure and Monitor Results
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Organizations with Higher Patient
Satisfaction Data Transparency Have
Higher Scores
6. Data Transparency = Improved Results
Source: Poster presented at the 2010 AcademyHealth Annual Research Meeting, held June 27-29, 2010 in
Boston, MA.; The relationship between transparency and quality performance in urban safety net hospitals
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Eat, Drink, Mingle – Lunch!
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The Road Ahead – Afternoon Agenda!
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Before we Proceed!
What is your greatest insight
or learning thus far?
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Proven Solutions in Team Experience
• Review of Evidence Based Solutions
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Key Empowerment Drivers
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1. Resiliency / Code Lavender
2. Connected Communication
3. No Excuses Teams
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Key Workforce Experience Solutions
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Prevalence of Burnout and Stress
• Up to 60% of physicians report symptoms of
burnout*
• 50% 3rd yr med students report burnout**
• 40% of hospital nurses have increased levels
of burnout***
• 26% of nurses who leave the field report
stress as the cause****
• 57% of nurses reported stress****
*JAMA 2002;288(12):1447-1450.
**Mayo Clin Proc. 2006; 81(11): 1435-1442.
***JAMA 2002; 288(16): 1987-1993.
****Nursing Economics 2005;23(1):25-30.; Carol Reineck; Antonio Furino; Nursing Career Fulfillment: Statistics and Statements From Registered Nurses
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Reduced Satisfaction
Increased Medical Errors
Increased Malpractice Risk
Increased Mortality Rates
Burnout and Emotional
Exhaustion
Reduced Capacity for
Empathy
*Journal of Nursing Care Quality April 1996 - Volume 10 - Issue 3 Dugan et al. Stressful nurses: the effect on patient outcomes.
** Journal of Applied Psychology, Vol 73(4), Nov 1988, 727-735 Jones et al Stress and medical malpractice: Organizational risk
assessment and intervention.
***Stress and Health Volume 22, Issue 2, pages 131–137, April 2006, A proposed physician–patient cycle model
****AHRQ May 2003, David H Hickam, MD, MPH , The Effect of Health Care Working Conditions on Patient Safety
Why Resiliency in Healthcare Matters
89
The Stress Spectrum
90
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Code Lavender™
Percent of staff who
“do not feel supported”
decreased from
24% to 2.7%
“The lavender alert has changed
the energy on the unit in a huge
way. Our manager is more
compassionate during stressful
times, and we recognize each
others burdens better than we did
before. The palliative care team,
and others that have supported us
in various lavender alerts are
wonderful and amazing!”
-ICU Employee
0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100%
I do not feel supported
Other Resources
Multidisciplinary Team
Leadership
My Colleagues
During stressful times in the ICU, I feel
acknowledged and supported by:
June 2013 December 2013
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Calling a Lavender Alert
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Elements of Resiliency Programs
1. Mindfulness
2. Self Awareness
3. The Practice of
Gratitude
4. Social Support
1. Self-regulation
2. Intentionality
3. Self-validation
4. Social Support
5. Self-care
Source: BJC Compassion Fatigue
Innovation Showcase, ExperiaHealth
CXO Roundtable, April 25, 2012
1. Fostering
acceptance
2. Finding meaning
in life
3. Gratitude
4. Spirituality
5. Retraining your
attention
Source:
http://www.mayoclinic.org/resilien
ce-training/
1. 3 Gratitudes
2. Journaling
3. Exercise (self-care)
4. Meditation
(Mindfulness)
5. Random Acts of
Kindness
Source:
http://www.ted.com/talks/shawn_a
chor_the_happy_secret_to_better_
work.html
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Resiliency Program Results
Pre-Program 64% of participants showed signs of burnout as
measured by “Emotional Exhaustion”
6 Weeks Post Intervention (N=21):
• 90% of participants improved results on the “Emotional
Exhaustion” scale
8 Months Post Intervention (N=17):
• 82% still showed sustained improvement on the “Emotional
Exhaustion” scale
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Drivers: Communication, Teamwork, Connection and
Relationship
Source: Ascension Health
� Communication � Connection� Teamwork � Relationship
Inpatient CorrelationEmergencyDepartment
Correlation Outpatient Correlation
Overall Quality of Care .809 Overall Quality of Care .698 Overall Quality of Care .526
Level of Safety You Felt .791
Staff Met Your Individual
Needs .654
Teamwork between
Doctors Nurses & Staff .481
Staff Met Your Individual
Needs .791
Teamwork between
Doctors Nurses & Staff .642
Responsiveness to
Concerns & Complaints .465
Teamwork between
Doctors Nurses & Staff .788
Responsiveness to
Concerns & Complaints .636 Respect for Privacy .452
Courtesy & Friendliness
Shown by Staff .736 Staff Communication .627
Doctors Understanding
and Caring .449
Nurses responsiveness to
needs and requests .736
Staff met Emotional
Needs .620
Courtesy and
Friendliness of all Staff .446
Sensitivity to Spirituality .735 Sensitivity to Spirituality .614 Sensitivity to Spirituality .443
Responsiveness to
Concerns and Complaints .728
Overall Quality of Doctor
Care .613
Staff Informing about
Waits and Delays .429
Rate the nurses'
Understanding and Caring .721
Courtesy and Friendliness
Shown by Staff .607
Nurses Understanding
and Caring .428
Correlations Between Experience Elements And Loyalty (willingness to recommend) Across Care Settings
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“I entered the room focused on me and
left focused on others.”
- Tiffany Rodery, TRRMC
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Connected Communication
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The Connected Communication Model
1. Empathy on Arrival
Front office staff greets patient and ensures they are comfortable
2. Patient Prep
MA Sets expectations for visit and prepares patient for talking to
provider.
3. The Healing Visit
Care team provides clear exam room communication (the 4 Habits model)
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Guiding Principles – Connected Communication
1. Build a Connection – Discuss Fears and Concerns
2. Identify and Engage Loved Ones (e.g., family members, caregivers, etc.)
3. Address Spiritual Needs
4. Identify Language Preferences
5. Capture Comfort Preferences
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5. Connected Communication Impact
0
1
2
3
4
5
6
7
8
Q1 2012 Q3 2012 Q2 2013 Q3 2013
Avg of Place to Work Avg of Come for Care
23% Increase
Patient Satisfaction
17% Increase
Pulse Survey Results
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No Excuses Teams
No. Excuse. Team. @ Twin Rivers Regional Medical Center
Empower Staff to Lead Change
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Tap into the Wisdom of the Team
• No Excuses Team (NET): empowers a multi-
disciplinary group of staff and managers to
eliminate the culture of learned
helplessness that had become rampant at
TRRMC.
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103Page 103
No Excuses Team in Action!
Employee of the Month Parking Associate Appreciation Fixing 3S Printer
Clocks in Patient Rooms Patient Welcome Packages Pediatric Crash Cart
16 Wins implemented in two days… !!
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Benefits to Date – The Rising Tide
Top Box – Overall Hospital Rating 117% Increase
in Patient
Satisfaction
Interventions
• Staff and MD Pulse Survey
• Town Hall Communication Series
• Lightening Rounds
• No Excuses Team (NET)
• “Sacred Moment” at Admission
(Healing Handoff)
95th %Physician Satisfaction
in Press Ganey Database
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Operationalizing “No Excuses” with Experience Huddles
• Who’s Involved: 2 leaders (1 clinical, 1 non-clinical)
• Where: Each clinic or Department
• How Often: Twice a Week
• Duration: 10-15 minutes min/department
• Common Practice: Tools and questions to guide
huddle are provided and will focus on patient
experience, the work environment, healthcare
excellence and performance improvement.
Key ComponentsKey Components
“We do a great job talking with each other
about our cares and concerns. We don’t
let miscommunication fester.”
-Post-partum nurse
• Which of our values do we live well, what could we
do a better?
• What are you worried about that I should be
worried about?
Sample QuestionsSample Questions
Goal: Connect leadership and frontline staff around organizational priorities
106
Results – Maple Grove Hospital
50% 60% 70% 80% 90%
Motivation
Highly recommend
Engagement
Benchmark hospitals Maple Grove
+14%
Workplace Dynamics Employee Survey
+11%
+10%
Results based on 500 responses (757 invited)
50%
60%
70%
80%
90%
100%
Mar '13 Apr '13 May '13 Jun '13
Maple Grove
HCAHPS Overall Willingness to Recommend
90th
%ile
Engaged Employees Delivering Exceptional Experience
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107107Page 107
Relax, Restore, Re-caffeinate
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Aligning to Deliver
• Team Breakout Sessions
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109
Initial Pulse Survey
• March 2014
Staff Satisfaction
Improvement Plan
• April 30, 2014
Final Pulse Survey
• November 2014
Summary of Project Work
• January 31, 2015
PIP Timeline
PIP = Practice Improvement Program
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110110
• How could these Always Events benefit the workforce at our facility or clinic?
• Would one be more beneficial than the other?
• What would this look like for our clinic?
• What would make or break a successful adoption? What would be measure or monitor as an outcome?
• Are there other Always Events that we should examine?
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With your team
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111
Pulse SurveyWorkshops &
WebinarsCoaching Calls
Building a Better Workplace
Supports Practice Improvement Program (PIP) measure
PE 1: Staff Satisfaction Improvement Strategies
Page 111
112Page 112
Accelerating Execution
• Experience Transformation Roadmap
• Workshop Recap and Evaluation
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Your Action Plan
� Finalize appropriate intervention for adoption
� Schedule and observe care at your clinic for 2 hours (step
outside of your day to day role)
� Host clinic-based town hall meeting to share results of
observation and Pulse
� Brainstorm ideas for improvement
� Introduce and modify intervention to be adopted
� Run a PDSA of your intervention
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Ask yourself - Why?! Why?! Why?! Why?! Why?!
With fresh eyes, step into the role of a family member with a loved one to observe the
experience and identify the “Moments of Truth” across four dimensions.
� Did the patients, families, staff, and
providers receive the right
information at the right time?
� How did the patients, families,
staff, and providers perceive the
quality of care?
� Did the physical environment
support the patients, families, staff,
and providers needs?
� Were the patients, families, staff,
and providers emotional needs met?
Relationship Building
Relationship Building
Quality & Safety Perceptions
Quality & Safety Perceptions
Physical ComfortPhysical Comfort InformationInformation
ExperienceExperience
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115
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The PDSA Model
• Plan – What is your objective and how will you achieve it
• Do - “Just do it” (i.e. do the plan)
• Study - What did you learn?
• Act - What will you do with the knowledge you learned?
A P
S D
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117117
Implementing Always Events
A P
S D
A P
S D
A P
S D
A P
S D
A P
S D
PDSA Fits Here
Introduce Written Action Plans
Routine use of Action Plan for Better Self-
Management
A P
S D
Cycle 1: Test with 1 provider/1 patient
Cycle 2: Revise and test with 2 provider and 6 patients
Cycle 3: Revise and test with 3 providers including patients from different cultural preferences
Cycle 4: Train for Implementation
Cycle 5: Monitor continued use by providers
Aim: Routine use of Action PlansMeasure: % of patients with documented action plans
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Start Small, Then Scale
A P
S D
A P
S D
A P
S D
A P
S D
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Page 119
Start with a Small Test of Change
Conduct the initial test with…
� one clinic� one office � one doc� one patient
Plan:
Do: Describe what actually happened when you ran the test
Check: Describe the measured results and how they compared to the predictions
Act: Describe what modifications to the plan will be made for the next cycle from what you learned
List the tasks needed to set up this test of change Who? When? Where?
Predict what will happen when the test is carried out Measures to determine if prediction succeeds
Planning 1 PDSA Cycle
120
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Additional Resources
Common Challenges Tactics and Tool-kits
How do we best observe our clinic?� Toolkit – Observation Guide
How to we encourage staff and family
members to participate?
� Communication: Informing the staff
that the goal is to improve the
experience for patients, families, and
staff.
� Formal Invitation: Consider a formal
letter of invitation from senior
leadership
� Incentives: Consider incentivizing staff
with gift cards or a team lunch.
How do we summarize our findings? � Toolkit - Preliminary Findings Template
How do we create a project plan for
implementation?
� PDSA Template
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Parting Thoughts
“What I’d like to see change? In the long-term we aren’t
billed around patient experience, but that is the way the
world is going. It is what is important. It is exciting to be
involved at this time. The human things are what is missed
and falls outside of job descriptions now. I hope that this
project will help us to look at how we can make a culture
change to meet people where they are and be human.”
- One of you!
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Pulse SurveyWorkshops &
WebinarsCoaching Calls
Next Steps
Baseline: February 2014
Final: November 2014
Webinar: Feb 18, 2014
QCS Workshop: March 18, 2014
EIN Webinar: Showcasing Early
Wins, May 15, 2014
Best Practice Sharing: September
2014, Quality Culture Series
EIN Coaching Call #1:
Embarking on the Path to
Improvement (Apr/May)
EIN Coaching Call #2:
Capturing Stories (July/August)
EIN Coaching Call #3:
Reviewing Wave #2 Survey
Results (Nov/Dec)
Pulse Survey to be administered by CEPC
EIN = Experience Innovation Network Page 123
124124Page 124
The Experience Innovation Network supported by Vocera Communications and
the Stanford Clinical Excellence Research Center fosters partnerships across
organizations to revolutionize healthcare experience and outcomes. Founded
by Dr. Bridget Duffy, the first Chief Experience Officer in the nation, this
network of healthcare pioneers is accelerating the discovery and adoption of
innovations that restore the human connection in healthcare that ultimately
improves clinical outcomes, increases patient and staff satisfaction, drives
physician loyalty, and creates market differentiation in an uncertain healthcare
environment.
For more information, please visit www.experiahealth.com and follow-us on
Twitter at @ExperiaHealth.
About the Experience Innovation Network