san francisco health plan|march 18, 2014 quality …...3/24/2014 1 improving workforce experience...

3/24/2014

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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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3Page 3

Your Sherpas

Ateret HaselkornSolutions Development Director

Kim PettyManaging Director

44Page 4

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


� “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.


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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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5353Page 53

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


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


Lake County Tribal Health Consortium Work 14% 58 43% 60 29%pt improvement


Golden Valley Health Centers Work 7% 44 13% 40 6%pt improvement


Axis Health Centers Work -3% 109 16% 106 19%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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6666

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!

8484Page 84

Before we Proceed!

What is your greatest insight

or learning thus far?

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85Page 85

Proven Solutions in Team Experience

• Review of Evidence Based Solutions

86Page 86

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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Page 9191

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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

93

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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


Responsiveness to

Concerns & Complaints .465

Teamwork between


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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97

“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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101101Page 101

No Excuses Teams

No. Excuse. Team. @ Twin Rivers Regional Medical Center

Empower Staff to Lead Change

102Page 102

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… !!

104Page 104

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

108Page 108

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

Page 109

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?

Page 110

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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113Page 113

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

114Page 114

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

Page 116

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

Page 118

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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121121Page 121

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

122122Page 122

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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123123

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)


Capturing Stories (July/August)


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

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