October 2010 OU Medicine Leadership Academy - Hardwiring ...

Leadership Academy
Denise Dwight
EXCEL Coach
October 28, 2010

Relate not Compare!!
2

Learning Objectives:
Review Linkage Grid Execution Results to Date
Connect to Purpose & How to Make it Stick “Hardwire”
‣ Rounding on Staff
‣ Thank You Notes
‣ AIDET
New Communication Tool
‣ Stop Light Report
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So…..Who Are You?
4

ATTITUDE
IS
EVERYTHING
You Become what
you think
5

Group Exercise
Leadership:
‣Think of the best leader you have every worked for.
What was it about that leader that made them a great
leader?
‣Write down your thoughts and prepare to share in
large group.
6

Group Exercise
Leadership:
‣As a leader, what legacy do you want to leave behind
at OU?
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PASSION
Wherever you choose to go, go there with all your
heart.
Passion fuels Enthusiasm
(Passion, Ownership and Urgency)
8

Passion and Prescriptives
Passion
Prescriptives
9

Healthcare Flywheel ®
Prescriptive
To Do’s
Rounding
for
Outcomes
AIDET
Purpose,
worthwhile work
and making
a difference
• Bottom Line
Results
(Transparency and
Accountability)
• Reduced TO
• Increased Quality
• Reward &
Recognition
• Increased
Satisfaction
Self-
Motivation
®
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Evidence Based Leadership (EBL)
Foundation
STUDER GROUP:
Leader
Evaluation
Leader
Development
Must
Haves SM
Performance
Gap
Standardization
Accelerators
Implement an
organizationwide
leadership
evaluation
system to
hardwire
objective
accountability
(Principle 7)
Aligned Goals Aligned Behavior Aligned Process
Create process
to assist
leaders in
developing
skills and
leadership
competencies
necessary to
attain desired
results
(Principle 4 & 8)
Must Haves SM
Rounding
Thank You Notes
Employee
Selection
Pre and Post
Phone Calls
Key Words at
Key Times
(Principle 3, 5, 6, & 9)
Re-recruit
high and
middle
performers
Move low
performers up
or out
(Principle 4)
Agendas
by pillar
Peer
interviewing
30/90 day
sessions
Pillar goals
(Principle 1 & 2)
Leader Eval Mgr
(LEM)
Staff Eval Mgr
(SEM)
Discharge Call
Manager (DCM)
Rounding Mgr
Idea Express
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Linkage Grid Results
No
Yes
DESK Conversations
No
Yes
Rounding on your employees or internal customers
No
Yes
Managing Up
Response percent
Response total
No
Yes
Thank you notes
All responses - 31
Incomplete surveys
No
Yes
Communication
0 10 20 30 40 50 60 70 80
12

Connect to Purpose Communication
13

Thank You Notes
14

Managing Up
15

Round on Employees & Internal Customers
16

DESK Conversation
17

Barriers
• Time
• Extremely Busy
• Not Enough Hours in the Day
• Heavy Workload
• Short Staffed and Training New Employees
• Have done but not consistent
• Need note cards to write thank you notes
18

Rounding for
Outcomes
19

Rounding for Outcomes
• Senior Leader Rounding
• Rounding on Staff
• Rounding on Patients
• Rounding on Internal Customers
20

Employee Engagement: The 12 Items That Matter
Q12. This last year, I have had opportunities at work to learn and grow.
Q11. In the last six months, someone at work has talked to me about my progress.
Q10. I have a best friend at work.
Q09. My associates or fellow employees are committed to doing quality work.
Q08. The mission or purpose of my company makes me feel my job is important.
Q07. At work, my opinions seem to count.
Q06. There is someone at work who encourages my development.
Q05. My supervisor, or someone at work seems to care about me as a person.
Q04. In the last seven days, I have received recognition or praise for doing good
work.
Q03. At work, I have the opportunity to do what I do best every day.
Q02. I have the materials and equipment I need to do my work right.
Q01. I know what is expected of me at work.
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Employee Satisfaction Increase
2010
2010
Overall Overall RSFH 96.8%tile
RSFHCorporate Services 96.8%tile 98.4%tile
Corporate Bon Secours St.
Services Francis 98.4%tile 96.8%tile
Roper
96.8%tile
Bon Secours
St. Francis 96.8%tile
Roper
96.8%tile
Source: South Carolina Hospital, Admissions=25,837 Total beds = 594, vendor = PRC
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Rounding for Outcomes: Leaders Rounding on
Staff and Physicians
Impact of Rounding on Willingness to Recommend as a
Impact of Rounding on Willingness to Recommend KPNW as a
Place to to Work Work
% favorable Recommend for Work
100%
80%
60%
40%
20%
0%
50.2%
Never
55.6%
Rarely
(Couple times a year)
79.3%
Often
(At least quarterly)
87.4%
Tactic and Tool Implemented:
• Leader Rounding on Staff and Physicians
Frequently
(At least Monthly)
Frequency of Rounding
Oregon Integrated Health System; 8700
employees
* Results are one year following implementation of Leader Rounding on Staff
and Physicians; Staff and physicians rounded on at least monthly had the
highest satisfaction levels.
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PEOPLE
65%
OU Physicians Employee Turnover
55%
45%
35%
25%
15%
5%
Jul-08 Aug-08 Sep-08 Oct-08 Nov-08 Dec-08 Jan-09 Feb-09 Mar-09 Apr-09 May-09 Jun-09 Jul-09 Aug-09 Sep-09 Oct-09 Nov-09 Dec-09
Total 33% 27% 23% 22% 22% 22% 22% 21% 21% 21% 21% 21% 14% 14% 14% 14% 13% 14%
Voluntary 27% 21% 19% 18% 18% 18% 18% 17% 16% 16% 16% 16% 12% 12% 12% 11% 10% 11%
GOAL = Maintain a Voluntary Turnover Rate
of 15% or less
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What All Types of Rounding Have in Common
• Proactively engaging, listening to, communicating
with and supporting our most important customers
(family, employees, patients, partners, and other
departments)
• The exact opposite of an open door policy
25

Rounding –
Not a New Concept but will look different
26

Rounding on Direct Reports:
Outcomes
Outcomes:
• Build relationships
• Harvest wins
• Identify process improvement
needs
• Repair and monitor systems
• Coach and reinforce
behaviors
What direct reports want in a
Leader:
• A good relationship
• Approachability
• Efficient systems
• Training and development
• Tools and equipment
• Appreciation
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Rounding Log
• Rounding logs
are not optional
• After rounding
for outcomes
begin to round
with coaching
28

Stoplight Report
(connect the dots from rounding)
• We can’t do now and here
is why
• Work in progress
• Completed!
29

Table Exercise
‣Pair up in two’s
‣Round on each other asking prescribed questions and
documenting your findings
‣Each will be in the role of leader and staff
‣5 minutes each round
‣Share experiences as a group
• Something you learned that you didn’t know before?
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Next Steps
• Share Leader Rounding on Staff with Stoplight Report at next
staff meeting
• Round on Staff at OU Standard
– Document on rounding log
– Action items on stoplight report
– Share learning’s each month at Staff Meeting
• Monthly Meetings with Supervisor
– Use Monthly Meeting Model
‣ Share logs & stoplight report
‣ Staff Agenda
‣ Manage Up – Thank you Note for Staff and Physician
31

Denise Dwight, EXCEL Coach
A
Acknowledge
I
Introduce
D
E
T
Duration
Explanation
Thank You
32

Key Words at Key Times
33

Five Fundamentals of Consistent
Communication – Key Words
Safety
A
Acknowledge
Decrease
Anxiety
Increase
Compliance
Quality
I
D
E
Introduce
Duration
Explanation
Patient
Loyalty
T
Thank You
34

HCAHPS Questions
Composite Question Summary Response Scale
Nurse courtesy and respect
ALWAYS, Usually, Sometimes, Never
Nurses listen carefully
ALWAYS, Usually, Sometimes, Never
Nurse explanations are clear
ALWAYS, Usually, Sometimes, Never
Doctor courtesy and respect
ALWAYS, Usually, Sometimes, Never
Doctors listen carefully
ALWAYS, Usually, Sometimes, Never
Doctor explanations are clear
ALWAYS, Usually, Sometimes, Never
Did you need help in getting to bathroom? 2 Yes No (screening question)
Staff helped with bathroom needs
ALWAYS, Usually, Sometimes, Never
Call button answered
ALWAYS, Usually, Sometimes, Never
Did you need medicine for pain? 2
Yes, No (screening question)
Pain well controlled
ALWAYS, Usually, Sometimes, Never
Staff helped patient with pain
ALWAYS, Usually, Sometimes, Never
Were you given any new meds? 2
Yes, No (screening question)
Staff explained medicine
ALWAYS, Usually, Sometimes, Never
Nursing
Communication
Doctor
Communication
Responsiveness
of Staff
Pain
Management
Communication
of
Medications
Staff clearly described side effects
ALWAYS, Usually, Sometimes, Never
Did you go home, someone else’s home, or Own home, Someone else’s home, Another
to another facility? 2
facility (screening question)
Staff discussed help need after discharge YES, No
Written symptom/health info provided YES, No
NA Area around room kept quiet at night ALWAYS, Usually, Sometimes, Never
NA Room and bathroom kept clean ALWAYS, Usually, Sometimes, Never
DEFINITELY YES, Probably Yes, Probably No,
NA
Willingness to Recommend
Definitely No
NA Hospital Rating Question 0 to 10 point scale (percent 9 and 10 reported)
Discharge
Information
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Value Based Purchasing
• VBP will transition providers from HCAHPS pay-for-reporting to
pay-for-performance, and the amount of reimbursement tied to
the survey will potentially double by 2017
• It’s about how well our organization can demonstrate that it has
hardwired quality
• Pay for Quality is here
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CMS Value Based Purchasing
Core Measures
(70% Weight)
P 4 P
(Pay for
Performance)
+
Performance will
determine total hospital
reimbursement
HCAHPS
(30 % Weight)
Plan Due by January 2012
Implementation FY 2013 (Oct 2012)
37

AIDET ~ Outcomes
100
90
80
70
60
50
40
30
20
10
0
Increase of
28%ile points
Increase of
17%ile points
Outpatient Inpatient ED
Increase of
16%ile points
Baseline
6 Months Post
Source: 2007 AIDET product evaluation survey of
PARTNERS and NONPARTNERS, N=68
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AIDET – Finance - Decrease Litigation
70
60
50
40
30
20
10
50% decrease
in complaints
# of Complaints
# of Compliments
0
*Data provided by University Medical Center, Tucson, AZ
1Q07 2Q07 3Q07
**Source: 2007 AIDET product evaluation survey of PARTNERS and NONPARTNERS
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AIDET SM – Impact on Safety and Quality
Change in Percentile Ranks
Ease of obtaining test results (60.0%)
CP instructions for follow-up care (80.0%)
CP information about medications (73.5%)
CP efforts to include in decisions (73.3%)
CP concern for prob/condition (84.2%)
Access to care (46.5%)
Overall Patient Satisfaction (53.0%)
Post AIDET
Pre AIDET
0 10 20 30 40 50 60 70 80 90 100
Percentile Rank
Source: Oklahoma University; OUP Hematology/Oncology Clinic & Infusion Center; 10 providers & 22 staff, take care of 15,000
clinic visits & 10,000 chemotherapy infusions per year
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AIDET - Finance and Growth
• For every customer that complains, 20 dissatisfied customers
do not
• Of those dissatisfied customers who do not complain, 90% do
not return
• The average wronged customer will tell 25 others
• It is 10 times more expensive to recruit new patients than to
keep old ones
-Zimowski 2004
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AIDET - Patient Loyalty
“In fact the only path to profitable growth may
lie in a company’s ability to get its loyal
customers to become its marketing
department.”
-THE ONE NUMBER YOU NEED TO GROW
Frederick F. Reichheld - Harvard Business Review Dec 2003
42

Five Fundamentals of Consistent Communication
– Key Words
Safety
A
Acknowledge
Decrease
Anxiety
Increase
Compliance
Quality
I
D
E
Introduce
Duration
Explanation
Patient
Loyalty
T
Thank You
43

Group Exercise
‣Develop AIDET as you would like to hear your staff execute at
the highest level
‣Pair up in two’s
‣ Role Play AIDET prior to today’s LA
‣ Role Play New AIDET developed at LA
‣Share experience as a group
44

How Do We Make AIDET ‘Stick?’
45

Rounding – Validate AIDET
• Rounding for Outcomes
– Rounding on Direct Reports
– Rounding on Patients
• Direct Observation
• Patient Satisfaction Results
• Patient Perception of Care Results
46

Add Questions to
Rounding on Staff Log
‣Share with me how
you are using AIDET
with every encounter?
‣Share with me a
tough “D” you had to
deliver?
‣Share example of
how you took “I” to the
next level
47

AIDET – Observed Validation
Identifies the purpose of using the AIDET principle.
Performance Criteria
Utilizes the AIDET principle to communicate with others, with a focus on patients and their families:
Self Assessment
Place an X in
box 1, 2, or 3
(See legend)
1 2 3 S D
O
Evaluator's
Assessment (see
legend)
1 2 3
S D S
O
ACKNOWLEDGES the customer:
• A smile, makes eye contact, greets them and calls them by name in a pleasant manner.
INTRODUCES self:
• States name and role at HOSPITAL NAME.
• Highlights skill and expertise of self and other healthcare team member.
DURATION:
• Gives the customer a time expectation.
• Keeps the customer informed as to the amount of time a procedure or/process will take.
• Includes letting them know if there is a wait time; gives time expectation of that wait.
EXPLANATION:
• Keeps customer informed by explaining all processes and procedures
• Communicates clear expectations of what will be occurring.
THANKS the customer:
• Thanks customer for their time and,
• Expresses appreciation to the customer for their cooperation and communication
• Asks if there is anything else he/she can do for the customer before ending the interaction.
Ensures non-verbal communication conveys the AIDET principle:
• Makes eye contact.
• Respects the patient’s personal space (as possible).
• Listens to what the patient is saying; allows for silence; does not interrupt with his/her own
thoughts.
• Ensures body language is relaxed, open and non-threatening.
• Displays a calm manner.
________________________________________
Competency Met ________________________________________
Employee signature Date Evaluator's Signature Date
________________________________________
Employee signature Date Improvement Plan Completed ______________________________
____________________________________________ Evaluator's Signature Date
Employee signature
Date
D
O
48

Next Steps
• Meet with Staff
– Develop AIDET Guide
• Update Rounding on Staff Log
‣ Add AIDET Questions to Rounding Log
Share with me how you are using AIDET with every encounter?
Share with me a tough “D” you had to deliver?
Share example of how you took “I” to the next level
• Update Leader Rounding on Patient Log - if applicable
• Observe staff execute AIDET
– Document on AIDET Competency Form
49

Monthly Meetings with your Supervisor
• Monthly Meeting Model
– Share Linkage Grid Action Steps to Date
– Rounding on Staff ~ Manage Up ~ Thank You Notes
‣ Share Monthly Agenda with Rounding on Staff
‣ Share completed rounding logs & Stoplight Report
‣ Share Recognition and Manage Up to Supervisor
1 employee
1 physician
– AIDET
‣ Share AIDET Competency Assessment Forms
Progress to Date
% Complete
50

•Leadership & Attitude
‣As a leader, what legacy do you want to leave behind at OU?
‣ Closing thought for the day……
“To accomplish great things we must not only act, but also dream;
not only plan but also believe.”
Anatole France
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Never Underestimate
the Difference You Can
Make
~ Quint Studer ~
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Thank you!!!
Denise Dwight – denise.dwight@studergroup.com
Visit: www.studergroup.com
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