Taking You and Your Organization to the Next Level Studer Group Mission and Vision Mission: To make healthcare a better place for employees to work, physicians to practice medicine and patients to receive care. Vision: To be the intellectual resource for healthcare professionals, combining passion with prescriptive actions and tools, to drive outcomes and maximize the human potential within each organization and healthcare as a whole. Execution company focused on achieving and sustaining! • Exceptional clinical, operational & financial outcomes. • Work with over 800 healthcare organizations in the US and beyond. • > 50 Coaches and Speakers • Educational Resources – Books, Training Videos, Webinars and Institutes. • Web-based software solutions for operational alignment and process efficiency/ improvement. Recipient of the 2010 Malcolm Baldrige Quality Award • Ranked #5 Great Small Workplace in America • Evidenced-Based tactics that • produce: Accelerated rate of improvement and efficiency in clinical quality (core measures, hospital acquired conditions, and readmissions) Favorable HCAHPS results Maximized reimbursement Increased physician loyalty Improved ED flow, operational metrics and patient experience External Environment Conclusions Physicians and Senior leader team feel the external environment will be more difficult in the future. 31% feel if an organization stays the same, they will be the same, better or much better. If 3 out of 10 people do not recognize urgency, the organization will never achieve outcomes and too much pressure is put on the other 70% of the people. Top Ten Challenges in Execution 1. Leaders / Others underperforming and still receiving a good evaluation (Accountability) 6. Push Back by leaders, staff and physicians (Accountability) 2. Change not connected to why (Alignment) 7. Not familiar with what “right” looks like (Action) 3. Lack of necessary urgency (Alignment) 8. Lack of frequency (Action) 4. Leaders do not have the skills to assure a solid implementation. (Action) 9. Inability to transfer best practices (Action) 5. Too many changes -- too soon (Action) 10. Poor processes (Action) Must Haves!! It depends on the diagnosis-DIAGNOSIS TREATMENT Employee Engagement Leader Rounding on Employees Responsiveness to Patient Hourly Rounding No-Shows Pre-Calls Readmissions Post-Calls with frequency, dependent on patient condition Physician Engagement Quadrant Exercise Physician Rounding Side Effects of Medication Bedside Shift Report Urgency Toolkit to explain the external environment .. “People wish to be settled; but only as far as they are unsettled, is there any hope for them.” Ralph Waldo Emerson How many of the employees that you directly supervise are not meeting performance expectations? Average = 8% Performance ManagementHow many employees do you have currently working for you who have documentation that they are underperforming? Average = 50% The Evidence Heart Failure Pneumonia Healthcare -Associated Infections Surgical Care Improvement Heart Attack 1 physician in 3 receives any data about performance. 1 physician in 5 receives data pertinent to clinical outcomes. 1 physician in 4 receives patient survey data. We have learned that the reluctance to address low/sub-par performance keep an organization from being the best. Quint Studer Definition H=HIGH PERFORMER Professionalism Teamwork Knowledge & Competence Communication Safety Awareness Comes to work on time Good attitude Problem solves You relax when they are scheduled Use of peer interviews Pillar ownership Brings solutions Good influence Adheres to policies concerning breaks, personal phone calls, leaving the work area, and other absences from work. Demonstrates high commitment to making things better for their team and organization as a whole. Eager to change for the good of the organization. Strives for continuous professional development. Consistently communicates organizational. Does not create we/they. Provides frequent feedback to staff. Demonstrates the behaviors of safety awareness in all aspects of work. Definition M=MIDDLE PERFORMER Solid performer Good attendance Loyal most of time Influenced by high and low performer Wants to do a good job Could just need more experience Helps manager be aware of problems Professionalism Teamwork Knowledge & Competence Communication Safety Awareness Usually adheres to policies concerning breaks, personal phone calls, leaving the work area, and other absences from work. Committed to improving performance of their team and organization. May require coaching to fully execute. Invested in own professional developments. May require some coaching to fully execute. Usually communicates organizational information. Occasionally uses we/they language. Provides some feedback to staff. Definition L-LOW PERFORMER Knowledge & Competence Communication Safety Awareness Points out problems in a negative way Positions leadership poorly Master of “We/They” Passive aggressive Thinks they will outlast the leader Says manager is the problem Does not communicate effectively about absences from work. Handles personal phone calls in a manner that interferes with work. Breaks last longer than allowed. Demonstrates little commitment to their team and the organization. Shows little interest in improving own performance or the performance of the organization. Develops professional skills only when asked. Does not communicate organizational information. Uses language to create we/they culture. Does not provide feedback. Performs work with little regard to the behaviors of safety awareness. Employees Patients Rounding with Employees EmployeeThankYou Notes Leader Rounding on Patients Peer Interviewing 30 Individualized Patient Care Bedside Shift Report AIDET® PreVisit Calls and 90 Day Meetings (Input) EmployeeAttitude Survey Employee Forums Bright Ideas Standards Post Stay/Visit Calls Hourly Rounding Physicians Physician Performance Feedback System Got Chart Physician Preference Card Physician Code Patient Agenda and Visit Guide Physician Note Pads Rounding for Outcomes AIDET Rounding for Outcomes Employee Rounding Tell your staff about rounding Do rounding with the prescribed frequency Use a rounding log Give feedback Concern and Care Align Questions to fit Desired Outcomes of the Organization What is Working Well People to Recognize Systems to Improve Tools and Equipment Follow-up Rounding for Outcomes Senior Leader Rounding Increases Senior Leader Visibility Reassures and Engages Staff Connects the Dots for Staff Regarding Organization Decisions/Outcomes Validates Department/Unit Leader Rounding Eliminates We/They Mentality Improve Physician Integration Areas of focus Round on direct reports the same way all leaders round on their employees Round in departments with other leaders using a scouting report Link to department leader rounding logs Supply important information about a given department Focus on external environment Identify tough questions Allow you to reward and recognize the right people Acknowledge which systems have been fixed Point to tools and equipment that have been purchased and those that still need attention To sustain the culture, selection is paramount. CURRENT PRACTICE � � � � � � � � � � � Department Meetings Employee Conversations Employee R&R Staff Selection and Orientation Staff and Patient Retention Staff Policy Patient Conversations Pre Phone Calls Post Phone Calls Staff and Leader Evaluation Only new item EFFECTIVE APPROACH Consistent Agendas Rounding for Outcomes Thank You Notes Peer interviewing and 30/90 Day Meetings Individual Employee Meetings Standards of Behavior Key Word at Key Times Pre Phone Calls Post Phone Calls Staff and Leader Evaluation Leadership Training Rounding on Areas Served – Example Acknowledge relationship /clarify expectations “Your dept is very important to us & our patients…” Rounding, Why & Duration “Our goal is to provide excellent service. I will be rounding on you each month…..” Review Accomplishments “Since I rounded with you last month, I wanted to highlight the following items/systems we have put into place based on feedback….” Working Well “What is my department doing well? Recognition ‐ Individuals “Is there anyone specific I can recognize for doing great work? What have they done?” Opportunities for Improvement “What 1‐2 things can my department do better? Any ideas on how we can improve?” Identify specific areas of focus from survey process “We want to respond in a timely manner”, “Can you explain a time when you had to wait for response from our department”, “When we did not respond in a timely manner, what do you typically wait to receive….?” Is there anything I can help you with? “Is there any other questions you have or anything else I can help with right now?....” Thank you and Appreciation “Thank you for your time …..” Establish next rounding date “I will be back in next month to talk again….” Studer Group Five Fundamentals AIDET® A Eye contact, smile and acknowledge everyone in the room. Acknowledge I Introduce “Hello Mr. Clark. My name is Jackie and I am your nurse today. I have been a nurse for 20 years and have worked in this hospital for over 8 years. I have done this procedure thousands of times and I go back for training each year….” D Duration “This procedure will take about 10 minutes to perform and then about one hour for the results….” E T Explanation Thank you “Let me explain some more about the procedure.” (Explain why performing the procedure, what will happen and what they should expect, understanding of side effects, and answer any questions.” “Thank you for choosing us ….Thank you for waiting … Thank you for coming in today…What other questions do you have?” Pre Visit Calls The Results!!! Reduce NoShow’s by: 70% Reference: Pre and Post Procedure Calls; Scott A. Strong, M.D., The Cleveland Clinic, 2003 Reduce Tardiness by: 60-70% Increased Patient Satisfaction: 25-30 Percentile Points Best Practice Contact Rate PATIENTTYPE ATTEMPT % INPATIENT • 100% patients discharged home/home with home healthcare CRITICAL CARE • 100% of patients discharged home and home with home healthcare • 100% of eligible patients discharged patients to home • If unable to attempt 100% start with specific patient groups based on acuity (e.g. chest pain) or risk factors (e.g. AMA's) • Non-eligible patients are admissions, transfers, deaths, psych patients and those with no current phone number (i.e. homeless) • Cath-lab 100%, OUTPATIENTS • • GI 100%, Radiology certain populations (e.g. 100% invasive procedures; specific number/day) MEDICAL PRACTICE • Set number – 5 per staff per week or 20 per week per person OUTPATIENT SURGERY • 100% of patients discharged home EMERGENCY DEPARTMENT CONTACT % 70-80% 100% 50-60% 100% 100% Reboarding/Onboarding Information Guide: Core Competency Tools & Resources Accountability Service and Operational Excellence Introduction Hardwiring Excellence, Chapters 1-3 Evidence Based Leadership graphic Complete Readings Rounding on Staff Hardwiring Excellence, Chapter 7 The Nurse Leader Handbook, Chapter 2 Rounding on Staff log Stoplight Report and Guidelines for Use of Stoplight Video: Rounding on Direct Reports Leader rounds on you to role model practice Completion of rounding on 100% of staff Completion of Stoplight Report Thank You Notes Hardwiring Excellence, Chapters 7 & 11 The Nurse Leader Handbook, Chapters 3 & 4 Send TY notes to direct reports Manage up thank you notes to leader Communication Hardwiring Excellence, Chapter 10 The Nurse Leader Handbook, Chapter 1 Agenda by Pillars Department Communication Board Working With your Leader – The Power of Aligned Messages webinar (2009) AIDET® Five Fundamentals of Patient Communication Building Patient Trust with AIDET® highmiddlelow® Performer Conversations Insight and Video: Overcoming Resistance to Change Insight and Video: The Power of Our Words Insight and Video: Spinach in your Teeth Messages: The Art of Giving (and Receiving) Honest Feedback Use Agenda by Pillar for staff meetings Update Dept Communication Board Date Completed Objective Evaluation Hardwiring Excellence, Chapter 9 The Nurse Leader Handbook, Chapter 15 Leader Evaluation Manager℠ Leader Evaluation Manager℠ tutorials Organizational Goals 90 Day Plans Monthly Report Card Webinar: Accountability Tools and Tactics Webinar (2008) Leader to review and set your goals Obtain Leader Evaluation Manager℠ training Complete 1st 90-day plan Update monthly report card Monthly Meeting Model The Nurse Leader Handbook, Chapter 22 Video: Supervisory Meeting Model Monthly Meeting Model Tools Tab on Studer Group website Scouting Report Insight and Video: Senior Leader Rounding Prepare for and complete MMM with your leader Senior Leader Rounding Effective Meeting Management Delegation Change Management Measurement Tools Rounding on Patients The Nurse Leader Handbook, Chapter 21 Agenda by Pillars Webinar: Leading Effective Meetings webinar (2009) The Nurse Leader Handbook, Chapter 23 The Nurse Leader Handbook, Chapter 25 Hardwiring Excellence, Chapters 4 & 9 The Nurse Leader Handbook, Chapter 18 Balanced Scorecard Patient Satisfaction Vendor tools Leader Evaluation Tools Tab on Studer Group Website The Nurse Leader Handbook, Chapter 8 Patient rounding log Four Goals for Rounding on Patients Hourly Rounding℠ Training Video A Rounding on Patients “AHA” Moment Video: Leader Rounding on Patients Prepare scouting report for your senior leader Round in your dept with senior leader Complete readings and video Complete reading Complete reading Complete readings Review Balanced Scorecard with your leader Obtain vendor training on measurement tool Observe colleague rounding on patients Round on your patients Complete patient rounding validation with mentor/coach Follow up with staff post rounding Rounding on Patients The Nurse Leader Handbook, Chapter 8 Patient rounding log Four Goals for Rounding on Patients Hourly Rounding℠ Training Video A Rounding on Patients “AHA” Moment Video: Leader Rounding on Patients Observe colleague rounding on patients Round on your patients Complete patient rounding validation with mentor/coach Follow up with staff post rounding Rounding on Internal Customers Internal Customer Rounding log Internal Customer Preference Card Video: Rounding on Departments Served Observe colleague rounding on customers Round on your customers Complete customer rounding validation with mentor/coach Follow up with staff post rounding AIDET® The Nurse Leader Handbook, Chapter 13 Video: AIDET® Five Fundamentals of Patient Communication Video: Building Patient Trust with AIDET® video AIDET® Observation Form Video: AIDET® and Support Services Leader Rounding Video: AIDET® Coaching, Food and Nutrition Video: AIDET® for Physicians Complete readings and video Develop your own AIDET® Practice your AIDET® Complete AIDET® validation with mentor/coach Key words at Key Times Hardwiring Excellence, Chapter 5 The Nurse Leader Handbook, Chapter 13 Develop your own KWKT Practice your KWKT Complete AIDET® validation with mentor/coach Service Recovery The Nurse Leader Handbook, Chapter 14 Webinar: Service Recovery – I’m Sorry to Hear That (2009) Complete readings and video Selecting Talent Hardwiring Excellence, Chapter 8 The Nurse Leader Handbook, Chapter 6 Video: Selecting Talent Webinar: Selecting Talent – Peer Interviewing Works (2009) Behavioral Based Interview Questions The Nurse Leader Handbook, Chapter 6 30 & 90 day rounding log Complete readings and video Performance Conversations Hardwiring Excellence, Chapter 6 The Nurse Leader Handbook, Chapters 3, 5 & 7 Behavioral Standards Performance Evaluation Highmiddlelow® Performance Conversations video Conducting highmiddlelow® Performance Conversations webinar (2009) highmiddlelow® Tools Tab on Studer Group website Complete readings and video Pre and Post Visit Calls Hardwiring Excellence, Chapter 5 The Nurse Leader Handbook, Chapter 9 Video: Post Visit Phone Calls Webinar: Centralized Discharge Call Center and Physician-Led Post-Visit Phone Calls Complete readings and video Hourly Rounding℠ The Nurse Leader Handbook, Chapter 10 Hourly Rounding℠ Toolkit Webinar: Hourly Rounding℠ webinar (2009) Video: Hourly Rounding℠ Training Video Complete readings and video Bedside Shift Report The Nurse Leader Handbook, Chapter 11 Best Practice video on Bedside Shift Report Complete readings and video 30 & 90 day meetings Complete readings and video Round on new staff using 30 & 90 logs Individualized Patient Care The Nurse Leader Handbook, Chapter 12 Video: Individualized Patient Care Cards Complete readings and video Financial Impact & Productivity Management The Nurse Leader Handbook, Chapters 16 & 17 Video: Calculating the Return on Investment of Great Service to Patients and Employees Webinar: Time and Energy Management webinar (2009) Complete readings and videos Collaborating with Physicians The Nurse Leader Handbook, Chapter 20 Engaging Physicians Video: The Art of Physician Courtship: Five Things Healthcare Leaders Can Do to Lay the Groundwork for Physician Integration Webinar: Engaging Physicians webinar (2009) Webinar: Studer Group Physician Webinar Series (2008) Complete readings and videos HCAHPS HCAHPS - It's All About Quality The HCAHPS Handbook It Starts in ED: Why Patient’s “First Impression” Sets the Stage for HCAHPS Success Webinar: HCAHPS: Hardwiring Your Hospital for Pay-for-Performance Success Webinar Webinar: HCAHPS – Part 2: Pay for Performance is Here Complete readings and video Insight and Video: Are you holding leaders accountable for only 1/8 of the HCAHPS pie? Video: The First Performance Period Is Over. What Now? The Age of HCAHPS: Four Reasons Why Those 27 Survey Questions Will Change Healthcare Forever Ask your Supervisor to find out more about these resources and many more!