CCRC's, SNF's, and Elephants

I presented a keynote recently, at the Revenue Summit of the Maun-Lemke Group's clients, where I discussed the service-revenue imperative with a group of administrators from continuing care retirement communities (CCRC's) and skilled nursing facilites (SNF's) from across the US.  The presentation highlighted the need for this vital sector of the healthcare profession to start taking seriously, the provisions in the PPAAC bill related to CAHPS.

I stressed the importance of CAHPS as a lever to improve not only operations but also service and revenue, and gave a dozen or so cases where the administrators could act immediately (at little or no cost).  We discussed the reality of ACO's as an incentive to improve service quality, then moved on to the very real experiences of the hospital sector with HCAHPS.

I told the story of how HCAHPS evolved from 'something I'd read about once or twice' (where the mindset of most in the room sat), to the current reality of Value-Based Purchasing and the reductions in DRG reimbursements to every hospital.

"You think this isn't your future too?"

We then moved on to some practical tips on how to manage resident satisfaction proactively.  I'm sure that you know the answer to the old riddle about how to eat an elephant - one bite at a time.  Funny how the simple wisdom of childhood riddles can help us attack real-world problems sometimes - or at least get a perspective on them.

The 'eat an elephant' strategy can help a hospital, CCRC, or SNF improve HCAHPS or CAHPS scores:
  • using your survey vendor's data, find the highest volume unit

  • find scores by unit (if available)

  • develop an elasticity table in Excel (if not provided by your vendor)...if you improved the mean on (say) Unit1 by 1 point, what impact would it have on the entire hospital?

  • focus on the highest-volume units

  • get staff and leader input...which dimension of HCAHPS/CAHPS should we target first, that will give us the biggest payoff (eg: Communication re Meds, or Quiet at Night?)

  • which one does staff feel that they can most easily affect, based on their current training, resources, process improvements, and staffing levels?

  • what additional resources will be required, and can these be reasonably provided?

  • what are the likely root causes?

  • can the root causes be removed quickly and efficiently?

  • how sustainable will the outcomes be?

  • what type of interim measurement process can we bring to bear, to assure daily forward momentum?

  • are there any staffing issues that are affecting our current performance (eg chronic shortages, etc)

These are just some questions to challenge you to focus and act!



A Bias for Action

We strongly recommend using an action-tracking system (such as our GoalMaster system) to not only ignite by focus movement against patient dissatisfiers to maximize HCAHPS performance.

Upon receiving your monthly or quarterly survey results, convene a meeting with all senior managers, and assign ownership of the specific under-performing question directly through GoalMaster.

For example, if ‘Quality of Food’ is the issue, assign (say) the COO as the Level 2 delegatee on the goal of “Improve Quality of Food Score by 3 Mean Points by End of Next Quarter” (or whatever works for your hospital).

GoalMaster will send the assignment to the COO before he/she even leaves the meeting! The COO can then action this item by delegating further to (say) the Director of Food Services, using the GoalMaster interface.

Auto-reminders will be sent to the Director of Food Services, asking for progress updates on a bi-weekly basis, allowing both the COO and CEO to monitor progress, and provide direction and assistance where necessary.


The Importance of Explanations to your 'Overall' HCAHPS Scores

I read an excellent blog by Robert Heinlein recently, who discussed how HCAHPS scores could be raised with Patient Education.

I agree with Robert that educating our patients - and managing their expectations - is an overlooked, and fundamental aspect of improving HCAHPS scores.

I say 'overlooked' because as clinicians, our first reaction is solve the problem with a clinical solution. We review processes, fine-tune systems, look for root causes, embark on sophisticated training and communications programs, etc, when sometimes a simpler fix may be all that's required.

Case in point is a small mid-western hospital I just visited, who was struggling with patient satisfaction scores in their ED that were less than what their patients (clearly) desired - but were clearly miles ahead of national averages in several key metrics.

...the disconnect? Misaligned expectations. Simple to fix, but often, it takes an outside pair of eyes to help see it.


CLS Continuing Care.com

I'm pleased to announce the launch of our new web site at http://www.ClsContinuingCare.com.

The service connects healthcare providers with long term care providers in the forum of ACO's, as well as provides a comprehensive service for improving the operations of the continuing care providers.

Check it out!


The 8-Hour Service Improvement Manager: Hour 1

The 8-Hour Service Manager is a new series, designed to help managers integrate service improvement into an already business day.

The suggestions that will be presented are tried-and-true solutions to improve both unit-level and business outcomes. If after adopting each suggestion for a month, and truly integrating it into your routine, and you don't see a positive change, I'll give you not one, but two complimentary registrations to the Healthcare Service Excellence Conference, to be held next January, 2012, in Dallas, TX!
Hour 1:

Before you sit down at your desk and check emails, daily reports, and the general paperwork that keeps your job in motion...hit the floor!

Spend 20 minutes visiting with your staff!

Connect with them on a personal level:

- how was the movie?
- what did you think of the game?
- are your kids feeling better?
- did your husband get the car fixed?
- how about this crazy weather?
- did you see that crazy Tosh.0 show on Friday?


This may sound silly, but it has a profound effect. First, it takes you out of your 'ivory tower' and engages you with your staff. Before long, the conversations will be less inane, and more sincere, approaching personal level of details. Additionally, you'll begin to plug yourself into the grapevine again, and hear about how problems with other departments are affecting your staff, and your customers.

Your staff will soon turn to you to remove service-related hurdles...something you can accomplish in your Hour 2!

Improve Service in your 8 Hour Shift...Hour 1:

- practice this 'rounding' with your staff for the next 30 days.



How NOT to spend too much on Quality Improvement

The financial imperatives of VBP are awakening hospital leaders to both vulnerabilities and opportunities in corners of their operation that have previously not been explored as quality improvement targets.

Like Rust (et al), we advocate a return-on-quality approach to assessing performance improvement initiatives that stress that quality improvement must be financially accountable.

Implicit in this is the acknowledgement that it is possible to spend too much on quality improvement activities.

When we work with a client, we develop a comprehensive Return on Quality framework that presents both the potential and the problem, in terms of market growth and cost reduction/risk avoidance. This top-down/bottom-up analysis is very helpful in setting the budget tolerances for the quality improvement project, and assessing the return on quality that can be expected from the project, and over which time frame.

Because quality improvement priorities are often well-known (through HCAHPS, internal patient satisfaction surveys, or even intuitively), the final task is developing the priority action steps that will deliver the desired outcomes – within the appropriate budget.

My Advice:

Before embarking on any quality improvement activity, whether you're considering a tweak to your existing processes or massive procedural and cultural overhauls, take the view that quality is an investment that deserves to yield a fair return.

Then, set about measuring the likely returns of your various improvement options. With return-on-quality as your indicator, you'll have a useful tool to help guide you to never overspend on quality improvement.


The Case for Empowerment in the VBP Era

You've heard about it for years now, and have likely even read cases about it in B-school.

You may have even wondered how it might work for your hospital or continuing care facility.

I'm talking about empowering your employees.

First, let me put your heart to rest: empowerment is the absolute opposite of abdication.

By empowering your employees, you're not letting them 'run the show'...you're letting them do their job.

By definition, an empowered workforce is a workforce that is highly trained, held accountable to strict productivity and quality standards, and operates with supportive, 'enabling' managers.

Empowerment also requires maturity:

- it requires that the empowering managers (starting from the CEO) 'get' their new roles as coaches, enablers, holders-to-account, and trainers.

- it requires that the employees being empowered 'get' their new roles, and why they are being asked to solve issues that previously were escalated to their supervisors. They must willingly accept this role...want this role...for their own good, their client's good, and the organization's good.

The latter can be a tough sell, particularly if previous relations with management haven't been the best.

Bowen and Lawler, in their groundbreaking work 'The Empowerment of Service Workers' laid-out the six factors favoring a strategy of employee involvement - all of which are present in today's hyper-competitive health and continuing care fields:

They are:

1. Strategy is dependent on competitive differentiation and offering personalized, customized service

2. Relationships with customers are ideally long-term ('customers for life') instead of transient transactions

3. The organization uses complex processes and technologies

4. The business is unpredictable - surprises are routine

5. Managers are comfortable letting employees work independently

6. Employees have a strong need to to grow

I'm a strong advocate of empowerment because:

1. It forces maturity on an organization, which brings rapid, customer-centric change. In this era of Value-Based Purchasing, hospitals simply can't survive without an empowered, motivated, and accountable workforce

2. It forces managers to challenge and re-engineer low-performing business processes.

3. It brings an organization closer to its customers: organizations that have successfully transitioned to a culture of empowerment inevitably enjoy increased customer satisfaction, sales, and profit.

Interested in an Empowerment Diagnostic? Give us a call at 1-800-667-7325.


Create synergy to improve employee engagement.

It's a tough thing to achieve, but it's an unstoppable force when it finally gets moving.

Synergy does amazing things.

By publicly declaring your intent to improve employee engagement in your company, you'll soon find yourself propelled by the power of the declaration and the pull of the expectation of the delivery of the outcome.

Committees will form to study and interpret your engagement survey. Action plans will fall out of these committees. Good things will begin to happen, and some people will begin to feel a sense of 'electricity'.

The challenge will be distributing this sense to every staff member in a disciplined, accountable, and sustainable manner. It gets tougher when other realities set in, such as customer priorities, meetings, financial pressures, and production deadlines.

We recommend that sustainability be engineered into the design of your engagement plan, and consideration be given to hiring external coaches to help guide the synergy.