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!

BL

Systems, attitudes, and behaviors.

A colleague told me of a terrible personal experience where she had to run a close relative to the hospital over the weekend, with suspicious chest pains. Sitting in the ED waiting room for much longer than expected (fortunately health was OK!), she observed many of the systems and procedures of a busy Emergency Department in action.

After she told me of this story, I reflected on the staggering number of systems, processes, procedures, dashboards, surveys, alerts, analyses, and so on that have taken on 'mission critical' status in our hospitals. Give it a minute, and I'm sure that you too will lose count!

Then, it hit me: how many systems are in place to proactively manage (or even affect) attitudes and behaviors, especially as they relate to the patient experience in a typical hospital?

Not many.

Sure, everyone has an Orientation program, some do employee opinion/engagement surveys, others do management development work that they hope trickles down to the attitude of their employees, which they hope will affect their behaviors.

No wonder HCAHPS scores barely move...who are we fooling here?

To make this point, consider known-excellent performers in other industries, and see how they proactively manage attitudes and behaviors. Marriott and Four Seasons are widely acknowledged to have the best customer service cultures - both highly successful businesses that differentiate themselves largely on their service levels.

Let's take a look at just a few of their methods:

1. Accountability for guest satisfaction is a big deal at both organizations, and is a priority for both the property managers as well as their department heads. This priority-foundation brings energy, creativity, and daily management of every guest-staff transaction in every area of the hotels. Hospitals can integrate this non-system thinking into their HCAHPS plan, by assuring clarity around 'who owns HCAHPS in this unit'.
2. Guest satisfaction training and re-training is a vital part of the cultures of each company. Hospitals can integrate this non-system thinking into their HCAHPS plan, by assuring that training on a variety of issues related to improving the patient experience is frequent, understood, and front-and-center in the minds of their employees.
3. Progress is celebrated in style. Department-level pizza parties, between-shift cookies/snacks, and other ad hoc celebrations happen whenever progress is noted - because it is so important to their mission. Hospitals can do this too!
4. Guest comments are treated as 'gold'. A single non-happy guest can trigger a morning of investigation, corrective problem solving, and service recovery, with involvement from the Duty Manager, or even the General Manager. These businesses 'get' the fragility of repeat business in the service sector, and they actively seek to satisfy every guest before she/he leaves. Hospitals can do this too!

It's not just Medicare in the VBP mix!

Reading the Patient Protection and Affordability Act, it's tempting to jump to the conclusion that Medicare is the payor most interested in HCAHPS performance (for reasons discussed at length earlier).

No so.

We know of many cases where 3rd party payors are using the externally-validated, HCAHPS data, and integrating it into their payment models.

We've seen it in half a dozen states recently, and we're sure that this is the tip of the iceberg. As other payors validate the HCAHPS/Medicare experience, its a good bet that they'll integrate HCAHPS, or a similar measure into their reimbursement models, shining an even brighter light on the importance of engaging frontline associates in your HCAHPS/patient care strategy.

Good, bad, and surprising news regarding VBP.

By now, most people are aware of the Value-Based Purchasing provisions in the Patient Protection and Affordability Act that was signed into law last March.

The good news is that there will be financial incentives for improvement of HCAHPS scores (achievement or attainment).

The bad news is that there's no new money to pay for the incentives.

Through a somewhat complex model, most hospitals will see their base DRG reduced by 1% on October 1, 2012, to fund the incentive payments described in the legislation. This amount will increase in 2014 to 1.25%, 2015 to 1.5%, etc.

Now here's the surprise to many people: while the incentive payments begin (funded by the base DRG reductions ) in 2012, they'll actually be paying the incentives for HCAHPS performance earned in 2011.

This means that effective Oct 1, 2011, your HCAHPS scores will actually start to 'mean something', as the baseline measurement period begins. So, in less than 13 months, the HCAHPS clock really begins ticking.

It'll be more important than ever to have a coherent strategy to manage the patient experience through the involvement of every frontline associate in your building.

My challenge - questions today are:

1. How effective is your current strategy at really improving your HCAHPS scores through enhancing the patient experience?
2. Do your frontline caregivers 'own HCAHPS'?
3. Who is the executive responsible for championing changes and initiating performance improvement?
4. Where do you stand relative to your competitors - have you done a gap-analysis?
5. Have you assessed the dollars at stake for your hospital under VBP?

'Communication' for really, really busy managers.

Every manager knows that communication is central to her/his job. We're taught it in B-school, and it was drilled into us way-back when we were still wet behind the ears.

What they didn't tell us was what the impact of good communication would be.

Did you know though, that a management team that is (uniformly) a group of great communicators links to a 29.5% market value premium of their company? Or, that companies with better organizational communicationl earned shareholder value 50% better than industry peers.

Watson Wyatt, in an '06 report, goes so far to say that communication is a central key to employee engagement, itself a leading indicator of market value.

Yet rotten communication persists.

We see it when branch offices are 'out of the loop' for months on corporate initiatives, or one or more departments are apparently marching to their own drummer when it comes to service, safety, or other items of strategic importance.

It's so common, that as consumers, we've become agile enough (or is it just patient enough?) to navigate around many company's service policies just to complete basic transactions (such as servicing our cars).

As managers, we can improve the communication in our organization, by:

• Recognizing the critical nature of communication to the bottom line, and personally committing to improving our skills, discipline, and focus in this area
• Position company communications to our employees through the filters of what they're interested in hearing:

- provide a clear line of sight to your company's strategy, so that your employees know how their work affects the 'big picture' and how the big picture affects their work

- provide knowledge so that your employees can affect their performance within this context

- provide recognition, guidance, and accountability, so that your employees know that their effort matters

Comments?

Improving the Patient Experience Through Collaborative Action Planning

Improving the patient experience is the right thing to do, on every level.

The added wrinkle is the new level of complexity soon to be presented through HCAHPS, which will introduce a financial imperative as described in the PPAC Act with Value-Based Purchasing.

While process improvements can and will make significant improvements in the patient experience (assuming that the myriad of interlocking and often complex root-causes can be isolated and systemmatically removed), there remains a critical 'missing link'...the human element.

....and it is here that almost every process improvement fails.

Let's learn from our colleagues in our other service industries who've mastered complete organizational transformation. Every single case has involved a process redesign, as well as an organization-wide, top-down/bottom-up commitment to service and solving the non-flow-able problems that routinely occur in service businesses.

If it's a people business, the transformation solution must involve the organization's people (or it will stall).

Successful organizations in the service sector (not just healthcare) make service a foundational element of the culture of the organization. It's part of the DNA of the place:

• Dissatisfaction is taken personally and resolved quickly, with deep and sincere apology
• Once the dissatisfaction is resolved, the case is reviewed, traced and every stakeholder or potential stakeholder is brought into the performance improvement team with an equal voice...to assure the situation never arises again

Other service organizations with vibrant (fanatical?) devotion to their customers implement a 'preventive' collaborative action planning process that might take the form of daily huddles that address the issues of the day, rumors, things that may cause disruption, etc. This highly effective communication process takes no more than5-10 minutes, and can serve the dual purposes of communicating news and problem avoidance.

These daily 5-10 minute huddles are:

1. Inexpensive
2. Amazingly effective at enhancing communication
3. Excellent forums to 'get the antennae up' related to key performance indicators
4. Not conducted by 99% of all service organizations

We'd be happy to share an outline of a process for this method of engaging frontline employees in problem avoidance and resolution, to create a vibrant service-driven culture that reflects in your HCAHPS performance and (very soon) in your Medicare Reimbursement under Value-Based Purchasing.

For more info, please visit us at http://www.customlearning.com/ or call us at 1800.667.7325.

The countdown clock has started - and this time it could cost you.

Value-based purchasing is a key component of the Patient Protection and Affordable Care Act (better known as 'The Reform Bill')...and there's stuff in there that you really need to start paying attention-to now!

Briefly, your hospital's base DRG will be reduced by 1% starting Oct 1, 2012, and accelerating in the years after that. This money goes in to a 'bonus pool' to incent hospitals to improve HCAHPS performance. Hospitals can earn-back their reduction through performance improvements measured by HCAHPS, the greater of either achievement or improvement.

It's a complex formula, that I'd be happy to share with you, and model your hospital for you.

Here's what you need to pay attention to now:

1. The benchmarking period begins Oct 1, 2011. This is when your HCAHPS scores 'start meaning something', and will factor into the equation that determines your Medicare Reimbursement in 2012.

2. You can calculate the cost of your performance (in Medicare Reimbursement dollars) by HCAHPS dimension. This will allow you to develop a meaningful, prioritize plan that links operations and patient experience directly to your bottom line.

3. There are elements in the Legislation that make HCAHPS-VBP a bit of a moving target yet. The more performance improvement initiatives that you have effectively in place now, the more engaged and collaborative your staff are in the process of improvement, the stronger you'll be in just a few months down the road.

4. The financial impact can be very significant.

Give me a call at 403.607.7444 or email me directly at brian@customlearning.com, and I'll present a customized VBP assessment to you.

Ignite consistent service delivery to improve HCAHPS performance.

If your published HCAHPS scores are currently below National or State averages, or (more worrisome), below those of a key competitor, I'm sure you'll agree there's room for improvement.

Through a disciplined, proven process, we'll collaborate with your team to deliver everything you'll need to ignite consistent service delivery to improve your HCAHPS scores within 60 days.

Specific deliverables include the:

- Engagement of leaders, staff, and physicians, you'll gain the enthusiastic support of these important stakeholders, to anticipate and respond to patient concerns

- Implementation of prioritized, proven best-practices, to give a strong foundation for HCAHPS score-improvement

- Strengthening of your system of accountability, to assure that everyone is focused on the same goal of patient service excellence

- Implementation of a robust performance improvement tool, you'll obtain immediate data to drive rapid-cycle improvement of HCAHPS performance at a unit-level

- Sustainability coaching to month six, to assure continued forward momentum.

- Is there a reason to wait?We're pleased to offere multiple payment options...we're serious about getting to work on your HCAHPS scores right away.

Find out how more..

Are you an 'inspirer'?

Sylvia Ann Hewlett, an economist and the founding president of the Center for Work-Life Policy blogs that "Leaders who still believe that inspiring employees should take a backseat to cost-cutting need to look to Apple."

She gives a few examples of inspiring leaders in her article, that, while not necessarily relevant in a hospital setting, are certainly enough to get us thinking outside of the box.

I'm writing to you today on the topic of inspiration, because it's my belief that without an inspired workforce, you're dead in the water. With HCAHPS value-based purchasing looming on the horizon, an inspired workforce that's focused on delivering outstanding service has never been more important.

I strongly urge all Administrators, PI Directors, CNO's, Service Excellence councils and others involved in HCAHPS management to seize the remaining few months before VBP kicks-in, to instill a culture that is fanatical about the patient experience (before it adversely affects your Medicare reimbursement).

One of the most inspirational activities that a manager can schedule is attending the Healthcare Service Excellence Conference. The 11th Annual event will be held January 26-28, 2011 in New Orleans. While details will follow shortly, I urge you to save this date and plan to attend this important event that for the last 5 years has scored 98% in Delegate Satisfaction.

SVEHMAAMYRQP

Does this sound familiar?

A phrase that I hear periodically from hospital leaders who are satisfied with their patient satisfaction results goes something like this: "if we could only manage to improve this one performance element on this one unit, then we'd really be where we want to be."

Well, tackling those high priority patient dissatisfiers at a unit level is now much quicker and easier than before, with Bellwether.

Bellwether is a performance improvement tool that's been designed to seamlessly integrate with any unit, and deliver the information needed to consistently improve performance...on a daily basis.

It helps you turn real-time feedback into fast and sustainable gains in HCAHPS and other key performance indicators.

If your hospital is struggling with improving HCAHPS performance at a unit level, I invite you to click here to read the details of the case study, how Bellwether works, and to arrange a 15-day trial.

60 days...

If your published HCAHPS scores are currently below National or State averages, or (more worrisome), below those of a key competitor, I’m sure you’ll agree there’s room for improvement.

Through a disciplined, proven process, we’ll collaborate with your team to deliver everything you’ll need to ignite consistent service delivery to improve your HCAHPS scores within 60 days. Specific deliverables include the:

1. Engagement of leaders, staff, and physicians, you’ll gain the enthusiastic support of these important stakeholders, to anticipate and respond to patient concerns
   
2. Implementation of prioritized, proven best-practices, to give a strong foundation for HCAHPS score-improvement
   
3. Strengthening of your system of accountability, to assure that everyone is focused on the same goal of patient service excellence
   
4. Implementation of a robust performance improvement tool, you’ll obtain immediate data to drive rapid-cycle improvement of HCAHPS performance at a unit-level
   
5. Sustainability coaching to month six, to assure continued forward momentum.
   

I personally guarantee that you’ll be satisfied with the result.

If after the initial 60 days you are dissatisfied with the progress or the service, I’ll provide you with additional training, software, and coaching services, until you are satisfied.

Is there a reason to wait?

We're pleased to offer multiple payment options...we're serious about getting to work on your HCAHPS scores right away.

I hope we’ll have the opportunity to do business together in the not-too-distant future.

Please call me directly at 1800.667.7325 to discuss the details.

Brian.

NRHA, Healthcare Reform, and Communicating with your Senator

I just attended an excellent Grassroots Strategy call, conducted by the NRHA, in which an excellent update of the status of healthcare reform was presented.

More importantly, delegates were urged to not get 'reform fatigue', and to remain very diligent during this important time, by getting the facts, and communicating with their Senators.

Sound advice (NRHA).

The association, as most, offers templated emails, letters, and contact information to get you started (and keep you engaged) with a message that's aligned with your membership values.

The Leadership Factor in Value-Based Purchasing

The countdown is on to the Healthcare Service Excellence Conference!

With relentless pressures such as present on admission (POA), recovery audit contractors (RAC), hospital acquired conditions (HAC), payment for performance (P4P), HCAHPS, Never Events and Core Measures, hospitals have a new urgency to understand how to thrive in a value-based purchasing environment.

While many hospitals have approached these initiatives as discrete and unrelated, connecting the dots between these initiatives reveals the urgency (and the opportunity) of VBP.
The Healthcare Service Excellence Conference has focused this year's agenda on Value-Based Purchasing to help navigate through the complexity.

It is a must attend for any healthcare professional.

Sessions of Interest:
The Leadership Factor in Value-Based Purchasing
Hospital of Choice 2010
Improving HCAHPS Results on a Unit-Level Basis

There's much more to this dynamic event, that I firmly believe that every hospital should send at least one leader!

Call me directly for more info (403-607-7444), or visit http://www.healthcareserviceexcellence.com to register.

Brian.

The Bottom 50 HCAHPS Performers

I set our analysts loose on the 2007 HospitalCompare data set, to analyze the bottom-50 hospitals in the category "Percent of patients who reported that YES, they would definitely recommend the hospital."

The objective of the analysis was to isolate trends that might point to cultural issues common in the lower performers at this time.

The analysis showed that the worst performance categories for these hospitals were in the areas of 'Staff Explanation'. They showed a general desire by patients to have their treatments, medications, and recovery instructions clearly explained to them.

While it's too soon to tell whether these failures are a cultural issue, the results might certainly be seen as an indicator of a culture-challenge.

To see the results click here:

Five Facts about Culture

Here are five facts about culture from a report titled 'Concepts of Culture and Organizational Analysis'.

Although most reports I've come across indicate that culture can be effectively changed, controlled and managed to support organizational goals they often downplay the complexity of such a strategy. If changing your culture is something your serious about, understand that it's not a "get in get out" solution. It takes time and specialty training.


1. Culture indicates the 'way of life' for workers who often take its influence for granted (they simply accept it). The firms culture becomes obvious when an aspect of it causes a corporate setback (it must change).

2. Culture is stable over time and it resists quick changes.

3. A culture involves internal and external aspects. Internally, a culture might encourage quality, cost effectiveness and accuracy.

4. Culture can be measured, evaluated and perfected.

5. Culture can be managed to support the firm's strategic plan.

Achieving 'Hospital of Choice' Status

Achieving the status of 'Hospital of Choice' in these tough times is both a rarity and (with HCAHPS) and an imperative.

Sky Lakes is a 133 bed hospital in south Oregon, that has achieved Hospital of Choice status, by moving their patient satisfaction scores from the low (Press Ganey) 30's to the 91st percentile.

Join me for a brief, one-hour webinar that will present an overview of the culture transformation process that Sky Lakes used, and how it helped to increase their patient satisfaction so dramatically (a process now in place at hospitals across North America).

This evidence-based session is a 'must-see' for CEO's, COO's, CNO's, and others who are passionate about and tasked with improving patient satisfaction.

Register here!

B

The Healthcare Service Excellence Conference - now more than ever?

As 'pay for reporting' inevitably gives way to 'pay for performance', the time to architect an aggressive HCAHPS score-movement strategy has never been more urgent. To that end, I'm proud to announce that the Healthcare Service Excellence Conference is coming around again (November 5-7, 2008, in Louisville - see the links below to register!).

The event is a 'combustible' gathering of service excellence pros from across the US...it's really quite inspiring. As this'll be my 9th year attending (I'm keynoting this year), I thought I'd share with you:

The 10 Reasons why the Healthcare Service Excellence Conference
truly is a 'Can't Miss' event for hospital leaders:

1. Create a positive impact on your HCAHPS scores

2. Develop appropriate standards to address disruptive Physician behaviors and staff perceptions

3. Implement accountability systems that will reinforce and sustain peak performance

4. Learn what's likely to come when value-based purchasing becomes a reality...and what you can be doing about it now

5. Drive strategic change through focused/invigorated leadership

6. Connect your team with the most vibrant online community of service excellence professionals, dedicated to solving problems and maximizing the patient experience (a community-style peer-to-peer best practices resource is being launched at the conference)

7. View new technologies that enable constant improvement in the patient experience, through dramatic increases in accountability and early-warning of negative trends.

8. Learn strategies to address and tie physician disruptive behaviors to improvements in clinical and satisfaction outcomes.

9. Challenge and learn from peers and experts from survey firms to learn the latest thinking, strategies, and best practices in the HCAHPS roundtables.

10. Learn how rapid cycle process improvement can impact your hospital, while producing sustained results.

...see you in Louisville November 5-7? B