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!

Analysis-paralysis, or patient-centered?

Let's face it, we're all getting pretty good at reading survey reports these days, aren't we?

Whether its an inpatient report, HCAHPS, or whatever else, we all seem to be inundated with stats that show 'where we've been' in crystal clear detail.

• When do you have enough data to act?
• What's your tolerance level to trigger action?

Think about it for a minute, then take a look at your last survey vendor report, particularly at the 'top 10' list:

1. How long have these items been on your top 10 list?
2. Why are they there?
3. Who owns these items, and what is the status of their corrective action plan?
4. What circumstances are conspiring to prevent your organization from taking meaningful action?
5. How engaged are your staff in delivering outstanding service levels?
6. How engaged are your managers?
7. Is your organization truly 'patient centered', if your top 10 list is essentially unchanged month after month?
8. Are unit leaders collaborating with their teams to act on the priority issues on their units?

...what do you plan to do next?

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.