Taking You and Your Organization to the Next Level

Transcription

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2 Taking You and Your Organization to the Next Level 2016 Winter Conference December Pam Beitlich, DNP, ARNP, RN, NEA-BC Craig E Deao, MHA

3 About me: Disclosure: Maslow s Hammer Senior Leader with Studer Group since 2006 Leadership, Culture, Accountability, Quality, Safety Co-led Baldrige journey Faculty for ACHE, US & Canadian health systems Quality committee of local heath system MHA, University of Minnesota (Minneapolis, MN) BA & BS, LSU (Baton Rouge, LA) Originally from New Orleans, now Pensacola Husband to Julie; Father to Sam (9) and Jack (6)

4 Studer Group: Who We Are We are dedicated to healthcare and aspire to role model exactly what we teach others. This relentless commitment to authenticity is key to who we are. 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. Values Teamwork, Respect, Integrity, Generosity, Learning, Measurable Achievement Organizational achievements 2010 recipient of the Malcolm Baldrige National Quality Award 99 th percentile employee engagement for 9 straight years Fortune Top 25 Best Workplaces for 7 straight years Customer Loyalty among Top 10 US companies

5 What We Do BUILD SKILLS Educational Conferences Speakers Books Videos Online learning GET RESULTS Fast improvement on a key organizational metric, e.g. patient experience, employee & physician engagement, ED turnaround CHANGE CULTURE Comprehensive organizational transformation through expert coaching to hardwire evidence-based practices across the board TRAINING IMPROVEMENT TRANSFORMATION

6 More about you: First or Worst What was your first job? Or your worst job? Person with birthday closest to today starts 10 Minutes

7 Vision without execution is h a l l u c i n a t i o n. Thomas Edison

8 It is all about creating a culture of execution.

9 Why Organizational Change Fails 1. Dots are not connected consistently to purpose, worthwhile work and making a difference 2. Do not achieve critical mass - Lack of balanced approach 3. Absence of an objective accountability system 4. Leaders do not have the training to be successful 5. Too many new behaviors introduced at once need of sequenced approach 6. No process in place to rerecruit the high and middle performers and address low performers 7. Inability to take best practices and standardize across organization 8. Failure to have leaders always do desired behaviors Source: Studer Group. Organizational Change Processes In High Performing Organizations: In-Depth Case Studies with Health Care Facilities. Alliance for Healthcare Research

10 Three Elements to Execution

11 Healthcare Flywheel

12 Sample of Studer Group Partners Healthcare Systems / Community Hospitals Academic / Teaching Hospitals Specialty Hospitals Physician Practices Rural and Critical Access Hospitals Canadian Hospitals Additional Healthcare Partners

13 People Service Quality Finance Growth Why We are Engaged MISSION

14 Adult Learners Quiet cell phones Be here Listen as if you were going to teach it (... because you will!) Take notes Participate, ask questions Relate vs. compare Own it

15 It is not the strongest of the species that survives, nor the most intelligent, but the one most responsive to change. Charles Darwin

16 When Organizational Change Doesn t Sustain Dots are not connected consistently to purpose, worthwhile work and making a difference 2. Do not achieve critical mass - Lack of balanced approach 3. Absence of an objective accountability system 4. Leaders do not have the training to be successful 5. Too many new behaviors introduced at once need of sequenced approach 6. No process in place to rerecruit the high and middle performers and address low performers 7. Inability to take best practices and standardize across organization 8. Failure to have leaders always do desired behaviors Source: Studer Group. Organizational Change Processes In High Performing Organizations: In-Depth Case Studies with Health Care Facilities. Alliance for Healthcare Research

17 Vision without execution is hallucination. Thomas Edison

18 Three Elements to Execution

19 Leading through Change and Transitions to New Opportunities Pam Beitlich, DNP, ARNP, RN, NEA-BC

20 Our Agenda - Review key changes in healthcare today Identify a model to effectively lead through change Identify individual opportunities to mature your leadership influence 20

21 Being a leader in healthcare today is like continuously walking up a down escalator. If one stands still they go backwards.

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23 Reactions to Change are Personal Consider 3 or 4 changes you have experienced- 1. What was the change and how was it introduced? 2. What was your initial reaction? Enthusiasm? Wait and see attitude? Ambivalence? Cynicism? 3. Did your attitudes change over time? 4. Was there a pattern to your response? 5. If you experienced ambivalence, how did you resolve it? 6. How have these experiences colored your expectations and feelings toward change in the future?

24 Situational Awareness- Key Changes in Healthcare

25 What is Reform really About? $/N Healthier population Lower Use Lower Prices Higher quality 2013 Time Seeing Beyond Reform: Governance and the Emerging New Healthcare; James Orlikoff, President; Orlikoff & Associates, Inc.; 4800 S. Chicago Beach Drive; Suite 307N; Chicago Il ; ;

26 A Better Definition- No Outcome, No Income

27 Other Significant Changes Transparency/public reporting/consumer influence Technology Research Integration Market changes Episodic vs. continuous change

28 What s Ahead - From illness to wellness Population Health From procedures to prevention Care coordination Virtual visits Patient portal Lab visits/clinics in shopping malls Telemedicine

29 Anything Changing Here? Quality of care Length of stay Efficiency, cutting out waste Reducing readmissions Financial stability Patient experience Employee Engagement

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31 Let s Pause and Reflect What is your WHY for being in healthcare? What truly inspires you to get up every day and come to work?

32 Culture Culture means creating consistency and alignment in human behaviour that is also in alignment with a certain way of thinking and living. Creating the right culture is of utmost importance. -Quint Studer

33 Behavior Standards are so Important Patients want to be cared for by a friendly, caring, and empathetic team

34 Culture Change Requires Behavior Change -

35 That s Just Her / Him

36 Everyone thinks of changing the world, but no one thinks of changing himself -Leo Tolstoy

37 Observations No victim thinking Control our own destiny People need you You not only save lives but you save healthcare

38 Five Behaviors of Engaging Leaders - Communicate content, frequency and mode (intentional about team and individual) Expectations and accountability Recognition and constructive feedback Development approaches assisting team members to grow Accessibility informed, responsive, available, and willing to discuss anything? - Gallup

39 Hhhhhhmmmmmm. 35% of U.S. workers polled by Parade Magazine would willingly forgo a substantial pay raise to see their direct supervisor fired Since the recent Recession, 52% of Americans admit to being disengaged in their jobs Actively disengaged is 18%

40 What are 3 skill sets you would like to improve as a leader? What interest/strength do you have that you are not currently using to your potential? 40

41 Leading Change 41

42 Three Separate Components External occurrences Internal changes Individual occurrences

43 Change not Always Bad or Feared

44 Phases of Organizational Change PHASE 1: THE HONEYMOON Sense of excitement Right to do list Things will get better (hope) Quick fixes are implemented Team in place Some skeptics Overall lots of enthusiasm PHASE 2: REALITY SETS IN We/they Inconsistency apparent Bigger challenge and more work than thought This will impact me Change for all Some are getting it and getting it faster Some are not and may not PHASE 3: THE UNCOMFORTABLE GAP Performance gap is evident Tougher decisions must be made Process improvement increases due to accountability and skill level Inconsistencies obvious that if not fixed, progress will halt and organization will go backwards PHASE 4: CONSISTENCY High performing results Everyone understands the keys to success Disciplined people and disciplined processes displayed in organization Proactive leadership

45 Phases of Competency and Change Even with positive change, there is resistance Expert? / Competent Consciously Unskilled Consciously Skilled Unconsciously Skilled Unconsciously Unskilled Novice (Incompetent?) Source: Abraham Maslow; 1940; Four Stages for Learning Any New Skill ; Gordon Training International by Noel Burch; 1970

46 Model to Drive Performance

47 Best Practices for Leading Change Leading through Change

48 People wish to be settled; but only as far as they are unsettled, is there any hope for them. Ralph Waldo Emerson

49 Unsettling occurs when a culture of optionality changes to a culture of accountability

50 Both Thinking and Feeling are Essential Thinking Differently 1. Analyze - Give the data and the evidence 2. Think Data and analysis influence how we think 3. Change New thoughts can change or reinforce changed behavior

51 Behavior Changes when we Feel Feeling differently - 1. See help people see by creating surprising and compelling visual experiences 2. Feel seeing something new hits the emotions 3. Change emotionally charged ideas change behavior

52 Change Models

53 Leading Change Change management is an approach to transitioning individuals, teams and organizations to a desired future state Operational Framework Managing Organizations and Change Managing Individual Change

54 Many Change Models - Kurt Lewin Everett Rogers John Kotter Switch - Heath and Heath

55 Adoption of Change Occurs over Time - Everett Rogers

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57 Creating the Climate for Change Create a Sense of Urgency Create the Guiding Team Develop a Change Vision and Strategy Help Others Feel a Gut-level Determination to Act, NOW Put Together a Group with enough Power and Skills to Lead the Change Clarify how the Future will be Different from the Past

58 The biggest obstacle in achieving high performance is not achieving the needed urgency for change Kotter, John P (2008) A Sense of Urgency. United States: Harvard Business Review Press.

59 Identify a Change, Initiative or Project One that someone at your table has, is or will be experiencing Develop the WHY that supports the change. What will capture head and heart to begin adoption of the change and embracing it?

60 Engaging and Enabling the Organization Communicate the Vision Empower Broad-Based Action Generate Short Term Wins Ensure Stakeholders Understand/ Accept the Vision and Strategy Remove as Many Barriers as Possible- Unleash People to do their Best Create Visible Success ASAP

61 Empowering People to Effect Change Communicate a sensible vision Make structure compatible with the vision Provide the training employees need Align information and personnel systems Confront supervisors who undercut needed change

62 Implementing and Sustaining Change Don t Let Up Make the Change Stick Maintain Momentum - Consolidate Gains and Produce more Change until the Vision is a Reality Anchor New Approaches in the Culture for Sustained Change

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64 Discuss strategies to collaborate with your peers and other departments -Who are the key stakeholders? -How will you begin?

65 Your Opportunities to Influence Change

66 How do YOU respond to Change?

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68 Champion of Change Competencies- Persuasion Relationship building and networking Develops others Provides rewards and recognition Practices inclusion and values diversity Innovates Drives for results Willing to take risks/ challenge the status quo Provides strategic direction - Zenger/Folkman, 2006

69 Inspire and Motivate Competencies Acts as a role model in the organization Adapts influence strategies to individuals Creates a learning environment Sets high personal standards Innovates Keeps the team informed Ensures agreement on priorities Creates a compelling vision Concern and consideration for others Empowers others to take responsibility for projects - Zenger/Folkman, 2006

70 Change vs. TRANSITION

71 Transition an Emotional Process Most people don t fear change, but the loss that comes with it Stages are characterized with typical reactions normal and healthy Chaos and loss of equilibrium Regaining balance and a new beginning Helps us prepare and plan

72 Successful Transition through Change - Letting go of what s old and familiar Sitting with what s unknown and uncertain YET avoiding the learned helplessness syndrome Adjusting to what s new and unfamiliar We all have multiple experiences of change Resilient to change

73 Your Role in Navigating through Transitions Before After During Round on your Team and Ask- - How are you doing? - What are you thinking? - How are you feeling? - What s working? - What s not working? - How can I help? Rounding on patients Thank You s and Recognition

74 Assist the Skeptics and Laggards - They dislike uncertainty Often the last to adopt Point of reference may only be the past Little tolerance for uncertainty Suspicious of innovation and change agents

75 Employees Cope Better - Feel same level of commitment, control and challenge as their leaders Understand that change is important Believe they can influence decisions and outcomes Experience the journey not as a threat but an adventure Leadership from top down must create conditions to make that possible - Bridges, Managing Transitions

76 Senior Leadership sets Expectations Leader rounding is not optional. It has to be looked at as seriously as giving correct medications. - Quint Studer

77 Best Advice from the Best Leaders Consistency is the key to success of a highly reliable organization. We have non-negotiable behaviors. It is more than just rolling out the training and assuming it is being done. It is my job to make sure they have the training and coaching to be successful. We validate and follow-up daily. - Dr. Rhonda Scott, Chief Nursing Officer Grady Memorial Hospital

78 Leading with Courage

79 Communicating: The Suggested Sequence Why What How

80 Connect your Heart and Mind Heart Mind

81 You Can only Take Someone as Far as you Take Yourself

82 Lessons Learned - Change can be tough for leaders too practice self awareness for loss occurring to you Find your connection and stay there Leaders set the strategy and expectations Keep a sense of urgency. follow-through As a leader, YOU must go first, as an always leader Transformation begins with transformational leaders

83 Gratitude Changes Everything Practicing gratitude awakens our senses, stirs our spirit and opens our heart 83

84 What is Constant in Healthcare Passion Fortitude Willingness to learn Desire to have purpose, do worthwhile work and make a difference -A Culture of High Performance Quint Studer

85 Become a Champion of Change -

86 Inspire and Motivate

87 HHhmmmmm.. A leader takes people where they want to go. A great leader takes people where they don t want to go, but ought to be. - Rosalynn Carter

88 References and Resources Balogun, J. & Johnson, G. (2005). From intended strategies to unintended outcomes: The impact of change recipient sensemaking. Organizational Studies, 26(11), Bridges, W. (2003). Managing Transitions: Making the most of change. (2 nd Ed.). Cawsey, T. Deszca, G., Ingols, C. (2011). Organizational Change: An action oriented toolkit. Thousand Oaks, CA: Sage. Heath and Heath (2010). Switch: How to Change Things when Change is Hard. Kotter, J. P. (1996). Leading change. Boston: Harvard Business Press. Kotter, J.P. (2002). The heart of change. Boston: Harvard Business Press. Kotter International (2012). Retrieved from: Lewin, K. (1947).Frontiers of Group Dynamics: Concept, method and reality in social science, social equilibria, and social change. Human Relations, 1,5-41. Ritter, J. (2012). Resistance to change and change management. In N. Borkowski (Ed.), Organizational behavior in health care (pp ). Boston: Jones & Bartlett. Rogers, Everett M. (1983). Diffusion of Innovations. New York: Free Press. Zenger Folkman Company. All rights reserved. UWMC.PM-CCDG.EL4.0 Rev

89 Moving Organizational Performance High-Solid-Low Conversations Pam Beitlich, DNP, ARNP, RN, NEA-BC

90 Today s Agenda Understand the importance of engagement in healthcare today Learn a process to move performance through High-Solid-Low Conversations 90

91 Engaged Staff- Engaged work with passion and feel a profound connection to their company, drive innovation and move the company forward Not-engaged essentially checked-out or sleep-walking through their day, putting time in but not energy or passion in their work Actively dis-engaged- not only unhappy at work but actively acting out their unhappiness. Every day these workers undermine what their engaged co-workers accomplish. - Gallup

92 Engagement is Critical - Staff who have the most patient contact are often the least satisfied and engaged There is a strong correlation between patient satisfaction and staff engagement. Organizations that can provide the best environment for employees will be rewarded with better patient care. - Press Ganey, 2010

93 Work arounds Employee Engagement and Safety Link Conclusion: Employees with low engagement are more likely to work around safety protocols, but are less likely to work around safety protocols when highly engaged 2 Low Engagement High Engagement Source: Leadership, Rework, and Workarounds; Grant T. Savage, Ph.D.; University of Alabama at Birmingham, February 2011

94 Five Behaviors of Engaging Leaders - Communicate content, frequency and mode (intentional about team and individual) Expectations and accountability Recognition and constructive feedback Development approaches assisting team members to grow Accessibility informed, responsive, available, and willing to discuss anything? - Gallup

95 High, Middle/Solid and Low Performers

96 What it IS - Re-recruitment tool 90-92% are positive conversations Methodology for moving organization performance Cascaded from the top down Leaders first, then staff Sequenced Highs first, then middle and finally low performers What it is NOT- Not a performance appraisal Performance appraisals review the full scope of annual performance with competencies and behaviors what is done well and opportunities for improvement Not tied to compensation Not mandated percentages in each category

97 Performance Curve - L M H 8% 58% 34% Low Performer Middle/Solid Performer High Performer

98 Definition of High Performer Always Definition Professionalism Teamwork Knowledge & Competence Communication Safety Awareness Comes to work on time Good attitude Problem solves You relax when they are scheduled Good influence Use of peer interviews Pillar ownership Brings solutions H 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 information. Does not create we/they. Provides frequent feedback Demonstrates the behaviors of safety awareness in all aspects of work.

99 Ask Yourself these Questions - Knowing what you know today, would you hire this person again? Absolutely! Are you comfortable being away when you know this person is in charge? If you are on vacation, you want them working Would this person be on the top of your list if you had to pick a team to start your own business?

100 Middle/Solid Performer Usually Definition Professionalism Teamwork Knowledge & Competence Communication Safety Awareness 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 M Middle 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. Demonstrates the behaviors of safety awareness in all aspects of work.

101 Ask Yourself the Next Questions.. Knowing what you know today, would you hire this person again? - Yeah, But. Does this person demonstrate consistent performance, especially when dealing with low performers? Is this person open to coaching to improve his or her performance?

102 AND, the Low Performer Sometimes Definition 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 ( Never? ) L Professionalism Teamwork Knowledge & Competence Communication Safety Awareness 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.

103 More Questions.. Knowing what you know today, would you hire this person again? If this person resigned tomorrow, would you and the rest of your department be okay with that decision? Does this person bring down the rest of the department? Does this person know how to improve performance temporarily, only to return to old behaviors? If you were on vacation, would you be more comfortable if this person was also on vacation?

104 Are YOU Working Harder at Their Success than They Are?

105 Important Note: 9 out of 10 conversations will be encouraging and positive for leader and employees

106 Moving the High Performers GAP L M H Performance

107 High Performer Conversation Goal: Reward, Recognize and Retain Thanks and Appreciation Importance Organizational Direction/Plan Input Thank them for their effort and work Outline specifically why they are so important to the organization Explain where the organization is going and how to meet goals Ask for their input: We want to retain you. Is there anything we should be doing better? What do I need to do for you?

108 High Performance Conversation Goal: Reward, Recognize and Retain Individual Thanks and Appreciation Importance Organization Direction/Plan Input Thank them for their effort and work Outline specifically why they are so important to the organization Explain where the organization is going and what is being done to meet those goals Ask them for Input We want to retain you. Is there anything that we should be doing better? What do I need to do for you?

109 Moving the Middle/Solid Performers Goal: Reassure and Retain Individual Let them know they are valued and calm anxiety S = Support Describe good qualities and tell the employee how important they are to the organization - be specific C = Coach the middle performer by sharing one area for professional development and improvement S = Support Reaffirm good qualities and let them know you are committed to their success - Ask if there is anything that you can do to help them in the area you identified

110 Solid Performance Conversation Goal: Reassure and Retain Individual S Support Describe good qualities calm down their anxiety C Coach Cover development opportunity S Support Reaffirm good qualities

111 Clear Expectations for Low Performers GAP L M H Performance

112 The Low Performer OF NOTE, we have learned 33 % of low performers can be coached 33% of low performers are in the wrong job, and may do well in the right spot 33 % will not succeed and need to be coached out of your organization

113 Low Performer Conversation - UP or OUT Do not start meeting with a positive D: Describe Describe what has been observed E: Evaluate Evaluate how you feel S: Show Show what needs to be done K: Know Know the consequences of continued same performance FOLLOW UP

114 Low Performance Conversation D Describe Describe what has been observed E Evaluate Evaluate how you feel/ impact S Show Show what needs to be done K Know Know consequences of continued same performance Follow-up

115 Improved Operational Performance across the Board New Old Performance

116 Top Five Questions Performance Management What if I think my boss is a low performer? What are some tips when working side by side with a low performer (peer)?

117 Top Five Questions - How do you move out an extremely nice, very good intentioned low performer? (employee is extremely nice but does not progress and puts a burden on the other staff)

118 Top Five Questions - How do I really address the low performer in the moment? Do you tell your staff your intentions to support high & middle and no longer support the negative, low performers unless they move up?

119 highmiddlelow Tools and Processes

120 HSL Leader Differentiator Tool

121 HSL Guidelines and Tips Communicate to team first Conversation tips for each type of conversation

122 HSL Tips for Handling Difficult Situations Focus on another employee Excuses Mistake made by manager Emotional / angry response

123 HSL Conversation Guide and Role Play Use this tool when role playing the three different conversations with your supervisor and to prepare for each performance conversation

124 Today s Agenda Understand the importance of engagement in healthcare today Learn a process to move performance through High-Solid-Low Conversations 124

125 What has Been Accomplished? Leader role models commitment to standards and behaviors Re-recruitment of high and middle performers is reinforced Employee has a clear understanding of expectations Employee knows the consequences if there is no change in behavior

126 Failure to Deal with Low Performers Our industry is loaded with compassionate people. This may prevent us from dealing with performance issues. What makes us good at the work of healing holds us back in weeding out problem staff members. - Straight A Leadership, Quint Studer

127 As an Organization - - Do you quickly move people out of the organization if they don t fit the culture or violate your behavior standards? - How long do you think leaders should be allowed to stay in their role if they don t get good results?

128 The biggest obstacle in achieving high performance is not achieving the needed urgency for change Kotter, John P (2008) A Sense of Urgency. United States: Harvard Business Review Press.

129 Great Cultures with... No Excuses Leadership AND Non Optional Behaviors of Excellence will separate those that win from those that lose

130 Key Words at Key Times An Absolute Must Have Pam Beitlich, DNP, ARNP, RN, NEA-BC

131 Today s agenda Learn the critical importance of key words at key times Understand how A-I-D-E-T forms the foundation of healthcare communication Commit to being a role model with key words 131

132 Execution Framework Evidence-Based Leadership SM

133 Execution triangle

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135 Consider.. Patients are scared Patients are anxious Patients are in pain Patients are away from home We understand; we empathize; we care

136 Key Words at Key Times Your Words Matter 136

137 Why is communication important? Improve clinical outcomes Improve clinical compliance with medications and treatment regimes Reduce 30-day readmission rates Increase patient and physician satisfaction Reduce malpractice claims and patient complaints Build loyalty and improve reputation in the community

138 What traits? Friendliness - an appreciation of the other person by a smile Relevance -establishing a connection Empathy - identifying with the other's situation Realness authentic, genuine, honest Humanness - Sanders. The Likeability Factor. 2005

139 WHY is communication important? Patients want to be cared for by a friendly, caring, and empathetic team

140 Empathy What is your biggest fear? 1. Infection 2. Incompetence 3. Death 4. Cost 5. Mix-Ups 6. Needles 7. Rude doctors and nurses 8. Germs 9. Prognosis 10. Communication issues 11. Loneliness - Colleen Sweeney, The Empathy Project

141 Hotels, fast food and coffee?

142 Key words at key times Key words reflect a communication style that improves the quality of information provided by every person in every interaction. Key words demonstrate empathy, dignity and respect. They reduce anxiety, build confidence, increase compliance and provide comfort Key times are defining moments that: Occur during times of vulnerability Greetings and goodbyes Personal times - like bathroom needs Handovers

143 Behaviors must match your message Non-verbal communicates with more honesty than words People will walk away with the message they see versus the message they hear Sit down time perception Use appropriate touch If you are going to write when the patient is talking tell them so up front

144 A-I-D-E-T

145 Five fundamentals of communication A I D E T Acknowledge Introduce Duration Explanation Thank You

146 Focus on the WHY and emphasize the E Focus on the A & I to show courtesy and respect and reduce anxiety Focus on the D & E to educate on treatment and to increase compliance A I D E T Acknowledge Introduce Duration Explanation Thank You

147 AIDET and key words at key times Narrate your care be more verbal in our approach with patients - Avoid silent assessments Hardwire AIDET - Introduction when can I stop? - 5 objectives to be met in every interaction, regardless of how brief Patients rating of quality is more predicted by their rating of the quality of communication than technical care. * Annals of Internal Medicine

148 Acknowledge?

149 A Acknowledge Acknowledge the patient by name Make eye contact, smile, and acknowledge everyone in the room - patient and family Key Messages You are important to me I respect you You can trust me

150 Eye contact be present

151 Importance of the greeting 78.1% of patients wanted their physicians to shake hands 91.3% of patients wanted to be addressed by their name Makoul, Zick, and Green, Annuals of Internal Medicine

152 I Introduce Introduce yourself, your skill set, your professional certification, and experience Manage up another caregiver Physician and/or Department Key Messages I am personally committed to your care This team is very competent to take care of you.

153 Duration

154 D Duration Accurate time expectation for tests and physician Identify/communicate next steps, or give a time when you will update Key Messages I want you to understand next steps and what is happening to you. I value your time.

155 E Explanation Listen to the patient s story 2 minutes Explain the plan of care for the day Clarify questions with empathy Do you have any questions? Closed loop communication - Tell me. Key Messages I want you to be very informed about your care. I have time to do so.

156 Notice any difference? Patient Knowing Diagnosis % of Physicians believe patients know diagnosis 77% % of Patients that know diagnosis 57% Source: Arch Intern Med Aug 9;170(15): Communication discrepancies between physicians and hospitalized patients. Olsen, DP et al 0% 10% 20% 30% 40% 50% 60% 70% 80% 90%

157 Any difference here? Physician Discussing Patient Fears % of Physicians stated they sometimes discussed patients' fears and anxieties 98% % of Patients that said physicians NEVER did this 54% Source: Arch Intern Med Aug 9;170(15): Communication discrepancies between physicians and hospitalized patients. Olsen, DP et al 0% 20% 40% 60% 80% 100%

158 T Thank you Closing key words for lasting impressions Thank you for choosing our practice I m glad I got to care for you during your stay. I will be thinking about you Key Message - I appreciate the opportunity to care for you

159 SM WHY AIDET? Decrease anxiety with increased compliance Decreased Anxiety + Increased Compliance = Improved clinical outcomes and increased patient and physician satisfaction

160 Key words at key times AIDET SM Inpatient satisfaction Tactic and Tool Implemented: AIDET SM Source: Lafayette General Medical Center, Lafayette, LA;

161 Key words at key times AIDET Environmental services Tactic: Introduction of AIDET in EVS Likelihood to Recommend Room Cleanliness Overall Rating Source: Upson Regional Medical Center

162 All the reasons I can t use AIDET I m a new nurse how do I manage myself up? I don t care for patients, I am just a volunteer. Do I need to introduce myself EVERY time I see the patient when they come to our clinic 3 times a week for therapy? What if I don t know how long it s going to be? Thank you for choosing HCA North Texas sounds scripted. I am not comfortable with that. What if I don t have anything nice to say about the physician treating the patient or the nurse who is caring for the patient?

163 Think about AIDET.. Pre and post discharge phone calls At reception/registration When greeting a guest in the hallway - 10/5 rule On the phone with collections or calling about a bill the patient owes Service recovery

164 Key words utilized throughout surveys Concern Comfort Waiting time Courtesy Informed Explanations Skill Sensitivity Ease

165 What are YOUR key words? I want to be sure that you are comfortable. Is there anything else I can do for you before I leave your room? I am pulling the curtain for your privacy How is your pain level this morning, on a scale of 1-10, 10 being the worst? Let me make sure you know your schedule for today.

166 Other key words - I am washing my hands for your SAFETY. I have TIME to answer your questions. I want you to be INVOLVED in your treatment plan I want to be sure I EXPLAIN everything to you For your COMFORT, your Dr. ordered pain medicine... I want to keep you INFORMED I want to make sure we are THOROUGH I am listening but I must look at the computer too. You are in good hands with the staff on this floor.

167 Key words..developing your own Privacy What do we do (actions) to protect patient privacy? Close doors Pull curtains Cover patient when transporting What do we need to say (key words) to connect the dots for our patients?

168 Action plan Review the survey Ensure staff know all questions Have staff complete the survey as if they were a patient in your area Discuss results Good versus Very Good and Always versus Usually Highlight key words in survey Ask staff What do we do that impacts this? Ask staff What do we need to say to connect the dots for patients? Create key words for your department to incorporate into their AIDET going forward

169 Anti-key words.. That s the way we ve always done it. We are short-staffed today. We had a sick call. That s not my department. We can t do that. The office is closed. You ll have to call back. You are 20 minutes late you will have to reschedule.

170 Leaders need skill development to coach.. We don t give immediate performance feedback and coach our staff Time It will make staff feel uncomfortable It will make them think we don t trust them The leader thinks the staff already do the skill well enough Patients report in rounds the staff are doing it GET COMFORTABLE BEING UNCOMFORTABLE

171 Engagement Attributes Date: Name: Role: STRENGTHS IDENTIFIED/RATING ESSENTIAL SKILLS (Each section equals 9 points for a total of 90 points) ACKNOWLEDGE Acknowledged entering the room (knock, hello, etc.) Acknowledged using customer name as appropriate Introduced self and role INTRODUCE Managed up experience/training/skill set, etc. Managed up others (co-workers/other depts./organization, etc.) DURATION Gave time expectation of how long will take, how long expected to wait Verbalized next step EXPLANATION Explained what would be taking place, why you are doing this, what will happen, and what they should expect. Addressed pain management Used language that the customer understands THANK YOU Thanked the customer and showed appreciation (i.e., thank you for trust, for asking your question, for the opportunity to work together; ask if there s anything you can do before leaving, etc.) NEED TO FOCUS ON IMPROVEMENT STRENGTHS IDENTIFIED/RATING OTHER (Each item equals 1 point for a total of 10 points) Active listening Non-multi-tasking Eye contact Tone of voice Appropriate speed of speech Appropriate use of touch Appropriate use of humor/emotion Physical positioning mirror customer s position, sit without table or desk between if possible, etc. Energy mirrors the needs of the customer Washed hands entering room and as leaving the room if patient care area NEED TO FOCUS ON IMPROVEMENT Expert at AIDET Would be a good mentor to others >90 pts = Competent EVALUATION SUMMARY: Total: (100 pts) Evaluator Comments: Repeat Skills Assessment Evaluator: Date:

172 How to give feedback Don t be too general connect to A.I.D.E. and T. Teach to the test this isn t about gotcha Be positioned to be an observer/auditor Have a plan/tool/form to outline the process and behaviors expected Be prepared to provide feedback on every step of the process and every behavior Offer one thing to focus on for improvement Ensure your feedback is aligned with the performance of the person being observed Improve your observation assessment skills with practice

173 Let s practice your skills.. Let s Practice Your Key Words..

174 Today s agenda Learn the critical importance of key words at key times Understand how A-I-D-E-T forms the foundation of healthcare communication Commit to being a role model with key words 174

175 Consistent and accountable.. Consistency is the key to success of a highly reliable organization. It is more than just rolling out the training and assuming it is being done. Everyone can have their own style but there needs to be consistency in the evidence-based delivery of rounding on patients from one unit to another. It is my job to make sure they have the training and coaching to be successful. Dr. Rhonda Scott, Chief Nursing Officer Grady Medical Center

176 You can only take someone as far as you take yourself

177 HHhmmmmm.. A leader takes people where they want to go. A great leader takes people where they don t want to go, but ought to be. - Rosalynn Carter

178 Evidence-Based Leadership - Must Haves for Patients Pam Beitlich, DNP, ARNP, RN, NEA-BC

179 Healthcare Flywheel Prescriptive To Do s Purpose, worthwhile work and making a difference Bottom Line Results Self-Motivation

180 Execution Framework Evidence-Based Leadership SM

181 The Why Evidence-Based Leadership Foundational, best practice tactics that ensures your ability to deliver quality care in your area by evaluating and monitoring processes and behaviours Reconnects leaders to patient care on a personal level Provides best opportunity for line of sight leadership to see the highlights and gaps leading to elevated performance Builds leadership assessment skills Reduces patient/family anxiety Proactively manages concerns

182 Must Haves 1. Leadership Evaluation aligned to Goals 2. Rounding 3. Thank you s This is Transformational 4. Peer Interviews/ day follow-up Change 5. Pre and Post Discharge Calls 6. Key Words at Key Times

183 Communicating: The Critical Sequence Why What How

184 Observations No victim thinking Control our own destiny People need you You not only save lives but you save healthcare

185 Patients and Families

186 Leader Rounding on Patients Set expectations for patient and family Find what s working well to recognize staff Outline what to do if expectations are not met Provide service recovery on the spot Transparency and accountability 186

187 Hourly Rounding on Patients Call Light Reduction Patient Fall Reduction Pressure Ulcer Reduction Patient Experience Increase Staff Engagement Increase Steps per Shift Decrease

188 Pre and Post Discharge Phone Calls

189 Discharge Phone Calls WHY? A telephone call made to a patient within hours after an interaction with Inpatient, Outpatient or ED services will help ensure a safe transition home and reduce unnecessary re-admissions. Goal is 100% of patients receive a discharge phone call Did your discharge instructions answer all your questions? Is there anything preventing you from taking your medications as ordered? Track attempt/complete rate and trended info associated with quality outcomes/readmissions

190 Thank you for the difference YOU make in the lives of so many

191 Pam Beitlich, DNP, ARNP, RN, NEA-BC Insert Your Photo Here Studer Group International Speaker

192 Three Elements to Execution

193 Tearing it up

194 Debrief Unclear expectations = Unmet expectations Were the instructions to each of you the same? Any variability in execution? (Does this ever happen to you?) Was I clear in my instruction? Did I ask if you understood or had any unanswered questions? Did you speak up and ask? Authority gradient/power distance Leadership judo Were you taught not to micromanage? How did you interpret that? When there s low tolerance for variation in the outcome, instruction must be given and must be clear.

195 Example Organizational Results Using typical Leader Evaluation

196 Example Distribution of Performance Using typical Leader Evaluation

197 Same Organization s Results After implementing Weighted and Objective Evaluation Excellence Service People Quality Finance Growth Increase Patient Satisfaction (Inpatient) Goal = 62 nd Current = 51 st Increase Patient Satisfaction (Ambulatory) Reduce Annualized Turnover Goal = 14.5% Current = 16.7% Increase Employee Satisfaction Decrease Mortality Index Goal =.77 Current =.77 Operating Margin Goal = 5% Current = 5.6% Reduce FTE per Adjusted Discharge Increase Inpatient Admissions Goal = 2.7% Current = 7.6% Increase Outpatient Visits Goal = 62 nd Current = 65th Goal = 1.15 Current = 1.15 Goal = 5% Current = 8.0%

198 Distribution of Performance After implementing Objective and Weighted Evaluation

199 Feb Apr Jun Aug Oct Dec Feb Apr Jun Aug Oct Dec Feb Apr Jun Aug Oct Dec Feb Apr Jun Aug Oct Dec Feb Apr Jun Aug Example Hospital 100% 90% Goal = 90% Inpatient Monthly Percentile Score Year 1 Year 5 95% 80% 70% 60% 50% 40% 30% 20% 10% Leader Evaluation Tool Implemented 0% Year 1 Year 2 Year 3 Year 4 Year 5

200 Jan Mar May Jul Sep Nov Jan Mar May Jul Sep Nov Jan Mar May Example Hospital 100% 90% 80% 70% 60% 50% 40% 30% 20% 10% 0% Goal = 90% Leader Evaluation Tool Implemented Inpatient Monthly Percentile Score Year 5 Year 7 99% Year 5 Year 6 Year 7

201 Big Rocks

202 Start the Discussion... If one year from now I have exceeded your expectations, what will I have achieved?

203 Three Elements to Execution

204 Phases of Competency and Change Individual Consciously unskilled Consciously skilled Unconsciously skilled Unconsciously unskilled Source: Abraham Maslow; 1940; Four Stages for Learning Any New Skill ; Gordon Training International by Noel Burch; 1970

205 Don t Wait for Direction From Your Supervisor Ask your supervisor: What am I doing well? What can I be doing better? Are my priorities in place? Is there some training that would be helpful for me in my development?

206 Three Elements to Execution

207 Key Tactics Employees Patients Physicians Rounding with Employees Employee Thank You Notes Peer Interviewing 30 and 90 Day Meetings (Input) Employee Attitude Survey Employee Forums Bright Ideas Standards Leader Rounding on Patients Post Stay/Visit Calls Hourly Rounding Individualized Patient Care Bedside Shift Report AIDET Pre Visit Calls Involve Physicians in Goal Setting and Skill Building Round on Physicians Focus, Fix and Follow-up AIDET

208 But it doesn t work here... vs.

209 Employees

210 Key Tactics Employees Patients Physicians Rounding with Employees Employee Thank You Notes Peer Interviewing 30 and 90 Day Meetings (Input) Employee Attitude Survey Employee Forums Bright Ideas Standards Leader Rounding on Patients Post Stay/Visit Calls Hourly Rounding Individualized Patient Care Bedside Shift Report AIDET Pre Visit Calls Involve Physicians in Goal Setting and Skill Building Round on Physicians Focus, Fix and Follow-up AIDET

211 Why Rounding? Because it gets results. Builds strong personal relationships Develops a culture of positivity & recognition Feel better driving home Build capacity for process improvement Reduce hassles Employee engagement

212 Why round on staff? What do employees want? A good supervisor Efficient work systems Tools and equipment Appreciation Collaboration with Coworkers 60% of employees who leave a position do so because of their relationship with their direct supervisor.

213 Employee Engagement Increase Overall RSFH 2011 Corporate Services Physician Partners Bon Secours St. Francis Mount Pleasant Hospital Roper Hospital 96.9 %tile 97.5 %tile 92 %tile 97.1 %tile 99.4 %tile 97 %tile Source: South Carolina Hospital, Admissions=25,837 Total beds = 594, vendor = PRC

214 Turnover and Vacancy Rate Decrease Source: Florida Hospital System, Admissions=69,107 Total beds = 1,218

215 Essential Elements & Sequence How is..(build relationships) What s working well? Do you have what you need (tools, skills, etc) to do your best for..(our patients, our team, etc) Do you have anyone I should recognize and WHY? Any processes you see may need fixed (if yes, what are some of your ideas) Can add focus question if needed

216 Body Language

217 Tell me about your weekend... One partner tells the other about his/her weekend. The other partner cannot say anything... but must indicate by what they do, expressions, etc. that this information is FASCINATING. Talker: How did that feel? Switch. Other partner tells the other about his/her weekend. The listening partner cannot say anything... but must indicate by what they do, expressions, etc. that this information is INCREDIBLY BORING.

218 Debrief Talker: How did that feel? Stopped talking? Embellished? Which of these would you like your patients/colleagues to do?

219 Multi-tasking: shifting tasks in fact increases amount of time to finish by 25%+

220 How to Start, How to Hardwire

221 Recommended Frequency

222 Tips for successful rounding No surprises, let your direct reports know what leader rounding is and why you are doing it Provide a copy of the questions Let them know you want their input I ll come back tomorrow... If you did know... Keep it short, 5-10 minutes is optimal Summarize any commitments/action items Close the loop follow up (Stoplight report, recognition)

223 Log and accountability

224 Closing the Loop

225 Simple way to close the loop GREEN: What COMPLETE is the stoplight report? Surgery: Lab Coats ordered for all staff- What delivered should Jan 13 th go on the stoplight report? 2 How Central: often Need new should I binders. Charge book post and where? falling apart. Both are ordered. YELLOW: IN PROGRESS Endoscopy: IMS (Integrated Medical Systems) to evaluate all Scopes for needed repairs and present condition Free Service 3 South / 4 Central: Equipment needs being addressed include: tape recorders, tapes, manual blood pressure cuffs, thermometers and chairs. RED: CAN T COMPLETE AT THIS TIME AND HERE S WHY 3 South / 4 Central Computers/eMAR in every patient room. Hoping for in next year, but very expensive. Seeking options 2 Central: More VS machines. Not budgeted for this year. Suggested not placing machines in isolation rooms. Looking into ordering more manual equipment for rooms. Lab: Ordered 2 additional phlebotomy cards for those who want them. 3 Central: Vs machines often stuck in isolation rooms. Will assess how many manual sets we are down, and order these. Case Management: The Case Management staff has outgrown its space. Due to the limited space within the facility, we are unable to move.

226 What gets rewarded gets repeated Recognition It s not a natural skill it must be taught! 65% of Americans reported that they received no recognition for good work in the past year Source: How Full Is Your Bucket-Tom Rath, Donald O. Clifton

227 The Ideal Thank You Note Timely Handwritten Short in length Includes specific behavior Managed up to senior leaders Leaders should share with their up-line leader the name of one Colleague who has gone above and beyond and deserves recognition.

228 Anatomy of a Thank You Note WHO IDENTIFIED BEHAVIOR November 20, 2014 Dear Pat, Mark wrote me the nicest note about how all your preparation and pre-work led to the successful implementation of our new software in the field last week. Thank you for being such a great role model of how to partner with our corporate services. Mark said he would work with you any day! SPECIFIC BEHAVIOR OBSERVED TIMELY Sincerely, Debbie

229 Thank You Note FAQs Will thank you notes become insincere because we are asking everyone to use them? How many is too many?

230 Day to Day Recognition Includes: Handwritten Thank You Notes or s Pats on the back Small/personalized tokens of appreciation Public Praise These should be done frequently, specifically and timely and ALWAYS connect the action to purpose, worthwhile work and making a difference.

231 Monthly Meeting Model Agenda Four Key Components 1. Review of performance (via report card and 90-day plan) 2. Verification of key behaviors that are being used to achieve results 3. Review of LDI Linkage grid to confirm status of completing linkage assignment 4. Professional development NOTE: Senior leader may begin the Supervisory Meeting with Rounding on their direct report

232 Tips for conducting the meeting Meet at least once a month Communicate your expectations Start with rounding for outcomes Focus on outcomes that have been achieved first Connect to purpose Document action items generated during the meeting

233 Getting (and keeping) the Right People on Your Bus

234 Execution Framework: Evidence-Based Leadership SM LEADER EVALUATION Implement an organization-wide leadership evaluation system to hardwire objective accountability LEADER DEVELOPMENT Create process to assist leaders in developing skills and leadership competencies necessary to attain desired results MUST HAVES Rounding, Thank You Notes, Employee Selection, Pre and Post Phone Calls, Key Words at Key Times PERFORMANCE GAP Re-recruit high and middle performers, Move low performers up or out STANDARDIZATION Agendas by pillar, peer interviewing, 30/90 day sessions, pillar goals ACCELERATORS Leader Evaluation Manager Validation Matrix SM Provider Feedback System SM Studer Group Rounding Patient Call Manager TM 234

235 Bringing Mission, Vision, & Values to Life

236 Do they hang on the wall?

237 Or walk in the halls?

238

239 So how do you systematize this?

240 Execution Framework Evidence-Based Leadership SM Rev 2.14

241 Tips Sign standards before hiring process begins Use behavioral based and peer interviews Intercept early turnover Balance how you rate standards and goal achievement Keep the standards top of mind (orientation, resign, Standards of the Month, etc.) If you want to prevent patterns, address episodes

242 Re-Recruit with 30 and 90-Day Meetings How do we compare with what we said? What s working well? Have there been any individuals who have been helpful to you? Based on your prior work, what ideas for improvement do you have? What could we do differently? Is there any reason that you feel this is not the right place for you? Do you know of anyone who would be a good fit for our organization? As your supervisor, how can I help you?

243 Stub Your Toe Conversation

244 244

245 ENGAGEMENT: The New Core Competency for Healthcare

246 You cannot enter any world for which you do not have the language. Ludwig Wittgenstein

247 It s All About Engagement Satisfaction Experience Engagement

248 What is Engagement? Not the same as satisfaction, nor happiness Emotionally invested in and focused on creating value for the organization, every day Giving discretionary effort; even when no one is watching

249 Competency by Proxy

250 Definition of an engaged patient Strive to be informed about health Are involved in healthcare decisions Participate in self-care Self-monitor and provide information Provide feedback on experience and outcomes Commit to long-term lifestyle changes Empowering patients (or, less restrictively, healthcare consumers) to take greater responsibility for their health. Requires partnership; making them feel valued.

251 How Engaged Are We?

252 Current State 252

253 Worldwide, only 13% of workers are engaged Source: Gallup s State of the Global Workplace Report, 2013

254 Only 30% of Americans are engaged in their job Source: Gallup s State of the Global Workplace Report, 2013

255 Only 34% of physicians are engaged in their work Source: Gallup s State of the American Workplace Report, 2013

256 How Engaged are Patients? 40% of deaths caused by modifiable behavioral issues People with chronic diseases take only 50% of prescribed doses 50% of patients do not follow referral advice 75% do not keep follow-up appointments Source: Parekh, A. K. (2011). Winning their trust. N Engl J Med, 364(24), e51.

257 Where Are We Heading? 257

258 What s it going to look like in a few years? Employees As unemployment drops, turnover is raging back Physicians The looming crisis ahead Patients Engaging with customers is the core competency of many new entrants

259 Why Does it Matter? 259

260 What engaged employees do...

261 Workarounds What engaged employees do Employees with low engagement are more likely to work around safety protocols Low Engagement High Engagement Source: Leadership, Rework, and Workarounds; Grant T. Savage, Ph.D.; University of Alabama at Birmingham, February 2011

262 What engaged physicians do... Improve health outcomes 30% increased chance a patient will stop smoking when a doctor advises a patient to quit Patients satisfied with their provider are more likely to adhere to treatment regimens for diabetes. Steward resources 51% more inpatient referrals 26% more productive $460,000 more annual patient revenue Sources: Fiore MC, Jaen CR, Baker TB, et al. Clinical practice guideline: treating tobacco use and dependence: 2008 update. Rockville, MD: Department of Health and Human Services, May 2008.; Gallup, 2014

263 Engaged Patients You can t fix the healthcare cost crisis without them. A few chronic disorders (e.g., diabetes and cardiovascular diseases) account for the majority of deaths and >75% of the nation s medical care costs These are largely preventable What are the big levers? Increasing physical activity Controlling weight Quitting smoking Source: U.S. Dept. of Health and Human Services, Prevention Makes Common Cents, 2003

264 Engaged Patients Accountable care requires me to be accountable. The average visit lasts 20 minutes The average patient sees a doctor 3x/year That s 1 hour/year with the doctor What about the other 8,674 hours?

265 Actively Engaged Patients Have Lower Costs $1,000 Predicted per capita billed costs ($) $950 $900 $850 $800 $750 $700 Level 1 (lowest) Level 2 Level 3 Level 4 (highest) J. H. Hibbard, J. Greene, and V. Overton, "Patients with Lower Activation Associated with Higher Costs; Delivery Systems Should Know Their Patients' 'Scores,'" Health Affairs, Feb (2):

266 Actively Engaged Patients Have Better Outcomes J. H. Hibbard, J. Greene, and V. Overton, "Patients with Lower Activation Associated with Higher Costs; Delivery Systems Should Know Their Patients' 'Scores,'" Health Affairs, Feb (2):

267 How Wide Is Your Moat? 267

268 Pick One Operational Excellence Low price Low hassle Product Leadership Best product Worth it Customer Intimacy What customers want Treacy, M., & Wiersema, F. D. (1995). The discipline of market leaders: Choose your customers, narrow your focus, dominate your market. Reading, Mass: Addison-Wesley Pub. Co. 268

269 269

270 270

271 271

272 272

273 Questions to ask: How would an Uber-like entrant disrupt you? How can you beat them at their own game, and offer patients wildly more convenient care at a lower cost? What are the operational aspects you ll need to transform? 273

274 Operational Excellence Low price Low hassle Product Leadership Best product Worth it Customer Intimacy What customers want Treacy, M., & Wiersema, F. D. (1995). The discipline of market leaders: Choose your customers, narrow your focus, dominate your market. Reading, Mass: Addison-Wesley Pub. Co. 274

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276 276

277 277

278 278

279 Questions to ask: What else do you need to know about your patients? How will you get that information? How will you use it? 279

280 How Wide is your Moat? 280

281 How Wide Is Your Bridge? 281

282 The Engagement Model

283 The Engagement Waterfall

284 SENIOR LEADERS: Mission, Vision, Values, Standards Compensation & Benefits You can t change anyone SUPERVISORS: Communication Setting expectations Giving feedback Development Positivity & personal connection 284

285 EMPLOYEES: Purposeful, worthwhile work Feeling valued & involved Relationship with supervisor Opportunities Own your own engagement 285

286 Key Tactics Employees Patients Clinicians Rounding with Employees Employee Thank You Notes Peer Interviewing 30 and 90 Day Meetings (Input) Employee Attitude Survey Employee Forums Bright Ideas Standards Leader Rounding on Patients Post Stay/Visit Calls Purposeful Rounding Individualized Patient Care Bedside Shift Report AIDET Pre Visit Calls Involve Clinicians in Goal Setting and Skill Building Round on Clinicians Focus, Fix and Follow-up AIDET

287 CLINICIANS: What Drives their Engagement? Quality Efficiency Input Appreciation Open, honest communications Relationships with patients 287

288 CLINICIANS: Impact on Patient Engagement? Build trust through expertise & empathy Individualize the care Empower & partner with patients & families Celebrate progress together 288

289 PATIENTS & FAMILIES: Strive to be informed about health Are involved in healthcare decisions Participate in self-care Self-monitor and provide information Provide feedback on experience and outcomes Commit to long-term lifestyle changes 289

290 The Engagement Model

291 How can we foster engagement? Shift the discussion from satisfaction to engagement Trust precedes engagement AIDET plus the Promise Bedside Shift Report/ Individualized Patient Care Hourly Rounding Sit vs. Stand Teachbacks / M in the Box Post-visit calls Active listening Master The 3 Why s

292 Listening Exercise One partner tells the other about his/her weekend. The other partner cannot say anything... but must indicate by what they do, expressions, etc. that this information is FASCINATING. Talker: How did that feel? Switch. Other partner tells the other about his/her weekend. The listening partner cannot say anything,... but must indicate by what they do, expressions, etc. that this information is INCREDIBLY BORING.

293 Debrief The way you listen will impact what people tell you Talker: How did that feel? Stopped talking? Embellished? Which of these would you like your patients/ colleagues to do?

294 The 3 Why s Satisfies: Sample Size Communication Channel Head Rational side 300+ Data Heart Emotional side 1 Stories WIFM Personal needs Just me Direct

295 Example: AIDET A I D E T Acknowledge Introduce Duration Explanation Thank You

296 The 3 Why s Satisfies: Sample Size Communication Channel Head Rational side Large Data Heart Emotional side 1 Stories WIFM Personal needs Just me Direct

297 Improvement in Patient Perception of Care Following Implementation of AIDET "Nurses Always Communicated Well" AIDET Implemented After 1 Quarter 0 0 After 2 Quarters After 3 Quarters After 4 Quarters After 5 Quarters After 6 Quarters Average Increase in Percentile Points among Partners Implementing AIDET National Average Percentile Point Improvement After 7 Quarters After 8 Quarters n=16 hospitals Source: HCAHPS: Hospital Compare Database, April 2011

298 The 3 Why s Satisfies: Sample Size Communication Channel Head Rational side 300+ Data Heart Emotional side 1 Stories WIFM Personal needs Just me Direct

299 The 3 Why s Satisfies: Sample Size Communication Channel Head Rational side 300+ Data Heart Emotional side 1 Stories WIFM Personal needs Just me Direct

300 I find that when I do AIDET, Patients are nicer And more engaged...

301 Craig Deao, MHA Senior Leader & National Speaker