achieving service excellence though relationships conference/ho... · learning objectives 1....
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Achieving Service Excellence though Relationships
Texas Council of Community Centers Annual Conference
June 1, 2012
Learning Objectives
1. Describe key partners and stakeholders in developing a culture that supports service excellence in the delivery of health care.
2. Discuss at least two strategies for assessing the needs of key customer groups such as patients, physicians, and payers to support quality improvement efforts.
3. Summarize the attributes of a relationship-centered organizational culture that supports service excellence in health care.
Disclosure to ParticipantsRequirements for Successful Completion of Continuing Education Activity Requires:1. Completing the registration form,2. Signing the “Sign – in” Sheet,3. Attending the entire educational activity,4. Participating in education activities instructed, and5. Completing the participant evaluation.
Commercial Support:This educational activity received no commercial support
Disclosure of Conflict of Interest:Planning committee members/speakers/authors for this session have disclosed the following financial interest(s) for this continuing education activity:
Non-Endorsement Statement:Accredited status does not imply endorsement by Department of State Health Services, Continuing Education Service Program of America Nurses Credentialing Center of any commercial products displayed in conjunction with this activity.
Off-Label UseThe speakers did not disclose the use of products for a purpose other than what it had been approved for by the Food and Drug Administration
Expiration Date for Awarding Contact Hours:Complete the attendance sheet and evaluation by the end of the conference.
Planning Committee/ Author Name of Commercial interest Nature of the RelationshipBeth Guyton Interactive Quality Owner/Consultant
What is Organizational Culture
What is Organizational Culture?The values and behaviors that contribute to
the unique social and psychological environment of an organization.
Organizational culture is the sum total of an organization’s past and current
assumptions, experiences, philosophy, and values that hold it together, and is expressed in its self-image, inner
workings, interactions with the outside world, and future expectations.
What is Organizational Culture
It is based on shared attitudes, beliefs, customs, expressed or implied contracts, and written and unwritten rules that the organization develops over time and that
have worked well enough to be considered valid.
Organizational Culture Manifests in 1) The ways the organization conducts its
business, treats its employees, customers, and the wider community
2) The extent to which autonomy and freedom is allowed in decision making, developing new ideas , and personal expression
3) How power and information flow through its hierarchy
4) The strength of employee commitment towards collective objectives.
What is Organizational Culture
It affects the organization's
productivity and performance.
It is termed strong or weak to the extent it is diffused through the
organization.
What is Organizational Culture
It provides guidelines on
customer care and service;
product quality and safety;
attendance and punctuality; and
concern for the environment.
What is Organizational Culture
It is one of the hardest things to
change.
Your Turn
What influences culture?
Give some examples of how culture influences employee behaviors,
processes, practices, or services?
How can an organization’s culture affect the patient?
Why Culture Matters?
It matters because it determines patient outcomes, employee commitment,
and business success.
What is Culture?
The way we do things around here - that really impacts our ability to provide quality care,
engage our staff and deliver business results.
“Culture eats strategy for breakfast everyday.” Peter Drucker
Service Excellence and the Customer Perspective
What is your organization’s perspective of the customer?
So….. Who is the Customer?
Who is the Customer?
The obvious customer is the patient…..and the
family
What is Patient/Family –Centered Care?
What is Patient-Centered Care?
Balint described it as “understanding the patient as a unique human being.”
IOM identified six aims of improvement for the U.S.
healthcare system by asserting that care must be:
safe, effective, patient-centered,
timely, efficient and equitable.
In 2008 Marjorie Wiggins described “Patient-centered”
as “…a new mental model that acknowledges the
patient’s expertise and ability to be a full participant in
care.”
Raise your hand if you can agree with these basic ideas.
What is Patient-Centered Care?A definition of patient centered care advanced by the Institute for Health Care
Improvement (IHI) includes …
consideration of “patients’ cultural traditions, their personal preferences and values, their family situations, and their lifestyles. It makes the patient and their loved ones an integral part of the care team who collaborate with health care professionals in making clinical decisions… [and] ensures that transitions between providers, departments, and
health care settings are respectful, coordinated, and efficient. When care is patient centered, unneeded and unwanted services can be reduced.”
Core Concepts of Patient/Family-Centered Care
Dignity and Respect: listen to and honor patient and family perspectives and choices. Patient and family knowledge, values, beliefs, and cultural backgrounds are incorporated into the planning and delivery of care.Information Sharing: communicate and share complete and unbiased information with patients and families in ways that are affirming and useful. Patients and families receive timely, complete, and accurate information in order to effectively participate in care and decision making.Participation: Patients and families are encouraged and supported in participating in care and decision making at any level they choose.Collaboration: Patients and families are also included on an institution-wide basis. Health care leaders collaborate with patients and families in policy and program development, implementation, and evaluation; in health care facility design; and in professional education, as well as in the delivery of care.(Institute of Patient-and Family-Centered Care 2004)
What is Patient-Centered Care?In 2009 Berwick described “patient-centered” as:
“ The experience (to the extent the informed, individual patient desires it) of transparency, individualization, recognition, respect, dignity, and choice in all matters, without exception, related to one’s person, circumstances, and relationship in healthcare.”
What is the ECHO Survey?The Experience of Care and Health
Outcomes (ECHO) Survey asks health plan enrollees about their experiences with
behavioral health care and services provided by either managed behavioral
healthcare organizations or
managed care organizations.
To be notified when the updated surveys and instructions are available, please subscribe for e-mail updates from CAHPS (https://public.govdelivery.com/accounts/USAHRQ/subscriber/new?) and select "ECHO Survey" under the CAHPS heading.
BACK ON TRACK
Who are the “Other” Customers?
• Payers
• Employees
• Co-workers
• Leadership
What are their needs?
Identifying Customer’s Needs
1. Focus Groups2. Surveys3. Patient Response Cards4. Post-discharge Calls5. Complaints6. Patient and Family
Advisory Groups
Focus Groups• Gather a collective point of view from
several customers at the same time
• Test a hypothesis concerning customer needs
• Solicit feedback on a number of topics
Challenges• Time consuming • Moderator can induce biases• Strong personalities can dominate
outcomes
Complaints• Offer Concurrent Data
• Ability to Have an Impact While Patient is in Your Care.
• Highly Actionable
Do your culture and systems support timely and accurate collection of complaints?
Surveys, Response Cards and Discharge Calls
• Offer Timely Information
• Focused Inquiry
• Can Support Complaint Reporting
Discharge Calls • Ability to Have an Impact on
Patient’s Recovery and Health • Enhances Satisfaction
Patient and Family Advisory Groups
• Excellent way to bring in Patient and Family Perspective
• Build Relationships and Loyalty
• Enhance Processes
• Ensure Roles are Well Defined• Orient both Volunteers and Staff• Have Clear Expectations• Carefully Select Projects for Quick Wins
Relationships that Impact Service Excellence
Caregiver to Patient and Family Care Team Member to Care Team
Member Leaders to Staff and Staff to
Leaders Organization to Payer
Caregiver to Patient and FamilyCommunication is the Driver of Exceptional Experiences• Define Expectations and Needs• Communicate Care Plans and Activities• Communicate Collaboration and
Coordination Across Settings• Ask for Feedback• Acknowledge Mistakes and Actively
Address Complaints
Organizational Culture’s Role
Attributes of a Relationship-Centered Organizational Culture
Trust
Mutual Respect
Mindfulness
Heedful Interrelating
Collective Mind
All of the Pieces Fit Together
Just Culture
TeamworkCollaboration
Leadership and Frontline Wisdom
Effective Communication
Outcomes Satisfaction Engagement
Social Trust
• Trusting that co-workers are competent and will do a good job
• Trusting each other to get the job done
• A willingness to take ownership of problems and work together with others collaboratively
Psychological Safety
• Feeling empowered to speak up and share ideas with other clinicians
• Being comfortable giving “safe constructive criticism” in order to make needed changes to improve patient care
• Having a learning attitude –mistakes and errors are seen as a teaching tool
• Being comfortable reporting errors and mistakes
Mutual Respect Creates …• Equal opportunity, empowerment, and an
environment that allows all to contribute • Confidence in individual’s ability to rely on
one another to achieve a common goal• The need to listen to one another and
value the unique contributions of other clinicians
• A sense that personal efforts and contributions are acknowledged and appreciated by colleagues
Linking Mutual Respect to Service Excellence
• Mutual respect establishes an open line of communication which translates into better patient care
• Having respect for your colleagues and respect for their abilities, makes it easy to interact with them effectively to meet patient needs
• Mutual respect enhances teamwork• Mutual respect gives each caregiver a sense of
ownership and the reward of being a contributor
• It builds team identity and team esteem
Mindfulness“Mindfulness is a flexible state of mind in which we are
actively engaged in the present, noticing new things and
sensitive to context.” (Langer, 1998)
“Mindfulness means paying attention in a particular way;
On purpose, in the present moment, and non-judgmentally.” (Kabat-Zinn, 2006)
“Mindfulness refers to organizational and employee awareness of self and others, of relationships, and of what is happening elsewhere in the organization, along with openness to new ideas and different perspectives .” (Safran, et.al., 2006)
Heedful Interrelating
• Acting with care, consistency, and purpose in a conscientious manner with each other in their contributions, representations, and subordinations to the common goal.
• Caring about how one represents his or her actions as contributions within an interdependent system.
• Highly dependent on effective social interaction.
(Weick and Roberts 1993)
Purpose
Collective Mind• The sum of the contributions all
members of a group make to a complex practice or operation
• Aggregate mental processes within complex organizations
(Weick and Roberts 1993)
Contributing Factors
• Effective Communication Strategies
• Diversity
• Supportive Interactions
Effective Communication Strategies
• Leadership’s Dissemination of Vision, Mission and Values
• Rich and Lean Communication• Consistency• One Message• Multiple Methods• Multiple Messengers• Messaging Cascade at the end of meetings
• Cultural and Ethnic Backgrounds
• Approaches
• Problem Solving
• Areas of Expertise
• Work Experiences
Diversity
Encourage Supportive Interactions to Decrease Burnout
Burnout is related to persistent interpersonal stressors on the job.
(Maslach, 1982)
Factors:1.Emotional Exhaustion 2.Depersonalization Related to the Work
Environment3.A sense of Diminishing Personal
Accomplishment (Maslach & Jackson, 1982, 1986)
Consequences of Burnout
1. Increased Turnover
2. Absenteeism
3. Lower Productivity
4. May Negatively Affect the Recipient of the Service
(Scott, 2001)
Supportive InteractionsSocial support is defined as "information that leads individuals to believe that they are cared for and loved, esteemed, and valued and that they participate in a network of communication and mutual obligation" (Cobb, 1976).
Categories of Social Support1. Listening2. Technical Support3. Technical Challenge4. Emotional Support5. Emotional Challenge6. Sharing Social RealityPines and Aronson (1988)
Creating an Ideal Workplace• Participative Decision Making• Openness and Candor in
Message sending and receivingRedding (1972)
Recommendations for Supportive Interactions
1. Consciously clarify and adjust to the expectations of others
2. Focus on the positive aspects in work life
3. Build strong social networks to mediate work place stressors
Farber (2000)
Leadership’s Role
• Modeling Behaviors• Alignment• Vision, Mission, Values• Performance Management• Engagement• Effective Communication
Modeling Behaviors
“Example is not the most important part of leadership – it is
the only part”. Albert Schweitzer
Importance of Reflection and Learning
Leadership must support a Just Culture where reporting is encouraged and every mistake or error is seen as an
valuable learning opportunity.
“I don't know what your destiny will be, but one thing I
know: the only ones among you who will be really happy
are those who will have sought and found how to
serve.” Albert Schweitzer
The Reward
Key Partners and Stakeholders1. All members of the care team2. Patients and Family3. Leaders4. Payers
Strategies for Assessing Stakeholder’s Needs1. Focus Groups2. Surveys3. Patient Response Cards4. Post Discharge Calls5. Complaint Data6. Patient and Family
Advisory Committee
Attributes of Relationship-Centered Organizational Culture1. Trust2. Mutual Respect3. Mindfulness4. Heedful Interrelating5. Collective MindSupported by Diversity, Supportive Interactions, Reflective Learning and Effective Communication
Summary
