quality embracing excellence

Janice Crenshaw, RN, MSNDirector of Quality Improvement

“Quality in a service is not what the supplier puts in. It is what the customer gets out and is willing to pay for. A service is not ‘quality’ because it is hard to do

or costs a lot of money, as providers typically believe. Customers pay only for what is of use to

them and gives them value. Nothing else constitutes quality.”

Peter DruckerManagement Theorist, Researcher and Consultant (1909 - 2005)

What is Quality?

Lakeside Memorial Hospital in Brooklyn, NY Earl K. Long Medical Center in Baton Rouge,

Louisiana Calhoun Hospital in Arlington, Ga. Renaissance Hospital in Terrell, Texas shut

down due to patient safety failures. Lee Memorial Regional Medical Center, in

Pennington Gap, Va. closed partly due to reimbursement cuts under the Patient Protection Affordable Care Act

Understand some of the challenges now facing healthcare & how it impacts the bottom line

Identify ways to address these challenges Learn how to communicate more effectively

to improve the patient experience Learn how to create a culture of

accountability that embraces excellence

PRO

CED

UR

ES

MISSION

PERFORMANCE STANDARDS

HER

OES

POLICIES

INFORMAL COMMUNICATION

ASSUMPTIONS

NORMS

EMO

TIONS FEELINGS

PREJUDICES

We exist first and foremost for those we serve. We exist to continue the healing ministry of St.

Francis of Assisi by providing care grounded in the ethical and philosophical beliefs of the church

We foster empowerment, respect and development of all employees

Denial Rationalization Blame “We/They” Unwillingness Not Skilled Lack of Accountability

The Best Co-Worker characteristics

The Worst Co-Worker characteristics

The day to day communication between supervisory managers and direct reports has more impact than any other single factor on employee productivity, quality, morale, and retention.

Bruce Tulgan, CEO RainmakerThinking Harvard Management Update, Mar 2003

A national study of 1,700 nurses, physicians, clinical staff, and administrators concluded that it is “common” for providers to say nothing when they observe “troubling” performance by colleagues.

62% of nurses see coworkers taking shortcuts that may endanger patient care, and 48% of nurses believe coworkers show poor clinical judgment; however, fewer than 10% of nurses, physicians, and other clinicians directly confront colleagues about performance concerns.

Silence Kills: The Seven Crucial Conversations for Healthcare, 2005, AACN and VitalSmarts

Procrastination

“Don’t have time” “Nothing can be done differently with

these types of patients” “We don’t need to” “We already are” We/they

More focus on staff retention & reward/recognition (i.e. employee rounding)

Service excellence departments Organizational Standards of Behavior Service excellence training for all staff More Senior Leadership transparency Higher levels of leader accountability Annual raises based on department

performance

Perception

=

Money!!!!!!!

Anger Unreasonable expectations Poor relationships with staff and physicians Perceptions that patient complaints are not taken

seriously Desire for substantial monetary settlement Perception that their actions are improving the

Healthcare system and positively influencing future patient care

In 2013 LA based Pacific Health Corp. closed all four of its hospitals in California – after the for-profit chain ran into Millions of dollars in law suits and legal fines.

Becker’s Hospital Review 2013

In 2011 Los Angeles, a team of attorneys that sued a Santa Barbara nursing home eventually uncovered five different versions of their client's chart. "Instead of providing the care, they're creating records – creating an illusion that care was there," said Michael Connors, a long-term care advocate for San Francisco-based CANHRR

Read more here: http://www.sacbee.com/news/investigations/article2573412.html#storylink=cpychart

The first step in taking ownership is looking in the

mirror and asking,

“How am I

contributing to the perception of

our work culture?”

Accountability A Paycheck

=

A clinician may conduct as many as 150,000 patient interviews during a typical career. If

viewed as a healthcare procedure, the patient interview is the most commonly used procedure that the clinician will employ. Yet communication

training for clinicians and other healthcare professionals historically has received far less attention throughout the training process than

have other clinical tasks

Institute for Healthcare Communication, July 2011

Smile and show passion

“Patients should never have to dig thru our biases, or be forced to misinterpret the presentation of care , trying to find our

passion”

The Heart & Soul of Rounding 2011 © Janice Crenshaw

Key words with passion = results Touch the heart and engage the

soul

Heart to Heart

ompassion

HH Hello, Greet & Hello, Greet & acknowledge acknowledge

EE Explanation, Explanation, explain explain reason for interaction, any reason for interaction, any test, procedures and test, procedures and durationduration

AA Assess the patient or Assess the patient or the situationthe situation

RR Respect the patient, Respect the patient, recognize familyrecognize family

TT Time you will return, Time you will return, Thank YouThank You

A Framework

for effectiveCommunication

Managers communicate clear expectations Hold staff and co-workers accountable to

behavior standards Focus on a behavior standard each month with

facility/department activities Role play in staff meetings Reward/recognize & manage up high performers Reward /recognize unit with highest patient

satisfaction results

Thank YouJanice Crenshaw, RN, MSNJanice Crenshaw, RN, MSN