Improving patient satisfaction scores is a challenge that almost all healthcare facilities face.
That challenge is made all the more frustrating since, by and large, hospital leaders actually know what is needed to improve their HCAHPS numbers.
Since the early 2000s, assessment and consulting groups like Studer Consulting and Press Ganey Analytics have published their findings on the critical behaviors for hospital staff that predictably improve patient satisfaction scores. In our experience working with dozens of hospitals, not only are hospital administrators keenly aware of these behaviors, but their managers, staff and clinicians are as well. This raises an obvious question: If they know what to do, why are they struggling to do it?
There are two natural human tendencies that contribute greatly to hospitals (and many other organizations) falling into the gap between knowing something and actually doing it: The tendency to choose the urgent over the important and the tendency to give themselves more credit for improvements than is deserved.
The first tendency—to default to urgent activities over important activities—has a powerful influence on human behavior in most circumstances, but is particularly compelling given the “Code Red” atmosphere prevalent in the hospital environment. We get addicted to urgent activities; it may even be driven by our body chemistry. The challenge is that the new behaviors necessary to drive patent satisfaction never feel as of the moment. The barrage of activities and procedures necessary to run a hospital—charting requirements, unopened email, and a call light from room 304—all feel urgent. Taking the time to ask the patient one more thoughtful question before leaving the room does not.
The second tendency—of giving ourselves too much credit—is influenced by “confirmation bias,” when we seek and filter information and experiences to uphold our beliefs. In this case, we are bound to find evidence to support that we are doing these behaviors far more often than we actually are.
Most of us have experienced this personally when trying to diet or exercise to lose weight. It’s that frustrating moment of standing on a bathroom scale and thinking, “I said no to desert all week and I know I exercised at least three times, why haven’t I lost any weight?” The truth is, despite our recollection, we didn’t diet or exercise as well as we needed to move the scales.
Four Disciplines Of Execution
There are four disciplines that can break the “knowing-doing” gap by allowing caregivers the ability to consistently execute on important new behaviors in the face of the whirlwind of urgent tasks.
1. Focus on the Wildly Important
This involves moving from the general idea of improving patient experience to a specific metric that can be driven at the team level. The first step is defining specific Wildly Important Goals (WIGs), each with a starting line, a finish line, and a deadline. The goal structure should be “We will go from x to y, by when.” Caregivers must know what the goals are, how they apply to their job, and the deadline for achievement. While the facility should have a primary, overarching WIG—improve HCAHPS from 55% to 75% by end of year, for instance—each team or department should have a more narrowly defined WIG with its own timeframe.
2. Act on Lead Measures
This discipline focuses on identifying lead measures: those activities that predictably influence achievement of the goal, then measuring the results of implementing those lead measures. The team closest to the work should have the most say in choosing a measure that will make the most difference. It’s where those who are doing the actual work get to make the ‘big bet.’
For example, if the lag measure or goal, is to improve communication with patients, caregivers may decide to choose a lead measure that they will always ask patients if they have any questions before leaving the room. When this strategy was used by nurses at a regional hospital in Atlanta, they saw improvement in their HCAHPS score for the survey question: “nurses listen carefully to you.” However, when one nursing unit added just three more words—“I have time”—they saw their scores go up even more. When yet another unit added the behavior of “sitting on the edge of the bed” while asking the question, the scores went up by over 10 points.
When these teams see their bet paying off, they are playing a game they can win. It’s exciting stuff that can rise above the urgent whirlwind of activity around them.
3. Keep a Compelling Scoreboard
It is not enough for caregivers to know in some general sense that they are making progress toward the wildly important goal. They must see progress. People play differently when they are keeping score. In the case of “Improving Communication with Patients” the scoreboard was designed and built by the nurses to track their progress towards both the lead and lag measures. Keeping it simple and visible will provide the sense of focus (and urgency).
4. Create a Cadence of Accountability
Accountability is achieved by holding a short (20 minutes) weekly meeting where caregivers meet and report on weekly commitments aimed at driving the scoreboard. These WIG sessions create a sense of accountability that drives execution on the WIG.
These disciplines have the primary benefit of moving those stubborn patient satisfaction scores. But there is another by-product as well. When hospital staff see they are making a difference, there’s always a corresponding and dramatic jump in staff morale and engagement, too. Nothing like seeing that “big bet” pay off.
Chris McChesney is the Global Practice Leader of Execution for Franklin Covey.