Barbara Balik, RN, EdD Volume 8, April 2012
Patient and Family Experience Putting the Puzzle Together: Lessons from the Field Part 2 Lessons from the Field – Part 1 highlighted learnings from organizations in the U.S and Canada as they strive for more person-centered care and improved patient experience. The lessons were: 1: The puzzle pieces have to fit together 2: Adding more tactics does not get results 3: Partnerships – know where are you in the journey Additional lessons in this Lantern include: Lesson 4: Use the Driver Diagram for Assessment Numerous colleagues shared that they have used the IHI Patient Experience White Paper driver diagram to engage colleagues in conversations about where the organization is in achieving great patient/family experiences. Using a 1-5 scale on each of the primary and secondary drivers, building on strengths, and determining where to go next have aided their work. The driver diagram illustrates that patient experience is about the wholeness of transforming care, not one aspect. Team members can better see how their work contributes to the entire experience rather than just the view represented in the HCHAPS survey. Balik B, Conway J, Zipperer L, Watson J. The Patient and Family Experience. IHI Innovation Series white paper. Cambridge, Massachusetts: Institute for Healthcare Improvement; 2011.
Lesson 5: Sequence matters The downside of the Driver Diagram is that it covers all aspects of care. The question emerges – where to start? Foundational elements that help accelerate gains in the whole care experience are: Leadership Behaviors, Patient/Family Partners, and Effective Infrastructure. Executive Leadership Behaviors: • Demonstrate the purpose – engage others by describing and role modeling the purpose of Patient/Family-Centered Care and Patient/Family Experience for everyone in the organization – What and Why. • It is everybody – assure that all leaders are clear and consistent in words and actions about the Purpose. • Connect the dots – between Patient and Family experience and other strategies – safety, quality, staff/provider engagement, and financial vitality. • Spend time close to the work – understand firsthand the organization’s systems – both the barriers and assets; identify and learn from the positive deviants – those in the organization who excel while others struggle. • Develop leaders – especially Performance Improvement and coaching skills. Patient/Family Partners • Family presence – long espoused by the Institute for Patient-and Family-Centered Care , replace arbitrary visiting hours with family presence where family is defined by the patient. • Skilled patient/family partners involved in experience improvement – Advisors who share their story, aid in the design and improvement of care, and orient staff and providers contribute to rapid changes in entrenched care patterns that
limit partnerships with patients. • Health literacy = mutual understanding – healthcare professionals often overlook the barriers of health literacy in achieving mutual understanding. We cannot be effective partners if we do not understand each other. Competency in Teach Back is a highly effective first step in mutual understanding. Effective Infrastructure • Performance improvement system – for the whole organization; not only a small skilled team, but a system that assures all leaders and staff understand and practice rapid, small tests of change with improvement close to the work; team members who are able to effectively understand and use data, with run chart proficiency as a starting point. Perla et al
connected to patients thus continually improving the experience and are more likely to hold each other accountable for behaviors that create great care experiences. Key steps include recruiting, hiring, and evaluating for values; assuring effective, reliable systems (also a foundation for safe care); and having performance improvement resources close to the work.
Observe the journey - See the experience through the patients’ eyes – patients/families are the only ones who know the whole journey, the white spaces between clinicians and sites of care; by seeing the journey through their eyes using direct observation, process and emotional mapping, and learning touchpoints (from experience based design) we are able to understand care processes as they really happen, close gaps and reduce waste.
Lesson 6 illustrates that patient experience requires everybody’s involvement. HR leaders are essential in achieving engagement through their expertise and links to effective resources. A recent HRET publication provides valuable workforce practices. A wise colleague, Neil Baker, also has insights into effective leadership with challenging situations.
(2011), "The run chart: a simple analytical tool for learning from variation in healthcare processes", BMJ Qual Saf; 20; 4651
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Lesson 6: Engage the Hearts and Minds of staff and providers – Engaged team members are part of a virtuous, reinforcing cycle for patient and family experience. A focus on excellence in patient experience connects people to why they are in healthcare and reinforces the noble work they do; engaged team members are more
Kouzes and Posner, in their work Encouraging the Heart provide a superb guide. Their studies illustrate the following leadership engagement actions: • Set clear expectations • Expect the best • Pay attention • Personalize recognition • Tell the story • Celebrate together • Set the example
The Six Lessons I have highlighted have elements consistent with other studies of effective leadership which should give confidence to our actions. As we continue to learn together, new lessons will emerge! Please contact me with questions, challenges or additional lessons learned.
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