Using Student Interns to Improve the Patient Experience

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Using Student Interns to Improve the Patient Experience

At Studer Group®, we work to harvest, distill and disseminate best practices learned from organizations across the United States, Canada, Australia and beyond. One of the ways we share information is at our national What’s Right in Health Care® conference each year. We invite high-performing organizations coached by Studer Group to present and share the tools and best practices that are helping their organization achieve outstanding results. In 2013, Steven R. Smoot, Regional Vice President, Urban South Region, Intermountain Healthcare, presented at What’s Right in Health Care® and shared how the organization utilizes student interns and the benefits that both the students and the organization have recognized. We received such an overwhelming response from individuals looking to learn more information on the topic, that we asked Todd Hendricks, Director, Patient Experience, to share Intermountain’s story. The content and resources in this whitepaper, available exclusively to organizations coached by Studer Group, are Todd’s words and Intermountain Healthcare – Utah Valley Regional Medical Center’s experiences with this program.

“The enthusiasm of the interns for the work is refreshing. They help us maintain focus on what really counts: our patients.” - Janet Hintze, Ortho/Neuro Manager, Utah Valley Regional Medical Center

Students who intern at a hospital develop valuable skillsets working with clinical and nonclinical team members. They gain exposure to facility operations, leadership decisions, financial analysis, and mentoring networks. In turn, interns can accelerate the hospital’s efforts to improve patients’ experience. By working on projects like validating staff on AIDET® and the 8 Behaviors of Hourly Rounding®; performing their own rounds on patients; conducting skills labs; and working on target projects, student interns add energy and much-needed support to patient experience initiatives. During 2013, it was my privilege to work with 42 interns at Intermountain Healthcare - Utah Valley Regional Medical Center. They volunteered around 6,800 hours (more than 3 FTEs!), and they paid around $1,000 each (including immunizations, drug test, background test and university tuition) to participate. These committed students have contributed significantly to the patient experience. Our intern program began almost by accident. Brigham Young University student Brett LeFevre, in his role as the vice president of the student Healthcare Management Association, inquired about the possibility of students interning at the hospital. I agreed to give his idea a try.

Fortunately, we had started our journey with remarkable Studer Group coach Terre Short and talented account manager Tonia Breckenridge, who each gave great input into designing a program using the Evidence-Based LeadershipSM model. Terre and Tonia suggested a framework in which interns would contribute to aligned goals and aligned behavior to ensure aligned processes. Tonia shared another valuable component: part of my own employee evaluation would include the interns’ evaluation of their experience.

Evidence-Based LeadershipSM Aligned Goals

Objective Evaluation System

Leader Development

Aligned Behavior

Must Haves®

Performance Management

Foundational

Aligned Process

Standardization

Accelerators

Breakthrough

Aligned Goals

Aligned Behavior

Aligned Process

• Expectations & outcomes clearly articulated

• AIDET® & Key Words at Key Times

• Intern accountability log

• Rounding for Outcomes

• Behavior validation

• Behavioral standards • Skills labs & ongoing coaching

• Thank you notes

• Mandatory weekly training on operations, HCAHPS & traits of a great employee

A key factor in the success of the program was our engaged operations officer, Kyle Brostrom. Kyle advocated for the interns, ensuring their access to C-suite and frontline meetings and helping them gain broad exposure to hospital operations. From Kyle, interns learned about the rapid changes in healthcare delivery and the teamwork that makes Intermountain Healthcare a leader in high quality, low-cost care. You may already be thinking of some potential barriers or concerns about implementing this process at your organization. We’ve addressed some of the top concerns and possible solutions in this resource. This whitepaper is designed to help you successfully launch an ongoing, mutually beneficial internship program.

“A lot of hard work goes into training, validating, and hardwiring the habits that help an organization to always deliver safe, quality care. I learned that I can make a difference.” - Carson Ralphs, Winter, Summer, Fall Intern 2013

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STEP 1: IDENTIFYING AND RECRUITING INTERNS Many colleges and universities have pre-healthcare management clubs for students interested in pursuing advanced degrees or careers in hospital administration. These students have traditionally made up the bulk of our internship program, but students from all undergraduate majors and areas of graduate study are welcome to participate, as long as they (1) complete the appropriate paperwork through Intermountain University’s student programs manager, (2) pass a background check and drug test, (3) receive required immunizations, and (4) register for course credit through an accredited college or university program. Students bear all responsibility for the costs, which typically run around $1,000, including a portion of their semester’s tuition. We ask that students register for a minimum of three internship credits and plan to be on the hospital campus for at least 9 hours a week—two of those hours occurring Friday from 2 to 4 p.m. for a mandatory meeting. Given the requirements in time and money, students tend to self-select for our program. This means administrators spend little time interviewing or screening candidates. At present, our only prescreening occurs at a group lunch in the hospital cafeteria. Through conversation, I try to find interests that specific students share with specific unit managers. (For example, a manager who is passionate about tennis might be matched with an intern who is passionate about tennis). Often, good matching makes for better outcomes. Much of the intern recruiting occurs through students talking with other students about their positive interning experience. Appendix A contains information we emailed to students considering the internship. Appendix B includes additional information for students from our hospital’s manager of student programs, the talented Tiffany Myles-Mills. You may be wondering how many interns you should recruit. We recommend at least five; more if possible. Engaging many interns at once offers advantages for the hospital and for the interns, too.

BENEFITS TO INTERNS: In evaluations, interns say they appreciate the opportunity they’ve had to make friendships and network with peers. We advise them from the beginning that because healthcare administration is a relatively small field, they should consider their interactions with each other as interviews with potential coworkers. Interns frequently comment that even though everyone at the hospital is friendly, they appreciate knowing others who are experiencing a similar new experience. They also motivate and help each other toward excellence. BENEFITS TO THE HOSPITAL: Having a group of interns can help alleviate your training burden. It’s just as easy to train one person on AIDET® as it is 20 people. Then you can identify those who excel at certain skills (like rounding) and invite them to mentor and coach others. Interns help each other through the social transition and answer each other’s questions, freeing administrators to focus on training specific skills. Students who repeat the internship for a second (and third) semester can model appropriate behaviors and validate the skills of new interns.

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STEP 2: MANDATORY INTERN TRAINING Interns attend a mandatory four-hour training the second Friday of the semester. Each student receives a copy of Studer Group’s The HCAHPS Handbook, The Great Employee Handbook and a copy of the syllabus (see a sample syllabus in Appendix C.) The first hour covers expectations, then students rotate among three hour-long breakout sessions: Leader Rounding on Patients skills lab in a patient room, Living our Healing Commitments using AIDET®, and hospital and department orientation.

“My internship allowed me to see healthcare through a different lens. My understanding of the complexity, challenges, and disparities of the industry deepened, and my skills as a presenter, coach, and project leader improved. The experience served as a springboard for my new job as a physician consultant.” - Brian Adamson, Winter Intern, 2013 In the expectations section of the meeting we emphasize several key points for the students’ success. (This information was also emailed to them when they were considering the internship.) We discuss gaps between a student’s classroom education and the skills needed in the hospital workplace (see Appendix A). We emphasize that interns must work collaboratively with hospital employees, and that their internship ends if they damage a relationship in the hospital. Interns are told that they are never to coach frontline employees or infer to any hospital team member that “I’m going to be your boss someday.” Several PowerPoint slides highlight positive comments that leaders have said about interns; other slides list specific ways that interns can succeed. This positive information is posted in the intern room and positive feedback about intern behaviors occurs at the beginning of every Friday meeting. In the concurrent breakout sessions, interns practice rounding on patients; familiarize themselves with the facility, HIPPA, and code pink; and gain an in-depth knowledge of how the AIDET® framework supports our practice of Intermountain’s behavioral standards known as the Healing Commitments. Everything about our partnership with Studer Group is aligned with our Healing Commitments and is communicated that way to our team.

“Participating in how a hospital works from the patient perspective, the clinical perspective and the executive perspective was extremely valuable. I learned things I could not have learned by sitting in a class or reading a book.” - Brett Evans, Summer Intern, 2013

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HEALING COMMITMENTS I help you feel safe, welcome and at ease.

AIDET® Acknowledge Introduce

I keep you informed and involved. I ensure our team works with you. I take responsibility to help solve problems.

Duration Explanation

I listen to you with sensitivity and respond to your needs. I treat you with respect and compassion.

Thank

STEP 3: RESOURCING THE INTERN EXPERIENCE Hosting interns requires very few monetary resources. A copy-machine work room was revamped to include a cork board, a white board, two desktop computers, 8 chairs, and a long work counter we call “the intern bar.” A small refrigerator is stocked with leftover soft drinks and bottled water from meetings, which interns are welcome to drink. We do spend money on dinner and small gift for interns at the end of their internship. After creating individual log-ins, interns receive access to a shared intranet space and the Microsoft suite (Outlook email, Excel, Word, PowerPoint). They are not granted access to any other systems (patient or financial). The main resource required is time. During the second week, I round on patients with the new interns, one-on-one. Interns observe rounding, and then I observe them as they round. Once interns demonstrate rounding competencies and have memorized the Healing Commitments and AIDET®, I set up a meeting to introduce the intern to the floor manager. The manager rounds on patients with the intern and also validates that the intern is competent to round on patients. Every intern is assigned to a specific unit that has requested intern support. In the beginning, many departments declined intern help because of unfavorable experiences with students in the past. In maintaining department relationships, it’s critical that the manager and intern know the program expectations. Interns understand that it is unacceptable to vary hours (we encourage them to be consistent, be “always”) and emphasize that it’s never appropriate to cancel rounding appointments because of a test or review session.

STEP 4: THE DAILY INTERN EXPERIENCE The focus for each day is for the interns to answer and record a response to this question: What meaningful connection did I make with a patient, guest or team member?

Access an example of interns’ assigned areas, their schedules and their projects. Some of the intern projects include implementing post-visit calls, caregiver call light audits, AIDET® projects and so on. (Access a list of some intern projects and the skillset interns develop.)

In terms of work flow, intern priority is always to help their assigned unit first, and then work on an additional project. One of the benefits of student schedules is that many interns are available on weekends and nights to help with night audits, round in the ED, and so on. As they enter the hospital, interns typically come to the intern room, leave their backpacks and coats, and head to work in the unit. Male interns wear dress shirts with ties and name badges; female interns wear professional dress (recommended flat shoes versus heels) and name badges. We’ve found it works best for managers to introduce interns to the caregiver team, explain the why of the intern, and have the intern always report in and report out to the manager or charge nurse.

“Bryce has been a phenomenal intern on the telemetry floor. He is very service oriented and creates a positive environment. After rounding on patients, he shares the positive patient comments with the nurses. They feel good and want to do even better.” - Maria Black, Nurse Clinical Operations Director, Utah Valley Regional Medical Center

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Sometimes managers request that the intern shadow staff and assess compliance with AIDET®. Sometimes managers have interns round on patients, particularly when managers have a day full of meetings. (Interns are not granted badge access to lockdown units, such as Mom-Baby or pediatrics, so their arrival must be coordinated through the manager on these floors.) Interns are expected to always deliver positive information to frontline employees and focus on what’s working well with the team. They are never permitted to provide coaching to frontline employees unless explicitly granted permission from the manager. Any concerning information about a team member’s behavior is immediately brought to the attention of the manager or director. Interns are instructed there is a difference between passing along information and coaching. For example, it’s entirely appropriate if a patient is in pain for the intern to contact the nurse and share, “I told the patient I would contact you and let you know she’s in pain and that you’d be in to follow up.” It’s not appropriate for the intern to say, “You know best practice is to hourly round and be proactive about pain, potty and position. The patient communication board is not updated and your standard of care is questionable. Please address these immediately.” At the end of each intern shift, interns update the Intern Accountability Log on the shared intranet. In this Excel spreadsheet, interns input the hours they worked, key learning and experiences, how many pieces of garbage they picked up, and most important, what meaningful connection they made with a patient, guest or team member. (Interns never record patient information, such as name, room number, or diagnosis.) On a weekly basis, interns write one handwritten thank-you note to a team member and record to whom they sent it in the Intern Accountability Log. Interns address the cards using the first and last name of the team member, then they deliver the cards to the administrative assistant, who locates the address and mails them out.

Date

Activity

Skills I learned or developed

Meaningful connection with a patient, guest or employee

Pieces of garbage picked up

Hours

Sept. 30

Rounded on 15 patients, met more 7th floor staff, worked on intern project

Listen. All people want to be listened to. Many patients asked me to stay and visit for a while.

I visited with a patient who didn’t complain about his health but just wanted to share funny stories about his stay. When I started leaving, he cried and thanked me for the visit. I didn’t do anything except listen. He made my day better.

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Oct. 1

Tuesday Hospital Huddle, training from Studer Coach Terre Short, patient rounding

Leadership. Meeting with Terre Short was awesome! I learned about the Evidence-Based Leadership Chart. She discussed the importance of working as a team and all working to achieve goals.

While rounding a patient said, “Whatever your manager is doing, tell him to keep it up, because this is the best floor of any hospital I have ever been to!”

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3.5

Several times during the 16-week semester, interns attend hospital-wide huddles, C-suite leadership meetings, director meetings, manager meetings, staff meetings, clinical manager meetings, or 1:1 meetings following the monthly meeting model. Administrative assistants post a calendar of meetings with dates and locations. If there are no space constraints, everyone is welcome to attend. When seats are limited, interns sign up to attend.

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STEP 5: ASSESSING THE INTERNS’ ONGOING EXPERIENCE In directing the interns, we use all of the behaviors and processes in the Evidence-Based LeadershipSM model. I round on interns and communicate on a stoplight report what I learn, and each Friday I conduct an intern huddle where there is typically a lot of positive feedback from managers. It is easy to assess how engaged an intern is when you ask the rounding questions of, “What’s working well?” and “Is there someone I can recognize for you?” You can determine if an intern is connecting the dots on the “What’s working well?” question by how they tie theory to best practice, to their own observations, and to patient care. If the intern can mention several team members for recognition (besides the manager of the unit), the intern is becoming part of the team. Often I send handwritten thank-you notes to the parents of interns, sharing with them the worthwhile work their daughter or son is doing and how it’s making a difference. (Parent mailing addresses can be collected during a weekly meeting.)

“The interns have had an extremely positive impact in the Emergency Department, helping to reinforce and validate principles such as hourly rounding, communication board completion, and AIDET®. The staff appreciate their presence and often eagerly seek out the interns to round on their patients.” - Kelly Smith, Emergency Department Assistant Manager, Utah Valley Regional Medical Center

STEP 6: THE WEEKLY MEETING Interns must attend a two-hour Friday meeting where everyone discusses what’s working well and each intern takes a turn leading a discussion from Studer Group’s The HCAHPS Handbook or The Great Employee Handbook. There is also an hour where a guest speaker discusses her or his role in the hospital. Each semester we usually have the CEO, CNO, CFO and operations officers present to the interns, along with a variety of other individuals. Presenters address topics such as the role of a quality or HIM department or how to work with clinical employees. This is a very casual discussion (no PowerPoints, no handouts) where interns take notes and ask questions based on what the leader shares. Appendix C, the sample syllabus, lists the readings, which intern will lead the discussion, and who will be the guest presenter.

STEP 7: INTERN EVALUATION AND GRADUATION Interns anonymously complete an evaluation of their experience, the program, and my practice of living the behavioral standards, known as our Healing Commitments. The results are tied to my own employee evaluation. The questions that are asked can be accessed here. The Friday before final exams is the last day of the internship. We celebrate with intern graduation. One intern plans the dinner and program highlighting the accomplishments and key learning from the experience, and he or she usually creates a fun slideshow about the experience, as well. I present each intern with a small gift of appreciation (bearing the Intermountain logo) and a handwritten note. Within a few weeks, we repeat these steps with the next semester’s incoming interns. In closing, we have found this process really works well for our organization and for the interns. While the interns are helping Intermountain Healthcare improve patient experience, we in turn can give the interns a meaningful internship experience. It’s a mutually beneficial partnership that makes a big impact.

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ABOUT THE AUTHOR: Todd Hendricks is Director, Patient Experience at Utah Valley Regional Medical Center, American Fork Hospital, and Orem Community Hospital, part of Intermountain Healthcare. He has been with Intermountain Healthcare since 2008 and has been in his role of Director, Patient Experience, since 2012. In 2013, he worked with 42 interns through Intermountain’s intern program and was kind enough to detail the inception of the intern program and its impact on patient experience at Utah Valley Regional Medical Center in this whitepaper.

ABOUT STUDER GROUP: Studer Group® works with healthcare organizations in the U.S. and beyond, teaching them how to achieve, sustain, and accelerate exceptional clinical, operational, and financial outcomes. As the metrics the industry publicly reports get expanded—and as reimbursement is increasingly tied to these results— organizations are forced to get progressively better at providing top-quality care with fewer dollars. Studer Group helps partners install an execution framework called Evidence-Based LeadershipSM (EBL) that aligns their goals, actions, and processes. This commitment to helping organizations accelerate their ability to execute led to Studer Group’s receiving the 2010 Malcolm Baldrige National Quality Award. To learn more about Studer Group, please visit www.studergroup.com.

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