Have you ever noticed how the faster you go, the “behinder” you get? It’s really true that sometimes, we just need to slow down to actually catch up.

I have always loved Lewis Carroll’s stories Alice in Wonderland and Through The Looking Glass. It is probably because, even as a child, I could relate.   Life is crazy, hectic, and sometimes, doesn’t make a lot of sense. Of course, in real life there aren’t Cheshire Cats, Mad Hatters and evil Queens, but there are a lot of different personalities we interact with on a daily basis and sometimes you can see the resemblance.

It’s no wonder we feel like we’re always behind. Somewhere there is the expectation that we need to “keep up.” We try to do this by tethering ourselves to technology: cell phones; tablet computers in our purses and briefcases; email; Facebook; Twitter; Foursquare; Pinterest; yada yada…

Add meetings, projects, clients, bosses, family, friends, TV, music, news laundry, cooking, cleaning, holidays and celebrations, bills, exercise, to-do lists, children, caregiver responsibilities, car maintenance, gardening, religious responsibilities, vacations…(yes, at this point, even vacations become a chore). 

Notice that sleep wasn’t mentioned once in the above paragraph.
Just as a not-so-famous workout queen of the 80′s would say:  “STOP THE INSANITY!”

In order be most effective in our personal and work lives, it is important to stop and breathe once in awhile. After all, we can’t survive without breathing. Sometimes, we just have to be reminded. 

Breathe in. Breathe out. We can’t be all things to all people.  Rinse, and repeat.
And remember another of my favorite Louis Carroll quotes from Alice in Wonderland:

We measure excellence. That’s important. But sometimes we settle for items that are less than excellent in life. Take my morning coffee for example; it’s an important part of the day. Maybe I’m high maintenance, but I want it to be an excellent experience that starts my day off right. When I settle for mediocre coffee in any dimension, it’s just not the same. If my ‘cup of joe’ is at a mediocre temperature, it doesn’t warm me up the way that a steaming cup can jolt me into high gear. If my mix of hazelnut creamer and full teaspoon of real cane sugar are off from haphazardly eyeballing the mix in a rush, it doesn’t taste right. And if I get sidetracked by a panic filled co-worker first thing in the morning, that beautiful coffee sits on my desk, neglected.

When my morning starts off right, I sip an excellent cup of coffee slowly, resting it on the coaster that sits right next to a smiling picture of Zig Ziglar. Zig’s smile and a little caffeine wake me up as I am reminded to be “Better Than Good” from Zig’s tattered and worn book jacket that sits among my prized desktop inspirations. I think about my day and take another sip of that perfect mix of freshly brewed Columbian coffee and sweet hazelnut creamer. At this point, I think through the to-do list and realize that it really can be ‘better than good.’ Thanks, Zig. My day is off to a great start and I’m motivated to achieve excellence.

Isn’t it amazing how our day can be influenced positively by the littlest things? At PRC, we measure excellence and want our clients to create excellent experiences across their entire organization. These are the little moments and important experiences in healthcare, like helping the older gentleman with limited mobility mix his own cream and sugar because he is adamant that his coffee is prepared ‘juuust’ right. It’s spending the extra minutes at the teenage girl’s bedside going through chemo because you noticed a deep disappointing expression on her face as she paged through prom dresses on an iPad. She won’t be able to attend her prom this year. Taking the moment to sit at the bedside and connect on a personal level with a patient, to ask an open ended question – then listen, to help mix up some coffee and respond to a little request compassionately is what helps create an excellent experience.

As Zig watches me sip my coffee in the morning, he inspires me to engage in excellence, not to settle for the mediocre. In his book, good is average, good diffuses other developments, good is the killer of conversation. During my morning pleasantries with co-workers, I try to connect with them in a conversation that is focused on excellence. “How are you today?” Uh, oh. At this point, I’m hit with a choice. Good, Bad or Ugly are some normal responses but I’m clutching onto an excellent cup of coffee, so I am reminded to think differently.

“Can’t wait to attack these projects.” “Excellent, look at what we are developing.” “I feel blessed to be doing this work.” “Happy to be alive and kicking.” “Excited about the challenge of this demanding schedule.” “Ready to influence some lives today.” “Hoping this day is just as amazing as this steaming cup of coffee!”

Excellence is in the details. Excellence is in the overall experience. Excellence starts with an attitude. Wishing you an excellent day.

Submitted by Dustin Strickler (PRC Client Development Specialist)

Today marks the first day of publicly reported data for the Home Health CAHPS (HHCAHPS) Survey. The results for data from patients who received skilled home care from October 2010 through September 2011, have been posted on the Home Health Compare link on the Medicare Web site at http://www.medicare.gov/homehealthcompare/search.aspx.   

As a reminder, HHCAHPS Survey results are publicly reported when a Home Health Agency has 4 quarters of HHCAHPS Survey data. An HHA must have survey response data in all 4 quarters included in the public reporting period for their results to be publicly reported.  The results are scheduled to be refreshed quarterly, with data from the oldest quarter being replaced by data from the most recent quarter of the HHCAHPS Survey.

PRC has downloaded the database which contains the data used for the Home Health Compare site; we will be reviewing it and working on incorporating these results into PRCEasyView.com® as benchmarks for your Home Health CAHPS data. After we have done so, we’ll be sure to let you know.

PRC Contacts: Katie Obst, Jan Gnida or Matt VanEpps

Last week I had the honor of presenting at ACHE’s Annual Congress on How Service Excellence Can Drive Stronger Charitable Giving, as a follow up to an article I co-authored last year.  While the research on this topic was interesting –you can read more about it here – what especially intrigued me were the discussions that followed our presentations:

• Income is shrinking; can foundations truly impact the bottom line? My co-presenter Betsy Taylor, is President of Erlanger Health System Foundation, and provided attendees with a plethora of research on just how much foundations can impact on hospitals’ financial strength.  She shared that Moody’s Investors Service considers a strong fundraising program, as a complementary strategy to patient care operations, when conducting credit assessment and bond rating.As hospitals’ capacity to increase capital through operations, debt or selling assets is becoming more and more limited; attendees were intrigued with the idea of ramping up philanthropic efforts to offset these constraints.  Even through our recent economic downturn, hospital donations remained strong and continue their upward trend.

• If service excellence impacts donations, shouldn’t foundations focus more on this.
  Yes, and here’s why – by doing so they have the potential to more than double their donors!  Across the nation, one-fifth of consumers have donated to their preferred hospital.  But….this is the kicker…if that hospital provided excellent quality care, exceeded expectations and its employees were excellent, nearly half will donate.Each time I presented this information participants wanted to know what quality of care means (from the patients’ perspective, which is how they were treated as a person and not clinical quality), what types of patients were most affected (it was actually the friends and family who were most likely to donate), and what happened if employees weren’t quite excellent (very good wasn’t good enough…employees had to be excellent).Finding out that friends and family were more likely to donate was surprising; we had assumed grateful patients would be our donors. Yet when you think more about it, it makes sense.  Last year my dear friend battled an especially horrendous cancer.  I wanted to stay with her in the hospital, care for her kids, and feed her family.  But as she lives several states away that wasn’t possible.  I am so grateful for the caregivers who helped her when I could not.  I was positive they’d save her life, but I wasn’t certain that they’d know her as a kind and loving person instead of just another cancer patient.  They were amazing. (Even during a chemo-induced episode when she was convinced they were hiding her shoes.) You can bet that if they asked me to donate, I would.

Which brings me to my final point….

• Isn’t it a bit tacky to solicit patients for donations?
  Yes. And no.  Our society doesn’t like to ask for money, so this feels strange.  Yet how will potential donors know your need unless you tell them.As I was developing the ACHE presentation I spoke with Suzanne Hendery from Baystate Health in Springfield, MA.  In 2008 their foundation needed to increase giving but wasn’t sure where to start.  We conducted their consumer perception study and found that a only small percentage of their consumers had been solicited for donations, yet one-third said they would if asked.  Three years later after increasing their communication efforts, including direct solicitations, giving dramatically increased.  Surprisingly their efforts even had a halo effect – donations to ALL area hospital increased.

  HIPAA does allow foundations to solicit patients and families.  If you’re interested in knowing more about, these resources published by the AHA (link to www.aha.org/aha/content/2002/pdf/HIPAAFundraisingAdvisory.pdf) and AHP (link to www.ahp.org/Resource/advocacy/us/HIPAA/Analysis) are helpful.

As I write this, two people contacted me wanting to know more about this subject.  The first person was a hospitalist who is sharing this message with physicians and hospital leaders. The other was writing an employee newsletter and using this data as another message that reinforces the importance of service excellence.   I’m pleased this idea is catching on and I wonder if other foundations are involved in service excellence.  I’d love to hear your thoughts.  Drop me an email at JBinder@PRConline.com

If you spend much time in an airport, you’ll discover there are hundreds of ways people say hello to one another: hugging, screaming, bowing, smiling, rolling eyes, dancing, shaking hands, crying, jumping, laughing, signing, etc. Greetings are important and set the tone for future interactions – in airports and exam rooms.

A proper greeting begins by addressing the patient by name. One study reports most patients want their first name to be used when physicians initially greet them. (In more than half of the encounters studied, physicians never mentioned the patient’s name at all.) As with many improvement endeavors, balance of values is important. Though patients prefer their first name be used, the authors suggest physicians use first and last names of patients when greeting them, given the role patient identification plays in safety.

Addressing someone by name is an easy way to personalize an encounter. A patient is no longer “a hip” or “diabetes,” she is “Jill Zimmerman.” She is a unique individual.

The same study reports that most patients prefer physicians introduce themselves with their first and last names. Using names instead of titles in the initial introduction paves the road for effective, two-way communication.

Patients also prefer physicians shake hands. Certainly, there may be some patients who would rather bump fists or avoid hand-to-hand contact all together. Research does not replace the need to pick up on other signals and recognize individual preferences, but it helps clarify a starting point.

These findings suggest that patients simply want the same courtesy provided to them that they would receive in any other personal encounter. Though shaking hands and using first and last names may seem like insignificant details, they are not insignificant to patients. Patients are in unfamiliar environments and want to feel welcomed. A solid greeting puts the patient at ease and helps physicians develop that sacred relationship.

Contributor: Teira Gunlock, PRC Client Education Consultant

Those who only “like” us might leave us. A 1995 Jones and Sasser article reported the reason customers (including patients) often switch from one provider to another is because they are merely satisfied and not completely satisfied. It is not enough to simply meet customers’ expectations to earn their loyalty. Customers who are merely satisfied, while not actively shopping, can be lured away with the possibility of something better. Patient indifference impedes growth of healthcare organizations and acts as a barrier to long-term success.

Rather than patient satisfaction, we need patient loyalty. Fred Lee (2003) even referred to patient satisfaction as “fool’s gold.” It seems appealing, but has little value. Instead of focusing on the absence of error, we need to focus on the presence of “wow.” We need to keep our current patients by exceeding their expectations and creating memorable experiences. These excellent experiences, not ones that are merely “good” or “very good,” motivate our current patients to recommend our services to families and friends. We fight the battle of patient indifference by arming our patients with positive stories to share.

Contributor: Teira Gunlock, Client Education Consultant

To create a culture that generates excellent experiences and patient loyalty, organizations need to focus on more than preventing failures; they need to focus on cultivating achievements. The “positive deviance” approach focuses on replicating success. Richard Pascale and Jerry and Monique Sternin (2010) write about this approach to improvement in The Power of Positive Deviance: How Unlikely Innovators Solve the World’s Toughest Problems. They explain, “The basic premise is this: (1) solutions to seemingly intractable problems already exist, (2) they have been discovered by members of the community itself, and (3) these innovators (individual positive deviants) have succeeded even though they share the same constraints and barriers as others” (p. 3-4).

“Positive deviance” comes from statistical terminology to describe outliers. When Chip and Dan Heath (2010), authors of The Switch: How to Change when Change is Hard, discuss this approach as being paramount to change, they call it “studying the bright spots.” The underlying theme remains: find what works and figure out how to breed more of it.

This approach has been used to dramatically improve childhood malnutrition in Vietnam, hospital acquired infections, and other problems across 48 countries and six continents (Pascale, R., Sternin, J., & Sternin, M., 2010). Positive deviance can also be a powerful tool in improving patient perceptions. Exploring our bright spots is valuable because it reveals creative tactics for creating excellent patient experiences, motivates employees to improve, and utilizes our unique strengths to create customized solutions.

Our tendency is to spend disproportionate time and emotional energy studying problems. When it comes to improving patient perceptions and creating loyalty, this negative focus is, in itself, a problem. Focusing on complaints only addresses a small percentage of our patients. More importantly, the absence of error does not guarantee the presence of “wow.” Fixing problems is a worthy endeavor but the real “problem” when it comes to improving patient perceptions is not that several patients are dissatisfied; rather, too many patients like us and not enough love us. Too many patients are simply satisfied.

Solutions to the problem of satisfaction require innovation and creativity. Employees and staff need to innovate new ways to impress patients and exceed their expectations to provide excellent experiences. A negative focus blinds us to creative solutions. A positive focus asks, “What’s working?” “Where are our areas of success?” “What makes an experience memorable?” and promotes new ideas and creative pathways to pursuing excellence.

Studying the bright spots also develops confidence in employees, engenders a sense that great things are already happening, and provides motivation to improve. We need our employees to feel confident in their abilities to provide excellent care from the perspective of the patient – and they do provide excellent care most of the time. All too frequently, however, several units’ patient perception scores are shown at a meeting and while many are doing well, the few falling behind receive the most attention. The resulting discussion is about personal shortcomings and eradicating failure instead of personal strengths and cloning success. Harping on negative scores and inadequacies does not strengthen employees’ motivation to “wow” patients.

When many executives discuss motivating employees to change and help improve patient perceptions, the conversation quickly moves to carrots and sticks. Employees need more than carrots to chase. They need purpose. Leonard Berry and Kent Seltman (2008), authors of Management Lessons from Mayo Clinic: Inside One of the World’s Most Admired Service Organizations, write, “If our goal is excellence, no artificial incentive can ever match the power of intrinsic motivation. People who do exceptional work may be glad to be paid and even more glad to be well paid, but they do not work to collect a paycheck. They work because they love what they do” (p. 121). A culture that focuses on learning from our success in providing excellent care from the eyes of the patients connects employees to purpose.

One of the key features of this way of thinking is its decentralized approach to change and ability to adapt to unique situations. Healthcare organizations are quick to take advice from renowned hospitals and consulting firms, but often slow to learn from their own high performers. Every organization has people or units that consistently connect with their patients and provide them memorable experiences. We should recognize the home-grown bright spots because solutions organically grown within organizations inspire buy-in.

Becoming excellent in the eyes of our patients involves learning about ourselves. By studying what we already do well within our organizations or departments, we can create solutions that capitalize on OUR strengths and address OUR needs.

Contributor: Teira Gunlock, Client Education Consultant