Katie Owens - Healthcare Speaker and Executive Coach

Lead Author, The HCAHPS Imperative for Patient-Centered Excellence

Author: Katie Owens (page 2 of 2)

Person Centered Excellence – Compassion

Taking on the role of a patient is one commonality we all share. Whether we have been one at an urgent care, to have a child, to fix a broken bone, seek treatment for a chronic condition we are all a part of the healthcare ecosystem. I have the privilege to work with thousands of healthcare leaders, staff, and providers each year – it is one that I do not take lightly. I work hard to stay on top of industry trends and remain connected to the daily demands of patient care across the continuum. It is fair to say that Healthcare takes up the majority of my daylight hours (sound familiar?). And I feel compelled to play a positive role in making healthcare better because every patient is a person who wants the very best care possible. The human experience matters. Compassion matters.

The reality is that we spend more time at work and with our co-workers, patients, and visitors than our own families and loved ones. We are people taking care of other people – in their greatest time of need, where uncertainty and the need for reassurance peaks.

So many times, leaders ask me, “What matters most to drive outcomes; focusing on engaging your employees or patients?” I have given this question tremendous reflection over many site visits with hospitals and health systems, as well as my families own personal healthcare journeys over the years. I have come to the conclusion that as healthcare leaders, employees, and providers, we need to unapologetically establish and promote cultures of person-centered excellence. Cultures where each person is treated with respect, dignity, and accountability. At the heart of person-centered excellence is actively displaying compassion and empathy for each individual.

In thinking about times when I have personally been a patient (and researched my own symptoms online – to which I am not alone. It is estimated that over two-thirds percent of patients Google their symptoms prior to an office visit), every team member has made me feel that I am in good hands by demonstrating compassion (or made me feel uneasy by failing to demonstrate compassion).

Every interaction that you have is an opportunity to demonstrate person-centered excellence in action by displaying empathy and compassion or denigrate it. Your presence with your employees, providers, patients, visitors and community matters.

Honestly, nearly all of us strive to be empathetic and compassionate (granted there are some CAVE People – Citizens Against Virtually Everything), yet too often I see a disconnect between an individual’s intent and the perceptions of the recipient. There are three likely scenarios where we can close gaps (and the good news is that none of these require additional budgetary dollars).

Among leaders and employees

As a leader, do not assume your team knows all of the tremendous work you do behind the scenes. Communicate often and genuinely. Be visible, always make eye contact and engage your employees. If your team members do not feel and experience compassion from you, how can you expect them to give it to your patients?

With patients and their loved ones

As caregivers, we must recognize that every patient and loved one that comes through our doors (regardless of where – the Lab, Emergency Department, Imaging, Inpatient, Medical Office) sees themselves as the most important person. Healthcare is unfamiliar to them, they likely have fears/anxieties and want to be reassured they are going to receive quality, compassionate care. We need to set expectations early and often, display empathetic and compassionate behaviors and never assume patients understand what we are doing and why.

Among peers

Since we spend more time with our peers than our loved ones, we need to explore ways to empathize with one another. Sometimes this takes a degree of courage to confront matters of safety, avoid errors or hold people accountable. I was recently shadowing bedside shift reporting with an organization and noticed a pair of nurses doing their end of shift report outside of the room. The retiring nurse later shared with me that she “knows” they are supposed to do their shift report in the room with the patient but does not feel confident in speaking up with those who are not onboard with the initiative. Everyone loses when we miss opportunities to cultivate peer-to-peer empathy and compassion.

Let’s get excited to seek out opportunities to Cultivate Person-Centered Excellence by establishing essential appreciation of the human experience in key roles to walk in patient’s crutches or slippers, wear the employee badge or the leadership hat. I can promise you, it will be a more rewarding voyage than focusing on what is not working in healthcare today.

Moments That Matter: The Role of every Person in Healthcare

The success of our healthcare organization

Patients begin to evaluate a healthcare experience long before they enter a facility. Whether the first encounter is by telephone or with a valet service in the parking lot, patients and family members begin to judge the quality,
safety, and service of the organization before they reach the front door. It is not only what we say but how we sound and the way we look that impact what a patient and family take away from a healthcare experience. We
are each ambassadors for the mission and vision of our organization, and we have the opportunity to represent our hospitals, emergency departments, ambulatory settings, and post-acute facilities positively or negatively.
It is up to us to let patients know we care, through every action, every word, every interaction.


Moments that Matter encompasses the idea that all healthcare personnel have an impact on patients’ healthcare experiences. By understanding, empathizing, and developing ways to deliver an excellent experience, healthcare workers are in a unique position to impact lives. Whether we provide clinical care or not, each of us is integral, not only to the outcome of a single event, but to the way in which people approach healthcare moving forward.
There are eight primary principles for creating Moments That Matter; they include purpose, empathy, trust, communication, teamwork, accountability, appearance, and attitude. While these principles are easy to identify, they require mindful practice to live every day. A connection with purpose requires asking and answering the fundamental question, “Why did I choose healthcare?” Drawing on purpose means the person washing sheets understands he or she contributes to the health and well being of every patient. It means the parking lot attendant knows he or she makes the journey to the front door easier for many people. Empathy is a quality many of us embody; it draws us to healthcare. And, it requires we put ourselves in the other’s place and that we attempt to understand another human being at a very deep level. Likewise, trust is crucial; trust in ourselves, in our areas, and in our organizations. Underpinning many of these principles is effective communication, the ability not only to speak clearly and transparently but also to listen well to what is said and what is left unsaid. Being part of a high performing team means that we share a collective vision, know where the team is headed, carry our weight, and reward each other regularly. Associated with effective teamwork is accountability. Accountability ensures we follow through on our commitments and do what we say we will do. Professional appearance is an important principle in that it engenders confidence in our skills and in our organization. Finally, attitude provides the capstone; attitude is a choice that helps our patients know they matter to us.


Let’s examine Moments That Matter by walking through a healthcare experience with Mary. Mary’s journey begins at home. She contacts her primary care provider’s office after hours when she experiences unexplained stomach
pain for several days. She speaks with the office nurse who consults her physician and recommends Mary go to the local emergency department. A Moment That Matters occurs as the nurse reassures and listens to Mary, acts
with confidence, and empathizes by reflecting Mary’s concerns to make sure she understands.

On arrival at the emergency department, Mary notices she must park far from the door. On her way in, she sees trash in the parking lot and worries about the cleanliness of the facility. An early, critical Moment That Matters has been missed. Now, in addition to her pain, Mary experiences anxiety about the treatment she will receive, worrying that if the parking lot is dirty, the hospital may be also.

Entering the ED, Mary is greeted by a Plexiglas window bearing many notices; there are almost too many read. Through a small opening, Mary sees a person looking at a computer screen. Although Mary approaches the opening, the person does not look up. Another crucial Moment That Matters has been wasted. From the uninviting window to the lack of human connection, Mary now feels uneasy about what lies ahead.

Fortunately, the remainder of her ED visit goes very well, with clinicians keeping her informed of the time test results will require and helping to manage her pain. Using excellent communication skills and following through on commitments has helped Mary regain confidence in the hospital and in the ED team and has contributed successful Moments That Matter to Mary’s perception.

Mary learns she is to be admitted for observation. Her hospitalist and the nursing team on the floor exhibit excellent patient experience skills, updating Mary’s white board, narrating their care when explaining tests and time-frames, and being genuinely interested in Mary and her son, who is now with her. She notices that the housekeeper asks whether he can close the door for her privacy when leaving and the person delivering her tray calls her by name, smiling and looking her in the eye when entering the room. Each of these experiences demonstrates a Moment That Matters, and Mary feels relieved.

When Mary’s illness has been diagnosed and she is ready to leave, she is met by a member of the transport team. This transporter has the choice to impact Mary positively or negatively. He will be the final person Mary encounters while in the hospital, and his words and actions are another opportunity for a Moment That Matters. He looks Mary in the eye, smiles, and helps her into a wheelchair, saying, “We want to make sure you are safe, even when you’re going home. We’re so glad you chose our hospital for your care.”

As Mary travels home, she reflects on her experience. For her, it began, not with the emergency department or her stay on a hospital floor, but with a call to her doctor. She sees the entire experience as one event. And, while we like to think Mary will hold a positive overall opinion of her experience, not all aspects have been positive, and Mary may view the totality of the visit either positively or negatively.

The challenge for each of us in healthcare is to show up fully and to enter into our work wholeheartedly, knowing that we each have opportunities for providing Moments That Matter every day. Regardless of our role or title, it is only when we offer an excellent experience to every patient, every time that we have succeeded in living the principles embodied in Moments That Matter.

Published April 2016, PX Advisor


Infectious Disease: Are We Prepared?

2014 was one of the busiest years for infectious disease in the U.S. in more than a decade (Stobbe, 2014). Ebola dominated the news throughout the second half of the year, garnering more public attention than even the controversial mid-term congressional elections (Altman, 2014). Although Ebola received most of the attention, a number of other infectious diseases were in play, such as Enterovirus 68, the measles, whooping cough, and chikungunya. In fact, the number of threats from infectious diseases is so pronounced, one expert from the Johns Hopkins University School of Medicine contends, we are in the midst of an “epidemic of epidemics” (Bartlett, 2014).

As late as mid-2014, America was confident in its ability to handle such menacing infectious diseases as Ebola, with public officials touting our readiness on nightly news shows and the radio, but more recent experience has taught us a number of things:
• we are not impervious to outbreaks that occur halfway around the world,
• international travel severely compromises our ability to contain a large outbreak of an infectious disease, and
• we most definitely are NOT prepared for even one or two cases of something as serious as Ebola (Stobbe, 2014).

“Ebola has raised attention to serious gaps in our ability to manage disease outbreaks and contain their spread,” Jeffrey Levi, PhD, executive director of the Trust for America’s Health, reported to Medscape Medical News. “It was very disturbing that many of the most basic infectious disease controls failed when tested” (Lowes, 2014).

In response, hospitals throughout the U.S. are taking steps to improve preparedness. When the outbreak in West Africa first began, the message from the Centers for Disease Control (CDC) was that any hospital in the U.S. with private rooms should be equipped to care for Ebola patients (Healio, 2014). However, after the recent experiences in Dallas, the CDC has changed its position. Thirty-five hospitals throughout the country have now been designated
by health officials as Ebola treatment centers. The role of the local hospital is to identify a patient with Ebola and then send the patient to one of these 35 centers.

“All hospitals need to be prepared to identify and triage a potential patient with Ebola. Beyond that, it’s not realistic to think that all hospitals could deliver equally effective chronic care, nor it is practical to have all hospitals be prepared to do so,” says Keith S. Kaye, MD, MPH, professor of internal medicine and infectious diseases at Wayne State University School of Medicine, in Infectious Disease News in late 2014 (Healio, 2014).

Some experts worry that many hospitals have overreacted to the threat of Ebola and over-prepared for this one disease at the expense of other threats. According to several infectious disease experts at the University of California, “hundreds of hospitals have overspent, overconsumed, and overtrained for a rare disease that will most likely never pass through their doors” (Huffington Post, 2014). Rather, many infectious disease experts throughout the world
have voiced concern that we are not maintaining the ongoing vigilance and public health networks that are necessary to be safe from the broad set of threats we face. For example,
• each year, more than two million Americans get sick from antibiotic-resistant bacteria and more than 23,000 die from those infections;
• approximately one of every 25 people who are hospitalized contacts a healthcare-associated infection, resulting in roughly 100,000 deaths per year;
• more than 48 million Americans suffer from a food-borne illness every year; and
• an average of 62 million Americans—20 percent of the population—get the flu each year, causing between 3,000 and 49,000 deaths annually, depending on the strength of that year’s flu strain (Levy, 2014).

Last year, the CDC released its list of the top threats facing the U.S. They recognized several new and emerging infectious diseases, such as Ebola, but they also acknowledged long-standing threats from diseases like AIDS, polio, and the leading causes of death in America.

The CDC’s Top Public Health Challenges
• New Infectious Disease Threats
– Ebola
– Antibiotic resistance and healthcare-associated infections
– Enterovirus D-68 (EV-D68)
– Middle Eastern Respiratory Syndrome (MEARS)
• Continued Fight Against Infectious Diseases
– HIV/AIDS pandemic
– Polio
• Laboratory Safety
• Leading Causes of Death
– Cardiovascular diseases
– Smoking
– Fatal overdose (CDC, 2014)

“When I was in medical school, the leading experts declared that infectious diseases had been conquered in the United States. It’s now clear how wrong they were.” – Dr. Eric Toner, senior associate at the University of Pittsburgh Medical Center’s Center for Health Security

Even though the U.S. faces numerous challenges from infectious diseases and the number of threats is on the rise, a recent report indicates that most states are not ready to respond. The Trust for America’s Health and The Robert Wood Johnson Foundation jointly released a study in 2014 that assessed all 50 states on their readiness to respond to infectious disease outbreaks. They monitored states on such metrics as funding of public health efforts, vaccination rates, infection control at medical centers, attempts to prepare for climate change, and surveillance efforts to track cases of HIV and E. coli. On a 10-point scale, no state received a grade higher than eight.

Half of the states received a score of five or lower. Only five states received a score of eight—Maryland, Massachusetts, Tennessee, Vermont, and Virginia. Arkansas received the lowest grade in the survey, with a score of only two.

The study’s authors refer to a U.S. trend to let its guard down when there is no imminent threat and then to find itself off-guard when threats like AIDS, SARS, or Ebola emerge. “When I was in medical school, the leading experts declared that infectious diseases had been conquered in the United States. It’s now clear how wrong they were,” Dr. Eric Toner, senior associate at the University of Pittsburgh Medical Center’s Center for Health Security, said of
the report (Levi et al, 2014).

The study recommended five steps the U.S. should take to better prepare itself for future threats from infectious disease. These include:
• ensuring that the U.S. has a strong public health system supported by strong laboratories;
• developing and implementing solid containment strategies, including vaccinations for contagious diseases and adequate treatment for chronic conditions;
• regularly training hospitals to be prepared for an epidemic that results in a flood of patients;
• improving communication with the public to keep them aware of threats from infectious diseases without causing panic; and
• increasing federal funding for vaccines, stronger antibiotics, and other treatments that can counter outbreaks (Levi et al, 2014).

In 2014, we came face-to-face with our nation’s lack of preparedness and the potential impact on the public’s safety. Hopefully, we will learn from our experience and work hard in 2015 to improve our readiness to respond to the infectious diseases that are a growing menace to our collective health and well-being.

How Deadly Is Ebola?

Ebola is one of the most deadly diseases known to man, with a fatality rate that is much higher than most other infectious diseases (50 to 90 percent). Since 2013, in the latest outbreak in West Africa, Ebola has infected 17,942 people and caused some 6,388 deaths.

Infectious disease - Ebola


Almendrala, A. (2014). “How America’s Healthcare System Could Benefit from Ebola,” Huffington Post, www.huffingtonpost.com
Altman, D. (2014). “Poll: Ebola Was a Bigger Story Than the Midterms.” The Wall Street Journal.
Bartlett, J.G. (2014). “ID Update 2014: New and Emerging Threats.” www.medscape.com
Centers for Disease Control (2014). “Top 10 Most Critical Health Threats of 2014.” www.cdc.gov
Infectious Disease News. (2014). “US hospitals step up training, preparation for Ebola.” www.healio.com
Kaiser Family Foundation (2014). “Ebola Characteristics and Comparisons to Other Infectious Diseases.” www.kff.org
Levi, J., et al. (October, 2014). “Most States Not Ready to Handle Infectious Disease Outbreaks.” MedLinePlus, National Institute of Health. www.nlm.hih.gov/medlineplus/news/fullstory_150042.html
Levi, J. (December, 2014). “Lessons for Ebola: The Infectious Disease Era, And The Need To Prepare, Will Never Be Over.” Health Affairs, www.healthaffairs.org/blog
Lowes, R. (2014). “Go Beyond Infectious Disease of the Month.” Medscape Medical News. www.medscape.com
Stobbe, M. (2014). “2014 was a busy, messy year for disease control.” Jacksonville Times-Union.

Printed Winter 2015 PX Advisor



HCAHPS: An Asset or Liability for Recruiting and Retaining the Best Workforce?

HCAHPS scores are a recruitment issue, as well as a clinical issue.

At the heart of many healthcare organizations’ mission statements is an imperative to place the patient at the center of our work. Either directly or indirectly stated, the quality of the patient experience (both clinical quality and patient’s perceptions of care and service) is paramount to why many organizations exist. The Hospital Consumer Assessment of Healthcare Providers and Systems Survey (HCAHPS) has become the standard by which we evaluate excellence in the patient experience.

At face value, the HCAHPS survey is 32 questions measuring patient perceptions of care across seven dimensions, two individual items and two overall items (of which all are publicly reported on HospitalCompare.hss.gov). Each day, more than 8,400 patients complete the HCAHPS survey and give feedback on the quality of their experience (Lehrman & Goldstein, 2013). Our health systems and workforce are currently in the second year of accountability for performance, based on Value-based Purchasing where HCAHPS represents 30% of the Total Performance Score.

In April 2015, Centers for Medicare and Medicaid (CMS) will be adding a five-star rating to simplify consumer understanding of performance and “spotlight excellence in healthcare quality”(HCAHPS, 2015).

With growing simplicity in transparency, there is a heightened need for constant vigilance on HCAHPS as a magnet to attract and retain the very best. Our coaches work with hospitals and health systems to create cultures of excellence where everyone in the workforce is mission critical, from the boardroom to the bedside. This article will help you leverage HCAHPS to support attracting, selecting, and retaining talent.


In a world where our patient experience scores are readily available and our applicant pools have myriad means to research our organizations to make their employment decisions, some key questions emerge, such as: Why should a candidate choose your organization over a competitor? And, do your HCAHPS scores tell a positive story about your commitment to patient-centered excellence or a negative one?

According to a 2013 CareerBuilders survey, reputation is incredibly important to job-seeking candidates. This study found that candidates would be willing to accept a lower salary if the employer made a great impression during the hiring process and that the employer’s brand plays an integral role in their decision (CareerBuilder, 2013).

It is important to evaluate your organization’s unique proposition of excellence, and HCAHPS data can be an incredibly valuable validation of your accomplishments. As a resource, how well are your recruitment assets aligned to tout your HCAHPS commitment?



While most would agree it is critical to select individuals that reflect the organization’s commitment to patient-centered excellence, all too often selection is rushed to fill vacancies. Anyone who has ever made a bad hire knows that the impact can be damaging on so many levels.

Selection should be rigorous, so each employee can be engaged and empowered to make a difference (and ultimately be set up for success in the organization). Your selection process determines the candidates and, ultimately, hires that will be entrusted to care for your patients. The goal should be to narrow your organizational “front door” so that only those who embody your values and commitment to excellence can walk through. The following are proven strategies to elevate your selection process:

Standards of Performance

Standards are the behavioral expectations for all leaders, staff, and physicians that demonstrate your organizational values in action. Creating emphasis on your standards is an integral link to the “Always” experience HCAHPS requires. Many of our clients require all applicants to sign a commitment statement to their Standards of Performance as a component of the job application.

Behavioral-Based Interviewing

Behavioral-based interview (BBI) questions are a powerful inquiry tool to allow the hiring manager to evaluate past behavior (successes and failures) of the interviewee. Our experience is that BBIs can be a powerful lever to ensure that new employees already possess the behaviors necessary to achieve HCAHPS goals, particularly the communication skills that are part of most of the HCAHPS dimensions. These examples from our HealthStream Coaching Library can be used to elevate selection techniques:
• Tell me how you help your patients understand your responsiveness to their needs (e.g., call-light response, bathroom, personal needs).
• Tell me about a time when you had to work with a team to improve your HCAHPS scores.
• Describe a challenge you have had to overcome with physician communication.
• Tell me how you have engaged your staff to improve nurse communication.
• Give me an example of how you have involved non-clinical teams in the patient experience.

It is so important for hiring managers to practice active listening during the interview process. BBIs will reveal rich background information on each candidate; however, the onus is on the interviewer to ask probing follow-up questions. Some commonly asked follow-up questions include:
• What was the first key thing that you did?
• How did you determine the strengths and weaknesses of that approach?
• What was the outcome of the situation?

Peer Interviewing

Peer Interviewing is a selection process where high-performing team members are allowed to evaluate job candidates and assist the manager in the candidate selection process. Involving peers creates further validation for the hiring manager, builds early rapport with candidates, and creates peer investment for a new hire’s success.

The most successful peer interviewing programs are planned and launched to equip the peer interviewers to successfully recommend the best candidates to hire. Peer interviewing can create an integral link to hiring those most aligned with your HCAHPS expectations and aspirations. Preparing peer interviewers to ask HCAHPS-related questions and to share the organization’s commitment to patient-centered excellence creates clear expectations to the job applicants.


Now that they are hired, how do we garner their full engagement and get these employees to stay? Retention needs to be a constant focus that begins on day one. Every employee needs to know their contributions to the patient experience and how they can impact HCAHPS.


Bringing new leaders, staff, and physicians up to speed on the organization’s commitment to service, HCAHPS, and the patient experience sets clear expectations and accountabilities from day one at orientation. Organizational and departmental orientation should include:
• education on the importance of HCAHPS,
• the survey tools used to measure the patient experience,
• how to access patient experience results and key reports,
• organizational and departmental goals for HCAHPS improvement, and
• tools and resources to improve HCAHPS scores.

The First 90 Days

Our coaching teams recommend adopting 30-, 60- and 90-day meetings as an integral onboarding process to engage new team members and validate their progress.

During 30/60/90-day meetings, leaders can engage their new hires to assure the promise of the job equated to the reality, solicit ideas for improvement, and further engagement and enthusiasm for the organization’s success. Maintaining congruency with HCAHPS is important during these discussions. The leader can (and should) reinforce commitment to the patient experience, maintain accountability for “Always,” share recognition, and ask for the employee’s fresh perspective to improve service and operations.

Equally important to layering learning for new team members is the team that will support successful onboarding. HCAHPS performance and patient comments can be a valuable lens to identify employees that can be role models and/or preceptors for other new leaders, employees, and physicians.

There are endless reasons to make HCAHPS a priority in your organization. In this churning and evolving healthcare environment, leaders are more challenged than ever before. We’re responsible for more lives at a time when the healthcare industry faces soaring costs, falling reimbursement rates, rigorous standards of quality, workforce shortages, and more informed patients.

HCAHPS as an enabler to your selection, onboarding, and retention systems is not a matter of luck, it is the intersection of process, expectations, and engagement.

30/60/90-Day Meetings
• 30 days: establish the relationship
• 60 days: ensure things are going well
• 90 days: get feedback from the 30/60-day discussions


CareerBuilder. (2013). New CareerBuilder study reveals nine lessons for job seekers and recruiters that may surprise you. Retrieved from http://www.careerbuilder.com/share/aboutus/ pressreleasesdetail. aspxsd=10%2F17%2F2013&id=pr785&ed=12%2F31%2F2013
HCAHPS. (2015). HCAHPS Star Ratings. Retrieved from http://www.hcahps.org/StarRatings.aspx
Lehrman, B., Goldstein, L. (Autumn, 2013). HCAHPS Executive Insight Letter. Centers for Medicare & Medicaid Services, Baltimore, MD. Accessed January, 2015. Retrieved from http://www.hcahps.org/executive_insight/default.aspx

Printed Winter 2015 Healthcare Workforce Advisor


Individual Care is Key to Patient Compliance

Cynde Gamache on Patient ComplianceAn Interview with Cynde Gamache, MA, RN, NE-BC Vice President, Baptist Health Care Chief Nursing Officer, Baptist Hospital, Pensacola, FL

Working in the healthcare industry as a Registered Nurse for more than three decades, Cynde Gamache has a passion for improving care for patients. This personal fervor and commitment revolves around creating conditions by which healthcare organizations can advance in the areas of care quality, safety, and service. Functioning in varying leadership roles for nearly 20 years has provided Gamache with a broad perspective on the operations and challenges currently faced by healthcare systems.



Patients have a tremendous influence on their own health outcomes. Their level of compliance in taking medications, adhering to treatment regimens, and making healthy lifestyle choices can directly influence not only their longevity but their quality of life along the way.

Here are some startling statistics (Assistmed, 2015).
• Approximately 125,000 people with treatable ailments die each year in the U.S. because they do not take their medication properly.
• About 50% of the 2 billion prescriptions filled each year are not taken correctly.
• Up to 21% of patients never fill their original prescriptions.
• 60% of all patients cannot identify their own medications.
• As many as 40% of patients do not adhere to their treatment regimens.
• 23% of nursing home admissions are due to patient noncompliance (380,000 patients).
• 10% of hospital admissions are due to patient noncompliance (3.5 million patients).
• 30-50% of all patients ignore or otherwise compromise instructions concerning their medication.
• 12-20% of patients take other people’s medicines.

Clearly, there is an opportunity to improve patient outcomes by positively influencing patient compliance. Baptist Health Care’s Cynde Gamache is all about improving patient outcomes. In this article, she answers key questions about patient compliance, based on more than 30 years of personal experience as a Registered Nurse, Chief Nursing Officer, and healthcare system executive.

1) How big an issue is patient compliance for most hospitals?
Patient compliance is an important concern for inpatient and outpatient providers across the continuum of care. It is a systemic challenge that impacts patients and their loved ones and has financial repercussions for both patients and providers. Every U.S. health system is aware of the impact of patient compliance on the health of our communities, workforce, families, unnecessary hospitalizations, Emergency Department visits, and further resource utilization. Our challenge is to improve patient compliance through personalized patient care, in order to mitigate these downstream consequences.

2) What are the biggest challenges you face with patient compliance?
As providers we must understand individual patients and what drives them. All too often we may get frustrated with patients we see as “non-compliant.” Look at the person in his or her entirety, taking into account social, environmental, and medication details. We have to understand their perceptions of what is important in order to work with them to increase compliance.

Creating Behavioral Awareness
It is imperative that we ensure patients are aware that compliance is necessary (or that they are not complying with recommended treatment). Patients will not pay attention to compliance with their treatment regime if
they do not understand they suffer from a chronic illness and that there are implications if they are non-compliant. It is quite difficult to modify behaviors that are problematic—especially those influenced by social
settings. Our roles as care providers often involve asking patients to make major lifestyle changes and potentially to give up a behavior seen as enjoyable (e.g., giving up smoking or eating healthy). There is
tension inherent to this purpose that can put our teams in the position of influencing new behaviors that may be viewed as unfavorable by the patient.

Medication Compliance
Compliance with medication is a major issue; challenges may include getting patients to fill their prescriptions, to take their medicines (and as prescribed), and to continue to take medicines after symptoms subside.

3) In which clinical areas is it most difficult to get patients to comply with their treatment regimens?
Compliance is not necessarily tied to demographics, diagnosis, or illness. I have seen challenges across the board. Some areas in which you see them are more common: for example, diet, lifestyle, smoking, diabetes, and obesity. Compliance is also challenging from patient to patient due to lack of health insurance, high deductible consumer plans, and education. Again, it comes back to determining what patients want to accomplish.

4) Are there certain types of patients or certain demographics who are less likely to be compliant with their treatment?
We need to get beyond categories and focus on personalized patient care. Developing trust between patient and the provider is critical. If we can empathize and understand what patients are thinking, they will begin to trust us.
It’s important to see the situation through the patient lens, and inquiry is a critical skill needed by our teams to uncover individual patient needs. How do they perceive us? Do they understand? We must be vigilant to eliminate jargon and not assume or believe a patient should understand. Uncovering the real problem is imperative. For instance, the real problem may not be diabetes management—it could be the patient does not like the shot.

5) What are some of the techniques you have learned or innovated to help increase patient compliance?
We focus in the following areas:
TIME: We need to spend time to understand what patients think. Appreciative inquiry is critical, and we work to explore their values. It is vital to acknowledge if we are not on the same wavelength.
CONTROL: Everyone benefits when we find ways to give patients some form of control. We also need to re-empathize with the loss of autonomy when someone becomes a patient or has to manage a chronic condition. Our goals as providers may be different from the patient. We are most successful when we understand the patient’s paradigm and values.
LISTENING: Acknowledge that patients do know their own bodies. We trust our patients, listen to them, and understand the meaning underneath what is said.
GOALS: Work on small goals that patients can control. Ask them a question—If you could change one small behavior, what would it be? Identify a single step towards the goal and demonstrate success, celebrating it. Be aware that resistance is normal and not just a person being obstinate. What drives that? Is it fear or the social environment with which they work? We cannot take it personally as a provider. We try everything in our power to make them better. We have not failed. We have to allow patients to be responsible for their own progress.
FOLLOW UP: Connect with the patient through discharge call or email. That check-up will further develop the provider-patient relationship and help create accountability, as well as allow them to share a concern that what was prescribed cannot be done.

6) How do patient compliance issues differ in the inpatient vs. outpatient environments?
At Baptist Health Care, our 2020 nursing strategy includes getting nursing caregivers to start dialoguing and opening up lines of communication across our continuum of care. First and foremost, as leaders we need to make communication and information flow more supportively across the care continuum. We also need to make certain we give caregivers in the primary care office, inpatient, and outpatient settings the same, beneficial access to all patient information.

7) What advice/coaching do you give doctors, nurses, and other caregivers to try to improve patient cooperation?
Communication channels are critical. We cannot be too rushed and hurried. As we are talking we need to use open-ended questions and ensure patient understanding. I have not only seen this professionally, but in my own family where there can be a reluctance to ask healthcare professionals important questions and get clarifications. Sometimes patients feel they did not have the time or would be judged as unintelligent. Emphasize that we are there with them and not judging them if initially they do not understand. Use reflective listening. Summarize your understanding and confirm it with the patient. It’s easy for us to say “xyz” and for the patient to say “xyz”—but are they really the same? Have the patient demonstrate his or her understanding. Lastly, motivation to change must come from the patient.

8) Are there any other comments you would like to make?
Look at patients in their total environment—family, culture, etc. These details factor into whether patients can be compliant. If the patient needs to stop smoking and lives with smokers, this only sets up the patient to fail. Get the family to quit. Look deeper into the situation and consider it in the entirety. These environmental factors significantly influence the ability to comply. Find small successes. How have patients approached previous health issues? Are there keys to unlock what was done previously that can be applied to the current situation? Work closely with the individual. Whether we agree or not, the patient has the ability to accept or decline the advice and care we give. Quality may be more important than quantity to understanding the ramifications of every behavior. The BEST way to change behavior and drive compliance is through the use of stories. It helps us to insert ourselves into the situation and understand. Using stories helps us make the connection or connect with another human being about the same challenge—i.e., someone needing to quit smoking can learn about a smoker who has successfully quit.

Printed July 2015 PX Advisor


Hospital 5 star rating system set to roll out in April: CMS

by John W. Mitchell , Senior Correspondent

The Center for Medicare & Medicaid Services (CMS) is ratcheting up accountability for hospitals with the rollout of a consumer overall 5- star single rating system in April.

CMS spokesperson Alper Ozinal told DOTmed News there is good reason to emphasize hospital scores through a single star rating in addition to category-by-category ratings.

“HCAHPS scores have been found to be positively related to other quality indicators, including process of care, outcomes, safety and readmissions.” He added that HCAHPS scores have been improving in hospitals since introduced in 2006.

“This is a big change,” said Katie Owens, Vice President of HealthStream Engagement Institute, a company that both surveys nearly 1.7 million patients a year about their hospital experience and coaches hospitals on how to improve scores by creating patient-centered service. “With consumers now so active on social media the use of 5 star ratings on such sites as Yelp, Trip Advisor and Consumer Report, it seems CMS is looking to follow suit to simplify things in the eyes of the consumer,” she told DOTmed News.

The American Hospital Association (AHA), which represents nearly 5,000 hospitals and health care systems, has concerns about this new single star rating system, officially titled HCAHPS (Hospital Consumer Assessment of Healthcare Providers and Systems) Star Ratings.

“The current hospital compare site [which was developed with help from American hospitals] was not designed for single star system rating from multiple scores for patient experience,” Akin Demehin, Senior Associate Director for Policy at the AHA explained to DOTmed News.

“Hospitals are committed to sharing quality data but we’re concerned the single star rating (for patient satisfaction) will not be particularly useful to consumers in making health care decisions. We think it might be more understandable for single star ratings planned in the future for clinical outcomes, such as heart attack.”

Owens, with HealthStream, noted that improving patient satisfaction requires a systemic effort to create a patient-centered culture.

“The Star System does not change anything as far as our work with hospitals. We work to place patients at the center of health care through a hospital leadership commitment to cultural change,” she said.

She noted the biggest barriers to improving hospital ratings are: lack of accountability; lack of skills to consistently deliver patient-centered staff behavior; and lack of buy-in from staff and physicians.

To Access Article:


Common Sense for Improving the Patient Experience

Three proven techniques — “personnel” attention, setting expectations and accountability — can transform your hospital’s culture.

At the risk of stating the obvious, all health care begins and ends with the patient. Yet, we are falling short on instilling behaviors and systems centered on the patient. In fact, hospitals have a dismal disappointment rate of 29 percent: According to the most recent Centers for Medicare & Medicaid Services HCAHPS survey, American patients believe they were treated at the best possible hospital a mere 71 percent of the time.

If you consider how hospitals, physicians and the industry as a whole are judged, the patient experience can make or break your reputation as well as the bottom line. My challenge to you is simple: Use common sense to create a solvable scenario for our leaders, employees and physicians who care deeply about being successful.

Critical Questions
Patient surveys and the potential financial impact of value-based purchasing have elevated the patient experience to one of the most pressing issues currently facing health care organizations. The Beryl Institute’s 2013 benchmark study, “The State of Patient Experience in American Hospitals,” revealed that patients rank their care experience as one of their top priorities. Yet, a 2013 HealthLeaders Media study revealed that 58 percent of health care leaders have not made specific patient-experience investments.
In this time of unprecedented change, financial pressures and competing priorities, how will your hospital meet or exceed quality measures? How can you avoid the financial penalties associated with underperformance? How can you create systems of accountability and recognition to ensure that your culture achieves results?

Patient-centered excellence is the commonsense answer to these questions and more. Each patient is your hospital’s core responsibility, but are you committed to providing service excellence? Is your staff taking the time to remember that “the gall bladder in 205” is really a retiree named Miss Peggy who volunteers as a crossing guard in her neighborhood? Does Mrs. Jones know without a doubt that her care and needs are your priority on any given day, despite emergency department volumes greater than 100,000 visits per year? If not, patient-centered excellence is not a priority at your hospital.

I am going to outline three proven techniques that can put your hospital on the right track to improving the patient experience.

Cultural Transformation through “Personnel” Attention
HealthStream Engagement Institute poll given to 250 health care leaders ranked “people” last in their list of priorities. How can we ask our team to create exceptional quality, financial or experience outcomes if we are not developing and engaging the people who achieve our results?

What does it take to transform a culture? Unfortunately, it does not happen overnight. Cultural transformation is a journey that begins with “personnel” attention. It involves learning new skills and creating opportunities to mentor staff and leaders.

To put this into perspective, I have yet to find a hospital that excels in patient-centered excellence that does not value and nurture its own personnel. From senior leaders to physicians, and the environmental team to valet drivers, your personnel must take ownership in your hospital. They must feel heard and respected and ultimately be a part of the conversation.
Take a moment to rate your hospital’s commitment to patient-centered excellence. Answer the three challenge questions listed below.

patient-centered excellence

If you cannot rate your teams predominantly between fours and fives, chances are you are encountering one or more of nine common barriers to cultural transformation:

1. failure to set clear direction and mission;
2. lack of staff ownership and buy-in;
3. fragmented communication;
4. lack of recognition and rewards;
5. failure to hold staff accountable for performance;
6. inadequate data-collection and measurement process;
7. satisfaction with the status quo;
8. insufficient leadership commitment and visibility;
9. lack of an open and trusting environment.

I encourage you to review these barriers and then do the exact opposite.

Great Expectations
An easy-to-remember but tough-to-implement mantra is “every patient, every time, every interaction.”

Just as it is your leaders’ job to set expectations with your personnel, your personnel must strive to set proper expectations with patients. The first step for staff is to try to understand the patient experience from the patient’s perspective. The second step is to deliver a consistent experience to every patient, every time. Unless we understand the patient’s perspective, we will be unable to deliver the best experience possible.

Another key factor for staff is knowing that there’s a big difference between what’s important to the patient and what’s important to us as health care providers. Human beings are not used to being patients, so we have to help them know what to expect during their hospital stay. After all, they spend most of their lives outside the hospital. It is our role and privilege to understand and manage what the patient sees, feels and experiences.

An example of properly setting expectations is explaining what kind of noise a patient will hear at night, going so far as to illustrate that the patient might hear noises different from those in his or her home. Additionally, we need to tell the patient that “ultimately our job is to make you feel secure. We’ll respond 24/7 and take care of you during your stay.”

Accountability and the Patient Experience

Accountabilities predict the outcome. This is a fact that I have witnessed countless times. The challenge lies in properly evaluating behaviors and setting accountability measures. We are astute at holding people accountable for financial and quality measures, but the patient experience can be tricky. We need to establish, clarify and champion specific accountabilities for the patient experience.

Evaluation with consequence sustains results. The best way to illustrate this claim is to imagine the best nurse, physician and technician in your hospital. Now imagine the ones whom you would not want within 20 feet of your loved one. If you pulled annual performance evaluations from both, would there be a difference? If not, there is a lack of accountability and consequences. We need to remove this deficit to transform the patient experience.

Tools and tactics work best one at a time. The three I have outlined here — “personnel” attention, setting expectations and accountability — will get you on the right track. I guarantee that recognizing patient-centered behaviors will elevate your market position and financial performance. Patient-centered behaviors cost nothing, but they earn dividends. Are you prepared?

Katie Owens is the Vice President of HealthStream Engagement Institute based in Pensacola, Fla. She is the lead author of “The HCAHPS Imperative for Creating a Patient-Centered Experience.”

To Access Article:

Patient-Centered Communication: Verbalizing while using EHRs

Effective patient-centered communication is the foundation of high-quality healthcare. Nearly all healthcare interactions — from making appointments and registering to discussing medical symptoms, treatments and care options — rely on effective communication. Technology, in particular, electronic health records (EHRs), holds the power to improve our communication with our fellow healthcare providers and our communication with patients and their loved ones or denigrate it.

While electronic health records can create the opportunity for real-time documentation and information sharing, we must leverage this tool to enhance our interactions with patients. At HealthStream Engagement Institute, we recommend three important tools to support the intersection of EHRs and patient-centered communication:

1. Use “words that work,” ban “words that don’t work” and take advantage of your investments in leading technology to provide the best patient care possible.

patient-centered communication

Words that work are designed to create a positive impression of your organization; however, words that don’t work are likely embedded in your organization as well (especially when it comes to EHR technology). By working with and engaging your teams, you can identify the words that don’t work, create crosswalks to words that do work and have fun in the process.

2. Narrate your care and process: Explain every step. Whether you are entering demographic information at admission, conducting bedside shift reports or validating medications, we cannot assume patients understand the intricacies of care delivery.

3. Use RELATE, our patient-centered communication model, to engage patients while documenting their care electronically.

Reassure: Discuss the importance of bedside documentation to assure the highest quality care. Verbalize your commitment to quality. Acknowledge any fear or anxiety a patient or their loved ones may be feeling.

Explain: Explain the process for documentation and how the information will be used.

Listen: Listen for any questions the patient may have about charting, care delivery.

Answer: Answer their questions in easy to understand terms. If possible, use techniques like “teach back” to validate the patient’s understanding of your explanations.

Take action: Narrate your care and process every step of the way.

Express appreciation: Thank the patient for the opportunity to participate in their care.


Katie Owens is Vice President at HealthStream Engagement Institute. She works with senior teams to front line staff to establish alignment and engagement and coaches how measurement and data influence behaviors and drive outcomes for patients and their families.

Published in EHR Intelligence, 2014


Creating a Culture of Accountability – Where Do You Stand?


If you want to achieve world-class levels of performance in the patient experience (or any other key performance measures) you must create a culture of accountability in leaders for achieving results and ultimately aligning the actions and behaviors of staff and physicians to help reach desired outcomes. HealthStream Engagement Institute has coached nearly 60,000 leaders, staff, and physicians over the last 12 months and, through that coaching, we have seen some interesting trends:

Yet, when we ask leaders if we could tell the difference between their high, solid, and under-achieving performers based on their annual evaluations, we overwhelmingly hear a common response: “No.” This problem is so pervasive that on our HEI patient-centered excellence survey of nearly 25,000 responses, the lowest scoring items include tolerance for poor performers and employee input leads to change. These gaps are magnified because organizations are allowing poor performers to continue undermining success. Meanwhile, leaders fail to engage and recognize their high performers. You can put any performance system in place. What is typically missing is how to establish the right accountability for outcomes. In our work with America’s hospitals and health systems, we find four crucial elements to understanding your strengths and gaps for creating a roadmap to sustainable accountability.

• Selection and Retention
• Workforce Development
• Performance Management
• Measurement

What is Your Snapshot?

The following items are a limited portion of the evaluation process that HEI uses to determine the state of organizational accountability. Take a look and see how your organization scores.



Phelps Memorial Hospital CenterSleepy Hollow, NY

Phelps Memorial Hospital Center (PMHC) began a journey of transforming patient experience in February 2012, beginning with HEI’s Patient-Centered Excellence Assessment. That process provided them with a roadmap to improvement, part of which included enhancing their methods of leadership development and creating accountability for performance. Each level of leadership, from executives to frontline supervisors, has embraced their roles and responsibilities and committed to a long-term investment in their culture. As a result, PMHC has experienced drastically improved outcomes in employee engagement and the patient experience.


High-performing organizations create an environment of accountability where their top talent is aligned and engaged to produce the right results. This type of culture is pervasive throughout the continuum of employment, one which starts with the application and interview process and continues throughout the life cycle of an employee. An environment that is geared towards maximizing the potential of each member of its team and empowers them to improve things for themselves and those they serve will put your organization in the best position for success.

Printed Summer 2014, Healthcare Workforce Advisor


The Role of Coaching in Patient-Centered Excellence

Article by Katie Owens and Kathleen Lynam, Executive Coach, HealthStream Engagement Institute

TODAY’S CHALLENGING HEALTHCARE ENVIRONMENT includes reconciling competing priorities and ensuring a culture of quality, safety, and continuous learning. Add the reams of data found in dashboards, Gantt charts, spreadsheets, and electronic reports for payroll, time off, compliance, and quality. It is easy to become distracted— especially with the realities of our economic climate and reform.

We believe that providing excellent patient experience is the foundation of competency in healthcare; yet, nationally only 70% of patients reported in 2013 that they received care at the “Best Possible Hospital” (HospitalCompare.gov, 2014). What can organizations do right now to support leaders, including frontline nurse managers, medical directors, and department directors, in their efforts to manage costs, direct resources, role model effective behaviors, and lead and inspire staff to provide the highest quality and cost-effective, patient-centered care?

It is imperative that organizations understand that embracing a culture of coaching is critical to ensuring patient-centered excellence. Coaching individuals on how to lead initiatives, deploy tactics, and give essential feedback to staff will help them be more successful sooner by creating a better path forward and avoiding common pitfalls to improving the patient experience. Whether your organization has a dedicated team for patient experience leadership or has a committed team of internal champions, this article is designed to support organization efforts to build the proficiency of coaching to overcome performance gaps and sustain progress.


The majority of the changes we see occurring in healthcare today are driven by a focus on a deficit or outcome that did not meet its target. It may sound contradictory, but with a sole focus on the “red” or “negative” performance, you miss the opportunity to develop, nurture, and invest in the bright spots, processes, or individuals who will ultimately achieve and replicate success for the organization. Without a culture of coaching, healthcare providers miss an approach that builds on strengths, promotes better outcomes, develops trust, and reinforces your most critical priority—the patient.

Many of the tools used to improve the patient experience are not new. Every leader and organization we encounter have already begun the journey to achieve patient-centered excellence. Many organizations have deployed proven techniques—hourly rounding, service recovery, communication models (such as HEI’s RELATE), and standards of performance. But if everyone is using them, why does achieving patient-centered excellence remain a challenge for so many?

Healthcare organizations expend significant effort with only limited success because they lack a culture of coaching. According to a 2014 BLG poll of nearly 200 leaders, only 12% of leaders reported use of transformation techniques to improve the patient experience are effective. These findings reveal that healthcare organizations have made significant efforts, but with limited success. Our data (Owens, 2011) shows that:

• Most organizations that embrace a new initiative, experience some improvement, but then regress back to their previous state.
• Managers in many healthcare facilities struggle with execution because they have too much on their plates for consistent focus.
• Underperforming leaders and staff don’t embrace change, naysay, and wait for initiatives to fail.
• Loss of discipline occurs because leaders are not equipped with new skills and accountability tools to sustain new behaviors and tactics.

In order for organizations to break through the challenges of the common scenario, coaching is critical to build on strengths, develop a plan to educate and reinforce patient-centered skills, and establish a platform for accountability. In our experience with assisting organizations through leadership development sessions, coaching roadmaps, and adoption of new or enhanced tactics and communication models, consistent feedback is that the most valued part of an engagement is one-to-one personal coaching.

For the leader and the department teams, obtaining validation that what he or she is doing in real time, the words and actions used, is a critical part of developing competencies and becoming expert in the realm of patient-centered excellence. A coach is in a unique position to observe, teach, mentor, give feedback, and in some cases, even to direct. A competent coach has the wider vision and is able to gain the trust and confidence of the leader, staff, or
physician who is coached; he or she is a great listener, an astute observer, and an effective communicator.

Use of PX Transformation Techniques


The Role of the Coach

Patient experience coaches and internal champions, when following a proven, executable blueprint, can accelerate an organization’s ability to achieve outcomes to support CAHPS, employee engagement, and physician loyalty successes. Coaching affords organizations the opportunity to hold up the mirror: they can praise what is working well and coach-up skills to take an individual or team to the next level. Coaching can create a platform to drive and support strategic initiatives to ensure a culture where every patient, every time has an excellent experience. We believe HealthStream Engagement Institute’s proven model that seeks to create alignment and develop internal coaches, leaders, staff, and physicians ensures development equates to successful execution and sustainability of gains achieved.

“I have spent many years of my career working towards a culture of ‘every patient, every interaction, every time’ and am passionate about improving the patient experience. But… it wasn’t until I had the opportunity to partner with HealthStream Engagement Institute and work directly with our coach that we realized a cultural transformation where we “always” place the patient first. Our patient experience scores continually improve and our patients keep coming back.” – Lynn Charbonneau, Director, Patient and Community Experience, Waterbury Hospital, Waterbury, Connecticut



Keeping the patient at the center of everything we do— every patient, every time.  Assessing and developing the people who deliver care to understand and manage what the patient sees, feels, and experiences.

HealthStream Engagement Institute’s Coaching Model: Alignment – Development – Execution – Sustainability

In leading change, an organization, department, or service line must have a clear vision of where it is going; creating the message to communicate the “why” to staff and leaders alike is a critical element. Employees must grab onto the “why” before we can begin to teach them the “how and what” that ensures leaders are progressing. Coaches can identify strengths and gaps in current performance, as well as accountability and engagement for the organization’s journey. This alignment creates a unique coaching plan to assure the best means to develop and reinforce the desired change.


You cannot expect leaders, staff, and physicians to automatically have proficiency in patient-centered skills and behaviors. It can, however, be developed.


Ensure that skills and proficiencies are executed well and consistently. Coaching plays a powerful role in validating that skills are transferred.


Constantly monitor outcomes and execution—this is key to maintaining focus. However, coaches must make certain to engage new leaders, staff, and physicians and ensure the onboarding process is aligned and that cultural expectations for the patient experience are maintained.

The Coaching Model in Action: Teaching Hourly Rounding

Let’s take a practice that our coaches regularly address during client engagements: hourly rounding.

• Build trust with the departments that need to adopt or improve hourly rounding.
• Discuss the benefits of hourly rounding and understand previous strengths or barriers to hourly rounding in the past.
• Agree to a policy and practice for executing hourly rounding and set non-negotiables (ex. No pass zones for call lights).
• Set time-bound goals for implementation and results monitoring.

• Work with department/division leadership to understand the skill of hourly rounding. Teach the leader how to validate hourly rounding through patient rounding, coach their staff on hourly rounding, and recognize great practice.
• Train the staff using evidence-based practice (HealthStream Engagement Institute recommends addressing 5 key patient needs: Pain, Positioning, Personal Needs, Potty/Bathroom, and Privacy) and use tools such as an hourly rounding log to visibly confirm hourly rounding with the patient.
• Work with the staff to develop Words That Work and the RELATE model for patient-centered communication to narrate their care and the hourly rounding process. Manage up the importance of hourly rounding to patients.

• As a coach, take the opportunity to let staff simulate hourly rounding.
• Use an hourly rounding competency tool to create development plans.
• Observe leaders validating hourly rounding and coaching their staff on hourly rounding.

• Use patient experience and quality outcomes as metrics of success.
• Leverage hourly rounding tools to ensure this evidence-based practice is occurring.
• Pair up high-achieving leaders and staff with team members who may be struggling.
• Celebrate, celebrate, celebrate successes.
• Integrate into new employee and leader orientation the skills necessary to adopt this practice.

The art of coaching can be applied to each and every technique you want to see adopted in your organization— and it produces results. Coaches trained in patient-centered excellence are in a unique position to see, assess, design, and tailor coaching to address an organizations’ challenges in providing not only clinical excellence but service excellence. Coaching supports developing your workforce and building your most critical assets—your people.


HospitalCompare.gov. Hospital Consumer Assessment of Healthcare Providers and Systems Survey (2014), Owens, K. The HCAHPS Imperative for Creating a Patient-Centered Experience. BLG, 2011.

Printed Summer 2014 PX Advisor


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