Katie Owens - Healthcare Speaker and Executive Coach

Lead Author, The HCAHPS Imperative for Patient-Centered Excellence

Category: Competency

The Imperative of Culture

There is no doubt that we work in an industry filled with challenges to overcome. However, throughout my career working with America’s hospitals and health systems, I have found that organizations make the most progress focusing on building up strengths and then closing gaps with areas that are not working well. Time and time again, our culture can rise to the occasion to let our best and brightest team members bring our mission forward to assure patients receive the very best care possible.

Have you ever wondered how you can leverage your culture to achieve better results? Recently our team at HealthStream was inspired to conduct an empirical study of the impact of culture on key performance outcomes. With so much uncertainty in healthcare today, we wanted to test the value of high performing cultures create for their patients, employees, and providers. In particular, we wanted to assess the attributes of culture that equip organizations to achieve great outcomes. Our study was published this month in the Journal of Healthcare Leadership.  I hope you will take a moment to read about the study.

Creating Employee Joy: Best Practices for Employee Engagement

Jim Eggers and I have recently been immersed in uncovering findings for our HealthStream National Benchmarking Study on Healthcare Employee Engagement. We analyzed responses from over 250,000 leaders, staff, and physicians. In my last HealthStream blog titled, “Making a Difference in Healthcare Employee Engagement,” I shared results relative to the stagnation of employee engagement (e.g., no positive or negative progression with national norms), disparities between leadership and staff engagement, and strategies to create engagement based on our key drivers. As we look at the dynamics of healthcare, it can ask one to question, “Does joy still matter today?”

To me, the question comes back to, “Do our patients and their loved ones deserve to encounter employees and providers who are engaged and find meaning (dare I say joy) in their work?” The answer is yes. To that end, my goal is to focus on sharing learnings from our study that will help leaders change the status quo.

We know from our research that:

  • Daytime employees are more engaged than night and evening employees with their organization. (3.26 vs 3.21 and 3.10 respectively)
  • The first six months is the peak of employee engagement. Engagement falls steeply over the first five years of employment.
  • Groups that experience the lowest intent to stay include nurses and millennials.

I had the chance to present our findings to more than 150 attendees on a recent Healthstream webinar. Our goal was to discuss how we can create employee joy based on what we learned during our benchmarking study. Interestingly, when I asked respondents to share barriers to creating joy, I received some of the following responses summarized by this word cloud. Additionally, some of the direct feedback included:

  • Workload, stress level, and reward (is the pay adequate for the amount of work)
  • Staff burnout, uneven workload, and communication
  • Being so busy that there is never any downtime, having a supervisor who doesn’t acknowledge anything positive that you do, not allowing staff to pursue their special interests (as appropriate within the organization)
  • Negative attitudes and being short staffed
  • Distrust, negativity, fear, and lack of engagement


Employee Barriers

Webinar Poll: What are barriers to creating joy?

To be quite candid, I was heartbroken to see these responses. Healthcare leaders, employees, and providers are some of the most talented and hardworking individuals. Their skillsets and compassion literally save lives every day.

After we discussed the barriers, I shared strategies to turn the tables and create more joy. After all, there is no denying we work hard in healthcare. There are good days and bad days. We have to be emotionally honest about the demands of our careers. Yet, there are steps that leaders and individuals can take to make a positive difference. To that end, I closed out the webinar by asking participants to share one step they can take to create more joy. While I was clearly saddened by the barriers, I was beyond encouraged to see the takeaways of participants.

Responses to ways to create more joy included:

  • Follow up – let employees know you are listening to them.  Show empathy especially during stressful times.
  • Conduct town hall meetings and focus on answering the whys. Senior leadership — presenting achievements and the how/why it makes a difference for the employees and patients.
  • Utilize the RELATE model with managers and encourage them to use it with their staff.  Provide senior rounding more often including all departments.
  • Positive feedback.  Staying positive in spite of circumstances.  Thanking the staff for what they do. 
  • Personal accountability for creating daily joy… Be the reason someone smiles today.  It’s about the relationship!
Creating Employee Joy

Webinar Poll: What is one step you can take to create more workplace joy?

Recognition, Communication, Listening, Rounding and R.E.L.A.T.E. (HealthStream’s people-centered communication model) are all budget neutral items. You can appreciate someone despite being short staffed. We can encourage each other and listen when we are having a personal bad day. Let’s take a stand together to make a positive difference for ourselves and our colleagues. I am confident we can cultivate these steps and remember that through each of our hands, every patient is counting on us to be our best and engaged.

Download a copy of our Benchmark Report: 2016 Employee Engagement in Healthcare here.


20 New Year Tips to Help You Elevate the Patient Experience in a More Efficient and Effective Manner

With 2016 coming to a close, I thought I would include 20 tips for 2017 to help elevate the patient experience in a more efficient and effective manner. I like to call it #PXHACKS!

Wishing you a happy New Year that will bring you greater heights of success and prosperity.  -Katie

  1. Ask your team what made them feel most reassured when they have been a patient. Rate your department on those criteria.
  2. Set a measurable, time-bound patient experience department goal. Strive to achieve a target that links to your organizational goal.
  3. Ask your staff to take Patient Experience Survey most related to their work environment. Educate how patients hold us accountable
  4. Create a list of Zero Tolerance words (short staffed). Engage your team to turn negative words into reassurance.
  5. Engage high achievers as champions in Patient Experience journey-those motivated & passionate- let them create momentum with you.
  6. We are always onstage with the Always Patient Experience-Compassion, Verbal, Non-verbal Cues.
  7. Upon visit, have admissions ask patients and families what is most important for their care. Use whiteboard to document.
  8. You are empowered. If you see trash pick it up, greet colleagues, patient and families with eye contact and a hello.
  9. Sit at eye level when communicating important information.
  10. Narrate your care and process. Never assume patients and families understand what you are doing and why.
  11. Always reinforce your patients and their families are in good hands with you and your organization.
  12. RELATE w/ every patient: Reassure, Explain, Listen, Answer, Take Action & Narrate Care, Express Appreciation.
  13. Block 30 minutes every week to walk in the shoes/crutches of your patients. See & feel patient experience from their perspective.
  14. Set Expectations early and often. Remember every person in your care is not used to the role of patient.
  15. Reward & recognize employees for going above & beyond for Patient Experience. No one ever feels over recognized at the end of each week.
  16. Give staff feedback about their performance. Share Survey results, patient experience comments and rounding feedback.
  17. Seek patient and family feedback when implementing programs. Let the voice of your healthcare community guide you.
  18. We miss the mark with Hourly Rounding & Bedside Report. It is not about the checklist or task but patient engagement and empowerment.
  19. Go on a ‘gurney journey’ to empathize with your patients and design improvements.
  20. Establish PX competencies for individuals who wear badges across the care Train and validate behavior.

What are your 2017 #PXHACKS (Patient Experience) Tips? Send me your feedback. If you enjoyed this post you may also like the article titled, “Can We Afford to Stay in Our Lanes to Achieve Patient Experience Excellence?”


Can We Afford to Stay in Our Lanes to Achieve Patient Experience Excellence?

As I was driving to the Nashville airport after a successful week at HealthStream Summit I saw a traffic sign that read, “Stay in Your Lane.” It caused me to reflect on how often we inadvertently give messages to our best and brightest talent to keep their eyes focused on the road ahead and not to waver. Looking at my own career and experiences, the most memorable moments, achievements or sources of support came from those chances to go above and beyond or be on the receiving end of an individual willing to go the extra mile. Can we afford to stay in our lanes to achieve patient experience excellence?

The Patient Experience

When it comes to the patient experience, there is not a person in our care that wants us to deliver a checklist, only do our job. They want to know they are our biggest priority- they want to trust us that in their moment of need, we will not stay in our lanes- we will unapologetically go above and beyond for them. We will be brave to speak out in the event we see an error, pray with them when they are scared or losing hope, comfort their loved ones and sit at their bedside just a moment longer.

The realities we face in our day to day grind can sometimes cause us to lose perspective. My dear colleague Kathy Boswell, Director of Organizational Development at Brookwood Baptist Health, shared; as leaders if our employees do not see us at our best, how can we expect each patient to see us at our best. Kathy reminded me that we are always on stage.

I was asked to be the opening keynote at our Patient Experience Workshop (attended by a group of national leaders who are passionate about every patient receiving the best care possible) and decided to poll the standing room only crowd. I wanted to know what actions or behaviors made them feel most reassured when they were a patient. The results (below) were compelling… When we are a patient, we want confident employees, communication, and eye contact. None of these require a capital investment. We are all called to re-sensitize the powerful role we play each day as soon as we put on our badge. It’s time to take action! I challenge you to stand up and stand out among your colleagues. Lead by example and BE the difference in the lives of your patients.

Stay in Your Lane

Let us not get distracted by the grind, our glance time, our productivity and forget that every patient deserves our very best. We can’t have a different standard between what we would want for ourselves or our loved ones and what we want for our patients. Do you think we can afford to stay in our lanes to achieve patient experience excellence? Let me know your thoughts by leaving a comment.

If you enjoyed this article you may be interested in “20 Tips to Help Elevate the Patient  Experience in a More Efficient and Effective Manner.”

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



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


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.”

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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


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