HCAHPS Success:
It's About Engagement, Cooperation and a Passion For Service
There's a great article in the October 2013 issue of Inc. Magazine titled "The Re-Education of Jim Collins," by Bo Burlingham. The writer explains how Collins worked with cadets at West Point and observed that these men and women—with their rigorous and demanding daily lives which contain failure after failure—are far happier than those at civilian universities like Stanford (where Collins taught for seven years).
Not only that, these cadets were in the words of the Inc. article, "curious, questioning, and intellectually engaged" and they "went out of their way to help one another…"
Collins realized that cadets not only viewed failure as a pathway to growth, they saw their lives at West Point as deeply meaningful. Burlingham quotes him as saying "I've never been in an environment with so strong an ethos of service running through it."
Doesn't this sound like the kind of culture we strive to create in healthcare?
Consider how such a deep level of engagement and cooperation might help us in HCAHPS performance. The Centers for Medicare & Medicaid Services (CMS) mandatory Value-Based Purchasing Program has forever closed the door on any perception that the patient experience is "soft." And by linking reimbursement to HCAHPS results, it created a new urgency for delivering consistent quality care. (Yes, patient perception of care and clinical quality are two sides of the same coin.)
Now, consider the tough financial reality we face: The average U.S. health system in 2011 achieved just a 2.2 percent net operating margin, which is projected to fall to -16.8 percent by 2021 (based on CMS reimbursement changes) if an organization keeps operating exactly the same as it has. And to add fuel to the fire, third party payers are increasingly adopting CMS reimbursement rates, which will further negatively impact hospitals with a high private payer mix.
Fact: If you're not getting better faster than your peers, you're getting worse. Quick and dramatic performance improvement is critical to an organization's ability to operate so it can live its mission and fulfill its vision.
Employee Engagement Drives HCAHPS Results
The evidence shows that employee engagement is clearly correlated with an organization's HCAHPS performance. Studer Group has evaluated data submitted by more than 34,000 leaders at greater than 500 hospitals between 2009 and 20137 as part of Quint Studer's Straight A Leadership Assessment.
In comparing HCAHPS performance of those who cited employee engagement as "one of the top three areas we perform well in" to those who didn't, organizations who said they excelled in employee engagement most often had the highest HCAHPS results in all ten composites compared to those organizations who did not list it as an area of strong performance.
Organizations with the best HCAHPS performance aren't telling people "Come on, we need to get our HCAHPS results up!" Instead, they are doing a good job of creating the right kind of culture, where people are naturally engaged because they have a deep sense that their work is meaningful and filled with purpose.
The aforementioned Inc. article says:
If you want to build a culture of engaged leaders and a great place to work," [Collins] says, "you need to spend time thinking about three things.
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Service to "a cause or purpose we are passionately dedicated to and are willing to suffer and sacrifice for.
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Challenge and growth, or, "What huge and audacious challenges should we give people that will push them hard and make them grow?'
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Communal success, or, "What can we do to reinforce the idea that we succeed only by helping each other?"
Our industry already has the "audacious challenges"—especially now. Our job is be sure we're connecting the dots for people on the incredible service we're providing and to make it easy for staff to collaborate with each other.
Engaging employees has always been at the heart of Studer Group's balanced approach to driving performance for goals around People, Service, Quality, Finance, and Growth.
While the national average top box score for all ten HCAHPS composites has increased over time, the industry as a whole is slowing its rate of increase. And yet, organizations coached by Studer Group are actually increasing their rate of improvement. They currently outpace the nation by 127 percent (2Q10 to 2Q11).
Perhaps that's why organizations coached by Studer Group outperform the nation by up to 23 percentile points across HCAHPS composites. When organizations hardwire a culture of excellence with respect to the patient experience (HCAHPS), using aligned and measurable goals and a culture of accountability, they also perform well across core measures. There's a direct correlation.
In fact, at Studer Group's 2013 What's Right in Healthcare Conference, October 21 to 23 in Atlanta, GA, 18 healthcare organizations will be recognized for their outstanding HCAHPS performance (3Q2011 to 2Q2012). These range from critical access hospitals like Hansford County Hospital in Spearman, TX that ranked in the 99th percentile for "doctors always communicated well" to Patewood Memorial Hospital (part of the Greenville Health System in Greenville, SC) that ranked in the 98th percentile for "Yes, patients would definitely recommend this hospital."
As Jeffrey Filner, MD, Dean of the Faculty of Medicine at Harvard University noted at Harvard's 2012 Forum on Healthcare Innovation conference, "We need approaches to solutions that aren't…additive, but are in some sense, logarithmic."
Employee engagement is just such a solution. It's the best way to unlock the potential for collaboration that creates and sustains a culture of service and high performance.
1 [Straight A Leadership] comparison data collected 2009-2013, database of 34,139 leader responses; >500 healthcare systems.
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