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Healthcare Quality Improvement

It Starts with Culture Change


Updated September 18, 2013

Healthcare Quality Improvement
@Jupiterimages, Getty Images

Healthcare quality improvement has traditionally been focused on the clinical aspects of care whether in a nursing home, hospital or in the home. Many skip over the fact that healthcare quality starts with culture change. And that is based in people. Empowered people led by inspiring leaders are the key to quality improvement in aging services. This article serves as an underpinning for any quality initiatives that you might be pursuing whether from a clinical standpoint or otherwise. In short healthcare quality improvement and culture change are tied at the hip.

Marketing and Customer Experience

Two-thirds of the economy is influenced by word of mouth. One word of mouth is equal to 600 advertising exposures. Word of mouth is the most potent marketing a business has going. Just ask the auto industry. In a 20-year span they increased their television advertising by 1,378 percent but sales only increased 17 percent.

Consider this quote from Andy Sernovitz, CEO, Word of Mouth Marketing Association: “In many cases, WOM isn't actually "marketing" at all. It's great customer service that earns customer respect.”

So word of mouth is spread through customer experiences. Yet not all experiences have the same value. You can buy a cup of coffee for a quarter in many places. So why do many spend three dollars or more to buy one at Starbucks? Yes, it’s the experience. But what about it? My Starbucks-like experience is at Panera Bread. The following contributes to my experience.

  • It is a place to gather and be with others.
  • I conduct business there. In fact I can spend a whole day in a Panera and never be asked to leave.
  • They have free WIFI.
  • They have good, healthy food that I perceive as reasonable priced.

In short it is the total experience that makes me loyal. In healthcare, there have been numerous studies of quality. But here’s the thing. When those in the profession talk about quality, they speak of certain metrics, specific measures around clinical care. When the public talks about their quality healthcare experience, they are referring to the total experience. So even if the operation was a success, if the discharge planning fell apart, well some might convey to others that they had a bad experience. So first connect marketing to experience. Now let’s look at experience management in healthcare, the building block for any clinical quality improvements.

Experience Management Slow to Make Progress

There is a big movement afoot in healthcare to change patient experiences. In hospitals they call it patient centered care. In nursing homes, it is person centered care. Being an “insider” I am very close to the industry and see the advances that have been made. Yet perceptions outside of healthcare are neutral or negative. And actual patient/resident experiences have not progressed very far.

In an annual survey of caregivers and nursing home staff, My InnerView found that 85% of consumers rate nursing homes as good to excellent in satisfaction and willingness to recommend. Of that, 35 percent give it the excellent rating. On the other side, 68 percent of employees rate their nursing home as good to excellent place to work. While you may think these figures are good, they are a good start only.

In one of our presentations, we show a photo of a nursing home manual entitled “Death and Dying in Long Term Care Facilities, Operational Guidelines. The person who posted that picture on Flickr, cynically commented:

“So, if you die in a long term care facility without following the operational guidelines, do they make you die all over again (correctly this time)?”

The point made is that in healthcare we are often swallowed by regulations that we tend to forget that there is a real person at the end of this who is receiving care. Healthcare is siloed and often all the parts do not communicate with each other because they are too busy following the rules that govern their domain.

Here is another analogy we use that might shed light on why quality and experience management has not moved more swiftly.

Consider that healthcare workers are like firefighters. Both experience tremendous joy and sorrow as part of the job. Yet the healthcare family suffers from burnout while people actually volunteer to be part of the firefighter culture. The firefighting culture includes the camaraderie and community of the firehouse where firemen share, vent, cry and laugh. They are considered heroes.

Yet, healthcare workers suffer burnout. The stress they carry has nowhere to go so they take it home. Stress leads to poor quality, missed steps and can endanger lives.

Cleveland Clinic has helped address this by instituting what they call Code Lavender. If anyone in the organization is suffering emotionally and mentally (maybe a close patient died) a team of social workers, pastoral care workers and others will come in like a SWAT team and help that person or unit.

So you start to see how any clinical improvements must first start with the culture of the organization.

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