For the past year, COVID-19 has been the focal point for hospitals across the country. It has required an enormous amount of energy and resources to ensure we have enough staff, personal protective equipment and critical care beds. Our team members have put their physical and emotional well-being on a back burner while they care for hundreds (if not thousands) of critically ill patients. It’s been a year filled with hard decisions, strong emotions and human sacrifice.
Now that we’ve started vaccinations and there is a light at the end of the tunnel, we find ourselves looking toward the future. We can start returning our focus to the things we worried about pre-pandemic: growth, efficiency, employee engagement, and quality and safety. At the center of all this is the patient experience, which is increasingly integral to operations.
At University of Iowa Hospitals & Clinics, we hold a position that is, frankly, rare among similar academic institutions. As the only comprehensive academic medical center in Iowa, our beds are typically very full. Before the pandemic, we had a median occupancy rate of 87%, compared with a national average of 65%. We also have the third highest rate in the country of transfers coming from other hospitals.
We are proud that so many Iowans from across the state choose us for their care, but filling nearly every bed almost every day—and with high-acuity patients—puts pressure on our infrastructure and caregivers.
As a result, we made a conscious decision to focus with purpose and urgency on patient satisfaction in the drive to be a high-reliability healthcare organization. Some of our work related to patient satisfaction is operational. Putting COVID-19-related operations aside, we’ve added beds and converted more rooms to single occupancy.
Our work has already paid off in dividends: This past year, we substantially improved patient satisfaction scores and quality scores despite the challenges posed by the pandemic. However, this is just the start of a longer journey. The deeper and more powerful work relates to the relationships and communications our providers have with individual patients and with each other. There is much work still to be done, and here is what we’ve learned so far:
Think From a Patient Perspective
At UI Hospitals & Clinics, we collect feedback though our Patient and Family Advisory Council. The council helps us navigate through a host of questions and keeps us accountable to do what our community needs, not what we convince ourselves that they need.
This is best illustrated by something as ordinary as parking. We didn’t think paid parking was a big issue, but we were wrong. It turns out that, in some cases, patients were avoiding care because of it. Once we listened, the complex logistical issues became secondary to the need to change. If we were in retail, for example, we’d be doing everything we could to make every part of a customer’s interaction with us seamless. So, we took a step in that direction by adding free patient parking.
Get Out of the Office
We’ve heard many times from speakers and consultants to get out of our offices, and it’s true. Spending time on the floor can be among the most valuable habits each of us can develop and improve on.
Leadership at UI Hospitals & Clinics has made this approach a critical tool for maintaining staff morale throughout the pandemic, and it is everything we already know: a chance to hear directly from staff and patients about the good and bad and reconnect with the organization’s mission—something we could all use when staring at mounds of paperwork.
Don’t Underestimate the Power of Communication and Coaching
We’re helping our clinical staff make the most out of their time with patients though our Provider Communication Program. A team of coaches from our Office of Patient Experience facilitate workshops with clinicians and then follow up individually 30 and 60 days later.
This training opens a whole spectrum of positive results. Strengthening communication between patient and provider can lead to improved patient satisfaction, more collaboration and better decisions. Critically, “better” doesn’t necessarily mean “according to the latest issue of JAMA.” It means “what is best for each patient in their unique circumstances.” For example, an elderly patient with orthopedic issues may look like he needs major surgery, until the physician listens to understand that he simply wants to walk in his daughter’s wedding, not run a marathon next spring. That changes everything.
Create a Culture of Safety That Involves Everyone
“We’re creating a culture of safety” is another common refrain in healthcare today. At UI Hospitals & Clinics, we do it a bit differently by involving everyone. Training through our Excellence Every Time Program is open to all employees, including housekeepers, food service staff, maintenance staff, physicians and nurses.
The result is that we have a shared language, and little things are caught before they become big problems.
We also highlight positive messages, and no story is too small to note. It’s a profound way to demonstrate that the organization is serious about improving across the board. Highlighting small things is a step toward changing—or reinforcing—our culture, which leads to better operations and patient care.
Make the Hard Change, Personally
Executives are good at talking. “Culture,” “mission,” “vision,” “shared goals” and “values” are easy to include in a presentation. Creating the right environment and culture, though, starts with us. Our hospitals cannot become high-reliability organizations if we ourselves aren’t right there in the fight.
UI Hospitals & Clinics’ leadership team conducts serious self-evaluation and then holds ourselves and each other accountable, a humbling and sometimes painful experience. It’s one thing to see a set of numbers indicating room for improvement; it’s quite another to hear those numbers made real in the form of negative experiences from the people who lived through them. But hearing real stories from our patients is also incredibly energizing.
Of course, there is no perfect solution. What we have found in building a culture of patient-centric care and working to become a high-reliability organization is that the best programs create a framework for anticipating and understanding needs. It’s less about being prescriptive—though that is at times necessary—and more about giving every member of the team the foundational knowledge, core resources and personal enthusiasm to make decisions and solve problems.
Often, as healthcare leaders, we can become so focused on the measurable that we lose sight of the intangibles that lie just under the surface. However, we are seeing that an explicit focus on those intangibles directly affects the hard numbers and can lead to growing success, even during challenging times, by increasing the satisfaction of patients and employees.
Suresh Gunasekaran is CEO of University of Iowa Hospitals & Clinics, associate vice president of Iowa Health Care, Iowa City, Iowa, and an ACHE Member.