If you work in a hospital or health network, there is one word you know all too well: Stress.

Internally, overwhelmed physicians and nursing shortages create an environment that is not always the most conducive to patient satisfaction. Externally, patients who are frustrated or not educated properly are more likely to be readmitted in the near future, often under emergency situations, exacerbating the overwhelmed physicians and understaffed nurses.

For your patients, going to the hospital is stressful enough. There is the anxiety of potential health problems, knowing that they’ll have hospital bills to pay or to pass on to their insurance provider and the fact that they are most likely missing work or doing what they love.

By taking time before and after care to guide patients through their treatments, you can avoid unnecessary visits from frightened and frustrated patients.

BerylHealth targets these stresses by:

• Giving patients proper information before their visit
• Connecting patients to information for physician referrals
• Assisting with preventive care
• Scheduling follow-up appointments
• Providing information for class registration
• Ensuring the care transition includes follow up calls to patients to reinforce medication compliance

The result is an enhanced patient experience, leading to more satisfied patients who will return for future care. 

BerylHealth has created a simple graphic to outline how satisfied patients drive better volume, post-discharge calls reduce adverse events, and hospitals and health systems reduce re-admissions and improve reimbursement, leading to a measurable Return on Patient Experience (ROPE)™.

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BerylHealth is very excited to be attending this year’s American Organization of Nurse Executives conference in Boston. The conference, which runs from March 21 to March 24, is in its 45th year and is all about leadership, networking, and professional development in the nursing field. The theme for 2012 is “On the Precipice of Change | The Courage to Lead.”

When our BerylHealth attendees arrive in Boston, they’ll get right to work at our shared booth with Phytel, a company that provides population health management solutions. They’ll be sharing with our booth’s visitors information on the topics of post-discharge services, reducing 

And guess what? On top of all that, we will be giving away an iPad, too. So be sure to stop by our booth!

In addition to the offerings of the BerylHealth booth, what else can AONE attendees expect to get from the conference? According to the AONE website:

• Information on current health care leadership trends, issues, and best practices;
• Lessons learned from health care experts and industry thought leaders;
• Networking opportunities with colleagues from around the country; and
• Viewings of the latest marketplace solutions in AONE’s ever-expanding Exhibit Hall

That’s an awful lot of stuff to keep those heading to the conference plenty busy!

With all of the annual meeting’s great programs, hopefully the conference’s attendees will still be able to find a bit of spare time to meander through Harvard Square and Beacon Hill, browse for some new reading materials at the local bookshops, and spend some serious time assuaging their seafood cravings.

Hope to see you in Boston!

After substantial input from hospitals and health systems, Centers for Medicare and Medicaid Services (CMS) published its final rules related to Value-Based Purchasing (VBP) in November 2011. Due to take effect in 2014, the new regulations have settled on three factors that will determine the final “grade” and the financial bonus or penalty for hospitals. How will hospitals and health systems be graded? It’s all about, patient experience, clinical processes and clinical outcomes.

The only unchanged component of the proposed regulation was the 30 percent attributed to the patient experience. While the term “patient experience” has become quite a buzzword during current reform efforts, “studying to the test” won’t achieve the best HCAHPS scores. Instead, hospitals must shift their organizational culture to refocus on experience. Hospitals will need to develop relationships with their patients – before, during and after they receive care.

The 45 percent incentive based on clinical processes will reward hospitals that are investing time, technology and human resources in best practices, rather than operational models. In the end, clinical integration and evidenced-based care will indirectly improve Medicare efficiency. The primary beneficiary, of course, will be the patient. CMS removed the Medicare efficiency component, originally proposed to account for 20 percent of reimbursement. In the final calculation, the efficiency factor was reallocated, increasing clinical processes to nearly half of the total calculation.

As hospitals become accustomed to the changes to the final rules related to value-based purchasing, there is still anxiety about timing. VBP is not the only change in the Affordable Care Act that will impact reimbursement. In addition, even though most hospitals and health systems started making adjustments to optimize both care and revenue, they are scrambling to make the operational and cultural adjustments that will ensure success. With these growing pains comes the opportunity and impetus for innovation and collaboration. For the patient, the end result will be better coordination of care and a welcomed change from “business as usual” in the delivery of their healthcare.

2012 is right around the corner and so is value-based purchasing. Both quality and patient satisfaction have never been more important. Hospital executives around the country cringe as we ring in the New Year. HCAHPS performance and reportable quality indicators from October 2011 are soon to be reported, and it begs the question: are your scores “always” going to pay you? Unfortunately, most front line staff struggle with attaining and sustaining the dreaded “always factor.” To top it off, Centers for Medicare and Medicaid (CMS) are requiring higher standards for quality of care; due to hit the wallet in January. What is more challenging is that many of the perceptions about the patient experience start with visit to the ER.

Research shows that 78% of patients discharged from the ER do not understand their diagnosis, their ER treatment, home care instructions, or warning signs of when to return to the hospital. ER doctors find it difficult to manage health and wellbeing when patients are inappropriately using the ER. By constantly flooding the ERs with questions about their treatment, patients who desperately need emergency care are forced to wait. In a recent study, it was noted that nearly 20% of Medicare patients who were discharged from a hospital were readmitted within 30 days. Unplanned readmissions are costing hospitals more than $17 billion a year across America.

Patient care doesn’t end when a patient leaves the hospital. For many, something as simple as a follow-up telephone call soon after discharge can improve care transitions from hospital to home, clarify discharge instructions and remind patients to fill their prescriptions or schedule a follow-up appointment.

Post-discharge calls not only provide patients with important clinical information, they also help reduce readmissions and improve physician satisfaction. In today’s world of healthcare reform and value-based purchasing, this impacts a hospital’s bottom-line now more than ever before.

While it might be ideal for nurses to make follow-up calls on their own patients, this is not realistic for most hospitals. In fact, research shows that nurses in acute care environments typically complete 100 tasks per shift with interruptions every three minutes. Besides, even if nurses could make these calls, is it the best allocation of resources?

Beryl’s Post-Discharge calls alleviate this task from the nurses so that they can spend more time at the bedside caring for patients. In addition, our calls can be customized to provide hospitals with what they need – valuable data to make improvements – while providing patients with another communication touch point to demonstrate how much you care about their wellbeing.  While we have always provided personal clinical and non-clinical follow-up calls from a trained patient experience advocate or nurse, our recent partnership with Phytel has helped us broaden our capabilities so that we can combine personalization with automation for post-discharge outreach.

With post-discharge follow-up, it’s all about giving patients the right call, at the right time. This not only helps improve patient care, it ultimately helps hospitals improve their bottom-line.

Nearly one in six Medicare patients will wind up back in the hospital within a month after being discharged for a medical condition.  These unnecessary readmissions can have a huge impact on families, leading to more tests and treatments, more time away from their home and family and higher healthcare costs.

Readmissions hurt hospitals too. Beginning in fiscal year 2013, hospitals will be fined up to 1 percent of their total Medicare billings, and that penalty rises to 2 percent in 2014 and 3 percent in 2015. Hospitals have a lot of work to do until then. New data from the Dartmouth Atlas Project shows that readmission rates have increased nationally for some conditions over the past five years.

Hospitals need to find ways to effectively manage care transitions to reduce their readmissions.  This means redefining the point of care to include follow up care in addition to care at the bedside.  By understanding that care doesn’t stop when patients exit the hospital door, hospitals can build stronger relationships with patients and ensure that they don’t end up entering the same doors with an avoidable readmission. There are a few strategies that can enhance follow up care:

• Calling patients after their discharge to ensure that they are following their discharge instructions
• Connecting patients to health classes to manage and improve their health
• Connecting patients to a primary care physician

Beryl research shows that post-discharge calls help reduce 30-day readmissions and improve patient satisfaction.  This is even when these calls are outsourced to nurses who don’t work for the hospital.  Connecting with patients after discharge also supports overall Customer Relationship Management (CRM) goals by strengthening the patient relationship and facilitating the conversation to link patients to other appropriate resources.  Good follow-up care is not only the right thing to do when it comes to managing the patient experience, but it’s also the right way for hospitals to prepare for impending readmission penalties. 

The system that is integral to our every day is foreign to patients.  They don’t know which health system their doctor is affiliated with, and no matter whose shift it is, they want to see their nurse.  They see inconsistency where you see continuity of care, and they see a bad experience where you see a good outcome.  This is because communication, not process, has the greatest impact on their perception.

Hospital executives spend a lot of time in other people’s shoes, including everyone from the charge nurse to primary care physicians to mayors.  As big an undertaking as that is, it’s important to step into patients’ shoes too. Every interaction you have with a patient will enhance your brand or detract from it.  Consider a few strategies for opening communication channels:
 

Never check patients off your list.

Once the patient is discharged from our care, we tally the procedures, collect the revenue, audit the outcomes and send out a survey to see what they thought. Then, we’re done – until the next time the patient needs care. We hope we have done a good enough job that they will choose us again. Rather than hope, why not continue the relationship?

Get to know your patient further, and you’ll discover their health needs didn’t stop when they exited the hospital.  How many discharged patients do not have a primary care physician?  How many patients are readmitted to your hospital because they did not understand their discharge instructions?  How many patients discharged had a negative experience you don’t know about?

Invite doctors to the table

Patients often miss the connection between doctors and hospitals, so affiliated or independent, physicians are shaping the patient experience in your hospital.

Just opening up the issue of patient communication for physicians to discuss can make a difference for both hospitals and physician practices.  Start the discussion with “I’m Sorry” shield laws.  The University of Michigan Health System says over 10 years, their I’m Sorry policy halved malpractice claims and improved patient satisfaction.  If these two words lead to savings and satisfaction, there are bound to be others that create loyalty and preference.

Communicate wherever, whenever

Delivery on your brand begins with the first encounter. How you handle the initial inquiry and help to meet need is critical. That first encounter can take place anywhere.  It could be a call, or stopping by a physician practice.  These days, it could be a tweet or a Facebook post.

Patients expect to be able to interact using two-way communication through your website and through social media. Your digital strategy should incorporate real-time answers.  While new channels create challenges, opportunity is greater.  You can increase frequency of communication and leverage word of mouth to establish your hospital as the provider of choice.

The common thread through these solutions?  Speak!  Hospital leaders must understand and respond to the relationship gaps in hospitals, physician offices and patients’ homes.  The experience doesn’t start and stop the way some hospitals think it does.  If you’re doing it right, it will never stop at all.

(P.S. If you’re at the November Greystone Healthcare Internet Conference in Orlando, please plan to join us for the Tuesday 1:45-2:45 session, “If You Think Selling Snowballs to Eskimos is Hard…” In this session, you will hear from us and our client on bridging the relationship gaps with patients).

In its simplest form, healthcare’s problem is this – costs are too high and value is too low.  Similarly, the healthcare industry has two basic options—it can cut care or improve it. 

Enter value-based purchasing.

The Affordable Care Act allowed Medicare to create value-based purchasing, potentially the biggest game-changer since managed care. Beginning in October 2012, hospitals will be paid for inpatient services based on the quality of the care, rather than the quantity of services.

The program’s initial rollout includes 13 measures. While the majority measure adherence to evidence-based practice guidelines, the remainder measure the patient experience.  The patient experience, once heralded by nurses, doctors and staff on the floor, will soon become the battle cry of the CFO.  The result?  As hospitals tighten their belts and focus their efforts, they will need to make smart investments to improve care from the patient perspective.

The hospital’s bottom line will be a direct reflection of the patients’ responses to their HCAHPS survey.  According to the HealthCare.gov website, the Patient Experience of Care Measure will count the following questions for or against reimbursement:
• How well nurses communicated with patients
• How well doctors communicated with patients
• How responsive hospital staff were to patients’ needs
• How well caregivers managed patients’ pain
• How well caregivers explained patients’ medications to them
• How clean and quiet the hospital was
• How well caregivers explained the steps patients and families need to take to care for themselves outside of the hospital (i.e., discharge instructions)

While it seems easy enough, nurses and doctors are so weighted down by heavy caseloads, regulatory paperwork and adapting to needed technological changes in the workplace that the care experience often falls below patient expectations.

It’s important for hospitals to begin understanding their patients’ disappointments in real time, before HCAHPS reports turn up ugly.  Beryl’s post-discharge services do just that, “closing the loop” to offer an immediate opportunity for patients to comment on a positive or negative experiences.  With this input, hospitals can be agile in identifying problems and improving their rapport with patients.  Beryl’s registered nurses can also review post-discharge instructions to ensure proper follow up.  Patients have a better experience, and the hospital improves patient compliance and reduces readmission rates.

There is a direct correlation between the business culture of a company and its financial success, and people are the drivers of both. With this in mind, when hiring, it's wise to focus more on finding someone who fits into the company culture rather than exclusively looking for certain skills. I base hiring decisions 60 percent on fit and 40 percent on skills.

This doesn't mean simply hiring someone you like and hoping they can do the job. The goal should be to analyze the candidate's personality and introduce the potential employee to the company's culture, so you both can make the right decision.

A few years ago, we had a senior executive who didn't fit. She had been hired through an extensive interview process, but since no hiring process is perfect, we didn't pick up on some key fit clues. Once she was onboard a few months, she began creating havoc across the company, making decisions without gathering input or gaining consensus, and putting our culture at risk. After coaching failed, we decided to let her go. When we did, a cloud lifted off the entire company. In hindsight, we waited too long to act.

Here are 10 tips to help you avoid making the same mistake and hire with fit in mind:

1. Make the hiring process tough so managing will be easy. When hiring, the goal should never be to just put a butt in the seat. Have patience and hire the right person for the job.

2. Look internally first. Since these individuals are already part of the family, chances are they fit.

3. Ask job candidates to go through multiple interviews. These interviews should be with the hiring manager, HR representatives, and peers above and below the candidate's position. By gathering perspectives from up and down the organization, you will have a broader perspective on fit.

4. Make sure interviewers ask fit-related questions. These are generally behavior-based questions, and there are plenty of guides on the market that can help.

5. Ask candidates to complete personality assessments. But keep your expectations reasonable. There is no ideal test for fit.

6. Communicate the importance of company culture and values. Make sure they understand how these elements factor into hiring and firing decisions so they can recommend outside candidates who might fit into the company's culture.

7. Reward employees for referrals. Create a recognition program that acknowledges employees who are living out the company values and supporting the company culture.

8. Provide coaching for employees who have veered off-course. Some people can change if their behaviors aren't too deeply ingrained.

9. Conduct annual culture reviews. These reviews enable the senior management team to determine which individuals have fit problems and uncover whether others have simply developed misperceptions about certain individuals. You can also identify "fit superstars" who can serve as mentors. In grading employee goal performance, keep fit in mind. Twenty to 50 percent of an employee's evaluation should be based on fit or adherence to company values.

10. Don't delay in pulling the trigger. If an employee consistently falls outside the company's cultural boundaries, don't be afraid to let them go. That's a tough position to hold in a company with a familial atmosphere. But just as hiring the wrong employee hurts morale and impedes your company's ability to reach goals, keeping those same employees makes matters even worse.

I always say to hire the heart and not the head. This principle holds true whether you have two employees or 2,000. I can teach people skills, but it's very hard to teach fit. For the most part, people either fit into a company's culture or they don't, and having people who fit is a key to success.

How to Hire With Fit in Mind: Ten tips to help you hire people who fit your company culture
http://www.entrepreneur.com/article/217475
Reprinted with permission of Entrepreneur Media, Inc.
Copyright 2010 by Entrepreneur Media, Inc.
All rights reserved.  

Profits are important. I think more businesses will adopt a multiple stakeholder approach in 2011, realizing that relationships with customers, suppliers, the community and especially employees will be the keys to business success.

I predict 2011 will be marked by a growing realization by companies about the importance of supporting, growing and driving employee engagement, more so than the pursuit of profits as the primary business priority. If you begin with the fundamental goal of increasing employee loyalty that will lead to customer loyalty and loyal customers will drive profit into your business. You can then use those profits in part to invest back in your employees to give them better tools and resources to do their jobs.

This “Circle Of Growth™” philosophy will undoubtedly grow in popularity and practice, not only in the U.S., but at a global level as well. I . I recently had the opportunity to visit other countries, from Brazil to Vietnam, and the response to these philosophies was very positive. This experience tells me that businesses around the world are more open than ever to a new way of thinking about business objectives and how business is conducted.

In addition to focusing on employee engagement, successful businesses in 2011 will also:

1. Focus on developing a “trust and track” system for performance management, rather than relying on a “command and control” system of leadership. In other words, the days of company leaders simply dictating what employees do to improve revenue or reduce cost without regard for their opinions or welfare are on the way out. A trust and track management system fosters more independent thinking, empowerment and accountability among workers.
 
2. Spend money to enhance company culture. Right now, most employees are staying in place because the economy makes it hard to get other jobs. But when the economy starts to rebound, you’ll be at risk of losing your good people if you don’t consistently show them how much you appreciate what they do for you. It doesn’t take a lot of money. It just takes a commitment from the top and an ongoing effort to improve internal culture.

3. Focus on engaging talented employees, not simply hiring talented employees. We have a big performance problem in this country. That’s because only about one-third of workers are totally engaged in their work. American companies are losing money because of reduced productivity, which points directly to this lack of engagement. In fact, one study showed that highly engaged employees outperform their disengaged colleagues by 20-28 percent (Conference Board, 2006). Spend time developing your stars.

4. Elevate character over technical knowledge or skills when hiring leaders. This market provides employers tremendous opportunity to hire talented leaders with great skills. But hiring leadership should be 60% fit and 40% skill. Take the time and have the patience to make sure your newest leaders help maintain and even elevate your culture.

5. Develop corporate and individual performance and compensation goals that encompass more than just the bottom line profit. While overall profitability is certainly an important goal and a key component of any balanced scorecard, individual and corporate performance measures should take into account employee and customer satisfaction, as well as people’s ability to build relationships and adhere to the company’s core values.

6. Hire for fit and fire for a lack of it. Coming out of this very bad economic period, companies should do some soul searching and ask, “How do we want to start over?” Part of this analysis should be, “Who is going to be on board to help with our rebuilding effort, and who do we want to keep on our team? Who fits?” Don’t be afraid to get rid of those that don’t “believe.”

7. Expand communications with employees. Company newsletters and intranets will continue to be essential elements of employee communications, but so will blogs and “tweets” from multiple executives … and not just the CEO. For companies that are focusing on retention, I also think you will see the return of personal notes of thanks and appreciation. Technology will never replace the personal touch when it comes to enhancing important relationships.

I believe that, as entrepreneurs, we have a higher calling. I believe that our #1 job is to enhance the lives of the people that work with us. Many successful business leaders have already grasped this approach.
 
Why am I so confident that other companies will adopt this employee-first philosophy? Because the track record of companies that have pursued it is very strong: Southwest Airlines, The Container Store, Costco and Whole Foods are great examples. In the 10-year period ending June 2006, these companies, which focused on building positive employee cultures and employee engagement, returned 1,026 percent for their shareholders. Meanwhile, companies in the S+P 500 earned 126 percent. Bottom line…focusing on culture and the factors that build it pays off, and will do so even more in 2011.