Achieving Medicine of theHighest Order – Cultural

Transformation Based on “Horton Hears a Who”

Bradford C. Berk, MD, PhD

May 22, 2013

Faculty Institute for Teaching and Learning

May 30, 2009

Back to work

Thanksgiving 2009

I’ve learned what’s important

• Treating patients and families with dignity and respect

• Showing compassion and attentiveness• Valuing the patient and family

as an integral part of the

health care team• Listening to our patients

and their families

2007-12 URMC Mission and Vision

• Mission: Using Education, Science and Technology to Improve Health.

• Vision: Develop a high quality, cost-effective patient-centered healthcare delivery; lead by our world class researchers, educators and clinicians.

2013-18 URMC Mission and Vision

• Mission: The University of Rochester Medical Center is a home of healing, learning, research and innovation committed to improving health and quality of life for our patients, families and community.

• Vision: To be nationally recognized by 2020 for improving community health through transformative approaches in compassionate care, education and research.

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Strategy Map

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People and Culture- Key Component of Strategic Plan

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Enhancing Standard HR duties — benefits, hiring, payroll

New-

Implement Business Partners: who understand the specific HR challenges that their clients face to learn time-tested tactics for fostering employee engagement to be able to help managers structure incentives that drive peak

performance

Talent management software to function with existing HRMS system

Boost Evaluation Process and Tools

The healing power of touch

Compassion – We need to show we care Attentiveness – We need to pay attention to

show we care

My personal experiences:

• as a leader, • a care provider and• a patient

Patient and Family Centered Care (PFCC)

A set of principles and values that when implemented successfully improve quality, safety, and long-term outcome. In addition, data shows improvement in patient, family, care provider, and staff satisfaction.

Transforming a culture

Patients and families are repeatedly telling us we need to do better in these areas:

• Response to your concerns/complaints

• Staff addressed your emotional needs

• Staff included you in decisions regarding treatment • Nurses and Physicians kept you informed

• Staff worked together to care for you

• Time physician spent with you

Communication, Compassion and Attentiveness are Critical

URMC components of PFCC

Safety

Quality

Courage

Caring

Patient and Family-

Centered Care

Creating value enhances PFCC

Create Value (Quality/Cost) by implementing LEAN process improvement strategy

Eliminate waste in our system without diminishing the patient experience

• remove extra steps in patient flow• simplify operational processes• eradicate duplicate and unnecessary

paperwork results in better patient and staff

satisfaction Utilize LEAN approach to help create a patient and

family-centered care culture

Building a PFCC Culture

Areas of Focus:

• Facility• Medical Advances• Information Technology• Delivery of Care• People

Facility

PFCC requires a comfortable supportive environment

private rooms with family

sleeping spaces atmosphere that promotes healing

• Cancer Center Expansion• New Children’s Hospital • Upgrade of Current

Facilities

Information Technology

eRecord will promote PFCC

provides immediate and more thorough understanding

provides improved communication among providers

can identify high-risk patients to ensure comprehensive care plan and enhanced communication

can encourage attentiveness and compassion

o i.e. electronic sticky notes can enhance patient and provider’s bond by reminding care providers to engage in topics most important to patient

“I am very sorry to know that you recently lost a loved one” “I understand you are anxious to return home to care for your cat”

Transforming the way we Deliver Care

encourage patient/ family involvement

promote practices to improve patient/family and provider communication (i.e. rounding and shift change at the bedside)

breakdown silos – enhance communication among providers and multidisciplinary care teams

develop specialized Hospitalists to promote efficient, but compassionate care

shift from episodic approach to care to full continuum of care

advanced medical homes

People are the most important part of PFCC

Train all medical staff and employees to be respectful and offer compassion

• How we communicate determines how effectively we convey compassion and attentiveness

• We need to convey to our patients compassion and attentiveness by communicating about things that matter to them

• The healing power of touch

Our employees need to feel cared for to provide patient/family-centered care

Staff need to be: treated with respect supported empowered recognized

Caring for the caregivers

PFCC across URMC delivery system

GCHAS

URMC PFCC Steering Committee

SMH Highland Highlands at Brighton

Highlands at Pittsford

VNS

Patient and Family Members

Creating an ICARE Culture

Integrity - Compassion - Accountability - Respect - Excellence

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Influences on Patient Experience

Personal – behaviors/culture

Operational – systems/processes

Physical – environment/facility

Coordination of 3 broad efforts - medical center-wide - department/unit level

focus of PFCC

initiative

•2010 - 2 of the 8 HCAHPS domains at national average

•2012 - 6 of the 8 HCAHPS domains exceeded national avg.

Hospital Environment Pain Management

•2013 - Hospital wide rollout – next stage of PFCC initiative

Clearly defining ‘desired patient experience’ Focus on ‘consistent delivery’ of the experience

PFCC efforts are making a difference

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Making progress butstill below national average

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Patients’ Overall Score for Hospital is Improving

Q4 2010 Q1 2011 Q2 2011 Q3 2011 Q4 2011 Q1 2012 Q2 2012 Q3 2012 Q4 201260

62

64

66

68

70

72

74

65.7

63.1

67.667

69.4

70.569.9

70.4

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HCAHPS Overall Hospital RatingStrong Memorial Hospital

Achievement Threshold = CMS Value Based Purchasing minimum (National Median) / 50th PercentileDisplayed by Discharge Date / All Surveys

% 9

or

10 Achievement

Threshold

Nursing Communication continues to rise

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Q4 2010 Q1 2011 Q2 2011 Q3 2011 Q4 2011 Q1 2012 Q2 2012 Q3 2012 Q4 201270

72

74

76

78

80

82

84

71.7

73.6

76.5

75.3

77.9 7878.7

77.7

78.9

HCAHPS Nurse CommunicationStrong Memorial Hospital

Achievement Threshold = CMS Value Based Purchasing minimum (National Median) / 50th PercentileDisplayed by Discharge Date / All Surveys

% A

lwa

ys

Achievement Threshold

Staff Responsiveness exceeds national average

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Q4 2010 Q1 2011 Q2 2011 Q3 2011 Q4 2011 Q1 2012 Q2 2012 Q3 2012 Q4 201246

48

50

52

54

56

58

60

62

64

66

52.751.6

56.5

53.7

58.6

61.262.1

64 64

HCAHPS Staff ResponsivenessStrong Memorial Hospital

Achievement Threshold = CMS Value Based Purchasing minimum (National Median) / 50th PercentileDisplayed by Discharge Date / All Surveys

% A

lwa

ys

Achievement Threshold

Employee Engagement/Commitment Scores

Difference from:

Workforce Commitment Item

2012 URMC

ClinicalEntrprs

% Unfav

Natl UHC Avg

Natl HC Avg

2011 URMC

Clinical Entrprs

43. I am proud to tell people I work for this organization. 4.38 3% +.02 +.02 +.06

49. I would recommend this organization to family and friends who need care. 4.34 3% +.05 +.01 +.05

56. I would like to be working at this organization three years from now. 4.34 5% +.08 +.06 +.06

59. I would stay with this organization if offered a similar job elsewhere for slightly higher pay.

3.71 15% .00 -.01 +.07

64. I would recommend this organization as a good place to work. 4.29 3% +.14 +.11 +.10

65. Overall, I am a satisfied employee. 4.10 6% +.06 +.03 +.09

Measuring Workforce Commitment

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Top 10 NYS value based / readmission penalty

“I’ve learned that people will forget what you said,

people will forget what you did, but people will never forget

how you made them feel.”

- Maya Angelou

Thank You