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The Real Dollar Value of CultureHow can you know?

Presented By: Lyn Ketelsen, MBA, RN

Vice President & Chief Patient Experience Officer

HCA, Nashville, TN


From Memorial Hospital of Tampa:

A patient’s sister called to compliment a new nurse on our post-surgical

care unit. The caller’s brother is deaf/mute and his sister has come to

expect that he will get sub-standard care because of his communication

deficit, so she stays with him the entire time whenever he is hospitalized.

She commented that this was the first time she was comfortable going

home because she knew he was in good hands. The nurse made up

flash cards with all the typical questions a nurse would ask a patient and

flash cards with all the potential answers. She was able to effectively

communicate with the patient without having to get an interpreter. The

sister said she had never been so impressed and wondered why no

other nurse had ever thought to do this.

At Memorial we strive to be innovative in always putting the patient first

and this is a great example of the innovative team of people we have on

staff.

2

Every Patient Has a Story


• 250+ hospitals and freestanding surgery centers in 20 U.S.

states and in the United Kingdom

• 26 million+ patient encounters annually

• 8.1 million emergency room visits annually

• 233,000 employees

• 37,000 active physicians

• 79,000 nurses

HCA at a Glance


Above all else, we are committed to the care and improvement

of human life. In recognition of this commitment, we strive to

deliver high-quality, cost-effective healthcare in the

communities we serve.

4

HCA Mission

Dr. Thomas Frist, Sr.


5

The HCA Patient Experience


A set of qualitative and quantitative tools are used to conduct

facility/unit assessments across common characteristics

Site visits3

1 Employee surveys, focus

groups, interviews Quantitative assessment2

▪ Structured interviews and

surveys with facility leaders and

nurses around leadership and

employee engagement

dimensions

▪ Analysis of performance across

key operational, clinical and

financial dimensions correlated

to HCAHPS performance

▪ Standardized assessment of

performance across primary

practices proven to drive patient

experience and explicitly asked

on HCAHPS surveys

SOURCE: McKinsey Customer Experience Service Line


SOURCE: Patient experience survey of ~150 facilities across US, 2015; facility site visits

Facilities that consistently perform in the top-quartile for PE and RN

retention have several common characteristics

Leader-

ship

Employee

engage-

ment

Specific

tactics

Key satisfaction/performance drivers

Leaders are accessible, approachable,

and committed to the vision for priority

initiatives

▪ Clearly communicate mission, vision, standards of behavior

▪ Ensure effective leader employee rounding for all shifts,

with follow-up

Goals/governance for priority initiatives are

well-defined, and there is accountability for

performance and quality

▪ Clearly communicate mission, vision, standards of behavior

▪ Ensure effective leader employee rounding for all shifts,

with follow-up

Hiring reflects the priority initiative(s),

vision and mission

▪ Enhance effectiveness and consistency of hiring / selection

processes

▪ Implement peer interviewing practices

Staff are aware of the mission and

empowered to help shape the vision of

initiatives

▪ Provide consistent messaging, training, and opportunities

for input

▪ Drive high impact engagement through purposeful

communications and messaging

Specific tactics are in place to maximize

performance against priority initiatives

▪ Implement first priority tactics (e.g., hourly rounding, nurse

leader rounding)

▪ Focus on consistently executing priority tactics before

expanding playbook

Performance is tracked and people are

held accountable for quality and

consistency of implementation

▪ Routinely track quality and consistency of execution

▪ Make delivery of PE tactics core piece of incentives and

review process

Example actions

Not exhaustive


Given the unique profile and starting point of each facility/unit, tailored

assessments are required to determine priority focus areas

Key satisfaction drivers▪ Employee surveys, focus

groups, interviews

– Structured interviews and

surveys with facility leaders

and nurses around leadership

and employee engagement

dimensions

▪ Quantitative assessment

– Analysis of performance

across key operational,

clinical and financial

dimensions correlated to

HCAHPS performance

▪ Site visits

– Standardized assessment of

performance across primary

practices proven to drive

patient experience and

explicitly asked on HCAHPS

surveys

1AssessmentN/A 1 2 43

Each facility receives score based on weighting of assessment inputs

2

3

Conduct standardized assessments

across key drivers using 3 tools


Assessments are translated into tailored action plans, which are

supported by robust performance management practices

Managing performance requires regular

tracking of both leading and learning

indicators

Action plans should focus on 3-5 priority

tactics given a facilities unique profile

▪ Performance management systems identify

issues, drive strategic resource deployment,

and align incentives, e.g.,

▪ Track leading indicators against each key

action in addition to learning indicators

(HCAHPS)

▪ Tie manager compensation to priority actions

on plan

▪ Action plans should be data-driven, focused

and detailed, e.g.,

▪ An algorithm using validated metrics guides

facilities to the highest impact areas

▪ Facilities choose 3 primary and 3 secondary

major actions to focus on

▪ Facilities provide supporting tactics and

validation methods informed by list of best

practices


• 83% (188,244) of total population participated in 2016

• All of the survey categories below saw improvement from 2015 to 2016

10

HCA 2016 Healthy Work Environment SurveyCultural Elements

Survey Category YOY Change

Leadership +1%

Leadership: Immediate Supervisor +1%

Leadership: Senior Management +1%

Voice +3%

Rewards +1%

Culture +2%

Quality +2%

Outcomes +1%


• Peer interviewing

• High performers only being culture guardians

• CEO meeting 1:1 with re-hires

• Senior Leader Clipboard Rounds

• Employee Rounding

• Employee Forums/Town Halls

• Culture

Strategies


12

HCA’s Patient-First Focus


13

Clipboard Rounding


14

Peer Interviewing

Thank You!

Lyn Ketelsen, MBA, RN

Vice President/Chief Patient Experience Officer

[email protected]

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mailto:[email protected]

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