The Patient Experience Skill Building System:
The WellSpan Experience
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Click below to hear comments from Jamie Markel, Director of Organizational Development at WellSpan Health in York, Pennsylvania, about her organization’s exciting strategy to train 8000 staff and physicians with the Patient Experience Skill Building System.
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Q: Why did you start this training initiative?
Jamie: We’ve been developing strategies to build a service culture for over 12 years and we keep getting average scores on our patient feedback surveys.
Q: How did you decide to work with Wendy and her team?
Jamie: I personally had followed Wendy’s work for over 20 years and really used a lot of her resources in the last 12 years. Then in 2007, we invited her to speak at our system’s Board Leadership Retreat about the strategies for achieving breakthroughs in the patient experience. The guiding principles she shared for achieving an exceptional experience so resonated with our physicians and leaders that we knew involving Wendy would really catapult our efforts. So we had Wendy and Jill come and meet with our leadership, our executive leaders and we started to talk about how this massive training for 8000 staff and physicians would look. The thought of developing, coordinating and facilitating a series of leadership and skill building sessions was daunting for our organization, given its size. Wendy and Jill not only are content experts, they were instrumental in creating a dynamic format that’s been both fun and effective. What we really appreciated about working with Wendy and Jill is that they didn’t come in and tell us what we needed to do. They worked with our leaders, they met with our human resource team and they made this WellSpan’s service initiative, not Wendy and Jill’s initiative.
Q: How did you start?
Jamie: We started with our leaders. We developed a leadership summit with Wendy Leebov and Jill Golde’s guidance. We held eight sessions with an average of 100 leaders per session. Each of our senior leaders introduced the sessions with our service vision, our guiding principles and personal commitment. And not only did they do a thirty minute introduction; they sat down at the tables with the other leaders in the room and they participated fully the entire day. We focused on the importance of leadership in this initiative and we helped leaders develop their personal commitment and zeroed them in on what accountability involves. The energy in the room and the positive feedback from them was just overwhelming. We always have our naysayers but now we have supervisors who are held to task and hold themselves accountable to our service commitment.
Q: How long did it take to get all the training done?
Jamie: We started the skill-building videos as a journey, not a training blitz. We understood that changing behaviors takes time and focus. We set a target for learning one very specific skill at a time, each one over a 1-2 month timeframe. That means we had to schedule about 18 to 20 months for the entire skill set. We know we are in it for a long haul to really see the improvements we want.
Q: What about the quality of the materials?
Jamie: The resource packets that accompany the videos provide managers with very clear instructions and great tools for hardwiring the skills. That’s one of the most important aspects of this, the training package. We also knew that the videos had to be short; they had to be easily woven into our daily work and the workshop part had to be easy enough for all of our managers to facilitate. We’re happy with the product on both counts.
Q: How do you make the videos available to everyone?
Jamie: Two ways: We installed all the videos on our intranet. A manager or staff member can go in, click on the title of the video they want, and it comes right up. Some managers, especially if they’re working with a small team and don’t have access to a projector, show the videos on a computer right from the intranet. We also created a lending library of 75 DVD copies of the videos for managers who prefer to show a DVD. Many people rely on borrowing the DVDS. Also, when employees miss a session, they can watch the video on-line.
Q: How do people take the quiz?
Jamie: Each quiz has five questions. It takes people about five minutes to complete, if that. Staff who really understand the skills can take that quiz in just a couple of minutes. People can take the quiz on-line at their convenience. Our Learning Management System gives the quiz, scores it and tracks who completed it successfully. That way, we can report back to managers about who has taken it and who still needs to. And we have an easy way to document for JCAHO purposes. A few people administer the quiz in paper-pencil form, but that’s not as convenient.
Q: If we don’t have time for the employee workshops, can’t we just have people view the videos on-line at their convenience?
Jamie: At WellSpan, we don’t want people to just rapidly go through watching video after video and taking a quiz. That’s not learning and it won’t lead to behavior change. Our intent was for them to participate in a session at the local level with their team-mates, have discussions and plan how they can improve their performance as a team.
Q: WellSpan is a system. How did you deal with multiple entities?
Jamie: We’re an integrated healthcare delivery system with a complex organizational structure. So, we allowed our different entities to establish their own timeframes for rolling these skills out. We thought some flexibility was necessary because our different hospitals have different priorities and timeframes. It turns out that when we put all their time schedules together, they matched pretty well and there was a lot of consistency in their plans. It was almost serendipitous without a lot of formal strategy around the timeframes.
Q: Are all managers conducting the employee workshops with their own teams?
Jamie: Most are, but some are following a different approach. We have several employee facilitators who are conducting some sessions especially as a makeup for people who missed their team’s session and also for night and weekend people.
Q: Are physicians expected to go through the training too?
Jamie: Yes, one way or another. We have medical group practices that have incentivized their physicians to participate with their staff. Once the physicians started engaging in the videos with their staff, we started getting really positive feedback from the physicians. Also, so far, one of our hospitals invited Wendy to do briefings for all of our hospital physicians in person. She addressed more than 250 of our physicians at York Hospital. They went extremely well.
Q: What happens when an employee misses a session?
Jamie: Both of our hospitals have scheduled supplemental sessions so when staff can’t make it to their team meetings, they have an alternative. They attend a session with people from a mix of other departments. We have a rotating list of facilitators identified as champions in each hospital. They offer sessions several times a week to cover all shifts. In our smaller hospitals they’re offered once a week and facilitators take turns facilitating those.
Q: How do you measure results?
Jamie: Four ways. First, we took our formal surveys for patient feedback and identified seven questions that should rise as a result of the skills the staff are learning, items about patient perceptions of staff courtesy, how staff respect and treat them with dignity, the helpfulness and responsiveness of staff and the like. We rolled these indicators into a composite score and we’re calling it the Care and Communication Composite. Each of our major entities and service lines can look at the composite scores monthly to see how they’re progressing. Second, we monitor the number of patient complaints that have to do with the staff and physician attitude and behaviors, and we have a tracking system in place that allows us to run reports specific to these attitudes and behaviors. Over time, we hope to see the number of complaints in those categories diminish. A third way we are measuring is through our annual employee opinion survey. While these methods will give us quantitative data, I think the most important way we’ll be measuring the success of this education journey is through the anecdotal stories.
Q: What kind of feedback have you been getting?
Jamie: We’ve been overwhelmed with the positive feedback so far. Just the other day, our HR VP was walking down the hall and he passed a staff member and said “Good morning” and the person looked at him and said, “I would rate that as a good greeting, not so sure it’s a great one!” So there’s acknowledgement of the skills that we’re trying to embed across the organization as well as some fun in the process.
Q: Are departments that don’t provide direct patient care finding the program helpful?
Jamie: The videos and worksheets include many non-clinical examples. And the skills certainly transcend beyond the clinical. At the beginning, our clinical information officer was just beside himself because he wasn’t sure how his IT folks were going to adopt these skills because the skills are so patient-focused. Recently, he came into my office after conducting one of the employee workshops with his team and he said “I can’t tell you how wonderful it is that my directors and managers have embraced these skills! They’re already planning how to improve some of our internal processes to make their customers less anxious about things that go wrong with their computers."
Q: Are managers really capable of facilitating the employee workshop pieces?
Jamie: In our initial Leadership Summit, managers expressed a lot of concern around their fear of having to facilitate a session. They didn’t see themselves as skilled facilitators. But once they started with the first skill, we got several calls from managers who said “I can’t tell you how easy this was! I had no idea that the resource packet would walk me through step by step. This wasn’t hard at all and I had a great time.” In fact, one manager said that the first session was so invigorating for the staff that once she returned to the unit, there was a lightness in the air, and she said “It was only the first video!” Most managers are really excited to go further. They look forward to it.
Q: Are all managers successful facilitating the employee workshop piece?
Jamie: Some managers have been concerned that they can’t get staff to engage in conversations when they are having their video sessions. When we really talk with the managers, we find out that the ones having trouble are bypassing the activities that are intentionally designed to get people involved. The activities before and after watching the video are simple and great. When managers realize how important those activities are and they follow the plan and have their staff do the activities, they come back and say, “You know, this really does work!”
Q: Do the managers really do the follow-up activities?
Jamie: Our leaders have given us really great feedback about the wealth of information in the follow up activities. And the resource packets are much more than people expected. We know that there are also managers who don’t want to deal with the follow up activities and they hold the sessions, watch the video and then they go on to the next. To address that, there’s a group of us that try to touch base with managers. We keep awareness out there about the importance of the follow-up activities. We ask at meetings for managers to share how they’re using them. This puts people on the spot when they’re not using them and gives the people who are a chance to attest to their value.
Q: What advice do you have for other organizations considering this program?
Jamie: One thing we did that was a wise decision was to start with our leaders. The leadership summit was really successful in laying the groundwork. I would definitely recommend leadership development to support the program.
Q: What is the role of executives in the program?
Jamie: First of all, our executives are learning the skills too. Also, as they do rounding, they are asking managers to share stories. One of our VPs said to me, “You know, the currency of leadership is attention and that is so key to accountability. What you pay attention to gets the interest of managers. What you ask them to tell you about gets the interest of managers. So, if you don’t ask them how their service performance is, or if you don’t ask them for stories about patient complaints, then they don’t think this improvement strategy is important to leadership.”
Q: What was the focus of your leadership session on accountability?
Jamie: Building and communicating clear performance expectations and defining what it means to “meet” or “exceed.” Having conversations with your high, middle and low performers and building in recognition as well. Our concentrated effort around accountability really hit home with managers at every level, from executives to frontline supervisors.
Q: What do you do about new employees?
Jamie: At first we thought it would be easy enough for new employees to catch up by watching the videos on the iNet, taking the quizzes and having conversations with their managers and teams to apply those skills. But as we got into the first few videos, we started hearing from managers about how valuable the employee workshops were and couldn’t we do something to engage new employees beyond having them watch the videos. So, we’ve developed a two-part orientation to these skills. We have a 90 minute orientation to service that’s embedded in our system orientation. In addition to that, we will offer two sessions a month for new employees. The first: Reducing anxiety and moving from good to great. The second: The Caring Communication skills. Each part is two hours long. They’ll still have to go back, view the video on the iNet and take the quiz to get full credit and they’re required to complete it in their first 90 days.
Q: How much time do the sessions really take?
Jamie: 30 minutes at most, and that includes a pre-video activity, the video, and a skill application activity which is really very focused. So 30 minutes of staff time plus the time it takes to watch the video on the iNet if they want to review it and take the quiz.
Q: How much staff time is needed to coordinate the program?
Jamie: We have one dedicated education specialist who coordinated all of the logistics. She follows up with managers, monitors the completion of quizzes on our learning management system and also facilitates some of the general sessions at our hospitals.
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