Why 99.63% Is Not Enough
Q&A on How to Get to Always
with L. Keith Granger, CEO, Trinity Medical Center, Birmingham, AL
HR: In your keynote at Studer Group’s 2013 HCAHPS Summit, you posed the question, “Why is achieving 99.63% not good enough?” with respect to performance on HCAHPS and process of care measures. Isn’t 99.63% pretty strong?
KG: It is strong, but we must strive for 100 percent in each of the core measures, which we achieved at Trinity Medical Center in 2012 and at Flowers Hospital in 2008. The point I make to leaders and staff is this: "What if it is your mother, father, sister, husband or wife who suffers that one fall, ends up with a hematoma, and never comes out of ICU or has a serious infection?"
If all the other patients received great care, but it was your loved one who had a clinical variance, would you be okay with that? While 99 percent is a great goal, we cannot rest until we reach 100 percent for each and every core measure and patient. We must change our thinking so that we focus on having zero variances in clinical outcomes and patient experiences.
HR: So how can we get to 100 percent?
KG: You have to start wherever you are. It requires a very intensive and collaborative focus by every employee and physician. To achieve that, you must have a strong culture of engagement. In fact, it's a CEO's job to unleash the leadership potential of those around him or her.
Ask your organization: Why do we exist? Is it merely to collect funds from Medicare or to provide jobs? No, we are mission-driven. If your organization exists to provide quality care to patients and your community—and you communicate that vision consistently—your team's daily priorities must shift to truly place patients at the center of each decision.
If that's not where the focus is, it's up to leaders to disrupt that process of focusing on the wrong things and establish a new vision. Ask yourself: What are you doing to enrich the culture and how are you creating opportunities for everyone to demonstrate effective leadership, whether they have a leadership title or not?
Transparency is critical. At every employee and department meeting, we have to be willing to "hold up our underwear" and inspect it for holes that need fixing, so that we are not apologizing to patients for gaps in providing quality care.
HR: Where did you focus to move performance quickly?
KG: At both Flowers and Trinity, we always "hire hearts" because we know we can teach skills. We set clear expectations—this is someone's loved one in every bed—and ensure that everyone knows how their performance will be measured. Every meeting we conduct is centered around quality, safety, and the patient experience. We ensure that we over-communicate how critical patient experience is to the long-term reputation, brand, and success of our organization.
We expect 100 percent performance from each of our employees. That is our shared vision. I remember once, when we couldn't get congestive heart failure discharge summaries completed in a timely manner, I asked for a daily email at 8 am showing how many were incomplete. This is now a daily e-mail that is monitored and shows our priorities. Soon we were at 100 percent compliance. If we can monitor daily admission and financial metrics, shouldn't we also be monitoring clinical core measures and outcomes?
You have to be a role model in a no-excuses culture and demonstrate your priorities through your daily actions and behaviors. You must also remember to acknowledge excellent performance when you set high expectations for your organization. Occasionally, certain leaders will self-select out and leave the organization, rather than step up to those expectations. This may open the door for the right individual to support other high performers. I've seen it happen time after time.
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