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work smarter

what about employee-centered care?

Yesterday I was lucky enough to hear Chip Conley speak to an intimate group at Experia Health’s Patient Experience Round Table. Conley shared an anecdote about meeting the then CEO of Southwest Airlines. He was handing out peanuts during a flight. This was 2010, before Southwest began advertising their bags fly free campaign, although they were not charging at that time anyway. When Conley asked the executive why they didn’t charge his answer was an interesting one. “We don’t want to put that burden on our employees. First, it’s uncomfortable to collect the fee, people expect their bags to go with them as part of air travel. But what we really don’t want is to ask our staff to deal with having to check bags once the overhead bins are full. Have you seen the flight attendants on those other airlines, they are miserable now.”

(Well, he said something like that, I’m paraphrasing the paraphrase)

I’m concerned about how we work in healthcare. Despite the rewards caregivers get from taking care of patients, largely the work of healthcare has become a lot about things other than clinical work and caregiving. It’s meetings, hand-wringing, politics, wrought processes, data entry, reporting and analysis. Don’t get me wrong, some of those are worthwhile tasks —hey, it’s a large percentage of my job (hopefully not the hand-wringing part). But, there are two problems. First, we’ve built a lot of inefficient, difficult to execute processes under the banner of regulation, reporting needs, and analysis. Secondly, we’ve failed to adapt to modern work environment expectations.

The modern workplace has changed, and how we work has changed. Today, Millennials entering the workforce want to work in jobs which provide smart phones, offer flexible work hours and have cool cultures. Does that sound like many health systems?

Airlines, banks, mobile app developers —they all got hipped to the importance of realtime data years ago. Do you think it takes US Airways two weeks of abstracting and analysis to know the demographics of patients on any given flight? No way. And staff at telecom giant Vodafone don’t even have to be in the office to get data. Realtime dashboards are pushed straight to their phones and tablets via a platform called Roambi.

This may sound like a tech post. It is not. It’s a people post.

When we add layers of complexity on top of an antiquated work environment, well, this is what we get.


Here’s what we know, companies which are great places to work take better care of their customers. At Bon Secours, we measured employee engagemnt with Gallup’s Q12. the Q12 is a remarkably effective and simple way to understand how employees feel about their work. Gallup tells us an indicators of employee engagement include having the tools to do your job and working in a supportive environment. Until we wake up and realize we’ve made the process of working in healthcare less desirable than other industries, how will we ever tackle patient experience in a meaningful way?

I’m not suggesting the key is giving everyone an iPhone. I think we can start with some even easier steps:

1 Take Something Away - This is the first, crucial step to working smarter, not harder. Examine all the work our teams have to do, and take at least one thing away. Remember the lesson of Southwest and the baggage fees. Something which may look like attractive revenue on a spreadsheet can actually push staff past the breaking point. Which would you rather have? It can be the least important thing and you probably won’t have to look far to find it. Maybe it’s a superfluous field in a registration screen, maybe it’s a non-clinical tasks for a nurse. Whatever it is, ask yourselves do we really need this? If not, stop doing it.

2 Practice gratitude Chip Conley speaks about recognition in his TED talk. Taking the time to acknowledge each other is a surprisingly powerful emotional uplifter. Hey Joan, you worked later than expected last night to care for those patients… thank you for doing that! The trick is to make it a ritual. Start huddles or end meetings with moments of gratitude. It works.

3 Think about Employee-centered care too Patient-centered care is a result of engaged employees. Managers, try this: walk into somewhere you have employees and pretend it is your first day at work and you are hired to do their job. How’s the space? Is it clean, is it nice to work in? Do you have the tools do do your job? Do you clearly understand what your job is? Most importantly, ask yourself if this is the job you dreamed of walking into. Just because they didn’t give us dot-com style offices when we started in healthcare, doesn’t mean we can’t be the change we want to see.

Remember, every system is perfectly designed to achieve the result it achieves * . So, reverse engineer the system. If you sense, or worse can measure, staff dissatisfaction or burnout, consider the root cause. If you are focused on patient experience, observe the system in reverse order. What influenced those experiences? Likely it’s interactions with employees. Are those employees loving their job - are they called to it?

*Good luck attributing that often used quote. Most suggest Don Berwick first used it in 1996. Goolge returns several articles and transcripts of talks, each purporting to be the originator.