Report: What Your Organization Must Do to Achieve Transformational Change

By John Palmer

Engaging the workforce in a healthcare community, empowering leadership, and ensuring that quality patient care is at the forefront of your organization’s priorities are the keys to efficient transformational change.

That’s the conclusion of a new report released by Press Ganey, an organization devoted to helping healthcare providers understand and improve the entire patient experience by offering enterprise transformation solutions and advice to thousands of organizations worldwide.

Released in March, the 2019 Strategic Insights Report reinforces the idea that the bold, systemic change needed to drive true transformation must come from top administration, and all teams underneath these leaders must understand their role in the journey.

“With seismic changes being driven by value-based payment models, mergers and acquisitions, and consumer-driven demands, the expectations to deliver care that meets patients’ needs has never been greater,” wrote Patrick T. Ryan, executive chair of Press Ganey, in the report. “Meeting the needs of patients and creating a purpose-driven workforce requires a commitment by senior leaders to work across hierarchical and functional boundaries toward an aligned culture of excellence.”

The report focuses on the acceptance that transformation in healthcare is inevitable, and that trends such as value-driven payment models are transferring risk assumption to providers. As a result, profitability hinges on quality and efficiency, the report says, and mergers, acquisitions, and partnerships in healthcare systems are making the marketplace ever more competitive. In addition, brand loyalty is not necessarily guaranteed; to keep patients coming back, healthcare organizations have a responsibility to provide customers with performance information.

“The necessary degree of change extends far beyond practices and processes to encompass mindsets, behaviors, and culture,” the report concluded. “It demands organization-wide alignment with the transformational vision that starts at the top with a CEO who sets the strategic direction to create focus, clarify priorities, and demonstrate commitment to change.”

For transformational change to occur, it must start from the top and trickle down to employees in various departments of the healthcare system. Traditionally, this culture shift is hard to come by, and many employees in hospitals feel a disconnect from the C-suite. For instance, safety and security staff, as well as nurses, often feel like their needs in the workplace are overlooked because of leadership’s budgetary concerns.

Another thing to consider are the growing voices of patients themselves. An increasing amount (70%) of consumers make their healthcare decisions based on online reviews, making it more important than ever that healthcare organization put on their best faces and create brand loyalty in an ocean of competition.

“For authentic health care transformation to occur, leaders must have a deep understanding of patients’ needs and the adjustments that are required to deliver care that meets those needs every day,” the report said. “They must also recognize that data is the single most important asset they have available to them to gain this level of understanding. There is no ‘easy’ button, nor will a single ‘smiley face’ feedback icon or point solution provide the depth and breadth of operational and cultural insight that is needed. Instead, they must embrace a platform that can support a structured, comprehensive, and integrated data strategy.”

What does that mean, exactly? Basically, consumers are much choosier these days about where their loyalty lies, and with so many choices for healthcare out there, they are doing their homework. That being said, the report authors say organizations need to adhere to a series of “transformation principles,” including the following:

• Commit to a goal of zero harm
• Put patients at the center of the planning, delivery, and assessment of care
• Recognize and define safety, quality, and patient centricity as the primary elements of the patient experience, and understand the critical interdependencies between them
• Drive change using data and transparency
• Transform culture and leadership
• Focus on accountability and execution

If it’s true that transformation starts from the top, then there needs to be a plan. According to the report, an assessment of the readiness of your organization’s leadership is crucial to identify gaps between the transformational vision and the ability of leaders to actually implement it. If that’s not solidly in place, the plan to transform will likely fail. If you’re looking to assess the readiness of your organization, consider the following recommendations from the report authors:

• Convene your senior leaders. That means everyone from safety, clinical quality, patient experience, medicine, nursing, finance, human resources, marketing, and technology. Align them with the transformational vision and ensure that they understand their respective teams’ roles in achieving it.
• Share the data. If your metrics are bad, you need to come clean with your team so that they know where they are starting from and where they need to go. Communicate the need for cross-functional collaboration and provide specific examples of areas in which the performance metrics that guide one team’s progress intersect with those of other teams.
• Get in the weeds. The report suggests that hospital administrators conduct informal surveys and small-group discussions to assess perceived and actual collaboration across teams. This helps uncover unaligned goals and makes sure that data sharing and reporting is transparent across all departments.

A road map for change

Not surprisingly, the report recommends that any systemic change in a healthcare organization should come from the top and work its way down, starting with buy-in from senior leaders and CEOs, and articulation of a strategic vision for the organization.

Organizations that are reported to have seen positive results from using transformational change techniques to create measurable metrics include Parkland Hospital in Dallas and Mount Sinai Health System in New York City. The report mentions that Parkland was able to identify a direct relationship between patient satisfaction survey feedback and three key workforce metrics, including employee engagement, employee turnover, and number of leaders directly involved with patient care (referred to as Tier 1 leaders).

“Based on this information, patient experience and HR leaders collaborated to address the workforce issues that the data suggested were most likely to influence patients’ care experience, including ensuring shift coverage and nurturing communication and trust between employees and managers,” according to the report’s findings.

Specifically, over a three-year period, Parkland saw many improvements across the organization, including the following:

• The mean employee engagement score rose by nearly 6%
• The number of Tier 1 leaders jumped from 32 to 122
• Turnover rates decreased from 18.5% to 15.1%
• The organization saw improved performance on the “Likelihood to Recommend” metric, both for the system overall and for inpatient services

Among the report’s specific recommendations are the following:

An enterprisewide assessment. In order to know where you’re going, you have to know where you stand. The report’s authors recommend a clear and accurate assessment of the organization’s performance.

“The assessment should include systemwide, unit-level audits across multiple performance domains, leadership surveys, and stakeholder interviews, as well as a careful look at the total amount of money organizations are currently spending on all of these vertical domains,” according to the Press Ganey report. “Collectively, this information enables leaders to examine business processes for optimization, identify high-value improvement opportunities, and uncover obstacles to progress.”

Analyses of performance interdependencies. Teams that work in a vacuum can’t work together to succeed. The report suggests that teams across several disciplines should be audited, and changes should be made to make sure everyone is on the same page.

“A clear understanding of interdependencies across safety, quality, patient experience, and workforce engagement is needed to inform integrated improvement efforts,” the report said. “Making the intersections of performance actionable is highly dependent on each individual organization’s operating model.”

Measurable targets. Just like in teaching or any other goal-oriented effort, organizations need a clear objective and a way to assess success.

“In addition to a well-articulated strategic vision, transformational plans require action-item prioritization, goal setting, and management feedback loops to monitor performance and course-correct when necessary,” the authors wrote.

An integrated dashboard. Lastly, the plane’s captain needs to be able to see what’s going on.

“Although leaders of individual business operations may be fully aligned with the strategic vision, their relatively vertical frame of reference can obstruct their view of the bigger picture,” the report said. “The CEO’s enterprise-level view is necessary for setting expectations for collaboration and cooperation and for consistently communicating those expectations to leaders and caregivers across the organization.”

John Palmer is a freelance writer who has covered healthcare safety for numerous publications. Palmer can be reached at johnpalmer@palmereditorial.com.