Faculty Institute for Teaching and Learning Achieving Medicine of the Highest Order – Cultural Transformation Based on “Horton Hears a Who” Bradford C. Berk, MD, PhD May 22, 2013 Faculty Institute for Teaching and Learning

May 30, 2009

Back to work

Thanksgiving 2009

I’ve learned what’s important Treating patients and families with dignity and respect Showing compassion and attentiveness Valuing the patient and family as an integral part of the health care team Listening to our patients and their families

2007-12 URMC Mission and Vision Mission: Using Education, Science and Technology to Improve Health. Vision: Develop a high quality, cost-effective patient-centered healthcare delivery; lead by our world class researchers, educators and clinicians.

2013-18 URMC Mission and Vision DRAFT Mission: The University of Rochester Medical Center is a home of healing, learning, research and innovation committed to improving health and quality of life for our patients, families and community. Vision: To be nationally recognized by 2020 for improving community health through transformative approaches in compassionate care, education and research.

And he climbed with the lad up the Eiffelberg Tower. “This,” cried the Mayor, “is your town’s darkest hour! The time for all Whos who have blood that is red To come to the aid of their country!” he said. “We’ve GOT to make noises in greater amounts! So, open your mouth, lad! For every voice counts!” Thus he spoke as he climbed. When they got to the top, The lad cleared his throat and he shouted out, “YOPP!”   And that Yopp… That one small, extra Yopp put it over! Finally, at last! From that speck on that clover Their voices were heard! They rang out clear and clean. And the elephant smiled. “Do you see what I mean? ... They’ve proved they ARE persons, no matter how small. And their whole world was saved by the Smallest of All!”

Strategy Map How can diversity and inclusion help us achieve our objectives?

People and Culture- Key Component of Strategic Plan Enhancing Standard HR duties — benefits, hiring, payroll New- Implement Business Partners: who understand the specific HR challenges that their clients face to learn time-tested tactics for fostering employee engagement to be able to help managers structure incentives that drive peak performance Talent management software to function with existing HRMS system Boost Evaluation Process and Tools

The healing power of touch Compassion – We need to show we care Attentiveness – We need to pay attention to show we care

My personal experiences: as a leader, a care provider and a patient

Patient and Family Centered Care (PFCC) A set of principles and values that when implemented successfully improve quality, safety, and long-term outcome. In addition, data shows improvement in patient, family, care provider, and staff satisfaction.

Communication, Compassion and Attentiveness are Critical Transforming a culture Patients and families are repeatedly telling us we need to do better in these areas: Response to your concerns/complaints Staff addressed your emotional needs Staff included you in decisions regarding treatment Nurses and Physicians kept you informed Staff worked together to care for you Time physician spent with you (Taken from the Press Ganey Priority Index) Communication, Compassion and Attentiveness are Critical

URMC components of PFCC Safety Courage Patient and Family- Centered Care Quality Caring

Creating value enhances PFCC Create Value (Quality/Cost) by implementing LEAN process improvement strategy Eliminate waste in our system without diminishing the patient experience remove extra steps in patient flow simplify operational processes eradicate duplicate and unnecessary paperwork results in better patient and staff satisfaction Utilize LEAN approach to help create a patient and family-centered care culture

Building a PFCC Culture Areas of Focus: Facility Medical Advances Information Technology Delivery of Care People

Facility PFCC requires a comfortable supportive environment private rooms with family sleeping spaces atmosphere that promotes healing Cancer Center Expansion New Children’s Hospital Upgrade of Current Facilities

Information Technology eRecord will promote PFCC provides immediate and more thorough understanding provides improved communication among providers can identify high-risk patients to ensure comprehensive care plan and enhanced communication can encourage attentiveness and compassion i.e. electronic sticky notes can enhance patient and provider’s bond by reminding care providers to engage in topics most important to patient “I am very sorry to know that you recently lost a loved one” “I understand you are anxious to return home to care for your cat”

Transforming the way we Deliver Care encourage patient/ family involvement promote practices to improve patient/family and provider communication (i.e. rounding and shift change at the bedside) breakdown silos – enhance communication among providers and multidisciplinary care teams develop specialized Hospitalists to promote efficient, but compassionate care shift from episodic approach to care to full continuum of care advanced medical homes

People are the most important part of PFCC Train all medical staff and employees to be respectful and offer compassion How we communicate determines how effectively we convey compassion and attentiveness We need to convey to our patients compassion and attentiveness by communicating about things that matter to them The healing power of touch

Caring for the caregivers Our employees need to feel cared for to provide patient/family-centered care Staff need to be: treated with respect supported empowered recognized

URMC PFCC Steering Committee PFCC across URMC delivery system Patient and Family Members URMC PFCC Steering Committee SMH Highland VNS Highlands at Brighton Highlands at Pittsford URMC Steering Committee charged to coordinate PFCC implementation throughout URMC Each facility has it’s own leadership team charged to oversee PFCC implementation - all leadership teams report up through URMC Steering Committee GCHAS

Creating an ICARE Culture Integrity - Compassion - Accountability - Respect - Excellence

Influences on Patient Experience Personal – behaviors/culture Operational – systems/processes Physical – environment/facility focus of PFCC initiative Coordination of 3 broad efforts - medical center-wide - department/unit level 26

PFCC efforts are making a difference 2010 - 2 of the 8 HCAHPS domains at national average 2012 - 6 of the 8 HCAHPS domains exceeded national avg. Hospital Environment Pain Management 2013 - Hospital wide rollout – next stage of PFCC initiative Clearly defining ‘desired patient experience’ Focus on ‘consistent delivery’ of the experience Making progress but still below national average 27

Patients’ Overall Score for Hospital is Improving 28

Nursing Communication continues to rise 29

Staff Responsiveness exceeds national average 30

Employee Engagement/Commitment Scores

Measuring Workforce Commitment Difference from: Workforce Commitment Item 2012 URMC Clinical Entrprs % Unfav Natl UHC Avg Natl HC Avg 2011 URMC Clinical Entrprs I am proud to tell people I work for this organization. 4.38 3% +.02 +.06 49. I would recommend this organization to family and friends who need care. 4.34 +.05 +.01 56. I would like to be working at this organization three years from now. 5% +.08 59. I would stay with this organization if offered a similar job elsewhere for slightly higher pay. 3.71 15% .00 -.01 +.07 64. I would recommend this organization as a good place to work. 4.29 +.14 +.11 +.10 65. Overall, I am a satisfied employee. 4.10 6% +.03 +.09 These are the six items used to measure Commitment/Engagement. Green, large numbers indicate significantly outpacing respective comparison. Later slides describe comparisons. Improvement on all items from 2011 survey, all but one improving statistically significantly. 32

Top 10 NYS value based / readmission penalty

“I’ve learned that people will forget what you said, people will forget what you did, but people will never forget how you made them feel.” - Maya Angelou

Thank You