1. 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

2. May 30, 2009

3. Back to work

4. Thanksgiving 2009

5. 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

6. 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.

7. 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.

9. 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!”

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

11. 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

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

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

14. 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.

15. 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

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

17. 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

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

19. 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

20. 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”

21. 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

22. 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

23. 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

24. 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

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

26. 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

27. PFCC efforts are making a difference
of the 8 HCAHPS domains at national average
of the 8 HCAHPS domains exceeded national avg.
Hospital Environment
Pain Management
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

28. Patients’ Overall Score for Hospital is Improving28

29. Nursing Communication continues to rise29

30. Staff Responsiveness exceeds national average30

31. Employee Engagement/Commitment Scores

32. 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

33. Top 10 NYS value based / readmission penalty

34. “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

35. Thank You