1. Journey to EXCEL-lence

2. Superiority Eminence Caliber Greatness Quality
EXCEL-lence
Superiority
Brilliance
Distinction
Eminence
Caliber
How does one achieve excellence as an individual, a leader, an organization? We all know it’s not luck. Jim Collins who wrote the book Good to Great has studied organizations of excellence. He describes that it’s not one monumental event or revolutionary idea, but the culmination of doing the little things right. You make the right choices for long enough, they snow ball into a force to be reckoned with.
Greatness
Quality

3. Journey to EXCEL-lence
Key Words and Key Times / AIDET®
How to coach for results
Rounding for Outcomes
This morning and into this afternoon, we are going to continue the work you started at the last LDI to really understand the journey to Excellence you are on. We’ll begin with the topic of managing change and in particular, how our Excellence Journey helps us to effectively manage change. We’ll then move into KWKT and AIDET® our communication structure - new for some and review for others – AIDET® is a powerful tool and is often underappreciated because of how we use it. But setting expectations about KWKT and AIDET® isn’t enough. The competency of coaching for results is something all leaders of excellence need to possess, so we’ll use AIDET® as our framework to discuss how to coach and give feedback. This afternoon, we’ll look at the Must Have tactic of Rounding for Outcomes.

4. Key Words at Key Times – AIDET®

5. Links: Words + Behaviors @ Key Times
Key Words at Key Times
Links: Words + Key Times
Ensures the patient / customer interpretation isn’t left up to chance
Positively impacts outcomes
Defined by:
What does our patient / customer want to know?
What do we need our patient / customer to know?
How can we communicate that consistently, always?
Pulling the curtain
Hand washing example.
KWKT is about connecting the dots.
Think in terms of when you see the most anxiety from your patient or customer: hand offs, procedures, getting a report back from you,

6. Never Words Hopefully Usually Probably Try
Pretty Quick / A few minutes/ ASAP / As soon as we can
If you don’t want your airline pilot using them, they don’t belong in healthcare either.

7. Five Objectives in Communication
Utlize KWKT within the framework of our communication model. AIDET® is simply a pneumonic way of remembering the five objectives we want to achieve when communicating with patients, customers and collogues. What we say and the words we choose, has a tremendous impact on our patients and customers. The right words can calm, comfort and reassure. The wrong words can produce anxiety and create confusion in a situation that is likely already stressful.
Healthcare leaders who make the connection between the way we communicate and the outcomes we achieve are embracing AIDET.
When used in conjunction with EXCEL, AIDET will increase your likelihood of creating a culture of consistent excellence, a culture of "ALWAYS"—a culture that meets the tough requirements set forth by health reform.
Consistent communication is a priority in healthcare today? Nursing communication is the HCAHPS composite that is most highly correlated with the Overall Hospital rating. Physicians who communicate effectively have fewer law suits, better patient clinical outcomes, better clinical compliance with treatment regimens, lower 30-day readmission rates and have a better patient perception of care. 
Shuttle bus from car rental station to airport.
Hi, my name is sally. We’ll be taking about a 5 minute ride to the station and we’ll be making one stop for all airlines. I hope you all got a chance to get out and enjoy Dallas. Did you have some fun? Good. Well, we really appreciate you coming to Dallas and hope you come back soon. When we arrive at the stop, we’ll be arriving at baggage. Ticketing is directly up the stairs or you can curb side check in as well.
What does AIDET® decrease?
When anxiety goes down what goes up?
When anxiety goes down and compliance goes up we get better what?

8. Meeting Title Here (on Notes Master)
Advantages of AIDET®
Decrease anxiety with increased compliance
Decreased Anxiety
Increased Compliance
Improved outcomes and increased patient physician and employee satisfaction + =
© Studer Group®

9. “Good morning Mr. Warner…”
Acknowledge
In person, with your body:
Smile!
Make eye contact
Acknowledge everyone in the room
Use open body language
10/5 Rule:
“Good morning Mr. Warner…”
Care touch
Measure out 10/5

10. I Introduce First Generation Name Department Next Generation
“Hello Mr. Warner. My name is Jackie and I am Dr. Smith’s medical assistant….”
“Hello Mr. Warner. I’m Jackie, and I am Dr. Smith’s medical assistant. I have worked with Dr. Smith for 5 years and he is a very sought after internist! He is one of our best providers in dealing with your condition…”
Next Generation
Self, Skill Set, Experience and Certification
Co-workers
Other Departments
Physicians
The introduction is about who? The patient
I’m terrible with names. Someone introduces themselves, I’ll even repeat the name and 2 seconds later, it’s gone. The average patient has upwards of 60 individuals they may come in contact with in a given day. What is the likelihood they’ll remember your name? Hi, Stephanie your nurse again.
May expand and evolve your introduction based upon the level of comfort you are there to provide.
Manage up: position someone or something in a positive light

11. Advantages of Managing Up
Self
Coworkers
Other Departments and Providers
Reduces patient anxiety
Improves compliance
Improves clinical outcomes
Increases patient perception of care
Reduces complaints
Patient feels better about their next care giver
The patient feels more at ease with the handoff, thus their coordination of care
Coworker has a head start in winning confidence
Reduces Complaints
Reinforces coordination of care and teamwork
Positions other department well so they don’t have to win the patient over
Decreases patient anxiety and concern
Pilot: You have an excellent flight crew today and they will do everything they can to make this a pleasant experience for you.

12. “ I would like to see you back for a f/u in 6 months.”
Duration
How long will the wait for ____be?
How long will the patient need to wait before they can return to work…?
When should patient/customer expect results or a returned phone call?
When should the patient schedule their next appointment?
Rounding in Reception “It may be 15 minutes before we call you to back to see Dr. Smith. I will update you if it is later than that….”
“ Your test results will be posted on your personal patient website in 3 days. Someone from my office or I will also call you when we review the results?”
“ I would like to see you back for a f/u in 6 months.”
Remember, with KWKT, we are anticipating their needs.
Time estimates are always a challenge in healthcare. We are afraid we are going to get backed into a corner. Under promise, over deliver. And if the time passes, what do you need to do?

13. E Explanation Why are we doing this?
What will happen and what should you expect?
What questions do you have?
USE UNDERSTANDABLE LANGUAGE
“Let me explain some more about the MRI I ordered….” (Explain the why for ordering the test, what will happen and what patient should expect, including understanding of side effects, and answer any questions.)
What questions better than do you have any questions. Says we expect them to and creates a dynamic more apt to ask.

14. T Thank you Show appreciation Provides a positive closing
Thank patients for trusting us with their care
“Thank you for choosing us ….Thank you for waiting … Thank you for coming in today…What other questions do you have?”
A nice way to close but not limited to the end of the conversation

15. Engagement Active listening Non-multi tasking Eye contact
Tone and speed of voice
Appropriate / therapeutic touch
Appropriate use of humor / emotion
Physical position
Energy mirrors need
You can technically demonstrate all components of AIDET® and still not reduce anxiety.

16. Tips for knowing when and how to use AIDET®:
Every Interaction, emphasizing and repeating parts as necessary
Defines the five objectives to be met in context of your interaction with others.
Not Order-Specific
Works in All Departments and Disciplines - Not just a CLINICAL communication tool
Patient Communication (White) Boards:
Standards of Behavior
Using Only Parts of AIDET® as Necessary: There are times when you will need to verbalize only one or two of the elements of AIDET®. For example: You are caring for a patient for the third day in a row and they call you by name as you enter the room. It is not necessary to introduce yourself. The communication process is a dynamic one. The decision to “skip” one of the elements should be deliberate and made only after ensuring the customer has that information already. It is always essential to assess if the patient has the necessary information and fill in any gaps that exist. Remember that just because you know you introduced yourself this morning does not guarantee that the patient recalls your name in the afternoon.
In telephone conversations, AIDET® is extremely important. So much of our message is lost when we cannot
rely on the visual cues of body language. Standardizing the content of telephone communication with AIDET®
can fill some of that gap.
When calling the help desk with a computer problem, customers appreciate:
 A: Being acknowledged;
 I: Knowing who they are speaking with on the phone and knowing that the team is experienced and can handle requests;
 D: Knowing when they can expect things to occur;
 E: Understanding what is happening and what the next step will be;
 T: Hearing a pleasant close to the conversation like, “Thank you for letting me know about this issue.”

17. Coaching for Improvement

18. Leadership in Healthcare
Being a leader in healthcare today is like continuously walking up a down escalator. If one stands still they go backwards.

19. Why Do We Need to Coach? Clarity about the purpose and the goals
Guidance with best practices along the way
Assure consistency and standard practice
Empower employees and promote accountability
An effective coach will get employees to go outside of their comfort zone- promote change and work with staff to embrace the change.
Being able to define expectations of KWKT and AIDET® as well as assessing the quality and effectiveness of them applied, is a different competency than coaching that employee on what to continue and what needs improvement.

20. Phases of Competency and Change
Son is driving
Unconsciously Unskilled: Honeymoon – Sense of excitement, “this is going to be great”. He’s asking about $70,000 cars and how long it will take him to save up for one.
Consciously Unskilled: Reality is setting in and this is. Bigger than I thought, His Dad takes him into a parking lot and purposely makes him spin out. I take him to Target via the highway and then through various mall parking lots. He turns to me and says, “he’s going to shred his permit and why did we ever give up horse and buggy anyway”. Anxiety is real here. We often want to revert to our old ways. This is when cheat sheets and equipment of the past are resurrected from the dead.
Consciously Skilled: Now he wants to start driving with the radio on, he’s slinging one arm over the wheel and there is a sense that he can do this. We are now back to car discussions but a little more realistic. Behind the wheel will occur in a few short weeks and we make revert slightly, but that will defiantly lock him into that consciously skilled. Performance gap is evident, Tougher decisions must be made, Process improvement increases, Inconsistencies obvious
Unconsciously Skilled: In time, he’ll be there. High performing results, Everyone understands the keys to success, Disciplined people and disciplined processes, Proactive leadership
In change situations, what we find the hard part is we go from unconsciously skilled backed to unconsciously unskilled– we just don’t like the feeling, not necessarily the change; there’s always push-back; if we don’t understand its not the skill, it’s the emotional feeling of going backward; i.e. you asked me going back to feeling unskilled through charting;
Get it done SO much its unconsciously skilled – through repetition + frequency

21. Accountability Consistency Reliability
Execution Triangle
Accountability
The execution triangle – what does this really mean?
Usually has 3 components: Accountability, Consistency and Reliability
Accountability (key drivers of accountability are consistency and reliability).
The challenge is do we do it consistently? This is a great illusion in healthcare (do we have the consistency that creates the reliability).
We have many organization that we work with that are highly reliable organizations – consistent processes, tools, and techniques to drive the best outcomes they can drive.
Consistency
Reliability

22. Coaching It’s not about pulling the weeds… It’s about fertilizing the
Garden…

23. Leader Must Haves when coaching employees
Inspires employees to reach their highest potential
Encouraging, Challenging, Modeling- leads by example
Frequent and Consistent (knows what you are doing and provides regular feedback)
Knows their employees and the culture of their department/organization
Tells you why you are doing something and takes time to explain how
Allows you to learn from your mistakes
Listens without being judgmental and sets aside personal biases
Provides feedback – positive and negative, in a constructive manner

24. Building Competency Model
observe
reinforce
response
coach
commit
Validate
recognize
Training
trust
This DIAGRAM takes you through the steps of how to build competency in your employee. Boxes in green represent the leader roles in the process, and boxes in blue represent the employee roles.
The Building Competency Model revolves around the trust you establish with your employees to lead them through successful change and/or personal development. It was created as a closed circle because building competency is a never-ending cycle. Healthcare is constantly changing, so we must be willing to continue building competencies to address these changes to keep up with our competitors. Remember the fixed mind set vs. the growth mindset from our change content.
This model assumes that an individual has been taught a new tactic, behavior or process. Training is the first step, but it will only be as successful as the steps you take following the training to reinforce learning that leads to effective execution and hardwiring.
© 2012 Studer Group

25. observe
reinforce
Observe
Leader assesses the employee’s skill (after a practice period) by witnessing it firsthand and documenting findings on a standardized competency assessment form.
Reinforce
Real-time feedback is provided by the leader to the employee immediately following the observation and starts with the most positive elements of performance. What gets recognized gets repeated.
We recommend observations be completed by the direct supervisor of the employee
Be prepared to provide feedback on every step of the process and every behavior. To receive feedback constructively, employees must experience three compliments for every one coaching opportunity to create a positive learning experience
© 2012 Studer Group

26. Response from employee
What do you think you did well?
Was there anything you felt you could have done better?
Coach
Choose 1 or 2 opportunities for improvement
Give clear examples of “what right looks like”
Direct them to additional resources on the Studer website (i.e. Learning Lab, webinars, etc.).
Commit
Summarize WINS
Ask employee to commit to improvements
Set a time expectation for improvement
response
coach
commit
Response—the observer asks the employee, “What do you think went well?” (gives an idea of how they define excellent). The leader then asks, “Was there anything you felt you missed or could have done better?” (gives an idea of their awareness of areas for personal improvements).
Coach—choose one or two opportunities for improvement that you believe will have the greatest impact if improved upon, and demonstrate how you want them to improve by showing them what “right looks like.” Give clear examples, direct them to additional resources on the Studer website (i.e. learning lab, webinars, etc.).
Be specific
Commit—summarize what the employee did well and ask the employee if he/she will commit to making improvements. Set a time expectation (1-2 WEEKS) for them to practice and accomplish the goal.
© 2012 Studer Group

27. Use specific examples of how they improved
validate
recognize
Validate
Reassess the employee’s performance for improvements in the agreed-upon development area at the agreed-upon deadline (data and observation)
Recognize
Manage up progress
Use specific examples of how they improved
You may establish a certificate of achievement program for those who achieve full competency
Improve your observation assessment skills with practice, practice, practice
© 2012 Studer Group

28. How to give feedback Teach to the test – this isn’t about “gotcha”
Have a plan/tool/form to outline the process and behaviors being evaluated
Be prepared to provide feedback on every step of the process and every behavior
Summarize with what is the one thing to focus on for improvement
Ensure your feedback is aligned with the performance of the person being observed- A work vs. C work
Improve your observation assessment skills with practice, practice, practice
Don’t be too general
Validation tools are really critical for this step.
You are the leader and accountable to the quality of interactions in your dept. or on your unit. Don’t give an A evaluation for C work.

29. What about Resistance?
Resistance may occur- continue to reinforce the why and connect to the mission.
Built on the level of Trust in the Department
Trust is enhanced by employee rounding
Go back to the WHY
A likely symptom of moving into the consciously incompetent. Remember from our change slides, we have to make it manageable. Employee rounding and the connection to why is critical.

30. Barriers to effective coaching in the workplace
Time
It will make staff feel uncomfortable
It will make the leader feel uncomfortable
It will make them think we don’t trust them
The leader thinks the staff already do the skill well enough
Patients report in rounds the staff are “doing it” – are we asking the right questions?
Coaching behaviors is personal and subjective
© 2013 Studer Group

31. Setting the stage for a safe environment
Clearly communicate the why of observation and validation before you formally observe staff performance
Share the standardized competency assessment form you will use during the observation to help them prepare
Explain the benefit of building competency to the employee and your commitment to their development
Let staff observe you first
Create a skills lab
Above all, ensure you clearly communicate that this is not a punitive exercise.
© 2012 Studer Group

32. On-going AIDET® Validation
During employee rounding, talk with the staff about AIDET®- “when you used AIDET® this week, what was the impact on the patient? Or How did the patient respond when you used AIDET®?”
Patient Rounding, ”Are staff introducing themselves? Are they providing good explanations and answers to your questions?”
HCAHPS Results and patient comments
Direct observations
Post visit calls
During your monthly meeting with your one up- give report on number validations complete and what you are hearing and seeing as a result of AIDET® being used.
HCAHPS DOMAINS A I D E T
Nursing Communication 
Doctor Communication
Responsiveness of Staff
Pain Management
Communication of Medications
Discharge Information
Cleanliness and Quietness of Hospital Environment

33. AIDET Accountability and Validation Cycle
Regular teaching, coaching and validation is key to hardwiring AIDET
General Orientation
Dept Orientation
Individual Coaching
Validation
Accountability
Consistency

34. you have a human responsibility to act, and to do so with all urgency.
When you know you have a solution to a problem that is causing pain for someone –
you have a human responsibility to act,
and to do so with all urgency.
~ Quint Studer

35. High Middle Low or EAL Conversations
Aligning Behavior with Outcomes

36. EAL Conversations

37. Where do EAL Conversations fit?
Pillar Goals are established and department goals are outlined in LEM
Behavior Standards are in place
Rounding is hardwired to assure that everyone has tools and equipment to take care of patients
Critical Conversations and Coffee Cup Conversations help leaders have conversations in real time regarding goals and behaviors
EAL Conversations are structured coaching and performance conversations that are based on patterns of behavior

38. Why EAL Conversations Positive Outcomes
Re-recruit/Retain excelling performers
Coach achieving performers
Manage lagging performers; up or out
Support Retention
Build Relationships
Clarify Expectations

39. EAL Conversations - How
Conducted annually
Training held for leaders
Cascades from the top
Tools and resources provides at the time of roll out

40. Thank you! Tools and Resources Questions - Comments
OU Medicine Excel Website
Excel Tools 2014 – OUMC Intranet
Studer Group Website