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Developing the ideal patient experience and creating culture

Written by Jen Volland, DHA, RN, MBB, CPHQ, NEA-BC, FACHE, Vice President Program Development, NRC Health


Culture. It’s one of the hardest things for organizations to articulate and it’s always unique in top performers. Everyone wants to be part of a thriving organization yet the essence of what goes into creating the optimal organizational culture, and how all the different pieces fit together, can seem a mystery.

However, once you do have a vibrant culture it goes a long way toward making your organization an environment where people want to work and that fosters patients’ and their loved ones’ loyalty. Organizations can always improve but it all goes back to the underlying rule: culture is key.

National Healthcare Corporation (NHC) is a healthcare entity comprised of 76 skilled-nursing centers with 9,597 beds, five residential-living centers, and 25 assisted-living communities. NHC has shown outstanding performance in the industry as a top performer in “Overall Rate” and “Would Recommend” scores and in indicators of quality of life, quality of care, and quality of service. Embedded within these three latter indicators are items that apply to all healthcare organizations, including patient/resident choices and preferences, facility safety, staff respectfulness, patient/resident meals, RN/LVN/LPN care, care/concern of staff, and management responsiveness.

How does NHC perform exceptionally well across the board on all these metrics? Although there are many different aspects to the organization, two main ways they’re working stand out:

  1. Decentralization of centers (facilities). Locations are given autonomy on how initiatives are implemented with the corporate level setting which components of the initiatives become the focus. This gets everyone moving in the same direction, yet allows flexibility for each site to realize initiatives in ways that are unique to their staff and patients/residents—allowing them to demonstrate their understanding of the individualized needs unique to their key stakeholders and their environment.
  2. Setting of behavioral standards. How to treat each other and their patients/residents is ingrained into the NHC culture from the very beginning starting with the hiring process, reinforced through orientation, and sustained through recognition, modeling, and holding individuals accountable. A different behavioral standard or “promise” is reviewed each day for 20 days then the whole cycle is renewed. Two of the “promises” to which all levels of the organization are held accountable are:
    • Promise #4. “Put my heart” into everything I do. I will empathize with you, value your perspective, and care for you the way you want.
    • Promise #10. Resolve any of your concerns. A complaint is a gift; I own it; I will fix it.

Many of these promises have clear forms of delivery that are shared with staff. This isn’t meant to be scripting but rather a roadmap of what’s expected. For example for Promise #10, “Resolve any of your concerns,” there is a Concerns and Grievances Recovery Process that provides step-by-step direction while allowing individuals to remain authentic in their interactions. These steps are:

Step 1: Show empathy. This is done by putting yourself in the shoes of the customer.
Step 2: Be honest. To the point that shows you care.
Step 3: Take initiative. This is the action you take to make it right, right now!
Step 4: Take responsibility. Follow up to ensure that the action taken has corrected the situation.
Step 5: Involve customers. Involvement of the patient/family is effective only after the first four steps are taken and a bond has been created with the patient/family member.

For NHC, relationships with patients/residents don’t just start at their entry and last through their encounter or stay. They’re seen as ongoing relationships that build loyalty and support the patient/resident and his or her family. Consequently, every individual who is being discharged to another care setting has a TAKE OFF Transition Plan,” which helps ensure that everything he or she needs has been accounted for.

The elements of TAKE OFF include:

  • The patient (T)akes the right medications
  • The patient’s (A)ctivities are carried out safely
  • The patient is left (K)nowledgeable about medical conditions
  • (E)quipment is obtained/ordered to optimize safety at time of transfer
  • (O)pportunities are presented to improve caregiver confidence
  • A (F)ood plan is in place to optimize health and minimize risk of complications
  • A (F)ollow-up plan is put in place

Each of these elements involves knowledge, performance, and process expectations—items that need to be put in place by staff and patient/family behaviors that should be exemplified by the time of discharge to enable effective self-care upon transfer to the next care setting or home.

Organizations of all sizes oversee the transfer of responsibility, initiatives, and information–whether on a corporate level to different facilities or within an organization from leadership to staff. Additionally across the health continuum of services, patients rarely remain in one setting. They shift between levels of care, transfer between different types of facilities, or are discharged home (potentially with the addition of home health or homecare services). This process also involves the transferring knowledge to patients and families to enable them to see a provider in the clinic, take the right medications, carry out activities safely if there’s been a physical change, and have confidence in their treatment or wellness plan.

While a patient’s discharge information may appear to be unrelated to staff behavioral standards (e.g., to the interactive promises listed above), at a deeper level they both provide a framework of expected behaviors and how to carry those behaviors out in a way that represents organizational culture and sets individuals up for success. Both are ways to promote the organizational culture among staff, patients, and their families, giving everyone the tools they need to meet and exceed expectations in a way that will set the organization apart from its competitors.

For more information about these processes and NHC, please take a moment to watch our Best Practice Webinar that deep-dives these topics to gain actionable takeaways for creating a thriving culture and building patient loyalty.

Download the case study to discover how NHC cultivates a vibrant and seamless culture.