How healthcare facilities Mary Tellis-Nayak · Quality Of Care Ratings 2.78 2.78 2.80 2.59 2.49 Mean Mean 3.23 3.21 3.19 3.06 2.92 Closing this gap is critical Why are satisfaction

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April 6, 2017

Mary Tellis-Nayak, RN, MSN, MPHVP Quality Initiatives – NRC [email protected]

Why /How Do People Complain?

Mary Tellis-NayakRN, MSN, MPH

Vice President of Quality Initiatives

[email protected]

773-942-7525

What do people think of us?

favorableunfavorable

Favorability (ranked by mean) Mean Ratio Hard ID

3.31 9.11 91%

3.28 8.80 98%

3.23 8.20 92%

3.21 6.00 98%

3.21 8.55 86%

3.19 7.66 78%

3.06 4.66 85%

2.92 3.23 93%

2.48 1.06 95%

2.43 1.06 95%

Home Health Care

Doctors

Assisted-living facilities

Hospitals

Rehabilitation and skilled nursing facilities

Acute rehabilitation hospitals

Long-term care facilities

Nursing Homes

Health insurance companies

Pharmaceutical companies

How healthcare facilities are viewed by Americans

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2.91 3.08

2.84 2.58

2.80 2.23

2.78 2.11

2.78 2.35

2.59 1.45

2.49 1.17

However, Americans viewthe quality of care

positivenegative

Quality of Care RatingMean Ratio

Hospitals

Home health care

Acute rehabilitation hospitals

Assisted-living facilities

Rehabilitation and skilled nursing facilities

Long-term care facilities

Nursing homes

favorableunfavorable

Favorability Ratings (ranked by mean)

Assisted-Living Facilities

Rehabilitation and Skilled Nursing

Facilities

Acute Rehabilitation Hospitals

Long-Term Care Facilities

Nursing Homes

positivenegative

Quality Of Care Ratings

2.78

2.78

2.80

2.59

2.49

MeanMean

3.23

3.21

3.19

3.06

2.92

Closing this gap is critical

Why are satisfaction survey data important

to providers ?

50% have problem, yet don’t complain

45% complain to frontline staff

5% complain to management

Good quality is good business(TARP studies)

Complaints that reach you: Tip of the iceberg!

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Technical Assistance Research Programs’ (TARP’s) fi rst study for the White House Office of Consumer Affairs revealed consumers with problems who did not complain were less loyal than those who did and had their issues resolved.

TARP surveys have revealed a

decline in complaint rates, even

for serious problems, due to

growing cynicism that

complaining doesn’t do any

good.

We call this behavior

“trained helplessness,”

which adopts the mind-set it’s

futile to bother complaining

because nobody will change the

policy.

Complaint rates appear to be declining in all sectors.

Most people won’t complain to you … they will just find someone else to

provide the service.

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Why do families and residents complain?

• Because they didn’t get what they were promised

• An employee was rude to them or their family member• A perception that no one is listening

• An employee projected a “can’t do” or a negative attitude• A feeling of indifference

What do families and residents want when they complain?

• They want– Action to be taken– Solutions to be suggested– Commitment to care of the elders– Timely responses from management– Individual, personalized attention– An apology when things go wrong (and

they do)– Value for the money they (or others) are

paying for services

Why don’t people complain?

• It won’t do any good• It’s not worth the trouble• I don’t know where to complain• I am afraid of retribution

All of these barriers can be reduced or eliminated via effective communication.

Did you know?

• Problems due to mistreatment, quality or incompetence evoke between 5-30% complaint rates because of a belief that nothing will be done

• Mistreatment and incompetence result in 5x more damage to loyalty than do monetary concerns

• 4x as many angry customers post negative comments on websites as those with positive comment

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Criticism is the

school book

from which

we learn.

It’s the negative feedback that will be of most benefit to you if you are committed to growing your census and reputation

based on outstanding service

Did you know?

• A customer who complains and is satisfied is 30% more loyal than a non-complainant and 50% more loyal than a dissatisfied complainant

• A friendly 90-second interaction creates an emotional connection that cemented the relationship with the customer

• Someone who goes to the effort to complain but remains dissatisfied is 50% less loyal than someone who did not bother to complain-

Consumers are the fastest growing payer of healthcare

services

SOURCE: National Research Corporation’s MARKET INSIGHTS study, 2008-2015, n sizes vary from 176 (qual) to 278,824 (quant)

Consumer Trust Index –Perception vs Reality

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50% of organizations incorporate experience data in compensation programs

29% of consumers claim viewing online ratings and reviews is their very 1st step in searching for a provider

Personal recommendations and consumer reviews are the 2 most trusted sources of information when choosing a provider

Healthcare organizations are investing in coaching programs and resources to support low performers

Experience, Transparency, and Consumerism

Meet

• 87% of Americans use the internet regularly

• 39% have visited WebMD.com

• 22% have visited a local provider website

• 35% of consumers are likely or very likely to prefer a healthcare provider following a website visit

Virtual Experience: Web = Virtual Frontline

SOURCES: National Research Corporation’s Market Insights survey,n size = 231,482, PEW Research Center, 2014, n size = 857

The Changing Pattern of Consumer Communications

For the past several years, we’ve been examining how U.S. consumers prefer to communicate with each other, analyzing their answers to the question, Which method would you most likely use to communicate with your friends?

• Text messages are on the rise (+8 points between 2012 and 2016), while home phones (-6 points) and email (-5 points) are on the decline.

• Cell phones (increases with age) and text messages (decreases with age) are the most variable choice based on age group.

• Text messages are the preferred channel for all ages below 45 years old.• Cell hones are the preferred channel for 45- to 74-year-olds.

• Home phones are the preferred channel for people who are older than 74.

• Online chat via Facebook has increased in preference (+4 points since 2012), and is most popular with 25- to 34-year-olds.


Base: 10,000 U.S. consumers | Source: Temkin Group Q1 2012 & Q1 2016 Consumer Benchmark Studies

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Base: 10,000 U.S. consumers | Source: Temkin Group Q1 2012 & Q1 2016 Consumer Benchmark Studies

• 74% of online consumers use social media websites

• 1 in 5 interacted w/ local healthcare provider

• 64% passively interact; 36% actively interact

• Average age of user is 45 years old

• Posts more positive than negative

Social Media Driving Online Patterns

SOURCES: National Research Corporation’s Market Insights survey, n size = 231,482, PEW Research Center, n size = 857

What form of social media do you use as a source of health information?

Popular Social Media Sites for Healthcare

SOURCE: National Research Corporation’s Market Insights survey, n size = 231,482

What form of social media do you use as a source of health information?

Popular Social Media Sites for Healthcare


55%

media sites

55%trust or highly trust

information received from

providers via social media sites

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• 22% of consumers have used a mobile device to seek health information

• 25% anticipate using a mobile device to seek health information in the next year

• 18% prefer to interact with healthcare providers exclusively via mobile device

Mobile is a Marketing Must


Consumers Increasingly Connected

• All signs point up for continued consumer use (and trust) of digital sources of information

• Furthermore consumers are increasingly relying on these forms of communication to make real, physical decisions on their care

• Long-term care providers still lag behind in forming digital relationships with consumers

Digital Experience -> Purchasing Decisions

• The digital experience is driving consumer purchasing decisions across all industries

• The most essential component to purchasing decisions is the ability to know about a product or service before the point of purchase

• The Effect: consumers are now supplementing their gut feeling – increasingly relying on information from others


73 percent view online ratings/reviews before purchasing a product/service

– 83 percent of 18-34 years old



– 52 percent of 65+ years old

SOURCE: National Research Corporation’s Digital Decision Maker study, n size = 3,002

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73 percent view online ratings/reviews before purchasing a product/service

54 percent say positive reviews cause them to trust a brand more

41 percent say negative reviews cause them to avoid a brand


Online vs. Word of Mouth

23 percent of consumers do not trust online reviews as much as personal recommendations

77 percent of consumers do trust online reviews based on the following criteria:

– I can read multiple customer reviews

– I believe the reviews are authentic

– It depends on the type of business


Online ratings/reviews are important 1st step:

• 21% of consumers have already rated or reviewed a healthcare provider online

• 45% have already viewed healthcare-related ratings/reviews online

• 30% feel viewing ratings/reviews online is their first step in seeking care

Digital Experience -> Healthcare Experience

SOURCE: National Research Corporation’s Digital Decision Maker study, 2015, n size = 3,002

We have an irrational view of the negative rating:

• 12% of consumers left a negative rating or review for a healthcare provider

• 51% of consumers received a response from the healthcare provider or parent organization

• 58% of consumers removed their negative rating or review

A Word About Negative Reviews


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Digital is the Engine of Transparency

• Consumers will increasingly seek digital sources of information to decide on their future care

• The quality and speed of information will be key -58 percent of consumers dismiss any review older than a year as “out of date”

• Performance data will re-prioritize what’s important to the future consumer of healthcare


Comment from an AL Family Member

• We‘re very happy with xxxxxxx. With rare exception, the staff is very caring and professional. However, I think the management needs to focus on improving communication between the facility and the family members of those who are living there. You have the family members' email addresses, yet you never use them. Why wasn't there an email to family members letting us know that the director was leaving? Why wasn't there an email to us introducing the new director? Many of us, myself included, are paying our parents' bills and yet there is absolutely no attempt on your part to communicate with us and that's shocking given that we are as important an audience to you as the residents themselves. When communication is so important and so valued in today's world (we're all on email and smart phones all day long), you choose to ignore the many ways you have to stay in touch. You should have your new director do a monthly email update to family members. It would be excellent pr.

How do I measure satisfaction?

• Listen to concerns expressed by your residents and their families

• Conduct satisfaction surveys– At least annually– When residents move in– When residents move out

• Get actionable reports and use the results in your performance improvement programs

• Read and act upon the comments

Where do I start?

• Let’s look at some considerations when thinking about resident satisfaction.

• Let’s look at some of the data from satisfaction from residents to see what they find as important to them and– What will cause a resident to recommend your

community to someone else.

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Key FindingsAcross theContinuum

Important to managing

Top Drivers for Recommendation to Others

Independent Living Resident Assisted Living Resident

Home-Like Atmosphere .61 Responsiveness of Management .61

Responsiveness of Management .59 Choices/Preferences .60

Commitment to Independence .58 Comparison of Charges .59

Care (Concern) of Staff .57 Competency of Staff .59

Responsiveness of Staff .56 Care (Concern) of Staff .58

Nursing Home Resident Short Stay Residents

Care (concern) of Staff .63 Care (Concern) of Staff .77

Competency of Staff .63 Competency of Staff .77


Choices/Preferences .59 Responsiveness of Management .72

RV/LVN/LPN Care .58 Quality of Medical Care .72


Assisted Living Family Skilled Nursing Family

Competency of Staff .72 Care (Concern) of Staff .76

Care (Concern) of Staff .72 Competency of Staff .75


Choices/Preferences .69 Responsiveness of Management .71

Responsiveness of Staff .68 RV/LVN/LPN Care .71

When you don’t

remember

anything,

you’re satisfied!

Loyalty is generated by memorable thingsthat happen that we didn’t expect

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What if Winniethe Pooh had been in a bad mood?

The Law of Memorable Events

• Though it takes somebody doing something special beyond what is expected, it doesn’t take everybody doing something special all the time

• It takes only one brief experience on only one day of a stay to determine dissatisfaction or loyalty

If one were to

pick out the

synonyms for

compassion,

there is an amazing

consistency in the

qualities that have

the greatest impact

on patient loyalty

Compassion,

caring,

comforting and

kindness —

these make up

the bulk of the

adjectives linked

to loyalty … they

are all rooted in

empathy

The capacity for empathy is “the ability to

share in another’s emotions or

feelings”

When people receive empathy,

they feel loved and cared about

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For long-term care not to teach the role of empathy, or inspire compassion, is a colossal omission, because empathy

has the capacity to heal by its effect on stress, and compassion is the primary influence behind patient loyalty.

A wonderful sweet elderly resident passed away at the community where I work tonight. A woman who never complained, always had a smile, and said thank you to all us for helping her out. She spoke with a very soft voice. She had no visitors ever , which breaks my heart ♥ The other staff I worked with tonight all sat on her bed..holding her hand, praying and letting her know she wasn't alone. 9:45pm This wonderful sweet lady is now at peace.

Resident Satisfaction

Studies have repeatedly confirmed that residents and their family members valuethe quality of the relationships they have with the frontline caregivers higher that the quality of the medical care and the quality of the food.

NCCNHR, Public Health Institute

• lowest status age group

• loss of health, roles, home

• dependent, frail

• powerless to change

• weakest social class

• lowest social status job

• least paid, least autonomy

• powerless to change?How does the Administrator generate quality of life ?

where two

worlds meet

where two

worlds meet

CaregiversResidents

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The cradle of quality

=

Resident’s world = caregiver

• 90% of personal care

• Much more than an LPN or RN

Q of life = this relationship

Caregivers significant world =

The ALF

• 50% of waking hours

• 90% economic support

• significant social bonding

• self image, self respect

Q of life = work relationships

Resident Caregivers

interaction

“The executives who ignited the transformations from good to great did not first figure out where to drive the bus and then get people to take it there. No, they first got the right people on the bus (and the wrong people off the bus) and then figured out where to drive”.

“Good to Great” – Jim Collins

Hiring at Disney

• Is this person happy?• Is this person smart?

If you are smart, we can teach you anything.If you are happy, I know you will make the

customers happy.Even in a prestigious Disney restaurant,

experience and skill were secondary to talent.

• Emphasize character attributes rather than specific experience or education

• Exceptional leaders know that skills and knowledge are teachable whereas– Character traits are

ingrained

Determining who the right people are

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Independent Living Employee Assisted Living Employee

Care (Concern) of Management .61 Care (Concern) of Management .69

Assistance with Job Stress .59 Assistance with Job Stress .67

Attentiveness of Management .58 Attentiveness of Management .66

Clear Expectations by Management .57 Clear Expectations by Management .64

Support of Career .56 Fairness of Evaluations .62

Skilled Nursing Employee

Care (Concern) of Management .73

Attentiveness of Management .71

Assistance with Job Stress .69

Safety of Workplace .63

Fairness of Evaluations .61

Employees leave managersnot organizations.

Why are satisfaction survey data important

to providers ?

What gets measured,

gets improved.

Peter Drucker

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www.nationalresearch.com

SUMMARY OF RELATIONSHIPS

StaffSatisfaction

Resident/FamilySatisfaction

StabilityTurnover

Qualityof care

& service

FinancialHealth

KEY PERFORMANCE DRIVERS

higherfamily

satisfaction

lowernursing

assistantturnover

higheremployee

satisfaction

higherfamily

satisfaction

KEY PERFORMANCE DRIVERS

highersatisfaction

amongfamilies

and employees

higheroccupancy

rates

• Benchmarking: A standard by which something can be measured or judged

• You can benchmark against yourself over time• Who else might you compare yourself to:

– Those in your state– Those of similar ownership– Those of similar size– Those of similar location (urban, rural, suburban)

The importance of benchmarking

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65

• Provides crucial information– Tells you loyalty of respondents– Correlates to other quality outcomes:

• All items in survey• Occupancy• Quality indicators• Employee satisfaction

• That is why this question is used for Priority Action Agenda

The importance of “Recommendation”

Because whencustomers

recommend you,they’re putting their

reputation on the line.

They will take that risk only when they are loyal.

“In most of the industriesstudied, the percentage of

customers who were enthusiastic enough to refer a friend or

colleague — perhaps the strongest sign of customer loyalty —

correlated directly with differences in growth rates

among competitors.”

For My InnerView users,this is

“Excellent or Top Box”

“Research shows that, in most industries, there is a strong correlation between

a company’s growth rate and the percentage of its customers who are raving fans — that is, those who say

they are extremely likely to recommend the company to a friend or colleague.”

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If you want to grow your business exponentially,you must get serious about building and maintaining loyal relationships

with your customers

• Loyal customers are easiest customers to serve

• Long-term customers tend to spend more with you than new customers

• Happy, loyal customers purchase other products or services in company’s line

• Satisfied, loyal customers recommend company’s products or services

FREDERICK RIECHHELD:“THE LOYALTY EFFECT”

Quality of leadership andquality of the workplace

• Based on satisfaction surveys conducted by My Inner View:– 78,547 CNAs/NAs– 144,098 family members

• 3,216 skilled nursing facilities ranked in four gro ups based on percentiles (lowest, 2nd lowest, 2nd highest and highest)

The voice of CNAs

Indicators ofquality workplace

1. Pay compared to other nursing homes

2. Safety of workplace

3. Adequate equipment and supplies to do your job

4. Work allows you to make a difference in people's lives

5. Co-workers work together as a team

6. Fair performance evaluations

7. Respect shown for resident by staff

8. Help you get to deal with job stress and burnout

9. Staff communication between shifts

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Based on My InnerView employee satisfaction surveys completed by CNAs/NAs

Quality leaders produce a quality workplace

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Quality workplace earns staff recommendation

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Quality workplace earns family recommendation

Quality workplace creates quality of life for resid ent

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Based on My InnerView employee satisfaction surveys completed by CNAs/NAs

As staff are treated,

so will the elders be treated.

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Employeesspeak out about

leadership

Listen to your employees

The truths of leadership you need to know:1. We are watching everything you do

� If you show up late for a meeting you are telling us you don’t value OUR time

� If you lose your cool over small issues, we wonder how you will react with big ones

� You are ALWAYS leading, you can’t NOT lead

2. Everything you do counts� Sharing juicy gossip and remove yourself from your leadership role? NO

TIME OUTS� What you say to us outside the office COUNTS

Listen to your employees

3. We have expectations of you� Hire great people – this is one of the most important things you do

� Don’t just hire any “warm body” just to fill a position� You can be the best manager in the world but if we have people

on the team who are not talented we will not be successful� “De-hire” those on the team who are NOT contributing

to the mission� They are more detrimental than any of our competitors� If we get lucky, our competitor will hire them

� Treat us with respect� You need us just as much as we need you…sometimes

even more

Toyota’s Five Important

Questions

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The nurse made a medication error

The wrong medication was in the drawer

The pharmacy tech put it in the drawer

Just Ask Why


The tech read it off the computer that way

The nurse put it in the computer that way

The nurse misread the doctor’s writing as themedication was only one letter different from the oneshe thought was correct.


The nurse misread the doctor’s handwriting and entered the wrong medication on the order sheet

We did the best we could,

with what we knew,

And when we knew better,

we did better.MAYA ANGELOU

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Long-term care

will continue to evolve

and change. It is up leaders

to successfully lead

the profession through

this never-ending change.

Administrator and DON: The architects of excellence

W. EDWARDS DEMING

An organizationexcels or fails

with its managers f

“80% of all quality problems

are the fault of managers”

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Good leaders are made, not born

• Must have the desire and willpower • Good leaders develop through

never-ending process of:– Self-study – Education – Training – Experience

• Best leaders are continually working and studying to improve their leadership skills

SUMMARY

• People complain because they didn’t get what they think they “signed up for”– People have multiple outlets for complaining – more than ever

• Care/concern/compassion is the greatest influencer of recommendation for families and residents alike

• The vast majority of care is given by frontline caregivers• Caregivers greatest influencer is that management cares

about themTHEREFORE• Reducing complaints is all about leadership

WHAT KIND OF A LEADER ARE YOU?

Thank you!

[email protected]

773-942-7525

800-601-3884

Documents

How healthcare facilities Mary Tellis-Nayak · Quality Of Care Ratings 2.78 2.78 2.80 2.59 2.49 Mean Mean 3.23 3.21 3.19 3.06 2.92 Closing this gap is critical Why are satisfaction