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Crothall's Winning Strategy for Driving HCAHPS Success

Crothall’s focus on personal relationships is making the difference for HCAHPS success.

Raising the Stakes

14 months ago, when the Centers for Medicare & Medicaid Services (CMS) first publicly posted patient satisfaction scores, it prompted a change in attitudes. Surveys were no longer just a private tool for internal improvement, but a public verdict of either excellence or deficiency.

Hospital CEOs are holding all departments accountable for HCAHPS success as all areas of patient care affect the hospital’s overall score and, ultimately, CMS reimbursement. Facility cleanliness remains a highly visible symbol of hospital quality. In fact, the HCAHPS Hospital Compare web site provides a Hospital Checklist listing only a handful of key quality indicators, with facility cleanliness featured among them.

Targeted Strategy

Crothall is the first Environmental Services provider to develop a comprehensive strategy to target HCAHPS performance and raise scores. In July 2008, Crothall launched 7 Immediate Strategies for Driving HCAHPS Scores throughout all of its EVS accounts nationwide. The Immediate Strategies include key insights to address commonly overlooked obstacles to improving scores, as well as establishing a solid foundation for future success. In October 2008, Crothall rolled out the second phase of this HCAHPS initiative, The Crothall Way: Driving HCAHPS Scores for Success. The Crothall Way is a long-term approach to hard-wiring success by addressing patient interaction, employee satisfaction, and visual and frequency triggers to directly influence the patient’s perception of hospital room cleanliness.

Being a pioneer in HCAHPS strategy and monitoring the results have given Crothall insight into what really makes an impact with patients. These findings have become the core of Crothall’s winning strategy and are the keys to driving HCAHPS success.

Employee Satisfaction and Engagement

Great patient satisfaction comes down to a superior support staff that is engaged and invested in making an impact on patients. None of this is possible unless the front-line associates feel valued themselves and part of a critical component of patient care. When housekeepers understand that cleanliness protects patients from infection, they are more likely to see the importance of their jobs. Unfortunately, this central concept can be lost in the day-to-day priorities of their demanding jobs. If management doesn’t communicate in these terms, it is unlikely that the staff will embrace this key understanding.

Employee engagement is essential to the team’s effectiveness and quality. Crothall addresses the relationship between managers and hourly staff and among hourly workers, even across different shifts. Some of these issues are as basic as showing respect, acting as a team, and sharing the resources necessary to get the job done. Without employee satisfaction, everything else suffers, including patient satisfaction. The staff will not care about the hospital’s goals and strategies unless it feels valued, engaged, and important.

Focus on Communication

At Bergen Regional Medical Center in NJ, Crothall’s Immediate Strategies have delivered encouraging results. From an average “%Always” HCAHPS cleaning score of 71% in the second quarter of 2008 (just before implementation), average scores trended upward for the year to 76%, while the average for the state of NJ has been 66%. The hospital’s Press Ganey rank for the HCAHPS cleaning question moved from the 59th to 75th percentile in 2008.

Crothall EVS Director Luis Joglar has implemented The Crothall Way with a specific focus on improved communication— with the associates, clinical users, and patients. The team celebrates success (one of the 7 Key Drivers) through public recognition, with the entire staff gathering to applaud a job well done by a particular unit. Associates’ birthdays and milestones are recognized and celebrated by the department. The staff and managers round for results, speaking to the patients every day to get to know them. The EVS department has also made great strides in interfacing with Nursing. VP of Facilities Herman Lindenbaum says, “Nurses know their patients and what they need at the right time. They are the gatekeepers to patient satisfaction.” He has been happy with the increase in HCAHPS scores and expects nothing less than the best. “I am looking forward to even more success, and I am always optimistic.”

Bedside Manner

It is widely understood that because the HCAHPS survey measures frequency of care as opposed to quality of care, it takes more than just good cleaning to raise scores for the HCAHPS cleaning question. Success depends on patient interactions or “touches.” Interestingly, Crothall’s research has found that it is not necessarily the number of touches that boosts scores, but the quality of each touch, with hourly and management staff. It is the “magic” that happens at the bedside, the connection between people, that makes all the difference.

Crothall’s strategy involves connecting with patients to find out what they really think. This allows management to address the source of complaints and get to the root causes to make the patient’s experience positive. The goal is to discover what is really preventing the staff’s ability to raise scores. For instance, even the most skilled and engaged housekeepers will have difficulty connecting with a particular patient if they are constantly pulled from their normal routine to cover discharges or other tasks.

Above and beyond identifying and overcoming obstacles, what Crothall is really trying to accomplish is a fundamental shift in thinking. The goal is to change the staff’s attitude from one of taking care of requests to one of building a relationship with the patient. With this “all hands on deck” attitude, cleaning the room is viewed as only a part of the worker’s responsibility to the patient. Cleaning is a means to provide great care to the person; it is not an end to itself.

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