Regions Hospital is the largest private employer in St. Paul, engaging thousands of medical professionals to serve the Twin Cities area and western Wisconsin. The hospital has more than 26,000 admissions per year, as well as nearly 90,000 visits to its emergency center. As a not-for-profit teaching hospital, Regions partners with the University of Minnesota Medical school, helping train more than 500 resident physicians each year. The hospital is also well-known for providing charity care, treating more than 55,000 patients in 2017 at what amounted to $19.6 million in uncompensated services.
As part of their ongoing commitment to improve health and wellbeing within the community, Regions was interested in improving the patient experience in healthcare, their HCAHPS survey scores, and healthcare employee retention. The Hospital Consumer Assessment of Healthcare Providers & Systems (HCAHPS) survey is a standardized means of collecting information regarding patient satisfaction in healthcare. More than 4,000 hospitals participate in HCAHPS across the nation and over three million patients complete the survey annually. Patients are asked about various aspects of their hospital experience, including the communication between healthcare staff and patients, the cleanliness and quietness of the environment, and the responsiveness of hospital staff. Since 2012, the federal government has used HCAHPS scores to help determine a hospital’s eligibility for payments designed to incentivize the consistent delivery of high-quality care. Regions wanted to be in the top 10% of providers in terms of patient experience. To reach this goal would require new levels of responsiveness and healthcare employee collaboration across the organization.
The ecosystem of a hospital is complex and interconnected: countless individuals across dozens of different departments influence the patient experience, from security and custodial teams, to behind-the-scenes administrative functions, to the nutrition teams and kitchen staff, to the surgeons, doctors, and nurses providing treatment and recovery services. Regions partnered with Arbinger to conduct a pilot program testing various configurations of front-line staff training in hopes of producing meaningful results. Rather than focusing solely on the external behaviors described in the HCAHPS survey, the training programs would emphasis outward mindset principles and practices, empowering Regions staff to connect more deeply with the humanity of their patients while improving the healthcare employee responsiveness.
Our goal is to be among the very best in the country. I believe that the outward mindset is fundamental and integral to achieving that next level.Anabel De Juan-Gomez – Leader of Organizational Development & Learning
Our goal is to be among the very best in the country. I believe that the outward mindset is fundamental and integral to achieving that next level.
Over six months, Arbinger and Regions collaborated to test various modes of training for the hospital’s front-line staff. Due to the urgent and fluctuating nature of hospital work, it was crucial to find flexible means of training that account for inevitable interruptions during employee shifts.
To that end, Arbinger created video training segments that could be adaptively used in conjunction with traditional workshop training methods. Additionally, some of Regions’ care management teams received both leader development sessions and one-on-one coaching. The programs delivered factored in the availability of staff to teach, coach, and act as role models of the outward mindset, frequency of development meetings, and the percentage of staff able to attend initial training workshops. Despite different implementation strategies, all training focused on building employee self-awareness regarding the mindset underlying their efforts in hopes of improving patient satisfaction in healthcare.
Participants were helped to realize that the way they viewed patients, coworkers, and supervisors could either amplify or undermine the effect of their behaviors. They came to acknowledge a greater responsibility than merely conducting their work obligations with professional competency. Instead, they saw both the need and the benefits of fully encountering the personhood of others—both their patients and their coworkers. One staff participant noted, “It’s so easy to get focused on what I need to get done and what I think is important. Arbinger helps us meet people where they are at.”
Each version of the pilot training program was evaluated in a few different ways: by comparing relevant HCAHPS categories, by examining Regions’ employee engagement survey, and by considering the results of Arbinger’s Organizational Mindset Assessment. While the level of impact was influenced by factors such as the percentage of staff who attended training and implementation sessions, Regions experienced dramatic improvements in each program and across a range of key metrics.
Before Arbinger training began, Regions employees were surveyed to see how well they felt management understood and responded helpfully to their needs and concerns. The pilot programs enabled an improvement of 43% in one program, and 26% in another, indicating improvements in healthcare employee responsiveness and healthcare employee collaboration. The survey question asking how well people understood each other’s goals and objectives increased by an average of 23% following the pilot training. These metrics indicate a culture transformed to be more collaborative, an internal shift that ultimately facilitated an improved patient experience. Not only were they successful in improving patient experience in healthcare, but Regions Hospital also found that healthcare employee retention also improved—a major challenge in the healthcare industry.
Three different HCAHPS measurements showed notable improvement following Arbinger’s training. In one wing of the hospital, the number of patients who felt that nurses explained things in an understandable way increased by 8%, exceeding the improvement goal established by the hospital management. The same intervention resulted in a 5% improvement in the number of patients who felt that nurses listened to them carefully. In another wing of the hospital, the implementation of Arbinger’s tools resulted in a 5% increase in patients who felt like their preferences were taken into account. These percentage increases reflect hard won progress considering the tense emotional and financial strain that often accompany patients who visit the hospital. Simply applying the outward mindset training improves communication between healthcare staff and patients, thus increasing patient satisfaction in healthcare.
Another noteworthy result from a pilot program was captured by Regions’ annual employee engagement survey, where a group that received Arbinger training showed a striking increase of 68% in the number of employees who felt that their leaders explained the reasoning behind their decisions. In fact, that pilot group reported improvement in all seven categories measured by the employee engagement survey, an important indicator of employee satisfaction and involvement. Tyler Schmidtz, Executive Director of Ancillary Services called the change in engagement scores “frankly remarkable.”
In terms of qualitative results, participants in the pilot programs reported seeing improvement in how teams worked together to solve problems and felt that the training helped to cultivate lasting relationships with coworkers. Arbinger training also helped employees better appreciate how coworkers with different roles contributed to patient wellbeing. As Director of Nursing Sarah Cassell summarized, “The outward mindset is giving us tools to be more collaborative with all the people that we interact with on a day-to-day basis.”
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