As I was watching the pregame show, studio analyst Tony Dungy gave his overview of the game.  Dungy is a retired NFL head coach who won the Super Bowl in 2007 with the Indianapolis Colts.  All told, he spent 12 years as a head coach in the NFL, making the playoffs a record ten times in a row.  He’s known best for his quiet demeanor and a coaching philosophy that encourages teaching and supporting his players, rather than screaming at or belittling them.  He is known as a “good guy,” but it was his part of this past Sunday’s mortality play that the casual fan didn’t appreciate.

You see, he had a leading role in the rehabilitation of Michael Vick when he was released from prison.   Watching him reminded me of what he was credited with saying to Vick:  “Integrity is what you do when no one is watching; it’s doing the right thing all the time.”

Now some could never forgive Vick, and I’m not going to get into that now.   But I think that there is a lesson in Tony Dungy’s approach to life.  The real person you are is revealed in the moments when no one is watching and you’re not attempting to impress anyone.  Your true nature comes out when you’re just being yourself and doing the right thing.  I’ve stressed to my kids that in moments when no one is watching is how you conduct yourself with integrity.

This same idea is ingrained in a lot of our people at ARAMARK.  I’m always impressed by the stories I hear about the great things ARAMARK employees are doing every day – often when no one is looking.  Sometimes it’s just a small gesture on a random day that only affects one person – but makes a huge difference.

At the San Martin campus of St. Rose Dominican Hospital in Henderson, NV, Environmental Services (EVS) Director Robert Stewart took it upon himself to help a patient who most people might not give a second thought.  As a result, Robert was honored as the hospital’s Star Performer for August, which is a monthly employee recognition that is voted on by San Martin’s case managers.  Even more impressive, according Hospital President Rod Davis, this behavior is pretty typical from Robert. 

Joni Kurata, a Licensed Social Worker at San Martin, told us about a homeless patient who came in with chest pain.  Obviously, he wasn’t in the best condition, and his clothes – the only clothes he owned – were extremely dirty.  Robert overheard several individuals discussing the patient during the daily bed placement meeting. 

Just to provide some background, ARAMARK’s EVS directors handle a number of tasks, including managing the cleaning and housekeeping services, maintenance, and waste disposal, all while using environmentally conscious processes and equipment.  While the work our EVS group handles does affect patient safety, comfort, and confidence, they aren’t directly responsible for patient well-being.

Well, except in this case.

While the patient was receiving tests, Robert went and personally found the patient’s clothing, pretreated the stains, and ran them through the washing machine and dryer, having them back to the patient within a couple hours.  The patient was extremely grateful and the entire staff appreciated his unsolicited effort.  “I could tell he (Robert) was really busy that day, but he still went out of his way to help,” said Joni.  “I am so impressed by ARAMARK’s staff and their willingness to help, no matter what the circumstance.”

“What can I say other than Robert does a fantastic job?” mused GM Lee Timothy.  “He always takes ownership, steps in, takes initiative, and makes things happen.”

He makes things happen.  Even going so far as to tackle what clearly wasn’t an enjoyable task, when no one was watching.  Robert went out of his way to ensure that this patient’s stay would be as pleasant and comfortable as possible.  Employees like Robert Stewart are our unsung heroes, and they are who make us successful.

The need to evaluate expenditures in terms of value – and how to define that value – is more important in the business of healthcare.  I’m very proud of ARAMARK Healthcare’s sponsorship of the HFMA Value Project which found that hospitals and health systems are recognizing the shift to a value-based healthcare system and are preparing for changes in the payment system.

A webinar that features Valley Baptist Health System’s Stephen W. Hill, Administrative Director of Nursing and Cynthia Gray, VP of Finance, along with Michael Morgioni the CFO of ARAMARK Healthcare, will focus on how Valley defines value.  This HFMA Value Project webinar will share strategies providers can implement to build a culture of performance and efficiency to prepare for healthcare reform. It will specifically discuss collaboration efforts among support services and nursing so that nursing has more time for patient care. Outcomes will be highlighted from activities instituted by ARAMARK Healthcare  known as I Impact. Those outcomes include higher patient satisfaction, better employee retention, and safety outcomes that drove profitability and productivity. The application of operational benchmarks and standards to reduce variability while improving quality outcomes will also be discussed.

If you want to learn how you can accelerate organizational change using collaboration tools, leverage employee engagement, and engage operations in value creation, this webinar may help provide you with some good approaches.  In addition, the webinar qualifies for 1.5 CPEs.

I’ll be tuning in – on October 4, 2011 at 3:00 to 4:30 Eastern;  2:00 to 3:30 pm Central.

The article details the approach CHRISTUS Santa Rosa (San Antonio, TX) used to develop a five year implementation plan for improvement activities and system replacement initiatives.

1. The ability to recognize failure and success for patients. That means the ability to use data—collecting it, refining it, and most importantly understanding.
2. Devise solutions. He spent some time talking about checklists in Healthcare, for instance.
3. Scaling solutions so that everyone functions together seamlessly like a pit crew.

As I think about the work ARAMARK Healthcare team members do, it is a lot like that of a pit crew. You could liken the hospital to the race car itself, and the race car drivers may be the docs, nurses, and members of the care team. Support service workers at hospitals are the ones making sure that they can perform to the best of their ability—that’s what support is all about. 

The parallels continue even with the strategy of devising solutions and using checklists to do that. At ARAMARK Healthcare, we have an entire system of standards and processes for each of our services. And we even have what looks like a checklist for each operation to make sure that we are reducing operational variation and maximizing efficiencies for our services. 

There’s no question that the environment is changing rapidly—whether its healthcare reform, medicine itself, technology—you name it. With things moving faster and faster, the analogy of the Pit Crew is spot on.

ARAMARK Healthcare Fellow, Teenice Nebblets at her desk at Main Line Health System

Nebblets worked with Donna Phillips, the President of Bryn Mawr Rehabilitation Hospital (BMRH), a member of the Main Line Health System, and one of the leading freestanding rehabilitation hospitals in the country, to establish a Project SEARCH program. The program provides education and training to young adults with intellectual and developmental disabilities through an innovative workforce and career development model that benefits the individual, workplace, and community. The primary goal of the program is to secure competitive employment outcomes for each student graduate.  BMRH is the first in the region – and second in the nation to establish the program.  Project SEARCH was originally developed by the US Department of Labor and implemented by Cincinnati Children’s Hospital in Ohio to provide internship experiences for high school-aged children with disabilities.   The US Department of Labor recognizes that identifying alternate labor pools, which can include individuals with disabilities, can be a viable strategy to confront critical workforce shortages.  BMRH recognizes the potential in a historically underutilized workforce. 

BMRH, in partnership with the Pennsylvania Office of Vocational Rehabilitation (OVR) and Main Line Health, serves as a single conduit for delivering vocational training and employment services for adults with disabilities. At the conclusion of the program, BMRH anticipates hiring graduates of Project SEARCH within the Main Line Health System to improve performance in high-turnover, entry level positions.  Seems like a win all around to me – for BMRH, for the state, and for the employees.  And it keeps with the mission of hospitals – which is to improve the health of the community.

Nebblets authored this article about Project Search, in Winter 2011 issue of Health Policy Newsletter , a publication of the Jefferson School of Population Health.

 Great job, Teenice!

Trudi Stafford (center) with members of the Baylor All Saints host/hostess team

Stafford speaks with the team during a group session

With the start of a new year, the hope for a better tomorrow is couched with the need to get down to work to make that tomorrow happen.   Chief Nursing Officer Trudi Stafford  at Baylor All Saints Medical Center in Fort Worth, Texas, created a program that allows her to experience different perspectives to solve the problems at hand. 

Called, “Walk a Mile in My Shoes”, Stafford’s goal is to gain firsthand experiences on the front line. I learned about one of Stafford’s “walks”, in the (safety) shoes of a hospital hostess.   Starting at 6:30 am, Stafford trained for four hours with Danyel Rodgers, a hostess with ARAMARK Healthcare, in three areas: the Nutrition Services office, the kitchen, and on the floors. Stafford checked and delivered patient trays, picked up soiled trays, and assisted with patient menus. 

 Stafford developed some keen insight into food services:  “While working side-by-side with Danyel as my training assistant, I was able to see the hospital and the employees in a totally different light.”  Rodgers guided Stafford throughout her routine rotations, demonstrating how to properly respond to certain situations and how to execute AIDET with expertise. AIDET is a framework designed to allow staff to easily communicate with patients and their families. Staff (A) acknowledge each patient by their name, (I) introduce themselves, (D) duration – let patients know how long staff will be in the room, (E) explain step by step what will happen and ask the patient if they have any questions, and (T) thank the patient.

Stafford takes the Walk a Mile in My Shoes as an opportunity to build positive relationships with hospital departments.  Danyel Rodgers said that she appreciated Stafford’s interest in their operation and views the experience as an encouraging influence. “Having upper management walk in my shoes made me feel special and proud,” states Rodgers. “I am happy that Trudi took time out of her busy schedule to experience my role as a hostess. Her willingness to gain a hands-on experience made me realize how much she cares about our patients.”

Yes, the learning goes both way.  The ARAMARK host/hostess team were pleased with Stafford’s performance and the learning tactics she gained from the walk.  Joe Yannetti, Assistant Director of Food Nutrition Services, summed up the experience of having the CNO walk in the shoes of food service workers. “Having Trudi engage herself as a member of our group and dress the part allowed us to see that we are not alone in our service and that we are on the right path in this journey of patient satisfaction.”

Pictured are Bakery Chef, Amanda Garcia (right) and her two daughters Jennifer and Lisa with their finished product at ARAMARK Healthcare’s Gingerbread House event at Baylor University Medical Center in Dallas.

One of my childhood memories is the sweet smell of Christmas cookies.  Maybe more than the actual taste, it was helping my mom with the pizzelle iron. For those who are unfamiliar, pizzelle are thin waffle-like Italian cookies.    Making pizelles was more than just a tasty treat; it was part of being a family.

One hospital found a way to use the spirit of the season to enhance collaboration with nurses and support service teams.  ARAMARK Healthcare hosts an annual Gingerbread House Decorating at Baylor University Medical Center at Dallas (BUMC) that has turned into a way for the support service team to connect with nurse managers outside of working hours.  The result is a stronger workplace relationship. 

Shannon Heard, Resident District Manager for Food Services at Baylor Health Care System, was a part of the initial conception of the event. “In the past, ARAMARK chefs built gingerbread houses to decorate the lobbies of the hospital,” said Heard. “In the spirit of collaboration, we thought it would be a great idea to use this project as an opportunity for BUMC nurse managers and their families to join our ARAMARK managers and their families to decorate the houses and establish a closer network.”

The literature indicates that nurses who are happier with their jobs deliver better patient care.  Since nursing and support services work closely together, stronger collaboration among these groups can also lead to better patient outcomes for the hospital.

Patricia Ault, Nurse Manager at BUMC has enjoyed bringing her grandchildren and other family members to the event for the past 3 years.

“This year I brought 14 people,” Ault said. “It gets us in the mood for Christmas and we look forward to attending every year.” “This event is a great way to have a different look at employees outside of the day to day operation.”

Throughout the month of December, the gingerbread houses are displayed in “villages” throughout the two hospitals, along with a sign that informs onlookers about the program. The displays assist with increasing the holiday spirit in the hospitals for patients, visitors, and staff year after year.

Reminds me…when my kids come home from school, I’ll break out the pizzelle iron!  Happy holidays!

The quote from contemporary French author Frédéric Beigbeder: “Le plaisir présente un avantage: contrairement au bonheur il a le mérite d’exister!” In English: “The advantage of pleasure: unlike happiness it deserves to exist!”

“Non s’efforcer vers le plaisir mais trouver son plaisir dans l’effort mem s’est le secret de mon bonheur”, from the famous French author, André Paul Guillaume Gide. Translated: “Not in making an effort to find pleasure, but in finding pleasure in the effort, that’s the secret to my happiness.”  

When I began my career in healthcare, I took a Medical Terminology class to try to get my arms around the complex world of medicine. Patients don’t go through such classes, although we frequently communicate with them in our professional vernacular. I was at a hospital in Texas, which had a similar approach to the Hotel Chateau Laurier, to try to explain to its patients the types of tests that they are having.

Using photos and a description of what the tests provide, the hospital artistically displayed on the halls leading to many of its outpatient testing areas what is being performed. The photo below shows ARAMARK Healthcare fellow Chenita Lawrence next to one of the terms, Chemistry, in the outpatient laboratory. It’s a comforting way to bring to patients an understanding of what tests they are having done. Not surprisingly, this hospital’s commitment to its patients resonates with them … it is in the 90th percentile of outpatient patient satisfaction!

Since my employer, ARAMARK Healthcare provides environmental and food services  there, I was able to drill down to see what our team did there and look at some metrics.  For example, there is  a low turnover rate among our support services employees over the past several years.  While some turnover statistics can be chalked up to a tough economy, the overarching strategy for employee engagement also has had a direct impact.

So I drilled into the low turnover rates and found that support service employees at CHRISTUS St. Michael follow a strategy called I-Impact.  They use a concept called “rounding,” where managers regularly spend time talking with employees to make sure they have the tools and support to do their jobs. Employees in turn “round” on other important stakeholders, such as nurses, to determine if they can help to improve any aspect of their jobs.

The culture is one of recognition.  I found out that when an employee does a good job, managers regularly send thank you notes to their homes. Employees are also encouraged to send notes to their partners within the hospital to recognize special effort.

Some other common processes include a training program where support service employees are coached on how to talk with patients.  Employees are presented with key words that they can use to talk with the patients at key times. This helps to reduce anxiety for both the employees and patients.

Empowering employees to become part of the hiring process is another part of the strategy. When an opening for a new team member becomes available, leading candidates are interviewed by department peers. This helps determine cultural fit and also provides winning candidates with mentors to help them along once they start.

Anyone familiar with the Studer Group will recognize some of these tactics. In fact, Studer plays a large part in Modern Healthcare’s conference.

The ARAMARK Healthcare support service team’s performance is consistent with St. Michael’s overall performance.  This comes as no surprise to an organization ranked as one of the best places to work in healthcare.

A September 21, 2010 article based on an interview with Trent Haywood, MD, JD, chief medical officer, VHA, Inc., Irving, Texas, and former deputy chief medical offer at the Centers for Medicare & Medicaid Services in Healthcare Financial Management (HFMA)  talked about how less-than-stellar patient satisfaction results are dragging down hospitals’ value-based purchasing (VBP) scores—a tally that CMS intends to use in calculating Medicare reimbursements beginning October 1, 2012.

 There are many things that hospitals need to do to improve patient satisfaction scores.  Haywood states, “With HCAHPS, there is a much wider distribution (in scores). While many hospitals are starting to focus on patient satisfaction, many still have room for improvement.” 

It is hard to improve scores…patients don’t really want to be in a hospital….it’s a somewhat strange environment for most … and patients lose a lot of control over their environment.  Some hospitals are trying to give patients back some control, over something that they are very familiar with…food. 

I saw this video featuring Leonard Votion, Director of Food & Nutrition Services at Trinity Mother Frances Hospital, a 395 bed acute care hospital in Tyler, Texas.  Votion is interviewed on KETK NBC 56 about the room service program that they started to offer in August 2010.  Said Votion: “Food is healing.   It is a real satisfier.”  Votion added that TMF provides ” What they eat, to when they  eat, at no additional cost for the patient.”  Room service staff  works with patients and their medical team to help ensure that patient dietary wants work in harmony with the dietary needs necessary to properly aid in a quick recovery.  I love the quote at the end from the host —food can make a difference.  

Food is not part of the HCAHPS survey, but I feel that it has a halo effect.  Sure it does NOT make up for poor care…but it does provide an additional level of comfort and control for patients who are being well cared for clinically as well.  As patient satisfaction scores become a part of CMS’ Value Based Purchasing program, hospitals that gain an edge by finding cost-effective ways to create satisfied patients —and strong clinical outcomes —will succeed.