Electronic Health Reporter

Guest post by Greg Link, co-author with Stephen M. R. Covey of the national bestseller Smart Trust: The Defining Skill that Transforms Managers into Leaders. 

As the name implies, patient satisfaction scores are nothing more than a measure of a patient’s healthcare experience. Like customers in any other industry, healthcare patients expect good, old-fashioned, caring customer service and to have their expectations met. Unfortunately, due largely to the extreme complexity of the healthcare experience, patients have historically lowered their expectations and defined extraordinary service as merely having their health issue ultimately resolved. That’s like ignoring all of the service aspects of a hotel stay as long as you slept through the night.

Now, in response to the Affordable Care Act, which links hospitals’ government reimbursement payments to how well they score in the Hospital Consumer Assessment (HCAHPS) on patient care, hospitals across the country are scrambling to improve their scores. 

“The reality is, hospitals can’t talk themselves out of a problem they behaved themselves into,” Stephen M. R. Covey said, author of The Speed of Trust and Smart Trust. 

Covey suggests that the patient experience is not a campaign or a department; it is a function of a high-trust culture generated by good, old-fashioned, common-sense behaviors demonstrated by all stakeholders.  These behaviors are common to trusted people and organizations throughout history – behaviors like listening first, clarifying expectations, talking straight, creating transparency, extending trust, and demonstrating respect. One compelling example of a remarkable extension of trust is the Cleveland Clinic, where they are so transparent they give patients online access to their own charts and medical records, including doctors’ notes.

While there is no quick-fix solution to the now acute problem of patient satisfaction levels, confronting reality, another high-trust behavior, dictates that the solution lies in changing chronically ineffective behaviors and creating a high-trust culture.  A culture of fully engaged, satisfied healthcare workers produces the natural outcome of satisfied patients. 

As Covey puts it, “Like the value a strong immune system is to the body, nothing will inoculate a healthcare system against the ravages of massive change as effectively as a high-trust organizational culture.”

In a low-trust culture, people may be able to coordinate; with a little more trust, they may be able to cooperate; but true collaboration—the collaboration demanded in healthcare—requires a high-trust culture.

So why don’t more hospitals have high-trust cultures? One reason some leaders don’t extend trust is that they think they will have greater control in a culture that depends on rules, policies, and regulations to cover every contingency. What they don’t understand is that the relationship between trust and control is actually inverse: The greater the level of trust, the greater the control.

The French sociologist Émile Durkheim put it this way: “When mores [cultural values] are sufficient, laws are unnecessary; when mores are insufficient, laws are unenforceable.” In a low-trust culture, it’s literally impossible to put enough rules and policies into place to control people’s every action. In a low-trust relationship, the legal agreement can’t be long enough to cover every possibility. Therefore, the best way to increase control is to create a high-trust culture.

In response to this tremendous challenge in the healthcare industry, FranklinCovey developed an enterprise solution we call CultureCare. Based on The Speed of Trust by Stephen M. R. Covey, CultureCare is a whole-hospital transformation process that takes a unique, behavioral approach to creating a high-trust collaborative culture – which becomes the foundation to creating a superior patient experience.

CultureCare produces transformational results such as increased efficiency, safer transitions, quality clinical outcomes, increased engagement, decreased re- admissions, fewer errors, and, consequently, increased patient satisfaction? scores.

In the fast-paced, lives-at-stake world of healthcare, now more than ever, the key to satisfied patients is a trusted experience flowing from a high-trust collaborative culture .  As Peter Drucker liked to say: “Culture eats strategy for breakfast!”

Greg Link is co-author with Stephen M. R. Covey of the national bestseller Smart Trust: The Defining Skill that Transforms Managers into Leaders. (Sept. 2013) They are co-founders of FranklinCovey’s Speed of Trust Practice & CoveyLink.  SmartTrustBook.com; Twitter @CoveyLink.