Lessons from an Olympic Coach

Like most people I have my day job and an outside life. When I am not helping health care organizations improve, I can often be found on a horse practicing dressage, the art of training for obedience, flexibility and balance. The highest form of dressage known to most is performed by the Spanish Riding School in Vienna. Earlier this year, I had an opportunity to spend three days with three-time Olympic dressage coach Jane Savoie. She invited her worldwide community of online mentees to a reunion in Wellington, Fla., and about 60 of us made the trip. What I realized after I got home is that the lessons she teaches can be applied to health care.

Olympic level horses are not born knowing how to do fancy movements. Dressage champions are created. It takes perseverance and hard work. Riders train their horses many years to attain this level. While some horses have characteristics that allow them great success in international competition, others don’t have the same qualities. The beauty of dressage is that any healthy horse can learn the principles and techniques and improve. The basics are exactly the same for all.

The same goes for health care organizations. Some just have the qualities that make it easier to achieve high patient experience scores. However, organizations without those characteristics can also be successful. They just have to work harder and longer to get there. The basics are exactly the same.

“If you have a crummy X and keep practicing crummy X, you will get very good at crummy X.” Well, actually, Jane didn’t use the word crummy, but her point is that if you keep doing something poorly, it is not going to get better. Break down the action into ridiculously small, no-fail, baby steps and make them better, then start putting things back together into larger pieces. If something isn’t working, go back a step and break it down.

I often see this in hospitals that try something they think qualifies as hourly rounding. It goes something like this: The nurse enters the patient room and asks, “Is everything OK with you?” The patient nods, and the nurse leaves. After a few months, I get a call asking why “rounding” isn’t moving the needle on patient experience scores.

Often when rounding nurses try to do all of the activities at once – introduce, acknowledge, ask and answer questions, take care of patient needs, etc. Some people are very good at this, but others who struggle need to break rounding down into the more basic components. The first step might be introducing themselves to the patients and family members. If necessary, break down the components of the introduction into smaller segments, and focus on elements such as eye contact and smiling.

When that gets as easy as breathing, then add the next part. After some weeks or even months, all of the ingredients will be there, and rounding becomes a natural extension of the interaction between nurse and patient. Hourly rounding almost always fails not because staff members don’t want to do it, although in some cases that’s certainly true. It fails because there is no continual feedback mechanism for staff to know how or if their actions are the correct or desired ones.

Another moment from my dressage weekend really hit home. We were watching some warm-up rides just outside the show ring, and one rider was aggressive with her horse and bullying him into submission. Unfortunately, the horse did not have all of the basic ingredients necessary to do what his rider wanted. He was confused and his body exuded tension and anxiety.

How many times in health care do we bully staffers into doing something we want without giving them the necessary training and ongoing support? We say, “You will start rounding tomorrow,” and roll it out in a meeting or with some online learning tool, and then expect everyone to understand and begin to use it. No daily reinforcement of the activity, no practice time, no coach or trainer, and yet we expect people to suddenly have the skills to perform the task in front of patients and family. There is often no feedback mechanism until a patient or family member complains in person or on a patient satisfaction survey. Then, out comes the stick, with the nurse being reprimanded for not doing as told. The result is a demoralized employee.

Dressage is a centuries-old training process. There are hundreds if not thousands of manuals describing how to do it. Fads come and go, and with them gadgets and tricks that only work in the short term. While patient satisfaction is a much newer field, the tried and true techniques always work. There are fads and gimmicks that are good for the short term, but don’t have long-term sustainability.

In order for a health care organization to achieve the highest levels of patient satisfaction, it takes self-awareness, time, discipline and hard work. With patience and persistence, everyone can get it right.