Award-Winning Organizations: The Secret to Their Success

Added on Feb 16, 2017

Award-Winning Organizations: The Secret to Their Success
By Diana Mahoney
Industry Edge February 2017

The strategies, tactics and behaviors that contribute to the success of high-performing health care organizations are not really a secret. In fact, they fall into fairly predictable categories, such as communication, cooperation, collaboration, engagement and accountability, as evidenced by the common themes that emerged from an analysis of characteristics shared by Press Ganey 2016 award winners.

The secret lies in making the strategies, tactics and behaviors stick by integrating them so thoroughly into the culture of the organization that they become part of its fabric.

“Culture is what sustains performance,” according to Dr. Jim Merlino, president and chief medical officer of the Press Ganey Strategic Consulting Division. In other words, it is not only what the nearly 400 recipient organizations did to achieve performance goals defined by each of the four 2016 Press Ganey Award categories, it is also the environment that supported and enabled their achievement that holds the key to their successes.

“These top performers have demonstrated that the foundational work necessary to attain and sustain high-quality patient experiences and workforce engagement is rooted in culture and a supportive organizational structure built on communication and teamwork,” Dr. Merlino said.

To identify commonalities within this framework across 2016 Press Ganey award winners, researchers at Press Ganey surveyed the recipients of the Guardian of Excellence Award (322), the Pinnacle of Excellence Award (48), the Success Story Award (15) and the NDNQI© Award for Outstanding Nursing Quality (6) and conducted a thematic analysis of the information provided by 112 respondents.

Each award is defined by distinct performance criteria. The Guardian of Excellence Award honors organizations that have reached the 95th percentile for patient experience, engagement or clinical quality performance for each reporting period of the award year. The Pinnacle of Excellence Award recognizes those that have maintained consistently high levels of excellence over three years in one or more of these categories. The Success Story Award recognizes organizations that have demonstrated innovation and leadership resulting in measurable improvement in one or more of these categories. And the NDNQI Award for Outstanding Nursing Quality honors the best-performing hospital in each of six categories: academic medical center, teaching hospital, community hospital, pediatric hospital, rehabilitation hospital and psychiatric hospital.

Common themes emerged from the survey responses, including the importance of the following:

  • Improving communication skills to identify and meet patient and caregiver needs
  • Individual and team accountability for reducing patient suffering
  • High Reliability practices for ensuring patient and caregiver safety
  • Transparency of performance data
  • Shared decision making among patients, families and care providers
  • Teamwork and care coordination

The most effective practices that were widely implemented across the award winners embody several of these themes. One example is the adoption of multidisciplinary unit-based councils, which typically comprise elected representatives from within a unit (front desk, staff nurses, physicians and technicians) and are designed to promote shared decision making and empowerment in decisions that influence patient care within the units. Nearly two-thirds of the respondents reported using this practice, and all of those that did considered it to be highly effective.

“Shared governance is an important component of an effective practice model,” according to Dr. Thomas H. Lee, chief medical officer at Press Ganey. “It provides a framework for staff and leadership to share in responsibility, problem solving and authority, and it gives everyone in the unit a voice in the way patients are cared for and how staff are treated.” The governance model also encourages accountability and ownership of patient care outcomes on the unit.

Based on the perceived efficacy of practices by award winners overall, the following emerged as the top 10 most effective practices:

1. Multidisciplinary unit-based councils (used by 65% of respondents; rated 100% effective)
2. Use of checklists in the OR (used by 86%; rated 99% effective)
3. Safety culture assessment (used by 83%; rated 99% effective)
4. Hourly rounds (used by 89%; rated 98% effective)
5. Use of checklists in the ICU (used by 51%; rated 98% effective)
6. Nurse leader rounding on patients (used by 92%; rated 97% effective)
7. Sharing patient experience survey data (used by 99%; rated 95% effective)
8. Nurse manager rounding on staff (used by 91%; rated 95% effective)
9. Caregiver coordination interventions, such as huddles and SBAR communication (used by 91%; rated 95% effective)
10. Multidisciplinary rounds (used by 83%; rated 94% effective)

Patient Experience Practices: Communication Is Key

Looking at patient experience practices specifically, 14 practices were used by at least 80% of the survey respondents, with efficacy ratings ranging from 83% to 99%. In addition to some of the aforementioned practices, these include formal and ongoing training related to the patient experience for all staff and physicians; shared decision making with patients; bedside shift reporting; patient-centered communication interventions, such as teach-back and whiteboard use; and post-discharge and post-visit follow-up. And the frequency of three practices—nurse leader rounding on patients, shared decision making with patients and post-discharge/post-visit follow-up—increased by more than 10% compared with 2014, when award winners were last surveyed. This finding indicates the perceived importance of practices that focus on information sharing and communication with patients.

One practice, the use of patient and family advisory councils, did not meet the threshold of use by 80% of respondents, but of those that did report using it, 83% felt the practice was very effective, which represents a 38% increase over 2014. This finding suggests that patient and family advisory councils may have the potential to influence the patient experience more than is currently being recognized, according to the researchers.

Clinical Quality: High Reliability Drives Performance

Given the link between care safety and quality, it is not surprising that the top three most widely used clinical quality practices rated by effectiveness embody High Reliability principles to ensure patient safety: use of checklists in the OR, safety culture assessments and rapid response teams. Other widely used, effective (i.e., reported to be used by at least 80% of respondents with a greater than 90% efficacy rating) clinical quality practices include peer mentoring of new nurses, multidisciplinary quality committees and risk assessments that trigger protocols or pathways.