What we can learn from Coach K about patient experience accountability

I never thought I’d be writing a blog post under this headline.
With a wife who is a die-hard Kansas Jayhawk and a son who is a loyal Indiana Hoosier, admitting that I could learn anything from Duke Blue Devils Coach Mike Krzyzewski is unthinkable in my house. Applying a lesson from college basketball to patient experience strategy seems even more improbable.
But in December when Coach K suspended guard Grayson Allen indefinitely after he tripped an opposing player, his decision made me think about how well we as leaders in healthcare organizations hold every member of our team accountable for the impact their behaviors have on patients’ experiences.
First, a bit of background. If you are not a college basketball fan, the central incident in the Grayson Allen story was his intentional tripping of an Elon University player during their game on Dec. 21. Perhaps the more important detail in this story is that this was not the first time Allen had tripped opposing players. In earlier games this season against Louisville and Florida State, players were victims of Allen’s seemingly uncontrollable need to cunningly trip other players, then feign innocence.
So what does all of this have to do with patient experience? In most provider organizations, we know there are unfortunate, atypical instances when members of our teams unwittingly – or sometimes knowingly – emotionally “trip” patients or family members during their stay.
Recently, I regrettably experienced this first hand. In mid-December, my wife had major spine surgery followed by a 5-day inpatient stay. The care she received from physicians, nurses, therapists and patient care technicians was superb – with one exception. One night-shift nurse’s attitude and seeming indifference to my wife’s struggle and pain blemished an otherwise positive experience.
Like Coach K, health care leaders must confront and make difficult decisions regarding behaviors that can ruin patients’ experiences while they are in our care and at their most vulnerable. Following are important consideration for leaders who want to diminish the possibility that inappropriate behaviors occur and deal with them effectively when they do.
 
Treating others well must be a priority
Many organizations have developed and adopted “behavioral standards” to provide guidance for staff around what is and what is not acceptable. That’s a great start, but for the standards to be meaningful, they must be reiterated, reinforced and reminded consistently. Regardless of how inspiring the words might be, if the guidelines are only published once then not adhered to, they are useless.
A very wise team I had the privilege to work with at St. Thomas Rutherford Hospital several years ago insisted that “behavior standards” sounded too cold and administrative. They chose the more inspiring phrase, “Who we are. How we serve.” to describe why the behaviors were central to the mission of the hospital. Maybe “How We Treat Other Human Beings,” works, too.
 
Leaders must model and coach the behaviors they expect from caregivers
A culture of compassion, respect, safety and ethical care is created and reinforced at all levels of an organization, but it starts at the top. Staff have to have a clear vision of organizational priorities, and they understand and internalize those best through leaders’ actions, not their words.
Effective coaching is critical to reinforce positive behaviors and change problematic ones. In some cases, caregivers may not even realize that they appear cold, distant or uncaring to patients, family member and colleagues. But ignorance does not excuse the behavior. Leaders owe under-performing staff members the benefit of constructive criticism. Other high-performing members of the team also deserve and should expect that lower performers are counseled because suboptimal care impacts the entire team.
 
Uncaring behaviors deserve serious consequences
Like Coach K’s decision to suspend his player who committed an act he eventually described as “unacceptable and inexcusable,” health care leaders must sometimes take equivalent steps in the form of corrective action. Especially when uncaring, dismissive behaviors that ignore or minimize patients’ suffering are repeated, written corrective action that clearly outlines the consequences of continued unacceptable behavior is essential.
Today, the Blue Devils announced that Allen would return to the starting lineup. Hopefully that’s because Coach K is convinced that Allen now understands that his tripping was more than simply a terrible mistake; it is a behavior that will not be tolerated if he wants to continue to play for Duke.
Too often I’ve heard health care leaders protectively say, “but s/he’s such a good nurse.” A staff member with excellent technical skills but uncaring, unacceptable social skills would never be described as a “good nurse” by patients or family members. And ultimately, it is only their experience and assessment of care that really counts.