Episode Transcript
[00:00:02] Speaker A: Welcome to PG Pulse Press Ganey's podcast on all things healthcare, tech and human experience. In this podcast, we'll be joined by some of the best and brightest minds in the industry to discuss challenges, share insights, and innovate the future of healthcare. Thanks for tuning in. We hope you enjoy the conversation.
[00:00:22] Speaker B: Welcome to another episode of PG Pulse. I am Jessica Dudley Press Ganey's chief clinical officer, and we are here on the floor of our annual pediatric summit. Joining me today is our three colleagues from Cook Children's healthcare system. First, we have Kathy McLean, vice president, brand and team experience. Megan Chavez, vice president of Cook Children's experience, and Keith Holtz, chief administrative officer, Cook Children's Healthcare System. Hello to all of you. Thank you for being here and spending this time with us so that we can really dig in deeper to all of the work that you guys have been doing, which I think is going to be so helpful for so many. So the first thing I wanted to talk with you guys about and learn from you about is your focus on building a culture of excellence. I know this is something that has been top of mind now for a while. I would love to kind of go through each of you and have you share, you know, what your journey looks like, what are the key parts of that, and, you know, whatever you can share with us so that everybody can learn from this focus.
[00:01:31] Speaker C: So, for me, culture is super important. At Cook Children's, we're a very relationship driven organization, but we always struggled to say what our culture is. We didn't have words for it, but we knew it was awesome. We were 100, almost in 106 years old. And luckily, our culture just grew naturally, which is amazing. And so we just. We set out to define our culture, put it down on paper, and then use it to continue our road to what we call preeminence, because we want to be the preeminent healthcare provider in the United States. That's our goal.
[00:02:10] Speaker B: Well, that's a lofty goal.
[00:02:11] Speaker C: I love to go.
[00:02:13] Speaker B: Love it.
[00:02:14] Speaker D: And the work that Kathy mentioned is so important because for so long, we were just one hospital where you literally could get to know each other by walking the halls and seeing each other. And everybody would always say, there's something unique about cook children's. You just feel it when you're here. But we've had exponential growth over the last about ten years, really last five years, and now we're 90 locations, and so you can't bake on the. You'll just feel it when you're here. We really needed to spend some time to put it into words, to make sure that it was part of our hiring processes, part of the way that we looked at processes and improvements and strategic planning to really invest in the things that we value and make sure that cook children's always feels like cook children's no matter where you are as a staffer, that was so important.
[00:02:57] Speaker C: So for staff or patient, no matter where you go, you have that same feeling. Kind of like Starbucks. If you go to Starbucks, it always smells the same. And hopefully your drink tastes the same from place to place. So we want that feeling all through cook children's and yet allow each little place to have their culture come through as well, because it should align with.
[00:03:17] Speaker E: Our, with our overarching the consistency of experience. Right. I think is really what makes our organization stand out. And we really believe that, you know, culture is a strategic advantage for us and really differentiates us from some of the other competitors. We have very competitive market in the Alice Fort worth area. And, you know, this culture is really, I mean, it really is defying factor for us.
[00:03:44] Speaker B: So I love you guys just covered a lot. And let me just pull out a couple things. So, first of all, the fact that you've grown so big, and I think that that's actually really important because so many places across the country now are not just one single site. And I meet with folks and we talk a lot about how do you create bridges and connections. And that's actually been a theme of our conference. And building social capital, connecting across. So how do you do that? Create this culture so that there is consistency across 90 sites, but then also permitting autonomy and local flavor. How do you make that happen?
[00:04:21] Speaker E: That's something that you can't just do overnight. So you have to invest a lot of time and energy into it as an organization, and you really have to have commitment from the top. And so if you don't have the commitment from the top to drive your culture, you're at a major disadvantage. But we've been blessed by having that support from the top. And our CEO, Rick Merrill, has been very intentional on really the importance of culture.
And realizing as we grow bigger, our footprint goes all the way out from Dallas Fort Worth to all the way out to West Texas. It's the size of New Mexico, actually bigger than New Mexico, our service area.
And with adding a new hospital this last year, the risk of the culture erosion is real and can happen. You've seen that happen in other businesses. As they get bigger, it becomes more and more a problem trying to maintain the culture we spent a lot of time and energy. It actually took us the better part of three years. It was during COVID when we were doing all this, too. A lot of stock start and stops due to Covid happening, but did a lot of listening to patients and families, our board, our employees, members of our health plan. We have our own health plan with 135,000 members in this Medicaid health plan. And so, really, you know, spend time listening to them about their opinion, their view of Cook children's, what. What attracts people to cook children's, what keeps them at Cook children's, and also why people would leave, you know, cook children's and trying to understand all that and then wrap that into what we ended up calling a culture platform.
And at the very highest level of that, we have our promise. But then we said, okay, and that's our mission and vision, but even that's a little bit long to remember. So we came up with a pinky promise, and that's everything for the child.
[00:06:22] Speaker B: And that's it. That's it.
[00:06:23] Speaker E: And that really resonates that Pinky promise, which fits into pediatric world. Every kid has a pinky promise. And, yeah, I remember doing that myself.
[00:06:32] Speaker C: Pinky promise with a kid, that's serious. Yeah, that's serious business.
[00:06:37] Speaker D: So I think once we had the words on paper and really started to think through what are those commitments? We needed to translate it into specific actions and behaviors. And so, again, at Cook children's, we really view experience as an ecosystem between the individual staff member, the teams, and our ability to then translate that into patients and families and what they experience, and ultimately, to deliver the best equitable clinical excellence and prevent all kinds of harm. But how do we do that in action? What does that look like? So that did translate into our specific experience standards that we kept intentionally very simple. It is relationship based. So our first experience standard is connect that intentional connection, human to human, between two people, whether that's staff to staff or staff, staff to patient, whatever that looks like. And then the next step is collaboration. Everything we do is a team sport. Teams with the families, teams with each other. So it's the relationship, first, that teamwork, and then that's when we take those next steps together. But those commitments, those values, the promise, it informs our action. It also informs our job descriptions. It informs the way that we interview the folks that we bring on board. It informs our surveys so that we have a barometer of how are we doing around our culture. And we're getting more sophisticated in that continuous listening strategy to really make sure that that's the lens with which we're assessing. Where are we doing really well and where's opportunities and where can we innovate?
[00:08:02] Speaker B: So I love how you frame this and I had the opportunity to hear you guys yesterday and it was fantastic.
And you talked about connection, collaboration and then elevation.
Let's talk a little bit about social capital. That's something that we've been talking a lot about, a lot at press ganey. And you're actually living it and have put a framework around that so that you can scale to your 90 sites across a catchment area that's bigger than the size of New Mexico, which is hard for people on the small crammed in east coast to even imagine.
So when we think about social capital, we think about things like trust, respect, teamwork.
And Tom Lee was talking yesterday about bridges, bridges and bonds. And I would just love to hear from your perspective how you're doing that. How are you creating bonds or supporting the creation of bonds within teams and then the work that you're all leading, I'm assuming with your leaders to create the bridges between different teams.
[00:09:04] Speaker C: Well, our brand is called connected care and our visual is a connect the dots. So you cannot work in our system without saying connect the dots. No, it's kind of a rally cry for us anymore. But I think what's good about cook children's and sometimes bad about cook children's is that there's long tenure there. So those, those that bond is already there. And those people have moved throughout the system over the years. So they have that bond from a long time ago. And I think that helps people who are coming in newer. And I point to Megan because on the three of us, she's the newer of us. And like one of the people said today, I've been there 16 years and still I'm a baby. We have a 50 person celebrating 50 years this year in our system. But to be able to work together so she can leverage my longevity in the system and I can leverage somebody else's longevity in the system to bring that trust and that works through collaboration.
[00:10:04] Speaker D: But I love what Doctor Lee talked about, which is this concept of all sorts of different teaming that we need to think about. You know, the first one is that that team, and I think we are excellent at thinking about how we work within our specific teams, but he has also talked about this concept of team of teams and that's something we're really doubling down on and it's going to be a focus for our leadership retreat this fall actually is thinking about, how do you really think about your first team being your peers, even more so than the team that reports to you? And that's hard in practice. You know, you've got lots of primary care locations and urgent cares and also a health plan and home health. Right. How do we truly work as a team of teams? It's so important for so many reasons. It's the key performance indicator for our staff engagement. It's the key performance indicator for our patient experience. When we looked at that correlation analysis for the last year. Plus, it's just good clinical quality care, right, is making sure that we are surrounding that child with the best of us and that we're surrounding each other with the best of us. And so that's a real challenge in reality, but something that we know is critical to what we need and what our patients and families need.
Because very quickly, and the whole focus of it, it was around protecting the experience. And so it started with looking at transitions of care for patients because we had situations, like so many organizations where primary care Doc would say, you need to go to the ED. They would go to the ED, and the Ed Doc would say, well, I don't know why they sent you. And it's like, whoa, we're on the same team. So it started with the patient focus, and they said, oh, we didn't know that's what it was. Let's look at our documentation, let's look at the way we're communicating. But very quickly, the conversations turned to, how can I make your life easier as a peer? Now those guys are clamoring for those calls. And so we've just sort of created the forum with that lens. And again, because the culture is something we double down on, it's happening organically. So just being intentional about creating those forums and those connections, we've started it, but I think we've always got more work to do.
[00:12:09] Speaker C: We do. Because if you think about remote workers now, how do we keep them connected to the culture and how do they build social capital and how do they work as part of a team of teams when they're maybe in Lubbock, but they work with the team that's in Fort Worth? That's, I think, going to be a challenge for a lot of systems going forward.
[00:12:27] Speaker B: It is such a challenge for so many systems right now. Everybody's kind of struggling this and looking for some examples of kind of best practice and evidence of it's working.
[00:12:38] Speaker C: So we used to have a thing called lunch with the administrator. So around the one year mark, you would be invited to a lunch, and there would be a group, usually two or three administrators, and you could sit and talk and you could bring up issues you saw or talk about the best parts of cook children's. But as we grew, it's. I mean, from prosperous 50 miles away, how do you come over for lunch and all of that? So we're proposing that we continue lunch with the administrator, but we focus on those new employees that are there between the one and three year mark because they. That's where our biggest turnover happens, and it will help solidify that connection to cook children's and those administrators. And then we're going to encourage other leaders to do what Keith's doing, especially the president of our medical center, because there's just so many nurses there that never get to interact with him. And he's very beloved.
So to be able to support him as he can sit down and do the same thing Keith is doing. So we just try to find those opportunities to get people who typically wouldn't be able to sit with administrators to talk to him. It's so funny. I was laughing with our CEO the other day, because when we go out places with him to do luncheons, he's like a celebrity, and everybody wants to take their picture with him because he's like, hey, the CEO came to our location, so that really goes a long way. Talk about social capital. That's huge.
[00:14:01] Speaker B: That's really, really great.
[00:14:03] Speaker E: But, Jessica, back to measurement.
[00:14:04] Speaker B: Yeah.
[00:14:05] Speaker E: So every quarter we calculate our turnover rate, and we analyze turnover. One of the things we found Kathy mentioned was our biggest turnover is in the zero to three year category. Over 50% of our turnover happens during those first three years. So one of the things that we're starting to look at is to do a deeper dive into that population group. We're going to do some listening sessions here in the next few weeks, actually, with employees that are in that category of zero to three years and find out from them kind of what's going on with them, you know, like, what attracted you, what's keeping you, what would maybe make you leave? You know, some of those questions did.
[00:14:50] Speaker C: You take since you had, when you came in were those.
[00:14:54] Speaker E: So something's happening that first three years, because if we can get them to stay three years, then the likelihood is really high that they're going to stay authorization. Now, one of the concerns I have because HR falls under my purview is in reading about generation Z, that if you can keep a Gen Z three to four years, you're probably going to be doing well. Right.
[00:15:16] Speaker C: I.
[00:15:16] Speaker E: So maybe turnover isn't the metric going forward to measure our workforce.
I think it might be productivity. Knowing that we're going to have these employees for three to four years, how do we get the most out of our employees? Getting them up to speed as quickly as possible, making them productive as possible, knowing that this generation is just that they're going to change jobs frequently. Right. We hoped they'd stay, but I don't know if it's realistic to think that they're going to stay maybe like some of the other generations previous to them. So I think we've got to start thinking about different measurements of the workforce.
[00:15:55] Speaker B: So one of the things that's clear from the pediatric data that looks different even than our adult data is the ability of the workforce to decompress. And even though we've seen some improvement this past year, just overall, as a cohort of our pediatric employee cohort scores decompression lower. And you were mentioning just now self care, can you explain or share any of the strategies that you have in place to really support your workforce in that?
[00:16:23] Speaker D: So we've got lots of strategies. I'll talk about some, but Keith has got even more to add. It's interesting, actually. During COVID we have seven facility dogs on staff that support our patients and families. And during those times, we didn't have the amount of visitors and things like that. And so we actually recognize that we've got to double down on our staff right now and make sure they're okay. So we redeployed one of our dogs to be self or staff care. And it was incredible to see these tense moments. And you've got, you know, the most amazing, beautiful golden retriever poodle mix that comes on to the site and to the area, and you see doctors just sit on the floor and just hug. I mean, it's these things that you think that, you know, gosh, it's just extra, but it's become so foundational now. So now we have a staff care dog that's specific to that. We also, in the last couple of years, hired our first staff, well being chaplain. So when there's tough situations in a unit or just cumulatively, they faced a lot of trauma, that is her sole responsibility is to check on the spiritual wellbeing of those groups. We have a whole cadre of folks that are skilled in critical incident debriefing. But again, there's so many things that we're continuing to do to be there in the moment in addition to a lot of the widespread programs we have that just invest in all of our well being.
[00:17:42] Speaker C: I want Keith to talk about one more thing.
[00:17:44] Speaker B: Oh, yes, please.
[00:17:44] Speaker C: The mental health support that we brought to cook children's.
[00:17:48] Speaker E: Yeah, thanks. Yeah. So a couple things. You talked about wellness.
We created an employee wellness center on our main campus. We have pelotons and all that's like a full, full gym, yoga, all that good stuff. And then I.
Right before COVID came into place, we created some employee and family near clinics. So we have free health care, primary care for our employees and their families for 18 years and older, because we have pediatricians for the ones below 18.
So we created, and there's one just within walking distance from our main campus. And we start out offering primary care as well as mental health care. And the demand was so high, we've now added a second mental health professional to that clinic. And now I hear that his schedule is full as well as our first person. Yeah.
[00:18:47] Speaker B: So we talk a lot about safety, both for patients in the workforce. We talk a lot about experience, both for patients and the workforce. And I know that one of the things you all have done so effectively is look at kind of measure performance in all those areas and then use that data to help you prioritize what type of support or resources or coaching you will offer or kind of provide for different units. And I'm wondering if anybody can talk about that briefly. You know, we at press Ganey call it a critical metrics map, where you pull them all together so that you can then figure out, where do we start? And I'm just curious if you could share a little bit about using that.
[00:19:30] Speaker D: So one of the things that we recognized is that we do have a lot of support for our areas, our departments, maybe too much because we were all kind of coming at them with different support pieces. Right. So you had the patient experience team looking at patient feedback, you had burnout and staff engagement looking at the team health. Right. You had quality and safety looking at their quality and safety indicators, all going to the same leader, same team. That's already probably pretty tapped out.
[00:19:58] Speaker C: So that could mean the reaction.
[00:20:00] Speaker D: Yes. And we realized, obviously in conversation that, for example, if their patient experience needed some improvement, to go to those folks and say, hey, your patients aren't happy, aren't doing well, without knowing that this is a very burnt out team, we would have actually exacerbated the issue. And so we developed an experience task force that in the beginning was very manual. And I think we're getting smarter about this, but bringing the experts to the table. So we've got quality and safety. We've got inclusion, diversity and equity. We've got our team experience. We've got patient experience. Folks looking at all this data collectively, to say that these are indicators. What's the core opportunity here? What's the right team to deploy to support these folks and making sure that when we go to an area to support them, it's with that knowledge, still having the teams with support, but making sure that, again, if burnout is a primary issue, that's what we're talking about. Not all of the other things that, you know, hey, your clabsis have gone up, right? We need to fix this first.
[00:21:03] Speaker B: Love it. I mean, it's really remarkable that you're able to bring all of those people together, because oftentimes we're very siloed and enabling that, creating that space using the data so that people can then look collectively so it doesn't feel like, I call it like, whack a mole. Like today you want me to do this, tomorrow you want me to do that? So I love that you've figured out how to kind of integrate and prioritize.
[00:21:31] Speaker E: And we're very hopeful about the HX platform, right. For the plugin for Presg anyway. But seriously, I mean that, you know, it's been a struggle for us and others, right, to pull all this data together and have a view into it and the data not being months.
[00:21:48] Speaker B: That is absolutely why we are all so focused on this, which is how do we make it easier, more streamlined, so that we can leverage the resources that we do have so that we can stop asking people to work more, but work kind of smarter and more strategically. So, for me getting to hear you yesterday and again today, it is remarkable how even in a system as large and geographically dispersed as yours, you have been able to deliver on this excellence, this culture excellence, creating an ecosystem, building bridges while also supporting the bonding that's happening and then measuring it all. And to me, that is truly remarkable and a story that I think can give others hope because we hear all the time about so many organizations that have gotten pretty big even over the last five years, but how do they kind of enable it to still feel small? So how do they, you kNow, weigh the autonomy, some local autonomy, but also this consistency like you guys spoke about in the beginning.
[00:22:56] Speaker C: We've begun. We're getting ready to roll out an employee promise, which will be our commitment as an organization to the employees. And so that will continue to hopefully shore up the employees so that to strengthen the culture, which will help us continue our work through measurement, and we'll be able to see engagement go up, burnout go down, patient experience go up and just continue supporting them. And we'll again, start with leaders, because we have to set expectations and accountabilities so that our leaders and physicians are seen living this employee promise that we're going to roll out and we'll have behaviors attached to our values as part of that. So great.
[00:23:38] Speaker D: Just to build off that. I mean, again, the magic in the bottle at Cookchildren's is our people and investing in them and empowering them. And so I think, really, the next frontier for us is it's one thing for us as leaders, senior leaders, to be sitting around a table looking at all these indicators and figuring out how we need to support them. But we want our leaders at every level to be armed with that information in a very intuitive way so that when they're sitting down to set their goals or identify, you know, how many ftes they need for next year or capital improvements they need, that's at the forefront of their decision making.
[00:24:14] Speaker C: They don't have to wait for us.
[00:24:16] Speaker D: No. And so that they've got kind of that continuous listening mindset armed with the information to make those decisions. So that's really the next frontier for us, is figuring out how we stoke those flames and empower our people. So, again, experience continues to drive all of our decisions.
[00:24:32] Speaker B: Great. Thank you, Meg.
[00:24:34] Speaker E: Yeah. I think the challenge for us, as well as any organization, is you have to live the culture.
And so we say sometimes that the culture work we're doing is more than putting new paint on an old barn. I mean, all day long, you can put new paint on an old barn and you could come up with a really fancy mission, vision, values. But if you don't actually live that, if it's just a piece of paper, then it's not, you know, it's just a piece of paper. Right. So the challenge is really how do you live that and the things you do? How do you, how do you do business? You know, knowing this is your, your promise, your commitments and your values, really, you know, living that, and then, you know, as a leader, it's up to me and Kathy and Megandae and others. We've got to walk the talk.
Yeah. And, yeah, and that's. Yeah.
[00:25:29] Speaker B: So that's, well, it's really impressive work. And you have your data to your measurement of your success to support it. I loved it. I loved Cathy, Megan, Keith, when you spoke yesterday and when you shared your thoughts with us today. So thank you. And thanks for everybody for listening to this version of our PG podcast.
[00:25:54] Speaker A: That's a wrap. Thank you for joining us today, and special thanks to our guests for sharing their time and insights. Stay tuned for our next episode, which will be released soon. In the meantime, visit our website, where you'll find more information on the human experience and a lot more.
