As part of our Leading The Way in Patient Care series featuring UPMC we conducted an interview with Chief Quality Officer Tami Minnier and Senior Director of Patient Experience Amy Ranier. They spoke on the CHRIS model and other ways UPMC is Leading The Way in Patient Care.
Q&A with Tami Minnier and Amy Ranier
Q: How important is process to your approach to patient care?
A: Tami: Every patient care process is designed to deliver the right result. What we know is that there are many processes in healthcare that are broken. My passion to learn about process has been for me to take that knowledge, bring it back into healthcare and patient care situations, and say, “We are not succeeding here because we don’t have the right process.” What is the best process to help that nurse on Saturday night know who to call? Is it to add five minutes to their new employee orientation when they are being barraged by 500 other people with new information? Or is it a simple phone number? All you have to remember is UPMC’s CHRIS Hotline for Patient Needs. What is a more effective design for sustainable, reliable performance?
Sadly, most health care professions have had no training in process. We are critically trained to the high heavens, but when you want to try to help clinicians understand process, some of them are as naive to say, “Well, you just tell people to do it.”
That is the key to our success. You have to have clinical credibility with your audience, but the knowledge of process is critical. If you don’t build a process well in health care, or restaurant management, you are not going to have good outcomes.
Q: What is unique about the way you gather feedback?
A: Amy: We survey at 100 percent of our patients, above and beyond what is required by law, because we want the feedback. We do this because we want to, and we use that feedback as basis for change. Every comment gets read, which includes about 8,000 a month just for physician office visits. We post all of the outpatient physician ratings and comments on UPMC.com.
Q: What is unique about the way employees are held accountable in terms of living these values?
A: Amy: The employees on the frontlines are the ones providing compassionate care, and this shows their work is valid. If someone isn’t living our values, they cannot stay here. We are held to a standard and if you don’t show you live the values, you must change that if you want to stay here
Q: Tami, you are a clinician by background but Amy comes out of marketing. How does Amy’s background in marketing contribute to the success of your efforts?
A: Tami: One of the key things about marketing is that it is fundamentally a communication science. How do you communicate better to convey a feeling and a message? When you think about all of the patient experiences, one of the number one issues is that we need to communicate better. They might say, “People didn’t understand what I was saying.” Amy’s knowledge of that has been amazing because she brings a completely different skillset to the table than our clinicians.
That is probably why our partnership has been so good. I will be talking about something we should do and she plays it back to me through her lens. Before you know it, we have a good clinical concept that has been put through a communications lens to be able to say, “This is how we could use it, this is how it would feel, or maybe we should use this word instead of this one.” She translates it in a way that clinicians can understand, but also in a way that patients can understand.
Q: Who inspires you?
A: Tami: At home, my inspiration has always been my parents or my son. I have a very small family, but my parents were incredible and my mom is still alive and she has my back every day. My son is 15 and he is such a good, good kid. We are very close and I am very blessed to have him.
Q: What keeps you going?
A: Tami: Interacting with patients is what keeps me going—making a difference for patients. I love my team. I would be nothing without the folks who work with me. I have been very blessed to have good colleagues.
Q: What are your passions outside of work?
A: Tami: Today, I still love to read, especially mystery novels. That brings me a lot of joy. I love being outside, so I love to be out walking, digging in the dirt and planting flowers. Anything that is outside and interacting with the environment. Most recently, I have started to bake more, particularly cupcakes. I am working on making the world’s best cupcake.
Q: What is in store for the future?
A: Tami: I still don’t know what I want to do when I grow up. I have a passion for patients and for making healthcare better, so I am going to keep doing that. I have a deep rooted passion for making things better and resolving problems.
Q: What is your motivation?
A: Amy: A lot of it is entirely the people I work with and the belief that we are working to make things better for patients, employees and the community we serve. Tami is an inspirational leader and there are so many people like that here. My entire focus is, “How do we make things better for our patients?” That’s what gets me here.
It’s 11 p.m. on a Saturday night at a UPMC hospital in Pittsburgh when a nurse realizes his patient doesn’t speak English.
But this doesn’t delay, derail, or impact the quality of care the patient receives.
Thanks to Tami Minnier’s leadership and insight as the Chief Quality Officer for UPMC, the nurse calls an internal toll-free number and is connected to a translator, ensuring the patient’s needs are met as soon as possible.
“If you, as a patient, have that translator, you can understand your care, ask the nurse questions, and ask the nurse to explain something that you may not have understood otherwise,” Tami said. “It enhances the patient experience.”
Creating a culture where patients are acknowledged and respected as whole and unique individuals through the CHRIS Initiative is exactly why Tami, Amy Ranier, and their team at UPMC are being honored by the Dignity and Respect Campaign. They Lead the Way, going above and beyond in the implementation of everyday operations. Their best practice in patient care ensures each patient is heard, respected, understood, and cared for as an individual person to the best of everyone’s ability.
When the CHRIS Initiative was first introduced to UPMC clinicians and employees, a graphic image of a person made up of puzzle pieces represented the program. The CHRIS patient care model allows leadership to help staff understand and put into action the value that not all people are the same – but they are all equally wonderful. Each puzzle piece signified a different attribute of a single patient: religious beliefs, sexual orientation, cultural background, personal goals, and other characteristics and values.
“As a caregiver, you need to figure out what is in those puzzle pieces for each of your patients. When you assume you know, and when you think you know, is when you fail. When you don’t meet your patients’ expectations, or you don’t deliver the care that is important to them, or if we don’t communicate to them in a way that they understand, that is when we fail,” Tami said.
CHRIS is at the core of UPMC’s patient care programming to the extent that now, each of the variables—or puzzle pieces—of a patient are embedded in electronic records. When a clinician admits a person to a hospital, questions about his or her religious beliefs, sexual orientation and cultural background are asked, so that each employee approaches the patient from the perspective of dignity and respect. The program makes sure every employee views every patient as a whole person with a complex identity and personal history.
In addition to embedding the CHRIS philosophy into UPMC’s electronic records system, the initiative can also be seen in action with a hotline that can be used by employees any time, day or night.
They simply call UPMC’s CHRIS Hotline for Patient Needs and a question is answered or a problem is solved. As a large organization with multiple locations, UPMC recognized a need to give employees a resource if they experienced a situation they weren’t sure how to handle.
“We have woven dignity and respect into the fabric of the organization,” Tami said.
These programs aren’t the only aspect of the organization keeping the values of dignity and respect at the forefront of employees’ minds and actions. The success is also measured by holding employees accountable. Fifty percent of an employee’s annual evaluation and potential merit increase stems from whether or not he or she is actually living the values of dignity and respect.
UPMC also evaluates potential new employees through the lens of these values, asking specific questions about how they react in various situations. This behavioral approach to the hiring process allows UPMC to make sure new recruits are ready to participate in a culture that values dignity and respect in daily operations—not just with words, but in practice.
In addition, UPMC added a Dignity and Respect Index to its employee engagement survey to measure success. Employees are asked about how they perceive the principles of dignity and respect are being implemented in the organization and how authentic they feel in the day to day activity and interactions taking place. From the patients’ perspectives, the program’s success is measured in the number of complaints and grievances.
“You realize that it is about how you have to change your culture, and as a result, we have seen the number of egregious complaints really reduced. I am really proud of that,” Tami said.
Amy Ranier, senior director of the patient experience at UPMC, is a member of Tami’s team. One of the many initiatives she helps to lead includes the Culture of Service Excellence initiative at UPMC. Leadership looked to direct-reports for support in developing this program, which has been led by employees. The training content—developed for and by employees—has been presented in four-hour sessions to nearly 60,000 individuals thus far throughout UPMCUPMC’s facilities.
“Those are employees who raised their hands and said ‘I want to train my staff in service excellence,’” Amy said. “Every hospital president and chief nurse went through the training and now we are at the staff level. We are so proud of this initiative. How we treat each other matters and how we treat our patients matters. It sends the message that this is how we do things at UPMC.”
The Culture of Service Excellence initiative is another demonstration of the commitment that Tami and Amy have to changing the culture for the long-term. Involving employees in every step has been the key to embedding the values of dignity and respect into operations.
“Tami and I lead a group called the Patient Experience Leaders. This is an informal group that meets every month. They developed the content of Culture of Service Excellence initiative. I cannot thank enough our training and development teams. They supported the training and this came out of the patient experience,” Amy said.
The results prove that leadership has communicated its initiatives effectively, making sure every patient who comes through UPMC’s doors is treated with respect and kindness every step of the way.
“Everyone is a mosaic with their own world experience and you can’t make assumptions. You need to think about how you approach people,” Tami said. “You have to build the right process if you want the right outcome.”