ABOUT THE PRACTITIONERS
Tami Minnier had the responsibility of caring for other living beings for as long as she can remember. Growing up on a 300-acre dairy farm in northwest Pennsylvania, she milked cows and had her first horse by the time she was five years old.
When she was just two months old, her father suffered a heart attack, adding to the degree of responsibility she felt as a young girl on the farm. “We were told, ‘Your dad might not live long,’ and because of that, I was drawn to medicine and drawn to health care,” Tami said.
These transformative experiences influenced Tami’s career at every stage as she now serves as the Chief Quality Officer for UPMC, responsible for the patient experience of individuals who are receiving care at more than 20 hospitals in the region. Drawing from them has allowed her to put authentic care at the forefront of her leadership style and initiatives, which all center on treating patients as the unique individuals they are.
Her passion for patient safety stemmed from her partnership and friendship with Sorrel King, mother of Josie King, a child who tragically died at Hopkins in 2001 as a result of a medical error. Tami listened to the mother speak at a forum and it revolutionized the way she thought of patient care.
“Sitting in the audience, I was so struck by two things. Josie died the same month my son was born. We were talking about rapid response teams and Sorrel sat there and said, ‘Why can’t I call one of those? I am the mom.’ I listened to her say that and I thought, ‘She is right—why can’t she?’” Tami said.
At the time, Tami returned to UPMCand told her staff, “We need to let families call rapid response teams.”
“They thought I had lost my mind and I needed to go back to where I was. It was such a paradigm shift. I picked up the phone, I called Sorrel King, who didn’t know me from Adam, and said, ‘I was one of the 5,000 people you spoke to and I was wondering if you would like to come to Pittsburgh and talk to me about it because I would like to give it a shot.’ It’s all kind of history from there.”
What evolved from that experience and those conversations is now called Condition H, which means: Condition Help, at UPMC hospitals. It allows caregivers to call for emergency help within the hospital without needing to wait for a clinician to make the decision. Between 500-600 hospitals in the United States have adopted Condition Help since Tami first established it at UPMC hospitals.
“It was one of my first very strong labors of love of empowering patients and families, particularly when you think about little ones and older people – they are the most vulnerable and people need to be able to advocate for themselves.”
Amy Ranier lived in Pittsburgh until the age of 7 before her family moved to the state of Indiana. A second generation communications professional, her father oversaw public relations for Purdue University.
Like Tami, Amy loves and cares for animals, specifically raising horses. “I have kids who are 7 and 9 and they ride, too. It’s something I have done my whole life and it’s a good outlet,” Amy said.
As Senior Director of Patient Experience for UPMC, Amy leads enterprise-level initiatives to improve patient engagement through effective education and communication, patient satisfaction improvement and shared decision making. Amy’s team facilitates the incorporation of patient and family input into all health care initiatives to drive change and cultural evolution within the organization. By using quantitative and qualitative data to develop strategy, the team works to improve the experience of UPMC’s patients and their families.
Amy is also the Director of The Beckwith Institute, a grant organization whose primary goal is to fund both immediate and long-term changes that significantly improve health care.
What’s Amy’s motivation on a daily basis? Both her colleagues and the patients UPMC serves.
Amy is proud of the work they have been able to accomplish as a team, particularly when it comes to transforming UPMC’s culture. “We are very good at a lot of things, but while kindness, compassion, dignity and respect may have been engrained in individual people, it wasn’t a part of the organization-wide conversation. You can’t focus on patient satisfaction unless you look at employees and see how we treat each other,” Amy said. “It is a work in progress and as much as we have seen an enormous amount of change, I can’t believe how quickly it has happened. But that change takes time. You can have most people on board with you, but it takes time to change a culture.”
“We have the right people at the table,” Amy said.
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.”
UPMC Executive Believes Healthfulness Depends Mostly on Your Environment
Scott Lammie becomes the first Dignity & Respect Champion of 2016
Everybody seems to know, or has heard of, Scott Lammie. When his name comes up, it brings a smile to people’s faces. That’s because of the way he lives his life. Scott is not an observer of life in Greater Pittsburgh, he’s an active participant in making our region a better place for all. Scott serves as the Chief Financial Officer of UPMC Health Plan and is Senior Vice President of UPMC’s Insurance Services Division. He has worked in the healthcare field for more than 30 years and has learned the impact a community can have on its people.
“Since working in healthcare, I have a greater appreciation for all of the factors that determine a person’s health status. Roughly 80% of health status has nothing to do with healthcare delivery per se, but rather is determined by the person’s psycho-socio and socio-economic circumstances and the environment in which the person lives, works, and plays,” Scott said.
Scott’s father died of cancer when he was seven years old. Scott and his four brothers and younger sister were raised mostly by their mother and they all learned the importance of helping one another. When his mother remarried, his step-father was very community oriented, so from a young age Scott understood how helping others could make a huge impact on improving a community.
“I have learned over my lifetime that people are the product of their environment. If a community isn’t safe, clean, and diverse; has poor educational outcomes; and offers limited employment opportunities, its people will suffer. Every citizen has the ability to help strengthen our underserved communities so that every person and family will have access to support, mentoring, and opportunity to help them lead healthy and successful lives,” Scott explained.
Scott walks his talk. He is active on many volunteer boards focusing on economic development and community service that supports the Pittsburgh community including Duquesne University, The Forbes Fund, Hill House Association, Laurel Highlands Council Boy Scouts of America, Little Sisters of the Poor, Manchester Bidwell Corporation, Phipps Conservatory and Botanical Gardens, Pittsburgh Cultural Trust Corporate Circles Board, Southwestern Pennsylvania Food Security Partnership, United Way of Allegheny County Tocqueville Society and Impact Cabinet, and Urban Innovation21.
Candi Castleberry Singleton, Founder and CEO of the Dignity & Respect Campaign nominated Scott Lammie because of the great humanitarian work he does for the Pittsburgh region. “When I think of a Dignity & Respect Champion, I see Scott. He is one of the only people I know who has the bandwidth and willingness to cross demographic, economic, racial, faith and education barriers to help individuals and organizations as a whole. I don’t know how he has the time to be a CFO, serve on multiple boards and donate his time to improving the community, but we are all beneficiaries of his efforts.” Candi said.
The Dignity & Respect Campaign is an awareness initiative designed to join individuals, community leaders, community organizations, educational institutions, businesses, and corporations under the common notion that everyone deserves dignity and respect. A Dignity & Respect Champion is someone ― nominated by a co-worker, family member, or friend ― who embraces diversity, embodies compassion, and demonstrates mutual respect. For more information and to take the Dignity & Respect Pledge, visit dignityandrespect.org or to nominate a Champion visit surveymonkey.com/s/DR_champion