JEFF BOKSER: I think what is so special and exciting about this institute is the ability for individuals who are in the health care field to voice and say why this can't be done, and on the other side of the fence, individuals in the hotel school and hospitality industry to say, here's how and why it can be done. And it very much reminds me of being married to a Hotelie and being told, here is how it's going to be done. And thank you very much for your opinion anyway.
So I think we have a lot to learn, a lot to learn here and a lot to learn in life. I think one of the challenges for us in innovation-- and we've heard this a little bit over the last day and a half or so-- is that we are at a point where, in health care, our margins are shrinking drastically.
And we've heard this for many years. But over the past year, there has been a real acceleration and decline in margins in hospitals and in health care. And the challenge for us is that 60% of our beds are filled by patients that we lose money on. And the remaining 40% or so of patients, commercial payer mix, is declining. And insurance companies are getting smarter. And reimbursement is moving in the opposite direction.
So we are at a point where we're innovating. And there's a lot of excitement that is happening. But we really have to get back to basics and start to think about how do we do this in a way, a more standardized approach, asking ourselves the question is this truly adding value to the organization and to the patient experience. And we've started to put all of our innovations through that lens and that value proposition.
While we're doing that, we're also going back to-- and I'll skip through this quickly. We are going back to a culture of basics. We feel that you can't build innovation unless you first start with the foundational elements. We've seen a lot play out over the last couple of years, whether it be on social media, whether it be on the nightly news, whether it be in society.
I feel we're really seeing a shift in how humans interact, how people speak to each other. And this is not unique in health care. It's happening everywhere. But today we have patients who come into our organization with demands, expectations, a tone of voice that is completely unrespectful.
And regardless of how someone feels, regardless of what someone expects, you have to have the basic elements of respect. And not only have we found this with our patients and our employees. We've also found this with employee and employee interaction. So we're really building now this strong culture built on a foundation of respect. And we've developed what we call a respect credo.
And every employee has to go through respect training. And every employee has to embody the values that are listed in this credo. This is actually something that we borrowed from Mass General that they have used very successfully. And this is so ingrained now in our culture that we have let individuals go from the organization who have not embodied the values of respect listed in the credo.
So this is really the foundation. And it's an important element, because without building the foundations that I'm going to go through, I feel you can't have any innovations. You have to have engaged employees. We heard a little bit from Odette earlier about that. That's essential no matter how good or unique the innovation is.
So building upon respect, we're also spending a lot of time focused on safety. And if we think about the basics of humans and what people need, whether it be Maslow's hierarchy or whatever it is, certainly food, and shelter, and respect, and human decency, and safety.
And we have to build a culture where employees, when they come to work, they feel that they're going to go home the same way that they came in. Health care is an industry that has one of the highest rates of injuries in the workplace. We have thousands of injuries a year occurring in our workplace. And we have over 44,000 employees. Last year, we had over 3,500 of our employees that were injured in some way or fashion.
So we're spending a lot of time on really understanding the why behind that, making sure that we have programs in place that help our employees feel safe. We're looking at new ways to do problem solving as to what was the actual cause of that injury so we prevent it from happening again.
We're looking at ways to provide the right resources and tools to our employees so that if we are lifting or moving a patient that they have the right equipment to do that in a way that they don't suffer a musculoskeletal injury. And we're really trying to also make sure we're taking care of our employees and providing for their well-being.
And I'm just going to skip ahead to this slide and come back. We're doing that through a program called NYPBeHealthy. I spoke yesterday in the strategy session at the advisory board meeting that our employees are often more unhealthy in some cases than our patients. And this has been a real transition for us to build a culture where we have our employees that are safe in a good environment but are taking care of themselves.
And by doing that and offering programs, whether it be an hour yoga session during the day, obviously difficult for everyone to get to, but we offer it at different times, or refresh and distress classes, or various fitness programs, providing them with different recipes or menus with our food and nutrition department to maintain a healthy lifestyle in their home.
We even have gone as far to pair up our employees with well-being coaches where we have every one of our employees set goals with those coaches. It's all done in a confidential way. But we have seen some tremendous results and a real positivity of pride in that culture that I work for an organization where my employer cares about me and cares about the safety and well-being.
The basis of all this-- another program that we have is around preparedness. And this is something that I talk a lot about, an area that I oversee. And right now the individuals, and hospitals, and providers in the panhandle of Florida are about to feel the wrath of Hurricane Michael, a category 4 storm that is hitting the coast.
And this is an element that we have all of our employees fill out, because we know that if our employees and their families are not well cared for, and, more importantly, we've learned that if our employees' pets are not well taken care of, then they will not be at the hospital to care for our patients. So this is another foundational element that we have built into our program.
And it's with all of these elements that you drive engagement, really demonstrating that we care for you as an employee, having individuals that get behind the mission and then are willing to go above and beyond for every single patient. But if you don't have these basic, inexpensive, foundational elements, then you're not going to be able to innovate. You're not going to be able to carry out that new program or idea, much of which we heard about this morning, into your organization.
But some of what this new culture of engagement has led to is really coming up with new ways to improve service, not only for employees, but also, of course, most importantly for our patients, the reason we're here. And we're coming up with ways to reduce our utilization of certain services.
So in our emergency departments-- and I was talking on the way out about an experience that someone had in one of our EDs waiting over 14 hours for a bed. This is a real challenge in a city environment. How do you work on all the operational issues to improve that experience?
So what we're trying to do is take patients out of the emergency department to provide the care in the comfort of their homes. Many patients come to the emergency department don't necessarily have to be there. It's something that they could do virtually and rolling out services through what we call NYP OnDemand.
We're coming up with ways on the inpatient setting to put all of our employees through boot camps. We have a program called patient experience boot camp where at the start of your employment, you go through a series of exercises. You participate in a patient experience lab.
Actually, Odette, this picture here was taken at the lower Manhattan hospital campus where you work. So you may recognize some of those spaces. And we really try and put our employees in the shoes, walking in the shoes of a patient and what it's like. And it's not until you go through this program that you're then out on the front lines taking care of patients.
And we have a lot of other innovations that are popping up all again, many of which are low cost, but coming up with ways to really humanize the approach to medicine.
Another innovation here, something called commit to sit. And what this involves is all of our caregivers, when they walk into a room, many will come in and they'll stand. They will not look engaged, really caring what's going on with you. They're more interested in going back and documenting what was taking place.
So we've really tried to change this culture by having all the caregivers, when they enter to the room, sit on the bed if possible, sit in a chair next to the patient, be on the same level to make eye contact with the patient. And we've seen this has made a real difference in the experience. And it's something now that we're partnering with our medical schools on to really ingrain in the training of medical students.
There was just an article published last week in The New England Journal of Medicine. I believe the title was called the name of the dog. And it's all about the experience of a resident from the perspective of someone who, because they've spent so many hours in a small room with no windows in an environment where you're always going patient to patient, very high stress, the resident took a step back. And they realized that they had lost sight of why they went into medicine. And they lost sight of that human connection.
And it was all about be yourself. And if you were having a conversation in a normal environment, you'd get to know someone's family. You'd get to know the name of their dog and to really try to incorporate that into your experience as a doctor and into how you care for patients.
So those are just some of the examples of what we are looking to do in the organization. And we're trying to do it in a way that is really standardized across all 10 of our hospitals. That is our motto. It's about what we say is standardization, virtualization, and regionalization. Those are the three focus areas for everything we do as an organization.
And we do this by bringing all of our employees together, setting at the beginning of the year what our goals are that we're looking to accomplish, and then through a variety of different programs, whether it be communication sessions or another innovative program that we have called patient safety Fridays where all of our front line managers get together to talk about ideas, goals, what we're looking to focus on in patient experience, and then go out and round and spread that message.
This is the format. This is the program that we use to build that standardized way to roll out the new ways, the innovations. And then we also have various different checks and programs. A management system is what we call it.
We have daily huddles where every day we have our front line managers coming together. And the question that is asked is, are we ready for that next patient? And we go through our staff. And we go through any individual issues that may be taking place on the unit.
And all that information then gets fed up to various different counsels, various different departments so that we make sure we are addressing the issues real time. And if it's a more systematic issue, we're working it through this collaborative council.
So this is something that is interesting that I saw the other day. And I think that it's really fundamental to what we are now starting to do as we explore in innovation and new program. Oftentimes, we come up with new ideas. We come up with pilots. And we think it's great. But is it really solving the problem that we are setting out to address?
About 25 years ago, the Washington Monument was disintegrating. And the question was asked why. And initially, they thought it was due to the use of corrosive chemicals. Why were they using corrosive chemicals? And the reason was to clean up the pigeon poop.
Then the question was asked, well, why do we have so many pigeons at the Washington Monument? Turns out they're there because they were eating spiders. Why are there so many spiders? The spiders are there because they like to eat gnats. Why were there so many gnats?
And you could see that the reason there were so many gnats was because they were attracted to the light at dusk. So we use this as an example often because I think so much of what we do is we react. We react to a symptom. We react to something that we think is the problem.
So we're now shifting more to a mindset where we have a systematic approach and a way to really do root cause problem solving. And whatever innovation, whatever service enhancement we're rolling out in the patient world, we look at it through this lens.
So that's a little bit about what we are doing at New York Presbyterian. But again, it's really all built and really seeing a transition back to making sure that we have an engaged workforce. That is the name of the game for all of us. And I think we've heard that throughout the day.
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Jeff Bokser, MHA ‘01, Vice President Safety, Security, and Emergency Services, NewYork-Presbyterian Hospital, speaks about building a foundation for service and cultural innovations in a large hospital organization. The talk was part of the Healthy Futures Roundtable held on October 10th, 2018.