Let's now conduct another set of polling questions before our next presentation. So the first question is, how would you rate the culture in your unit? Excellent, good to very good, fair, or poor? I think this is a very important question because it kind of states how important culture is in your unit. It can make you extremely successful or it can actually hurt you pretty bad if the culture is not, positive culture is not there. All right, so there we go. So good to very good. So that's always good to hear. I think reason 100, I mean excellence is never 100% because sometimes we always feel that we can always improve. So very good, thank you. So let's take another, our next question, and which area do you see as the greatest opportunity for improving the culture in your unit? Employee recognition or positive feedback from leadership, improvement in communication on policies and procedures and changes, staff behavior and interaction, or stronger leadership vision, structural improvements to the facility. So again, very good questions. Sometimes it's a combination of, you know, multiple answers are obviously adequate, but let's see what your number one reason is. Oh, very good, very interesting. So staff behavior, I think that's really important. And the rest are pretty, pretty well evenly distributed there. Thank you for your responses. And they certainly set the stage for our next talk. Well, welcome back, Dr. Raman Musasamy to address building the culture of your unit. Okay, so for my second talk, I'm going to talk to you about building the culture of your endoscopy unit and upping everyone's game. These are my disclosures. So we'll start off with talking about what is culture. And I think it's really a general umbrella term, which we use to encompass the social behavior and norms that are found in human societies, in particular, the knowledge, the beliefs, the arts, laws, customs, capabilities, and habits of individuals in these groups, in this case, the endoscopy unit, and I'm going to focus on sort of the bold and underlined aspects of culture in my talk today. So first, who benefits from improving the culture? Why even have a talk about this? I think we know the answer is pretty obvious. First and foremost, it's our patients. Certainly, it's our employees who work in the endoscopy unit, the staff, the nurses, the techs, the people at the front desk, really everybody who is involved in any way with the unit operations. Certainly, the endoscopists were usually, of course, part of the staff, but in some cases, maybe people who just use a facility from time to time. And lastly, the unit ownership and management due to improved performance. And we'll talk about all the many benefits improving the culture has on the bottom line of the institution and unit. So I think going back to our patients, really the relationship between customer satisfaction and loyalty in competitive industries is highly linked to the satisfaction of the experience, which I think is, as I'll show you, is related to the culture. And you can see oftentimes I get these scores and you'll see a 4.5 versus a 4.6, and you say, we're doing pretty well. But you can see even with a score of satisfied being 4, the loyalty in terms of retention may be as low as 30%. And you really start seeing a massive drive. Even at 4.5, you're probably running somewhere around 50% retention. So going from a 4.7 to a 4.8, which may typically say, well, that's not really that much, could have massive improvements in customer satisfaction and loyalty to your unit. So creating a culture of service quality, that's really the patient's judgment of the overall experience of the service that was done in relation to the quality that they expected when they signed up for the experience. And this usually occurs on sort of three characteristics. One, how was the outcome? Did the procedure go okay? Number two, how was the interaction? And as I'll go, that actually involves many levels. And then third, which is typically related to the day of the procedure, how was the environment? Was the unit nice? Was I warm? Were there blankets? Did everything seem clean? That sort of thing. And as you can see here, the life cycle of an endoscopy patient really has many steps from the time you make an appointment for a consult, a visit, discussing it, scheduling the procedure, the whole insurance issues, the pre-calls, confirming the appointment, clear instructions for the prep if there's a colonoscopy, et cetera, actually the date of procedure, and then the follow-up call. So you can see there's a lot of communication that occurs before then. And if you're step eight, there's many steps of communication. And many times, patients may have formed an opinion already even before you're meeting them, let's say, for example, if it's a direct access procedure or something of that nature where maybe there isn't an office visit in advance. So the five dimensions of service quality really involve reliability, which is really the ability to perform what you say dependently and accurately that you know what you're going to get, assurance, really the ability to inspire confidence. Between you and your staff to get the job done. The tangibles, which, of course, are kind of how you and your staff appear. You know, does your unit look up to date, modern? Is it clean? Empathy, which, again, is showing that you care and people feeling like they're well looked after. And then lastly, responsiveness, which is a willingness to help people and provide prompt service to answer questions, to deal with issues when things don't go according to plan. So, again, this all ranges back to communication and like medical procedures, skills can be learned and these skills have to be practiced. And really, you have to, in order to master them, you have to, you know, continuously practice, get feedback, and then try to improve on that. But that can make a big difference, really, in terms of how a patient views an experience. So in communicating with patients, you know, there's lots of little mnemonics. This one is called AIDIT or AIDET, and this is a technique that teaches, you know, care providers to use appropriate words at the right time to help you understand, in this case, the patient, you know, what is happening and why. So, of course, always introduce yourself to the patient, you know, both by acknowledging them and, of course, introducing who you are and what your skill set is. You know, people, I think, on procedure days, particularly if things are running late, give them an accurate estimate of time. How long is the delay? How long is the procedure likely to be? For families in waiting rooms, it's important to get a sense of, you know, don't get worried if it takes extra long because it's maybe a longer procedure, et cetera. You know, going through in sort of clear, you know, understandable terms each step of what's going to happen through their day. And again, I appreciate gratitude for the fact that they chose you and your unit for their services. So, again, I think the key is to see the patient, again, as a customer, you know, and it's something that we expect when we go out to other aspects of our lives, whether it's buying a product or, you know, going to a restaurant. But we often think of healthcare sometimes differently, but really, you know, it's still an experience for a patient, which in this case is a customer. So, they still, you know, appreciate courtesy and respect. They don't really want to be argued with. They want to understand things, particularly at a scary time in many cases when they're going through a procedure. You certainly want to thank them for their business. Again, show that you're trustworthy by keeping your promises. Make sure that they feel special and don't be indifferent to them. And of course, find out how, you know, they would prefer to be addressed or what they would prefer and try to accommodate that whenever possible. And of course, be polite while doing it. And again, some hospitals actually, you know, have little check-ins, you know, little lists of behaviors that you should perform during check-in or check-out or even in the hallway or phone interactions or the exam room. This happens to be from Massachusetts General Hospital. And I don't show it to you for the specifics, but just to show that people actually create sheets like this and talk about aspects of, you know, all these behaviors and what the expectations are. And I think these are the kind of things that help set your units or your institution's culture. So what is the... So I'm going to transition now a little bit from the patient experience to the employee experience, which I would argue is equally important. And in fact, as I'll show you, affects the patient experience. So the employee experience is really a set of perceptions that employees are going to have about their experience at work in response to the interactions that they have with the organization. And that could be with leadership, it could be with co-employees, etc. And so where the culture comes in is, of course, in an institutional lifespan of an individual with an organization. Obviously, first, they're attracted to the organization. They ultimately get hired. And it's really the third and fourth steps, the onboarding, where you kind of tell people, hey, this is kind of the way we do things around here and engaging them as they sort of ramp up and learn the system. This is really where kind of the cement becomes firm. And this is where, you know, you really sort of establish kind of what is expected from an employee. After that, hopefully by doing a good job here, you'll get great performance, which will then, you know, identify them as someone you want to develop for future opportunities in the organizations. And eventually, they may reach a point where they achieve a great leadership opportunity elsewhere, and that allows for a positive exit experience. But again, it all starts with the onboarding and engagement, where you set the expectations and culture. Again, drivers of your experience for employees. Again, you're here at a unit leadership course, and that's because leadership and management really define the behavior and actions. And then that leads to, you know, policies and procedures related to human workplace practices that hopefully will engender trust in the organization and foster co-worker relationships. You're hopefully going to provide the meaningful work in your unit. And it's important to recognize, and you'll hear me say this many times, opportunities for a job well done, possibilities for growth, give people a voice and feel comfortable in expressing their opinions. And of course, understand that things come up from time to time and balance their personal lives with their professional lives. And if you can do that, you'll create an experience for the employee that gives them a sense of belonging and purpose, achievement with what they're doing, and most importantly, happiness and vigor in their efforts. And of course, these outcomes will lead to good work performance, improved discretionary effort, and ultimately, employee retention. So again, the sense of, you know, belonging is key. You want to feel like you're part of the team, and you really want to make sure your employees feel like they're doing important work. I mean, in endoscopy, we're doing important work every day in terms of improving the quality of people's lives, detecting cancers early, treating, and now even, you know, in many cases, performing many therapeutics to either treat cancers or make them feel better. So again, I think that that part is happily very evident in our field. But again, you also want them to have a sense of achievement in what they're doing and understand, you know, the benefit of all the efforts of, you know, why it's important to reprocess these devices appropriately, et cetera. And hopefully, when they understand these things, they'll have a pleasant attitude and happiness that results from working at the unit, and that hopefully will lead them to be energetic, enthusiastic, and excited, and hopefully that'll rub off on other employees as well. So certainly, it's always nice to be part of a winning team. I sort of put this in here because UCLA Health sponsors two of LA sports teams, and so happened in one of the few good things in 2020. Both of our sponsor teams won their respective league championships this year, and here they are celebrating, and this is our staff. And I can tell you that certainly the institution put on a lot of events involving the teams this year, and I think that in a tough time, it served as certainly a pick-me-up for our staff. And I think there's certainly, you know, it's always people like to feel the success, the collective success, even if it's peripheral to a winning organization. So again, going back to creating a positive workplace culture, you want to give people meaningful work, and that really is giving them some autonomy, some ability to make some decisions, empowering your teams, and then giving them some time for slack and some ability to accomplish things, so make sure you set goals that are achievable. You certainly want to be supportive as management, as leaders, define what you want, provide coaching when needed, and really invest in the development of your staff so that they can someday, you know, kind of rise up in the organization, and so forth. Again, the work environment is critical. I think you have to show that there's a compassionate, humanistic workplace. I think you need to recognize employees for their work and make sure that someone does something that they recognize for it, and someone else doesn't sort of take the credit. And you want to make sure that it's a diverse work environment that's fair. And again, as you develop employees, they need to have an opportunity to see that there's room for growth, training and support for new skills, facilitated talent mobility, and there's ways to rise up in the organization, ability to learn sort of new things, as I said, and really to foster, and I'll come back to this, a culture of innovation where you can try to do new things, and it's not just bringing in new technologies in a unit, but it could be a new way of checking in patients or incorporating electronics into, you know, check-ins, or providing wireless ways to kind of do check-in, or, you know, just any kind of care pathway improvement could really fit into this. And then most importantly, if you're a passenger on the bus or a plane, you want to make sure you trust the bus driver or the pilot, and that's critical. And so you've got to have trust and leadership in terms of what's the mission and purpose, that leadership needs to be evident, and to continue to invest and be present to people. There's got to be transparency and honesty in your actions, and I think you need to lead by inspiration, and people need to sort of make a sense that, wow, we really want to be like that person and their vision, and, you know, the characteristics they embody. So why does all this matter? Unit culture and employee experience, because there's tangible benefits to this. It's not just a feel-good thing. Lower turnover intention and rates, you have, again, a much higher 47% turnover, unengaged employees versus only 17% for engaged employees. Higher discretionary effort, that means people might be willing to stay a little late sometimes, help out during a break, not necessarily to take advantage of them, but they just feel so invested in the work that they're doing. Employee engagement experience is also linked to healthcare outcomes, as I'll come to this in a minute, about improved patient satisfaction, clinical outcomes. Obviously, if you're, you know, we're in a field in the osprey unit where the nurses and techs are integral to the performance and success of procedures, then obviously, if they're engaged, you know, hopefully that's going to come under better management. And then, you know, if they're not, you know, if they're not engaged, you know, they're not going to be able to do the work that they're supposed to be doing. If they're engaged, you know, hopefully that's going to come into better procedural outcomes. You can improve service efficiency, reduce the need for revisits. And I think people can tell when, you know, people are happy. And I can tell you that back when we were flying, I was a member, I am a member of one of the major airlines, and I could tell a few years ago that the employees were not happy and it was shown in the service. And I don't know what happened, but over the last couple of years, I can definitely see the employees are happier and the experience on the flights have been, were much better. And I think that people can recognize that. And I think if your staff are happy, I think your patients will come to recognize that. Again, why unit culture and employee experience matters. Again, you have lower absenteeism, you know, reduced turnover, improved productivity, fewer safety accidents for both employees and patients, higher sales and profitability, fewer quality incidents. So again, lots of, and importantly, higher, 10% higher customer metrics. And again, the reason that is important is a 1% increase in employee satisfaction scores leads to a half a percent improvement in patient satisfaction scores. And so that means you saw what the impact between a 4.2 and a 4.7 does potentially on loyalty to your unit or to your institution. So again, these have potentially dramatic roles in these aspects. So what do we know about the employee experience? Again, existing literature highlights the best practices, promoting high-level leadership practices, managerial staff support, organizational commitment, work content, environment. But there's really limited studies on employee experience to date. And so I think it's important that we measure this. And there's a variety of ways you can do this Gallup, Press Ganey, Survey Monkey. You can do it whichever way you want. But again, in order to improve something, you have to measure it. And so you have to take employee engagement surveys seriously. You have to make sure each manager gets their own report score and share the results with your teams. You can see the sample size, what the score is, what your percentile rank is, how you did in the past, what the 75th and 90% ranks are, and sort of set games maybe to where you can go for the next measurement. And again, we've talked about this a bit already. Drivers that improve the employee experience are really the environment in terms of the organizational responsibility and trust in your relationship with your coworkers, giving people meaningful work, which we've kind of discussed already, kind of the ability of the person to provide feedback and be empowered to do their job, as well as flexibility when needed. And again, management needs to provide a clear sense of direction, personalized support, and commitment, and really set the tone and example. So again, leaders, you know, 54% of respondents say they didn't feel they'd regularly got respect from their leaders. And these are a lot of the characteristics of a good leader, which include, most important, integrity, vision, clear communication, and encouragement and recognition. I think that's critical. And again, for those who were respected by their leaders, 89% of them showed greater enjoyment in their jobs, 92% were more focused and prioritized at work, and 55% were more engaged on the job. And so maintaining staff morale, you know, communication, I think, is key. You have to really develop your employees and provide consistent communication procedures and policies through meetings. It's even potentially good to develop an employee engagement team, an employee satisfaction team, to kind of get a sense of what's the mood of the unit. And it's important to recognize, you know, and celebrate success. You know, we always hear about when something goes wrong, but I think it's important to also celebrate when a job well done. And, you know, thank you is free. And you can see here that in those who got thanked daily, their likelihood to leave the company was 28%. But if they never heard it, it was 81%. And inversely, you know, if you never heard you're likely to stay with the company is only 15% if you never were told thanks versus 38%. So it's about two and a half fold in either direction that simply saying thank you on somewhat regular basis can make a difference. So final thoughts. These are a couple of articles I've written about innovation and tips and pearls and running an endoscopy unit in a cost efficient manner. And this latter article is in this month's GIE. And I'll focus on culture and leadership. And really, it really involves encouraging your staff to identify opportunities for improvement and proposed solutions and to feel empowered to do so. When possible, offer staff incentives for achieving performance goals. Establish a clear unit leadership structure and maintain transparency in your policies and encourage open and frequent communication. And for hospital based units clearly define your differences compared to operating rooms, which is a big issue at many institutions. So in closing, I think it's important to create a positive environment. You have to recognize and reward those who identify challenges and create solutions and really say, you know, people can come to you with a problem. But then I encourage them to say, well, how do you think we should tackle this? Fostering innovation is a great way. And that's not just bringing in new technologies or new things to make yourself feel special in terms of our unit does this better than anyone else, which certainly is one way. But it could be care pathways. It could be creative solutions to common everyday problems. It's really important to celebrate and recognize successes in people's professional and at times personal lives as well to sort of engender that sense of culture. And again, communicate openly from those who might be dissatisfied to avoid dissemination of that dissatisfaction. So this is sort of the negative attitude, the negative Nancy or Bob or whoever it is to sort of say, look, you know, what is it you don't like and how can we get that better? And then again, most importantly, you're at a leadership course. So set the example yourself. So in conclusion, unit culture involves developing the knowledge, beliefs, bylaws, customs and capabilities and habits of your unit. A positive culture can improve clinical outcomes, patient and employee satisfaction scores and prevent financial losses. Leadership and managerial support set the stage for developing the unit's culture and establishing that culture makes the experience. An endoscopy unit should include measures of employee experience and their quality improvement processes to emphasize the importance of unit culture and the need to continually maintain and improve it. Thank you.

unit culture

employee experience

endoscopy unit

patient experience

positive culture

workplace culture