Think from the Chair

Lessons from a year on the road . . .

Andrew put me on the road last year. I made 37 trips to Hospices helping them
implement their Model. These organizations engaged us to help them raise
quality, instill accountability, and drive census and profitability. (And it works! See
the sidebar, next page.)
Here’s what I’ve learned from these organizations and the dozens of others I’ve
worked with last year.
Think from the Chair. Build your visit, and your program will follow.
We hear: Donors might not like that. The board won’t buy it. The nurses are going
to freak if you do that.
At MVI we have a gaudy purple “patient-family” chair. It’s our way of reminding
ourselves and our clients that all decisions should be made from the patient chair.
We sent out hundreds of stretchy-band-things last fall that Hospices can slip onto
the back of any chair in the office. One side says “Patient/Family/Feelings.” The
other side says, “We live to serve the Clinical Manager.” We encourage every
Leader, every Manager to sit in the chair, to make every decision from the point of
view of the patient and the family—being sensitive to their feelings and
experience.
Look, we’re cost accountants, so we care about the money, right? But we’ve seen
a direct link, a correlation, between visit quality and profitability. (For some of you
“profitability” means “not losing money.”) What’s that link? Dunno. But we think it’s
like this: Any organization that cares enough to carefully consider every aspect of
the visit, to give time and energy to perfect the visit, is the same kind of company
that considers good stewardship to be important.
Who are you trying to please? Yeah, yeah everyone says the patients. I don’t see
it in most cases. Don’t hear me saying you don’t care . . . I know you do. But the
best Hospices “think from the chair.”

Examples
What do your patients want more of? Help with pain
and aide services. Everyone knows that. Yet, in Hospice
Compare, what do we routinely do badly? Pain and
teaching on pain. When we think about visits what do we
think about first? RN visits. We give 80% of our time and
attention to our RNs, when it’s the aide visits patients
and families value once pain is addressed. Think from
the chair.
Once I showed a video detailing the training program of
a small award winning burger chain to the full clinical staff
of a Hospice. This chain won’t let a newbie flip a burger
for a customer without 30 days of training. Then I asked
the Hospice about their training program . . . everyone
looked down. No eye contact. Think from the chair.
Start the stopwatch. How long does it take from the time
you get a call from a referral source to the time we get
the patient on service and comfortable? I was in the
call center when a call came in from the county health
department. They had a man who needed Hospice
care and asked for immediate help. The call center
attendant took down information but was non-committal
to the caller. I asked her what was happening. She said
her Medical Director typically took a day to decide if
the patient was Hospice eligible. It was Thursday. By
the time she got info from the patient’s physician, a
requirement of the Medical Director, it might be Monday.
The call center attendant nearly cried. She’d seen this
story before. A month later, I was back and asked about
this patient. Died over the weekend without Hospice
help. Think from the chair.
One Hospice Clinical Manager cited “nurse burden” as
the reason why her nurses couldn’t document at the
bedside. It was OK to try to recall details of a visit hours
after. So what if a study from NetSmart says that 70% of
the details of a visit are gone within 6 hours. Think from
the chair.
I don’t see much “chair” thinking in Hospice. I see a lot of
fawning over nurses and implied fear that all the nurses are
going to up and leave. No they won’t. Your best nurses will
respect you more when you require mid-level nurses to step up.
Can’t we just do the right thing, from the chair?

–Bill Taylor