Improving the Patient Experience

A nurse manager reveals the keys to his team’s success.

Jane: I got to visit you this summer and be on your unit. I was so impressed with you and the way you’ve instilled a patient-centered culture throughout your staff. How did you do that?

Abel: I believe that, at some point, we’ll all be consumers of healthcare. So when I’m rounding on patients, I feel like I’m rounding on myself in the future. Or, I’m rounding on my brother, my dad or my sister. Whenever I’m rounding on a patient, I hear the truth of what’s really going on. If it’s a win, I really want to harvest the win. If it’s an opportunity [to improve], I really want to make sure I understand the true cause of the opportunity and advance to resolve it.

Jane: You’ve gotten a lot of consistency in your staff. That’s important to our patients, from day shift to night shift to weekends. How did you get everyone pulling in the same direction?

Abel: [When I served as a medic in the Texas Army National Guard], I had a really good drill sergeant who taught me that practice does not make perfect; practice makes permanent. What I’ve been coaching and teaching my team, is not necessarily to seek perfection through practice, but to seek and get consistency. Teach somebody consistently what is expected, coach them on the same things over and over again. And when we become consistent with the patient, we come across as one team that understands one plan and is doing one thing.

Jane: When you were prerounding with your nurses, you reviewed with them everything about the patient. Talk a little bit about how you do that.

Abel: It’s important to review the patient experience aspect, which always starts with patient safety. I have to know, first of all, what’s going on with the diagnosis. Because if I go to the patient, and I don’t know anything about them medically, then I’m just some guy checking on their well-being. Then I want to make sure that my team is adhering to the same script that we all follow for communication and compassion. What I’ve seen is we have a gap in compassion and making personal connections. This is the time I take to coach on that personal connection they’ve harvested. The people who are strong in this, I give them kudos. The people who are struggling, I give them pointers.

Jane: I loved it when you said to one of your nurses, “I challenge you to get this done by the end of the shift.” Is that something you use a lot?

Abel: Oh yes. That’s how we work as a team. We are constantly working to perfect things. I always leave them with challenges. I feel that part of developing a team means that, even with my high performers, I have to teach them something. If I don’t teach the high performers something because they believe they’ve arrived, they’ll start to lose interest, or start to veer from the goal of the team. We really want to make sure we’re continuing on one path.

Jane: You’ve made a huge improvement in your HCA HealthcareHPS scores. What are you most proud of?

Abel: As a manager, I’m most proud to see the development of my team. I see a nurse coming in, brand new, nervous, and they go through the internship. Then you see them three months later, and they’re getting better. Six months later, a year later, they’re precepting others. A year and a half later, they’re charge nurses. That’s what I live for. My proudest moment is when I go to a room, and the patient tells me their nurse did a wonderful job.

Jane: Anything else you’d like to add?

Abel: I really like our focus on the mission and vision. I think it’s made our work very deliberate. I was a nurse before I joined HCA Healthcare, and when you do good at the bedside, you make personal connections. But here, I feel like every day my work is more focused and, as a result, I know where I am on the journey. So I don’t get intimidated by the big tasks, because I know I have the tools to accomplish them.

Watch Jane and Abel’s full discussion about improving the patient experience: