Some Definitions

While I suspect that most of the language I use here will be understood by most, there are probably a few things that may cause people pause.

To that end, I provide an incomplete set of definitions that I will freely add to. I expect it to fit somewhere between Funk & Wagnalls and Ambrose Bierce.

8s to 9s: See “Moving 8s to 9s.”

Analysis Paralysis: The situation where an organization doesn’t want to act until they have a precise plan or a perfect solution. Sometimes it is that leader who thinks that one more factor analysis or logistic regression will unlock the real understanding. Sometimes it is that clinician that needs to see five referred articles in respected journals before they do what you ask them to do.

Black Box: A term used to describe a situation where the process for improvement is poorly-defined. “So, my plan is to get everyone in the same room, and then the magic happens, and we are all on the same page.” Usually a sign that someone doesn’t really have a plan, or, is aware of the fragility of the plan.

Complaints and Grievances:  the work of the Patient Advocate, ideally with support from all other areas in the hospital.  What is the difference between a complaint and a grievance?  Excellent question.  If you know, you could probably let The Joint Commission and CMS know, as I have no evidence that they currently do.

Compliance: See “Numerator Compliant.”

Corporate Telephone: This references the childhood game when you whisper something into the first of a long line of people, who then, in turn, whisper it to the next person. You then compare what the last person heard against what the first person said. In large organizations, this refers to the fact that what a CEO may ask for gets filtered through a number of ears before the front-line person hears their marching orders. Even when the differences are marginal, they can lead to incomplete, inefficient or inaccurate behaviors.

Eating the Toad:  Any task that is undesirable or dreaded.  It comes from advice my mother gave me that, if you have to eat a toad, best to do it early in the day to get it out of the way.  Otherwise, the longer you avoid it, the more it dwells on your mind.

Eyes Always Lie: Using a cursory evaluation or a oft-repeated concept instead of actually seeing if there is truth in that supposition. People will think that they see a correlation, but one does not exist mathematically. I remember a nurse at a tertiary hospital say that the reason their sepsis scores were so low was because other hospitals would transfer their sepsis patients as they were circling the drain, so they would die on her watch. I pulled the data and actually showed that they performed exceptionally well with these patients. Their problem was with their homegrown patients.

Fallout: See “Numerator Compliant.”

Fat-Shaming: Any process where a hospital is pilloried by other hospitals who have almost the same scores and the same problems instead of working collaboratively to solve common problems. Double-bonus points, if the hospital fat-shamed this year for bad luck with slips and falls, gets to fat-shame someone else next year, showing absolutely no self-awareness.

HCAHPS (Hospital Consumer Assessment of Healthcare Providers and Systems): A survey instituted by CMS (Centers for Medicare & Medicaid Services) to create a standard measure for inpatient experiences across all hospitals and vendors. The survey is long and its data is squished through a CMS playdoh factory before it is publicly posted, so it is unrecognizable from the original source data. I am sorry, I meant to say, it is useful data that has been standardized by CMS. Most would call it a four-letter-word, were it not for the fact that it is six letters and not a word.

Heat, not Light: I classify conversations using concepts pulled from my 7th grade earth sciences class. All conversations have energy and sometimes that is converted into heat (as in conflict, argument) and sometimes into light (insights, a path forward.) If memory serves, energy can also convert into radiation, but I don’t have a good conversational analogy for that one. OK, I did a quick Google search on energy and I am aware that my knowledge of physics is, um, rudimentary. Still, I like this as an analogy and to paraphrase my father, I am not one to let the truth get in the way of a good analogy.

Junk Drawer:  My affectionate term for a lot of PX departments, who, often through no fault of their own, get saddled with a lot of responsibilities which can charitably defined as tangential to PX.  If you own valet parking, volunteers or the gift shop, you, my friend, may work in the junk drawer.

Light, not Heat: See “Heat, not Light.”

Like-to-Love: References the fact that, unlike what many hospital folks believe (all the patients hate us!), in reality a majority of patients actually like them with some love them (aka giving out a top-box score.) So the real job is NOT to try and make patients who are dissatisfied somehow love you, but instead moving those patients who like you to love you. It is the same concept as identified in Moving 8s to 9s.

MEGO (My Eyes Glaze Over):  Anything that is overly complicated or of no importance to an audience, causing them to daydream, check emails or play Angry Birds.  Can be a problem with math, but any presentation that does not prioritize its audience can fall here.

Moving 8s to 9s:  The fun part of PX.  This is identifying and operationalizing the strategies to move the high scores higher.  It comes from the HCAHPS overall hospital rating question (and the broader approach to Net Promoter Score) of moving the ‘passive patients’ giving a hospital a 7 or 8 on the 11-point scale, to being ‘promoters’ giving a 9 or 10.

Numerator Compliant: Quality-speak for identifying a patient who is meeting a measure. So, a patient needing a colonoscopy who got a colonoscopy. A fallout is someone who is numerator non-compliant, or even someone who was compliant, but because of the passage of time or a bad test result, are no longer compliant. For example, after a patient gets a colonoscopy and may be numerator compliant for ten years. But in the eleventh year, if they don’t get another one, they fallout and are numerator non-compliant.

OG:  Abbreviation meaning Original Gangster.  In rap, it refers to the pioneers in the genre.  For me, it generally means any early adopter or anyone there at the beginning.  Sometimes I mean it affectionately and sometimes I mean it derisively and sometimes I mean it both ways.

Patient Advocacy:  I generally see PX having two components—the fun stuff of creating broad strategies to move 8s to 9s and the difficult work of addressing patient complaints.  This work is what I call Patient Advocacy, generally because the person tagged to field patient complaints is called the Patient Advocate.

PX:  Shorthand for Patient Experience.  I used to think this was universal, until I had more people than I can count ask me what the abbreviation means.  Definitely evidence that anytime you address an audience, don’t assume anything.

SDoH (Social Determinants of Health):  A body of work identifying that there are elements the drive care quality and experience that are outside of the traditional care space.  These cover several issues that sit at the crossroads of individual and social factors such as economic issues, access, transportation, availability of healthy foods, neighborhood resources and safety. 

Service Acronym: A mnemonic device designed to remind staff their conversational or service steps, like AIDET (Acknowledge, Introduce, Duration, Explanation, Thank You) or HEART (Hear, Empathize, Apologize, Respond, Thank). In theory, they are all equally helpful in reminding staff how to build a communication cadence with all of their patients and coworkers. In practice, they are all equally useless if they are not properly trained, reinforced and demonstrated by all members of an organization. You know, like senior leaders and c-suite types.

Shot-Callers: These are those who call the shots. My grade school teachers are probably not happy that I use the same words to define something, so… Most large organizations have those who call the shots and those who do the work. A hospital president may drive strategy and demand work, but they are not likely doing that work themselves. An organization’s success is driven in large part by how good the game of corporate telephone is to relay the leader’s vision to the employee’s action.

Telephone: See “Corporate Telephone.”