Scripps Health

Founded in 1924 by philanthropist Ellen Browning Scripps, Scripps Health is a nonprofit integrated health care delivery system based in San Diego, Calif. Scripps treats more than 600,000 patients annually through the dedication of 3,000 affiliated physicians and more than 16,000 employees among its five acute-care hospital campuses, home health care services, 28 outpatient centers and clinics, and hundreds of affiliated physician offices throughout the region.

Recognized as a leader in disease and injury prevention, diagnosis and treatment, Scripps is also at the forefront of clinical research. With three highly respected graduate medical education programs, Scripps is a longstanding member of the Association of American Medical Colleges. Scripps has been ranked five times as one of the nation’s best health care systems by Truven Health Analytics. Its hospitals are ranked No. 1 in San Diego County and among the best in the nation by U.S. News & World Report. Scripps also is recognized by Advisory Board, Fortune and Working Mother magazine as one of the best places in the nation to work.

One Thing Different

“One Thing Different” gives the staff and physicians the autonomy to do one thing of their own choosing to make a difference in the lives of their patients. Rather than scripting the staff or mandating behavioral changes, it relies on self-reflection and soul searching to try to make a simple yet meaningful change. How does this build trustworthiness? This practice shows that the administration cares about the well-being of its physicians and empathizes with them by allowing staff to share their frustrations and fears in a welcoming environment. It also demonstrates that Scripps is focused on improving its reliability and consistency.

How It Works

When I hear the tension in our AM briefings, I do a quick exercise. We have done 3 thus far. For the first one, I asked the team over the weekend to do “One Thing” just for themselves as I heard the burnout very clearly. The answers that were shared impressed me and ranged from simple pleasures like washing a car to going sailing and not checking email for a few hours.

The second one, I asked the team to do “One Thing” for someone else. My family had just reprimanded me for not being present and they were right, I was so preoccupied with the daily worry about our entire staff and patients that I forgot that they needed me as well. Once again, I was in awe when we shared what we had all done over the weekend. One person took the time to counsel a struggling family, another delivered food to an elderly friend, our CEO made us laugh as he said he went to the market to help his wife shop!

The third “one thing” team assignment was to share one thing they learned about engendering trust during a pandemic.

Skills and Competencies

It just relies on some personal self-reflection and soul searching to try to make a simple, yet meaningful change

Origins

This started from the Scripps Health Patient Experience Initiative. I started a practice called ” one thing different.” Instead of us scripting our staff or mandating behavioral changes, we gave our staff and physicians the autonomy to do one thing of their own choosing to make a difference in the lives of their patients. We started a website so staff from across our entire organization could share their personal changes and learn from each other. The idea came when I was first approached by an administrator on how to improve at the bedside, I was not happy that a non-clinical person was telling me how to improve. But i decided to try one thing and that was to ask my patients what their “greatest concern” was. The story is very impactful as I diagnosed leukemia in a 7 year old by just asking this simple question. It was a practice changer!

Effectiveness

Our one thing different for trust exercise revealed the following key themes. Evidence of trust was that our employee engagement scores during covid actually increased by 5 percentile. A higher jump than we have ever had.

Key Themes For Engendering Trust:

Consistency – the same rules have to apply to everyone. If you give one person or one site an exception, word spreads and you automatically lose credibility. Be able to say “no” quickly
Responsiveness – with so much angst and fear, answering calls and emails rapidly is imperative Transparency- open and honest communication regardless of whether it is what staff want to hear
Explaining – at times we have to be directive and move rapidly, but it is important to explain the “why” behind decisions
Sharing – from our CEO “ Information is Power, but only if shared.”
Honesty and Empathy – allowing the opportunity for staff to share their frustrations and fear in a caring environment so that they know they are not alone

Scalability

The practice has been scaled already. We have a one thing different video, a website and the theme is kept alive through our employee huddles and new employee orientation.