Spectrum Health

Case Study

Industry: Healthcare

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Influencer Training Helps Spectrum Health Achieve 96% Hand Hygiene Compliance

Describe Spectrum Health

Hi my name is Matt Van Vranken, I am the president of Spectrum Health Hospital Group in Grand Rapids Michigan. We are an integrated delivery system that includes 3 corporations.

We are about a three billion dollar company, 17,000 employees…

What goals were you trying to achieve?

I really view success and the transformation of this healthcare system as our ability to create something that has end-to-end connectivity. And it's not about a system, it's about how people behave and how they view their roles within a healthcare system.

What did you do to accomplish these goals?

In order for us to be able to create connectivity end-to-end, we need to influence a number of people across this organization. We believe that there are three vital behaviors that are going to make that happen.

The first is for people to take responsibility for their own actions and behaviors and to begin to focus on those things that we believe are most important.

Second is for us to be able to create an environment where people feel safe talking about those things that are most important. And where we can begin to have the kind of conversation that will allow us to be able to break through literally 50 or 60 years of hospital culture that finds us where we are today.

And then finally, we have a holistic approach to accountability which says I'm going to be accountable for the things I do but I'm also going to hold my peers accountable for the things that they do.

Every year, 1.7 million Americans are infected and 100,000 die as a result of hospital acquired infections.

Spectrum Health wanted to test their vital behaviors in a campaign to improve hand hygiene.

They turned to Influencer Training to create system-wide compliance, reduce infections, and save lives.

In order to focus on improved hand hygiene, people obviously have to speak up and hold people accountable. We've used both crucial conversations and crucial confrontations to drive our cultural and behavioral change. But we understood that the dynamics in that particular space were such that we really needed to understand better those things that influenced behavior. So we've used the Influencer model to be able to drive change quite frankly, I would say, is going to best practice in the country.

Describe how you used the six source Influencer model to improve hand hygiene.

When we went through the six source brainstorming tool that we used, we found that we had done a lot of the interventions one at a time, sequentially over the past several years and they had been unsuccessful. The value of the six source model was the realization that there was no such thing as a silver bullet. If we were going to be successful, we had to use all of these initiatives, all of these interventions together, to drive to our goal.

What were the results of your hand hygiene Initiative?

Since we've used the Influencer model, we've seen dramatic results in hand hygiene, in compliance. Prior to using the Influencer model, we were getting the kind of results that I think most of the hospital across the country get – less than 50% compliance. Since we've used this and since we've driven this cultural change, we are now in the third quarter, three quarters in a row, we've seen over 90% compliance in our hand washing and we're driving very very vigorously to 100% compliance.

Describe any lasting effects of Influencer Training.

As people have learned to hold each other accountable for something as simple as hand hygiene, it's a skills set they're using to holding to use each other accountable for other outcomes that are expected: patient safety, quality, efficiency. It has provided us with a cultural framework to drive high performance broadly within the organization.

Spectrum Health is a not-for-profit, integrated health system based in West Michigan providing inpatient and outpatient services at a variety of locations throughout Michigan. Spectrum Health’s 16,000 employees and 1,500 physicians share a common mission: to improve the health of the communities they serve.


The executive team at Spectrum Health was committed to building a culture of shared responsibility and accountability for the patients they served.

Driven to delivering the highest quality care, Spectrum Health purposefully set out to create a culture that ensured an excellent patient experience coupled with the highest standards in safety and quality.

To reach this culture goal, it became apparent that leadership and staff needed the tools (and the permission) to speak up and hold each other accountable. That’s why Kristine White, now Spectrum’s Vice President of Innovation and Patient Affairs, along with the hospital group executive team, decided to bring in a VitalSmarts presenter to speak at the hospital group’s annual 800-person leadership conference.

“Initially, I wasn’t looking for any sort of training initiative,” White said. “But the language the speaker used during the presentation became viral almost instantaneously in the organization. We left the session with people talking about ‘crucial conversations’ and ‘making it safe.'”

The Training Course

Spurred by the stickiness of the keynote speech, White and her fellow executives decided to implement the VitalSmarts training course Crucial Conversations within the system’s hospital group.

“Crucial Conversations Training fit hand-in-glove with the other work we were doing with leaders, from the executive and director level to staff supervisors and physicians,” White said.

Spectrum Health executives implemented the training in a unique way; they resolved it must be leader-led. This meant their organizational development staff did not conduct the training—executives and directors did.

In 2006, Spectrum Health’s twelve-person executive team completed the course, led by a team of Master Trainers from VitalSmarts. Once a week, the executives would then train the directors who reported to them. In turn, the directors would train their managers. Shortly, the material had cascaded through the entire organization.

After the initial top-down training rollout, Crucial Conversations was offered in formats tailored to the needs of the organization’s various audiences.

For example, physicians received the course in its traditional two-day format while staff received a consolidated version and a series of post-training coaching sessions. When new leaders took the course, offered three times a year, they attended in four, half-day sessions.

To date, an estimated 3,000 people at Spectrum Health have completed Crucial Conversations Training.


Since the introduction of the training, crucial conversations skills and vocabulary have permeated the culture at Spectrum Health. The executive team, including the president, keeps the skills front-and-center in their meetings and shares success stories regularly.

“To see the real results, you have to listen to what is happening at patients’ bedsides,” White said. “You have to hear the stories of managers reporting that staff members confront col- leagues on their own instead of going to their managers to resolve issues.”

White says “resounding” evidence of Spectrum Health’s culture change is that the staff are effectively addressing issues and concerns, and appropriately having the right conversations with one another. White describes the behaviors as being embedded in the “fabric of the culture of the organization.”

Perhaps even more remarkable, staff members are also speaking up about the behavior of physicians or others who may be perceived as unapproachable.

Here are some examples:

  • The president begins his monthly leadership meetings with what he calls “Patient Perspectives, the good, the bad, and the ugly,” in which staff members share real stories—good and bad—related to patient care. The stories illustrate how every action has an impact on patient experiences and patient safety. One story described a conflict between two colleagues whose very fractured relationship affected their performance. White coached one of the individuals by practicing the crucial conversation she needed to have with this colleague. “She ended up not only resolving the relationship, but the other person was also grateful for the dialogue. They went on to not only have a positive and impactful working relationship, but personally enjoyed working together.”
  • An executive was participating in rounds and entered a patient’s room without washing his hands, thinking this wasn’t a problem as he likely wasn’t going to touch anything. But the hospital had agreed on a mandatory policy that employees must wash their hands every time they go in and out of a patient’s room. A staff nurse was nervous about speaking up to the executive, but she used her Crucial Conversations skills to remind him to wash his hands. “It went very well for both parties. The executive appreciated the coaching and it built confidence in our staff member” White said, noting that the experience was shared as a best practice.
  • Remarking on the employees’ perceived value of the training, White indicated that new leaders must get on a waiting list to attend the training. Even while dealing with the demands and pressures of a new role, new leaders don’t require prodding to sign up for the course. “The training is a time commitment, so the fact that these busy leaders are prioritizing it is significant,” White said. “In fact, we had to reserve a larger conference room so new leaders would not be turned away.”

White emphasized that experiences like these are common at Spectrum Health.

“The training really works – that’s why we keep doing it,” she said, citing regular e-mails from staff and physicians, appreciative of the tools and training.

When asked whether outcomes can be tied to a specific ROI, White references improvements in staff satisfaction, patient satisfaction, efficiency and safety. “This is a key tool in building leader and organizational competence so that we can achieve our goals. I am not sure there is any greater tool than giving people the skills to speak the truth and hold each other accountable.”

White feels the skills have reached enough people to become embedded in the hospital group, and the resources are now rolling out to other entities within Spectrum Health.

“If we had reason to think Crucial Conversations was not making a difference, we would not invest any more time and energy into the initiative,” she said. “This training is part of our bigger strategy, and a key tool in preparing our organization to thrive not only today, but also in the future.”

Welcome to VitalSmarts.com

VitalSmarts and Poertner Consulting Group are pleased to announce a new era in their joint service.

VitalSmarts has acquired the business and will maintain the presence in your area to provide you with streamlined and enhanced customer support.

We look forward to working with you!

If you have any questions, please email VitalSmarts at support at vitalsmarts dot com.

Welcome to VitalSmarts.com

VitalSmarts and LeadershipSmarts are pleased to announce a new era in their joint service.

VitalSmarts has acquired the business and will maintain the presence in your area to provide you with streamlined and enhanced customer support.

We look forward to working with you!

If you have any questions, please email VitalSmarts at support at vitalsmarts dot com.