"Most of the patients and their families were supportive of the staff, but they said they looked like they are so busy and [that they] have the time," Pu says. "That was true. That was really occurring. The staff became demoralized. Then their attitudes begin to deteriorate and the compassion wasn't there anymore. That is how the downfall started. At the end of 2011 we were just in the pits."
Pu and his colleagues concluded that the initiatives failed because they came as a mandate that did not engage physicians from the start, nor ask them to lead.
"When you look at these things, and you look at other health systems across the country and usually all of these initiatives are targeted at front-line staff. The physicians have always been left out of the loop," he says.
"You get informed about it but they're not asking us to lead it. You have to have the physicians out front because if the front-line staff sees that the medical staff not only buys into it but owns it they are much more responsive. You don't want them to perceive it as just another task."