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The Beryl Institute invites members and guests to submit posts on patient experience related topics. For guidelines and information on submitting a post for consideration, contact michelle.garrison@theberylinstitute.org.

 

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The Challenge of the Patient Experience in Behavioral Health

Posted By James Rosser, LCSW , Monday, April 25, 2016

The patient experience is crucial across the continuum of all health related interactions; however, perception of the role of the patient experience differs at various points along the spectrum. Behavioral health (mental healthcare, psychiatry) is an interesting point to consider.

By training and nature, mental health professionals see themselves as patient focused and in possession of empathy and caring honed to a fine degree by intentional development. Does this mean that mental health providers are inherently good at the patient experience?

Certainly, people often choose to enter mental health because they want to be able to care for a disadvantaged group of people. Systems can either nurture such values or – intentionally or not – discourage them. Mental healthcare delivery suffers from the same organizational cultures and pressure as any other part of healthcare delivery – perhaps even more so. Too often mental health is the "stigmatized "part of the system itself, sometimes by misperception of our function, and often we are financially disadvantaged. This stigmatization can increase the burden of the care givers, and that team includes administrative, support and financial areas.

So how does mental health approach the patient experience? The good news is that enormous supplies of caring and empathy actually do exist in our facilities and systems. Extraordinary care gets delivered every second of every day. Does that supply of caring become pervasive and not just limited to the treatment room? That is the question to pursue for those of us in mental health.

Some key factors that may affect delivery of the optimal patient experience in mental health are:

  • Highly regulated patient privacy and confidentiality requirements
  • Philosophical training that intentionally discourages interaction with patients outside the therapy room
  • Inconsistent approaches to treatment that inform the actions of staff differently and, therefore, guide potentially confusing responses to patients
  • A culture of "protecting” clinicians from patients between visits
  • Involuntary treatment situations, either by law or family/societal pressure
  • Universal shortages of care
  • Possible misconceptions about the true meaning of the patient experience

These issues are daunting. Some require huge societal commitments that seem difficult to obtain. Others involve introspection – something we frequently ask of our patients but forget to use in our own structure and delivery of their care. Introspection can inform us in how we may not "walk the talk” of the patient experience.

Guidance from The Beryl Institute’s definition of the patient experience is crucial to success. The question is how often that definition gets translated into operational strategies and tactics that can foster successful experiences. The same question used to round on an inpatient medical unit may well be off the mark for inpatient psychiatry (we don’t usually have call buttons!).

The importance of the patient experience as it interacts with mood disorders, eating disorders and thought disorders is no less meaningful than when a person faces surgery; however, the solution set is likely different.

Nurturing and supporting future growth of the behavioral health component of the patient experience movement is the key to creating the kind of patient care we all desire to see for our patients, our loved ones, and perhaps ourselves.

Working in mental health for over 25 years, James Rosser, LCSW currently serves as the Director of Outpatient Programs at UCLA Health’s Resnick Neuropsychiatric Hospital. He has been at UCLA Health since 1999 and has been a leader in innovation in behavioral health services delivery. He currently oversees 11 programs that provide intensive outpatient services for those with acute behavioral health issues. He is a board member of Association of Ambulatory Behavioral Health-Southern California, and a member of the National Association of Academic Psychiatry Administrators.

Tags:  behavioral health  Continuum of Care  delivery of care  mental health 

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Transitioning from Hospital to Home: The Process is a Mess

Posted By Suzanne Steidl, Thursday, March 5, 2015
Updated: Thursday, March 5, 2015

For patients and families, remembering hospital experiences can be like remembering relationships —we recall the good and forget the awful. If the food was surprisingly good and the nursing staff was especially nice then it was a good experience; the bad is forgiven and forgotten or not acknowledged at all. Our experience surveys always arrived while I was in the throes of managing my mother’s illnesses and recoveries at home: I didn’t have time to do them and mostly forgot the details anyway. I had bigger fish to fry. So when I see a billboard declaring that a hospital is #1 in patient satisfaction, I have to wonder.

I’m emerging from six years of caring for my mother who was frightened into quadruple bypass surgery at age 82 despite the fact that her Parkinson’s disease was advanced. In addition to infection that required readmission, the surgery and recovery accelerated her Parkinson’s progression. Given encouragement and time to talk with her far-flung children before agreeing to immediate surgery, she may have thought about how she preferred to live out the rest of her life and decide against it. But she didn’t and she extended her life eight years, uprooting me from my home 1,000 miles away and challenging me to endlessly figure out, mostly on my own, "what do I do now”? I’ve experienced the continuum of care all the way to more than a year of corporate hospice care—I don’t recommend it—and getting zero information about alternatives to nursing home placement. My mother died in August, incapacitated and demented.

I don’t know what I don’t know so I depend on the experts to create processes and materials to help me make good decisions and to maneuver this often incredibly frustrating, difficult and potentially dangerous system.

My mother couldn’t function without her Parkinson’s meds and, until I wised up, they did not follow her from hospital to rehab. Early on, no one ever told me that there would be a medication gap so it became my job to remember to provide them. At discharge, everyone is given the same instructions regardless of our ability to retain information or foresight to take notes. For some, it takes courage to question or ask the discharge planner to slow down and clarify. Others are functionally illiterate. There’s an awful lot to organize. And who really has time or the will to read brochures when caregiving demands consume us? Not me.

Then there’s the home medical equipment. The guy who drives the delivery truck quickly explains how to operate the equipment. He’s always in a big hurry and doesn’t have printed material. Once, an oxygen concentrator was delivered and I was not instructed to fill it with distilled, not tap water or clean the filter. Filter? The alarm sounded the first night, I didn’t know why. I could go on.

I should know better. That I do not really troubles me. If I were an 80 year-old tending an antibiotic infusion pump at home, I don’t know what I’d do.

Maybe some facilities consider discharge planning and home care to be part of the patient experience that’s tracked and enhanced. That’s not my experience but I surely wish it were.

Suzanne Steidl is the founder of Your Daughter’s In Town: Health Advocacy for Elders. She is an advisory board member of the Healthcare Technology Safety Institute (HTSI) of the Association for the Advancement of Medical Instrumentation (AAMI) and is working to simplify DME Instructions for Use and streamline hospital to home processes. She is a member of The Beryl Institute.

Tags:  Continuum of Care  family engagement  Hospital  patient  patient experience 

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Contemplating Person Centered Care in the Expanding Continuum

Posted By Steve Shields, Thursday, December 4, 2014
Updated: Monday, November 24, 2014

We know how it is.

Anyone with a complex medical condition knows the feeling: Your doctor refers you to one or more specialists and therapists, and with each comes a new round of appointments to schedule, forms to fill out and recitations of your medical history, current diagnosis and the medications you’re on to a stranger focused only on one part of your total wellbeing.

None of the specialists or therapists seem to have communicated with your primary doctor or with one another. You’re on your own in navigating among the enclosed organizational silos of the medical industry where people, information and transparency seldom circulate beyond departmental or organizational boundaries.

So prevalent are these silos throughout the care continuum – hospitals, out-patient services, physicians, rehab centers and nursing homes – we’ve become numb to their existence. We fail to see how they prevent us from treating the whole person in a coordinated, integrated way.

We know what it takes; we just need to embrace a framework. Yet with the rise of Accountable Care Organizations and the Affordable Care Act, the healthcare system is calling for seamless integration among all these entities to bring costs down and quality of service up. And it’s starting to dawn on us that that seamlessness needs to extend from acute to post-acute to long-term care. But until we acknowledge that silos are a major impediment to integration, we will never restructure our organizations to achieve the level of person-centered care people want and deserve.

Failure to address the issue of silos is a consistent failure among many healthcare organizations that presume to undertake the cultural transformation to person centered care. Instead of reshaping top-down hierarchies to bring decision-making more to the point of service, many instead reach only for the low-hanging fruit, i.e. they stay in the traditional organizational structure while trying to create new models of physical design or iconic elements of person centered care. The roadmap is there; we just need to adapt it for the next wave.

A few long-term care organizations have made the difficult transition from top-down organizational silos to self-led teams and cross-trained staff on the scale of households, and they are a beacon for success. What they teach us is that the act of creating organizational change is far more than the positive outcomes for residents; it is the development of the mental muscles and change in chemistry among staff and management that results. It’s like a workout to prepare ourselves for the integration of the entire health care continuum because it’s the same thinking and driving principals that are required.

If we learn from those organizations, we have the potential to enable well-being in a comprehensive way while enabling those receiving our services to stay in the driver’s seat of their own lives. Imagine the ability for people to move from the doctor to the hospital to the specialists and therapist and, ultimately, to long-term care as if it were a coordinated experience with everyone tuned in to the person; that in accessing food, medication, therapy, doctor, transportation or whatever, you’re not doing it alone.

But if we don’t do the change necessary within our own organizations, the rest of the care continuum will encounter the same problems as have the low-hanging fruit pickers in long-term care. Seamless integration among all the components will be beyond our reach.

Steve Shields is the President and CEO of Action Pact Holdings, LLC with offices in Manhattan, KS, Atlanta, GA, Milwaukee, WI and Kolkata, India. Action Pact specializes in organizational transformation and repositioning, architectural design and construction, project development services, financial forecasting and strategic planning for the senior living sector.

Tags:  Continuum of Care  long term care  patient experience  person-centered care 

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