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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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Service Recovery in Healthcare

Posted By Rhonda Ramos, Wednesday, November 1, 2017

Service recovery is no foreign concept to the business world. It is a fundamental practice that can turn a negative situation into a positive statement about a company. Simply put, it is the process of making things right after something has gone wrong with the consumer’s experience. You see this common occurrence in retail, restaurants, and even airlines. Yet how can we adopt service recovery in healthcare?

Let’s face it, we’re not perfect. We fail to meet our patients’ expectations in numerous ways: excessive wait times, appointment scheduling problems, room/environment issues, miscommunication, and the list goes on. In the food service world, if I go out to dinner and a steak is not prepared the way I ordered it, the restaurant would probably remove the entrée from my bill. In healthcare, can we give a free prescription because a patient had to wait, or provide a coupon for a lab draw if the patient requires multiple needle sticks? Probably not.

In order to curb bad public relations since dissatisfied customers tend to tell others about their negative experiences, we’ve had to get a bit creative in healthcare. We know that the basis of all our interactions is communication; therefore, our service recovery program is grounded in the way we communicate during a complaint. We developed the acronym GIFT:

  • Gather – Listen to the individual’s concern and validate their feelings
  • I’m sorry – Offer a genuine apology for not meeting their expectations
  • Feedback – Explain what you plan to do and follow up
  • Thank – Thank them for sharing their concerns

These four simple steps provide a mental pathway as you’re attempting to diffuse a complaint. At UPMC Pinnacle Hanover, we carefully incorporated the Heart-Head-Heart communication method, which we adopted from the Language of Caring philosophy. By offering a blameless apology, we express ownership yet not necessarily assume fault. We involved our Patient/Family Advisory Council in the creation of this program, and they advised us that a genuine apology is the most critical element. The goal is to allow the complainant to feel heard, validated, and respected.

While most concerns can be resolved simply with proper communication, there are instances when it might be beneficial to offer something “extra” such as a gift card or other small token. CMS guidelines state that a service recovery item presented to a patient cannot exceed $10 per person or $50 in an aggregate year. (This is also under Department of Health and Human Services - OIG Advisory Opinion No. 08-07.) If a department chooses to obtain a supply of gift cards to various local vendors (restaurants, gas stations, etc.), they track them using our internal reporting system. Reports can be run, by patient, on a monthly basis to ensure that we are compliant.

One of the most important elements of this entire program is empowerment. Rather than only allowing a department head to resolve concerns, which could happen after a patient has already left the facility, we wanted to educate and empower each employee to utilize service recovery. By immediately responding to concerns and complaints we can create loyalty with our “customers.” We can create a learning culture that treats complaints as gifts, or opportunities for improvement, that steers away from a negative connotation to something more positive and patient-centered.

When an issue is identified and addressed before the patient is discharged, theoretically it will also help to reduce the number of formal grievances we receive. Unfortunately, it is difficult to quantitatively prove that our service recovery program has confidently reduced our number of formal grievances. However, we do know that there has been a shift in our culture and employees feel empowered to take ownership to provide quick and decisive action when something has gone wrong. And at the end of the day, that’s a win.

Rhonda Ramos is the Patient Experience Manager for UPMC Pinnacle Hanover and has worked for the organization for ten years. She is fluent in Spanish and started her career in healthcare as an interpreter and patient advocate. Rhonda grew up in Ellicott City, MD and currently resides in Hanover, PA with her husband and two children, ages 3 years and 6 months.

Tags:  communication  complaint  empowerment  grievance  patient advocacy  service recovery 

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Effective Patient Communication Builds Trust for Better Outcomes

Posted By William Maples, M.D., Monday, September 25, 2017
Updated: Monday, September 25, 2017

For physicians, a significant factor leading to optimal outcomes is to engage patients early on as part of the decision-making process. Understanding patients’ needs, along with their values and preferences, is critical to the success of your healthcare team.

However, we at The Institute for Healthcare Excellence have found that many times physicians don’t understand what their patients need or want from them. It takes effective patient communication—leading to an alignment of goals and expectations—to bring about positive outcomes and a stronger bottom line.

Patients need doctors who listen

What patients want most from doctors is to be respected and listened to. Technology and medical procedures may continue to evolve, but certain human needs will never change. Patients evaluate their relationship with a provider by asking: “Am I really being listened to? Am I being respected? Do you truly care about my health? Do you have enough time for me?” To get to “Yes” starts with doctors who listen well and build trust with patients.

The lost art of listening to patients

Physicians seem to have lost the art of listening to patients. On average, we interrupt our patients with an 18 seconds and often change what they really want to tell us. Research has found that up to 30% of the time, we completely miss why the patient is there to see us.1 It’s vital that we rekindle the skill of listening, of recognizing the emotions in the room and responding in a way that builds a trusting relationship with the patient and ultimately improves outcomes.2

In our work with health systems and hospitals to improve their patient satisfaction scores and medical outcomes, we’ve learned that creating an exceptional experience can lead to a culture of safety. As that culture of trust and teamwork grows, patient-adverse events begin to decline.

Physician leaders improve communication

The first step is to identify physicians who are ready to support initiatives that improve communication with patients. After all, the caregivers are the best choice to lead the effort, rather than having it dictated to them. Let’s not leave physicians out of the equation when they can play a major part in creating a high-quality experience for patients.

Of course, there’s never a perfect time to implement best practices for communication in healthcare. It takes patience and a deep commitment to nurturing a culture that’s built on relationship-based, patient-centered communication. It may be nine to 12 months before you see a measurable impact, and up to four years to realize the maximum benefit. Once that’s achieved, however, you can expect a fivefold return on your investment.

Better communication helps prevent physician burnout

One more factor to consider is that poor communication can increase the chance for preventable errors. When a physician is frustrated by inadequate communication with a patient, it can cause burnout—and that correlates to medical errors.

To help bring back the joy of practicing medicine physicians must build a meaningful relationship with patients. That involves learning to listen to patients, establishing a culture of trust and committing to executing a relationship-based communication plan. Often this approach surprises us as it does not take any longer. Meeting those objectives can transform the patient’s experience and lead to measurable, positive outcomes for you and your care team.

References

  1. Lipkin M, Putnam S, Lazare A. eds. The Medical Interview. Clinical Care, Education and Research. NY. Springer-Verlag.1995.p.531.
  2.  The importance of physician listening from the patients’ perspective: Enhancing diagnosis, healing, and the doctor–patient relationship. Justin Jagosha, , , Joseph Donald Boudreaub, Yvonne Steinerta, Mary Ellen MacDonaldc, Lois Ingramd doi:10.1016/j.pec.2011.01.028

William Maples, M.D. serves as PRC's Chief Medical Officer. Before joining PRC, Dr. Maples served as Senior Vice President and Chief Quality Officer at Mission Health in Asheville, North Carolina. Additionally, Dr. Maples serves as Executive Director of The Institute for Healthcare Excellence, where he and his consulting faculty employ a variety of strategies to improve patient experience and impact quality outcomes.

Tags:  communication  outcomes  patient engagement  patient's needs  physicians 

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What About Deaf Patient Experience?

Posted By Kate O'Regan, Friday, September 22, 2017
Updated: Monday, September 25, 2017

I recently read Dr. Cordovano’s compelling case for a patient centric comprehensive medical records system in her recent blog. She opened with:

A patient was recently discharged from an exceptional hospital after a 2-day stay. During those 2 days, he saw endless doctors, attendings, residents, fellows, interns, nurses, nurse practitioners, nursing students, TV and phone service staff, physical therapists, social workers, case managers, housekeeping staff, spiritual chaplains, food and beverage staff, transport staff and discharge planners. Forgive me if I’ve missed anyone. All of these hospital employees play an essential role in a patient’s care at the hospital. There was just one person missing…

As my eyes honed in on the words “there is just one person missing,” I immediately think of the historically marginalized deaf community who continue to receive unequal and ineffective communication access to healthcare, something that can be achieved by using an effective and trusted interpreter. But the most critical piece, is an effective and trusted system of communication access that is patient-centric.

I want to recognize The Beryl Institute truth that healthcare can change by advancing an unwavering commitment to the human experience. I witness, too often, the deaf experience that is framed as less than human and that is fundamentally problematic.

Every day globally, deaf people experience a lack of an effective system, of awareness and of respect as humans. It is time to start to listen, advocate with and provide (give back) leverage to deaf patients, leverage that is often taken away from them at first glance.

To achieve a successful and sustainable care plan for deaf patients, here is what should be happening:  budget for communication access, create an internal department or find a vendor who can manage your services locally and work with the local deaf community. Also, every deaf patient should have the opportunity to be greeted by a local deaf[1] community advocate. This advocate will guide the deaf patient and medical professionals throughout the healthcare experience.

Every deaf person have different unique preferences to communication access. One deaf person with more moderate hearing loss might communicate using spoken English, but  use an interpreter to effectively receive spoken English. Another deaf person with profound hearing loss might have a PhD in Business Administration, not fluent in spoken English and accesses health care best with an interpreter. A person who was raised in another country who just moved to America may not be fluent in ASL and would rather speech to text technology called CART.

Deaf people have different communication access needs and a lack of system to recognize this diversity leads to a lack of health care access. Health care organizations need to contract with an agency that understand the needs of deaf patients when it comes to access. If they don’t, there is a high risk of liability under federal law. Some hospital administrators choose to contract with national level technology companies to provide Video Relay Interpreting (VRI) services without the consult of the deaf individual which are consistently unreliable, ineffective, unlawful, and cause further oppression of deaf people lead to gross negligence of patient experience and numerous hospitals have been brought to court by the US Department of Justice. If healthcare providers truly value patient experience, we need ask deaf patients what is effective and then implement those services. 

[1] A deaf person needs to be employed in this position or from a trusted locally deaf-centric advocacy organization.  See DEAF GAIN #googleit

Kate O'Regan grew up in Montpelier, VT and is the Founding President of Civic Access. She believes in social entrepreneurship as a form of economic empowerment. She lives in Charlottesville, VA with her three children.

Civic Access, was founded with the philosophy that legally mandated services of communication access can support forward progress for deaf access in the public sector.  

 

Tags:  access  communication  deaf patient experience  interpreter 

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Bedside Shift Report from the Patient’s Perspective

Posted By Brooke Billingsley, Friday, March 17, 2017
Updated: Wednesday, March 15, 2017

Patients spend little time thinking about the nurse’s list of tasks to complete. They aren’t aware of the excellent job their nurse did charting their care, how staff made sure safety precautions were adhered to or what it took to provide a meal on time. 

Patients are functioning on an entirely different level. They are focusing on what they can control – which is very little – and how external forces are making it easier or harder to achieve their goals of getting better and getting out of the hospital. What registers with patients is ‘touch’ – those memorable moments in which staff made a genuine effort to connect with patients.

A positive transformation occurs in a patient’s perception of their care when touch is added to a task. That is certainly true with the Bedside Shift Report.

The BSSR is often misunderstood because it is seen as time consuming, does require effort, and for some, is uncomfortable. But the BSSR must be seen from the patient’s perspective to be fully appreciated. The benefits and value to the patient far outweigh the arguments against. 

Consider what the patient sees when a fully functioning Bedside Shift Report is conducted:

  • The BSSR allows patients to hear and physically experience how committed the organization is to their care and illustrates how unique and important their case is.
  • Patients are very conscious of how staff interacts with one another through conversations and body language. The BSSR presents an opportunity to show unity and camaraderie, which patients ultimately associate with good care.
  • Staff has the opportunity to give patients the assurance that they will receive the same great care from the new nurse as the previous nurse. It also increases the chance for mutual praise and promotion of the rest of the team.
  • Because the Bedside Shift Report is not a patient expectation (they are not likely to say, “Hey, I think I should be in on that get together in the hallway,”) the act itself is (novel) and memorable lending itself to increased satisfaction.
  • The BSSR demonstrates that time spent with the patient has value, which in turn shows respect for patients and their participation.
  • Adding some personality to the process completes the recipe for a guaranteed touch opportunity.

There are a few additional things you should consider in making the transition to a Bedside Shift Report a successful one.

  • Have a plan to determine what would be most beneficial for the patient to know and work out the details of the information exchange.
  • Practice until it feels comfortable. In time this should become second nature.
  • Communicate in a way that is most understandable to the patient.
  • If the patient is not able to participate, include family if they are present.

And finally, when you formally conclude your time with your patients, the BSSR shows that you care enough to say good-bye adding touch to a required task.

Brooke Billingsley is the CEO at Task To Touch™ e-Learning & Perception Strategies, Inc. a healthcare perception research company. Brooke is a speaker, consultant and author.

Tags:  bedside shift report  communication  improving patient experience  our  perception 

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Sustaining and Embracing Our Physicians and Advanced Practice Clinicians: Conversations We Need to Have

Posted By Jeremy Blanchard, MD, MMM, CPE, FACP, FCCP and FACPE, Wednesday, February 1, 2017
Updated: Wednesday, February 1, 2017

“I was on the inside looking outside. The millions of faces, but still I’m alone… I hope we’ll be here when they’re through with us.”
- Foreigner

When I hear Foreigner sing “Long, Long Way from Home,” I am reminded of conversations I have had with my colleagues, physicians and advanced practice clinicians (APCs). The world of medicine is so dynamic and different from when I started medical school in 1987. Many of these changes are good and have great intent, but many of the ramifications threaten core value attributes of our different generations of healthcare providers: autonomy, sacred relationships with patients, complex problem solving and the joy of practicing medicine. In these conversations the providers relate not having a voice, feeling like healthcare is changing without their input, and not for the better. They feel alone and not valued.

Being a caregiver seldom, if ever, starts from the perspective of practicing medicine as a business opportunity. It starts from a place of the desire to do good. As we enter medical school bright eyed, empathic and energized, what happens to us? Or at least how is our showing of empathy and building relationships threatened or compromised?

This blog is my call for action. A call for us, leaders in healthcare and patient experience, to develop a strategy to address the following question. How can we help our physicians and APCs, seasoned and new, from multiple different generations, feel valued and recapture or sustain their joy of practice? It is paramount, because the provider being empathetic, engaged and joyful is pivotal to our family and friends’ quality of care and how they feel when receiving that care (1, 2).

“I've learned that people will forget what you said, people will forget what you did, but people will never forget how you made them feel.”
- Maya Angelou
 

The reality of our present American healthcare model in regard to providers is reflected in these powerful statistics.

  • 54% of doctors show signs of burnout and only 40% of doctors are satisfied with their work life balance.(3)
  • For every 1 hour physicians provide direct patient care, nearly 2 additional hours are spent in activities associated with the Electronic Health Record.(4)
  • In one study 52% of medical students suffered from burnout; of those burned out, 35% admitted to unprofessional conduct related to patient care.(5)
  • 14% of Internal Medicine Residents rate life “as bad as it can be” or “somewhat bad.”(6)
  • 38% of Internal Medicine Residents had personal debts greater than $100,000 dollars (2008 monies).(6)
  • 6.3% of participating surgeons had suicidal ideations in the past 12 months.(7)

Physician burnout is real and threatening our whole healthcare system - the quality, safety and compassion of the delivery of healthcare.(8) Burnout is not just among older physicians or surgeons; it is across the whole spectrum of healthcare. In Maslach’s Burnout Inventory Manual, he states, “Burnout is a syndrome of emotional exhaustion, loss of meaning in work, feelings of ineffectiveness and a tendency to view people as objects rather than as human beings.”(9)

When considering this subject there is a complementary way of looking at it that I find valuable. In each of the above statistical bullet points there are multiple challenges accumulating to depersonalize and overwhelm the provider. But what if we were to focus on how we support these courageous and valuable members of the healthcare team? Instead of focusing on burnout, reposition ourselves and focus on developing resilience, investing in our providers to help them find their joy, recapture their personal and cultural value. The following are conversation topics I believe we need to discuss now to answer this call to action. Here are statements to serve as an agenda for generative conversations and next steps to action.

  1. Interventions for burnout need to be as multi-factorial as the causes. The etiologies of burnout for my generation of providers, compared to the millennial provider, may have the same or different root causes. Recognizing the differences in generations allows for more impactful and valuable interventions.
  2. Costs in healthcare live in silos with their relationships unrecognized or declared. A key to making this a prioritized conversation is identifying the price tag to this epidemic. The cost shifts this conversation from the doctor’s and APC’s problem to the CFO’s and CEO’s problem.
  3. We need senior leadership in health care to recognize and quantify the hidden opportunities of investing in our providers. Data shows doctors who have sustained empathy and joy provide safer care and a better patient experience. In population health models this translates to increased revenue.
  4. It is proposed with future physician shortages, APCs will have a greater impact on care delivery, healthcare revenue and patient experience; that “future” is now. We need to create systems that recognize the APC as a unique member of the healthcare team.
  5. With the changes taking place in healthcare we need to assure the new paradigm of excellent care outcomes (the quadruple aim) - enhancing patient experience, improving population health, reducing costs and improving the work life balance of those who provide care.(10)
  6. A happy physician or APC costs the institution much less in legal fees, mistakes, nurse turnover, etc. How do we help our medical culture apply the resources to address major causes of burnout and to support the development of resiliency programs?
  7. Essential to a successful navigation of our healthcare future is identifying communication as an advanced healthcare competency. It deserves the same attention as the mastery of procedural skills, knowledge base and work flow.

The time is now and the “who” is us. If we do not begin to have these conversations and change the perspective of healthcare, our “default” future is one of: not enough healthcare providers, increased healthcare costs and a loss of the “sacred” relationship between the noble men and women who care for patients. This conversation is focused on physicians, but applies to all who touch a patient’s life. Won’t you join me?

Bibliography:

  1. Lucian Leape Institute. Through the Eyes of the Workforce: Creating Joy, Meaning and Safer Health Care. Lucian Leape Institute of the National Patient Safety Foundation 2013.
  2. Beach M, Sugarman J, et al. Do Patients Treated with Dignity Report Higher Satisfaction, Adherence, and Receipt of Preventive Care? Annals of Family Medicine 2005; 3:331-8.
  3. Shanafelt T, Hasan O, et al. Changes in Burnout and Satisfaction with Work-Life Balance in Physicians and the General US Working Population Between 2011 and 2014. Mayo Clinic Proceedings 2015; 90(12):1600-1613.
  4. Sinsky C, et al. Allocation of Physician Time in Ambulatory Practice: A Time and Motion Study in 4 Specialties. Annals of Internal Medicine 2016; 165(11):753-760.
  5. Dyrbye L, Massie F, et al. Relationship Between Burnout and Professional Conduct and Attitudes Among US Medical Students. Journal of the American Medical Association 2010; 304(11):1173-1180.
  6. West C, et al. Quality of Life, Burnout, Educational Debt, and Medical Knowledge Among Internal Medicine Residents. Journal of American Medical Association 2011; 306(9):952-960.
  7. Shanafelt T, Balch C, et al. Suicidal Ideation Among American Surgeons. Archives of Surgery 2011; 146(1):54-62.
  8. Shanafelt T, Balch C, et al. Burnout and Medical Errors Among American Surgeons. Annals of Surgery 2010; 251(6):995-1000.
  9. Maslach C, et al. Maslach Burnout Inventory Manual, 1996.
  10. Bodenheimer T and Sinsky C, From Triple to Quadruple Aim: Care of the Patient Requires Care of the Provider. The Annals of Family Medicine 2014; 12(6):573-576. 

 

Jeremy R. Blanchard, MD, MMM, CPE, is a Chief Medical Officer at Language of Caring. Grounded in healthcare realities and aspiring to partner with others committed to healthcare transformation, Dr. Blanchard is an expert in ensuring physician development, commitment and wholehearted engagement. A dynamic speaker, skilled facilitator and coach, he provides tailored programs for medical staff, coaches individual physicians, and partners with physician leaders to assess needs and implement physician engagement strategies.

Tags:  burnout  clinicians  communication  empathy  language  physician  words 

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Of Heads, Hearts and Hands

Posted By Paul Westbrook, Friday, June 12, 2015

In the first article of this series entitled, "A Thin Line, The Nature of Care,” we discussed the inherent challenges discovered in our three-year patient experience transformation at Inova Health System. Our commitment to addressing those challenges, by focusing on hospitality principles was addressed. In the third and final section, we will present, "The Return on Hospitality,” indicating the objective and measurable success we’re achieving. Today, in this second installment, "Of Heads, Hearts and Hands,” the call of moving from the head – to our hearts and hands, from plans and strategies to actions and tactics is examined. As we get started, enjoy this quote:

"A person's most useful asset is not a head full of knowledge, but a heart full of love… and a hand willing to help.” – Anonymous

As we commenced our journey of patient experience transformation at Inova Health System, our first objective was to re-examine strategies and tactics, of uniting heads, hearts and hands in fulfilling the Inova Promise. The initial SWOT analysis revealed sobering realities and opportunities for growth. Through the valuable introspection of the newly formed Patient Experience Transformation Team, it was determined that the most effective channels for change would be to re-inspire five core work streams. This system-wide evolution across core work systems continues today at Inova as we embrace and fulfill our promise:

"We seek every opportunity to meet the unique needs of each person we are privileged to serve – every time, every touch.” Inova Promise

The Five Core Work Streams

  1. Culture.The heart of the matter of service excellence in healthcare is creating a culture that endures across all care areas and locations. With a passionate commitment to our promise, we embody a culture of making emotional connections. Where service is individualized. Where every action is built on intentionality and purpose – in an atmosphere of mutual respect.
  2. Communication.Information is power. Through open communication about mission and vision, staff members are empowered, have a sense of pride and see their roles as critical in the delivery of care. Leaders convey inclusion and respect by sharing insights through multiple channels such as recognition meetings, huddles, executive rounding, newsletters, blogs and other media. Consistent and cohesive communication is foundational to building a culture of shared values.
  3. HR Processes.To be the best, we strive to attract and retain the best. Through a combination of behavioral interviewing and setting the expectation early, we commit to attracting, selecting, orienting, on-boarding, rewarding/recognizing and nurturing the best people we can find, keeping a constant focus on the balance between talent and cultural fit.
  4. Leadership Development. Healthcare leadership requires clinical excellence coupled with interpersonal and administrative acumen. We foster well-rounded excellence in medical competence and leadership that invites and inspires and that is engaging, efficient and effective.
  5. Service Excellence. Our day-to-day engagements include developing champions and driving service essentials like rounding, white board completion and shift-to-shift handoffs. Moreover, we consider one another as internal customers and endeavor to pleasantly surprise each other and our patients with the unexpected anticipation of needs and desires.

The patient experience at Inova Health System embodies a three-stage effort of 1.) Approach 2.) Deployment and 3.) Results. As I’ve discussed the deployment of action through these five core work streams, the next blog post of this three-part series will present the results – results that illustrate a system’s integration of "heads full of knowledge,” and "hearts full of love and hands willing to help.” I will share results that show the impact of a system-wide transformation of service to those "we are privileged to serve – every time, every touch.”

*This is the second piece of a special three-part guest blog series focusing on various components of patient experience excellence, including patient and family care, culture and leadership and employee engagement. Read Part 1 and Part 3 here.

Paul is the Vice President of Patient Experience at Inova Health System. Prior to joining Inova, Paul began his service delivery consulting company, Westbrook Consulting, LLC, with the mission of transferring his 35 years of hospitality service in branding, strategic deployment, and operations to other service industries, to give back to his community and make a meaningful difference in peoples’ lives. Paul is also part of The Beryl Institute's Patient Experience Executive Board.

Tags:  communication  culture  Leadership  patient experience  team 

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Care Provider Well-being: A Prerequisite for an Ideal Patient Experience

Posted By Diane W. Shannon, Monday, February 10, 2014

As a primary care physician, I saw firsthand that the patient experience was not always optimal. Patients were often frustrated by miscommunication or by inefficiencies in the system. And they weren’t always given the respect and focused attention they deserved.

As for me, I burned out trying to provide compassionate care in the system as it was in the 1990s. I chose to leave after just three years of practice. In my second career, as a freelance health care writer, I have come to understand some of the large-scale factors that undermine an ideal care experience, such as a less-than-ideal organizational culture and traditional hierarchies that hinder open communication.

I’ve also come to appreciate that the quality of the patient experience is hugely dependent on the condition of the interface with the care provider. An optimal patient experience requires that both patient and care provider are able to show up at their best—the patient is informed, activated, and engaged and the care provider is empathetic, communicative, and respectful. For the provider half of that dyad to be fully present for that connection, he or she must be well.

And yet almost half of physicians have one or more symptoms of burnout. Burnout is a tragedy for providers who walk away from their chosen profession, for those who remain yet work at diminished potential, and most of all for patients. How can I show up to listen, to be present, to offer the best of myself as a clinician when I’m stressed to my limits as a human being? This isn’t the kind of professional life clinicians want and it’s not conducive to the kind of experience patients deserve.

What’s the solution? Providers can take steps to care for themselves, like meditation and practicing mindfulness. But no degree of self-care will completely inoculate providers from burnout in a system that fails to recognize the humanity of both patients and caregivers. Fortunately, researchers have identified specific factors in the practice environment that predispose to burnout, such as time pressure, lack of control regarding work, and insufficient resources.

Payment reform offers a unique opportunity to address these factors. As doctors and hospitals are increasingly paid to provide better care rather than doing more procedures and ordering more tests, there will be a greater incentive to invest in systemic changes to support better outcomes.

Done right, these changes can reduce burnout. For example, hospital executives can negotiate with payers to pay for important services, such as e-visits, that put extra strain on providers because these items are rarely covered under the fee-for-service payment structure. Leaders of physician group practices can hire additional clinicians to reduce to each provider’s patient panel to a reasonable size. They can support part-time positions and job sharing, allowing care providers with young children or elderly parents to scale back when needed. These steps will require an upfront investment, but will reap large dividends for both providers and patients.

To improve the patient experience, we must respect the humanity of those providing care. As a primary care physician said to me recently, "If we want caregivers to give, we must first care for the caregivers.” Common sense? Yes, yet a relatively unchartered area that offers a valuable opportunity to accelerate improvement and ensure that every patient receives the kind of care that we all want: care that is high-quality, safe, and compassionate.

Diane W. Shannon, MD, MPH is a freelance writer who focuses on improvement in health care. She lives in Massachusetts.

Tags:  burnout  communication  patient experience  payment reform  physicians 

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Turning Lemons into an Excellent Patient Experience

Posted By Diana B. Denholm, Ph.D., Monday, December 2, 2013
Updated: Wednesday, November 27, 2013

Reading Dr. Wolf’s Patient Experience blogs, we learn the importance of involvement in order to achieve excellence, that patients are partners and that we are the patient experience. Whether we’re actually the patient, or part of family or professional care teams, we all make up the patient experience. While instituting change may be arduous, if we see a problem, I believe it’s our responsibility to try to do something about it. We need to get involved and propel that move toward excellence – even if life has thrown lemons at us – or maybe because it has.

In 1999 my husband, John, received a heart transplant at a major teaching hospital. While in intensive care, he was intubated and was put in hand restraints so he couldn’t pull out the tube. Although it was still within his reach, his nurse call button was broken. Although the walls around him were glass, his charts were taped to the window blocking all view of his face. Then something went wrong - and he started choking. He was in distress, frightened and in danger - and he couldn’t get anybody’s attention to help him. Here in one of the finest teaching hospitals in the world, my husband had no way to signal for assistance. It was horrible for him.

I’ll never forget how panicked he was when I came into his room and discovered this inexcusable circumstance. I’ll never forget how appalled and angry I was that this had happened to my Darling John! What a horrific patient experience!

Once out of danger, he was given a piece of paper with the alphabet on it and told to point to letters to spell out what he wanted to say. This ridiculous method was infuriating. Yet, any time you or your loved ones are hospitalized, you face the possibility of encountering similar frustrating, frightening and dangerous circumstances because patient communication methods are often sorely inadequate. This shouldn’t happen to you, nor to those you love and care about.

Rather than citing the hospital for negligence, I did something more constructive and more important. I invented a patient concierge system to help every hospitalized person, you and your loved ones, have a better and safer patient experience.

Of course you want to have your loved ones close when you are ill, and loved ones want to be close to you. Yet visits aren’t always allowed. My secretary had a heart attack and was hospitalized for several months. Because she had a trach tube, written notes were her only form of communication. She was in a long-term relationship, but her gentleman friend was not allowed to visit because he wasn’t a relative – thus creating a greatly diminished patient experience for her. Picture your cell phone and computer in 1999 and you’ll quickly remember how difficult it was to communicate with anyone – even if you could get cell service. So, technology didn’t even provide a serviceable option. As a board certified medical psychotherapist, I know these loving interactions are crucial to a compassionate experience and to creating the most beneficial healing environment.

Instead of focusing just on the needs of the professional care team, which was the norm for hospitals for many years, the focus desperately needed to be shifted to patient-family centered care practices providing direct access links to care staff, support services, food services, and family and visitors. Though it’s taken many years since this 1999 incident, we’ve seen the tide begin to turn making the patient experience and patient satisfaction so fundamental that reimbursements are now linked to them. Patient partnering and involvement are what turned that tide toward an excellent patient experience.

Diana B. Denholm, Ph.D., an internationally recognized caregiving expert, is the inventor of myPAL™ – Patient Access Links and the author of The Caregiving Wife’s Handbook (www.caregivingwife.com) which is endorsed by the AARP, National Council on Aging and Mental Health America. She currently writes for Psychology Today, Stroke Network, PBS and a variety of print publications. She may be reached at dianadenholm@gmail.com.

Tags:  caregiver  communication  interactions  patient centered care  patient experience  patient satisfaction 

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