Posted By Liz Salmi,
Wednesday, July 19, 2017
Updated: Wednesday, July 19, 2017
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After dating me for only 18 months, my now husband became my health care partner. I was 29. He was 31.
In mid-2008, I suffered a massive seizure, landed in the ER, and a scan revealed I had a mass in my brain. Brett suddenly found himself in love with a 29-year-old gal with brain cancer.
After my first hospitalization, Brett jumped into caregiver mode. If I needed clothes for the hospital, Brett packed the bag. When a nurse missed one last stitch in my scalp, Brett finished the job with tweezers. When I needed help coordinating a complex regimen of medications, Brett designed a color-coded spreadsheet that matched my giant pillbox organized by days of the week and times in the day.
Meanwhile, I jumped on the Internet to research treatment options on PubMed, joined Facebook Groups and Twitter communities for people with brain tumors, and started blogging about my experience for family and friends.
There is no right way to respond to illness. My way was to respond with curiosity. I cared about understanding the how and why of my diagnosis and the what of my treatment. Brett’s way was to respond with unconditional love and support. And he cared about taking care of me.
But there is one thing we both needed and continue to need to be active and engaged participants in my care: access to the details of my ongoing care plan—information that is a part of my medical record and embedded in my doctor’s notes.
Brett and I didn’t even know notes were a thing until earlier this year when a change in health insurance forced me to uproot my care from one health system to another. While in the process of collecting my medical records I stumbled across a large PDF document that revealed an insider’s view of my last eight years of living with brain cancer—my notes.
Doctor’s notes (or visit notes, progress notes, clinical notes) are the most important information in our record. This information is readily available to doctors and other members of the health care team to remind them about a patient’s condition and plan for care.
I received great care from my previous health system, but like 96 percent of Americans, my clinical notes were not shared through the online patient portal. This made me wonder… why hide my notes?
I want this to change—for me, for my husband, and for every patient facing a health challenge or working to stay well.
OpenNotes is a national movement encouraging doctors, nurses, and other health professionals to share the notes they write with the patients they care for using secure, patient portals, with the ultimate goal of improving the quality and safety of care. Shared notes enhance the patient experience by improving communication and trust, and reading notes helps to empower patients to make more informed decisions.
Access to notes can help caregivers like Brett, too. In a 2016 study*, patients and care partners with access to open notes stated that they had better agreement about treatment plans and more productive discussions about their care, and patients were more confident in their ability to manage their health and felt better prepared for office visits. Even better, care partners reported improved communication with patients’ providers at follow-up.
In less than five years, the OpenNotes movement has grown access to notes from 20,000 to over 15 million people. That number is impressive, but it represents just 4 percent of the U.S. population.
When I, the patient, don’t have access to notes, neither does Brett—the person most invested in my care. I spend about two hours each year with my health care team, and over 5,000 waking hours in self-care or “Brett-care.” Access to my notes could help us remember what we need to do between now and the next appointment with my doctor.
So what’s the hold up? Why don’t more people have access to their full medical record and clinical notes?
Doctors and health systems claim people will not understand their notes, or be afraid of what is written in them. This makes no sense to me. I am already looking for information about my diagnosis on the Internet—shouldn’t my first search be based on information in my own medical record?
My husband and I are the most invested people in my care, and the notes are about me. Any information about my health and health care is important to us, and we want to know about it. We can handle it.
* Wolff J, Darer JD, Berger A, et al. Inviting patients and care partners to read doctor’s notes: OpenNotes and shared access to electronic medical records. J Am Med Inform Assoc (2017) 24 (e1): e166-e172.
Liz Salmi is the Senior Multimedia Communications Manager for OpenNotes. OpenNotes is a foundation-funded national movement advocating for clinicians to share their visit notes with patients via patient portals. She is also a patient who does not have access to her notes.
To hear more from Liz and about OpenNotes, join us August 29th for the upcoming webinar, The Power of Knowing. You will learn more about the OpenNotes movement and how your health system can participate, and hear from a doctor and a patient about their personal experiences with notes and transparency.
Posted By Marcus Engel,
Monday, July 17, 2017
Updated: Monday, July 17, 2017
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I can’t remember the impact, but I remember the headlights. Then, the pain. The all-encompassing horrors of broken jaws, crushed facial bones and desperate attempts to breathe. I remember the metallic taste of blood mixed with gasoline. Then…the blackness. But, how could I know that darkness was permanent? How could I know that I was now blind?
I can’t remember the medics, the crike, the ambulance speeding to Barnes Hospital, but I remember my clothing being cut off. And, I remember Jennifer.
Throughout that wretched night in the ER, Jennifer held my hand and never left my side. Her presence and her words, “Marcus, I’m here…” were the only things she could have done to help…and they were exactly what I needed.
Throughout the hospitalization and recovery, rehab and 20 years of life, I knew nothing else of Jennifer. Her story is in my memoir and “I’m Here: Compassionate Communication in Patient Care.” But, beyond that night? I knew nothing. No last name, not her position in the ER. Nothing.
Two years after the trauma, as a 19 year old, I found myself in Morristown, New Jersey, training with my first Seeing Eye dog, a black lab named Dasher. Some people measure life in years. I measure life in dogs. Dasher was by my side for seven years. When he retired at age nine, I thought my heart would break. I’d lost my sight, so I thought I knew what loss was…but I was wrong.
Life goes on. We all know that. Dasher’s retirement ushered in another black lab, Carson, who was with me for another seven years. Then came Garrett; a yellow lab who, if you’ve heard me keynote since 2010, you’ll probably remember.
Soon after I picked up Garrett’s harness for the first time, we moved to New York City where I began my Narrative Medicine Master’s program at Columbia University. As I continued keynoting around the country, Garrett was by my side for countless flights, hotel rooms, hospitals and conference centers.
Then, Barnes-Jewish Hospital, the facility that saved my life, invited me to speak. As always, I told the story of “I’m Here” and Jennifer. Afterward, a member of the patient experience team approached and said words I’ll never forget: “Marcus, we have a surprise for you… we found Jennifer.”
Shock. Disbelief. Confusion. I was nothing short of a blubbering mess as I, for the first time in 20 years, held her hands again. Finally, I got to say thank you.
Weeks later, Jenny and I were interviewed by the St. Louis Post-Dispatch.
The journalist asked lots of questions, including, “How long have you had Garrett? How long do Seeing Eye dogs work? Where will Garrett go when he retires?”
Seeing Eye dogs work, on average, seven to nine years. Provided Garrett stayed healthy, we would be together around four more years.
“Will you keep Garrett when he retires?” she asked.
“No, I’ll then get another dog and need to focus all my bonding on the new pup. That’s not fair to Garrett, so I’ll find someone who wants to adopt him.”
Jenny practically jumped out of her seat declaring, “I want him!”
“Absolutely, I would love to have him!”
“Done,” I said. “I can’t imagine better hands.”
Last December. I laid on the floor of a hotel room, thanked Garrett over and over for being mine, for keeping me safe and for his unconditional love. Tears fell onto his velvet ears. Then, a knock at the door.
I hugged Jenny, fell to my knees and held Garrett one last time.
As Garrett and Jenny walked out, all I could think of was love. Love. Compassion. Presence. That’s what I received from Jennifer on the worst night of my life…and that’s what Garrett gave throughout his working life. It is a model of what all truly excellent patient experiences are comprised.
Marcus Engel, M.S., CSP, CPXP is a Certified Speaking Professional & author whose messages provide insight and strategies for excellent patient care. As a college freshman, Marcus Engel was blinded and nearly killed after being struck by a drunk driver. Through two years of rehab, over 350 hours of reconstructive facial surgery and adaptation through a multitude of life changes, Marcus witnessed the good, the bad and the profound in patient care. Marcus and his wife, Marvelyne, are the co-founders of the I’m Here Movement, a 501(c)3, which is changing the culture of care with two simple words.
To hear more from Marcus, join us August 15th for the upcoming webinar, Presence: Compassionate Communication Through Everyday Mindfulness or September 15th for our Regional Roundtable event in Ontario.
Posted By Diane M. Rogers, BA, ACC, CPXP,
Tuesday, May 16, 2017
Updated: Thursday, May 11, 2017
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Daunting – that’s the word that described how I felt each time I thought about taking the Certified Patient Experience Professional (aka CPXP) exam. It seemed like such a daunting feat, and yet I truly believed it was something I should do – professionally and personally.
Professionally, taking and (hopefully) passing the CPXP exam, there were countless reasons why I thought it was something I should pursue – most predominantly credibility.
Personally, it was overcoming that constant battle in my head that I fight – the fear of failure. You’d think that as an adult, having lived more than half a century that I would be more comfortable with accepting my best self. But alas, finding triumph in simply having the courage to try alludes me.
Still, this was something that I couldn’t let go. I kept ‘playing the tape forward’ and could feel the disappointment in myself if I chose not to take the exam. But, ‘playing a different tape forward’ I could feel what it was like when I passed – when I called myself a CPXP. There was something empowering, bold and confident in that image that quieted the fear-filled voice in my head just a bit. Still, I wasn’t ready to apply.
I accessed all of the available information on the PXI website. I participated in the CPXP Prep Webinar. I purchased the CPXP Workbook – all in an endeavor to overcome that fear. But still, I didn’t apply.
My fear of failure is a loud, discouraging deterrent to growth and adventure, putting all of what matters on the end result. And this notion of ‘it’s all about the end’ is in such conflict of what I believe and have experienced, as one of my own mantras in life is – “It’s never about the end, it’s always about the middle”. So, I had to find a way forward – to appreciate the middle, and to celebrate the courage I had in choosing trying.
And so, I called Peggy, my Beryl Institute Faculty colleague, in the hopes that I could find support and a study buddy to bolster my confidence.
“Hey Peggy”, I said.
“Are you planning on taking the CPXP exam?” I asked.
“I hadn’t really thought about it”, she replied.
Seriously?!? Not thought about it?!? I haven’t stopped thinking about it! Now what?
“Well”, I said, quietly stepping into that space of vulnerability,
“I think I want to take it, and wanted to know if you would take it with me … I’m afraid I won’t pass”. (Even as I write these words, I am hearing the ridiculousness of this fear and the stifling nature of its implications.)
And almost immediately, I was calmed, comforted, and catapulted into the ‘middle’.
“Sure, what the heck”, Peggy responded.
Peggy and I set up our first prep call 3 months before the exam. It was clear from that first meeting that we had very different study patterns. I was very structured. I outlined a prep approach where we used the CPXP Workbook as our guide. I assigned focus areas with specified completion timeframes. I set up weekly teleconferences for us to review content. I made sure we had available all of the resource recommendations. And, within each structured step I took, Peggy was right there - encouraging me, supporting me, and patiently tolerating my prescriptive approach.
We met weekly, reviewing each knowledge domain, often surprising myself by how much I knew. And over time I began to relax. I began to trust myself, my knowledge, my experience, my understanding of the material. The more comfortable I got with the process of preparing and the material, the more confident I got in taking (and passing) the exam.
Soon our study sessions grew more into developing situational exercises and less into memorizing content. I began to appreciate Peggy’s brilliance and curiosity in asking – ‘I wonder how they would write an exam question for that’? I could feel Peggy’s confidence – it was contagious. I often thought, ‘If she can do it, so can I’!
And as you might expect, this ‘Sure, what the heck’ CPXP prep adventure grew into an remarkable friendship – one filled with respect, laughter and appreciation for each other and the strengths we share individually and collectively.
In October, 2016 I took the CPXP exam… and passed. And as I ‘play the tape backward’, reflecting on the choice I had in front of me, I am grateful for choosing to jump into the middle. The middle was filled with growth, courage, focus, support, encouragement, strengths, friendships and confidence. The middle helped remind me of my best self. And the middle helped to develop me into an even better patient experience professional.
“It’s never about the end – it’s always about the middle”.
P.S. With heartfelt appreciation, thank you Peggy.
P.S.S. For those of you considering any step forward into a new space of experience – Go for it! Trust yourself, your strengths, and those core qualities within you that make you your magnificent, best self!
Diane works with and supports The Beryl Institute as a faculty member, facilitating virtual classroom sessions, topic calls and workshops. She is also Founder and President of Contagious Change, LLC, assisting healthcare organizations to achieve new potentials. Specializing in improving the healthcare experience, she works with clients to tailor programs and improvement initiatives. She is a certified professional coach, and developer of The hArt of Medicine®, a program designed to engage the clinician in creating therapeutic relationships and improving their communication and empathy skills through a unique experiential learning approach. Diane believes that ‘everyone has the capacity to change a world’. Whether the world is the physical space that we occupy or a moment in an individual's life; we all have the ability to create a positive energy that brings about an amazing change.
To learn more about the upcoming CPXP Prep Course on June 20th in Chicago, click here.
Certified Patient Experience Professional
Posted By Justin Bright, M.D.,
Friday, May 12, 2017
Updated: Monday, May 8, 2017
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I have never in my life met a physician who woke up in the morning hoping that his patients hated him. I don’t know of any doctors who want their patients to have a terrible experience in their hospital, emergency department, or clinic. Yet, every time I am at a patient experience conference, the physicians there are seen as unicorns because they are actively engaged in improving patient experience. The question I hear most often from others involved in service excellence is, “how do we get more doctors to act like you?”
A question I ponder often is, if physicians care about the well-being of their patients so much, why are we having such a hard time getting physician buy-in on patient experience initiatives? If the physicians are already halfway there because they inherently deeply about the well-being of their patients, then why is this so hard!?!?!
I think it’s time that we as patient experience professionals engage in some serious introspection about how we are messaging the importance of patient experience to our physicians. What are your goals as a patient experience leader? What are the directives being handed down to you by hospital leadership? Do you want satisfied patients? Or do you want compassionate, empathetic and streamlined care? Are you leading every discussion about patient experience with stats, survey scores and percentiles? Does your health system make the physicians feel like they are terrible at providing a consistent and excellent experience to their patients without acknowledging just how incredibly complex it can be to actually do so? Are you celebrating the physicians who are doing well?
My suggestion is, you need to drop the term “satisfaction” from your vocabulary. That is not what any of us are trying to achieve. “Satisfaction” or mention of survey data makes doctors go insane. There is no partnership there. No inspiration. No buy-in. Just an adversarial relationship that makes physicians feel like leadership just doesn’t get it. Instead, focus on “experience.” Focus on communication. Inspire physicians with stories – using positive reinforcement to recognize the times when a patient’s experience was incredible. Physicians believe in a duty to their patients. The experience a patient has is the only 100% frequency event in our health systems. Care that does not involve compassion, empathy, and communication is not care at all. In my dream scenario, we are never mentioning satisfaction or scores to our doctors. Yes, the surveys need to continue, but should be monitored in the background by service excellence departments. If we engage our doctors, my hope is the rest will take care of itself.
My fear is that as patient experience continues to evolve, and as the pendulum continues to swing more towards “Patients First,” “All For You,” and other similar mantras, that we will fail to acknowledge just how difficult this endeavor is for our physicians. Sometimes it feels as if everyone is trying to push the patient experience boulder to the top of the mountain, but everyone is pushing in a different direction. If there were a simple solution, we’d all be doing it already. The key to organizational change is for you as a leader to have a clear goal, clearly delineate a path for your physicians to follow, and then you continue to drive them down that path in order to achieve sustainability. As we continue to look at ways to improve the consistency of physician communication and compassion, I also urge patient experience professionals to look within – how consistent and compassionate is your messaging to your physicians?
Justin Bright, M.D. is the Patient Experience Champion at Henry Ford Hospital in the Department of Emergency Medicine.
Posted By Rebecca Ruckno,
Friday, April 21, 2017
Updated: Friday, April 14, 2017
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We have all been there right? What hat should I wear at work today? The pretty hat? The thinking cap? Or maybe the hard hat? The role of the patient advocate can sometimes be confusing. We all agree that we need to support the initiatives of our hospitals while also supporting our patients and families. How can we keep ourselves whole?
Over the past year and a half, the advocates have been working with a new initiative; Proven Experience. If the patient perceives that their experience was less than satisfactory, they can request their co-pays to be waived or refunded. Proven Experience is a promise of providing the best patient experience for every patient every time. When doing the investigation on the issue brought forth by the patient we often hear “all care was appropriate”. But what does “care” mean? To the medical team, care may mean that all medical protocol was followed and the outcome matched the protocol. To the patient, care may mean more than the “medical” care. It’s about how they were treated as a person. Did they receive all the information required to make an informed decision? Did we respect the patient and follow our C.I.CARE initiative? Often it is the compassion and the communication that our patients tell us that we are lacking. The team discusses the request with the patient and arrive at a mutual conclusion ending with the refund of the out of pocket expense. Because the perception of the outcome may differ, we may choose we wear our hard hats!
Since the roll out of the refund program we have almost doubled the issues we handle monthly resulting in adding additional staff. The relationships between the advocates and the various departments that they interact with have become stronger. Particularly, the departments of Finance, internal audits, service lines and legal. This is due mainly to our development of a more collaborative agreement with a win/win for our patients. We are looking to improve telephone wait times, appointment wait times, smooth transitions and bills that are understandable. Kindness and compassion are integral in the journey to recovery for our patients. The patients are bringing their experiences to the team hoping to make it better the next time. Perhaps we have always taken care of these issues before but now the refund has new meaning. Research in the future will show us if customer loyalty is obtained because of improving the experience.
The frustration has been in the reliance of other areas to help us determine what the refund will look like. Information needs to be gathered from the patient, the teams and finance. Billing of insurances, waiting for information from various departments can delay the final response to the patient.
When we do have time to catch our breath we need to look at the repetitive issues, develop a strategy and truly fix the challenges. Data needs to be reviewed and solutions must be developed. We have a variety of hats to choose from every day. Often times we may need to change our hat to meet the needs of our patients while also meeting our own needs. Thinking caps are required.
Becky Ruckno is the Director, Patient Liaisons and Interpretive Services with Geisinger Health System.
Posted By Dr. Avnesh Ratnanesan,
Friday, March 10, 2017
Updated: Tuesday, March 7, 2017
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Empathy in healthcare is both a traditional concept as it is a new-age buzzword. That’s because it has never lost its importance as a legitimate element of a patient’s healing process.
Simply defined, empathy is the capacity to walk in the shoes of another. Essentially, the ability to understand, appreciate and relate to someone else’s emotions. There is more chatter in the industry now about defining, teaching, learning and measuring empathy in healthcare than there has ever been.
Making emotions a visible part of your (formal or informal) measurement validates the feelings of patients which in turn, 3promotes patient satisfaction, enhances the quality and quantity of clinical data, improves adherence and generates a more therapeutic patient-physician relationship.
Ultimately, it all links back to the Net Promoter Score (NPS) or the Friends and Family Test (FFT). A key HCAHPS question, the NPS or FFT asks the patient point-blank if they would recommend the hospital to family and friends.
There’s your ROI.
EMOTIONS AND NPS
Human emotions are core to every patient experience. At every stage of the patient journey, there is a feeling, sentiment or attitude that will, collectively, define the experience for the patient at the end of their engagement with a healthcare setting.
Hospitals are often obsessed with benchmarking against other hospitals in term of their respective performance indicators, however there is a need to first benchmark against the EXPECTATIONS of your own patient population:
- If the experience < expectations, then you have a satisfaction deficit which leads to frustration and anger
- If the experience > expectations, then you have a satisfaction profit which leads to delight and excitement
Frustration and anger are detractors to the patient experience. If these emotions are experienced, then you can be sure that the patient is on their way to relay their negative experiences to others or not return, or both! Feelings of delight and excitement on the other hand naturally motivate patients to ‘promote’ your healthcare setting to others.
Measuring emotions is key part of our 6E Framework, a step-by-step guide to producing a true holistic picture of patient experience. Its measurement impacts the full spectrum of this framework:
Understanding the real patient EXPERIENCE through EMOTIONAL data ENERGISES staff in their purpose and EXECUTION of solutions. Successes are repeated to produce EXCELLENCE in delivery and organizational capability in patient experience EVOLVES.
How do you draw these emotions out of a patient so you can understand, measure and respond appropriately? Some state it boldly, some 3hide their emotions through seemingly rational questions or casually drop a comment about their emotions, to test the waters on how it would be received in the healthcare setting. Pick up on these clues, don’t ignore it or change the topic.
For the uncertain and non-forthcoming patient, surveys are a great way to get emotional data. One would imagine that a survey asking about their emotions would not only surprise them but send a clear message that there is a space in that setting to talk about emotions, that a culture exists that encourages and supports emotions.
INTELLIGENCE FROM EMOTIONAL DATA
When the clinician and non-clinician are able to recognize the emotions around a patient, it allows them to be more authentic and honest in the support given to the person (not patient).
Clinicians are able to view the person’s emotions within a more accurate context and address it in specific ways: 2
- Learning: Where the patient is fearful because of a lack of information, there is an opportunity for staff to help educate the patient to reduce his fear
- Empowerment: Where the patient feels helpless in the face of his health, there is an opportunity for staff to develop the patient’s sense of power over the situation through education, tools and technology
- Self-discipline: Where the patient is frustrated over their personal management of their health, there is an opportunity for staff to help the patient develop discipline through motivation, tools and technology
- Feelings of control: Where the patient is overwhelmed with the amount of information around their diagnosis, there is an opportunity for staff to ensure that the communication of information is at a pace and volume that the patient is comfortable with and to involve the patient’s family members or friends in managing overwhelm.
When an organization can undertake the above in a systematic way, an ‘energy’ or a vibe starts to infiltrate through the ranks. Clinicians and non-clinicians start to discover or re-discover the meaning in their roles and the organization becomes more congruent with its purpose.
What’s the vibe like where you are?
1. Empathy and Emotional Intelligence: What is it Really About?’, International Journal of Caring Sciences, Volume 1 Issue 3, Alexander Technological Education Institute of Thessaloniki, Greece http://internationaljournalofcaringsciences.org/docs/Vol1_Issue3_03_Ioannidou.pdf
2. Adapted/Inspired from information from a Chapter Abstract from Patient Emotions and Patient Education Technology: http://www.sciencedirect.com/science/article/pii/B9780128017371000020
3. “Let me see if I have this right...”: Words That Help Build Empathy, Coulehan JL, Platt FW, Egener B, Frankel R, Lin CT, Lown B, et al. (2001).
Dr. Avi Ratnanesan is a medical doctor with broad healthcare sector experience including hospitals, biotech, pharmaceuticals and the wellness industry. He is a leading expert who coaches and consults to senior executives, entrepreneurs, practitioners, organizations and governments.
Posted By Sarah Fay, MBA,
Friday, March 10, 2017
Updated: Friday, March 10, 2017
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We can all agree that in order to have a well-rounded view of patient experience, we cannot look solely at the information that comes back to us in our patient experience surveys – they are just one piece of a larger puzzle that make up an organization’s culture. And culture is what drives the experience…for everyone. I believe that we must look at data from several vantage points. Some of these, include:
- patient experience surveys
- employee engagement surveys
- physician engagement surveys
- information gathered during executive and leader rounding
- patient stories
- key human resource metrics
- feedback from our patient and family advisory councils
- quality and safety data.
If we leave one vantage point out, we risk losing the complete picture. And this picture must include patient relations data as well.
I oversee patient experience for Southwest General Health Center, a long-standing 354-bed community hospital in Middleburg Heights, Ohio. Last year, we merged our patient relations department with our patient experience department. Unifying these departments has not only helped me in my work – it has benefited our patients too.
The richness of the data collected by our patient representative is invaluable to developing and executing our patient experience strategy. By combining our patient relations data with our patient experience data, we have a well-rounded view of our patients’ perceptions. Trending our patient relations data is key to this.
- Trends helps us determine where we need to focus our efforts. The trends in concerns and complaints bring to light an area that we have an opportunity in, while the trends in compliments bring to light an area we can celebrate. When we combine these trends with our patient experience survey data, we are better able to prioritize our strategies, programs and celebrations.
- Trends help us pinpoint areas that need additional support. When we combine these trends with our patient experience survey data, I am able to hone in on areas, departments, units or individuals that may need specific training or one-on-one coaching. It also tells me where we need to focus our process improvement efforts. The trends in compliments show me areas, department, units or individuals that I can rely on to champion the cause. Those people can then help train and coach others.
- Trends help us conclude if the initiatives we have put in place on the front-end are working. Combining the patient experience survey data with the trends of both compliments and complaints, tells me if our programs and initiatives are having the intended outcomes.
Our partnership extends beyond the data too. Our patient representative has a very unique skillset – one that I hope to transfer to the bedside through a robust service recovery program at Southwest General. With her distinctive skillset, she can help develop a program, train our staff and teach them how to embrace the skills necessary to handle concerns and complaints right at the bedside. This will shift her into a more proactive role and I believe that is the wave of the future.
Sarah Fay, MBA, is the Director of Guest Experience at Southwest General Health Center in Middleburg Heights, Ohio. She may be reached at email@example.com.
Posted By Alison Tothy, M.D.,
Tuesday, July 26, 2016
Updated: Monday, July 25, 2016
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What if bringing visibility to positive experiences helps connect us to our sense of purpose? In a recent shift in the Pediatric ER, I watched an interaction between a nurse and a child. We were getting ready to sedate an eight year old boy. The nurse engaged the patient and made him smile, while gently preparing him for the sedation and the upcoming orthopedic bone reduction. I watched as the patient relaxed under her calm hands and in turn, the father waiting on the bench next to the child took on a calm demeanor, his shoulders visibly unclenching as he observed his child receiving amazing care that was kind, compassionate, and gentle. As the physician, I spoke with the child and the parent, explaining the procedure thoroughly, but with easy to understand language. I answered all questions, and then in partnership with the nurse and the orthopedic resident, proceeded to sedate the patient and reduce the broken arm. With the sedation and reduction completed, I informed the father that everything went well and that his son was doing great. I left the sleeping child and the less anxious father in the hands of the nurse to continue my shift, taking care of at least another thirty patients that evening.
Walking out at the end of my shift, I saw the nurse that helped me with the child during the sedation. It would have been so easy just to walk out the door, wave over my head, and shout "Thanks for all your help, good night, see you tomorrow” - isn’t that the usual sign off after finishing a shift? But instead, I stopped, paused, and then said "Thank you so much for your help with the child that we sedated. You were so good with that child. Did you see how he relaxed when you talked to him about how he looked like an astronaut with the oxygen tubing in his nose? You made him smile. Did you see how he was relieved he was only ‘getting a hug’ from the blood pressure cuff? And, did you notice how reassured the father was, when you alleviated the worry and suffering of his son? Thank you!” Then, I watched the nurse… her eyes lit up, she smiled and sat up straighter. Not much later, I walked out and got in my car, drove home and went to bed. I did not imagine I would think about it again, but I did. Strange, because it was not the usual case that I perseverated over, such as the complicated case, the stressful trauma, the new diagnosis with a bad outcome -- instead, I thought about this powerful interaction I shared with my colleague.
I would like to believe the nurse left her shift with a sense of pride that was always there, but maybe had not felt in a while. I hope that she saw for a moment what I saw in her, the impactful way she cared gently for a patient. I wanted her to realize what it meant for the patient and parent and what her interaction meant for both of us. This interaction led to a moment in which I had the opportunity to highlight how she helped someone in a time of stress and to perhaps help the nurse feel more valued and appreciated. In emphasizing her connection with the patient and parent, I was also able to link back to my own sense of purpose.
Sometimes I forget how much I enjoy taking care of patients and their families. As a Pediatric Emergency Medicine Physician and the Chief Experience and Engagement Officer (CXO), I often have oversight of caregivers as they interact daily with patients and their families. The above interaction reminds me that there is much more than just looking at an x-ray and diagnosing a fracture or looking in an ear and searching for an infection. This encounter above could have been exactly that. Imagine that scenario If I had just walked by and did not stop and chat with the nurse and did not thank her for the work she did? If I had not helped her recognize how she helped changed this patient’s world in the moment? It could have happened, has happened, often happens. It is easy to get bogged down in the clinical work as a physician and the administrative work as a CXO. The day to day grind is exactly that, normalcy that moves me through standard work, allows me to complete tasks.
However, recently I have been increasing my efforts to take a step back and reflect on my work and the efforts of others taking place around me. I have begun to ask "what if”? What if I stop and help someone remember why they went into healthcare? What if I stop and say how can I help this patient, this family, this colleague be healthier, happier, have a better experience and stay engaged? What if I move from bettering individuals, to helping my department, the hospital, and the community engage in their health? These are not far reaching goals if I begin with the basics and consciously make an effort to pause and reach out, when it is easier at the end of a shift to just say a quick goodnight and thank someone without meaning behind it. Changes take effort, but good changes are worth the effort.
So, I chose to make an effort to change. Both as a clinician and as an administrator, I began to pay more attention to engaging those around me. I endeavored to notice how my interactions affected others and how other’s interactions affected patients, families and colleagues. Then, I started to call these moments out. I began to work with others to remember why they chose the job they did, often asking the question "Why did you go into healthcare?” I would provide subtle ways that demonstrated how important each interaction was to another and then tie it back to a sense of one’s purpose. Subsequently, this was connecting me back to my purpose as well.
Several weeks ago I began to think about how my journey has led me to change how I care for patients and care givers and why I continue to ask "what if” questions. As a visible leader in patient experience, I turned the "what if” question back onto myself. What if I could use my leadership to not only give a voice to the importance of strategies, but to also influence how each of us see ourselves as caregivers and its importance collectively as a community of caregivers?
About a year ago, as part of the journey to continually develop my skills as well as improve the experience for my patients, families, and colleagues, I researched the new Certified Patient Experience Professional Certification through the Patient Experience Institute. By definition, a certified patient experience professional (CPXP) is a formal or informal leader who influences the systems, processes, and behaviors that cultivate consistently positive experiences as defined by the patient, resident, and family in settings across the continuum of care. This certification fit my journey both as a physician and administrator. I enrolled, completed the necessary training, passed the exam, and became part of the inaugural certified class this past spring. This is a piece in my ever continuing training to become a better leader, and helps strengthen my ability to cultivate a community of caregivers that can reconnect to the importance of what they do each and every day.
In closing, I would ask each of you to think about the "what ifs” and how that can help us all connect to our purpose in the significant work of healthcare.
- What if we all carry this forward?
- What if we all pay attention to actions that positively affect others?
- What if we help others see the beautiful interactions that occur day in and day out while we care for our patients, their families, and each other?
- What if we were all more connected to purpose?
- What if we advance our skill set so that we can become exemplary leaders in the world of patient experience?
As the Chief Experience and Engagement Officer for the University of Chicago Medicine, Alison Tothy, MD leads efforts to optimize patient experience and engagement across the medical system. From high level strategic planning to oversight in development, implementation, and optimization of national best practice standards, patient-centered care strategies, and innovative approaches to patient care, Dr. Tothy strives to improve patient outcomes through strengthening patient, family, and caregiver engagement.
Posted By Martie L. Moore,
Sunday, November 1, 2015
Updated: Monday, November 2, 2015
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"The one thing all children have in common is their rights. Every child has the right to survive and thrive, to be educated, to be free from violence and abuse, to participate and to be heard.”1 - Secretary-General Ban Ki-moon
As a former pediatric nurse and expert witness for child protection services, I’ve spent a lot of time caring for children in the hospital and home setting. I know one of the greatest things I’ve learned is that we as caregivers can empower children during difficult situations. The need to support the wellbeing of children extends beyond healthcare: It is a universal initiative.
Universal Children’s Day on Nov. 20—unlike the traditional Mother’s Day or Father’s Day recognized in the United States— was established by the United Nations General Assembly in 1954. All countries are encouraged to promote not only mutual exchange and understanding among children, but also to initiate action to benefit and uphold the wellbeing of children around the world.
Children in the U.S. may not always face the same frightening conditions as elsewhere in the world. But this day helps us to remember that we as clinicians still have a responsibility to create an atmosphere that supports the children under our care. We know that the less stress and anxiety a child has, the better their ability to cope in a stressful situation. Hospitalization is one of the stressful situations that we can do something about.
Improving patient experience is already a major target for hospitals, and hospitals are measured and paid based on HCAHPS surveys completed by adult patients. In October 2014, the Agency for Healthcare Research and Quality posted a pediatric version of the HCAHPS survey. This pediatric survey is under review this year as a possible benchmark on which to base hospitals’ Medicaid and Children’s Health Insurance Program reimbursements, leading to the expectation that this pediatric HCAHPS survey will ultimately factor into reimbursement as the adult equivalent does now for Medicare.2
Now is the time to be thinking about how to address this special population. The ways you care for children in your facility can go a long way toward producing a positive experience for both the patient and their loved ones.
Make the Hospital A Safe Place for Children
We all know hospitals can be a very scary place for anyone, let alone children. A child doesn’t know what to expect, and is constantly meeting new strangers. He or she may not understand what’s happening to them. They could be experiencing pain from their illness, the treatment, or both.
So how do we make the hospital a place where a child can feel safe, participate, and be heard? You can make a big impact with small changes: Start with what they’re wearing. Pajamas are a great source of comfort, and while the child’s personal pajamas may not be an option, your facility can still stock pediatric gowns that promote comfort and modesty, have kid-friendly prints, and feel soft like the pajamas they may wear at home. Consider pediatric gowns with MRI-safe plastic snaps that negate multiple gown changes.
While using pediatric gowns that evoke the comforts of home, also be sure that a child’s hospital bed is a safe place. Avoid performing any painful treatments while they are in their hospital beds so that it remains a haven that they can trust.
You can also help by communicating directly with your patients. Talk to them, not at or above them, so they understand what is happening. Speak at their level, both intellectually and physically, crouching or sitting down to look them in the eye.
You may even choose to draw pictures to help demonstrate what is going on inside their bodies or a treatment they are about to experience. Many children "play nurse or doctor” at home; offer to let them participate in their care by holding the stethoscope, counting with you for their pulse or heartbeat, or perhaps picking a favorite color for a bandage or cast. Your conversation may also help distract them from their pain. The fun prints on their gown featuring friendly animals or characters could be a conversation starter in itself. Ask them about pets, sports, movies, or their funniest joke. A good belly laugh does wonders for the soul!
Good communication involves good listening. Take the time to hear what a child says to you. You could learn that something as simple as a special toy or a quick trip outside for some fresh air could make him or her feel better.
Listening and observing may also help you uncover any signs of abuse. If you observe these signs, stay calm and report the suspected abuse immediately per your facility protocols.
You Make a Difference
Every day, clinicians make a big difference in the lives of the children they care for. Make yours a good difference. Delivering extraordinary care to our children can change lives, helping them grow up to be healthy and successful adults who can protect the next generation of youth around the world.
1. Universal Children’s Day. Available at: http://www.un.org/en/events/childrenday/. Accessed October 15, 2015.
2. CMS may use new child HCAHPS to adjust Medicaid hospital pay. Available at: http://www.modernhealthcare.com/article/20150108/NEWS/301089948. Accessed October 15, 2015.
Martie L. Moore is chief nursing officer of Medline Industries, Inc. based in Mundelein, Ill, a leading provider of medical products and clinical solutions across the continuum of care. In this role, Moore provides nursing leadership for solution-driven clinical programs, delivers product development to enhance bedside practice and launches quality initiatives across the continuum of care. With what she learned during the nearly 30 years of clinical experience and extensive executive leadership, Moore now develops forward-thinking solutions and programs for those in the field today.
Posted By Christopher W. Kennedy, MSM,
Tuesday, October 13, 2015
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Nearly 7,000 diseases are classified as rare in the United States. These disease states require some of the most cutting-edge and technologically advanced therapeutics. Patients with chronic rare diseases will often require long-term medications throughout their lives. The management of a rare disease requires a multidisciplinary approach to healthcare. Continuity of care is front and center as patients are transitioned from inpatient hospital settings or outpatient clinics to their homes. Many will require frequent treatments, nursing visits, on-going monitoring, medication adherence plans and disease state education.
The Patient Experience drastically changes for patients after they are discharged from traditional care settings. Advancements in the Patient Experience movement within inpatient hospital settings has set an example for specialty and home infusion pharmacies to follow. While some hospitals have found it difficult to determine where their inpatient pharmacies fit into the Patient Experience movement, other leading health systems have fully recognized pharmacy as the medium that crosses all levels of the healthcare continuum.
Regardless of the progress being made in the hospital setting, the Patient Experience has stalled on the doorstep of the specialty and infusion pharmacy industry. This challenge requires organizations to redesign their "customer service” models. Heritage Biologics is a specialty pharmacy providing nationwide infusion and rare therapeutic services. The pharmacy was founded by a rare disease patient who asked a really BIG question: How do we improve care for people like me?
We have established Four Fundamentals that guide the organization’s framework for creating a successful Patient Experience platform:
- PARTNERSHIP: Customized solutions are designed to ensure the continuity of care between providers and all healthcare stakeholders.
- COLLABORATION: Insights are captured and shared with healthcare partners to allow for better outcomes management.
- EXPERIENCE: A new standard in pharmacy patient care is being established with our patient-centered solutions.
- GUARANTEE: A clearly defined emphasis on placing the patient before the business allows for a commitment to rare care that is unmatched.
The complexities of the evolving healthcare system in the U.S. have posed significant challenges for rare disease patients. Pharmacies must team with healthcare providers, payers and manufacturers to coordinate care efforts. This creates an environment where therapeutic health outcomes become the common denominator for everyone involved. Collaboration is critical for patient healthcare, and we hope other pharmacies will join the Patient Experience movement.
Christopher Kennedy is Vice President of Business Development at Heritage Biologics. He has spent the last 14 years as an executive leader and innovator in the healthcare space. His background includes launching several entrepreneurial start-up ventures designed to help advance patient care.