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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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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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Rounds for Change

Posted By Irene Brennick, Monday, April 25, 2016

As a volunteer director, I often make patient rounds with my CNO. At my hospital, staff and volunteers alike make patient satisfaction a top priority. We frequently round on patients, not only to assess their needs, but to also find out what didn’t go right so we can learn from it, correct it and make things better for everyone. During one particular interaction, I discovered how easy it can be to change a patient’s perception of the hospital from negative to positive.

My CNO and I walked into a room and encountered a female patient and her husband. We inquired about their experience, and their response revealed an opportunity for improvement. The woman said she was admitted through the emergency room, sent to another unit and finally arrived at the room she was currently in.

The patient told us how sick and scared she was. Her experience in the ER was somewhat of a blur, but she remembered very clearly an abrupt nurse in one of the units. She said the nurse didn’t listen to her, and her husband echoed the lack of attentiveness on behalf of the nurse. Once she was brought to her private room, however, she said she had received nothing but the best treatment.

After she recounted her story, my CNO told the patient "I am very sorry to hear that, because what I hear is that the care is very good. I will investigate the situation, and again, I am sorry.” I too have always heard about the exceptional treatment people receive in our facility, and was quite surprised to hear anything negative at all regarding the care. This patient and her husband started to protest a bit stronger. They repeated their story about how the nurse treated them in the unit.

I thought to myself, remember it is the patient’s perception of care and sometimes we have to do our best to make the patient experience better. When this patient goes to fill out a patient satisfaction survey we want to have eliminated or decreased the negative impression of our hospital. Before we left the room, I looked closely into the woman’s eyes and simply said, "I’m sorry you believe you didn’t receive the treatment you deserved. It’s not ok, and we need to do better.”

I wanted to let the woman know that I too heard her. If I were a patient and felt I was not treated compassionately, I would be upset as well. What happened next was pretty amazing. As we started to get up and walk out, the woman said, "Well, people are only human and everyone has a bad day. I don’t want to get anyone in trouble and really my care was very good.” At that moment I knew, just by being heard and acknowledged, the woman went from being upset, to all smiles, as she chatted about how she was feeling much better and hoped to be discharged soon.

I learned that day that making rounds is very important and we must really listen to what our patients are telling us. If a patient claims to have had a bad experience, they had a bad experience. It is our job as hospital staff to make the situation better, rather than be defensive. It is much better to just listen to our patients. Their information is a gift, and we should acknowledge their concerns. We should apologize, investigate and correct. Only then, will our patients begin to forgive any imperfections that occurred during their stay, and they could even become our greatest advocates. We want our patients to have the best experience when in our facility.

Since 2003, Irene Brennick has managed over 700 volunteers at Los Robles Hospital in Thousand Oaks, California and puts on health and education events as their Director of Community Services. She has a total of 24 years of experience developing and implementing dynamic volunteer programs. She has also addressed tens of thousands of people and her story has been featured in the L.A. Times, Daily News, and on television and radio. Ms. Brennick also speaks on topics that include, finding one’s purpose in life, the importance of giving back through volunteerism, and how anyone can be an inspirational public speaker.

Tags:  compassion  leadership  listen  patient advocate  perception  rounding  volunteer 

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Engaging Physicians to Improve the Patient Experience: A Few of My Life’s Lessons

Posted By Dr. Kenneth H. Cohn, Tuesday, June 24, 2014
Updated: Monday, June 23, 2014

Nikki, a weathered ED nurse, took me aside during my internship. "Just because that was your eighth patient with an ankle sprain this evening doesn’t mean it was her eighth ankle sprain.” My ears burned with indignation. How could people praise me for moving patients through the system and at the same time criticize me for not spending enough time with them? Now I salute Nikki and other nurses for believing that I was trainable.

The next step in my inadvertent journey to improve the patient experience came two years later when a lump in my neck proved to be a non-Hodgkin’s lymphoma. "It’s not fair,” one of my colleagues said. "You are a sensitive doctor. Why couldn’t this happen to some of the residents you work with who need to learn what it is like on the other side?” I felt that being a patient transforms a sensitive person into a sensitized person. I likened it to being a white male college professor who does research in race relations suddenly waking up and seeing that his skin has changed color. After that experience, it became easier for me to be in a room with an angry patient and family and say sincerely, "I can only imagine how upsetting this is for you,” and ask, "How can we work together to make your situation better?”

I witnessed the power of apology when I was asked to see a 20 year-old college student whose parents drove him from his college to the hospital where I was working after an ER doctor at an academic medical center dismissed his abdominal pain as alcoholic gastritis. After I went into the room, introduced myself, and said, "I’m sorry this has been such an ordeal for you,” I watched his parents’ shoulders drop several inches from the level of their ears. I operated on their son for appendicitis.

It wasn’t till I did a fellowship in surgical oncology that I learned that there is a time-tested framework for delivering bad news to patients. The SPIKES protocol consists of six steps, including:

  • Setting: respect privacy, involve others, be seated, look attentive and calm, listen actively, be available; let patient know of any time constraints ahead of time
  • Perception: ask patient’s and family’s viewpoint and concerns
  • Invitation: ask how much information patient wants to know
  • Knowledge: warn of upcoming news; give information in small chunks and clarify understanding at each step 
  • Empathy: acknowledge the patient’s and family’s emotion with phrases like, "I can only imagine how you must feel.”
  • Strategy: summarize events, check understanding, and plan for the future

That a surgeon like myself can learn from inadvertent experiences suggests to me that all physicians can benefit from training. I salute programs like the one where I trained (Columbia College of Physicians and Surgeons) that use actors to give medical students feedback about body language, tone of voice, and word choice. In general, physicians have done everything that we have asked of them. We:

  • Studied hard in college to get into medical school
  • Memorized and regurgitated facts the first two years of medical school
  • Worked 80-100 hours during residency and fellowship training

A physician CEO once told me, "We dismiss communication, negotiation, and conflict resolution as the soft skills, but they should be called the hard skills since they are so hard to do consistently and so hard to do well.” Physicians enjoy learning from fellow physicians. It can inspire all of us to be better role models in our daily practice.

Ken is a general surgeon/ MBA and CEO of Healthcare Collaboration, who works with healthcare organizations to engage doctors to improve the patient experience and organizational performance. To learn more about what he does, please visit Healthcare Collaboration.

Tags:  journey  knowledge  Patient Experience  perception  physicians 

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Could A Simple “Fix” Exist For Influencing the Patient’s Perception of Care?

Posted By Marlena Jareaux, Tuesday, October 29, 2013
Updated: Sunday, October 27, 2013

HCAHPS, enacted by Federal policy makers in response to the uneven care among hospitals, seemingly attempts to even the playing field. The primary goal is to lower the skyrocketing medical costs in our country while simultaneously giving more weight to the actual patient experience. This, in and of itself, is timely, very much needed, and will benefit our society as a whole in the long run. The problem is, as is often the case when a decision is made that attempts sweeping changes that affect many people, the mandate to essentially "fix it or be penalized” has made hospitals scramble to find fixes to a problem that many have found not to be as simple as it sounds. Or is it?

Recently, while doing a search on the internet on the phrase, "medical decision-making preferences,” I was struck by the synopses found within the first four pages of results.

Are there cultural differences in patient’s shared decision-making preferences
(of course there are)
Variability in patient preferences for participating in medical decision-making
(I would assume so)
A theory of medical decision making under uncertainty
(Is there just one?)

My favorite is the lecture notes from a medical education course on medical decision making. The first sentence reads, "This week we enter the strange and fascinating world of preferences, utilities and feeling.”

NOW, we’re onto something!

Tempting as it is to hope that your task of increasing your patients’ perception of quality care can be accomplished by a one-size-fits-all approach that can be purchased and implemented, it just doesn’t exist. Preferences change (don’t yours?), people change (gosh, do we), and circumstances change (the only thing that is constant, IS change). Fortunately, one of the greatest tools that can be used to keep abreast and stay ahead of the "strange” and seemingly complex world of your patients’ perceptions and expectations, is already embedded into the roots of every single healthcare organization that exists into this country and the healthcare workers working in them. CARE enough to ask. If you are human, you can care enough to ask.

I’m sure that in our pay-for-performance and results world that we live in, people will say "we don’t have the time to ask.” I’ve seen versions of this for myself: the revolving-door environments where the patient can barely see the eyes of the doctor or nurse to be able to even recall the color of those eyes, much less to detect any compassion in them. Or the seemingly thriving practice that delivers results for their patients, but can’t figure out why their scores for "likely to recommend” aren’t moving upwards.

Bottom-line is this: previously, hospitals could always rely upon patients walking through their doors because, well, they needed care and the hospital was there. Patients had to accept the care that they got, and only the truly-bad encounters got reported by those who bothered to take the time to do so. That landscape has changed. Like it or not, HCAHPS is here to stay, your patients are having their perceptions elicited, and you are being graded and rewarded (or penalized) according to those grades (and thereby, perceptions). Not only are those grades being publicized on the largest billboard that exists (the Internet), but so are the neon signs telling your patients and prospective patients to view your grades and choose in accordance with them.

On page one of the Hospital Quality Initiative Overview, found on the CMS website, you will read, "This will encourage consumers and their physicians to discuss and make better decisions on how to get the best hospital care…”

One powerful "fix” then, for all of you looking for one, is as simple as this: ASK.
 
Marlena Jareaux
Principal

Tags:  HCAHPS  patient experience  pay-for-performance  perception  quality of care 

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