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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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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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Connecting to our Purpose in Patient Experience

Posted By Alison Tothy, M.D., Tuesday, July 26, 2016
Updated: Monday, July 25, 2016

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.

Tags:  Community  healthcare  Leadership  patient experience  person-centered care  physician  physicians  voice 

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Thoughts from a Commodity

Posted By Brandon Parkhurst MD, Monday, May 4, 2015

From the perspective of the patient, healthcare is a commodity. I’ve spent the last 15+ years of my medical career getting my head around that statement and coming to an understanding of it. Today I accept it as fact. Commodities are exchangeable one for another. From the perspective of a patient, the technical aspects of treating high blood pressure, or asthma, or heartburn, or even having a hip replacement or heart bypass surgery are going to be based upon the diagnosis and aren’t going to change much from one provider to the next. I was smart enough to get into, and through medical school, but otherwise I don’t know how to prescribe blood pressure medicines in a way that’s wildly different from anyone else. The experience of a patient receiving care from my practice is the only thing that sets us apart from everyone else.

As it turns out, in this age of decreasing physician and medical provider autonomy, I do control, or at least significantly influence, the experience of receiving care from me! I control my priority of placing my patients’ medical needs before everything else. I can insist on my patient not leaving my office until I know that patient understands what I’ve said, the diagnosis, what signs/symptoms to watch for, the follow up plan. I can model patient-centeredness and raise the performances of those who assist me and are integral to my practice. I can work to ensure access to my care is meeting my patients’ needs. We can all demonstrate empathy and caring.

A patient’s experience is of the highest priority when the service one provides is a commodity. As Pine and Gilmore wrote in their landmark 1998 article Welcome to the Experience Economy, commodities are interchangeable and experiences are personal¹. When I provide an optimal experience, my patients should not only be healthier, for a wide variety of reasons, but should also be more loyal and more likely to return to my care. They might even promote my care services to their friends, promotion that is surely good for business. In general, providing optimal medical care and a positive, memorable experience for my patients is good for my patients and good for me.

As I’ve been writing this blog, I’m reminded of the difficulty of delivering an optimal patient experience and truly patient-centered care. A colleague just sent me a link to an article dated April 17, 2015 and published in The Atlantic. The title of the article is "The Problem with Satisfied Patients.”² The article is well written yet falls into the trap of treating patient satisfaction and patient experience as synonyms. Improving our patients’ experiences isn’t about satisfaction, happiness, or scores; improving our patients’ experiences is about understanding, collaboration, patient-centeredness, and most of all, personalization to the one situation we are a part of at a given time. Improving patients’ experiences isn’t about turning hospitals into 5 star hotels or restaurants; improving our patients’ experiences is about tailoring care to maximize every patient, resident, or family’s ability to Flourish³ and enjoy life on their terms.

My medical expertise is a commodity, yet the experience of receiving that medical expertise is unique to me. I firmly believe that providing an optimal experience of care improves the lives of those with whom I interact. I will spend the rest of my medical career seeking to improve their enjoyment of life and seeking to make their experience of receiving care from my medical practice, optimally positive and personal.

¹ Pine II, J. and Gilmore, J. (1998, July). Welcome to the experience economy. Harvard Business Review ² http://m.theatlantic.com/health/archive/2015/04/the-problem-with-satisfied-patients/390684/?utm_source=btn-facebook-ctrl3 ³ See Seligman, M. (2011). Flourish: A visionary new understanding of happiness and well-being. New York, New York: Free Press

 

Brandon Parkhurst is the Assistant Medical Director of Patient Experience for Marshfield Clinic and splits his time between the practice of Family Medicine and leading patient experience improvement. Brandon was born and raised in rural north Missouri where his parents and grandparents consistently taught him that you do right by people because it’s the right thing to do.

Tags:  healthcare  Interaction  medicine  Patient Experience  physician 

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How Did Dr. Dean Edell Save My Life?

Posted By Lee Tomlinson, Wednesday, July 23, 2014
Updated: Monday, July 21, 2014

"Life begins on the other side of despair.” - Jean-Paul Sartre

Did you know that hopelessness is the leading risk factor for suicide in cancer patients? Did you know that doctors have the highest suicide rate and nurses are the second most unhappy professionals in America?

Why so much despair?

Imagine being a cancer patient and feeling so dehumanized by your hospital care that you plan to commit suicide; no sense that you are in the hands of people who see you as a person, acknowledge your suffering or treat you with simple dignity.

I’m a C-level executive, author and internationally recognized speaker on customer service and the bottom line. Until my battle with Stage 3+ throat cancer, I assumed that customer service in healthcare (a patient’s experience) had some impact on profitability.

What I discovered, however, is that customer "compassion” can be a matter of life and death for patients, as well as caregivers and the institutions in which they serve. At my lowest point, hospitalized in a top-tier hospital with a life-threatening infection, my care was insensitive, unkind and totally lacking in human compassion.

Once, while waiting for a doctor to remove my infected PICC line, I heard him berating a nurse outside my door. When they came in, she appeared humiliated and I was terrified he’d treat me as insensitively. Sure enough, as he began, the pain was excruciating and I begged him to stop. He shrugged me off. "This will only take a minute.” It took far more than a minute and was among the worst physical and emotional pain I’d ever experienced.

When a dead gecko lay next to my toilet for three days, all I could think about was filth and infection. When my fever spiked and my room was sweltering, I was told to "call maintenance.” Frustrated, I rasped into the phone it was "so damn hot” in my room. The maintenance guy said, "Calm down and call back later” and hung up. Humiliated, I called back and he said he’d "get to it tomorrow.”

I have wonderful friends, but oddly, none came to see me. When I received a "Thank You” note from the hospital, I understood why. Over the whiteout on a used envelope was my name, but it began "Mrs.” (I’m a Mr.), was spelled wrong and had the wrong room number. My friends had been told I wasn’t there. I didn’t exist. Dozens of experiences like these pushed me from depression to despair and thoughts of suicide.

My will to live was restored by Dr. Dean Edell, America’s original "Media Doctor” and dear friend. I asked him, "If I use all these pain killers, will I die?” He said yes, but strongly proposed an alternative. He said, "Why not fight to live and combine your customer service knowledge, business acumen and patient experiences to become part of the solution?” Instantly I took his advice and am convinced I am alive today to do just that.

I have come to understand that:

  • Compassion has a measurable impact on healing and the will to live.
  • Healthcare providers are under enormous stress, and they deserve our compassion and gratitude.
  • All I care about now is that ALL patients receive the compassionate care they so desperately need and deserve.

So I ask, "What will it take for all institutions, physicians, and every person who touches us to see us not only as individuals and valued customers, but also see that every minor miracle of compassion alleviates our mutual suffering, reaffirms our shared humanity, and, over time, makes its way to the bottom line?"

Lee Tomlinson is a C-level executive, author and internationally recognized speaker on customer service whose life is devoted to improving the patient experience to benefit patients, healthcare professionals and the bottom line in hospitals in which they serve. Lee combines spellbinding speaking skills with in-depth business skills to reconnect, re-inspire and re-engage healthcare professionals to "up their games” when it comes to patient-centered care.

Tags:  compassion  Customer Service  despair  hope  Patient Experience  physician 

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Perspectives from the Invisible Husband

Posted By Emily D. Tisdale, Tuesday, November 19, 2013
Updated: Sunday, November 17, 2013

My husband did not care for my former obstetrician.

When we found out that we were pregnant with our first child, I scheduled get-acquainted visits and selected the doctor I liked. Over the course of my pregnancy, he accompanied me to appointments and we tackled the journey together.

The birth of our son was stressful to say the least. Going into labor three weeks early and enduring a long labor process that ultimately resulted in an emergency C-section left our emotions raw. But, life went on and we moved forward as new parents.

Fast forward four years later as we’re expecting our second child. As I talked about getting in touch with the doctor that delivered our son, my usually calm husband became wildly animated.

"Ohhhh no, we can’t go back to her. She was awful!”

What? I searched my memory for instances that would have led him to have such a negative reaction.

"It’s like I was invisible,” he continued. "Of course, you and the baby are the most important part of all of this but she never even looked my way. I had to ask my questions as she was walking out the door!”

As I thought back through all of the appointments, I realized he was right. She never addressed him or asked if he had any questions or concerns during our appointments; she only focused on me. And while focusing on me (the patient) was good, including my husband (the family member) in the process would have been even better.

The patient experience has an impact on so many levels and is undoubtedly an important starting point. From the patient perspective, I thought everything was fine. However, when my husband brought up his concerns, I realized that healthcare experience – considering the needs of both the patient and their loved ones – must be what healthcare organizations consider as best practice.

As a new dad and my primary caretaker post-delivery, my husband had a number of questions and anxieties that he needed addressed. My doctor, as good as she was to me, failed to engage my husband in the process. How many times have other well-meaning providers delivered a good patient experience only to stop there? How much more could the experience be enhanced if loved ones were considered as an integral part of the equation?

The most successful healthcare organizations have initiatives in place to support not just the patient, but also the patient’s support network of family and friends. These touches, while often overlooked, can make a major impact on the patient’s peace of mind and overall experience.

Like other parents, we knew better the second time around on so many things. When we learned that we were expecting our second child, we made certain to select the doctor we felt would address both of our needs and ensure a true healthcare experience.

Emily D. Tisdale is the Founder & Principal Consultant of Recourse Resource Consulting, a healthcare experience firm based in Indianapolis, IN. Emily and her team partner with healthcare organizations to produce sustainable outcomes in patient experience, employee engagement, and marketing.

Tags:  experience  family engagement  healthcare  patient experience  physician 

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