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

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

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

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

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

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

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

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

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

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

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

Tags:  burnout  communication  patient experience  payment reform  physicians 

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Applying Patient Experience Thinking to Medicine-Taking and Medicine-Making

Posted By Robbie McCarthy, Tuesday, December 3, 2013
Updated: Monday, November 25, 2013

After two decades of working in pharmaceutical company marketing and healthcare advertising, a fellow industry veteran and I had come — independently — to the same conclusion: "Something is rotten in the state of Denmark.” To use the line from Shakespeare’s Hamlet aptly summarized the current state of affairs in the branded medicine marketing industry, where once-valued and commonly used tactics now seem inappropriate and ineffective in today’s changing business climate.

With both the healthcare and regulatory environment undergoing constant changes, and patient access to information and overall empowerment level dramatically increasing, the marketing of healthcare products was simply not keeping up — remaining, by and large, how it was a decade ago.

It was time to usher in a new way of thinking. Observing the application of patient experience thinking to healthcare provision made us ask,"Could this same approach be applied to the marketing of pharmaceuticals?”

We decided to look beyond the traditional pharmaceutical marketing approaches that entailed influencing physicians with data and encouraging potential patients to ask their physicians about drug X or Y. Inspired by patient-experience-based thinking, we thought instead about being the patient: you, me or our loved ones. We asked ourselves: "Do we have a tangible experience of our medicines when we are ill and in need of treatment? Do those experiences influence our treatment success? Our relationship with our physicians? Our choice of options available?” We concluded that yes, they did, and began working on a new way to market medicines.

The patient-centered approach to medicine-taking and medicine-making stems from a shockingly simple six-point epiphany that we share with pharmaceutical manufacturers:

  1. As patients, we use the products that pharmaceutical companies make.
  2. Our use of those products results in an experience.
  3. This experience is physical, emotional, cognitive, psychological and financial in nature.
  4. Based upon our experience, we (as patients) are more or less likely to continue using a product.
  5. We report our experiences back to our HCP teams.
  6. Based upon these reports, HCP teams are more or less likely to prescribe a product again.

It is our belief that the way for a pharmaceutical brand to compete in today’s competitive environment is to employ this behavioral science approach to understanding the beliefs and behaviors that shape a patient’s relationship with medicine brands. Adopting this approach opens the door to addressing core experiential questions, such as what should an optimal brand experience look like? Once you break the patient brand experience down into its core components — those that result in a good, bad or indifferent experience for the patient — it’s possible to invest in making the brand experience for your medicine as good as it can possibly be by applying this insight to your core marketing platform. What’s good for patients and physicians is also good for business, while providing us with an ethical, authentic approach in the new world of healthcare — which is the right way to pursue medicine marketing.

A time of change is here, and pharmaceutical manufacturers are beginning to embrace what their health care counterparts already know: to build a stronger brand, you must start with the patient experience.

Robbie McCarthy is Principal and Managing Director of The Patient Experience Project (PEP), a behaviorally based communications firm that specializes in marketing for the pharmaceutical, medical device and patient care industries. His current mission is to help organizations reap the benefits of re-framed, patient-first marketing strategy. Connect with Robbie on LinkedIn, and Google+.

Tags:  marketing  medicine  patient access  patient experience  patient-centered  pharmaceutical  physicians 

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