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Experience as Integrator

Posted By Tiffany Christensen, CPXP, Monday, March 9, 2020

The other day I went for an iron infusion, and because I have a history of anaphylaxis with iron, I am required to receive pre-meds of IV Solumedrol and Benadryl. Taking these two medications together feels like someone has strapped my body to an electric fence and then put a spell on me so that my limbs are too heavy to move. It takes a lot of mental concentration to ride the sensations. As I am in the treatment chair trying to deal with my emotional response to my challenging physical state, a flutist plops down in a chair a few feet in front of me and plays songs like "Pop Goes the Weasel" for an hour. High pitched flute sounds pulled me out of my meditation/sleep over and over, and it was PAINFUL. Literally, physically painful.


Nobody asked me or any of the other patients if we wanted to hear a flute play while we got our treatments. The flutist never looked at us to check in or to see how the music was being received. Because of my “magic spell” symptoms, I was not able to open my eyes or speak without distress. I chose to put in my earbuds and turn up Lady Gaga, but the piercing flute notes still woke me as they overrode the melodies being piped directly into my ears. I was not able to articulate my experience while it was happening, and I felt trapped.


So, does this mean we shouldn’t have flutists in treatment areas? No. Does this mean I should go out and buy noise-canceling headphones? No. Does this mean music therapy isn’t a good idea? Of course not. What this means is something quite simple: Never assume you know what will be helpful to patients or families. ALWAYS ASK.


I tell this story because it highlights an unfortunate reality in healthcare today: With as much progress as we have made in the field of Patient Experience in the last decade, we still greatly lack a necessary integration of concepts, systems and individual capacity for customizing care.


Integration is the next necessary frontier in healthcare today, and it must happen on multiple levels. In my flutist story, we witness a lack of system and individual integration. The system has built a music program that lacks integration with understanding the lived experiences of patients and families. The individuals caring for me that day lacked integrated knowledge about the medicine given to me and the possible effects of taking it. The experience showed me that there is an overall lack of integrating the core concepts of “nothing about me without me” within that organization. However, this is only one slice of what we mean by integration in a healthcare setting.


Integration requires the intentional overlap of safety and quality, with experience as the driver. Integration requires tools to capture and act upon the perspectives of patients and families and rigor to embed them in standard workflows consistently and in every corner of the organization. Integration requires an investment in helping staff and clinicians think beyond their area or expertise to a broader concept of care. At the point of care, we MUST begin to integrate clinical excellence with excellent engagement and communication. This all requires experience to become the North Star.


If my flute story makes you think I am not a music lover, that could not be further from the truth. I love music, especially jazz and swing. The other night I went to see a “big band” style swing band. There were about 20 musicians and three singers that entertained us with songs from the 1930s, 1940s and 1950s. Watching all of these people play their instruments, I thought about the collective years of practice and evolution of skill in that room. The human ability to find a passion for something and work at it until it is both extraordinary and second nature is fascinating to me. Seeing it in the context of a big band—a place where many people have this dedication to building skills over time AND doing so in harmony with others—felt to me like a metaphor for integration in healthcare.


In healthcare, every member of “the band” (healthcare team) is required to bring his/her own skill set to create music or, in this case, health outcomes. Equal to the importance of skill and expertise of the band is its ability to also align with the listeners and dancers (patients) receiving their music. If the audience is a partner in the design and production of music, the experience is richer, more meaningful and the room is still full at the end of the night. In a similar way, the goal in healthcare delivery must be a collective goal and, therefore, the effort must be an integrated one. If there is a sour note or if the band lacks harmony, the music turns painful and hard to hear.  When there is integration of sound, however, the music has the power to move mountains.


I know we all have the power to move mountains. All of the band members are here and accounted for. We have the skill, the training and the passion. We have engaged, educated and poised audience members. Now, all we need is new sheet music. Sheet music that focuses on integration of sound with experience as the leader of the band. Integration is here and it’s right around the corner; we just have to set the intention, plan well and be open to a new song. If we can do that, we will make powerful change.  


Tiffany Christensen, CPXP

Vice President, Experience Integration
The Beryl Institute

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