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Radical Support After Adverse Events

Posted By Tiffany Christensen, CPXP, Thursday, June 7, 2018

Recently, I had the honor of speaking at Yale New Haven Health’s 2018 Inaugural Quality, Safety and Experience Conference. One of my favorite parts about presenting at conferences is the opportunity to attend and learn from the other presenters. This event was no different and it was a great day.

One of the most powerful sessions of the day involved two physicians discussing their experiences of harm and error. The focus of the conversation was not clinical and did not dwell on the details of the case—in fact, the patients discussed were clinically fine after an adverse event. Additionally, there was even some gray area about whether or not the physicians involved could have done anything differently to avoid the adverse event. This was not a conversation about clinical safety but, rather, emotional safety among colleagues.

Despite there being significant differences between the clinical elements of their experiences, the two physicians onstage shared many similarities in their experiences after the adverse event. They both considered leaving medicine; one physician confessed she wondered if she should make a career change to home renovation. Both struggled to sleep at night and both replayed the event over and over in their mind, seeking an answer to what could have been done differently. Perhaps most important, both physicians are haunted by the event to this day even though many years have gone by.

What I carried away from both of the stories shared that day was the deep sense of isolation both physicians experienced. When sharing their grief and trauma with collogues, they found they were met with responses that had good intentions but fell flat. “You did the best you could,” and “But the patient is alright, isn’t she?” didn’t sooth the deep, unrelenting self-doubt that had manifested within these dedicated doctors. The experience had not only caused them to question their worth as professionals but their worth as human beings. It seemed they had no safe place to turn. These two physicians made it clear that when mistakes happen the primary need for support goes to the patient and family. That does not mean, however, that support for the provider is not also needed.

Listening to these heart-wrenching stories, my mind went to an article I had read years ago. The article, “How the Babemba Tribe Forgives,” tells the story of a tribe in South Africa. In this community, when a person makes a mistake or does something irresponsible, everyone in the community drops what they are doing and circles around. For hours and sometimes days, the members of the tribe shower this individual with details of their good deeds, positive traits and strengths. Once they are satisfied that they have shared all of the good stories about the individual, the circle breaks and a celebration begins. I see this approach as “radical support” and is far from the standard way that most healthcare professionals receive support after a traumatic experience.

We live in a culture that often expects perfection of our healthcare professionals and, when a mistake is made, we don’t always have tools or skills to effectively support the person as they process and grieve. I can’t help but wonder, if the colleagues of these physicians had been given tools in order to react and provide support more effectively, might the physician wondering if she should move into home renovation see things differently? If, instead of replying with statements that invalidated the physician’s deep sense of insecurity, what would have happened if the response was to validate all of the physician’s strengths and good qualities as a person and a professional? What if the root of pain the professional is experiencing comes from an unconscious need for forgiveness and we offered that to them?

Assuming the “radical support” approach of the Babemba Tribe is philosophically intriguing, it may be challenging to imagine how it may translate into current systems and processes. For some teams, supporting a team member who is struggling with an adverse event may be a more informal conversation among leaders, staff and providers behind closed doors. Other organizations may benefit from a more formal approach that builds a new program or, ideally, integrates into an existing framework.

One potential framework that many organizations already use is Schwartz Rounds. Looking at The Beryl Institute White Paper, Schwartz Rounds: Supporting the Emotional Needs of Staff: The Impact of Schwartz Rounds on Caregiver and Patient Experience, it strikes me that both the spirit and the format would easily lend itself to a few adjustments in order to include “radical support.” A few highlights from this whitepaper quickly illustrate why one might connect the two:

  • The Schwartz Rounds program, now taking place in more than 425 healthcare organizations throughout the U.S., Canada, Australia, New Zealand and more than 150 sites throughout the U.K. and Ireland, offers healthcare providers a regularly scheduled time during their fast-paced work lives to openly and honestly discuss the social and emotional issues they face in caring for patients and families.
  • One of the primary goals of Schwartz Rounds Decreased is to reduce feelings of stress and isolation while fostering more openness to giving and receiving support.
  • One Schwartz Rounds participant articulated, “The ability to find a safe venue for expressing our unrest was, to me, the most attractive feature of the Rounds.” Another participant stated, “The emotions we feel, the stress we feel, does need to be ventilated someplace…”

The Beryl Institute has an unwavering commitment to the human experience in healthcare and, it is evident, humans working in this challenging field need more avenues to hear how much they are valued. Perhaps the Babemba Tribe approach is one worth adapting to the complex world of healthcare; whether through Schwartz Rounds or another framework already hardwired into the organization. No matter what, we must find ways to address isolation and provide better support to those facing questions of their own worth after an adverse event.

 

Tiffany Christensen, CPXP
Vice President, Experience Innovation
The Beryl Institute

Tags:  emotional safety  employee engagement  human experience  patient experience community  professional support 

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Don’t Underestimate the Importance of the Small Things

Posted By Deanna Frings, MS Ed, CPXP, Wednesday, November 1, 2017

Recently I traveled by motorcycle through my home state of Wisconsin enjoying the colors of fall. In planning this trip my husband and I were very intentional in choosing our route, selecting our clothes and determining the day we left.  We knew that paying close attention to these things was very important if we wanted to see the best color possible on the most scenic roads staying warm, dry and safe.

I would categorize these items as having a great impact on the overall quality and safety of our experience.  Many might say, they are the big important things.  In healthcare, there are many big important things in providing high quality, safe care.  And in my experience, we are typically very good at paying attention to these big, important things.

But what was affirmed for me during this trip is that doing things with a clear purpose, being present and intentional can have an equally huge impact on the overall experience even in the most insignificant interactions.  In fact, it is the small things that can often have the greatest positive impact.

When riding on the back of a motor cycle there isn’t much for me to do except to enjoy the scenery. My mind wondered a bit and I started thinking of the importance of being intentional.  Intentional in my work, intentional in my personal life and intentional in my relationships and all that I do.  It’s easy to get lazy and forget the importance and the impact intention can have on oneself and on others. It really does come down to presence, awareness and the power of choice.

At The Beryl Institute, we understand the power of choice and recognize that in every interaction, we have a choice to make. So, for the remainder of the trip it was my goal to create positive moments by being very intentional in the interactions I had. The criteria I used to measure my success included receiving a comment of appreciation such as a “Thank you”, noting a smile as a result of the interaction and/or walking away with an overall positive and warm feeling.

We came upon road construction several times throughout the week. On many of these occasions, the road merged into a single lane which required members of the construction crew to flag vehicles through from each direction ensuring our safety. At more than one of these locations, we were the first vehicle stopped by a person holding a stop sign waiting patiently for our turn to pass through.

I have always wondered what it must be like to be one of these individuals standing in the elements for several hours a day holding a ten foot stop sign. There have been a few occasions when I would nod slightly but on this occasion, I wanted to acknowledge the person and to let them know how much I appreciated the job they did to ensure our safety. On a motorcycle, it was very easy to have this conversation. I could see a smile come across the gentleman’s face and he nodded. As we passed through, he waved and said, “Have a great and safe ride.” This small but purposeful gesture, created a moment that enhanced this part of our journey.

Test number two came when we stopped for lunch. On a motorcycle trip of this length, stopping for lunch is a highlight of the day. Its time off the bike and that is always welcomed. It’s fun to stop at simple cafes and dinners and this particular stop was extremely enjoyable.  Not so much because of the food but rather our waitress who was extremely personable and good at what she did. I have always enjoyed watching people do what they do every day especially when you can tell they enjoy their work. 

She had purpose, presence and did everything with intention. It was fun watching her work the room. She acknowledged us the minute we sat down and indicated she would be with us in a just a moment. As promised, she came over immediately after delivering hot food to another table, introduced herself and seeing the clothing we were wearing and our helmets asked, “are you staying warm out there today?” She was helpful with the menu, anticipated all of our needs and provided us with a lovely 45-minute break off the bike.

As she was cleaning the dirty dishes from the table and leaving us the check, I asked her how long she had worked here and told her how much I enjoyed watching her as it appears she really enjoys her work. She was beaming at this acknowledgment and went on to share that it brings great joy to her when she can offer great service to her customers and thanked us for coming in today.

The final experiment came during a service recovery opportunity after being on the bike for a long 6-hour day. Upon entering the parking lot of our hotel, we were required to take a parking ticket from an automated machine that would subsequently open the gate. As we started moving through the gate, it immediately lowered itself onto the motorcycle prior to us passing completely through. It took all my husband’s strength to stop the gate from lowering all the way onto the bike and for those brief 20 seconds until I hit the button for another ticket, it was a bit terrifying. Not the most comforting way to end the day. 

We were greeted by a very nice young man at the registration desk. He noticed we were a bit distressed and inquired how he could help. After hearing our explanation about the gate prematurely closing, he did all the right things you would hope an employee would do at a time when service recovery is warranted.  He acknowledged our concern, apologized it happened and immediately went to work to make amends. As he completed the registration process, he once again apologized for this situation. We thanked him for his help.

Later in the evening when we came down to dinner, I wanted to once again acknowledge how much what he did meant to us. I proceeded to the desk to explain to him what I did at The Beryl Institute and how much we talk about the importance of service recovery.  The term was new to him but he really appreciated that I took the time to share this information and to thank him once again.  As I walked away, I turned back and he was fast at work welcoming another couple to the hotel with a great smile on his face.

Sometimes we never know the impact a small gesture might have.

Four years ago, I met a gentleman by the name of Andreas. At that time, he was a student at DePaul University. Jason Wolf was participating in a patient experience panel discussion for the class. Following the class, we joined the students for a light meal and further networking. Andreas was sharing how much he was learning about patient experience and his desire to ultimately find a job in the field but was concerned about his lack of work experience. During our conversation, I was very impressed with this young man. He had a clear vision, defined purpose and he was building an intentional plan to achieve his goal. And from where I was sitting, he had a true passion about patient experience. It was this that I wanted to reflect back to him. I simply put my hand on his shoulder and said, “Andreas, you are the Patient Experience;” I took one of our IMPX pins and secured it to his jacket.  He simply smiled and said, “Thank you”. 

Four years later, Andreas along with his colleagues presented at the Patient Experience Conference. Andreas came up to me during the conference and recounted that evening four years earlier and shared with me how much it meant to him. It gave him continued confidence to work toward his goal of working in the field of experience. I also noticed he was wearing his IMPX pin.

It was hard to hold back my tears. To think of the impact that small gesture had and the vivid memory it still holds was humbling. But you see, we all know because of our own experiences the positive and lasting impact these small gestures can have. Leading with purpose, being present and doing things with intention can positively impact both the big and small things in our everyday interactions.

In conclusion, I encourage you to think about these simple examples and the lasting impact they had on these individuals as well as the positive impact they had on me. There is an important conversation going on in the patient experience community about employee engagement. At the heart of our humanness, it is being in relationship with each other that keeps us engaged in caring for those we serve. And it’s all big and important stuff.

 

Deanna Frings, MS Ed, CPXP
Vice President, Learning and Professional Development
The Beryl Institute

Tags:  caring  employee engagement  impact  interactions  journey  patient experience community  power of choice 

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