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The Beryl Institute invites members to submit posts on patient experience related topics. For guidelines and information on submitting a post for consideration, please contact us at info@theberylinstitute.org.

 

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Leadership Experience at the Heart of Patient Experience Movement

Posted By Muneera A. Rasheed, Tuesday, January 7, 2020

Patient experience transformation, more than anything, requires a compassionate leader who is determined to create a unique experience for the patients, engaging his team through their changing experience on this exciting journey. The journey though sounds exciting can get very dark at times as one tries to change the way people have been doing things for years; and change when it is meant to do the right things that have been hurting others’ experience is even harder-meaning the journey even darker.

A transformation of experience of how people behave in a manner that it affects how others feel which include hundreds or thousands of patients and employees is a not just difficult but a daunting task. To lead from the front, to be strong so people can be soft, to provide compassion to the vulnerable at the risk of the displeasure of the powerful, trying to honest and transparent where feedback may not be welcome, to be hard on oneself for the benefit of others, to be selfish in their selflessness requires one to have immense emotional strength and unwavering belief in the vision. Taking these steps can lead to compassion fatigue for leaders. Compassion fatigue when sets in for leaders can risk the entire organization into the same fatigue. Hence, experience of the leadership is at the heart of patient experience transformation movement.

When experience interventions are implemented at large scale in organizations, the leaders are the first ones required to practice compassion. It is important as employees will believe in the intervention and start following them only when leaders do so. Another reason why it is important for employees to experience it because compassion is the most powerful at the receiving end. It is when employees are supported in their utter state of vulnerability; when decisions are implemented to protect them and when they are heard when in pain they truly transform and find the strength to let the virtuous cycle to continue and ultimately reach the patient to affect their lives1. The patient experience movement can be a starting point to transform societies to evolve as compassionate when they experience it in their own utter state of vulnerability. However to translate this vision of compassionate societies into reality within existing structures needs effective leadership.

One way to increase effectiveness is to provide mentorship to the leaders which is slightly different from coaching. It is more than just specific training; it is an emotional investment, in a whole person not just specific skills. It means to pick them up when in trenches, to help them stand their ground when questioned, to believe in themselves when doubted and to persevere no matter what. Even greater support can come from the community of healthcare leaders themselves and that needs to be created as source of sustainable support. The other additional and even more important advantage of the community would be creation of a new value system for healthcare leadership when existing systems are too weak to be led by an individual. A healthcare leadership academy can be an excellent avenue to achieve these benefits.  The aim would be to have leaders certified for leadership positions through both in-service and pre-service trainings. The ultimate deal would be having certified leadership training an essential criterion for hiring for leadership positions and by leadership position we mean any position that entails supervising other employees for supervision is where the key to compassion lies in organizations.

Literature from the developed world has also expressed concerns over quality of preparation of healthcare leaders2 and hence the need of greater investment in leadership development programmes in healthcare in high-income setting too3. Translating the science of compassionate leadership interventions for pragmatic application through detailing the nuts and bolts systematically is crucial. Lack of it can be often a challenge and one for the primary reasons for the interventions not being implemented effectively. A multi-disciplinary team of experts, with a well-crafted an intervention framework informed by evidence to ensure scientific pragmatism is the starting point.

 

References

1.     de Zulueta PC. Developing compassionate leadership in health care: an integrative review. J Healthc Leadersh 2016; 8:1.

2.     Robbins CJ, Bradley EH, Spicer M, & Mecklenburg GA. Developing leadership in healthcare administration: A competency assessment tool/Practitioner application. J Healthc Manag 2001, 46:3, 188.

3.     McAlearney AS. Exploring mentoring and leadership development in health care organizations: Experience and opportunities. Career Development International 2005; 10:6-7, 493-511.

 

Muneera A. Rasheed is the Director Patient Experience of Care at Aga Khan University Hospital. A paediatric psychologist and a public health researcher by profession, Muneera's interest is studying how behaviour sciences can complement healthcare for improved health outcomes and quality of life of children and their families. Her recent work includes leadership mentorship to implement employee engagement initiative for enhanced patient experience of care in a tertiary care hospital.

 

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Communication Awareness is Compassion and it Improves Employee and Patient Experience

Posted By Theresa Dionne, MA, CPXE , Friday, January 3, 2020

At Methodist Medical Group, our providers often ask, “How can we communicate compassionately with our teams and patients to promote a true healing environment in our outpatient clinics?” 

As healthcare professionals, we know communication is the foundation needed to engage with team members and patients. How we communicate is the vital link in creating meaningful lasting relations with our healthcare team members and patients.

Positive, purposeful communication promotes great team engagement and relations with patients. On the other hand, negative, vague communication creates stagnate teams and patient resistance. We can all benefit in learning how to develop and improve our communication. The first step in doing this is by building on our communication skills and taking responsibility to be more aware of ourselves in how we communicate.

Communication Awareness

Communication awareness is a responsibility we have as individuals to learn more about. Because of our own characteristics and traits, we are all unique.  Communication awareness is really about self-awareness. Self-awareness encourages us to look within. Communication awareness is about caring how we express ourselves.  It encourages us to explore the way in which one understands and controls behavior, thoughts and emotions and how this impacts others.

Humans communicate both verbally (words) and non-verbally (actions); therefore it is the delivery of the behavior, thoughts and emotions expressed to those we encounter and how the communication is received that is the true message of the communication. Our personality and communication style greatly impacts the messages sent.

Communication Styles

Understanding that there are different communication styles to communicate helps our interpersonal encounters and communication messaging. Communication styles play an important part in the way we communicate in the healthcare setting.

Effective team communication is enhanced if we are aware of our natural dominate communication style.  We can also benefit when we realize the communication style of other team members.  All of us have developed communication patterns that reflect our individual identities. These patterns develop over time and become our method and manner of communicating. Communication theory also teaches us that people communicate in varying degrees and intensity. For example, some are passive, aggressive, passive-aggressive and assertive.  These levels may alter based upon our mood, stress and characteristics. Communication is so dynamic!

Overall, communication theory teaches there are four major communication styles. The four communication styles are known as: 1) Driver; 2) Animated; 3) Amiable; and 4) Analytical.

 

Though our individual communication style is usually a combination or blend of two or more or for some people all four styles, we tend to have one stronger, preferred style.  Also, our style can fluctuate depending on who we are with or our audience, the situation, and/or content of what we are communicating.

 

By identifying our dominate communication style in the chart below and recognizing the strengths and challenges of all styles, we can adjust our style to enhance team and patient communication to ensure understanding, as well as relationship building.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 Compassionate Communication

 

The following are recommendations to keep in mind when engaging and expressing compassion. When communicating with the …

 

Driver person …

  • Focus on the topic, be prepared for follow up questions and answer confidently.
  • Expect “to the point” responses.

Animator person …

  • Approach them in a casual manner, as they are optimistic.
  • Put details and facts in writing for them to refer to afterwards.

Amiable person …

  • Practice active listening, and summarize content.
  • Approach them with a relaxed positive vibe.

Analytical person …

  • Organize the material and provide as many details as possible.
  • Give expectations and space to work on their own.

Communication awareness is about being honest with one’s self, as one explores and learns how to be mindful of the impact and respond to others in the most positive way possible. Compassionate communication entails understanding each style and why individuals use them in interactions. This is what really helps navigate relations in the healthcare setting. Paying attention to which styles our team members gravitate toward, can improve our interpersonal skills, build trust and help us meet the needs of our patients. Even better, understanding our differences can make our teams stronger.

 

Slow down and listen, to ourselves and others. Be patient and offer everyone some grace. When we recognize that we may not be expressing ourselves in the most positive way, (we may be reacting rather than responding), we can do a self-correct to represent our best; thereby bring out the best in others. This is how we communicate compassionately to promote a healing environment for us all.

 

 

Theresa Dionne, a highly skilled communication specialist and coach, is employed as Patient Experience Consultant at Methodist Medical Group with Medical Health System in Dallas, Texas.  She is an instructor in the “Introduction to Coaching” course for the University of Wisconsin’s on-line Health and Wellness Program. Her passion is encouraging employees to embrace patient-centered approaches and focus on relationship building in healthcare.

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Shifting your Organization’s Cultural Mindset + Evolving to Meet Patient Needs

Posted By Paul Tiedt, Monday, December 16, 2019

The healthcare industry overwhelmingly recognizes the importance of patient experience (PX) efforts. A recent SMG report, developed through research commissioned by The Beryl Institute where we spoke with 1,500 healthcare providers about the patient experience, shows that 4 out of 5 healthcare organizations (HCOs) cite it as a top priority over the next 3 years. But knowing the importance of PX measurement and taking action—past CAHPS requirements—are what set organizations apart.

The patient experience isn’t measured (or defined) consistently across healthcare. However, SMG noticed one consistent concept during our research—HCOs that take their PX efforts beyond CAHPS requirements report positive impacts throughout the entire organization. Now, the idea of implementing advanced, well-established patient experience efforts might sound intimidating—but SMG found a few key takeaways during our analysis of the research, which we’ve detailed below, to make starting the process less daunting.

Start with leadership

To see the benefits of well-established PX efforts at your organization, SMG suggests starting with leadership. According to our research, 50% of HCOs cite strong, visible support “from the top” as the number one factor in supporting PX efforts beyond CAHPS. To get your teams on board with advanced measurement, leadership must advocate for it and be willing to incorporate it into the culture of the organization.

Highlight its importance

During our research, we asked healthcare providers what they thought were the biggest roadblocks to PX efforts. The results were:

  • Other organizational priorities (48%)
  • Cultural resistance to doing things differently (38%)
  • Leaders are pulled in too many other directions (36%)

A clearly-defined strategy, emphasizing the importance of advanced PX efforts, lets the organization know where you stand—and why. SMG suggests establishing a clear owner of PX efforts who can help the entire organization understand how a better patient experience means better patient outcomes.

Get everyone involved

It’s always easier to prioritize something when you know what can be gained from it. Our research showed eight positive effects that HCOs can expect when you take a strong, unified approach to the patient experience—and those effects were seen at every level of the organization. HCOs that combine advanced PX efforts with CAHPS saw better results in clinical outcomes, employee engagement and retention, and physician engagement and retention than CAHPS-only organizations. With the right strategy, a vocal leader, and cross-departmental buy-in, SMG found happier patients as well, with high marks for consumer loyalty, community reputation, and new customer retention.

Experience the impact

Committing to advanced PX measurement efforts is no small feat—but with a strategic approach and organizational buy-in, HCOs can experience positive outcomes. To learn more about the state of PX and why it’s important to measure beyond CAHPS requirements , download our report: 3 patient experience questions answered: What 1,500 healthcare professional revealed bout shifting the cultural mindset + evolving to meet patient needs.

 

Paul Tiedt serves as Senior Vice President of Research at Service Management Group (SMG)—a leading experience management firm that combines an enterprise-level platform with differentiated, strategic services to help organizations measure patient, employee, and customer experiences. In his role, Paul uses his 20 years of experience in multivariate data analysis to spearhead research initiatives for SMG’s markets, clients, + partners. 

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Leader Rounding- A must for our Emergency Departments!

Posted By Dr. Swati Mehta, Monday, December 2, 2019

Historian Stephen Oates suggests “leader rounding” began when President Abraham Lincoln informally visited his troops during the American Civil War. Fast forward to present day, when numerous leaders trekk to their front lines in an effort to get real-time feedback—be it Tesla’s Elon Musk , Southwest Airline’s visionary leader Herb Kelleher , or the hospital C-suites at Cleveland Clinic, Stanford, and elsewhere.

Leader Rounding Defined

Leader Rounding (LR) is a focused, intentional, and patient-centric tactic whereby high-performing clinical leaders round on their patients in an effort to build trust, set expectations, and provide service recovery in real time. While simple in its premise, the impact of leader rounding is profound: gratifying & affirming, with multiple studies showcasing its positive impact on patient experience, patient perception of safety, and quality of care.

What LR is Not

Unfortunately, LR tactic fails when a few things happen: LR is perceived as “management rounds” or punitive. When LR is not standardized but merely a vague, “How are you doing?” When it’s a hurried check-the-box attempt, rather than an effort to take the time to build a relationship with the patient. The purpose of LR is not to be “big brother” or to identify “problem providers,” but to truly live our mission to deliver medical care with passion—to gain patient trust and truly listen to their needs.

Why LR?

The Emergency Department (ED) is a unique place in the acute healthcare continuum—organized chaos and frenzied pace with very little control of census. Patients are sick, anxious, and vulnerable (physically, emotionally, and often financially). To further add to these burdens, we often get patient feedback weeks later with a generic percentile score and a few patient comments, if we’re lucky. This feedback is realistically too little too late.

LR lets us regain control of our EDs by being proactive in terms of gauging patients’ perceptions of care. It allows us to:

  • Connect with patients, build trust & promote confidence in our teams.
  • Set reasonable expectations for wait times, NPO (nothing by mouth), delays in test results, etc.
  • “Manage up” our teams (e.g., “I see Dr. Thomas is your physician today. He’s our star provider and you’re in excellent hands!”).
  • Elicit recognition (e.g., “Who can I thank today from your care team on your behalf? Is there anyone who took great care of you today?” Then provide kudos to that provider in real time).
  • Provide service recovery (e.g., get them that blanket/barf bag; tell them why they can’t eat yet; tell them their excellent doctor will come by to discuss the MRI results momentarily; apologize sincerely for the noise due to construction or the wait time). It might not be our fault, but it is our ED. Good or bad, we need to own every bit of it.
  • Sit down and make patients feel heard, update the whiteboard with the plan, provide our care card/business card, and convey that their opinion truly matters.
  • Review rounding data to identify and rectify flow, communication, and safety concerns.

How Do Department Leaders begin?

Key factors that make LR successful:

  • Take the time (Block time dedicated to LR eg: every Thursday I will round on patients for 60min no matter what)
  • Standardize 2-3 questions
  • Less is more (we should be doing 20% of the talking- 80% is listening)
  • Close the Loop (To win our patients heart we must truly listen & provide immediate service recovery when possible)
  • Authentic Apology goes a long way (leave ego & defensiveness at the door!)
  • Share patient positive feedback & recognize the nurses, physicians generously!

We cannot possibly know how to improve patient experience by merely looking at dashboards & score cards. We need to truly walk the walk and “go to the Gemba

Take the plunge & begin LR- I promise you won’t regret it!

 

In her role as the Executive Director of Patient Experience for Vituity, Dr. Swati Mehta leads the Patient Experience program designed to help providers deliver world class compassionate care to greater than 6 million patients across the Nation. Dr Mehta serves in the Executive Physician Council for Beryl Institute , Society of Hospital Medicine and is an active member of Academy of Communication in HealthCare. She practices as an Adult Hospitalist in Northern California and is a fellowship trained Nephrologist. 

LinkedIn Profile:  https://www.linkedin.com/in/swati-mehta-21288226/

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Doctors’ Offices Should Be More Like the Genius Bar

Posted By Jeffrey Millstein, MD, Monday, December 2, 2019

“Take good care of that – it’ my life.”

This was not a plea from one of my sick patients. It was what my wife said to me as I headed out the door on my way to my Apple Genius Bar appointment. She was referring to her iPhone, which had been sending frequent error messages and refusing to make or receive calls. When she said that, I suddenly felt like more than a husband running an errand. I was the cell phone ambulance.

When I arrived at the store, I was greeted by a friendly associate with iPad in hand, who confirmed my reservation. The check-in staff were all mobile, and no one sat behind the impersonal shield of a window or desk. And there were no lines. I was actually early, but he said that they could see me no sooner than 15 minutes before my appointment, in case earlier scheduled clients arrived late, or had issues which were more complex than expected. Unlike many doctors’ offices, there were no threats that I could not be seen if I was late beyond their grace period.

The store was abuzz with a symphony of voices of all pitches, timbres and accents. When my Genius arrived, he immediately pulled up a chair, shook my hand, looked me in the eye and asked how he could help me. He did not logon to a device and start entering data. He listened, clarified, summarized. I couldn’t help but notice the contrast to many physicians, and the way we allow the computer to become a distraction. He even showed empathy for me, having to devote my free night to a phone service appointment. And he knew that we were talking about more than just a phone. It was, in a sense, a patient.

The technicians even borrow terminology from medicine. “I’d like to run some diagnostics,” the Genius said. He clicked through a menu on his iPad and then on my wife’s phone, and within a few minutes a report appeared, showing that a software and carrier update were needed. I only wish medical diagnostic testing was that clear. Their history taking, on the other hand, can be nearly as complicated as ours. While I waited for my diagnostic, I heard another Genius interview a client who was having trouble transferring information from one device to another, had forgotten passwords, and struggled with the smart phone terminology. He was like a patient with both poor understanding of health issues and a language barrier. I was impressed at the way the Genius began with open ended questions, did not interrupt, and then honed in on the problem with a carefully directed inquiry. These folks were much more than technicians.

When my Genius said that he could update the software for me, and the phone did not need to be replaced or sent out for repair, I showed my relief with a smile and an audible exhale. It was as if he had said, “It’s benign” or “You don’t need surgery.” He told me he would be back in ten minutes, then offered me a phone charger and their free Wi-Fi connection while I waited. When he returned (on time), he offered one last piece of customer service gold. He took down my number, then scheduled a date and time within the next three days to call me and see how his fix was holding up. There was no charge for this visit, but the Genius did verify my insurance coverage (Apple Care) just in case.

Caring for devices is far different than caring for people, but I noticed some overlapping skill sets and opportunities to learn from the Genius Bar. Most notable is our common essential need for excellent communication skills. The Geniuses I observed were unhurried listeners who engaged with their clients and made sure to understand the essence of the problem at hand before just collecting data. They also acknowledged the inconvenience of spending precious down time on repairs. Smart phones are far more than just fancy toys to their owners, and the Geniuses really seemed to get that. Maybe it’s a reach, but that sounds a lot like good doctoring to me.

 

Dr. Millstein is a practicing internist, writer and educator, and serves as Associate Medical Director for Patient Experience at Regional Physicians of Penn Medicine. He leads initiatives for clinicians and staff to help improve patient centered communication skills. He is an instructor in the “Doctoring” course and is a clinical preceptor for students at the Perelman School of Medicine at the University of Pennsylvania.

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Leveraging Listening Posts to Develop Patient-Centric Solutions

Posted By Magali Tranié, Monday, November 4, 2019

When it comes to effective patient experience improvements, health systems know that leveraging feedback directly from patients and family are key to innovating solutions and providing patient-centered care.

Additionally, recently, healthcare facilities have recognized the importance of focusing on staff, due to its impact on the patient experience. Therefore, building and leveraging listening posts with clinicians and support staff can also help develop innovations for patients.

So, where do you start? The Experience Framework is always a great starting point, and can be a great guide to build your strategic plan.

Once your strategy is in place, start small. Let’s pick an example: The Environment and Hospitality, and as part of that, patient comfort.

Develop Your Idea

Start with your idea of how you want to improve comfort. Is privacy an issue? Are you looking to improve the bed’s surroundings? Is the décor outdated?

For example, some of our medical facilities customers weren’t thrilled about the maternity gowns currently on the market. We thought: what’s missing? What could be improved?

An often-missing element is a refined script to properly verbalize what you want from participants. An effective script is concise and has specific sections: 1) being clear you’re not selling anything 2) a brief overview of the project 3) recognizing the recipient’s expertise, explaining that expertise is why you are reaching out to them 4) asking for help and being clear you just need their input, nothing else.

Build Listening Posts

Identify all areas where your recipients might be: areas within your facility, websites (like your appointment portal or payment portal), social media outlets, surveys you give them, or even different staff members. Use your script to invite patients to participate – in the form of an email, signage, additional questions on a survey, or a question your staff asks on the fly.

To continue with our example, one of our listening posts was reaching out via email to various Mother & Baby units of hospitals across the country to invite clinicians and staff to participate in a focus group.

Practice Active Listening

Ensure you do not prime your participants or lead them. This means being very cautious in how you word your questions. In our example, we held very open-ended discussions with Directors of Women’s Services, Nursing Department Leaders, Managers of Mother & Baby Units and their nursing staff.

We asked for their input on current maternity gowns, what was missing, the complaints they heard from mothers, their observations of their patients, their interactions with family.

Look for Trends

Be cautious fixating on one thing; looking for overall trends and patterns is essential to avoid confirmation bias and focus on the right elements to improve upon.

The trends we found were that many facilities use the ER’s IV gowns, which greatly lack in comfort or functionality and did not provide modesty nor comfort. Plus, no maternity gowns currently on the market addressed skin-to-skin needs.

Validate Findings

It’s important to ensure comprehension and avoid the trap of fixating on one thing, therefore circling back to your participants with a prototype solution is a good idea.

We returned to some of our participants with a rough prototype. They validated the gown design and provided feedback on color and the fabric, as nurses and administrators alike wanted a cozy fabric.

Implement Solution

Once you’ve refined your prototype to a final design, you’re now ready to launch and create a feedback loop for continuous improvement.

In our example, medical facilities were very excited with a maternity gown that prioritizes patient comfort, included patients’ needs, Mother & Baby expert input, and staff recommendations.

 


Magali Tranié is the Director of Marketing for ImageFIRST Healthcare Laundry Specialists. With over 20 years of experience acting as the voice of the customer, Magali has had to develop good listening habits. She has worked on product management, growth strategy planning and execution, helping businesses streamline marketing resources, develop growth programs, increase leads, build brands, and run new product development. 

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The Multiplying Effect of Satisfaction and Dissatisfaction on Reputation and the Bottom Line

Posted By Aaron Campbell, CPXP, Wednesday, August 28, 2019
Updated: Wednesday, August 21, 2019

“The most important figures are unknown and unknowable… One, for example, is the multiplying effect of a happy customer that brings business into the company. Another one is the multiplying effect of an unhappy customer that warns his friends and some of his enemies about his experience.” – Dr. W. Edwards Deming

Even after seven months, I can still hear my aunt’s screams of pain. Just 30 minutes earlier, I had been at my grandmother’s beside at one hospital when I got a call saying my aunt was unresponsive and being rushed to the ED at another.

I gave my grandmother a hug and headed to the car. As I sped down the interstate, I called the ED, identified myself as my aunt’s power of attorney and begged to speak with someone. My aunt had been ravaged by debilitating and deforming arthritis, along with congestive heart failure. They needed to know that she was a DNR, and her advanced directive had been sent with her in the ambulance.

To my dismay, the callous employee responded, “I’m sorry, but you can’t speak with anyone until she is registered in our computer—that’s our policy.”

When I arrived, the ED staff, unaware that I had called, had ignored her advance directive and administered Narcan to revive her. She was awake, dying and in the worst pain of her life because of “policy.” To make matters worse, the nurse sitting with her shamed me when I expressed anger over their actions and demanded they call hospice. It took nearly seven hours of suffering before the morphine hospice had ordered finally began to ease my aunt’s pain.

Just a few hours later, back at her little apartment, I held her hands as she took her final breath.

Taking Into Account the Unknown and Unknowable

In my professional role, I have the privilege of working with health systems across the country to improve the patient experience and strengthen (and often repair) their reputations. While I’ve helped design PX strategies for systems with 30,000+ employees, I felt completely powerless to help my own family. No HCAHPS survey, online review or formal grievance could capture the true depth of my feelings or the potential impact sharing my story could have on that hospital’s reputation and, therefore, bottom line.

Healthcare organizations make daily miracles and messes on the grandest scale. In a world of social media, positive and negative posts can be halfway around the world in a matter of hours. While most consumers think about a healthcare organization’s reputation and take seriously what friends have to say about their experiences, many providers continue to make investments in experience based on potential impact to reimbursement and by reviewing one-dimensional metrics, such as the overall hospital score from HCAHPS. They look at the obvious numbers and fail to consider the unknown or unknowable “multiplying effect” of patient satisfaction levels on an organization’s reputation.

Dr. Edwards Deming, an early leader in the management and LEAN movements, said “No one can guess the future loss of business from a dissatisfied customer.” He also said, “It will not suffice to have customers that are merely satisfied. Customers that are unhappy and some that are merely satisfied switch. Profit comes from repeat customers—those that boast about the product or service.”

Every decision and investment you make – or don’t make – towards a better, safer, more compassionate and convenient healthcare experience raises the stakes. And, the decisions you make not only affect your organization but your competition, too. This is why it is so important to look beyond the numbers and to take every opportunity to truly listen to your patients, their family members and to your employees. Internal policy and regulation, while crucial to a safe and organized healthcare organization, must be built with patients and their caregivers in mind.

“The most important figures that one needs for management are unknown or unknowable (Lloyd S. Nelson, director of statistical methods for the Nashua Corporation), but successful management must nevertheless take account of them.”  -- Dr. W Edwards Deming

Opening the door to dialogue and empowering and equipping your people to respond proactively and with authenticity to any situation is one of the only ways to change the story people will tell, and therefore take account of the unknown and unknowable.

Aaron Campbell, CPXP guides healthcare leaders on patient, employee and community engagement and experience in his role as senior managing advisor at Jarrard Phillips Cate & Hancock. The firm is a U.S. top 10 ranked healthcare communications consultancy specializing in change management, crisis/issue navigation, strategic positioning and M&A exclusively for providers. A social worker by training, Aaron has spent nearly 15 years working with diverse stakeholders in the public, not-for-profit and private sectors to improve health and social welfare policy and the delivery of care through strategy development, strategic communications, grassroots engagement and advocacy. Inspired by his personal experience caring for his aging grandmother and disabled aunt, Aaron leverages his passion, expertise and experience to help healthcare leaders develop strategies and buy-in to create and sustain change.

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Play as an Integral Part of Pediatric Patient Experience

Posted By Christina York, Monday, August 26, 2019

Within each child is a deep, intrinsic love for play—and not only is it something that they love, it’s something that they need. Play is how children of all ages discover, learn, and engage with the big world around them. The creator of the Montessori education approach, Maria Montessori, once said that “play is the work of the child.”

This reality does not change when children are at the doctor’s office or are hospitalized. In fact, in healthcare settings, play becomes even more essential. Play is the way kids prepare for procedures and cope with the pain and anxiety that come with treatment. Play normalizes the unfamiliar hospital environment that has many scary sights and sounds. Play is also a motivator for patients undergoing difficult rehabilitation therapy and recovery. As an occupational therapist once told me, “When you do pediatric therapy, you have to play games. Kids don’t care about your goals.”

Ultimately, incorporating play into the hospital is synonymous with improving pediatric patient experience and the experience of their caregivers. That's why there are so many tools, activities, and spaces to encourage play in hospitals. From simple distraction tools like bubbles to entire concourse remodels to innovative technologies like augmented and virtual reality, these methods all share the ultimate goal of helping kids focus on play and not on the negative aspects of hospitalization or treatment. It's also why hospitals have dedicated staff like child life specialists to provide support for patients.

Here are some ways to incorporate play for pediatric patients:

  • Create a welcoming space: Upon walking into a doctor’s office or hospital, the physical environment is the first thing patients experience. Needless to say, it makes a big impact on how patients experience their healthcare. A bland and sterile waiting area feels cold and uninviting in comparison to a space with lots of natural light, color, and activities for patients to engage in. Including artwork, plants, snacks, interactive games, and even space transformation are ways to create more interest in patient areas. Designated play areas or rooms are also helpful for providing more welcoming spaces for children.
  • Incorporate medical play, modules, and simulations: Incorporating age-appropriate medical play prepares patients before procedures in a way that helps them understand what is about to happen. This not only decreases anxiety for patients, procedures are done faster, and less unnecessary sedation is required. For certain procedures like MRI's, engaging patient education simulations can be used to prepare patients.
  • Use distraction therapy frequently: Whether during simple needle-related medical procedures or longer hospital stays, distraction therapy can be used throughout the healthcare experience. From traditional toys and sensory equipment to technology like augmented reality, distraction is a great way to help patients perceive less pain and anxiety during procedures as well as alleviate boredom. Find distraction tools that are appropriate and engaging for every age group, like video games, stuffed animals, virtual reality headsets, scavenger hunts, and more. 

Christina York is a user experience guru, technology visionary, and Founder/CEO of SpellBound, a company that creates therapeutic augmented reality tools to help children cope and engage with medical treatment. She can be reached on LinkedIn or at christina@spellboundAR.com.

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Caregiving in Alzheimer’s Disease

Posted By John A. Galdo, Pharm.D., M.B.A., BCPS, BCGP, Tuesday, July 23, 2019

My mom was diagnosed with Alzheimer’s Disease in January 2019. Despite living with the diagnosis for only a few months, the time has felt like a lifetime. However, the most unfortunate aspect to our story isn’t the various barriers in healthcare from lack of provider support or hurdles in health information exchange, but the fact that Alzheimer’s Disease is a terminal illness with no cure. We are never going to get lost time back, and, at a point in the disease journey, medications are less effective. This is why it is so important for family members to be a part of the healthcare conversation.

 

We were concerned about Mom’s deteriorating memory and social skills for a few years but didn’t react until safety became a concern (she became lost while driving, emotional outbursts from ‘missing’ items). My dad and I sent a letter to Mom’s primary care provider (PCP) stating our concern regarding Alzheimer’s Disease/dementia, and we requested a screening be conducted during her annual wellness visit. There are a variety of objective screening tools available to providers to assess for the risk of dementia and Alzheimer’s Disease. Yet, Mom’s PCP opted to go in a different direction. She asked Mom, “are you having any memory issues?” Of course, Mom answered no.

 

Even us finding out the ‘screening’ was simply ‘are you having any memory issues’ was an ordeal in and of itself. Mom, given her medical condition, is not a reliable historian, nor at the time, apt to include other people in the healthcare conversation. Mom needed an advocate and her care team (aka us) with her at appointments (we weren’t); so, we had to take matters into our own hands. However, for any of us to have a conversation with the PCP, we had to be co-signed on Mom’s medical records. I understand the value, but a simple signature became another barrier - multiple phone calls and an eventual trip across state lines to sign a piece of paper, so I could have a conversation with the PCP. And we did all of this just to find out a standardized assessment never occurred.

 

And this is why creating the proverbial ‘village’ is so important within healthcare. Mom was unable to advocate for herself, and Dad and I were barred. But once we created our support system and care team, our journey truly started. Through voicing our concerns to the PCP in a regular cadence, we were able to get an appointment with a neuropsychologist, who did conduct those objective screening tools. After the neuropsychologist’s four-hour exam (which no one told us the duration of this appointment), we were informed of a “probable” Alzheimer’s Disease diagnosis (a psychologist is unable to diagnosis based on scope of licensure in the state) and referred to a neurologist. However, the neurologist refused to see us until baseline imagine and laboratory work was complete – as a healthcare provider, I understand the clinical evidence behind this ‘checklist’ – but it was only with my background that I was able to navigate the system with any sense of urgency. My favorite system failure was when the neurology office sent my dad the medical referral paperwork, which is supposed to be filled out by the PCP referring to care! And bless his heart, dad tried to fill it out. We then had to wait a few more months to get an appointment with a neurologist who finally confirmed and started treatment for Alzheimer’s Disease. The entire process took over half a year.

 

Needless to say, we only ‘achieved’ a diagnosis because my dad and I became involved in Mom’s care. The best time to become an advocate and caregiver is now. And it can start with simply speaking up when concerned.

 

John A. Galdo, Pharm.D., M.B.A., BCPS, BCGP (Jake) is a caregiver and pharmacist in Alabama. He currently works developing and educating on healthcare quality measures and is a member of the board of directors for the Alabama chapters of the Alzheimer’s Association and American Diabetes Association. He can be found on LinkedIn.

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This Isn’t Rocket Science. In fact, It’s Harder.

Posted By Mark VanderKlipp, EDAC, Wednesday, July 3, 2019

Come on, you guys, this isn’t rocket science.” - said everyone ever

People glibly toss this statement off when they attempt to take the reductionist high ground, to speak of the simplicity of the task before them. They hold out rocket science as a discipline that’s almost impossibly complex, knowable to only a select few.

Rocket scientists have the luxury to focus for a period of time on delivering a payload through the atmosphere and into outer space. But as complicated as this problem may be, it is a definable problem, with physical laws that determine constraints, that has a defined beginning and a definite end.

On the other hand, moving a complex healthcare culture forward is a daily task that requires a broad definition of goals, barriers and opportunities (which vary for each individual over time), with only the murky boundaries of understanding to determine constraints, with no definable beginning and certainly no end. In our realm, individual behavior is situational, truth is subjective and emotion and urgency trump all.

To the extent that there’s an answer for our industry, it’s in defining human-centered processes that honor the lived experience of individuals in the system, and forward their expertise as shared learning occurs. This excellent article by Laura Hoppa lays out a great process for doing so: Activating Strategy through Experience Design.

I serve as a volunteer on a PFAC for Munson Medical Center in my hometown of Traverse City, MI. We recently heard a presentation from the Director of Facilities for a new surgical tower that will completely change the front door of the Medical Center: it moves an existing city street to the north and creates new connections to the building that alter pathways and process significantly.

As we were reviewing the goals for the project that the architect had written, the single word that kept coming back to me was “hygiene.” Mirriam-Webster defines this as “a science of the establishment and maintenance of health, or conditions/practices conducive to health.”

When I think of health in this context, I think of informational health, brought about by consistent informational hygiene.

As Jason Wolf so often says, “we are people serving people” and nowhere is the correct exchange of information more critical than in the world of healthcare. Good informational hygiene does not have an end point - it’s a practice that we must make a part of every day, if we wish to continually maintain and improve the health of our cultures and environments.

Thinking of the major changes about to occur here in Traverse City, our goal will be to maximize the exchange of information in order to meaningfully impact mindsets in ways that improve both staff and patient/family experiences. Here’s how I would define good “informational hygiene”:

  • Increase awareness
    • Lay the groundwork that necessary change is underway, well in advance of any “ask” or intervention
    • Build momentum in clear, consistent communications across media
    • Create avenues for conversation among diverse individuals that help frame the issue

  • Interrupt with novelty
    • Once defined, use metaphor/story to describe aspects of the issue as you see it
    • Create “landmark” informational experiences to establish the issue as one needing resolution
    • Design avenues for conversation to hypothesize potential solutions

  • Convince with facts
    • Cement the challenges with relevant, “sticky” facts
    • Support those with quantifiable information and stories to clarify, add shape to the issue
    • Communicate clearly and often

  • Change long-held assumptions
    • Name them as a way to frame the challenge
    • Acknowledge their value in the past, and the original thinking/necessity that brought them about
    • Contrast those with new information, and illustrate changes that might result with new assumptions

  • Build trust
    • Tell the truth as you see it
    • Be open to receiving critique and having your mind convincingly changed
    • Encourage co-design of solutions with humans on all sides of the experience

Once mindset change has opened the door, we can begin to communicate all the ways in which behaviors can change to support the greater good.

So when you hear someone say ‘Come on you guys, this isn’t rocket science!’, remember that convincingly altering mindsets to change behavior isn’t rocket science; it’s much harder than that. Kudos to all members of this organization, and the entire healthcare system, who bring their best to this challenge every day.

Mark VanderKlipp is an experience and systems designer, working in human-centered graphic design for over 30 years. He helps clients visualize the systems within which they function, empowering staff to deliver an experience that’s clear, relevant and human. He previously spent 24 years with a world-class wayfinding design firm, 13 as its president, where he was the lead strategist for diverse assignments in healthcare, higher education, civic, corporate, trails and tourism throughout North America. Mark is a 1987 graduate of the University of Michigan. In 2012 he earned his evidence-based design certification (EDAC) through the Center for Health Design, and in 2017 became certified in Systems Practice through +Acumen. He is also a founding partner of the customer experience consulting firm Connect_CX.

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