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Collaboration Leads to Understanding and Action

Posted By Stephanie Hillman, MNPL, Friday, July 31, 2020

Healthcare collects a lot of data. CAHPS surveys, focus groups, financial reporting, market share. So. Many. Data. Points. So many opportunities for applying those data. Yet, often readers of the data ask: “What does that mean? What should I do with that information?

Humans want to do the right thing. You want to take the next best step. In healthcare that can mean that you want to deepen engagement with the team, with faculty, with patients. I heard this question nearly every week over many years of listening to and working with teams to improve the experience for patients, families, and the people who served them. Clinical leaders asked me, frontline team members asked me, doctors asked me, administrators asked me.

Often, my response was: “Ask them.”


Reading The Beryl Institute's Human Experience 2030: A Vision for the Future of Healthcare, I was drawn to the Foundational Needs outlined. This one stood out: “Reframe how experience is measured from lagging to real-time indicators, ensuring a holistic assessment of safety, quality, service and engagement to demonstrate the value of care.”

Later Jason describes an action that spoke to the heart of my work over the years: Reframe consumerism to patient and consumer partnership. The request to “transform power dynamics by a global commitment to (1) partnership, where patients, families and consumers are actively engaged in co-design…” led me to write this.

I want to offer you a method for partnership. This is not a step-by-step proposal deeply steeped in the co-design process. I leave that work to others. This article offers some examples: Bring in user experience designers who have done this before. They work magic!

I like to say that data informs, and stories persuade. Earlier I listed a few types of data organizations collect. When you look at the results, you’re reading survey percentages, percentiles, mean scores. What comes next? You want to take the right next action. You want to make sure patients, families, employees, feel your commitment to them.

This process helps make decisions informed by end users. It is one way to include patients and/or family members so that your solution integrates their feedback. I would like to help you overcome barriers to trying this method, which in turn will reduce burden placed on patients and families to give feedback and has the potential of improving patient outcomes.

You can find the story, and that story will compel you to act.


I will use a COVID-19 example to bring a process for gathering qualitative insights that complement the problem seen in the quantitative data. You can listen to patients, families, or your team members every day.

They are in your waiting spaces, your cafeteria, your exam rooms, your inpatient rooms. On nearly every day, and in nearly every setting. Or they are a phone call away. Anyone who works in healthcare can talk with a patient on any day they want. Hint: most people answer the phone because their healthcare organization is calling them; it’s not a call they block. Your will, not their availability, is the first step to hearing the story.

Even while living in the COVID-19 pandemic, patients and/or their families are available. They want to help. What I heard from every single patient or parent or family member was that they were happy to give their input and feedback to make it better for the next patient. Hands down. Every single person.

Someone is ready to give you feedback on your problem. In this case, the problem is clear because of a survey result or a recurring patient complaint. It’s based on quantitative data.

Now we’ll look for the qualitative story, set in an example based on COVID.

The Story

The overarching problem is defined by the survey; the nuance of that problem comes from the mouths of patients to your ears. Their story shapes your solution.

At the beginning of COVID-19, what’s was most important to patients? Their safety – not getting the virus. What did this look like to them? Was it masks, staying in their car until the room was available, having appointments online? Several organizations added a question to their patient surveys. Many then asked to confirm or better understand patient needs. You can do this with an unlimited number of topics that come up in your myriad of data sources.

Possible Questions

  • Regarding handwashing: What is important about handwashing? Did clinicians wash their hands? Does that matter to you? Why?

  • For cleanliness: How clean were the rooms? The hallways? In what way? What did you see, or not see, that stood out for you?

  • For triage: What did you notice about how patients were put into the rooms? How important was it to know there were separate areas for positive, negative, or suspected COVID infections? Why does this matter?

  • Overall safety: What is important for you to feel safe during this visit?

One family mentioned that they weren’t sure the doctor’s hands were clean because they didn’t see her wash them. This family lives in a multi-generational household and knows to limit contact outside their home. They must keep Grandma Maria safe – she cares for the children while the parents work. This story offers the why for every clinician to wash their hands in front of the patients.

Patients provide the context through an illustrative story that highlights what’s important to them, what they value. They’ll freely share what it meant to them as a patient, or as the caregiver. Their story cuts through the complexity of healthcare, focuses your intervention, and identifies actions that you can replicate across care settings. Consider using their words - best done in cooperation with health educators - to identify plain language for signage and materials. This will help improve health literacy and provide the safe environment they deserve.

Given the decreased number of visits due to the pandemic, we must retain the trust of patients and families during the crisis. They may have to come back for another visit. We want to assure them that we’re doing everything possible to keep them healthy when in our care. We know they will tell friends and family how safe they felt. We need to discover their stories and run with their solutions.

You can you do this. You can approach patients, their families, and team members, to ensure better problem solving. As you try this, please consider these topics: fear; overburdened patients, families, and caregivers; permission; and brevity.

Overcome Fear

People may exhibit some unease with this suggestion. That’s what I witnessed. I acknowledge that I am an extrovert, but it didn’t seem to just be introversion. People were expressing fear. I soon realized it was they were worried about hearing something they couldn’t fix. Feeling ineffective is hard, for sure. Done too often, it can lead to moral distress, which is an element of burnout in healthcare and a reason why many nurses, doctors, and other people are fleeing the healthcare system. (Source: While this topic definitely needs attention, that is not what I am here to address today. What I invite you to consider is that asking families doesn’t always lead to distress, and it can be the shortest path to hear what they value.

A similar practice – with the related worries – is to give your business card to patients. This story of Dr. Feinberg, that I heard years ago while he was CEO at UCLA, was about leaving his card with thousands of patients. He chose to interact with patients, families and the care teams to uncover solutions. He relied on their partnership and feedback on the potential solutions to the multitude of problems. (source: He felt those interactions grounded him in his call to serve within healthcare. These interactions may bring you a “joy-in-work” moment – and highlight something that reminds you why you choose to work within this industry.

Reduce Burden

Another reason to ask patients who are right there in front of you is to reduce their burden of responding to another survey, focus group request or meeting invitation. I had a personal “a-ha moment” when I read this Vox article, “Unpaid, stressed, and confused: patients are the healthcare system’s free labor,” (source: Sarah Kliff shares her story about her painful navigation of the healthcare system due to a chronic foot injury. Many of the issues remain valid. I would like to think that most of us want to lessen the burden of healthcare on our patients and families instead of increasing it. Creating a real-time process for gathering input is one way to reduce burden.

A quick story: A child life manager led a team to conduct a trial for a blood draw clinic with autistic patients. They had patients come at a less-busy time of day, reduced lighting, and minimized distractions. She was keen to know what families thought. She called me and asked about how to collect this feedback. I encouraged her to call them, and she did. After doing that, she reached out to share that it was the best 90 minutes she had spent in a long time. She learned so much on how to improve lab flow for the next trial. Joy and a better process.

Ask Permission & Keep It Short

You are ready to try this. Please start by asking permission. Something like, “Do you have a couple minutes? We have this problem and are trying to figure out the best solutions for families like yours. I would like to hear what you think.”

If they say ‘no,’ that’s alright. They have a choice. Thank them for their time. Find another person. It’s best if that person doesn’t look just like you.

Ask your question. You can pose up to three. Listen to their responses. Write down key words and phrases. Show them that their words matter to you. Jot down any non-verbal cues you see.

Set a silent timer and keep it to less than 5 minutes. Respect their time.

Thank them.

Now, ask up to four more people. It’s likely you’ll start seeing patterns, hearing similar words. If you don’t have any repeated answers, ask five more people. If you still don’t have a pattern, you may be asking the wrong questions. Do some reflection: “does this question give me insight into what is important to my users?” and “are they providing feedback on something I am willing to change?” Use your own reflection to revise the question and try again.

Make It Happen

This process can reduce burden on families, even if it’s a tiny bit, and it should identify solutions you could never anticipate. You’re not living the experience from their perspective. It could bring a bright spot to your day. You may empathize more after hearing their stories. It will show that you care about them and value their feedback. It may help them have more confidence to come back next time.

Your problem doesn’t always require patients to do surveys or to attend another meeting. They will share their stories with you IRL. Don’t be afraid. Don’t spend too much time making up reasons you shouldn’t do this. I urge you: ask them when they are right there. And, let me know how it goes! 


Ms. Stephanie Hillman is a healthcare leader who has successfully developed and implemented systems that help organizations scale for growth and long-term success. Through the collection of quantitative data and qualitative narratives, Stephanie advises leaders to understand – from the user perspective - opportunities for improvement and to replicate best practices ascertained from exemplars. Stephanie was a founding member of a national pediatric experience collaborative that catalyzed action throughout the US to improve the experiences for patients, families, and the clinical teams who serve them. Last year Stephanie started her own consulting practice called PrairieWood Consulting, LLC, which recognizes her roots from the North Dakota prairie and her professional career in the beautiful Pacific Northwest.

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Junior Volunteers

Posted By Andréa Kennedy-Tull , Sunday, July 5, 2020

Like many of our healthcare colleagues, COVID-19 forced us to evaluate the relevancy of volunteer services.  IMarch, we suspended all volunteer activity throughout our system.  It was then that we recognized the potential of maintaining significance by pivoting to a virtual platform in order to maintain engagement with our staff and volunteers.  


Out of this realization, we created a virtual summer junior volunteer program.  We limited the program to 100 participants who had applied for our on-site program.  We then created a skeleton of what the program would look like and fleshed out the content and logistics of bringing it to life.


The program requirements included the following components:


  • Participants would contribute 50 hours of volunteer time. 

  • The program would be eight weeks in duration. 

  • Completion of online application, virtual interview and online orientation.  (4 hours)  

  • Program structure would have three key aspects: 


  • Leadership:  Mandatory weekly meeting with a volunteer manager.  Participants discuss competencies designed to help them develop skills to become better leaders.  (8 hours) 


  • Career Exploration:  Virtual speaker series with individuals throughout the organization speaking about different clinical and non-clinical healthcare professions. Junior volunteers are required to attend at least eight of these sessions.  (8 hours) 


  • Service:  A combination of mandatory and elective activities the juniors are required to complete.  A core service kit was provided that included materials for crafts that, would be distributed to our patients and staff. Materials to make masks, healthcare awareness event ribbons and greeting cards were the main items in the kits.  Juniors also partnered with our patient liaisons to complete one hour of virtual patient visits.  Personalized e-Greetings were sent to patients after visits.  The service component also included a list of optional service projects the participants could complete. With management approval, they were also given the opportunity to create their own service project.  (30 hours) 


  • All aspects of the program were conducted virtually.  Interactions with the managers, training and events were all completed virtually, typically through WebEx.  Delivery of kits and their return were all done in a contactless manner.  


The program has been favorably received.  After a virtual patient visit, a junior commented, “I enjoyed the experience…it gave me a front row seat to experience interactions between staff and patients and how best we could meet the patients needs.”  nursing administrator commented, The program is awesome!  It's innovative, educational, and engaging for the teenagers Similarly, a physician noted that the speaker series “has allowed the teenagers the opportunity to get a real-life perspective on different professions.” 


Participation at events and engagement with the service activities continues to be high.  There have been several lessons learned by our team:


  • Team Building:  Collaboration by the team was crucial.  The collective synergy that resulted from creating this innovative program highlighted the individual strengths of each manager for the greater good of our program and organization. 

  • Technology:  Virtual volunteering will be a permanent part of how we will provide services to our organization.  The technology learning curve was quick and steep, but manageable and necessary.   

  • Innovation:  While the external circumstances were not ideal, it has re-energized our thinking, forcing us to think more creatively about how we provide services.  Additionally, this new model has created excitement in our participants as they were being engaged in a new and different manner.


At a time when our clinical colleagues have been forced to provide care in a different and more innovative way, this virtual junior volunteer program has added credibility to our program, heightened awareness about our profession and laid the foundation for future innovation in the delivery of volunteer services.   

Andréa Kennedy-Tull is the Director of Patient Experience and Operations at Ben Taub Hospital in Houston, TX, part of Harris Health System. She holds a master’s degree in Business Management and a bachelor’s in Business and Spanish and is a certified administrator in Volunteer Services. Andréa has 25 years of experience in healthcare in the fields of Human Resources, Patient Advocacy and Volunteer Management. 




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Family Caregiving in the Era of COVID-19

Posted By GPFAB Members, Friday, June 5, 2020

For family caregivers, especially those of us who care for our loved ones with cognitive challenges like Alzheimer’s disease or Autism, COVID-19 is a worst-case scenario: a perfect storm of stress, chaos, and a virus that dictates our every move.

The caregiving universe changed in a flash, with little time to pivot or adjust to a new normal. Suddenly, the daily routines that provided some semblance of calm and well-being simply imploded. Access to home health, adult daycare, preventive care visits, and other critical services we use every day practically disappeared in most communities. Even worse, many medications used to treat chronic illness are in short supply, like hydroxychloroquine, used to treat lupus and rheumatoid arthritis.

Caregivers who provide care at home often have to leave their homes to obtain supplies or medications or wait many days for them to be delivered (in communities that have this luxury) due to the volume of home-delivery right now. This creates a scenario where caregivers are repeatedly visiting grocery stores and pharmacies and putting themselves at risk, which in turn, puts the people they care for at risk.

To make matters worse, we can’t visit our loved ones who reside in long-term care facilities, whose care we oversee and monitor on a daily basis, therefore, we have no window into the quality of care they are receiving.  We have frail family members who do not understand what is going on and why we are not there. If that family member ends up in the hospital, we have no idea if we will ever see them again. This puts immeasurable stress on family caregivers.

A few short months ago, we were reminding family caregivers about the importance of taking care of themselves and using respite care to take a mental break from their caregiving responsibilities. Those days are gone. There is no respite. We often care for the most vulnerable in our communities, who could easily succumb to this insidious threat, thus we are terrified to let anyone into our homes -- knowing they could be asymptomatic carriers of the virus.

“As the parent of a child with a complex medical condition, COVID-19 has changed the way we manage complex care at home. At 10:15 p.m., I open the door to a masked nurse holding up a thermometer to show me that she does not have an elevated temperature. This procedure does not feel adequate; I know carriers can be asymptomatic. But this is all I have, the only tool I can use to feel safer. The support of in-home care at night allows us to sleep and work, and we are grateful for it, but we are terrified of the prospect of inviting the virus in by way of the caregivers we need.” – Nikki Montgomery, Caregiver 

Many of us lost the full- or part-time jobs that kept us afloat. Suddenly, we face food and housing insecurity on top of our caregiving challenges. Even if we retained our jobs, we no longer have the caregiving support we relied on that enabled us to work in the first place.

We cling to hope that Washington will not forget us in the relief efforts. Democratic Reps. Joaquin Castro (Texas) and Deb Haaland (N.M.) led more than 30 of their colleagues in asking House leadership to broaden the definition of essential workers in the next relief package. “The frontlines of this crisis start at home and will remain there as we fight this pandemic for the long haul,” Castro said in a statement. “The gross inequality of our health care and childcare systems is starker than ever, and that includes a complete lack of support for our nation’s caregivers.”

The pandemic has cast a bright light on the shortcomings of our healthcare system and its unrelenting reliance on family members to provide the bulk of care for our chronically ill loved ones, even when it has become one of the most dangerous jobs in America. More than 40% of the total population of this country is living with a chronic disease. [1] We have an estimated 43.5 million caregivers in the United States supporting them.[2]

“It’s an extremely confusing time because we don’t have real national coordination. A caregiver may live in a different state or city from their loved one… that has different rules about what you can/cannot do for them. And it is very hard to get information to make good, timely decisions. If you have a parent in senior living or other settings, while there are best practice guidelines about communicating with families, there are not many actual laws. So, when we were trying to decide if we should move my mom, it became clear there wasn’t going to be any way to know if someone in her building started to have symptoms or even if a COVID case was diagnosed.” – Geri Lynn Baumblatt, Caregiver 

One thing that has become crystal clear: we need a national health (and pandemic) infrastructure that is designed with family caregivers at the forefront. I am hopeful that the RAISE Family Caregiver’s Act will help get us there. In the meantime, let’s not forget the unsung heroes, the family caregivers, who continue to battle on under extraordinary circumstances.


[1] Centers for Disease Control and Prevention. The Power of Prevention. (2009) Accessed at 

Tackling the burden of chronic diseases in the USA. Lancet 2009;373(9659):185. Accessed at

[2] National Alliance for Caregiving and AARP Public Policy Institute. (2015). Caregiving in the U.S. 2015 Report.


Written by members of The Beryl Institute's Global Patient and Family Advisory Board including Isabela Castro, Nikki Montgomery, Tony Serge, MaryAnne Sterling and Janepher Wabulyu. The Global Patient and Family Advisory Board complements the Institute’s boards by ensuring the voices of patients and families are a central consideration in the strategic direction and offerings of the Institute. The Board reviews the Institute’s areas of focus and current resources and offer suggestions on new opportunities, topics of interest, etc., ensuring the perspective of the patient is part of all Institute efforts. 


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Keeping the Magic in Children’s Hospitals in a Time of Isolation

Posted By Lauren Grant, Monday, June 1, 2020

No part of this has been easy.  Whether you’re on the front lines, at home, “essential” or otherwise, we’re all struggling in our own ways.  As adults, we have the luxury of being able to express how COVID-19 has impacted us- physically, mentally, and emotionally.  Children are living this, too.  Talk about a struggle that we never had: “Welcome to childhood-- it’s confusing, it takes years to learn to emote, and now let’s add a Pandemic.” And then there are children currently in hospitals.  Those not previously required to be in protective isolation are now isolated.  Some have been uprooted to make room for adult overflow.  Social programs have stopped.  Knowing the impact of emotional well-being on health, we want to help these kids cope during their hospital stay.  How do we rally to bring them the “magic” that we so desperately want to remain part of their childhood? 


Honestly, you might already be doing it. Here’s what we’ve seen:

1.   You are openly communicating.

In a chaotic, rapidly evolving environment, children may have difficulty comprehending a situation. They may not understand the importance of protective measures (handwashing, isolation) and may have difficulty describing symptoms and feelings.  St. Jude Children’s Hospital now offers a free coloring book to help children better understand COVID-19.  Many hospital workers are placing their pictures over their PPE for more human connections with patients.  Additionally, care providers are explaining the ever-changing situation openly, creatively, and kindly, which can dramatically improve a child’s experience.  

2.   You are embracing technology.

With current isolation procedures, many children have lost access to playrooms, shared toys and freedom to move around the floor.  Some hospitals such as Lucile Packard Children’s Hospital Stanford are using electronic greetings to provide that sense of connection.  J.J. Bouchard at C.S. Mott Children’s Hospital shared several inspiring ways his patient technology team is creating a positive patient experience.  Using YouTube, they are giving patients (and children at home missing their “hospital family”) that sense of connection.  Illustrating the increasingly important role of patient technology specialists (many sponsored by  Child’s Play Charity), another member of Bouchard’s team has been using his expertise to help optimize/implement telehealth operations. 


Phoenix Children’s Hospital also implemented telehealth at an amazingly rapid rate, transitioning to 6000 virtual visits in a single week.  Smart devices are also being used to help children stay connected to loved ones and engage, and Bouchard’s team has been diligently working to find appropriate gaming recommendations.  Children’s hospitals have begun to implement in-room digital scavenger hunts to help children self-entertain and get themselves moving within their room*.  Clearly, this has become the time to harness technology, and hospitals across the country are doing just that.

3.   You are being resourceful.

We’ve interviewed several experts at children’s hospitals, and the amount of creativity, resourcefulness, and determination to build a positive patient experience is truly awe-inspiring.  Donor support has been harnessed to bring in programming and resources.  Though many hospitals are in spending freezes, departments and healthcare providers are reaching out to foundations and grants outside of their institutions for help.  Children, caregivers, and providers are also championing this by communicating their concerns and needs, and they are sharing this information not only with one another, but with others at hospitals across the country.  In short, care teams are doing what they can to provide for their team and for their patients. 


To all working to bring “magic” into hospitals at this time, thank you.  This isn’t easy, but we must do what we can to support children during this difficult time.  After all, to care is human, right?



*Disclosure—Product of SpellBound


Tammy Barnes is a scientist with a passion for finding creative solutions to help people.  After pursuing her Ph.D. in physiology at Vanderbilt University and completing post-doctoral training in neurophysiology at the University of Michigan, she traded in her lab coat to work with SpellBound to provide a new level of patient experience and care to children’
s hospitals. 




Jenny Choi is a current medical student at the University of San Diego, California and Cancer Biology PhD student at the University of Michigan dedicated to pediatric healthcare. Her experiences growing up with a younger brother with autism/special needs and working in pediatric clinical trials motivated her to join SpellBound to lead their research efforts.

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Uniting as Teammates: The only way to get through these extraordinary times together

Posted By Magali Tranié , Thursday, May 7, 2020

Every person alive today is facing unprecedented circumstances. We can’t use our experiences to guide us on what we should do. We can’t offer words of wisdom to our children. Even my 100-year-old grandmother cannot offer advice. Our lives have profoundly changed in a very short time.


But we can still find a roadmap to navigate through these strange times if we broaden our scope and look at every hardship we have overcome as a guide. Think back: tough times have either brought out the best in us or the worst in us. In today’s crisis, the one thing we can control is whether we will dig deep and find our best, or let fear control us and bring out our worst.


It’s normal during these times for humans to snap into survival mode and adopt an “us vs. them” mentality (whoever “them” is for you). But the best of us get through it with the help of others, not by treating others as “them.”


The best in us will treat others as if they are teammates. Yes, that includes our family, especially the kids since school is closed. It also includes our staff, our patients, grocery store workers, gas station attendants, vendors… simply everyone.


It’s easy to “team up” with our coworkers, patients, and loved ones. It’s not as easy to unite with everyone else and not unusual for us to put everyone else into the “them” pile – just look how many grocery store workers were mistreated these last few weeks. After all, the presence of “them” helped us direct our anger at something.


Here’s my invitation to you: start treating “them” as your teammates. Social distancing doesn’t mean emotional distancing. On the contrary, the farther apart we are physically, the more we need to stay connected with each other. In business, now more than ever, this concept of connecting, partnering, and collaborating is the secret to surviving this impactful healthcare crisis.


I want to share a shining example of such a partnership as a solutions provider with The Beryl Institute. ImageFIRST Healthcare Laundry Specialists has been a partner with the Institute since 2016 and, like other solutions providers, we were looking forward to participating in the 2020 Patient Experience Conference. During a recent call with my contact Russell to talk about the unavoidable need to transition the conference to a virtual event, I was struck by the level of caring and concern he showed during our initial chat. The conversation started with Russell asking about my family and our health. He continued by asking, “How can we get through this together?”


To me, these words reflected how I’ve always experienced The Beryl Institute: caring, compassionate, supportive. I felt like a teammate. Switching to a virtual conference was not going to be easy, but Russell made it abundantly clear that the Institute valued its partnership with ImageFIRST above all else. I was personally grateful for such a collaborative and caring approach to this change.


Strong partnerships are the backbone to survival during tough times like we are experiencing today. Currently, the healthcare landscape is unrecognizable, with non-emergent facilities closed, temporary overflow hospitals opening, and a flood of patients expanding the need for more scrubs, clean curtains, and reusable isolation gowns. That is why we at ImageFIRST have worked with each of our clients to accommodate this increased need, ensuring we can provide safe, sanitized linen and uninterrupted service to them during the COVID-19 pandemic.


Emergency situations can often lead to new relationships, and that is what ImageFIRST has experienced during the crisis as well, and another great example of partnership in a challenging time. Teaming up with many new healthcare providers who are struggling, we have been able to keep up with the heightened linen demand of our healthcare customers to keep the heroes on the front lines safe; clearly an example of “better together.”


Finally, as a healthcare solutions provider in our new existence, ImageFIRST is making the health and safety of our associates and customers a top priority by increasing our infection prevention processes. Through teamwork and partnerships, patients and staff can be confident their linen is as clean and safe as possible.


At the end of the day, there is no “them.” Starting now, why don’t we begin treating the people in our lives as teammates so we can work together to get to the other side of this crisis. Let’s dig deep and bring out our best, so we get through this together – socially distant, yes, but united!


Magali Tranié is the Executive Director of Marketing for ImageFIRST Healthcare Laundry Specialists. Magali has been partnering with internal and external customers for over 20 years, building strong relationships and mutually beneficial programs. She has worked with local, national, and global teams towards common goals and has been called a “consensus builder.”

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Serenity Despite Chaos: Finding Peace with Anxiety and Grief

Posted By Melissa R. Thornburg, MA, Thursday, April 30, 2020

With COVID-19 currently monopolizing our daily lives, many of our previously normal routines have drastically changed. From how students are educated to where and how we work, to how we access food and other goods that we need, to how we socialize (or not) and what distance we keep from those we love, this worldwide pandemic has forced a new “normal.” This sudden, but also gradual upheaval has left some safe at home and others still actively working outside the home. However, for all of us, this transition has surely caused a myriad of emotions that can be confusing and hard to pin down, because, just like our routines, our emotions may not be “normal” due to this unprecedented worldwide collective experience.

What is it that you’re feeling? Are you anxious, scared or sad? Are you somewhat relieved because you’ve been forced to slow down and breathe, but worried about your job, finances, and the quality of digital education being provided to your children? Maybe you have cabin fever and are longing to step out, eat at a restaurant or take in a live show? You are missing something, perhaps, and longing for something else. You might feel discouraged, but hopeful that things will soon change and be better. It is confusing, frustrating and chaotic. You may be experiencing both anxiety and grief.

As a psychologist and through my previous role as the Director of Patient Experience at a large healthcare system, it is in my nature to look for peace when experiencing anxiety and grief. Having personally experienced several heartbreaking patient and family encounters in healthcare and hearing and watching news of our courageous frontline staff facing this every day, I wanted to offer some details around how to provide serenity for our healthcare heroes despite the current chaos. I know that it seems highly unlikely given the current pace of work in some of our most significantly affected healthcare systems, but in some way or another, it is possible.

Starting simply, it seems that the effects of sincere gratitude and appreciation both in and out of the workplace have been researched extensively. From that, we’ve learned a heartfelt and genuine “thank you” delivered in person or hand-written can make someone feel appreciated, help motivate them to do more, and can also have a positive effect on their overall health and well-being. This can be accomplished by anyone, whether it be a leader, a coworker or someone from a different department that recognizes how hard staff are working. Even without a budget or extra staff, this simple and effective skill of showing gratitude and appreciation can help during our current COVID-19 chaos. Start with saying thanks, then acknowledge the hard work of all those hospital employees, validate their feelings of anxiety, despair, frustration and grief. Let them know that it is real, it is normal and it is okay to express those feelings without judgement.

Next, consider having a basket of individually wrapped snacks and coffee, water and tea. Put them in an “off stage” private space and allow staff to take 10-minute breaks to not only refresh their minds and spirits but also nourish their bodies. Small cracker packs, chips and cookies seem to be the most popular and accessible choices, but a variety of mixed nuts, trail mix and jerky sticks may also be a slightly healthier option and provide some protein to your busy staff as they go on with their day. Having fresh apples or other fruit is a consideration, but they may need to be washed and wrapped individually.

If you have additional resources, this break can be offered in a Serenity Room. As the Director of Patient Experience, my staff and I found a rarely used conference room that was being used as more of a storage room. With permission, we cleared the room, cleaned it ourselves and developed it into a quiet, healing place for breaks. We put a note out to local churches, community groups, and supportive businesses asking for donations of a number of items including wickless candles, new Apple iPods for music, small desk-top fountains, sand trays, “twinkle lights”, aromatherapy diffusers, essential oils, black-out curtains and recliners. We also asked for individually wrapped snacks, water, scented hand lotions, sleep masks, gel sleep masks that be cooled in a refrigerator, word searches and cross word puzzles. We received several of these items, and others items were donated by staff members. We had enough to create two separate rooms just from the generosity of our community members and staff.

We blacked-out windows, set up comfortable chairs (a couple were unused reclining chairs from our OB unit!) and had soft music playing with the option to choose an IPod that had additional playlists and disposable headphones. We had snacks, aromatherapy diffusers and several essential oils that staff could choose from. We even had small absorbent sticker tabs the staff could put a drop of essential oil on and stick to their uniforms to enjoy for the rest of their shift. They could recline for a few minutes, do a mindless crossword puzzle, or close their eyes and just relax in a softly lit room. The room was well-used and appreciated.

If you don’t have access to all the resources above, try to convert an unused family waiting room temporarily (since visitation is restricted) or an unused family conference room. Use poster board to block windows, plug in a lamp with soft lighting, try to borrow some reclining chairs from OB, and create a simpler version of what is described above. The reality is that staff will appreciate any quiet space and an opportunity to briefly unwind.

Lastly, it is important to provide consistent and ongoing support to staff working the frontlines. To ensure that this is happening, gather a team of qualified crisis intervention and debriefing individuals to deploy as a Support Team, or what we called a Code Lavender team. In our healthcare system, a Code Lavender could be called during or after a sentinel event, a patient death, a staff crisis or a particularly difficult emergency room experience. When this was called, a team of individuals came with snacks, resources, and a willingness to debrief and provide support to the staff involved. Instead of having this as a reactive team for COVID-19, make it a proactive team by having these individuals available and rounding on busy spaces, checking-in on staff and offering support without “getting in the way.” These individuals can also staff your Serenity Rooms and provide quiet and gentle support for anyone who needs it. For more information on Code Lavender click here.

Whether you are able to say a quick but heartfelt “thank you,” offer snacks in a break room or Serenity Room, or even in an empty office away from the chaos, small opportunities to honor healthcare staff during this world pandemic will provide them with the care and support they need to continue to effectively treat their patients with compassion and respect. Look to your community to help provide some of the resources and look internally for skilled crisis intervention or counseling staff that are not currently active in their departments to be called on to make a difference for their peers. At the end of the day, every person deserves gratitude and appreciation, so don’t forget to take care of yourself, too!

Thank you for all you do for patients, families and staff members during this crisis.


Melissa Thornburg is a pCare Senior Performance Improvement Coach. In this role she assists clients on how to use real-time patient feedback and education for performance improvement on key strategic initiatives. Previously at the Planetree organization, Melissa worked as a Patient Experience Advisor with the VA and other organizations both nationally and internationally. Prior to Planetree, Melissa worked at the Cleveland Clinic as Director of Patients First, Experience Facilitator and Patient Experience Champion helping to establish several Patient and Family Advisory Councils and to lead both system-wide and local patient experience initiatives. Melissa earned a Master of Arts degree in clinical psychology from Western Michigan University, and a Bachelor of Arts degree in psychology from Niagara University.

Tags:  anxious  community  COVID-19  patient experience 

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Virtual Care Visits: Delivering Care that is Patient-Centered and Compassionate

Posted By Theresa Dionne, MA, CPXP, Thursday, April 30, 2020

Virtual care visits, once a “nice-to-have” for patients and providers, have quickly become a “must have.” Due to COVID-19, healthcare professionals across the United States have been propelled into the future of virtual medicine as a means of necessity to continue delivering care to patients. The response to the question asked by many providers, “How will we continue to compassionately care for patients and keep them safe?” has been answered and answered swiftly. Some would say old school is the new school; we are “going back to the future” in that doctor visits are at home again as in days past. Virtually, that is.

Now that many healthcare organizations are up and running and connecting with patients via various platforms such as Apple FaceTime, Google Duo, Skype, and Epic Video Visits, providers want to maintain great patient-centered, compassionate care but are concerned with how best to preserve patient-provider engagement.

As a provider, you demand best practices for your in-person care patient visits and the same holds strong for virtual care visits. Virtual care visits invite a multi-dimensional response to the way healthcare is delivered. Providers want to ensure professional, safe, efficient care, while ensuring privacy and quality are honored. At the same time, patients, even those truly welcoming virtual care visits, are entrusting this virtual method of care delivery.

For various reasons, some may struggle and resist virtual care visits, while most will support them. In time, this will be a win-win for providers and patients. These days, for many reasons, we find patients of all ages embracing telecommunication technology for medical treatment. For some, not having to take time off from work or limiting travel time to receive care is also greatly appreciated. For others, receiving virtual care is simply expected in this day and age.

We hope the following is useful advice for providers asking, “How do I continue to honor the provider-patient relationship during virtual care visits?” The answer is threefold: 1) trust the technology; 2) trust yourself; and 3) trust your patients.

1.     Trust Technology: Practice, Practice, Practice


a.     Attend and review training sessions offered until confident; rally with fellow colleagues to share best practices.

b.     Know the various Virtual Care Visit platforms available. Have your organization’s IT number handy for when concerns arise.

c.     Be sure to document clearly, connect with the patient portal and know the appropriate billing and coding instructions.


2.     Trust Yourself: Represent the best of yourself


a.     Review the patient’s medical concern and history; set an agenda, ask clear questions and take a thorough history of present illness. Clinical guidelines apply to virtual care visits just the same as in-person visits. Utilize Shared Decision-Making concepts. This may sound like, “Hello Mr. Chance. I looked at your medical history before our video visit.  I understand you are having some headaches. First, let me ask you some questions to help get a better understanding about your headaches. Then we can talk about your thoughts and concerns of how to manage your care.

b.     Always make a personal connection as you begin. Use the patient’s name and maintain comfortable eye contact. If this is a first virtual visit, reassure and invite the patient to ask you questions at any time. For example, you may say, “Mrs. Rose, I want to make sure I do a great job caring for you.  Please ask me questions as we visit here. I LOVE WHEN PATIENTS ASK QUESTIONS!” And don’t forget to smile, which is especially needed these days!

c.     As you close the virtual care visit, express thanks and explain next steps, such as, confirm where the patient will pick up their prescription, schedule a follow-up visit and/or advise who will call them back as needed. You may close with, “Thank you, Mr. Norman, for meeting with me by video and sharing your medical history. What questions do you have regarding what we talked about today before we end our visit?  Please confirm the name and location of the pharmacy you choose. Also, remember Maria will call you in two days to schedule your follow-up visit.”


3.     Trust Patients: Patients want to learn from you


a.     Share your screen to invite patients to see important images such as lab results; encourage them to take notes of any instructions or write down follow-up questions they may want to ask. This may sound like, “Miss Mary, can you see the chart on the screen clearly?  Let’s talk about what we are looking at.”

b.     Utilize the “TeachBack” tool to ensure patient understanding. TeachBack sounds like this, “Ms. Maple, I want to make sure I did a good job explaining your follow-up care. In your own words, please tell me the three steps we talked about regarding your new medication for heartburn control.”

c.     Invite patients to share what they appreciated about the virtual visit and how you can improve their experience. Invite their input by asking, “Tell me Mr. Smith, are you comfortable meeting with me on the computer this way? What can I do better to improve your experience?”


This advice is intended to inspire you to continue to provide the excellent compassionate care you deliver to patients.

As we observe social distancing, healthcare professionals are finding that virtual care visits provide an alternative way to compassionately connect with patients. Delivered effectively, virtual care visits will maintain the trust of your patients while keeping them, yourself and your team members safe.  


Click here to review a web-side manner tip-sheet.



Theresa Dionne, MA, CPXP, Consultant, Patient Experience, is a communication specialist and celebrates over 10 years in Patient Experience. In 2016 she joined Methodist Medical Group in Dallas, Texas. In addition, Theresa 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.

Theresa Dionne, MA, CPXE, Consultant, Patient Experience, is a communication specialist and

Tags:  connection  COVID-19  social distancing  technology  virtual care visit 

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“We all get to choose how to fill our cup each day and the attitude we will have about today’s crises”: Maintaining the care experience in the face of COVID-19

Posted By Julie Danker, Wednesday, April 1, 2020

Healthcare as we know it is being challenged more than ever before, and while we are all struggling to stay safe, delivering quality care while taking precautions, we still want to make sure that we are providing a great patient experience. While patient and staff safety supersede everything else, patient experience must be woven into the management of COVID-19 in order to overcome the literal and figurative isolation our patients and families are feeling. How do we continue to factor in the human experience in healthcare as we manage this pandemic and the separation and loneliness it creates for our patients and families?

Quarantining is essential to reducing the risk and spread of viruses like COVID-19, and yet it feels so dehumanizing. Being unable to provide a personal touch, express nonverbal gestures that often ease anxieties and show how much we care can be as hard for the caregivers as it is for the patients. Patients are closed off in their rooms. Signs are hanging on the doors to warn others before entering, and personal engagement and comfort is incredibly limited and even discouraged. Staff are having to gown, glove and mask-up before they walk into each patient’s room, decreasing the frequency of patient/caregiver interaction. Adding to this, patients are being cut off from having personal visitors at a time when they need support and advocacy more than ever before. This is a lonely, scary and unpleasant experience for everyone. This is the reality of what our patients are experiencing right now.

Yet, as leaders of patient experience, it is our duty to be an advocate and to help the patient and the caregiver through this difficult time. How do we do this?

What initiatives can we create to make sure quality care is happening?

How do we keep employees’ morale up, keep them safe, allow their concerns to be heard?

How do we create genuine advocates in every staff member, regardless of his/her role?

Here are a few things that the care team can do to help everyone through this challenging time:

  • Doing simple acts of kindness
  • Making eye contact
  • Leaving a special note on the white board
  • Keeping the sheets clean and the room tidy
  • Making sure that patients’ basic needs are attended to daily
  • Responding timely
  • Communicating with patients on their care plan
  • Encouraging patients to ask questions to reduce worry and alleviate anxiety

Through these actions, staff will find their work more rewarding by engaging more with patients and each other, while patients will appreciate the elevated care experience. 

Patients are frightened. The staff are frightened. As healthcare faces COVID-19, empathy can defeat fear. By working together, supporting one another and providing empathy, we can all find the WHY in what we are doing. We all get to choose how to fill our cup each day and the attitude we will have about today’s crises. Staff need you more than ever now. Reassure them, let them know their feelings and fears are valid and heard. They are not alone and not expected to do this alone. Support one another, and you will find that your support trickles down to the patient. 

This is how we will get through this: leading by example and maintaining care experiences that are comforting and safe. These actions will help us all to transcend this crisis and allow all of us to meet the goals we are striving to achieve through this difficult time and beyond.


Julie Danker, Chief Experience Officer for Smart-ER is passionate about Patient Experience and capturing the voice of the patient. Julie has worked many years in healthcare providing Social Work, Case Management, Patient Advocacy and functioning as the Director of Patient Experience. Julie is a Licensed Clinical Social worker and also holds the CPXP certification. In her role at Smart-ER, which is a Stage 2 technology company that automates communication the day after a healthcare encounter to check patient wellbeing and uncover any service issues, she has been able to learn a lot from the voice of the patient and improve services for providers and consumers. Julie enjoys spending time speaking nationally on this topic and working collaboratively with other organizations on improving the experience for all.

Tags:  #patientexperience #patientsincluded 

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“Doctor, you make me feel better every day!”: A patient encounter reflecting an etiquette-based approach to physician-patient communication

Posted By Sidra Javed, FRCPC, M.B.B.S, Monday, March 30, 2020

He was an old Italian gentleman with a complex medical background. An acute diarrheal illness brought him to the hospital, but his chronic issues had flared up keeping him in the ward for another week. He was angry and frustrated.


As soon as I entered the room, he exploded, “Check me and send me home. Do you have any idea how many things I have to do at home?”


This was my first encounter with him. I looked at him blankly, as I was trying to understand what was going on inside him. He sounded baffled. I sat quietly at his bedside, gave him  a little more time to vent. Eventually, he leaned forward and said with yearning, “Listen! I want to go to my granddaughter’s graduation and a Father’s Day dinner tomorrow.”


I replied, “Why not? We can make some arrangements for a day pass while we work on your discharge planning.”


“Can I really do that?” he asked in amazement. He appeared to be a little child who wanted to go to a toy store.


I left him with excitement to make arrangements for the day pass.


My patient was able to attend both events and was very thankful to the team who managed his care plan while he was out of the hospital. I sat with him for 10 minutes to listen to how the events went. He enthusiastically started to give the details of every step. His face was glowing, and his eyes were shining while he talked about his loved ones.


To add to his delight, I gladly announced, “You are going home tomorrow because we’ve arranged IV antibiotics for home.” He looked at me and exclaimed, “Are you sure this is not a joke?”  I laughed and left his room to let him enjoy the moment.


The next morning, I got the news that he had fallen overnight and fractured his arm. It was a non-operable injury, and he required rehabilitation to be functionally independent at home. It was now time for me to sign the patient over to another care team. I jogged to his room and sat down at his bedside.

There was nothing in his eyes other than darkness and frustration. He was resentful yet thankful, a surprising and unexpected response. He said, “You talked to me for a long time the other day and tried your best to get me home. That day, I felt refreshed for the first time in several days. I want to tell you one thing. Doctor, you make me feel better every day!” he exclaimed. “Please stop by later to say hi if you can!” he requested.


He made my day, yet his response left me with the question: What did I do differently?


Physician-Patient Communication


One of the core clinical skills to practice in medicine is to develop excellent communication. The conversation does not necessarily need to be detailed or even relevant. Kneeling at the bedside and asking the patients about their experience in the hospital reflects that you care about them.


Often patients do not just need evidence-based medicine to appreciate healthcare as much as they need etiquette-based medicine, which is demonstrated when a physician is respectful and attentive and practices good manners.1 A patient needs a good and active listener with interpersonal skills. Effective doctor-patient communication is determined by the physicians’ bedside manner, which patients judge as a major indicator of their doctors’ general competence.2

Terry Canale in his American Academy of Orthopedic Surgeons Vice Presidential address said, “The patient will never care how much you know until they know how much you care.”3

We in healthcare know that intense medical training and burn out, particularly during residency, suppresses empathy and often results in derision of patients.4 We are not born with this skillset; we learn it through our experience and exposure. Empathy is one of the most powerful ways to support our patients, reduce their feelings of isolation and validate their thoughts as normal and to be expected.5




As physicians impacting patient experience, there is nothing to do significantly different in healthcare than to spend a few more minutes acknowledging patients’ concerns and helping them realize we care about them. We need to honor our patients’ autonomy and dignity by considering them first as human beings and then as patients. Training for an etiquette-based approach to patient care would complement rather than replace training of physicians to be more humane.1. It is a critical core competency that as resident physicians we are expected to achieve.




1- Kahn, M. Etiquette-based medicine. N Engl J 2008;358:1988-89.

2- Hall JA, Rotes DL, Rand CS. Communication of affect between patient and physician. J Health Soc Behav. 1981;22(1):18-30.

3- Tongue JR, Epps HR, Forese LL. Communication skills for patient-centered care: research-based, easily learned techniques for medical interviews that benefit orthopaedic surgeons and their patients. J Bone Joint Surg Am. 2005;87:652-658.

4- DiMatteo MR. The role of the physician in the emerging health care environment. West J Med. 1998;168(5):328-333.

5- Ha JF, Anat DS, Longnecker N. Doctor-Patient Communication: A Review.  The Ochsner Journal. 2010;10:38-43


For more information, contact:


Sidra Javed, FRCPC, M.B.B.S: PGY5, General Internal Medicine

Cumming School of Medicine, University of Calgary, Canada,


Dr. Sidra Javed is a General Internal Medicine fellow at the University of Calgary, Canada. She graduated from Pakistan and had the opportunity to closely observe cultural differences that shape a patient care approach. She is a strong advocate of patient safety and healthcare quality improvement by evaluating organizations through the lens of a person/family that needs care and service. She is embracing patient and family involvement in decision making and gaining further skills through People-Centred Care Leadership program offered by Canadian Healthcare Association (CHA) Learning, a division of Healthcare Canada.

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Empathy in Times of Crisis

Posted By Helen Riess, M.D., Tuesday, March 17, 2020

We are facing a critical time of fear and uncertainty with the invasion of the novel Corona virus on the world stage, when healthcare organizations are scrambling to keep patients and workers safe, informed and calm. When fear takes hold, we can expect reactions to follow along a continuum from frank denial to full scale panic. Both of these extreme responses are not only unhelpful, but dangerous.


When people raid grocery stores or hospital shelves and stock up on more hand sanitizer, alcohol wipes or face masks than they could possibly need, they leave others vulnerable to infection and with even greater fear and loss of control. In a time of crisis, we need to worry about other people as much or even more than ourselves.

Many regard empathy as merely a soft emotion of feeling sorry for others. Empathy is a powerful tool in times of crisis (see more at TEDx The Power of Empathy.) Our hard-wired capacity for empathy involves both cognitive and emotional centers of the brain, and when effectively harnessed together, can help leaders provide truthful, caring, and helpful information while at the same time remain calm, steady, and decisive. Empathy is a crucial part of emotional intelligence that leaders need to employ in times of crisis.


How does empathy relate to emotional intelligence (EI)? EI is the ability to practice: (1) self-awareness (2) other awareness, (3) self-management, and (4) relationship management. Being alert to these practices and actually putting them into action through empathy can greatly impact overall health and well-being – of ourselves as well as others – during a healthcare crisis.




Self-awareness means recognizing your own emotions. Before springing into action, you must first assess your own mental states so you can manage them. Many empathetic people are better at perceiving the emotional needs of others than their own. Just as oncologists must steady themselves before delivering bad news so they don’t inflict their own stress onto their patients, you must recognize your own emotions. Self-awareness also involves understanding your own vulnerabilities and remembering what you need to do to remain calm and safe. In our current crisis, this means you must take into account how your decision-making may be influenced by your emotional state, and then adjust your choices accordingly.


Other-Awareness and Empathy


Every human being has a longing to be seen and understood, and this longing becomes much more acute in times of crisis. “I see you” is the meaning of the Zulu word for hello, “Sawubona”. It is also what opens the gate for other-awareness and empathy. It takes intention and openness to take in the emotional and physical expressions of others. Instead of looking at a waiting room as a sea of humanity, it’s important to see each person as an individual. Just a kind look in the eye or using the person’s name more than once in a conversation will help people know they matter.


Other-awareness involves not only appreciating the feelings of others but also understanding their perspectives and life circumstances. This capacity allows us to move beyond the chief complaints people have to valuing their chief concerns. Patients or co-workers who seem to be over-reacting to the current health crisis likely have some legitimate reasons for their fears. Genuine interest and careful listening will be necessary during this healthcare challenge to prevent dismissing concerns or labeling others. Showing empathy in this way will help calm fears and enable others to make rational choices for the care of themselves and others.


Self-Management and Self-Empathy


Implementing the tools that work best to calm your own fears requires knowing yourself and understanding your need for self-empathy. Contrary to popular belief, self-empathy is different from selfishness. It’s very hard to take good care of others if you neglect yourself. Self-empathy does not mean “I care more about myself more than you” but rather, “I need to take care of myself so I’m able to take care of you.” Every healthcare provider and staff member needs their own unique tool kit for self-management and know when to use it. And when we are asked to use social distancing and self-quarantine to avoid virus exposure, we do this to help both ourselves and others.


Relationship Management


The secret to effective relationship management is empathic listening and seeking to understand others’ feelings, thoughts and circumstances. It is essential to finding common ground. In a crisis, we need to relay facts with empathy and clarity. False assurances are worthless and cause greater alarm when truth is revealed. In other words, spreading false hope is destructive. True empathy requires the ability to tune into the fears and concerns of others and provide the best recommendations, even if they are not what people want to hear. It is walking the fine line of perceiving and taking care of immediate emotions while not losing sight of what is the best medical care in the long term. No one wants to hear that his/her normal routines and practices are now curtailed, but when focused on the long-term health of our society, the short-term restrictions make sense.


The Power of Empathy: A Call to Action


At this time of international emergency, there’s an urgent need for global empathy. The current situation calls for us to empower ourselves and others to collectively come together, bringing our best selves to the forefront to overcome this global health crisis. Far from the notion of survival of the fittest, where the strongest individuals only take care of themselves, we need altruism, cooperation, and collaboration to save our society as a whole. It is time to think about our patients as individuals, as well as our neighbors, co-workers, friends and family, and do what we can to support one another and to ask for help when we need it ourselves.


Helping each other is what brings us together and enlivens our spirit and our communities, and it is needed now more than ever, locally, regionally, nationally, and globally.


Dr. Riess is a psychiatrist and Associate Professor of Psychiatry at Harvard Medical School. She directs the Empathy and Relational Science Program at Massachusetts General Hospital. She has devoted her career to the art and science of healing relationships. Her research has been published in leading medical journals and has won many awards. Dr Riess's TEDx talk "The power of Empathy TEDX" has been viewed by more than 500,000 viewers. Her new book, The Empathy Effect has been licensed in nine foreign countries. In 2012, Dr. Riess co-founded an organization that provides evidence-based empathy and communication skills training for healthcare and education. Dr. Riess and her teams are dedicated to transforming healthcare systems into compassionate care systems. 

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