Posted By Sara Laskey,
Friday, July 20, 2018
Updated: Monday, July 16, 2018
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Silos. We talk about them all the time in our healthcare systems. We talk about how much easier it would be if we could break down the silos or work across them. We talk about this because we know that when we collaborate and learn from each other we create an experience that is easier for providers and better for patients and families.
But, even we in the experience and engagement world can find ourselves working in our own silo. As healthcare experience leaders, we work in one of the largest ‘customer service’ systems in the world, but how often do we wander outside of healthcare to explore how other industries are managing and dealing with what are often the same types of issues that we deal with daily?
Yes, I know, a bad fitting shoe is not a broken arm, and a missed airline connection is not the same a missed diagnosis. However, many industries deal with lots of consumers in various states of emotional distress and anxiety (think airlines), regulations (banks, insurance) and strive to meet the needs of those customers in ways that we in the healthcare space could learn from.
Recently, I had the opportunity to participate in the Consumer Loyalty Forum. This was an interactive 2-day session of high-level customer experience executives from organizations including MasterCard, Etsy, Hilton Hotels, Ally Bank, DFW Airport, Stratifyd, Hallmark, AARP and representing healthcare – me, from The MetroHealth System.
My key takeaways to share:
Voice of the customer:
We hear from our patients through many sources: surveys, complaints and grievances, social media, posted reviews. For all the data we have, how well are we collecting, analyzing, understanding and applying this information in a meaningful way? Many organizations are using tools that bring all this information together in ways that look not only at the sentiment but at the volume of the sentiment. They try to use the where/what/when information to help determine top issues for their organizations and drive change. By bringing everything together into a ‘single source of truth’ it becomes easier to quantify what customers’ top issues are. For a healthcare system this can be very meaningful.
I came back and looked at the top three issues from my System’s complaints and grievances in 2017. Then I looked at the top 3 negatives comments from my surveys during the same period. Not only were 2 of the 3 different, there was a 10X difference in the volume of issues brought up in the surveys. (800 complaints about communication; 8,000 complaints about wait times). While I absolutely addressed the communications issues – my process improvement goals will focus on wait times. This also ties in directly with the strategic goals for my organization.
User Journey Mapping:
If you aren’t doing this - you should be. Identify any area of your system where you want to improve the experience and work with an organization to better understand the highs and lows of the user journey from every angle. It is the true basis of human-centered design and a key element of knowing where to focus energy, time and dollars.
Customers are drawn to the effortless experience. Each of the two above concepts help us understand where people using our systems are expending the most effort to obtain our care. The goal for many of the organizations at the conference was to create experiences that decreased effort and increased the engagement of their customers. Healthcare is well-positioned to do the same. As we know, so many things about being a patient are hard, obtaining care shouldn’t have to be.
I had much to learn from these experts from other industries and believe I had a thing or two to teach.
I was pleased to share that healthcare has key learnings to teach other industries as well. We have done a remarkable job in developing and spreading the culture of human beings caring for human beings and the idea that we are ALL the patient experience. The fundamental concept that everyone involved in the healthcare system has a role to play in implementing and managing an easy and effortless experience was one I could share with my customer experience colleagues. One I am hopeful they will take back to their teams.
Dr. Sara Laskey was the inaugural CXO for The MetroHealth System in Cleveland Ohio. In that capacity she was responsible for all aspects of human-centered design and improving the experience for patients, families, visitors and staff. During her tenure she created three progressive culture-change programs culminating in the transformative “Caring People Caring For People – Welcome. Listen. Care.” workshops. Currently she is consulting for healthcare systems and progressive healthcare technology firms.
improving patient experience
Posted By Sarah Suddreth,
Friday, June 22, 2018
Updated: Tuesday, June 19, 2018
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A patient’s first interaction with a healthcare organization sets the tone for his or her overall experience. In fact, it only takes two negative phone experiences to diminish a patient’s view of his or her healthcare provider1. In non-emergent situations, the patient’s first touch is most often a phone call. Since the patient experience begins on the phone, your staff’s ability to consistently execute on every patient call is crucial.
Just think about the ease of today’s landscape: We order groceries to our doorstep, request cars from our couch to take us virtually anywhere and have prescriptions refilled by pressing a button. Almost every task is performed over the phone; we are increasingly turning to our handheld devices to fulfill our wants and needs.
Your patients expect the same ease and accessibility when scheduling an appointment or interacting with your healthcare organization at all. Let’s give them the most optimal patient experience every time that phone rings. They deserve it.
What should scripting look like on a patient call?
1. Identify yourself and your health system or practice.
- “Thank you for calling [Your Provider Name], this is [Your Name], how can I help you?”
- Assert that you can help and collect the caller’s information.
- “I can help you out with that. Whom do I have the pleasure of speaking with?”
- Ensure that you refer to the caller by name throughout the conversation to establish rapport and a personal connection.
2. Knowledgeably answer questions and collect necessary information.
- Be prepared to confidently obtain information and answer questions regarding:
- Accepted insurances
- Cash discounts or payment plans
- Services offered in office
- Schedule availability for particular services
- Consultation / initial exam price (for emergent care)
- Address and hours
- When someone calls in asking questions, that caller is likely looking to book an appointment. After obtaining all needed pre registration information, request the appointment. If the patient’s answer is yes, offer at least two different appointment times.
“Is morning or afternoon better?” “Morning, great! I have an appointment available at 9:30 Wednesday or 8:00 Thursday. Which do you prefer?”
3. Provide the Optimal Patient Experience
- Increase your appointment show rate and set the caller’s expectations for next steps. “We have you down for 8 a.m. on Thursday. Be sure to arrive 15 minutes early to complete initial paperwork. Do you know where our office is located?”
- Let the patient know what’s to be expected upon arrival for the appointment, such as check-in steps or needed documentation for the appointment. This is also a good time during the call to discuss payment expectations. Increase your cash collections by articulating what the patient should expect to pay, or collect it over the phone.
- When wrapping up the call, provide instructions for what the patient should expect to happen next. If he or she will be contacted by another individual to confirm paperwork and financial responsibility prior to the visit, make that known. Finally, do a self assessment. Did the patient feel at ease? Did you receive the necessary documentation and payment information? Is there anything that needs to be looked at again?
- “Thank you so much for calling XYZ Health System. We look forward to seeing you on August 8 at 11:15 a.m. Be sure to bring your insurance card and desired form of payment with you. Is there anything else I can help you with today?”
Proper usage of scripting on calls is homologous with an unparalleled patient experience. It puts patients at ease and strengthens provider-patient care. Having said that, for a health system to offer that white glove experience for patients calling in, there needs to be constant feedback on key performance aspects of every phone call, rather than just a sample call size. Other than scripting, what is your health system doing to monitor and enhance the patient experience on every single patient call?
1. “Consumer Survey Reveals the Customer Care Experiences That Most Impact the Relationship Between Cable Operator and Subscriber.” CSJ International Press Release. May 12, 2010.
Sarah Suddreth is a proud member of The Beryl Institute and Director of Business Development at Call Box, the leading telephony and artificial intelligence technology firm that works with health systems and providers to present more insight into their phone calls. Healthcare providers turn to Call Box when both internal and external patient experience issues continue to arise over the phone. Living in Dallas, Sarah works with healthcare executives across the nation to enhance Patient Access and Experience standards for patient interactions over the phone.
Posted By Anthony Orsini, D.O.,
Wednesday, May 16, 2018
Updated: Wednesday, May 16, 2018
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One of the hottest topics in medicine today is the continued growth of telemedicine.
According to a survey by Jackson Healthcare, Telehealth is expected to grow in the U.S. by 27.5%, reaching $9.35 billion by 2021. It is estimated that by the end of this year alone, the number of patients using telemedicine services will reach 7 million, with 44% of private practices making the development of telemedicine services, their number one priority. This approach is especially popular in rural areas where accessibility to physicians can be difficult.
As an increasing number of patients choose telemedicine as a more convenient option than emergency or urgent care visits, the challenges that physicians and other healthcare professionals face to build relationships with patients have become even greater.
The communication techniques healthcare professionals use to build trust are even more important during physician-patient video conference calling. The impersonal nature of communicating via screen amplifies the need to focus on communication techniques that build trust between the physician and patient. Without trust in their healthcare provider, patients are less likely to follow their treatment and have poorer outcomes.
Healthcare providers can use the following communication techniques to build trusting relationships with patients during telemedicine visits:
- Give the patient your undivided attention - It is easier to forget during videoconferencing that the patient is watching and interpreting your body language. Remember that 70% of all language is non-verbal. Take limited notes during the conversation. Writing or entering data in the EMR (electronic medical record) during conversations is perceived as multitasking and not interpreted by patients as being thorough. Be aware of your facial expressions. Since the patient cannot see your body positioning, he/she will be watching you even more closely than if you were in the same room. Your facial expressions can either be interpreted as compassionate, disinterested or rushed. The perception of eye contact can be felt even through video.
- Remember that each interaction with a patient is a conversation and not an interview. Don’t interrupt or ask follow up questions before the patient has finished speaking. Patients are even more sensitive to the feeling of being rushed during telemedicine. It is very important to let them feel that even though you may not be in the same room, they are the most important person to you at that moment.
- Be a genuine person. Although healthcare professionals will often be video conferencing with patients they have never met before, there is still an opportunity to form a trusting relationship in a short period of time. Today’s patient wants to interact with their healthcare professional on a personal level. Avoid the “all business” attitude. Relate on a personal level. Ask the patient where they are from and find a common interest if possible to help form that relationship.
By all accounts, telemedicine will play a large part in the future of healthcare. It has the potential for dramatic cost reduction, increases in healthcare accessibility and improved patient satisfaction. It should not be a replacement for the strong relationship between a patient and his/her healthcare provider as that is critical to any healthcare visit. By learning proper techniques in compassionate communication, healthcare providers can build relationships even through video conferencing.
Dr. Anthony Orsini, Founder and President, BBN, is a full-time neonatologist and expert in compassionate communication in medicine. He is currently the Vice-Chairman of Neonatology at Winnie Palmer Hospital in Orlando, FL. He also serves as the President of BBN, the organization he founded in 2012 that offers training services to educate professionals in the art and science of compassionate communication.
improving patient experience
Posted By Chris Anselmo,
Monday, March 5, 2018
Updated: Tuesday, March 6, 2018
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I will never forget the feeling of despair.
It was October 2011, and I was sitting in my neurologist’s office, staring blankly at the floor, devastated. I had urgently scheduled the appointment after recent developments in the progression of my muscle disease, Limb-Girdle Muscular Dystrophy Type 2B (also known as Miyoshi Myopathy). Two weeks prior, I had fallen for the first time in my life, at the ripe age of 25. I was walking to the store when my right knee gave out and I crumpled into a heap on the sidewalk. I thought that moment was devastating in its own right, but I had no idea the worst was yet to come.
The neurologist, whom I had seen twice before, was overall a nice guy. However, in my moment of vulnerability and fear, his words were anything but comforting. After I detailed my fall, he nodded and proceeded to tell me how my life would have to drastically change. “You are probably going to have to move out of your apartment,” he told me dryly. I was living with my best friends in a two-story walk-up, and was starting to struggle on the stairs, so although it didn’t necessarily come as a shock, it was still tough to hear. I was going to miss my friends terribly.
Unfortunately, the news got worse. “You’ll also probably need leg braces,” he said. Leg braces? All I could think of was Forrest Gump, and how, while standing in the road with his braces, unrepentant bullies hit him in the face with a rock. The news I was hearing that day felt like the rock. When I pressed my neurologist on what I was to expect in the future, he sighed and said, “You will probably be in a wheelchair by 30. It is not a guarantee, but that is the likely progression with this condition.” I looked at my parents, who were with me, and could see the color drain from their faces. “I wish I had better news,” the doctor told me when the appointment was over. “Just hang in there.”
I left that appointment despondent. It wasn’t a death sentence, but it also wasn’t a ringing endorsement of the rest of my life. I have five years left of walking, I thought. It was all too much to process, made worse by the fact that he offered no positive encouragement to soften the blow.
Already down on my luck going into the appointment, I spiraled further into depression. What can I reasonably accomplish in life if I’m going to continue to get weaker every day? Are any of my goals and dreams realistic now? Will I have the courage to deal with the difficulties to come? My life, for all intents and purposes, felt like it was over.
A few months later, while desperately searching online for any shred of hope, I came across a neurologist based out of Worcester, Massachusetts who was well-versed in my condition. I quickly scheduled an appointment for June 2012. I figured, at minimum, he could explain the science behind the disease, and keep me up to date on any progress on the drug front. If I was lucky, he might even be personable and sympathetic.
In the first ten minutes of my appointment, he told me more about my disease than all my previous doctors combined. I knew I was in good hands. Yet it wasn’t his knowledge that ended up making the difference that day.
After examining my muscle strength and telling me about the latest scientific progress, he started asking me questions I didn’t expect. What are your dreams? What do you want to do in life? I hesitated, saying that I wanted to go to business school someday, but didn’t feel I could go through with it. I told him that I had aspirations of working in the healthcare sector, helping patients, but with my declining strength and energy, I didn’t know how I’d be able to hold down a job long-term.
After listening intently, he gave me one of the most important pieces of advice I’ve ever received: “Don’t let this disease prevent you from achieving any of your goals.” He then proceeded to share an example of one of his patients who had battled ALS while attending Harvard Business School, and another man with my condition who was a businessman and who traveled frequently all over the country. “It might take some extra planning, but this disease doesn’t have to dictate what you do with your life,” he said. “It is only a part of your life.” I left that appointment feeling a sense of hope and a renewed optimism that I hadn’t felt in forever. I remembered thinking, maybe my goals aren’t so unrealistic.
Six years have passed since that appointment, and I think back on that moment often. I took my neurologist’s advice and went back to school, graduating in 2016 from the fulltime MBA program at Boston College. Today, although my goals and dreams have changed slightly since that appointment, I am well on my way towards achieving them, even though my condition has progressed significantly. I used to obsess on losing my ability to walk by age 30, but I am happy to say that I am now 31 and still on my feet. Although a wheelchair is in my near future, it is not something I fear anymore. If anything, I look forward to the freedom it will bring. Having goals and dreams to work towards has been instrumental in the acceptance of what is to come.
I share all of this because I have seen firsthand that dreams often get overlooked in the patient experience. As healthcare professionals, you are taught to diagnose, to treat, and to show empathy. And you do a great job! If I can offer one piece of advice, I would say to take the time to ask patients about their lives – what their goals are, what they dream of being someday, or what they want to do with the remaining time they have left. Really get to learn what makes their heart sing.
Dreaming is part of what makes us human. For patients diagnosed with a disease or dealing with a life-altering injury, our dreams oftentimes get dashed. Our hopes for the future evaporate into thin air. If you can help to open the doors that have shut in your patients’ faces - even just a little bit - it can make all the difference in their lives. They trust you, they believe what you have to say, and in those vulnerable first moments post-diagnosis, they are looking to you to gauge what is still possible in their lives.
If you can give your patient the permission to dream again – there is no better cure.
Chris Anselmo is a 31-year old writer and motivational speaker living with an adult-onset form of muscular dystrophy called Limb-Girdle Muscular Dystrophy Type 2B (LGMD2B). A Connecticut resident, Anselmo writes about his patient journey on his blog, Sidewalks and Stairwells, www.sidewalksandstairwells.com.
Posted By Tom Scaletta MD CPXP,
Thursday, February 15, 2018
Updated: Thursday, February 15, 2018
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I think everyone today can agree on the importance of having communication tools to interact with patients and family members. However, in the era of value-based healthcare, doing a good job interacting with patients is not nearly enough.
At my organization, we have created a simple communication tool called G.R.E.A.T.™ that will help inspire a service-minded culture. This service standard helped us align our mission/vision/values with our culture and leads to enhanced patient satisfaction, improved care quality and a more engaged staff. Connecting on a deeper level with our patients and being mindful of their understanding of what is going on are essential components in achieving optimal outcomes.
A key component of the G.R.E.A.T. ™ is the ‘R’ that stands for ‘relate.’ To truly connect to our patients (or their family members), it is essential to have a personal conversation separate from the medical issues (of course, assuming the patient is not in any immediate distress).
An easy way to create a rapport with patients, across generations, is to ask about one’s aspirations or accomplishments.
- With younger patients, “What profession are you planning?”
- With middle-agers, “What is your profession?” and
- With older patients, “What was your profession?”
Such questions typically leads to some back-and-forth banter that creates a nice bond. You will find you like the patient more … and they will like you more. The content of the conversation is not important though it must be authentic and empathetic. This type of interchange will create trust, the foundation of the people experience, that of both patients and providers.
These conversations are beneficial not only for the patient but also the providers of care. A great patient experience requires a great provider experience and a great provider experience requires a great patient experience. The closer you get to your patients the further you get from burnout.
I would like to share a story of this in practice. I was working a typical emergency department shift with a great team and had a steady influx of patients all evening. At 8 pm paramedics rolled in with an elderly, demented lady from a nursing home with right-sided weakness that began yesterday. A CT scan uncovered a golf-ball sized tumor with swelling. She had a history of breast cancer so this likely represented a metastatic lesion. Typical care ensued -- fluids, steroids, comfort medications and a call to the hospitalist for admission.
I then phoned the patient's daughter (and power of attorney) to suggest that she and other family members begin discussing how aggressive they wanted the treatment plan to be. The daughter interrupted, "Doctor, could you just go to my mom's bedside and say 'Dr. Peters, you were right'?" After my "Huh?" she explained "My mom is smart and knows her body. She has a PhD in both psychology and religion. Last month, a doctor told us she has progressive, incurable dementia. When he left the room my mom turned to me and said 'Well, yes, I'm certainly more confused but I'm not demented. They just haven't figured out what this is.'"
So, I went to her room, sat down, described the situation, and ended with "Dr. Peters, you were right." She turned to me beaming with pride and confidence and said "I knew it!"
She certainly did.
I slipped a copy of her CV that I found online into her chart. I wanted everyone to know this amazing woman that all of us were privileged to care for.
Tom Scaletta, MD CPXP CPPS, obtained an undergraduate degree in mathematics and computer science and worked as an computer programmer before entering medical school. He completed a residency at Northwestern and is board-certified in emergency medicine and clinical informatics. Tom serves as the emergency department chairperson and medical director of patient experience for Edward Elmhurst Health.
While President of the American Academy of Emergency Medicine, Tom collaborated with the Emergency Nurses Association to create a Code of Professional Conduct. His white papers, “The Seven Pillars of Emergency Medicine Excellence” and “The Calculus of Patient Satisfaction,” were published by Medscape.
Tom designed the first patient callback system in 1996 and the first automated means of text/email contact and staff notification in 2012. His models were praised by the Robert Wood Johnson Foundation and Urgent Matters (George Washington University), an organization that evaluates emergency medicine innovations.
Posted By Rhonda Ramos,
Wednesday, November 1, 2017
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Service recovery is no foreign concept to the business world. It is a fundamental practice that can turn a negative situation into a positive statement about a company. Simply put, it is the process of making things right after something has gone wrong with the consumer’s experience. You see this common occurrence in retail, restaurants, and even airlines. Yet how can we adopt service recovery in healthcare?
Let’s face it, we’re not perfect. We fail to meet our patients’ expectations in numerous ways: excessive wait times, appointment scheduling problems, room/environment issues, miscommunication, and the list goes on. In the food service world, if I go out to dinner and a steak is not prepared the way I ordered it, the restaurant would probably remove the entrée from my bill. In healthcare, can we give a free prescription because a patient had to wait, or provide a coupon for a lab draw if the patient requires multiple needle sticks? Probably not.
In order to curb bad public relations since dissatisfied customers tend to tell others about their negative experiences, we’ve had to get a bit creative in healthcare. We know that the basis of all our interactions is communication; therefore, our service recovery program is grounded in the way we communicate during a complaint. We developed the acronym GIFT:
- Gather – Listen to the individual’s concern and validate their feelings
- I’m sorry – Offer a genuine apology for not meeting their expectations
- Feedback – Explain what you plan to do and follow up
- Thank – Thank them for sharing their concerns
These four simple steps provide a mental pathway as you’re attempting to diffuse a complaint. At UPMC Pinnacle Hanover, we carefully incorporated the Heart-Head-Heart communication method, which we adopted from the Language of Caring philosophy. By offering a blameless apology, we express ownership yet not necessarily assume fault. We involved our Patient/Family Advisory Council in the creation of this program, and they advised us that a genuine apology is the most critical element. The goal is to allow the complainant to feel heard, validated, and respected.
While most concerns can be resolved simply with proper communication, there are instances when it might be beneficial to offer something “extra” such as a gift card or other small token. CMS guidelines state that a service recovery item presented to a patient cannot exceed $10 per person or $50 in an aggregate year. (This is also under Department of Health and Human Services - OIG Advisory Opinion No. 08-07.) If a department chooses to obtain a supply of gift cards to various local vendors (restaurants, gas stations, etc.), they track them using our internal reporting system. Reports can be run, by patient, on a monthly basis to ensure that we are compliant.
One of the most important elements of this entire program is empowerment. Rather than only allowing a department head to resolve concerns, which could happen after a patient has already left the facility, we wanted to educate and empower each employee to utilize service recovery. By immediately responding to concerns and complaints we can create loyalty with our “customers.” We can create a learning culture that treats complaints as gifts, or opportunities for improvement, that steers away from a negative connotation to something more positive and patient-centered.
When an issue is identified and addressed before the patient is discharged, theoretically it will also help to reduce the number of formal grievances we receive. Unfortunately, it is difficult to quantitatively prove that our service recovery program has confidently reduced our number of formal grievances. However, we do know that there has been a shift in our culture and employees feel empowered to take ownership to provide quick and decisive action when something has gone wrong. And at the end of the day, that’s a win.
Rhonda Ramos is the Patient Experience Manager for UPMC Pinnacle Hanover and has worked for the organization for ten years. She is fluent in Spanish and started her career in healthcare as an interpreter and patient advocate. Rhonda grew up in Ellicott City, MD and currently resides in Hanover, PA with her husband and two children, ages 3 years and 6 months.
Posted By William Maples, M.D.,
Monday, September 25, 2017
Updated: Monday, September 25, 2017
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For physicians, a significant factor leading to optimal outcomes is to engage patients early on as part of the decision-making process. Understanding patients’ needs, along with their values and preferences, is critical to the success of your healthcare team.
However, we at The Institute for Healthcare Excellence have found that many times physicians don’t understand what their patients need or want from them. It takes effective patient communication—leading to an alignment of goals and expectations—to bring about positive outcomes and a stronger bottom line.
Patients need doctors who listen
What patients want most from doctors is to be respected and listened to. Technology and medical procedures may continue to evolve, but certain human needs will never change. Patients evaluate their relationship with a provider by asking: “Am I really being listened to? Am I being respected? Do you truly care about my health? Do you have enough time for me?” To get to “Yes” starts with doctors who listen well and build trust with patients.
The lost art of listening to patients
Physicians seem to have lost the art of listening to patients. On average, we interrupt our patients with an 18 seconds and often change what they really want to tell us. Research has found that up to 30% of the time, we completely miss why the patient is there to see us.1 It’s vital that we rekindle the skill of listening, of recognizing the emotions in the room and responding in a way that builds a trusting relationship with the patient and ultimately improves outcomes.2
In our work with health systems and hospitals to improve their patient satisfaction scores and medical outcomes, we’ve learned that creating an exceptional experience can lead to a culture of safety. As that culture of trust and teamwork grows, patient-adverse events begin to decline.
Physician leaders improve communication
The first step is to identify physicians who are ready to support initiatives that improve communication with patients. After all, the caregivers are the best choice to lead the effort, rather than having it dictated to them. Let’s not leave physicians out of the equation when they can play a major part in creating a high-quality experience for patients.
Of course, there’s never a perfect time to implement best practices for communication in healthcare. It takes patience and a deep commitment to nurturing a culture that’s built on relationship-based, patient-centered communication. It may be nine to 12 months before you see a measurable impact, and up to four years to realize the maximum benefit. Once that’s achieved, however, you can expect a fivefold return on your investment.
Better communication helps prevent physician burnout
One more factor to consider is that poor communication can increase the chance for preventable errors. When a physician is frustrated by inadequate communication with a patient, it can cause burnout—and that correlates to medical errors.
To help bring back the joy of practicing medicine physicians must build a meaningful relationship with patients. That involves learning to listen to patients, establishing a culture of trust and committing to executing a relationship-based communication plan. Often this approach surprises us as it does not take any longer. Meeting those objectives can transform the patient’s experience and lead to measurable, positive outcomes for you and your care team.
- Lipkin M, Putnam S, Lazare A. eds. The Medical Interview.
Clinical Care, Education and Research. NY. Springer-Verlag.1995.p.531.
- The importance of physician listening from the patients’ perspective: Enhancing diagnosis, healing, and the doctor–patient relationship. Justin Jagosha, , , Joseph Donald Boudreaub, Yvonne Steinerta, Mary Ellen MacDonaldc, Lois Ingramd doi:10.1016/j.pec.2011.01.028
William Maples, M.D. serves as PRC's Chief Medical Officer. Before joining PRC, Dr. Maples served as Senior Vice President and Chief Quality Officer at Mission Health in Asheville, North Carolina. Additionally, Dr. Maples serves as Executive Director of The Institute for Healthcare Excellence, where he and his consulting faculty employ a variety of strategies to improve patient experience and impact quality outcomes.
Posted By Kate O'Regan,
Friday, September 22, 2017
Updated: Monday, September 25, 2017
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I recently read Dr. Cordovano’s compelling case for a patient centric comprehensive medical records system in her recent blog. She opened with:
A patient was recently discharged from an exceptional hospital after a 2-day stay. During those 2 days, he saw endless doctors, attendings, residents, fellows, interns, nurses, nurse practitioners, nursing students, TV and phone service staff, physical therapists, social workers, case managers, housekeeping staff, spiritual chaplains, food and beverage staff, transport staff and discharge planners. Forgive me if I’ve missed anyone. All of these hospital employees play an essential role in a patient’s care at the hospital. There was just one person missing…
As my eyes honed in on the words “there is just one person missing,” I immediately think of the historically marginalized deaf community who continue to receive unequal and ineffective communication access to healthcare, something that can be achieved by using an effective and trusted interpreter. But the most critical piece, is an effective and trusted system of communication access that is patient-centric.
I want to recognize The Beryl Institute truth that healthcare can change by advancing an unwavering commitment to the human experience. I witness, too often, the deaf experience that is framed as less than human and that is fundamentally problematic.
Every day globally, deaf people experience a lack of an effective system, of awareness and of respect as humans. It is time to start to listen, advocate with and provide (give back) leverage to deaf patients, leverage that is often taken away from them at first glance.
To achieve a successful and sustainable care plan for deaf patients, here is what should be happening: budget for communication access, create an internal department or find a vendor who can manage your services locally and work with the local deaf community. Also, every deaf patient should have the opportunity to be greeted by a local deaf community advocate. This advocate will guide the deaf patient and medical professionals throughout the healthcare experience.
Every deaf person have different unique preferences to communication access. One deaf person with more moderate hearing loss might communicate using spoken English, but use an interpreter to effectively receive spoken English. Another deaf person with profound hearing loss might have a PhD in Business Administration, not fluent in spoken English and accesses health care best with an interpreter. A person who was raised in another country who just moved to America may not be fluent in ASL and would rather speech to text technology called CART.
Deaf people have different communication access needs and a lack of system to recognize this diversity leads to a lack of health care access. Health care organizations need to contract with an agency that understand the needs of deaf patients when it comes to access. If they don’t, there is a high risk of liability under federal law. Some hospital administrators choose to contract with national level technology companies to provide Video Relay Interpreting (VRI) services without the consult of the deaf individual which are consistently unreliable, ineffective, unlawful, and cause further oppression of deaf people lead to gross negligence of patient experience and numerous hospitals have been brought to court by the US Department of Justice. If healthcare providers truly value patient experience, we need ask deaf patients what is effective and then implement those services.
 A deaf person needs to be employed in this position or from a trusted locally deaf-centric advocacy organization. See DEAF GAIN #googleit
Kate O'Regan grew up in Montpelier, VT and is the Founding President of Civic Access. She believes in social entrepreneurship as a form of economic empowerment. She lives in Charlottesville, VA with her three children.
Civic Access, was founded with the philosophy that legally mandated services of communication access can support forward progress for deaf access in the public sector.
deaf patient experience
Posted By Brooke Billingsley,
Friday, March 17, 2017
Updated: Wednesday, March 15, 2017
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Patients spend little time thinking about the nurse’s list of tasks to complete. They aren’t aware of the excellent job their nurse did charting their care, how staff made sure safety precautions were adhered to or what it took to provide a meal on time.
Patients are functioning on an entirely different level. They are focusing on what they can control – which is very little – and how external forces are making it easier or harder to achieve their goals of getting better and getting out of the hospital. What registers with patients is ‘touch’ – those memorable moments in which staff made a genuine effort to connect with patients.
A positive transformation occurs in a patient’s perception of their care when touch is added to a task. That is certainly true with the Bedside Shift Report.
The BSSR is often misunderstood because it is seen as time consuming, does require effort, and for some, is uncomfortable. But the BSSR must be seen from the patient’s perspective to be fully appreciated. The benefits and value to the patient far outweigh the arguments against.
Consider what the patient sees when a fully functioning Bedside Shift Report is conducted:
- The BSSR allows patients to hear and physically experience how committed the organization is to their care and illustrates how unique and important their case is.
- Patients are very conscious of how staff interacts with one another through conversations and body language. The BSSR presents an opportunity to show unity and camaraderie, which patients ultimately associate with good care.
- Staff has the opportunity to give patients the assurance that they will receive the same great care from the new nurse as the previous nurse. It also increases the chance for mutual praise and promotion of the rest of the team.
- Because the Bedside Shift Report is not a patient expectation (they are not likely to say, “Hey, I think I should be in on that get together in the hallway,”) the act itself is (novel) and memorable lending itself to increased satisfaction.
- The BSSR demonstrates that time spent with the patient has value, which in turn shows respect for patients and their participation.
- Adding some personality to the process completes the recipe for a guaranteed touch opportunity.
There are a few additional things you should consider in making the transition to a Bedside Shift Report a successful one.
- Have a plan to determine what would be most beneficial for the patient to know and work out the details of the information exchange.
- Practice until it feels comfortable. In time this should become second nature.
- Communicate in a way that is most understandable to the patient.
- If the patient is not able to participate, include family if they are present.
And finally, when you formally conclude your time with your patients, the BSSR shows that you care enough to say good-bye adding touch to a required task.
Brooke Billingsley is the CEO at Task To Touch™ e-Learning & Perception Strategies, Inc. a healthcare perception research company. Brooke is a speaker, consultant and author.
bedside shift report
improving patient experience
Posted By Jeremy Blanchard, MD, MMM, CPE, FACP, FCCP and FACPE,
Wednesday, February 1, 2017
Updated: Wednesday, February 1, 2017
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“I was on the inside looking outside. The millions of faces, but still I’m alone… I hope we’ll be here when they’re through with us.”
When I hear Foreigner sing “Long, Long Way from Home,” I am reminded of conversations I have had with my colleagues, physicians and advanced practice clinicians (APCs). The world of medicine is so dynamic and different from when I started medical school in 1987. Many of these changes are good and have great intent, but many of the ramifications threaten core value attributes of our different generations of healthcare providers: autonomy, sacred relationships with patients, complex problem solving and the joy of practicing medicine. In these conversations the providers relate not having a voice, feeling like healthcare is changing without their input, and not for the better. They feel alone and not valued.
Being a caregiver seldom, if ever, starts from the perspective of practicing medicine as a business opportunity. It starts from a place of the desire to do good. As we enter medical school bright eyed, empathic and energized, what happens to us? Or at least how is our showing of empathy and building relationships threatened or compromised?
This blog is my call for action. A call for us, leaders in healthcare and patient experience, to develop a strategy to address the following question. How can we help our physicians and APCs, seasoned and new, from multiple different generations, feel valued and recapture or sustain their joy of practice? It is paramount, because the provider being empathetic, engaged and joyful is pivotal to our family and friends’ quality of care and how they feel when receiving that care (1, 2).
“I've learned that people will forget what you said, people will forget what you did, but people will never forget how you made them feel.”
- Maya Angelou
The reality of our present American healthcare model in regard to providers is reflected in these powerful statistics.
- 54% of doctors show signs of burnout and only 40% of doctors are satisfied with their work life balance.(3)
- For every 1 hour physicians provide direct patient care, nearly 2 additional hours are spent in activities associated with the Electronic Health Record.(4)
- In one study 52% of medical students suffered from burnout; of those burned out, 35% admitted to unprofessional conduct related to patient care.(5)
- 14% of Internal Medicine Residents rate life “as bad as it can be” or “somewhat bad.”(6)
- 38% of Internal Medicine Residents had personal debts greater than $100,000 dollars (2008 monies).(6)
- 6.3% of participating surgeons had suicidal ideations in the past 12 months.(7)
Physician burnout is real and threatening our whole healthcare system - the quality, safety and compassion of the delivery of healthcare.(8) Burnout is not just among older physicians or surgeons; it is across the whole spectrum of healthcare. In Maslach’s Burnout Inventory Manual, he states, “Burnout is a syndrome of emotional exhaustion, loss of meaning in work, feelings of ineffectiveness and a tendency to view people as objects rather than as human beings.”(9)
When considering this subject there is a complementary way of looking at it that I find valuable. In each of the above statistical bullet points there are multiple challenges accumulating to depersonalize and overwhelm the provider. But what if we were to focus on how we support these courageous and valuable members of the healthcare team? Instead of focusing on burnout, reposition ourselves and focus on developing resilience, investing in our providers to help them find their joy, recapture their personal and cultural value. The following are conversation topics I believe we need to discuss now to answer this call to action. Here are statements to serve as an agenda for generative conversations and next steps to action.
- Interventions for burnout need to be as multi-factorial as the causes. The etiologies of burnout for my generation of providers, compared to the millennial provider, may have the same or different root causes. Recognizing the differences in generations allows for more impactful and valuable interventions.
- Costs in healthcare live in silos with their relationships unrecognized or declared. A key to making this a prioritized conversation is identifying the price tag to this epidemic. The cost shifts this conversation from the doctor’s and APC’s problem to the CFO’s and CEO’s problem.
- We need senior leadership in health care to recognize and quantify the hidden opportunities of investing in our providers. Data shows doctors who have sustained empathy and joy provide safer care and a better patient experience. In population health models this translates to increased revenue.
- It is proposed with future physician shortages, APCs will have a greater impact on care delivery, healthcare revenue and patient experience; that “future” is now. We need to create systems that recognize the APC as a unique member of the healthcare team.
- With the changes taking place in healthcare we need to assure the new paradigm of excellent care outcomes (the quadruple aim) - enhancing patient experience, improving population health, reducing costs and improving the work life balance of those who provide care.(10)
- A happy physician or APC costs the institution much less in legal fees, mistakes, nurse turnover, etc. How do we help our medical culture apply the resources to address major causes of burnout and to support the development of resiliency programs?
- Essential to a successful navigation of our healthcare future is identifying communication as an advanced healthcare competency. It deserves the same attention as the mastery of procedural skills, knowledge base and work flow.
The time is now and the “who” is us. If we do not begin to have these conversations and change the perspective of healthcare, our “default” future is one of: not enough healthcare providers, increased healthcare costs and a loss of the “sacred” relationship between the noble men and women who care for patients. This conversation is focused on physicians, but applies to all who touch a patient’s life. Won’t you join me?
- Lucian Leape Institute. Through the Eyes of the Workforce: Creating Joy, Meaning and Safer Health Care. Lucian Leape Institute of the National Patient Safety Foundation 2013.
- Beach M, Sugarman J, et al. Do Patients Treated with Dignity Report Higher Satisfaction, Adherence, and Receipt of Preventive Care? Annals of Family Medicine 2005; 3:331-8.
- Shanafelt T, Hasan O, et al. Changes in Burnout and Satisfaction with Work-Life Balance in Physicians and the General US Working Population Between 2011 and 2014. Mayo Clinic Proceedings 2015; 90(12):1600-1613.
- Sinsky C, et al. Allocation of Physician Time in Ambulatory Practice: A Time and Motion Study in 4 Specialties. Annals of Internal Medicine 2016; 165(11):753-760.
- Dyrbye L, Massie F, et al. Relationship Between Burnout and Professional Conduct and Attitudes Among US Medical Students. Journal of the American Medical Association 2010; 304(11):1173-1180.
- West C, et al. Quality of Life, Burnout, Educational Debt, and Medical Knowledge Among Internal Medicine Residents. Journal of American Medical Association 2011; 306(9):952-960.
- Shanafelt T, Balch C, et al. Suicidal Ideation Among American Surgeons. Archives of Surgery 2011; 146(1):54-62.
- Shanafelt T, Balch C, et al. Burnout and Medical Errors Among American Surgeons. Annals of Surgery 2010; 251(6):995-1000.
- Maslach C, et al. Maslach Burnout Inventory Manual, 1996.
- Bodenheimer T and Sinsky C, From Triple to Quadruple Aim: Care of the Patient Requires Care of the Provider. The Annals of Family Medicine 2014; 12(6):573-576.
Jeremy R. Blanchard, MD, MMM, CPE, is a Chief Medical Officer at Language of Caring. Grounded in healthcare realities and aspiring to partner with others committed to healthcare transformation, Dr. Blanchard is an expert in ensuring physician development, commitment and wholehearted engagement. A dynamic speaker, skilled facilitator and coach, he provides tailored programs for medical staff, coaches individual physicians, and partners with physician leaders to assess needs and implement physician engagement strategies.