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 Allison Chrestensen, MPH, OTR/L,
Friday, February 16, 2018
Updated: Friday, February 16, 2018
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If you’ve listened to the patient experience conversations over the last decade, you know that much of the focus is on what happens inside hospitals (and on hospital grounds) and to a lesser extent, in outpatient clinics and doctors’ offices. And while The Beryl Institute’s definition recognizes the patient experience is shaped by a diverse group of professionals and occurs “across the continuum of care”, most of the operational focus around patient experience is on what happens within the walls of the hospital. My own patient journey, as well as my work as an occupational therapist helping patients to regain independence after illness, has taught me that it’s what happens after a patient leaves the hospital that is perhaps the most challenging part of the continuum of experience.
My first significant patient experience occurred when I suffered sudden cardiac arrest in 2013. I was unconscious during the acute phase of my illness, so my perspective is of the long recovery process, which I view in two separate phases. The first phase took place in the hospital where a team of healthcare professionals cared for me around the clock. There were people who kindly addressed my questions, even the ones I asked no less than four times; who asked how I was doing and seemed to actually want to know the answer to the question; who knew my husband by name and greeted him as they changed the bed linens and emptied the trash; who collected my meal card and patiently listened to my complaints about how a pureed dinner roll tastes nothing like real bread. There was my clinical team to whom my husband and I felt enormous gratitude for saving my life. My physicians thoroughly explained the plan to insert an implantable cardioverter defibrillator (the only treatment option for sudden cardiac arrest), a device that constantly monitors my heart rate and will deliver an electric shock if ventricular defibrillation is detected. I remember feeling very safe and secure—all of my concerns alleviated, my questions answered (or at least the ones my post-coma brain could generate at the time). I was discharged home the day after my ICD surgery.
All of that care and attention came to an abrupt end with the second phase of my recovery, which began once I arrived home from the hospital. The flurry of activity and round-the-clock care stopped, my husband went back to work where he admits he spent more time worrying about my wellbeing than he did on actual work tasks. Soon after I arrived home, I began conversations with my own employer about short-term disability, coverage for my job responsibilities, and all sorts of other details I felt unprepared to address. My friends were raising children, planning vacations, and going after promotions at work. I was fearful of going to the grocery store, afraid that I might collapse to the floor in the cereal aisle while this foreign device in my chest delivered a series of electric shocks.
In that transition time between experiencing a catastrophic illness and attempting a return to normalcy, my husband and I were left on our own to process our experience and its impact on our lives going forward. That, to me, was far more challenging than having my blood pressure taken every hour, waking from a deep sleep for a needle stick, or understanding a 10-page after visit summary.
It was only after I began to adjust to this new reality as a cardiac patient that feelings of resentment that began to overshadow my sense of gratitude for the life-saving care I received. Rather than choosing the best treatment option for myself, I began to feel that I had given consent to the treatment plan my physicians wanted for me. Note there is a significant difference in designing a treatment plan for the patient and designing that same treatment plan with the patient. Granted, in my case, the only other option would’ve been to have no intervention at all, a hard option to consider for a thirty-something-year-old woman who is at risk of experiencing another arrest in the future. As someone who likes to feel in control of her own health and wellness, however, having the opportunity to discuss this admittedly less desirable option with my team would’ve made all the difference to me as I navigated the path of recovery.
My own experience taught me that when the proverbial dust settles, the “what now?” question remains for our patients. This is an important facet of the patient experience, and it is directly impacted by what happens (or what doesn’t happen) during the patient’s time in the hospital. The extra five minutes that the physician or nurse spends asking about a patient’s values, hopes and fears can mean the difference between feeling like a number and feeling like a person. The compassionate actions of the environmental services and dietary staff, the rehabilitation and nursing teams, all create impressions and emotions that patients and families take with them into their recovery. For the patient, these actions can make the difference between feeling powerless to manage a chronic illness or cope with an unexpected health scare and moving forward with new perspective and determination.
This is the “long view” of patient experience—the awareness that our actions as healthcare professionals have far-reaching impact. We become part of the patient’s story. My patient story is about the pain of losing control of my wellness and my decision-making power in the midst of immense gratitude for receiving miraculous, life-saving care from dedicated professionals. It is also about the care and compassion that my care team showed to me and the way that fueled my desire to derive meaning from my experience and to make a contribution in this field. I am a patient. However, a patient is not who I am.
Taking the “long view” of patient experience work helps us to realize the true impact of “the little things”, and it may just help each of us to reach beyond an organizational commitment to excellence and toward an individual commitment to doing good.
Allison Chrestensen is the founder of Tandem Healthcare Solutions, a consulting firm specializing in co-designing experience improvement for patients and staff, using the Experience-Based Co-Design model. Allison brings her perspective as a clinician, patient, and quality improvement project leader to her work and has served in project leader, faculty and advisor capacities for healthcare organizations around the U.S., U.K., and Canada to facilitate building innovative and sustainable models for partnership with patients and community members.
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 Erin K. Brandt,
Monday, August 21, 2017
Updated: Wednesday, August 16, 2017
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The patient experience movement is one of astounding energy, driven in large part by the realization that fellow humans respond positively when empathy and partnership are at the forefront of care decisions. The majority of those employed in healthcare are not working tirelessly to manufacture a product; their purpose lies in improving the human condition. Sure, there are thousands of innovations marketed every day with the goal of providing solutions to our health problems, but it’s the human connection that has such a monumental impact on how patients respond to our efforts. Human connectedness builds trust, opens lines of communication and creates an environment capable of health and healing. While our hospitals and health systems have made significant gains, I must ask where independent medical practices stand in this storm of pressing innovation.
I consider my work with small medical practices a grassroots effort to inspire empathy as an office culture. How many providers or staff members have taken time to sit in the waiting room or exam room? I believe it’s imperative to consider what message we are sending through our actions and our environment. Are the chairs uncomfortable, the floor dirty, reading material outdated and torn? When the MA calls you back does she smile and call you by your preferred name? Do we have policies that build barriers instead of bridges between our patients and providers?
Today’s medical landscape is crowded with challenges related to payment models, quality metrics and frustrating non-compliance. How can we help patients who don’t appear to want to help themselves? In my experience, the answer lies in a culture of empathy. Understanding the broader scope of social health determinants and their impact on a patient’s ability to follow through can mean the difference in treating a patient with apathy versus compassion. Make no mistake; patients read body language, tone and other social cues while visiting their providers. These impact their decision-making and behavioral attitude towards where they will go to receive care. This, in turn may determine a patient’s follow through with filling prescriptions, imaging, labs or referrals to specialists.
While we have done extensive work in the hospital and outpatient setting related to patient experience. We also see that primary care clinics and specialty offices remain the frontline of a fragmented system in rural America. Visit on a typical business day and you’ll observe massive stacks of facsimiles, incessant phones ringing, paperwork shuffled and names being called. The medical assistants, schedulers and receptionists I work with admit they become incensed by the lack of understanding on behalf of the patient. They forget they are experts in their role and patients are navigating foreign territory, sometimes scared or too embarrassed to ask further questions. Add the ever evolving changes for the latest software update and every one is confused and less than patient.
Many small medical practices continue to work under fee-for-service payment models. Many I speak with are put off by the pressures to utilize EHRs and perceive value-based payment systems as another way for payers to gain control over their quest to do what is best for the individual patient. They feel many of the technology solutions are beyond their reach due to issues of interoperability and gaps in IT prowess and staffing.
While I have a healthy appreciation for the innovation entering the healthcare space, I would like to point out this is not an “all or nothing” ultimatum. My vision includes guiding small and mid-size practices to understand the value of adopting small changes to achieve empathy as an office culture. If we make a commitment to weave compassion and understanding into our communication, our policies and our daily decisions, we position ourselves to help patients in a way indifference cannot. Practices I speak with often feel discouraged by the barrage of high tech investments pitched to them as the sole pathway toward improving patient experience. No amount of technology can replace humanness. So while I dream of large-scale changes to the systems of heath care, I am encouraged by the efforts of independent practice managers working low-tech solutions to create a much needed culture of empathy.
Erin K. Brandt is a public health advocate, facilitator and passionate patient experience leader. Her start as a grassroots health educator working with inmates, the homeless and those suffering from addiction ignited a deep passion for facilitating change through the human connection. Erin currently works with organizations developing leadership pathways, coaching and supporting the patient experience movement. Along with her role as a Patient Experience and Care Advocate at Yuma Regional Medical Center, Erin teaches courses for Arizona Western College Community Health Worker program and designs custom training content for local businesses and healthcare practices.
Posted By Marcus Engel,
Monday, July 17, 2017
Updated: Monday, July 17, 2017
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I can’t remember the impact, but I remember the headlights. Then, the pain. The all-encompassing horrors of broken jaws, crushed facial bones and desperate attempts to breathe. I remember the metallic taste of blood mixed with gasoline. Then…the blackness. But, how could I know that darkness was permanent? How could I know that I was now blind?
I can’t remember the medics, the crike, the ambulance speeding to Barnes Hospital, but I remember my clothing being cut off. And, I remember Jennifer.
Throughout that wretched night in the ER, Jennifer held my hand and never left my side. Her presence and her words, “Marcus, I’m here…” were the only things she could have done to help…and they were exactly what I needed.
Throughout the hospitalization and recovery, rehab and 20 years of life, I knew nothing else of Jennifer. Her story is in my memoir and “I’m Here: Compassionate Communication in Patient Care.” But, beyond that night? I knew nothing. No last name, not her position in the ER. Nothing.
Two years after the trauma, as a 19 year old, I found myself in Morristown, New Jersey, training with my first Seeing Eye dog, a black lab named Dasher. Some people measure life in years. I measure life in dogs. Dasher was by my side for seven years. When he retired at age nine, I thought my heart would break. I’d lost my sight, so I thought I knew what loss was…but I was wrong.
Life goes on. We all know that. Dasher’s retirement ushered in another black lab, Carson, who was with me for another seven years. Then came Garrett; a yellow lab who, if you’ve heard me keynote since 2010, you’ll probably remember.
Soon after I picked up Garrett’s harness for the first time, we moved to New York City where I began my Narrative Medicine Master’s program at Columbia University. As I continued keynoting around the country, Garrett was by my side for countless flights, hotel rooms, hospitals and conference centers.
Then, Barnes-Jewish Hospital, the facility that saved my life, invited me to speak. As always, I told the story of “I’m Here” and Jennifer. Afterward, a member of the patient experience team approached and said words I’ll never forget: “Marcus, we have a surprise for you… we found Jennifer.”
Shock. Disbelief. Confusion. I was nothing short of a blubbering mess as I, for the first time in 20 years, held her hands again. Finally, I got to say thank you.
Weeks later, Jenny and I were interviewed by the St. Louis Post-Dispatch.
The journalist asked lots of questions, including, “How long have you had Garrett? How long do Seeing Eye dogs work? Where will Garrett go when he retires?”
Seeing Eye dogs work, on average, seven to nine years. Provided Garrett stayed healthy, we would be together around four more years.
“Will you keep Garrett when he retires?” she asked.
“No, I’ll then get another dog and need to focus all my bonding on the new pup. That’s not fair to Garrett, so I’ll find someone who wants to adopt him.”
Jenny practically jumped out of her seat declaring, “I want him!”
“Absolutely, I would love to have him!”
“Done,” I said. “I can’t imagine better hands.”
Last December. I laid on the floor of a hotel room, thanked Garrett over and over for being mine, for keeping me safe and for his unconditional love. Tears fell onto his velvet ears. Then, a knock at the door.
I hugged Jenny, fell to my knees and held Garrett one last time.
As Garrett and Jenny walked out, all I could think of was love. Love. Compassion. Presence. That’s what I received from Jennifer on the worst night of my life…and that’s what Garrett gave throughout his working life. It is a model of what all truly excellent patient experiences are comprised.
Marcus Engel, M.S., CSP, CPXP is a Certified Speaking Professional & author whose messages provide insight and strategies for excellent patient care. As a college freshman, Marcus Engel was blinded and nearly killed after being struck by a drunk driver. Through two years of rehab, over 350 hours of reconstructive facial surgery and adaptation through a multitude of life changes, Marcus witnessed the good, the bad and the profound in patient care. Marcus and his wife, Marvelyne, are the co-founders of the I’m Here Movement, a 501(c)3, which is changing the culture of care with two simple words.
To hear more from Marcus, join us August 15th for the upcoming webinar, Presence: Compassionate Communication Through Everyday Mindfulness or September 15th for our Regional Roundtable event in Ontario.
Posted By Dr. Avnesh Ratnanesan,
Friday, March 10, 2017
Updated: Tuesday, March 7, 2017
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Empathy in healthcare is both a traditional concept as it is a new-age buzzword. That’s because it has never lost its importance as a legitimate element of a patient’s healing process.
Simply defined, empathy is the capacity to walk in the shoes of another. Essentially, the ability to understand, appreciate and relate to someone else’s emotions. There is more chatter in the industry now about defining, teaching, learning and measuring empathy in healthcare than there has ever been.
Making emotions a visible part of your (formal or informal) measurement validates the feelings of patients which in turn, 3promotes patient satisfaction, enhances the quality and quantity of clinical data, improves adherence and generates a more therapeutic patient-physician relationship.
Ultimately, it all links back to the Net Promoter Score (NPS) or the Friends and Family Test (FFT). A key HCAHPS question, the NPS or FFT asks the patient point-blank if they would recommend the hospital to family and friends.
There’s your ROI.
EMOTIONS AND NPS
Human emotions are core to every patient experience. At every stage of the patient journey, there is a feeling, sentiment or attitude that will, collectively, define the experience for the patient at the end of their engagement with a healthcare setting.
Hospitals are often obsessed with benchmarking against other hospitals in term of their respective performance indicators, however there is a need to first benchmark against the EXPECTATIONS of your own patient population:
- If the experience < expectations, then you have a satisfaction deficit which leads to frustration and anger
- If the experience > expectations, then you have a satisfaction profit which leads to delight and excitement
Frustration and anger are detractors to the patient experience. If these emotions are experienced, then you can be sure that the patient is on their way to relay their negative experiences to others or not return, or both! Feelings of delight and excitement on the other hand naturally motivate patients to ‘promote’ your healthcare setting to others.
Measuring emotions is key part of our 6E Framework, a step-by-step guide to producing a true holistic picture of patient experience. Its measurement impacts the full spectrum of this framework:
Understanding the real patient EXPERIENCE through EMOTIONAL data ENERGISES staff in their purpose and EXECUTION of solutions. Successes are repeated to produce EXCELLENCE in delivery and organizational capability in patient experience EVOLVES.
How do you draw these emotions out of a patient so you can understand, measure and respond appropriately? Some state it boldly, some 3hide their emotions through seemingly rational questions or casually drop a comment about their emotions, to test the waters on how it would be received in the healthcare setting. Pick up on these clues, don’t ignore it or change the topic.
For the uncertain and non-forthcoming patient, surveys are a great way to get emotional data. One would imagine that a survey asking about their emotions would not only surprise them but send a clear message that there is a space in that setting to talk about emotions, that a culture exists that encourages and supports emotions.
INTELLIGENCE FROM EMOTIONAL DATA
When the clinician and non-clinician are able to recognize the emotions around a patient, it allows them to be more authentic and honest in the support given to the person (not patient).
Clinicians are able to view the person’s emotions within a more accurate context and address it in specific ways: 2
- Learning: Where the patient is fearful because of a lack of information, there is an opportunity for staff to help educate the patient to reduce his fear
- Empowerment: Where the patient feels helpless in the face of his health, there is an opportunity for staff to develop the patient’s sense of power over the situation through education, tools and technology
- Self-discipline: Where the patient is frustrated over their personal management of their health, there is an opportunity for staff to help the patient develop discipline through motivation, tools and technology
- Feelings of control: Where the patient is overwhelmed with the amount of information around their diagnosis, there is an opportunity for staff to ensure that the communication of information is at a pace and volume that the patient is comfortable with and to involve the patient’s family members or friends in managing overwhelm.
When an organization can undertake the above in a systematic way, an ‘energy’ or a vibe starts to infiltrate through the ranks. Clinicians and non-clinicians start to discover or re-discover the meaning in their roles and the organization becomes more congruent with its purpose.
What’s the vibe like where you are?
1. Empathy and Emotional Intelligence: What is it Really About?’, International Journal of Caring Sciences, Volume 1 Issue 3, Alexander Technological Education Institute of Thessaloniki, Greece http://internationaljournalofcaringsciences.org/docs/Vol1_Issue3_03_Ioannidou.pdf
2. Adapted/Inspired from information from a Chapter Abstract from Patient Emotions and Patient Education Technology: http://www.sciencedirect.com/science/article/pii/B9780128017371000020
3. “Let me see if I have this right...”: Words That Help Build Empathy, Coulehan JL, Platt FW, Egener B, Frankel R, Lin CT, Lown B, et al. (2001).
Dr. Avi Ratnanesan is a medical doctor with broad healthcare sector experience including hospitals, biotech, pharmaceuticals and the wellness industry. He is a leading expert who coaches and consults to senior executives, entrepreneurs, practitioners, organizations and governments.
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.
Posted By C.J. Weese,
Tuesday, February 3, 2015
Updated: Tuesday, February 3, 2015
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I have had 36 major surgeries and over 100 minor procedures, been rushed to the hospital 13 times, life-flighted three times and have had six flatlines. I have legally died six times. And all of this occurred before I was 25.
I was born with Tracheoesophageal Fistula (TEF) with atresia. I had approximately four centimeters of esophagus coming from my stomach, which formed a pouch, and less than two centimeters of esophagus coming from my mouth. That part of my esophagus was connected to my lungs. I was born at 5:43 a.m. and at 6:03 a.m., I was being rolled into an operating room for the first of many surgeries to correct my abnormality. Between 1989 and 2009, I did not go more than one year without having a surgery or some type of procedure done. To say the least, I am very familiar with the healthcare field, but I take a different view. My view is through the eyes of a patient – a patient who has not known a normal life, but rather a life that was controlled by my health and the doctors who treated me. I have spent my life gaining insight into what a talented healthcare professional is and during my college years I gained an even deeper understanding of the vital role of talented individuals to any healthcare organization.
Shortly after beginning college, I started having problems swallowing as well as a lot of pain in my chest and left shoulder. I went in for a routine appointment and brought it up to my gastroenterologist. My doctor decided that I had an esophageal stricture and needed a dilatation. After three unsuccessful attempts to fix the problem, my pediatric surgeon referred me to a new surgeon because he thought a new set of eyes could help.
The new surgeon decided the original four centimeters of esophagus needed to be removed. They were right. The surgery was a success, but it was also a battle in and of itself. The surgery was supposed to take four hours. It took 12. I spent 17 days in the hospital recovering, 11 days of which I was in a medically induced coma. However, during my time in the hospital, I had the opportunity to meet some amazing people.
My experience began when I first met "Dr. Jones,” the new surgeon my previous pediatric surgeon recommended. He was amazing from the start. Dr. Jones took the time to listen, and showed me compassion and empathy. After he listened to me explain everything, from birth on, he took a moment and just looked at me. Then he told me, "I can’t imagine how hard this is for you. But I know that I can fix it.” He did not jump into the medical terminology of what he was going to do, but rather spoke to me in a way I could comprehend and allowed me to answer questions as he spoke. I had a discussion with him rather than being told what was going to happen. Not only did he treat me like an individual, he was honest with me. While all doctors lay out the worst case scenario, he did so in a way that made me trust him and his competency. He was very direct about what could go wrong, but he also discussed how he would fix it if it did. He assured me he had a plan in place and several back-up plans as well. I trusted Dr. Jones – not just because he was a doctor, but because he built that personal one-on-one relationship with me and took the time to make sure I knew everything and was comfortable with it all.
When I was moved down to a regular recovery room, I was assigned a nurse whom I will call "John.” He was amazing. Most nurses I encountered have been compassionate, but he went above and beyond. When John came into my room, he always had a smile on his face. Even when I was in pain and struggling, he was able to brighten my mood. He instilled hope in me and faith that I would get through this and be stronger for it. He spoke to me and learned things about me – he knew what classes I was taking and about my family and friends. He cared. He took my mind off the pain. John helped to nourish and mature our relationship with one another, which ultimately helped me recover. He gave me hope and advice and always listened to me. His positivity was admirable and something I had not yet truly experienced.
The healing I found here was more than just physical, but equally as important. Oftentimes, I feel healthcare professionals forget their patient is a person. A person who is struggling not just with physical ailments but emotionally and mentally as well. The doctors and nurses I encountered during my stay were not only inspiring, they were life changing.
C.J. Weese works at Talent Plus, where she has learned new lessons about how important finding people with a talent for health care is. She spends her days joining the goal of Talent Plus to impact one million patient lives, much like the doctors, nurses and physical therapists who saved her and made her who she is today.
Posted By Dr. Bryan Williams,
Monday, July 29, 2013
Updated: Friday, July 26, 2013
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Every patient in every hospital is in a rather strange position. They need the services that the hospital and healthcare providers are giving; but they do not want to be in a situation where they need healthcare in the first place. For the most part, people don’t "enjoy” getting sick or injured, but they do. And since this is inevitable, patients reluctantly find themselves fully dependent on people
(who they usually don’t know). Every patient is saying, "I need you.” It is critical for every
healthcare professional, from physicians to nurses to ER registration clerks, to fully understand the moral and emotional responsibility of their work.
My family and I live in the Washington, D.C. metro area, and love it. Before moving there in 2004, I never experienced any asthma problems in my life. Since the move, however, I’ve developed asthma-like symptoms every year during allergy season. After a few years, it got really bad, so I found a pulmonologist, who diagnosed me with asthmatic bronchitis. He prescribed the appropriate medications to get rid of the ailment. Over the next few years, the same cycle ensued:
allergy season begins…I get sick…I go to the doctor…the doctor prescribes medication…I feel better…repeat same sequence the following year
Then one year my wife said to me, "Why don’t you just go see the pulmonologist at the very beginning of allergy season to get the medication? Then you can take the medication every day, as a prophylaxis, until the season ends.” Ok, sounds logical, but I immediately thought, "Obviously if that were the case, the doctor would have told me that years ago…right?” So I went to see the doctor and mentioned my wife’s suggestion. To my surprise and disappointment, he said, "Well, yes, taking the medications pre-emptively is the best route for you to take.” What?! Why didn’t he tell me that before?
As a patient, I need you to:
- Know that I am a whole person, and not just another transaction.
- Make me feel like you are prepared, and looking forward to seeing me.
- Tell me what I don’t even know I need to know…after all, you are the subject matter expert.
- Don’t just comply with my requests, but rather look for suggestions to improve my life.
- Encourage me to follow through on your prescribed actions (medications, etc).
Most of all, I need you to care about me, and not just my ability to pay or your ability to cure. I need you to care about my well-being and genuinely want me to be healthy overall.
As I’ve written previously, it takes a special person to serve others, and it takes an extra special person to serve in healthcare. Healthcare professionals are, in fact, special people. Besides skills, they have the responsibility and privilege to literally improve the life of someone else. Those who fully embrace that responsibility serve with their hearts, and it’s a beautiful sight to see. They let love pervade everything they do and say with their patients.
Your ability to connect, sympathize and empathize makes you far more valuable than any check that could ever be written. I need you. Inpatients need you. Outpatients need you. Families need you. Communities need you. Serve with your heart and know that your healthcare job is one of THE most relevant ones the world has ever seen.
Dr. Bryan Williams is a service consultant, trainer and author. He has travelled worldwide to work with more than 100 companies in various industries, and is very passionate about helping companies reach high levels of service and organizational excellence.