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Re-centering Our Attention on Clinical Excellence

Posted By Kelly Parent, Wednesday, June 20, 2018
Updated: Tuesday, June 19, 2018

“Unless someone like you cares a whole awful lot, Nothing is going to get better. It's not.” - Dr. Seuss

If your health care organization is anything like the ones for which I have worked, you have been exposed to a myriad of philosophies, principles, and tactics (i.e., service excellence, patient/person and family centered care, patient and family engagement, relationship-centered care) that seek to define a culture that achieves optimal patient and family outcomes and experiences through the creation of trusting and empathic relationships, effective communication tactics, and patient and family engagement and activation. There is compelling evidence for the value of such efforts, for they have been shown to improve clinical outcomes, decrease harm events, reduce litigation, and save health care dollars.

However somewhere along the way, the health care industry has become a bit preoccupied by “the test,” viewing the patient experience largely through the lens of patient satisfaction scores. Somewhere along the way, we have allowed ourselves to transpose the patient experience with the customer experience as incongruously defined by hotel standards. We are spending large amounts of time (and money) focusing on a number instead of a person, reacting to mismanaged expectations, and trying to surpass our competition by offering gourmet food, fancy wait space amenities, and concierge services. It is time to get back on track re-centering our attention on clinical excellence. We must re-focus by respecting the needs and perspectives that patients and families bring to the table, communicating with them in ways that are understandable and affirming, welcoming and encouraging their participation in care planning and decision making, and evaluating success in meeting goals of care.

“It's not about what it is, it's about what it can become.” - Dr. Seuss

Fifteen years ago, my family was thrust into the world of doctors, hospitals, fear, and pain when our daughter was diagnosed with a serious illness. Being health literate, we were relatively well positioned to navigate this complex world, for we understood medical jargon, knew how to get answers to our questions, and most importantly, grasped the importance of becoming an active member of her health care team. However despite our confidence, knowledge, and skills, at times we were too vulnerable, too intimidated, and too exhausted to comprehend every conversation, engage in every discussion, and speak up every time that we were unsure. We learned to appreciate the staff who took the time to see where we were (sometimes with needs changing from shift-to-shift) and adapt care tactics accordingly. During highly emotional and difficult times, we needed staff to take care of us and do things “to and for” us. At other times, we needed to be fully present, engaged, and activated to partner “with” our daughter’s providers to make decisions and learn how to manage her care at home, and we always needed staff to know our daughter, the little girl, and not just our daughter, the illness.

My daughter’s illness turned out to be my training ground to become an advocate for patient and family centered philosophy and culture and create institutional readiness for patient and family partnerships. Over these past twelve years, I have learned that patient and family centered care is the way to achieve optimal outcomes and experiences, but to accomplish culture change it takes all of us:

  • We must commit to finding our passion to care for those who come to us at their most vulnerable needing us to provide emotional, spiritual, and physical support.
  • We must remember that unless you ask, you have no idea what patients and families fear most.
  • We must commit to creating and sustaining a culture of teamwork, trust, and compassion welcoming our patients and families as full members of their health care team.
  • We must remember that no one knows more about our patients than the patients themselves and their families.
  • We must commit to welcoming family presence and participation across the care continuum.
  • We must remember to acknowledge family expertise and point out strengths.
  • We must commit to providing transparent, understandable, and timely access to medical information and coordinating care and communication across all settings.
  • We must remember to explain “why” and teach “how”.
  • We must commit to respecting and encouraging patients and families to speak up if something does not feel right.
  • We must remember that what is routine for you is far from routine for patients and families.
  • We must commit learning what matters most to patients/families.
  • We must remember to truly listen.

“Today I shall behave, as if this is the day I will be remembered.” ― Dr. Seuss

Kelly Parent has twelve years’ experience leading patient and family engagement efforts across clinical, education, research, and quality/safety initiatives. Kelly started as a Family Advisor, served as PFCC Program Manager at a large academic medical center, worked as a PFCC educator and consultant, and is currently the Vice President for the Patient and Family Experience at Beaumont Health System.

Tags:  patient and family engagement  patient centered care  patient experience  service excellence 

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Finding the Right Fit for Mom: A Daughter's Journey

Posted By Chari Tager, Tuesday, September 6, 2016

This was the situation for my family in 2014:

My mother, Ruth, 82, was in a nursing home in Boynton Beach, Florida. She had moved there after starting to show signs of mild dementia and the beginnings of Parkinson's. My father, Edward, 85, who still lived in their home, visited her every single day, checking up on her care and bringing her meals… and love.

After a year of this routine, which followed several years during which Dad cared for Mom at home, my father was physically worn out. After much discussion, my father, my sisters and I agreed that he should scale back. He moved into a senior independent living residence in Boca Raton, a wonderful place with lots of people for him to interact with. He no longer had to come home to an empty house, he had lots of friends, the staff prepared meals the way he liked and, if he needed it, a car was available. He was so happy, and it felt good knowing he was so well taken care of.

With my father no longer able to keep an eagle eye on my mother, and my parents now in separate facilities 40 minutes apart, my sisters and I decided to see if we could move our mother into the nursing home attached to my father’s facility. Well, we found a place for her there… after waiting almost nine months. She moved in in December, but just a little over two months later, in February 2015, my father passed away unexpectedly.

After consulting with Mom, my sisters and I decided to move her back to New York, where we had grown up and where two of us live. It was a big decision—my parents had spent 27 years in Florida—but my mother was OK with it.

Of course before we could move her, we had to apply for New York State Medicaid. Even though my mother had Medicaid in Florida, the process of getting Medicaid in New York was long and arduous.

Still, the biggest challenge was to find the right place for Mom to live. Unlike Florida, which has lots of nursing homes to choose from, Manhattan has few options. Frankly, the pickings are slim and it was very hard to find a place that we liked and where we thought Mom would be comfortable.

At some point we learned about the Small Houses, the Green House™-based small-groups homes on the Westchester campus of The New Jewish Home. While Westchester is not as convenient for my family as Manhattan, we decided to visit and were so impressed. Of course, as with everything else associated with this transition, getting my mother into one of the three Small Houses was not straightforward. There was the predictable waiting list, which we put her on, and hoped for the best while we continued to expand our search to areas outside but near Manhattan.

After months of searching and of working with lawyers, doctors and bankers to get all of Mom’s paperwork in order, my sisters and I were becoming desperate. Almost panicked, I put in another call to the Admissions office at The New Jewish Home. As luck would have it, a space had become available.

My family was so relieved, but not just because we had finally found a home—a wonderful home—for Mom. We were relieved because there was simply no comparison between the other places we had visited and The New Jewish Home, both in terms of the way the staff treated us—their “customer service,” you might say—and the Small House philosophy. Everything about the experience was comforting and supportive and easy. Even the application was more user-friendly and less intimidating than the ones we got from some of the other places.

As for the Small House where my mother now lives, it is amazing! My mother is a big fish in little pond, and she’s tickled pink. She does ceramics, which she never would have tried before. She looks forward to music therapy, in which she participates wholeheartedly. Most important, she has people around her who care deeply about her, and whether I’m there or not, I know they are giving my mother the best care possible.

(As an aside, I am not only blown away by the care my mother receives, but by the care all of the residents receive. One woman no longer has the ability to speak, but that doesn’t stop the aides from giving her as much attention as they give everyone else. They attend to her as if she were their own parent, helping her put on her lipstick and the perfume that she loves.)

And the food—it is wonderful. At my mother’s first nursing home in Florida, my father had to bring all her meals because the food was inedible and she was losing weight. Here, the food is so good that, when I’m visiting if Mom does not finish what’s on her plate, I eat it! And if she wants something special, the aides cook it for her. She only has to ask. The residents even help create menus at their monthly house meetings, and many of their recommendations end up on the dining room table.

If I had to sum up what makes the Small House idea so powerful, I would say that it is the respect and the caring. The people who work there make my mother feel as if she has choices, because she does—about when to get up, what to do with her day, what tasty things to eat. And that is so important given how few choices she, like other older adults, has in other areas of her life. Every staff member I have dealt with has been so kind and giving, to my family as well as to Mom. That speaks not only to how well trained the staff is, but also to how happy they are in their jobs. And you definitely want happy people caring for the people you love.

It has been a long journey, but Mom is now in the most supportive, the most respectful, the most caring place possible. My sisters and I all agree moving Mom was the best decision we have ever made.

Hear more of Chari's story at the upcoming Long-Term Care Regional Roundtable.

Chari Tager is a dedicated daughter who enjoys spending her free time with her mother Ruth, a current resident at one of The New Jewish Home’s Small Houses in Westchester.

Tags:  caregiver  long term care  nursing home  patient and family engagement  small house 

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“I don’t do direct patient care.”

Posted By Ahmanielle Hall, Monday, August 15, 2016
Updated: Monday, August 15, 2016

“I don’t do direct patient care.”

Every time this phrase comes up in conversations I get the tiniest cringe at the emphasis of “do.” As healthcare administrators, we are responsible for sharing the narrative of how great our patient care is and how many services we provide, yet to say one does not “do” direct patient care implies that there is no connection to what takes place on the floors daily.

Of course, not every role in healthcare physically touches the patient, but it is important that all support roles in healthcare organizations understand the impact of their contributions to the patient experience.

Correction: If you work in healthcare in any capacity, you do participate in direct patient care. Maybe it’s the use of the word direct, perhaps that should be eliminated so that there isn’t a scale of responsibility that implies there are two groups in healthcare—those employees in the trenches doing everything they possibly can to provide for the actual care of the patient and others doing everything they can without having what can be perceived as a direct stake in the patient experience.

There appears to be a divide in healthcare into clinical and administrative silos. Two different approaches to healthcare, but both are supposed to have one clear objective: make patients and their families the number one priority. There has to be a way to tie the two functions together to see not only how each group not only takes part in creating the patient experience, but also how both roles need to be symbiotic in creating value for the patient.

Everything we do as healthcare administrators has an impact on care. Whether it’s engaging employees around major strategic initiatives or doing a media story that connects our community to the services we provide, yes—we touch the patient experience. Every piece of collateral, every project, every report in some way has an effect on someone else and their ability to take care of those who trust us with their health.

Clinical teams are able to make this connection easily; however, making the patient experience real for administrative roles in an organization takes more time and effort. It is often said that it takes a special kind of person to be a physician or nurse, but it also takes special people in IT, finance, communications, human resources, parking—all of these areas need special people who see the value in what it is they contribute to healthcare organizations to make patient care effective and meaningful.

Dear healthcare provider, clinical or administrative—you provide direct patient care. You are important and you have a role that connects you in some way to the quality and delivery of patient care. What you do daily has the power to impact or detract from someone else’s experience. We all have a responsibility to provide the best interactions between colleagues, patients and families to create value. Encourage those around you to contribute their very best. Smile, be courteous, help motivate teams to see how providing their best efforts and being strategic about their work can make all the difference in patient care.

Ahmanielle Hall, MSPR serves as a Senior Communications Specialist at Cedars-Sinai. Her experience in public relations, social media marketing and internal communications has provided insight into the importance of building and strengthening relationships not only across healthcare organizations but also in the communities they serve.

Tags:  employee engagement  leadership  patient and family engagement  patient care  quality of care 

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Patient and Family Engagement to Improve Patient Safety

Posted By Tejal K. Gandhi, MD, MPH, CPPS, Monday, March 7, 2016
Updated: Monday, March 7, 2016

Patient engagement is an essential component of safe, appropriate, high quality healthcare. But what do we mean by patient engagement and how does it relate to patients’ experience of care?

A recent report published by the National Patient Safety Foundation (NPSF) notes that most definitions of patient engagement include the common themes of "partnership, communication, information exchange and respect.”

The Beryl Institute defines patient experience as "the sum of all interactions, shaped by an organization’s culture, that influence patient perceptions across the continuum of care.”

There are overlaps between patient experience of care and patient engagement. If patients are not respected as partners in their care and if clinicians do communicate with patients effectively, then it is highly unlikely that the patient’s experience will be a positive one. Moreover, research has linked patient experience to clinical outcomes, with a 2013 paper finding "patient experience is positively associated with clinical effectiveness and patient safety and [data] support the case for the inclusion of patient experience as one of the central pillars of quality in healthcare.”

The NPSF report, Free from Harm: Accelerating Patient Safety Improvement Fifteen Years after To Err Is Human, makes a number of recommendations for improving patient engagement to improve patient safety:

  • Training and education: Clinicians and health professionals need to be educated about concepts such as shared decision making, health literacy, cultural sensitivity and respect.
  • Ease of access to information: Patients and families need timely access to medical records, test results and tools and resources that help them understand complex medical information.
  • Patient representation: Members of the community served by a healthcare organization should be represented on the governing bodies and committees of those organizations. Only by such representation can we ensure that safety and quality initiatives and care processes that affect patient experience are designed with patients in mind.
  • Tools and strategies: From including families in bedside rounding to the use of tools like the Ask Me 3 program, which encourages patients to ask key questions about their health and care plans, there are tools and strategies that can help engage patients and improve their experience of care.
  • Reporting and measuring: The Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) serves to measure, to a degree, a patient’s experience of care while hospitalized. We also need ways to measure patient engagement, including ways to capture patient reports of safety lapses.

Arguing for greater patient and family engagement is not new to NPSF, and is in fact an issue that we and others have been advocating for some time now. While educational efforts such as the Agency for Healthcare Research and Quality’s Questions are the Answer campaign are useful for patients and consumers, we also know that even experienced health professionals sometimes have trouble speaking up when put in the vulnerable position of patient.

While patients should be encouraged to be full partners in their care, their clinicians are the ones who really hold the key to making that possible.

Improving patient and family engagement is one of eight recommendations in the new NPSF report, which is a focal point of Patient Safety Awareness Week, March 13-19, 2016. The theme of the week this year is United for Patient Safety, a reflection of the belief that clinicians, patients, policy makers, researchers and everyone involved in healthcare must be part of making care safer for everyone.


Tejal K. Gandhi, MD, MPH, CPPS, is President and Chief Executive Officer of the National Patient Safety Foundation, the NPSF Lucian Leape Institute and the Certification Board for Professionals in Patient Safety. She is advocating for patient safety at the national level, driving educational and professional certification efforts, and helping to create and spread innovative new safety ideas.

Tags:  healthcare  patient and family engagement  patient engagement  patient safety  research  service excellence 

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