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

 

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Top tags: patient experience  healthcare  communication  culture  patient  HCAHPS  Leadership  patient engagement  empathy  physician  survey  compassion  perception  physicians  technology  caregiver  community  data  employee engagement  family engagement  healing  Hospital  improving patient experience  collaboration  Consumerism  Expectations  interactions  patient and family engagement  pediatric  person-centered care 

All the Hats We Wear: A Look at the Challenges Facing the Healthcare Advocate

Posted By Rebecca Ruckno, Friday, April 21, 2017
Updated: Friday, April 14, 2017

We have all been there right? What hat should I wear at work today? The pretty hat? The thinking cap? Or maybe the hard hat? The role of the patient advocate can sometimes be confusing. We all agree that we need to support the initiatives of our hospitals while also supporting our patients and families.  How can we keep ourselves whole?

Over the past year and a half, the advocates have been working with a new initiative; Proven Experience. If the patient perceives that their experience was less than satisfactory, they can request their co-pays to be waived or refunded. Proven Experience is a promise of providing the best patient experience for every patient every time. When doing the investigation on the issue brought forth by the patient we often hear “all care was appropriate”. But what does “care” mean? To the medical team, care may mean that all medical protocol was followed and the outcome matched the protocol. To the patient, care may mean more than the “medical” care. It’s about how they were treated as a person. Did they receive all the information required to make an informed decision? Did we respect the patient and follow our C.I.CARE initiative? Often it is the compassion and the communication that our patients tell us that we are lacking. The team discusses the request with the patient and arrive at a mutual conclusion ending with the refund of the out of pocket expense. Because the perception of the outcome may differ, we may choose we wear our hard hats!

Since the roll out of the refund program we have almost doubled the issues we handle monthly resulting in adding additional staff. The relationships between the advocates and the various departments that they interact with have become stronger. Particularly, the departments of Finance, internal audits, service lines and legal. This is due mainly to our development of a more collaborative agreement with a win/win for our patients. We are looking to improve telephone wait times, appointment wait times, smooth transitions and bills that are understandable. Kindness and compassion are integral in the journey to recovery for our patients. The patients are bringing their experiences to the team hoping to make it better the next time. Perhaps we have always taken care of these issues before but now the refund has new meaning. Research in the future will show us if customer loyalty is obtained because of improving the experience. 

The frustration has been in the reliance of other areas to help us determine what the refund will look like. Information needs to be gathered from the patient, the teams and finance. Billing of insurances, waiting for information from various departments can delay the final response to the patient.

When we do have time to catch our breath we need to look at the repetitive issues, develop a strategy and truly fix the challenges. Data needs to be reviewed and solutions must be developed. We have a variety of hats to choose from every day.  Often times we may need to change our hat to meet the needs of our patients while also meeting our own needs. Thinking caps are required.

Becky Ruckno is the Director, Patient Liaisons and Interpretive Services with Geisinger Health System.

Tags:  advocate  compassionate care  finance  patient care  patient experience 

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The Patient Experience as the Ethos of Nursing

Posted By Susan E. Mazer, Ph.D., Tuesday, January 24, 2017

The key to the optimal patient experience is sustainably grounded in the ethos and practice of nursing.

From Florence Nightingale: “I use the word nursing for want of a better. It has been limited to signify little more than the administration of medicines and the application of poultices. It ought to signify the proper use of fresh air, light, warmth, cleanliness, quiet, and the proper selection and administration of diet -- all at the least expense of vital power to the patient.”

To nurse someone to health makes us think of specifics images of caring, as well as any number of tasks and responsibilities. The professional nurse, however, does so much more with skill, knowledge, and in-depth commitment. 

When Nightingale wrote this, she was writing a job description of one person. However, in current healthcare organizations many of these tasks wind up being handed to environmental services, housekeeping, and dietary services. Further, a nurse aid or CNA might also take over bathing patients and providing blankets.  

Yet, there is higher risk with the nurse not doing the bathing and not observing patients except at medication time. Nightingale often wrote about how a patient would perk up when the nurse walked into the room, but such a burst of energy was for performance or out of pride. A skilled and trained nurse would see past this to actually understand what was happening with the patient.

The result is that, for patients, many people are involved in their care, with the nurse administering medications and performing a variety of clinical tasks. What’s more, nurses do all the work of tending to medical needs according to what physicians request and, as well, what they see.  

For patients, each person that enters their room performing any of these roles carries the mantel of nursing. Because of this, it is common for patients or family members to ask whichever staff person is in the room about the next pain medication, meal, or any number of other things. 

If you ask patients who is the most important to their recovery, they will tell you it’s the physician and the nurse. They tolerate the system that sends in surrogates, but become frustrated with the inconsistency in quality and authority.

Where is Nursing Located in the Patient Experience?

Nurses have not yet been called to, called for, referenced, or sought out to lead us into a more humane model of care that has been codified in each nurse from the day they decided to go to nursing school. The patient experience is a nursing tradition of compassion and respect for the personhood of the patient. It is inseparable from what nursing is. 

Further, a subculture of nursing has formed without acknowledging its dilution of the patient experience/caregiver relationship. Patients now have one person to tend to taking their vital signs, another to respond to all their non-clinical needs, another to feed them, another to bathe them, and still another to get the “real” nurse. 

Each one of these individuals knows a piece of the patient only to the degree their position allows. The rigorous call to service that is the nurse, the attention to every detail that holds the clue to the patient’s pain and suffering is not part of this subculture. In fact, the tasks that a CNA or nurse aide performs are done with minimal understanding of what human caring is.  While they are considered non-professional assistants, to patients these individuals are in their room to care for them. And to do so with the highest regard for the patient and family.

In service to patients, the cohesive practice of caring should be consistent in all those who take on even a small piece of the total responsibility. Everyone, then, who enters into the domain of the patient is a nurse in the sense, as Nightingale expressed, that the health of the patient has been entrusted to them. Anything less is unsafe and inappropriate to the healing relationship and integrity of care.

Nightingale wrote that the task of the nurse is to make sure that her patient is cared for exactly as she would if she is not there, for any reason at all. 

She wrote, “Let whoever is in charge keep this simple question in her head (not, how can I always do this right thing myself, but) how can I provide for this right thing to be always done?” 

And Then Came HCAHPS

The HCAHPS survey makes visible what Nightingale acknowledged 150 years ago and is the mandate of Watson’s Theory of Human Caring. 

HCAHPS surveys begin with questions about physicians and nurses speaking to the patient with respect. Nightingale wrote this about how to speak to a patient:

“Always sit within the patient's view, so that when you speak to him he has not painfully to turn his head round in order to look at you. Everybody involuntarily looks at the person speaking. If you make this act a wearisome one on the part of the patient you are doing him harm. So also if by continuing to stand you make him continuously raise his eyes to see you. Be as motionless as possible, and never gesticulate in speaking to the sick.”

Respect has many meanings, each unique to the individual and the situation. However, holding the patient in the highest regard was a founding tenet for the Nightingale nurse. She wrote about how not to strain the patient, how to acknowledge by one’s actions that the patient’s comfort was primary to the conversation.  At that time, and even today, this is a demonstration of respect.

Many nurses have no idea what HCAHPS is other than memorandums coming from others.  They are removed from the other side of HCAHPS because the ethos of their practice disavows disrespect for the patient, for the family, and for each other. And, what HCAHPS measures is already within their professional mission and practice.

As we continue to move into greater depth of our understanding what the patient experience is for the patient, those who care at the bedside must be acknowledged and supported. The key to the optimal patient experience is, again, in the ethos and practice of nursing. It is in the mission of caring merged with skill and knowledge that is in the core of each nurse that we will find answers to how to respect and heal patients into wholeness.

 

Susan E. Mazer, Ph.D. is the President and CEO of Healing HealthCare Systems®, Inc., which produces The C.A.R.E. Channel. In her work in healthcare, she has authored and facilitated educational training for nurses and physicians. Dr. Mazer has published articles in numerous national publications and is a frequent speaker at healthcare industry conferences. She writes about the patient experience in her weekly blog and is also a contributing blogger to the Huffington Post’s "Power of Humanity" editorial platform, dedicated to infusing more compassion into healthcare and our daily lives.

Tags:  compassion  HCAHPS  healing  heart of healthcare  nurses  patient care  serve  tradition  wholeness 

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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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