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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, contact michelle.garrison@theberylinstitute.org.

 

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The Clinician Progress Note as a Tool for Improving Patient Experience

Posted By Jeffrey H. Millstein, MD, Friday, July 20, 2018
Updated: Monday, July 16, 2018

Earlier this year, our practice was asked to become part of a project enabling patients to view our progress notes along with other chart elements via our online portal. My initial reaction to this was curious, and a bit defensive, as was the case for my colleagues at our site. Don’t progress notes belong to us, the providers? Why should we have to share our tool?

In large scale studies, patients report feeling a greater sense of control over their health with this element of transparency. This is a continuation of a national movement toward greater patient autonomy and collaborative care which began with the creation of the “Patient Bill of Rights” in the 1970s. With the momentum unlikely to change in the foreseeable future, the question then becomes: do we resist this, or embrace the change? Making this win-win means re-evaluating the purpose and potential of our notes.

Until recently, I viewed progress notes as serving three purposes: documentation of what transpired during the visit and thoughts on diagnosis and treatment, providing information for colleagues reviewing the chart, and determining level of service for billing. Making shared notes most effective requires reframing our notes as primarily serving the interests of education, improving safety and reinforcing a caring connection. These are already a part of our core mission in patient care, so we can leverage our notes to those ends. They will still fulfill the other traditional goals, but with a shift in priority.

It has been demonstrated that patients often retain little from their office visits, which causes concern about safe adherence to prescribed regimens. Shared notes, along with teach-back, offer a strong opportunity to reinforce clinical plans. It requires adjusting our documentation style a bit, with some effort to avoid language that may be viewed as disparaging, clarify instructions and avoid abbreviations the patient may not understand. I have seen some providers create a separate section at the end of their notes titled instructions, beneath which are clear directions written specifically for the patient. I like to conclude my visits with a reminder, “Mr. X, remember that you can go on the portal and see my notes. If there is anything you forget about our plan, the notes are available for your review.”

There is no question that the EHR is a source of frustration, and a core contributor to clinician burnout. I will not mourn if someday I am able to delegate more EHR keystrokes to another care team member, but I view shared notes as an extension of my connection with patients. I can still view my notes as my own tool, but one which I choose to share in the interest of taking better care of people. Further, if my notes are collaborative in nature, then I can engage my patient while writing them, making the EHR less of a barrier. While there is a little extra up front effort, my patients may be safer and better informed. Who knows? It may even cut down on some after-hours calls and messages. Imagine that.

Jeffrey Millstein, MD is a practicing internist, and physician champion for patient experience at Clinical Care Associates of Penn Medicine.

Tags:  charts  Electronic Health Records  Patient Experience  patient records  providers  transparency 

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Phone Skills: Making or Breaking The Patient Experience

Posted By Sarah Suddreth, Friday, June 22, 2018
Updated: Tuesday, June 19, 2018

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.

Why?

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
    • Doctor availability
    • 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.

Tags:  communication  patient experience  scripting  technology  telephone 

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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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A New Framework for Putting Patients at the Center of Digital CARE

Posted By Niall O’Neill, Tuesday, May 15, 2018
Updated: Wednesday, May 16, 2018

"Oh great." I hear you say. Yes, this is another article about consumerism in healthcare. McKinseyForbesDeloitteNYTimesHarvard Business Review, you name it – industry leaders and commentators have all called this trend in recent years, and consumerism was a hot topic at HIMSS. But the truth is, this conversation started at the turn of the century.

A long, long time ago, in the year 2000 AD...

The Institute for the Future made some alarming projections about healthcare. They identified early connections between healthcare spending and consumerism.1

 

Patients

 

Consumers

Passive recipients of care

Actively making choices about care

 

A healthy economic market requires competition, and therefore, informed and engaged consumers empowered by choice. Other industries like retail, travel and technology2 have adapted rapidly, and consumers expect the same in healthcare services.

This isn’t about Siri replacing your primary care physician or Amazon’s robot surgeons replacing hips at Whole Foods. While we might get there one day, let’s dim the science-fiction fantasies for now and focus on the present reality.

We need a simple framework to drive today’s digital solutions so we can adapt quickly to healthcare consumerism, put patients at the center of care, and create a meaningful, interoperable platform to enable the future. Solutions for this new landscape must adhere to four fundamental principles of digital CARE:

  • Convenience
  • Accessibility
  • Relationships
  • Empowerment

Convenience

Once upon a time, patients may have had one choice - the community hospital. With the ongoing consolidation in the US market, super-systems now compete regionally for consumer loyalties.

Today, consumers have a choice, and are influenced by the same drivers as other industries – a need for convenience and responsiveness.3 When we look at the evolution of digital tools like smartphones, convenience drives us.

A zero-friction customer service model isn’t just “nice to have.” It’s absolutely necessary for acquiring and retaining consumer relationships. For patients, particularly those with ongoing care needs, convenience will reduce the burden of these interactions.

One technique is to map the consumer’s journey, starting from the point at which they have a need for care. Try thinking from the user’s vantage point. Even if a process works well for you and your staff, it may not optimally address your consumers’ (or their families’) needs. When we walk in our consumers’ shoes, we better understand what they are thinking and feeling, and can identify new opportunities for improvements.

Only when you understand your opportunities for improvement should you identify digital solutions.

When you can anticipate your consumers’ needs and think holistically about their interactions with your organization across multiple channels you can design personalized solutions that make it easy for them to get the information and communication they need, at the right time, in the right way. Reduce the friction, make it easy for your consumers.

Accessibility

Ron Mace, founder of the Center for Universal Design has defines Universal Design as the “design of products and environments to be usable by all people, to the greatest extent possible, without the need for adaptation or specialized design.”

To achieve this, involve as many consumers as possible in your design process. Connect with patient leaders through Patient Advisory Boards, or through organizations like WEGO Health and the Savvy Coop. Ask them to share their stories, and let them shape your diverse, realistic user personas. For those who don’t speak software, that just means your consumer experience must work for everyone, even outliers. Real life is messier than fiction, so let them inspire you to test your design in ways you wouldn’t have otherwise. And remember, your consumers speak many languages – emotionally, culturally and literally. Will everyone know what to do? Feel understood? Heard?

Technology creates new possibilities for accessibility.

Relationships

It is the best of times, it is the worst of times. Providers that meet or exceed expectations will gain and sustain relationships with consumers. Sounds great if you’re a consumer, but do providers have the time to be heroes?

They do if you leverage technology to automate their routine administrative and clinical tasks, so they have time to spend enriching patient interactions. Look for tools that enable them to focus on care and the interpersonal relationship, rather than data entry.

But remember, technology can do A LOT more than automate. Think of a time when you talked to an old friend living 10,000 miles away, or followed a new friend on Instagram because they had the best kitten memes...we are delighted in these moments. Can you foster the same humanity between doctors and patients using technology?

Digital tools have the power to improve communication in our relationships and foster partnership among consumers and caregivers. Today’s open, secure platforms for video and text-based dialog with “carers” (providers, family, friends) allow consumers to access care, share preferences, ask questions, and make shared medical decisions in the hospital or at home.

Empowerment

Knowledge is [em]power. *Knowledge (noun), the application of information through actions. We need to transition from information-sharing to knowledge transfer.

Patient portals are the standard patient engagement tool, thanks to Meaningful Use requirements. They give patients a view of some data captured in an EHR, but in many cases that information lacks context or helpful next steps about disease management. It’s not actionable.

Tools that empower consumers impart knowledge to facilitate self-care, give context and ensure that patient preferences, fears and motivators are factored into a longitudinal plan of care. We live in an exciting time for innovation in healthcare, and I believe that digital technologies can help truly put patients at the center of CARE.

1.  https://www.mckinsey.com/industries/healthcare-systems-and-services/our-insights/debunking-common-myths-about-healthcare-consumerism

 

Niall O’Neill is the Vice President of Business Development at Oneview Healthcare, a health technology company focused on improving the experience of care for patients, families and providers. Based in Dublin, Ireland, Niall turned to healthcare after over a decade of management consulting in other industries with Accenture and Deloitte, driven by a belief that technology can make healthcare better for all.

Tags:  choice  Consumerism  patient experience  relationship  technology 

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Patient Experience: Putting the Patient Front and Center

Posted By Katie Joyce and Katie Ziemer, Friday, April 20, 2018

Better patient experience has been linked with better health outcomes, improved treatment adherence, and increased provider and staff satisfaction. It creates a continuous positive upward spiral. However, initiating that upward spiral can be difficult due to the complexities of patient experience.  

To continue the dialogue around understanding and addressing these complexities, we decided to bring together experts in the field, including healthcare services researchers, technology innovators, and leaders in clinical organizational improvement. We published their perspectives in the Ipsos Understanding Society, Patient Experience edition. Below, we provide the main take-aways from this initiative.

What is not measured is not improved

Before patient experience can be improved, it must first be measured, but measured in the right way. Measuring the patient experience allows us to see what needs to be improved, and points to how to improve it. When tracked over time, it lets us see whether our improvement efforts are actually making a difference. However, a number of factors need to be taken into consideration when measuring the patient experience so that we can ensure the results are actionable and accurate. 

  • First, it’s important to measure the aspects of the healthcare experience that actually matter to the patient. What are their expectations? What barriers impede them from getting their needs addressed? Using a journey mapping approach, where patients describe their entire experience before, during, and after the encounter, can be a useful way to get this information.

  • Second, the patient experience needs to be linked to the systems and staff that impact their experience. What procedures do the staff use to check patients in? What are the rules for family visitation in hospitals? This information points to which aspects of the system or staff need to be changed to have the biggest impact on the patient.

  • Third, measuring the patient experience should place as little burden on the patient as possible. Increasingly, this can be accomplished through technology, such as online surveys and incorporating alternative data streams.

  • Fourth, we need to consider and account for the factors that can influence patient experience scores to gain as accurate of a picture as possible. For instance, primary care providers who have an ongoing relationship with their patients tend to receive higher scores than emergency care providers. This context needs to be taken into account when comparing scores between providers to make them equitable. Ipsos has developed fair scorecards that provide adjusted benchmarks to account for this context.

  • Fifth, while patient experience is important to measure, we also need to recognize that it represents subjective perception rather than objective clinical care. For example, patients’ satisfaction with their experiences depend on their expectations. If an experience meets or exceeds expectations, the patient will be more satisfied with the experience, whereas if the experience falls below expectations, the individual will be dissatisfied. 

Making the data actionable 

Once patient experience information is collected, the question then becomes what do you do with it?  Again, it’s important to identify the aspects of the patient journey (good and bad) that have the biggest impact on the overall experience. Patient-provider communication, care transition, and the availability of home-based medical care are all aspects of the patient experience that tend to significantly impact perceptions of the overall experience. Patients want to feel heard and respected by their doctor, a seamless transition once they leave the hospital, and the convenience of having their care team come to them (especially for elderly patients). 

Once the most important aspects of the patient experience are identified, the units and staff responsible for these aspects of care need to be engaged and part of the feedback loop and continuous improvement process. Getting the right information to the right people who can take action is essential.  In addition, getting staff buy-in and having a concrete action plan with tailored guidance and defined accountability are indispensable for creating successful improvements. This is often easier said than done as improving patient experience may necessitate large-scale institutional change. For instance, the Department of Veterans Affairs (VA) is rolling out patient experience improvement initiatives such as WECARE Leadership Rounding, where hospital leaders connect with patients and staff on a regular basis. Given the time, effort, and resources these initiatives require, facility leaders need to continually assess the success of these initiatives, keeping the ones that work and discarding the ones that don’t. This continuous feedback loop ensures that only the most effective initiatives are continued and promotes the upward spiral of providing patients with a better experience. 

Additional details about our findings on the challenges and solutions for improving the patient experience can be found here: https://www.ipsos.com/en-us/knowledge/society/understanding-society-us-edition-patient-experience

Katie Joyce leads the US Public Affairs Government and Healthcare Service (GHS) research portfolio, with full business management responsibility. She oversees a senior team of data scientists, Ph.D. social scientists and statisticians, technologists, and project managers, as well as a behavioral science practice. In addition, Katie leads the portfolio of private health work in consumer survey research and brand tracking – key clients include Anthem, Blue Cross Blue Shield, and Kaiser Permanente. 

 

 

Katie Ziemer, PhD, is an Associate Research Scientist at Ipsos Public Affairs. She conducts behavioral science research for federal and non-federal clients, including study design, data collection, data analysis, reporting, and advising. She also co-leads the development of a Behavioral Science Community of Practice which brings behavioral science service offerings to market and builds internal capabilities. Her research interests include attitude formation, behavior change, health promotion, disease prevention, brief psychosocial interventions, and positive psychology. Katie is a licensed clinical psychologist with a doctorate in counseling psychology from the University of Maryland.

Tags:  data  measurement  patient experience  process improvement  research  survey 

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Where’s My Casserole?

Posted By Glenn Kopelson, Monday, April 2, 2018
Updated: Monday, April 2, 2018

Did you know that 18%1 of the population has a mental health condition?  Did you also know that 11%2 of the population has heart disease? There is less heart disease in the United States than people with mental health disorders. With mental health issues more  prevalent than heart disease, why are mental health patients and families stigmatized?

Recently, the stigma associated with a mental health disorder affected me in a very profound way. I’m familiar with mental health issues because my family has a history of depression and anxiety, but in 2016 my 14 year old daughter had a suicide attempt and we were exposed to the stigma in a way which was new to us. Our journey started with my wife and I rushing my daughter to the emergency department where she had another three visits over the course of four months and was also admitted to the psych ward each of those times. After her time in the hospital, she spent the next several months attending a daily intensive outpatient program for adolescents. Next she spent one month living in a residential treatment facility. She spent the next six months at home enrolling in online schooling. With many doctors visits for medication management and one-on-one therapy in addition to group Dialectical Behavioral Therapy, she was able to integrate back into High School this year. I’m happy to say that she is doing much better as her suicidal ideations have diminished thanks to all the care we received over the past year. It’s been a long road to recovery and it would have been easier had stigma not been a part of her journey.

Unfortunately mental health disorders are viewed as embarrassing. It’s embarrassing for the patient, but also for the family because the subject is viewed as taboo by friends and family. This isn’t the case with other illnesses. Why is having heart disease less embarrassing than suffering from depression? Why is taking Lipitor more acceptable than taking Prozac? My family was faced with an ambush of gossip and innuendo. Your friends and family think, “they must be bad parents because they didn’t know what was going on with their daughter.” Moreover, what do I tell people at work? They surely won’t understand that I need time off to care for my daughter  I can’t say anything at work because then it will go through the rumor mill and I don’t want to deal with all of that office craziness. Sure we received support from some of our friends, but for the most part, people were scared to talk to us because this was a mental health issue. 

In addition to the stigma that my wife and I experienced, my daughter went through her own pain with shame caused by her friends.  She was now labeled the crazy girl who was admitted to the psych ward. Teenagers perceive the psych ward as a place where crazy people are in straight jackets because that is how it is portrayed in the movies. A psych ward is a far cry from the depiction in movies like “Girl Interrupted” or “One Flew Over the Cukoo’s Nest.” So the stigma is perpetuated in the movies and television which does a disservice to how therapeutic a psych unit actually works and looks. In addition to fighting to heal herself, she had to navigate through misconceptions and the pressure that adolescents go through with their peers.

Let me provide a little more context to our journey with stigma that my family experienced. My next door neighbor was recently diagnosed with cancer. She told me that she has more casseroles in her freezer than she knows what to do with. Another friend of mine, whose father has terminal cancer, decided to take his dad out of the hospital so he could spend his final days at home. He too has a refrigerator filled with casseroles. My daughter suffers from depression, anxiety and PTSD and was admitted to the hospital for over a month. WHERE IS MY CASSEROLE? Of course I’m not really looking for a casserole, but for people to understand that mental health issues should be treated no differently than other medical disorders. They should be discussed with the same compassion and thoughtfulness that people provide to those suffering from all other ailments. 

Let’s eradicate the stigma associated with mental health by seeking to talk openly and honestly about the issue. There are a few simple things you can do to help:

  • Don’t be afraid to talk about mental health, but educate yourself and embrace that this is a common disease that affects nearly all families.
  • Know that mental health is a disease, just like diabetes, heart disease and cancer.  
  • Most importantly show compassion.  It’s amazing how far a little compassion helps a family or person with mental health issues.
  • Finally, if you know someone with a family member with mental health issues, perhaps you can make them a casserole.  Here’s a helpful website to get you started.  https://www.delish.com/cooking/g1702/casserole-recipes/

1 Substance Abuse and Mental Health Services Administration
2 Center for Disease Control

Glenn Kopelson is Co-Chair of the UCLA Resnick Neuropsychiatric Hospital Patient Family Advisory Council where he works on issues to improve the patient and family experience.

Tags:  compassion  mental health  patient experience  perception  stigma 

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I’m an Industry Professional. Where I Go For Healthcare Recommendations Might Surprise You

Posted By Cally Ideus, Tuesday, March 27, 2018

I don’t like to think of myself as just a demographic. However, as a 43-year-old mother of five, I can’t help but identify with a famous trope in healthcare: women as the “Chief Medical Officers” of their households.

If you’re a woman, perhaps you can relate. We’re the healthcare gatekeepers for our families: 92% of us assist our loved ones with navigating care; 80% of household care decisions happen on our say-so. And research suggests that when we make these decisions for our loved ones, we rely heavily on social media to guide us.

As a professional in the industry, I understood all of this intellectually. But it took two overlapping health episodes to make me feel, on a visceral level, why we household Chief Medical Officers depend on social media to navigate our healthcare choices.

Where We Turn in a Crisis

The crisis began with a close friend’s devastating diagnosis. Just a year ago, before she got sick, we were skiing buddies. At 58, she was impossibly athletic, and she’d sailed past me on black-diamond courses without breaking a sweat. It was inconceivable that she’d ever become ill—until, of course, she did.

A week before Christmas, she learned that she had been diagnosed with inoperable, Stage IV soft-tissue carcinoma in her lungs. The prognosis was bleak. Stunned and scared for her, I wanted to lend a hand. The least I could do would be to help her find the best doctor she could.

I believed I was well equipped for this. My work puts me in contact with dozens of health systems on a regular basis, which meant I knew many knowledgeable professionals whom I could have called for a recommendation.

But I didn’t use those contacts at all. Instead, I started my search like over 80% of all healthcare consumers: online. In the heat of the moment, when I desperately wanted my friend to be in good hands, I felt compelled to turn to Google, Facebook, and star ratings on provider websites for validation.

Unfortunately, another panicked healthcare search experience would follow shortly thereafter when I got a phone call from my college-aged son. “Mom,” he told me, “I’m lying on the floor and I can’t get up.”

That frightened me. At the risk of sounding boastful, I can say that my son’s a very robust young man. A tri-sport athlete in high school, he once played through a serious bout of pneumonia, over my protests. If a health problem had literally floored him, I knew it must be serious.

My first instinct was to send him to the emergency room. After consulting with my sister, a medical professor at the nearest hospital, I learned that the ER had a serious backlog, and wouldn’t be able to see my son for four hours. My brother-in-law, a doctor, suggested urgent care.

So once again, I found myself (somewhat frantically) trawling through Google search results, trying to find a high-quality urgent-care clinic that could see him right away. My sister and brother-in-law pitched in as well—not by speaking with their colleagues, but by scanning Google results for top doctors in the area.

The reviews, provider websites and patient comments we found pointed the way to a nearby urgent-care provider, to whom I felt comfortable bringing my son. We got him an appointment, and learned that he had an extremely severe case of mono. A few weeks of bed rest later, and he was well again. Sadly, I never received a survey to compliment the amazing caring staff that took care of my son and his frantic mother. I did leave my reviews where I could, however, and raved to all who would listen on Facebook.

I wish I could say the same in conclusion to my friend’s fight with cancer. Despite our best efforts to secure her care, the insurmountable diagnosis ultimately claimed her life. Her voice lives on through her eternal comments left on social media, giving credit to the care she received throughout her journey.

The Emotional Pull of Stars

These are just two instances of how I—a relatively sophisticated and health-literate consumer—found star ratings on social media and provider websites irresistible when I needed help finding a provider. I’m certain that similar experiences happen thousands of times a day, all over the country. (In fact, there’s data to prove it: "Patient Ratings/Reviews" contain the most important information needed on a hospital website, according to the 2016 National Healthcare Consumer Study by NRC Health Market Insights.)

I believe that’s because of the unique frame of mind that a health crisis imposes on us. Such times can be frightening and extremely stressful, leaving us hungry for guidance, validation, and certainty. While no one can guarantee results in healthcare, I believe that we find comfort in the wisdom of the crowd.

Health systems looking to attract adult women, the gatekeepers of care for their families, should take note. Your online presence matters, a lot. And in cultivating it, you’ll be well served by giving your patients a voice, and by being transparent with what they have to say.

The more reviews accumulate, on your own website and elsewhere, the more information patients will have to help them with their care decisions. In moments of crisis, that information makes all the difference in the world—especially for “Chief Medical Officers” like me.

Cally Ideus is a combat veteran and international human intelligence scholar, and currently serves as a business development manager for NRC Health. In her role, Cally helps healthcare providers thrive in a consumer-driven economy by providing holistic customer intelligence essential to designing and delivering care experiences that surprise, delight, and inspire loyalty.

Her passions run deep for faith, family and justice. This is one of the reasons she speaks on multiple veteran and human intelligence subjects, but her favorite is “Battle ground on the home front” a story of survival after returning home. Cally lives in Nebraska on a ranch with her husband Jerod and sons Dalton, Quintin, Collin, Garret, and Mason. Her life wouldn’t be complete without the unconditional love of her two dogs, Daisy and Ziba.

Tags:  patient experience  perception  reviews  social media  star rating 

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Give Your Patients Permission to Dream

Posted By Chris Anselmo, Monday, March 5, 2018
Updated: Tuesday, March 6, 2018

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.

Tags:  communication  diagnosis  empathy  listening  patient experience 

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Taking the Long View of Patient Experience

Posted By Allison Chrestensen, MPH, OTR/L, Friday, February 16, 2018
Updated: Friday, February 16, 2018

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.

Tags:  care plan  compassion  empathy  patient experience  transition 

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Connecting with Patients is Key

Posted By Tom Scaletta MD CPXP, Thursday, February 15, 2018
Updated: Thursday, February 15, 2018

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.

Tags:  communication  connection  empathy  patient experience  provider experience 

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