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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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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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Bedside Shift Report from the Patient’s Perspective

Posted By Brooke Billingsley, Friday, March 17, 2017
Updated: Wednesday, March 15, 2017

Patients spend little time thinking about the nurse’s list of tasks to complete. They aren’t aware of the excellent job their nurse did charting their care, how staff made sure safety precautions were adhered to or what it took to provide a meal on time. 

Patients are functioning on an entirely different level. They are focusing on what they can control – which is very little – and how external forces are making it easier or harder to achieve their goals of getting better and getting out of the hospital. What registers with patients is ‘touch’ – those memorable moments in which staff made a genuine effort to connect with patients.

A positive transformation occurs in a patient’s perception of their care when touch is added to a task. That is certainly true with the Bedside Shift Report.

The BSSR is often misunderstood because it is seen as time consuming, does require effort, and for some, is uncomfortable. But the BSSR must be seen from the patient’s perspective to be fully appreciated. The benefits and value to the patient far outweigh the arguments against. 

Consider what the patient sees when a fully functioning Bedside Shift Report is conducted:

  • The BSSR allows patients to hear and physically experience how committed the organization is to their care and illustrates how unique and important their case is.
  • Patients are very conscious of how staff interacts with one another through conversations and body language. The BSSR presents an opportunity to show unity and camaraderie, which patients ultimately associate with good care.
  • Staff has the opportunity to give patients the assurance that they will receive the same great care from the new nurse as the previous nurse. It also increases the chance for mutual praise and promotion of the rest of the team.
  • Because the Bedside Shift Report is not a patient expectation (they are not likely to say, “Hey, I think I should be in on that get together in the hallway,”) the act itself is (novel) and memorable lending itself to increased satisfaction.
  • The BSSR demonstrates that time spent with the patient has value, which in turn shows respect for patients and their participation.
  • Adding some personality to the process completes the recipe for a guaranteed touch opportunity.

There are a few additional things you should consider in making the transition to a Bedside Shift Report a successful one.

  • Have a plan to determine what would be most beneficial for the patient to know and work out the details of the information exchange.
  • Practice until it feels comfortable. In time this should become second nature.
  • Communicate in a way that is most understandable to the patient.
  • If the patient is not able to participate, include family if they are present.

And finally, when you formally conclude your time with your patients, the BSSR shows that you care enough to say good-bye adding touch to a required task.

Brooke Billingsley is the CEO at Task To Touch™ e-Learning & Perception Strategies, Inc. a healthcare perception research company. Brooke is a speaker, consultant and author.

Tags:  bedside shift report  communication  improving patient experience  our  perception 

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Rounds for Change

Posted By Irene Brennick, Monday, April 25, 2016

As a volunteer director, I often make patient rounds with my CNO. At my hospital, staff and volunteers alike make patient satisfaction a top priority. We frequently round on patients, not only to assess their needs, but to also find out what didn’t go right so we can learn from it, correct it and make things better for everyone. During one particular interaction, I discovered how easy it can be to change a patient’s perception of the hospital from negative to positive.

My CNO and I walked into a room and encountered a female patient and her husband. We inquired about their experience, and their response revealed an opportunity for improvement. The woman said she was admitted through the emergency room, sent to another unit and finally arrived at the room she was currently in.

The patient told us how sick and scared she was. Her experience in the ER was somewhat of a blur, but she remembered very clearly an abrupt nurse in one of the units. She said the nurse didn’t listen to her, and her husband echoed the lack of attentiveness on behalf of the nurse. Once she was brought to her private room, however, she said she had received nothing but the best treatment.

After she recounted her story, my CNO told the patient "I am very sorry to hear that, because what I hear is that the care is very good. I will investigate the situation, and again, I am sorry.” I too have always heard about the exceptional treatment people receive in our facility, and was quite surprised to hear anything negative at all regarding the care. This patient and her husband started to protest a bit stronger. They repeated their story about how the nurse treated them in the unit.

I thought to myself, remember it is the patient’s perception of care and sometimes we have to do our best to make the patient experience better. When this patient goes to fill out a patient satisfaction survey we want to have eliminated or decreased the negative impression of our hospital. Before we left the room, I looked closely into the woman’s eyes and simply said, "I’m sorry you believe you didn’t receive the treatment you deserved. It’s not ok, and we need to do better.”

I wanted to let the woman know that I too heard her. If I were a patient and felt I was not treated compassionately, I would be upset as well. What happened next was pretty amazing. As we started to get up and walk out, the woman said, "Well, people are only human and everyone has a bad day. I don’t want to get anyone in trouble and really my care was very good.” At that moment I knew, just by being heard and acknowledged, the woman went from being upset, to all smiles, as she chatted about how she was feeling much better and hoped to be discharged soon.

I learned that day that making rounds is very important and we must really listen to what our patients are telling us. If a patient claims to have had a bad experience, they had a bad experience. It is our job as hospital staff to make the situation better, rather than be defensive. It is much better to just listen to our patients. Their information is a gift, and we should acknowledge their concerns. We should apologize, investigate and correct. Only then, will our patients begin to forgive any imperfections that occurred during their stay, and they could even become our greatest advocates. We want our patients to have the best experience when in our facility.

Since 2003, Irene Brennick has managed over 700 volunteers at Los Robles Hospital in Thousand Oaks, California and puts on health and education events as their Director of Community Services. She has a total of 24 years of experience developing and implementing dynamic volunteer programs. She has also addressed tens of thousands of people and her story has been featured in the L.A. Times, Daily News, and on television and radio. Ms. Brennick also speaks on topics that include, finding one’s purpose in life, the importance of giving back through volunteerism, and how anyone can be an inspirational public speaker.

Tags:  compassion  leadership  listen  patient advocate  perception  rounding  volunteer 

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Engaging Physicians to Improve the Patient Experience: A Few of My Life’s Lessons

Posted By Dr. Kenneth H. Cohn, Tuesday, June 24, 2014
Updated: Monday, June 23, 2014

Nikki, a weathered ED nurse, took me aside during my internship. "Just because that was your eighth patient with an ankle sprain this evening doesn’t mean it was her eighth ankle sprain.” My ears burned with indignation. How could people praise me for moving patients through the system and at the same time criticize me for not spending enough time with them? Now I salute Nikki and other nurses for believing that I was trainable.

The next step in my inadvertent journey to improve the patient experience came two years later when a lump in my neck proved to be a non-Hodgkin’s lymphoma. "It’s not fair,” one of my colleagues said. "You are a sensitive doctor. Why couldn’t this happen to some of the residents you work with who need to learn what it is like on the other side?” I felt that being a patient transforms a sensitive person into a sensitized person. I likened it to being a white male college professor who does research in race relations suddenly waking up and seeing that his skin has changed color. After that experience, it became easier for me to be in a room with an angry patient and family and say sincerely, "I can only imagine how upsetting this is for you,” and ask, "How can we work together to make your situation better?”

I witnessed the power of apology when I was asked to see a 20 year-old college student whose parents drove him from his college to the hospital where I was working after an ER doctor at an academic medical center dismissed his abdominal pain as alcoholic gastritis. After I went into the room, introduced myself, and said, "I’m sorry this has been such an ordeal for you,” I watched his parents’ shoulders drop several inches from the level of their ears. I operated on their son for appendicitis.

It wasn’t till I did a fellowship in surgical oncology that I learned that there is a time-tested framework for delivering bad news to patients. The SPIKES protocol consists of six steps, including:

  • Setting: respect privacy, involve others, be seated, look attentive and calm, listen actively, be available; let patient know of any time constraints ahead of time
  • Perception: ask patient’s and family’s viewpoint and concerns
  • Invitation: ask how much information patient wants to know
  • Knowledge: warn of upcoming news; give information in small chunks and clarify understanding at each step 
  • Empathy: acknowledge the patient’s and family’s emotion with phrases like, "I can only imagine how you must feel.”
  • Strategy: summarize events, check understanding, and plan for the future

That a surgeon like myself can learn from inadvertent experiences suggests to me that all physicians can benefit from training. I salute programs like the one where I trained (Columbia College of Physicians and Surgeons) that use actors to give medical students feedback about body language, tone of voice, and word choice. In general, physicians have done everything that we have asked of them. We:

  • Studied hard in college to get into medical school
  • Memorized and regurgitated facts the first two years of medical school
  • Worked 80-100 hours during residency and fellowship training

A physician CEO once told me, "We dismiss communication, negotiation, and conflict resolution as the soft skills, but they should be called the hard skills since they are so hard to do consistently and so hard to do well.” Physicians enjoy learning from fellow physicians. It can inspire all of us to be better role models in our daily practice.

Ken is a general surgeon/ MBA and CEO of Healthcare Collaboration, who works with healthcare organizations to engage doctors to improve the patient experience and organizational performance. To learn more about what he does, please visit Healthcare Collaboration.

Tags:  journey  knowledge  Patient Experience  perception  physicians 

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Could A Simple “Fix” Exist For Influencing the Patient’s Perception of Care?

Posted By Marlena Jareaux, Tuesday, October 29, 2013
Updated: Sunday, October 27, 2013

HCAHPS, enacted by Federal policy makers in response to the uneven care among hospitals, seemingly attempts to even the playing field. The primary goal is to lower the skyrocketing medical costs in our country while simultaneously giving more weight to the actual patient experience. This, in and of itself, is timely, very much needed, and will benefit our society as a whole in the long run. The problem is, as is often the case when a decision is made that attempts sweeping changes that affect many people, the mandate to essentially "fix it or be penalized” has made hospitals scramble to find fixes to a problem that many have found not to be as simple as it sounds. Or is it?

Recently, while doing a search on the internet on the phrase, "medical decision-making preferences,” I was struck by the synopses found within the first four pages of results.

Are there cultural differences in patient’s shared decision-making preferences
(of course there are)
Variability in patient preferences for participating in medical decision-making
(I would assume so)
A theory of medical decision making under uncertainty
(Is there just one?)

My favorite is the lecture notes from a medical education course on medical decision making. The first sentence reads, "This week we enter the strange and fascinating world of preferences, utilities and feeling.”

NOW, we’re onto something!

Tempting as it is to hope that your task of increasing your patients’ perception of quality care can be accomplished by a one-size-fits-all approach that can be purchased and implemented, it just doesn’t exist. Preferences change (don’t yours?), people change (gosh, do we), and circumstances change (the only thing that is constant, IS change). Fortunately, one of the greatest tools that can be used to keep abreast and stay ahead of the "strange” and seemingly complex world of your patients’ perceptions and expectations, is already embedded into the roots of every single healthcare organization that exists into this country and the healthcare workers working in them. CARE enough to ask. If you are human, you can care enough to ask.

I’m sure that in our pay-for-performance and results world that we live in, people will say "we don’t have the time to ask.” I’ve seen versions of this for myself: the revolving-door environments where the patient can barely see the eyes of the doctor or nurse to be able to even recall the color of those eyes, much less to detect any compassion in them. Or the seemingly thriving practice that delivers results for their patients, but can’t figure out why their scores for "likely to recommend” aren’t moving upwards.

Bottom-line is this: previously, hospitals could always rely upon patients walking through their doors because, well, they needed care and the hospital was there. Patients had to accept the care that they got, and only the truly-bad encounters got reported by those who bothered to take the time to do so. That landscape has changed. Like it or not, HCAHPS is here to stay, your patients are having their perceptions elicited, and you are being graded and rewarded (or penalized) according to those grades (and thereby, perceptions). Not only are those grades being publicized on the largest billboard that exists (the Internet), but so are the neon signs telling your patients and prospective patients to view your grades and choose in accordance with them.

On page one of the Hospital Quality Initiative Overview, found on the CMS website, you will read, "This will encourage consumers and their physicians to discuss and make better decisions on how to get the best hospital care…”

One powerful "fix” then, for all of you looking for one, is as simple as this: ASK.
 
Marlena Jareaux
Principal

Tags:  HCAHPS  patient experience  pay-for-performance  perception  quality of care 

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