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“I don’t do direct patient care.”

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

“I don’t do direct patient care.”

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

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

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

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

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

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

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

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

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

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Patient Experience: A Relational Achievement

Posted By Kenneth J. Gergen, Friday, June 24, 2016

We often think of experience as a private mirror. That is, there are events in the world, and they are reflected in our private experience. A patient may thus experience individuals in a healthcare system as nurturing and helpful as opposed to cold and indifferent. This view is shortsighted in two related ways. First, we are not passive recipients of others actions toward us; we are active agents in the world – even as patients – and these activities affect how we experience others. The quality of experience depends on what we are seeking, and what role we are playing. For example, the experience of pain you might experience at a sharp blow to your head is not the same as that of a boxer in the ring. Likewise, the pain of a needle being stuck in your arm is quite different for a patient who fears pain and is trying to avoid it, than one who eagerly seeks a blood test. The way we participate in health systems will vitally color what and how we experience.


This brings us to the second flaw in the common assumption that experience is like a mirror. It is not simply that the way we participate colors our experience. But this participation does not take place in a vacuum. The quality of experience depends on the relationships in which we are participating. Consider again the pain of the boxer. He is not boxing alone, but participating in a traditional form of relationship. In the same way, when we approach health systems with fear and defensiveness, we are also participating in a particular social tradition. Similarly, the way one experiences the probing hands of a doctor – a formalized relationship - is far different than the same touches occurring in the hands of a partner’s embrace. In effect, we may say that experience vitally depends on our participation in relationships.


In this light, the concern with patient experience shifts focus from the individual to the relationships of which the individual is a part. In effect, our sites turn to relational practices, and especially those practices that enhance the patient’s experience. Some of these practices are clear enough. We all know the positive impact of family relations that can lift the spirits and give meaning to the future. New innovations are also emerging on the scene. Programs in which patients are drawn into the treatment team – collaborating with physicians and nurses in their own care – are blossoming. Programs that increase the empathy of doctors for their patients, and patients for their doctors, are growing in numbers. Practices in which patients contribute to the education of physicians are inspiring. In all cases, there is an increasing sense that the best in healthcare grows from an awareness that "we are all in this together.”


For anyone wishing to know more, to explore the many potentials of a relational approach to healthcare, I would also like to recommend an upcoming conference Relational Practices in Health and Healthcare: Healing through Collaboration. It promises to be a lively, informative, and significant event.

This international conference will be held in Cleveland, Ohio at the new Global Center for Health Innovation, November 10-12, 2016. The conference is offered by the Taos Institute in collaboration with the International Institute for Qualitative Methodology, Alberta, Canada. The significance of relational practices will be underscored by a plenary offering from Jason Wolf, President of The Beryl Institute, and passionate champion of positive patient experience.

Kenneth Gergen is a Senior Research Professor at Swarthmore College and the President of the Taos Institute. He is internationally known for his writings on social construction and relational process, and their many applications to professional practice.

Tags:  collaboration  participation  partnership  patient  quality of care  relational healthcare  relationship 

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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

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

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