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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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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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Give a Better Patient Experience by Introducing the Care Team

Posted By Julie A. Snow, Wednesday, February 1, 2017
Updated: Tuesday, January 17, 2017

As a patient, it can be uncomfortable and overwhelming to stay in a lonely hospital room with a seemingly neverending stream of unfamiliar faces coming and going throughout all hours of the day and night.

Hospitals can do a lot to improve the patient experience. One simple, yet surprisingly effective way to do so is by simply taking the time to introduce the patient to his or her care team professionals. This one act can improve a patient’s familiarity with their care team members, enhance their awareness of what to expect from each member and increase their confidence in the care that is being provided. When these things happen, the doctors, nurses and other hospital staff can also feel more connected with and more committed to providing the best care possible.

With both patients and providers quickly establishing a relationship with each other, patient satisfaction with their overall hospital experience can improve drastically while hospital staff feels more fulfilled in their work. It becomes a win-win situation.

Improve Patient Familiarity with Care Team Members

A team-based approach to patient care is widely used by hospitals. This is to ensure the best care possible for each patient. When the team is optimized by being composed of staff members who are working to the highest level of their expertise and abilities, the following can be accomplished:

  • Patients gain enhanced access to a team of experienced professionals
  • Patients are more satisfied with their stay
  • Care will see improved levels of quality, reliability, and safety
  • Hospital costs will reduce

If there is a downside to using a whole team of rotating professionals, it’s that the patient may not be given much of a chance to establish a relationship with each team member. This delays or reduces the chance for trust to be built. However, by keeping patients regularly updated on not only the name of their care provider but also their photo, title, and qualifications, it is easier to build a higher level of trust in a shorter amount of time.

Increase Patient Trust and Confidence

So what happens when patients are more familiar with the background, qualifications and certifications of each team member who is responsible for their care? Patients feel more comfortable in the hospital environment and even the confidence in themselves and their ability to heal is increased.

With this newfound trust and confidence, patients can become more empowered to voice their concerns, ask questions regarding their care plan or prescriptions and accept the advice of experts. After a patient leaves the hospital, they will be more likely to follow their doctor’s instructions and seek needed follow-up care.

A New Way for Introductions

A nurse can write his or her name on a whiteboard hung up on a patient’s wall, but now there is a better, more engaging way to make introductions. Hospitals are introducing their patients to care team members via an in-room television or even a digital whiteboard displayed on a personal tablet. This method has proven effective since the updates happen automatically, in real time, and patients are familiar with the format.

Easy access to information and enhancing patient awareness both play a big part in the encouragement of patients to open a consistent dialog with their care provider. A simple conversation can make all the difference in the health and wellness of a patient.

Patients are determined, more than ever before, to be fully engaged and educated in their own health care. By giving them the opportunity to be proactive when interacting with their care team, you are also giving them the opportunity to be more fully satisfied with their overall hospital experience.

 

Julie A. Snow is a health researcher and writer who has worked together with Sonifi Health to improve patient experience. When she isn’t working or mothering, you’ll usually find her in an Ashtanga Yoga arm balance or eating (sometimes both at the same time).

Tags:  Interactions  introduction  patient access  patient engagement  relationship  team  technology 

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Patient Experience Sits at the Center of Nursing

Posted By Susan E. Mazer, Friday, October 21, 2016
Updated: Friday, October 21, 2016

The patient experience is neither new nor revolutionary in healthcare. 

Florence Nightingale, 1820-1910

In fact, it goes all the way back to the work of Florence Nightingale who, in response to what she saw in the Crimean War, realized so much suffering could be relieved with the standardization of nursing practices. 

In her first and most famous monograph, Notes on Nursing, Nightingale claimed that suffering should not be presumed as part of the disease. Rather she wrote that “the symptoms or the sufferings generally considered to be inevitable and incident to the disease are very often not symptoms of the disease at all, but of something quite different -- of the want of fresh air, or of light, or of warmth, or of quiet, or of cleanliness, or of punctuality and care in the administration of diet, of each or of all of these.” 

From experience and observation, Nightingale knew how rudeness and inconsideration on the part of physicians and nurses could cause patient suffering. The task of the nurse was to protect the patient.

She warned that the vital energy needed by the patient to go through the reparative process should not be wasted nor distracted. Nightingale considered all disease to be reparative, coming on over many years and finally showing itself in a serious of symptoms observable and obvious to both patient and nurse.

There’s no doubt that nursing is where the patient experience initiative began and is what should guide it today.

Our healthcare system has thrown out the idea that nursing might be where we could best learn about the patient experience. And yet nurses have always been the strongest clinical advocates for patients. They understand the source of pain and suffering first because of their intimate relationship with patients.

In truth, the patient experience began to deteriorate when our healthcare system became consumed with medications and technologies. Patients then became the last people to be consulted about their condition and their needs. And, nurses became medicalized as the whole system sought to make all symptoms ripe for medical diagnosis and treatment.

However, Nightingale defined nursing as managing symptoms of suffering that were neither medical nor complex -- symptoms that could be solved by manipulating the environment or paying attention to the patient’s spoken needs. Or, symptoms that reveal other issues that would undermine that patient’s own capacity to heal.

My relationship and work with nurses, which began in 1980 when I designed educational programs on the use of music as therapy, has given me perspective on the considerations prioritized by Nightingale. Dallas Smith and I wrote and presented a docudrama (now a podcast), “Florence Nightingale: In her Own Words,” that brought to life her frustrations with the system that inspired her work. Nightingale’s writings were and are consistent with her absolute commitment to the humanity of the patient, to the uniqueness of each individual and the specificity of their situation.

Additional study of nursing theory has also helped me understand and respect the transpersonal relationship that nurses have with their patients and the way that nursing holds the tradition and expertise of the patient experience.

Dr. Jean Watson, Professor Emeritus and Nurse Theorist, moved Nightingale’s work further in identifying the unique role of nurses in her Theory of Human Caring (or Caring Science). Her Caritas principles, which are the guide to her Nursing Practice Model, call upon nurses to be authentic in their caring for their patients, to treat themselves and others with loving-kindness and equanimity, and allow for the depth of physical and spiritual wholeness in themselves and their patients.

Our relationship with Dr. Watson has taken Dallas and I to Qatar and Jordan, working with nurses in the Middle East who are committed to human caring across borders and political conflict. There, where some Palestinian nurses are not paid for nine months, and where Israeli nurses take in Syrian children and love them as they heal their physical and emotional wounds, human caring has taken on profound meaning.

The bottom line for nurses is to respect patients and their autonomy regardless of their acuity, capacity, or personality. Then allow patients to do as much as they can for themselves and to not get lost in a system where patients are often just medical records.

May Solveig Fagermoen, Ph.D., R.N., associate professor at the Institute of Nursing Science at the University of Oslo, Norway writes, “In nursing, respect must be, or rather is, grounded in the inherent worth of individuals as human beings regardless of their capacities and characteristics (a nonsecular position). … a person is respected not because of his individuality, we do respect him in his individuality. We take his interests, purposes, and degree of autonomy itself into account in the particular way we treat him.”

If the patient experience demands respect from physicians and nurses, identifies the patient’s right to expect and need for quiet and cleanliness, and if it presses to not have patients wait for any reason, then the practical map of how to do this lies in Nightingale’s work and ultimately in nurses.

And, if there is absolute respect for the suffering that you could not know, the anxiety you do not want to cause, and a sense of professional accountability for each patient, then the patient experience sits at the center of nursing, in each nurse, in every hospital.

 

Susan E. Mazer, Ph.D. is the President and CEO of Healing HealthCare Systems®, Inc., which produces The C.A.R.E. Channel. In her work in healthcare, she has authored and facilitated educational training for nurses and physicians. Dr. Mazer has published articles in numerous national publications and is a frequent speaker at healthcare industry conferences.

Tags:  accountability  healing  nurse  Nurse Leadership  relational healthcare  relationship 

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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.

AS WE PARTICIPATE, SO DO 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.

TOWARD RELATIONAL HEALTHCARE

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.”

A CONFERENCE ON RELATIONAL PRACTICES IN HEALTHCARE

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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