A Letter that Reminds Us What is at Stake

A while ago I came across a letter that was floating around social media from the New York Times. The letter was written by Peter DeMarco after his young wife, just 34 years old, passed away due to a massive asthma attack.  He recollects all of the kind, humane ways in which the care team treated his wife, her family, and him during her final seven days in the hospital.

He touches on all of the seemingly “little” ways the doctors, nurses, and staff treated them with empathy and ultimately love. Blankets when they were cold, special visitor requests granted, endless coffee and water, a chair when needed, a shower, a question answered, an explanation given with patience and compassion, and “sadness in [their] eyes”.  His letter shows the depth of compassion and kindness that surrounded this family during the hardest time of their lives.

You have to read it to the end though. I haven’t cried like that for a stranger’s situation in a really long time. He not only  captures beautifully the essence of what it means to compassionately care for those who desperately need it, he also captures the delicate fragility of life and what it’s like to lose someone you love.

The letter not only serves as a well deserved thank you to all the caregivers who cared for his wife and their family, it also reminds me of the depth of what is at stake in the everyday moments of our lives, as rushed and routine as they can become.

Read it here.

 

 

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Practicing Mindful Communication

I spent the last week in Orlando, Florida at the Press Ganey National Client Conference. There were so many highlights, including having the opportunity to listen to Condoleezza Rice as well as a plethora of others doing their best to leave this world better for them having been in it. What inspires me the most is their unswerving dedication, despite having seen so much opposition, to continue to fight to improve our lives, whether it be in the realm of security, or healthcare.

One of the most insightful and inspiring sessions I attended was titled, “Activating Physician Culture with Physician Coaching in Relationship Centered Care.” The session was led by three doctors who have instituted a training program at Texas Children’s Hospital for doctors to improve the skills it takes to build relationships with patients that foster meaningful communication. They spoke of the directionally correlated relationship between good communication and quality of care outcomes.

One of the distinctions they made was the emphasis on relationship centered care–not “doctor centered” or even “patient centered”–but relationship centered. They spoke of the lack of communication training that physicians–but in reality all caregivers–receive, and yet, they said, communicating is one of the most common “procedures” a physician will do. Yet so many do it so incompetently: they stated studies have shown a physician will typically interrupt their patient in the first 14 seconds of a conversation. I would say that is not necessarily only a physician problem, but a human problem.

In the training one focus is on the importance of listening. To demonstrate they had us participate in a listening activity they do in their trainings with the physicians. The concept was simple: in pairs, one participant would share with the other a challenge they were having at work, while the other would listen. The game rules were that the listener would not interrupt, but rather they would let the other’s story unfold. Once the speaker was done, the listener would then try to restate  what they think they had heard, specifically listening for the other to confirm by saying something like, “Yes, that’s right.”

I have to admit I did an inner eye roll when they said we were going to have to do this activity. I think I’ve done something similar at some point, and I’ve always considered myself a good listener. In this particular case, I was the speaker. I let my story unfold. My listener, a stranger, leaned in, gave me all of her attention. She didn’t interrupt me, and when I was done, she tried to repeat in her own words, the meaning behind what I was saying.

She was a good listener. In less than two minutes, I felt like she knew me, she connected with me. And I realized how rare this type of communication is. I realized how rarely I am a good listener, because I am mostly hearing in order to know how to respond.

I realized I’ve been missing out on the stories I could have let unfold. On understanding and connecting with others and letting conversations flow and travel down their own paths, paths to new meaning and new understanding, vs me taking control and guiding the conversation to at best a familiar path, and at worst (how many times have I done this?) to a screeching halt.

Today I tried to listen to understand. I tried to get the meaning of the stories behind what people were talking to me about and I was cautious of injecting my own experience, insight, or whatever. Because what I saw in a new way through this particular session was the importance and significance of others’ experiences, not just my own.

**In my video I mention one of the doctors was from John Hopkins. When I went back to confirm I realized that was not correct. The speakers were Laura Cooley, PhD, Executive Director, American Academy on Communication in Healthcare (AACH); Larry H. Hollier, Jr. MD, FACS, FAAP, Chief, Division of Plastic Surgery, Texas Children’s Hospital; and Calvin Chou, MD, PhD, FAACH, Vice President for External Education, AACH; Professor of Clinical Medicine, UCSF.

 

 

Caring for the Caregivers: Schwartz Rounds

After six years in healthcare I still have so much to learn, but one thing is certain: patients aren’t the only ones who suffer in hospitals. Caregivers can also experience a significant amount of suffering, not the least of which is the emotional and psychological effects of the situations they find themselves thrown into while caring for patients and their families.

It’s this emotional side of healthcare that rarely gets addressed. There are too many tasks to perform and protocols to follow to spend any time focusing on the emotional impact the work may be having, for good or for bad. With healthcare burn out on the rise and retention a hot topic for any healthcare leader, healthcare administrators are looking for solutions to these very real, very sensitive topics.

Enter Schwartz Rounds. Schwartz Rounds are all about caring for the caregiver and are one way to help with burn out and retention.  Usually when “rounds” are spoken of in a hospital setting they refer to checking in on the status of patients. Schwartz Rounds, conversely, check in on the status of the caregivers themselves.

“Schwartz Rounds are a place where people who don’t usually talk about the heart of the work are willing to share their vulnerability, to question themselves. The program provides an opportunity for dialogue that doesn’t happen anywhere else in the hospital.” – Participant
  The Schwartz Center for Compassionate Healthcare

Schwartz Rounds create an open forum for anyone who cares for patients–clinical or non–can come together to discuss the social and emotional issues that arise in caring for patients.

Here is how it works:

 

Prior to the forum, a case is chosen. There is great care in choosing the cases; it has to have had a significant impact on caregivers. It doesn’t necessarily have to be a hard or sad case, although I would say a majority of them probably are.  Often overlooked in healthcare is the necessity to talk about the positive emotional impact of the work.

Once a case is chosen, a panelist is chosen to present the case. There are facilitators to help the group process through and talk about the different emotional and social aspects the particular situation brought up for them. Caregivers who may not have been directly involved in the particular case can comment and participate by drawing on similar past experiences.

What’s cool is that everyone is invited, and it’s a way for the different teams of doctors, nurses, environmental staff, techs and anyone else involved in the care of a patient to come together, to share stories, to laugh and cry and leave strengthened.

According to The Schwartz Center for Compassionate Healthcare website, participants in Schwartz Rounds reported:

  • Increased insight into the social and emotional aspects of patient care; increased feelings of compassion toward patients; and increased readiness to respond to patients’ and families’ needs.
  • Improved teamwork, interdisciplinary communication, and appreciation for the roles and contributions of colleagues from different disciplines.
  • Decreased feelings of stress and isolation, and more openness to giving and receiving support.

Addressing the needs of caregivers is paramount to providing the best care for the patients they serve. It is also paramount to decrease burnout and help retain compassionate and skilled caregivers.  Schwartz Rounds is one way to help caregivers process through some of the suffering and some of the joy they experience while taking care of the people and the communities they serve everyday.

Doing Better: The Transparency Tactic

In a world swarming with millennials and linksters, service industries are changing, including healthcare.

Long gone are the days when business could shout with a megaphone who they say they are and think that anyone would believe them. Today, with the internet in our pockets and customer reviews available to anyone at anytime for practically any service,  companies are no longer who they say they are–they are who we, their consumers, say they are.

We listen not only to online reviews but also to our neighbors, our communities on Facebook and Twitter.  Marketing campaigns are only as successful as the truth that spills out all over the internet, available with a swipe of a finger.

Healthcare does not get to jump ship on this. As consumers, patients and those involved in their care have every right to seek out healthcare experiences where they not only get the quality of care they want but also are treated in a way where they feel valued as a human being. Their clinical care could have been absolutely solid, but if they felt ignored, not listened to, disrespected or treated poorly, caregivers do not get free pass.

Patients have a voice in a way they’ve never had before, and CAHPS is just a small part of it. Even without the five star ratings, patients are talking and  listening to each other in ways that weren’t possible even ten years ago.  Although healthcare is moving at a snail’s pace, it is moving nonetheless towards accepting and coming to terms with what all of this means.

Organizations like the University of Utah Health Care and Wake Forest Baptist Health are leading the way, grasping the opportunity to use the technology and values of these generations to drive improvement in ways-up until recently-were rarely talked about in healthcare.

One of the ways they are doing this is by going fully transparent with their patient experience data rating online. They aren’t just posting the good things-they are posting everything. Not only does this give patients and their loved ones information when it comes to choosing their healthcare providers, it also is getting the attention of providers in a big way.

In Beyond the Buzz: Transparency Drives Real Improvement, Dr. Thomas Lee, Chief Medical Officer at Press Ganey, says that stepping into full transparency should be done thoughtfully and considerately. He recommends three phases: “First, collect more [good] data and report it to clinicians. Next, share it openly within the organization. Finally, go public.” 

He thinks transparency will play a key role in driving positive change among clinicians:
“…I think the most powerful way to get clinicians to focus on improvement is to share data publicly. And the data that seem most compelling when shared are patient comments. Everyone can spend all day arguing about the methodology use to analyze date, but a comment is a comment–it’s a unit of data. Something good or something bad happened (and most comments are good). Even if the something bad is a rarity, that doesn’t change the fact that it happened.”

It only makes sense. No one wants a bad review. And when it’s out there for all the world, including your own colleagues and patients to see, it naturally drives the question, “How can I do better?”

And that’s a question we should always be asking.

 

 

 

 

My Response to Doc Vader: It’s Not About the Turkey Sandwhich

I saw this video on the intranet today. It made me really sad, that some caregivers have the perception that wanting to improve healthcare by involving the voice of our patients (CAHPS) is silly or stupid. That as long as we don’t kill people, we have done our job.

I realize the video is supposed to be funny, and I’ve spoken with enough caregivers to know that many resonate with its message.

The thing is I’ve also spoken with enough patients and family members who have gone through a significant amount of unnecessary suffering that had nothing to do with their medical condition and everything to do with the way they felt treated by their care team, to not find much humor in it at all.

Even yesterday, I spoke with a mom who told me about her experience with her twenty-eight year old daughter who has Hodgkin lymphoma. This is her third round of chemo. Her daughter is also a wife and a mom; her own daughters are four and six years old.

Last week her daughter started to experience unbearable pain in her stomach. Her mom took her to the ER so that her husband could stay at home with the girls.

When they got to the ER,  she said they waited for over eight hours with very little interaction from any caregivers whatsoever. They felt ignored, but worse they felt judged: as if the staff, including the physician, assumed she wanted drugs for pain to get high.

My daughter felt like they striped her of any dignity she had left. When the people you have gone to for help  ignore you and pass judgement on you, it causes a lot of pain.

I can only imagine what it must be like to have cancer ravaging my body, but then, on top of that,  to feel like the very people I’ve gone to for help have turned their noses up at me, or worse, have acted like my feelings, my situation, my life, doesn’t matter–all that I would have left would be rage.

And so it was with this young woman.

Feeling like no one was listening and wanting to get away from being in a place surrounded by people who she felt were judging her, they left AMA. She saw her oncologist the next day and and he immediately told her she needed to go back to the hospital to be admitted.

This is what patient experience is all about. It’s not about getting a patient a cup of coffee if he or she asks for one, or patients and their families being prima donnas. It’s about people who need help and our ability as caregivers to meet that need with compassion, respect, and love. Sometimes that involves a cup of coffee (or a turkey sandwich) but it’s so much deeper and more significant than that. If we think patient experience is simply making our hospitals look like hotels and nurses becoming waitresses, we have missed the point entirely.

What do you think?  I’d love to hear your thoughts!

 

 

 

 

Designing the Perfect Inpatient Unit Part II

Back in June I was part of a 3P (Production, Preparation and Process) Workshop. In this workshop employees were given the opportunity to create and  design a new inpatient unit.

As you’ll see in this video, the process was very interactive and included a lot of time for exploration and play in the sense that we were continually asking ourselves, “What if…?”

Working with architects as well as multidisciplinary front-line staff, the team used all sorts of props and boxes in order to “design” and “build” a new unit. By using props that were malleable and easily moved we were able to quickly develop our ideas in a visible and creative way.

The safety and overall experience of the patient, family, and caregivers kept us focused and constantly challenged us to push our thinking. Check it out!

 

 

 

 

The Human Experience: Why Chick-Fil-A Could Drive Your Patient Experience

If you’ve been in healthcare for even a small while you are probably familiar with Cleveland Clinic’s video series on empathy. The videos are emotional and powerful, reaching beyond our minds and into our hearts.

The videos beautifully show the very human side to our healthcare experiences. After watching the video, despite the complexity, technology, and process focus of healthcare,  you can’t help but walk away reminded of the humanness of it all.

It’s the humanness that patients understand best. It’s the small things we do to show them compassion, even if we don’t know the full onslaught of details of what is going on in their lives. We are sensitive that every patient is a human with a story: a life of  worries and stresses that they are doing their best to handle, with the added anxiety of their health situation to boot.

What many people don’t know is that the Cleveland Clinic empathy videos were inspired by a  video put out by a quick service chicken restaurant,  Chick- Fil-A .

You heard me right. Chick-Fil-A.

I found Chick-Fil-A’s video just as moving if not more so than the Cleveland Clinic videos in the way it evokes the truth of our human condition no matter where we are.

Chick-Fil-A does more than dish out food. They want to make a valuable connection with other human beings in their community. Food is the means by which they have opportunities to “create a remarkable experience.”

Healthcare is a means by which we also have ample opportunities to create memorable experiences for others. To give back. To make our communities stronger. To change people’s lives for the better. To fulfill our own individual missions as well as be a part of something bigger and have way more of an impact than anything we could ever do on our own.

In a hospital or picking up a sandwich at Chick-Fil-A, it’s the raw experiences of being human that connect us all.