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.

#Hello My Name Is: The Power of Introducing Yourself

You’d think it’s no big deal, a seemingly insignificant detail that if missed doesn’t affect much.

Think again.

Dr. Kate Granger knows how much of an impact introducing yourself–or not–can have on a patient and their families. A terminally ill cancer patient herself,  she began the campaign after a hospital stay in 2013 where she developed post-surgical sepsis. She experienced first hand the many interactions with caregivers who never introduced themselves before delivering her care.

As doctor, she wanted to do something to bring to light this seemingly insignificant  yet profound interaction which she says,  “…is the first rung on the ladder to providing truly person-centered, compassionate care.”

She began the #Hello My Name Is campaign to  raise awareness of the importance of the  simple act of introducing oneself.  The worldwide campaign has caregivers re-thinking what it means to say hello.

“I firmly believe it is not just about common courtesy, but it runs much deeper. Introductions are about making a human connection between one human being who is suffering and vulnerable, and another human being who wishes to help. They begin therapeutic relationships and can instantly build trust in difficult circumstances.” –Dr. Kate Granger

I often teach the importance of a good introduction as the foundation to a good patient experience. It’s the strong base of a relationship between the caregiver and the person who is receiving care that is centered on trust.

Unfortunately, I’m afraid often times we over complicate it. We layer on acronyms and scripts–all with good intentions of helping–only to further push caregivers into the task trap while forgetting not what’s most important but who: the person sitting in front of them.

The most important thing that can happen in that moment when caregiver and patient meet is laying the foundation for a relationship that is based on trust. Introducing yourself extends the simple yet profound dignity and respect that every human deserves.


Closing the Gap Between Good and Great: Compassion

Recently Mark Behl shared a blog highlighting Fred Lee’s  TedxMaastrict talk, Patient Satisfaction or Patient Experience?  I really enjoyed watching the video. Lee is both funny and poignant as he demonstrates how the “little” interactions between the patient and their caregiver can send an experience from  “It was okay” to “I want (him/her) to take care of me every single time!”

The latter response is what cements patient loyalty. So how do we get there?

We can check all the boxes as to what we are supposed to do in an interaction with a patient, but when it gets down to it, the human-to-human interaction that occurs needs something more than a script. Our interactions with each other have to be driven somewhere from our hearts–no one wants to be cared for by someone who doesn’t really care.

In his Ted Talk, Lee demonstrates how we can check all the boxes in the world and still miss the mark as it relates to reducing a patient’s anxiety  and easing their way during their visit. The interaction can be ‘perfect’ and yet still leave the patient running for the door.


 “In any way you can measure what she did it was perfect. Perfect clinically. Perfect for service. Perfect for courtesy. But was she great?” 

The answer, obviously, is no. Mr. Lee would never choose to have the first “Shari” take his blood again. In fact, despite hitting every mark on anything measurable in that interaction, it’s safe to presume that Mr. Lee would have no qualms seeking out another healthcare provider the next time he needed a service.

The second ‘Shari’, however, confirmed her spot in Mr. Lee’s mind–and heart– as a caregiver who is competent and caring. The small nuances in her interactions with him, such as the way she asked a non clinical question to help put him at ease and the words she chose to say as she explained the procedure– “I’m going to be as gentle as possible”–have immeasurable effects on his perception of care.

Our compassion is what closes the gap between “good” and “great”. Compassion is lived out in the smallest of acts, and next to safety in a patient’s mind, few things matter more.



Music and Stories: Healing through Sunshine and Play

One of the best memories I have of when I was in a hospital in California with my son was being able to go outside.

We had been in the hospital for almost a week to address his microtia and to begin the reconstruction process on his right ear. I hadn’t left his side but to run down to the cafeteria to grab some cereal or a bar. The artificial lights and constant beeping and lack of sleep were making me irritable and cranky.  I didn’t realize how much the stuffy and cramped environment was getting to me–all I knew was that I was miserable.

A kind and gentle family advocate could see how much I needed a break and encouraged me to “get outside” for a little while and have some time to myself. She assured me she would stay with Ethan. It was hard to leave him, but I reluctantly grabbed my bag and walked out of the room.

I squinted as I stepped outside for the first time in what felt like weeks but was really only about four days. I felt the warm sunshine hit my face. The fresh air filled my lungs and I immediately felt some of the tension and stress in my body from the previous week release. I walked. I took some deliberate breaths. I let the sun bath my  face and with each step I allowed all the frustration and stress from the week a way out of my body.

I found a coffee shop. I sat outside and watched the people pass by. I couldn’t get enough of the fresh air.

I returned an hour later feeling new.  I was able to be the mom I needed to be to help Ethan heal. I have never forgotten the way it felt to be able to step outside after being cooped up in a hospital for a week–how important it was for me, his primary caregiver outside of the RN’s and CNA’s, to be able to have some time to myself and the intuitive role nature played in my own healing, so that I could return my attention fully back to Ethan.

It is this experience that drives my passion for our Music and Stories in the the Renown Children’s Healing Garden. Every week we work with our volunteers, Child Life Specialists, and our Healing Arts Performer, Melissa Taylor from Reno Little Theater, to bring pediatric patients who are able down to the garden for fresh air and a little bit of normalcy. To get them away from their beds, from the beeping, from the machines, and get them in a familiar environment where they can relax and play and forget they are sick–even for a moment.

It’s also a time for family to do the same. For parents and siblings, who are cooped up right along with the patient, to be refreshed and renewed. We encourage them, if they’d like, to get a Starbucks or take a walk, that their children will be safe and cared for while they get some much needed time to themselves. Most of the time they choose to stay, but they still leave feeling renewed because music and stories–and sunshine– are healing regardless of age.