The (in)Patient Experience

The Work That Can Never Be Completed

Earlier this year I was asked why my physician organization’s goal for the “Communication with Doctors” section of the HCAHPS survey isn’t a top box score of 100%. My explanation was that setting a goal of absolute perfection for a subjective assessment of communication between doctors and patients would likely be counterproductive, producing apathy rather  than engagement on the part of physicians (if you’re a fan of setting SMART goals, you’ll know that ‘A’ stands for attainable).

 

I later realized that although my answer may have been indicative of some short term managerial savvy, I failed to understand the challenge that my questioner was issuing. This realization struck me - nearly six months later - while reading a compelling piece from the New England Journal of Medicine entitled “The Word That Shall Not Be Spoken,” written by Dr. Thomas Lee, Chief Medical Officer of Press Ganey.

 

In it, Dr. Lee asks whether the relief of suffering is a reasonable expectation of the patient experience mission and explores why physicians traditionally shun the notion that they are responsible for “relieving suffering.” He writes that, “Relief of suffering may be a task too vast to seem real for most people — something on the order of achieving ‘world peace'.”

 

Despite this perception, Dr. Lee concludes that the relief of suffering is a valid overarching vision, noting that “good organizations have ambitious goals.” He also acknowledges the enormity of this profound goal and shares the critical message that lies within it, “Collectively, we should not shy away from work that can never be completed.”

 

As 2013 comes to a close, I’d like to commend the increasing numbers of physicians and physician organizations that have committed to improving the patient experience despite innumerable challenges and imperfect means of measuring success (read more in the Beryl Institute's white paper, "Voices of Physician Practices and Medical Groups: Exploring the State of Patient Experience").

 

We must continue these great efforts not because the patients receive surveys or because we’ve been offered performance incentives, but because our calling obliges us to promote, as Dr. Thomas Lee says, the relief of suffering. HCAHPS scores are short-term goals. The relief of suffering is the vision. Spend 5 minutes talking about your latest HCAHPS scores. Spend your career learning how to better relieve suffering.

 

And recognize that quality in healthcare will never be “complete”. Those who make great strides in patient experience improvement will be those who don’t shy away from the work despite this reality. Much of the challenge - and the beauty - of the work we do to improve the patient experience is that it is unending. While this may sound ominous, I find it reassuring for two reasons. First, it implies that it’s never too late to begin focusing on patient experience improvement. And second, it is indicative of the richness of the patient experience and the many incredible ways that we can positively impact it.

 

In retrospect, I believe the person who asked me why our organization wasn’t targeting 100% HCAHPS top box scores was making a deeper inquiry about our vision. They wanted to know that our doctors understand this is a career-long pursuit and that they won't shy away from the unending work of improving the patient experience. Now I understand the question. And I promise, we won’t.

 

 

Do I Deserve to Take Care of Patients?

Consider this message in a current advertisement:

This is it. 
This is what matters. 
The experience of a product. 
How it makes someone feel. 
When you start by imagining  
What that might be like, 
You step back. 
You think.

How will this help? 
Will it make life better? 
Does this deserve to exist?

These thoughts are from a company that makes phones, music players and computers. I couldn’t help but read this print and web ad from Apple over and over, wondering if we in healthcare are asking ourselves questions about the patient experience that are nearly as tough. In particular, after reading the last three lines, I kept thinking:

How do I help? 
How do I make lives better? 
Do I deserve to take care of patients?

These are questions we must ask ourselves regardless of rank or role. Our technical training has earned us a spot on the healthcare team but it does not differentiate us from any of our colleagues nor make us shine in our patients' eyes. The antibiotics and fluids I prescribe work just the same when my partner orders them for her patients. The medications you successfully administered could have been given properly by another nurse. Sure, there are times when these tasks call for a bit of finesse. In the balance, however, technical skills rarely set us apart when it comes to great care.

Do I deserve to take care of patients?

I do if I’m sure to address what I call the patient’s “core concerns”:

What is happening to me? 
Will you listen/talk to me? 
Will you look out for me?

And those who truly understand this commitment will also listen, talk to, and look out for their co-workers, knowing that those efforts ultimately serve their patients as well. And these are also the people who see the strength in saying "yes" to those in need, creating great experiences for others knowing it's the shortest path to their own satisfaction and freedom in the work place. As author Pandora Poikilos wrote, “We are so accustomed to the comforts of "I cannot", "I do not want to" and "it is too difficult" that we forget to realize [that] when we expect others to dance around us, we are not achieving greatness. We have made ourselves weak.”

How do I help? 
How do I make lives better? 
Do I deserve to take care of patients?

I'm using these questions to stimulate conversations about the patient experience. Ask the next person you interview to reflect on them. And ask these questions of yourself. I’m doing the same. 

3 Tips to Help You and Your Business Card Improve the Patient Experience

Recently overheard in the hospital:

Nurse: “Has your doctor been in yet?”
Patient : “Yes, he was here earlier .”
Nurse: “Was it the doctor who saw you yesterday?”
Patient: “No. He did tell me his name... I just can’t remember it. I’m sorry.”

We’re the ones who should be sorry.

Let’s face it. Hospitalized patients have an exceedingly difficult time remembering who their providers are. Studies have repeatedly shown that few inpatients, often in the 20-30% range, can correctly name even a single physician provider. This should come as no surprise. Think about the last time you were at a business meeting or dinner party and multiply the number of new faces by at least ten. How would you fare on a pop-quiz asking you to remember who was who?

If you want to make a lasting impression that improves the patient experience, make sure patients know who you are and how much you care by using your business card. I’m all for using white boards and electronic patient communication systems (if your hospital can afford one), but they’ll never replace the value of a thoughtfully constructed and utilized business card.  Here are three tips for making sure that you and your business cards deliver a high impact message:

1) Use Big Fonts
This one is pretty straightforward. Traditional business cards often use miniscule fonts. Patients who are sick, tired and often without their reading glasses shouldn’t have to work hard to read a business card.

2) Include a Welcoming Photograph
People are much more likely to remember you when they have access to a picture. And a welcoming photo (one with a warm, encouraging smile) implies accessibility and genuine interest. There is data to suggest that photographs improve not just patients' recollection of their physician, but also patient experience of care perceptions.

3) Use It to Convey Accountability
This critical step is on us. Explain to patients that you are giving them your business card because you want to be sure they know who is caring for them. In addition to conveying accountability and confidence, this also helps to establish trust. And if you really want to knock it out of the park, combine this with a statement of accessibility and managing up, such as, “if you have any questions for me, please let [nurse name] know. He/she can reach me easily.”

No one should have to struggle to recall the name of their physician.  As Dr. Anthony Breu, a hospitalist, pointed out in a thought provoking January 2012 KevinMD blog post, “I am constantly a stranger and a new face.” It’s our responsibility to do everything in our power to facilitate patients’ understanding of who we are and how we are involved in their care. Use your business card well. And don’t be a stranger.

(Below is the business card of one of my colleagues who gave me permission to post this digital image of her card - this is a format we use throughout our organization. Note the inclusion of the statement, “I work with your doctors:” which allows us to write in the name of patients’ primary physician or the specialist that consulted us.)

Interested Parties Should Have the Following Attributes

Last week I noticed a new independent coffee shop in my neighborhood. Seattle has a preponderance of coffee shops - in case you weren't aware - so I was curious to see what Milstead & Co. might have going for it. I googled the store name and found their website which contained a blog with a recent entry titled, "Milstead and Company is Hiring for Part Time," and consisting of the work requirements.

I've been perusing job descriptions for roles outside the healthcare industry to learn how others express the passion and commitment they seek in their employees, so I was interested to see what Milstead was looking for.

I'm a firm believer in the notion that healthcare has a lot to learn from industries further along in the quest to improve the quality and consistency of the experiences they offer.

The fact is, every industry offers the same service: the solution to a certain type of problem.

That problem might be pneumonia, or the need for an attorney, or the simple desire for a cup of coffee. And sure, the stakes are quite different in each case, but the fact that the quality of every consumer's experience is determined by our communication and actions holds true whether we're providers of healthcare, legal services or a cup of joe.

With that in mind, let's look at Milstead and Co.'s job posting:

We are looking for individuals that are interested in providing our clientele with a singular coffee experience. Interested parties should have the following attributes:

• Self-motivated – are you the first one to attack a problem?
• Hard working – are you the last one to quit?
• Empathic customer service – can you connect with our customers in a professional manner?
• Thirsty for knowledge- do you want to learn new skills? Are you open to criticism and self-improvement? Are you excited about the task at hand?
• Sense of urgency – can you do many things at once? Can you identify and prioritize what needs to be done and do so in a speedy, efficient manner whilst never breaking a sweat?
• Observant – do you pay attention? Are you diligent, careful, and keen to remember all of the details of our process?

What struck me most about this posting was the focus on attitude rather than skill. The question isn't what kind of problem you can solve, it's whether you'll be the first one to attack it. It's not whether you'll connect with customers, but whether you'll do it empathically and professionally. And perhaps most importantly, it's not just that you're interested in learning a specifc skill set. Rather, you're open to criticism and self-improvement.

I stopped by Milstead & Co.'s shop to chat with owner Andrew Milstead, an accomplished Seattle barista who has used his undergraduate work in psychology and his ten years of experience in the coffee business to distill the attitudes and behaviors of successful people. He is particularly on the lookout for those who exhibit "proactive living," which he describes as people who have a passion for "engaging with life and people."

"Ultimately, as a business, it's not all about the product - it's about how we take care of the people," says Milstead, adding, "If we don't take care of the people we're serving - it's worthless." His least favorite experience in life is, "going someplace that I want to love because they offer a great product or service, but finding people with miserable attitudes. Life is too short for that."  

If life's too short for mediocre attitudes at our favorite retail and hospitality providers, then surely we don't have time for such attitudes in the healthcare setting. 

Yes, it's true that doctors, nurses, phlebotomists or CNAs must be properly trained and capable of maintaining certain clinical skills. But these competencies are simply an admission ticket to consideration for the job. The requirements should never stop there.

Caregivers of every discipline should understand that they must lead with a constructive and service-minded attitude to earn a spot on the healthcare team today.

And leaders in healthcare must clearly focus on hiring for attitude by creating organizational expectations and job descriptions that acknowledge skill requirements and put the focus squarely on attitude.

As Andrew Milstead points out, interested parties should have the following attributes...