Patient Experience Tips
"When you have an angry patient, 
respond with empathy."

 

Imagine this scenario, which could occur in either the hospital or clinic: Your patient, Ms. Johnson, is quite ill. Her daughter flew in from out of town to bring her to the doctor, and she is  desperately waiting to hear what you have to say. As usual, it's a busy morning so you are running behind. When you finally enter the room, her daughter let's you have it.

Finally, you're here! How could you keep us waiting for so long? My mother is sick and you took your sweet time coming in to see her! How could you be so thoughtless?

What can you do to address her concerns with empathy?

I want to share 3 great suggestions from my course with you:

1. Listen - our tendency is to interrupt and defend ourselves, but in these situations, taking time to truly listen without interruption goes a long way. While listening, actively use expressions to show that you are tuned in. 
- "Hmmm"
- "I see"
- "Uh huh"
- "Go on" 

2. Name the feeling - one of the first things we can do is name the feeling that our patients and family members are expressing. Some great phrases to use are:
- "It sounds like..."
- "What I'm hearing you say is..."
- "What you're telling me is..."
- "I can tell that you're [emotion person is expressing]" 

3. Imaginative empathy - this refers to us imagining what someone else is going through from their perspective. In my course, they taught us never to say, "I know what you're going through" or "I understand what you're going through". This is disingenuous because you don't fully know or understand. Instead, use imaginative empathy phrases.
- "I can imagine what this must feel like..."
- "I can imagine how scary this is for you"
- "I can imagine how frustrated this experience has been"

Knowing this, how can you respond to Ms. Johnson's daughter?

After listening to her concerns, you could say something like this. I'm so sorry to keep you waiting. I can tell that you are frustrated. It sounds like your mom has been ill for several days and it's been very scary for you, especially since you've been trying to take care of her despite living in another state and having a family of your own. I can only imagine how stressful this is.

Granted, her daughter may still have some residual anger/frustration, but you have definitely made more progress with this approach than if you had responded angrily or defensively. To be honest, I've used this approach many times before, and even though the patient/family may have been angry when I initially walked in, they are incredibly thankful and grateful for my care by the time I leave.

That's it for this week. I hope this helps, and next time, I'll give you a few more tips that I learned in my course for responding with empathy.

Take care,
Trina

 

 

 

Thanks to everyone who came out to support me during my talk at the  Cleveland Clinic Patient Experience: Empathy + Innovation Summit. It was such an honor to present at the conference, and I hope you learned something new.

 

 

Do you want to improve your patient experience? If so, your wait is over.Physician's Guide to Surviving CGCAHPS & HCAHPS and CGCAHPS & HCAHPS Breakthrough are two great books for anyone looking to improve their patient experience!

Thank you to everyone who has already bought a copy! I appreciate your support, and I sincerely hope my books have helped you improve your patient experience.

 

 

Click HERE for Physician's Guide to Surviving CGCAHPS & HCAHPS

 

Click HERE for CGCAHPS & HCAHPS Breakthrough

 

Want to subscribe to my newsletter?
 http://www.drtrinadorrah.com/subscribe.html

 

 
 

 I recently had the opportunity to hear Maureen Bisognano, CEO of Institute for Healthcare Improvement, speak at the Society of Hospital Medicine 2015 Annual Conference. In her keynote address, she challenged us to focus less on asking what's the matter with our patients and more on asking what matters to our patients. One way to do this, she noted, is to start asking our patients what a good day looks like to them. Why is this so important? As providers, we have a specific agenda we want to accomplish while in the room with the patient. As we've gotten busier, the time we spend just talking has decreased. Given the rush, we often don't stop to ask our patients what their actual preferences are. Taking a moment to ask our patients, What's a good day look like for you?, puts the focus back on our patients and their wishes. It's not complicated, and it only takes a minute, but the answers could be transformative.

Imagine a patient with pneumonia. As the physician, a good day in my opinion would be one in which my patient takes the antibiotics and doesn't spike a fever. However, in my patient's mind, a good day may be one in which he or she sits outside in the hospital's healing garden for a few minutes. You can see that my good day and my patient's good day are completely different. In fact, I may never suggest the healing garden on my own. By taking the time to ask the patient what a good day looks like, I now know one small thing I can assist with to make a huge difference for my patient. The nice thing about this question is it applies to both the inpatient and outpatient setting. 

Maureen Bisognano challenged all of us at SHM to start asking our patients what a good day looks like for them, so now I challenge you to do the same. 
 
 

Patient Experience
"Explain 3 Ways"
 

As providers, explaining in ways our patients understand is one of our most important jobs. When I shadow providers, I tell them to make sure they explain 3 ways. I encourage them to say it, show it, and write it down.

Say it
As providers, this is what we're used to doing. We give instructions to our patients with the hope that they understand and comply with our recommendations.

Show it
A lot of patients are visual learners, so taking the time to show them a visual as you explain tremendously improves their understanding. You can use a poster, 3D model, picture from the internet, etc.

Write it down
If you give your patients written information to take home with them, they will be much more likely to remember and comply with your instructions. This can be something you write out for them, a handout, pamphlet, etc.

 

Example: prep instructions for a colonoscopy


Say it: "Mr. Allen, in preparation for your colonoscopy, you're only allowed to have clear liquids for the entire day before your colonoscopy. You cannot have any solid food."

Show it: "Mr. Allen, here is a picture that shows what things qualify as clear liquids."

·  Example of clear liquids. Picture taken from http://www.pico-salax.ca/bowel-preparation.html

 



Write it down: "Mr. Allen, here is a handout for you to take with you that shows exactly what qualifies as a clear liquid." 

·  Example of written instructions as taken from http://www.pico-salax.ca/bowel-preparation.html

 

 

If you're going to the Cleveland Clinic Patient Experience: Empathy + Innovation Summit next week, come and check out my talk. I'll be speaking Monday at 2pm (How to get physicians to the table and keep them there).

 

 

Do you want to improve your patient experience? If so, your wait is over.Physician's Guide to Surviving CGCAHPS & HCAHPS and CGCAHPS & HCAHPS Breakthrough are two great books for anyone looking to improve their patient experience!

Thank you to everyone who has already bought a copy! I appreciate your support, and I sincerely hope my books have helped you improve your patient experience.

 

 

Click HERE for Physician's Guide to Surviving CGCAHPS & HCAHPS

 

Click HERE for CGCAHPS & HCAHPS Breakthrough

 

 
 

 To be honest, rounding with nurses is something I did in residency as part of team rounds, but I had gotten away from it  since moving beyond an academic setting. Thus, when hospital leadership asked the hospitalist team to consider nurse rounding, I was a bit skeptical. I always thought it sounded good in theory, but I didn't think it would work in reality. As it turns out, I've really enjoyed it, so I wanted to share it with you so you can consider it as a way to improve your patient experience. 

The exact logistics will vary based on your hospital's size, but for me, when I arrive on the unit, I find the nurse's portable phone number and call him or her. I let the nurse know where I'm headed, and he or she makes it a priority to join me. I spend a lot of time with my patients, so I try to respect the nurse's time by stating the plan while the nurse is present. That way, if he or she needs to move to another room, the plan has been discussed. I also make sure to ask the nurse his or her input and address any questions or concerns he or she has. 

It's been working great, and one of the things I like most about it is that everyone can benefit - the patient, the nurse, and the physician. One of the challenges when introducing new initiatives for staff and providers is to show how it benefits them. Nurse rounding is a patient experience initiative where everyone benefits.
 
Everyone benefits * Patients benefit by having the nurse and doctor working together at the same time to discuss the patient's care. Rounding is done at the bedside with the patient so the patient is really able to participate and feel included. If the patient or family has a concern, they can express it at that time to the two members of the care team who are best able to advocate for them. It's also an opportunity to show the patient and family that you work together as a team. Patients want to know their entire care team is on the same page and focused on their care, and physician/nurse rounding is one way to accomplish this goal.
 
Nurses benefit because they hear the plan directly from the physician, as it is conveyed to the patient. Oftentimes, nurses have information that would alter the treatment plan, so being in the room with the physician as the plan is being expressed helps both the physician and the patient.

For example, if I'm discussing discharge planning and my nurse tells me the patient is unsteady on their feet and requires 2 nurses to get out of bed, I'm going to think about rehab placement as opposed to sending the patient home to live alone.

Physician/Nurse rounding allows nurses to be more knowledgable of the plan, so they can reiterate important information to the patient and family about that plan throughout the day. 

For example, if the nurse hears me tell the patient they will be going home on insulin, he or she can begin educating the patient on insulin and how to administer it.

Physician/nurse rounding also encourages nurses to raise questions and concerns during rounds as opposed to trying to locate the physician at a later point in time. This helps nurses to feel like valued members of the care team, which improves nurse satisfaction and retention.

Finally, physician/nurse rounding helps nurses to better learn their physicians' styles and preferences to better assist the physician in taking care of the patient.

*Physicians benefit because the nurse is more knowledgable about the plan, and can more easily answer patient and family questions. Pages to the physician are reduced. No more pages from nurses asking questions that have already been addressed in rounds, and fewer pages from nurses asking doctors to update families. It doesn't completely eliminate the need for physician/family updates, but having the nurse give a basic update eases family anxiety and often alleviates the need to speak directly with the doctor about every concern. As doctors are increasingly pressed for time, anything to improve efficiency helps. Physicians also benefit because nurses have a unique perspective, and this perspective can help the physician as they create the treatment plan. Common things nurses bring up are issues related to wounds, debility, nutrition, and discharge planning. However, as the physicians and nurses become more comfortable with each other, the relationship evolves and the nurse truly becomes a valued ally to help the physician with his or her work.

Regardless of how you implement physician/nurse rounding, I definitely encourage you to give it a try. It really is a win/win for all - patients, nurses, and physicians. 
 
 

by Dr. Trina E. Dorrah

I’ll admit it. I like reality TV. In fact, one of my favorite reality TV shows is Dallas Cowboys Cheerleaders: Making the Team. It shows what it takes to become a Dallas Cowboys Cheerleader. Why am I talking about cheerleading in a health care blog? Because the Dallas Cowboys Cheerleaders put more effort into hiring cheerleaders than most health care organizations do in hiring doctors. If you’ve read any of my previous blog posts, you know I spend a lot of my time training doctors on specific things they can do to improve the patient experience. Physician training is a common tactic in health care, but when those efforts fail, health systems spend a lot of resources trying to help their habitually low performing doctors. Lately, I’ve been thinking we should try a different approach. Why not focus more attention on hiring for the patient experience from the start?

How does this relate to the Dallas Cowboys Cheerleaders? In health care, we aspire to hire the best. The Dallas Cowboys Cheerleaders are one of the country’s best professional cheerleading teams, but they didn’t gain this distinction by solely focusing on dance skills. Instead, they have created an audition process that ensures they select cheerleaders who embody the mission and values of the organization. I think health care should follow their lead.

3 hiring tips … taken straight from the Dallas Cowboys Cheerleaders

1.    Redesign your hiring process to produce the results you want.
·      DCC: To become a Dallas Cowboys Cheerleader, you must be able to do more than just dance. The interview process puts applicants through a variety of situations, all designed to ensure candidates have what it takes to uphold the values and vision of the Dallas Cowboys Cheerleaders.

·      Health care: In health care, we are often understaffed, so we fall into the trap of hiring the first competent physician who applies for the job. The problem with this approach is we really don’t know how well they communicate with patients, if they are empathetic, or if they connect well with others. Health care needs doctors who are excellent clinicians and patient experience advocates. Unfortunately, we’re really good at assessing technical competence, but we’re lousy at assessing the more subtle qualities that make or break a patient’s experience.

2.    Focus on your core values.
·      DCC: In order to become a Dallas Cowboys Cheerleader, you have to repeatedly show the judges that you posses the values and characteristics they desire. Because the interview process spans several weeks, it’s easy to know who is genuine and who is simply faking it.

·      Health care: We all have a code of conduct we want our doctors to adhere to and we all have a set of core values we expect them to possess. However, few health care systems have a reliable way to gauge during the interview process if a doctor can or will live up to these standards. Even when we ask, we take the doctor’s word for it without ever verifying if his or her prior actions demonstrate hostility towards improving the patient experience.

3.    Assess communication skills.
·      DCC: To become a Dallas Cowboys Cheerleader, you must demonstrate that you are a good communicator by performing well in a Q&A interview session. If an applicant fails to communicate effectively, she gets cut.

·      Health care: In health care, our interview process does assess general communication skills. However, communicating to an interviewer is entirely different than the communication that is required for effective patient care. Being able to communicate things in a way patients understand is critical for providing a good patient experience, and health care currently does little to evaluate this skill when hiring.


Now that I’ve mentioned some of what’s missing from health care’s current hiring process, let me explain what I think we should do to change it. Yet again, the Dallas Cowboys Cheerleaders have already figured out the solution.

“Assess applicants’ skills before offering the job.”

What does it take to be a Dallas Cowboys Cheerleaders? Their website outlines the following steps: 1) Complete the application, 2) Preliminary Audition, 3) Semi-Final Audition, 4) Personal Interview, 5) Written Test, 6) Final Talent Auditions, and 7) Complete training camp. Notice how many steps I listed - seven! The last step alone takes several weeks. In health care, most interviews last 1-2 days max, and although applicants speak with several interviewers, they are rarely asked to demonstrate one of the most important things – their commitment to the patient experience.

3 ways to assess patient experience skills before offering the job

1.     Review prior patient experience survey results – virtually every health care organization measures the patient experience. Review your applicant’s prior results. If you’re planning to hire a physician who consistently scored at the bottom of his or her peer group, or who consistently had more patient complaints, consider hiring someone else.

2.     Focus on the patient experience throughout the hiring process – this should begin as soon as a physician submits an application. For example, put a video on your website explaining your organizations’ commitment to the patient experience, and require applicants to review it before they can submit an application. Likewise, the patient experience should be discussed throughout the interview process.

3.     Interact with patients – before you make an offer to a new doctor, observe his or her interactions with patients. You can work with your legal department to use real patients under the direct supervision of a staff physician. You can use volunteers, members from a patient advisory council, or paid secret shoppers. The point isn’t to judge the doctor’s diagnostic or technical skills, but to observe their body language, emotional intelligence, and communication skills.

In the end, not every physician will be a good fit for your organization. By learning to hire better, you can hire physicians who embrace your organization’s commitment to the patient experience. This is much easier than trying to correct behavior after the fact. What do you think?

Dr. Trina E. Dorrah (@drtrinadorrah) is an internal medicine physician/hospitalist and the author of Physician’s Guide to Surviving CGCAHPS & HCAHPS. She can be reached through www.drtrinadorrah.com.
 
 

What's in a name?

by Dr. Trina E. Dorrah

Have you ever noticed the reaction you get when you mention the patient experience? Undoubtedly, you’re met with a few providers who demonstrate frustration, anger, and disgust. You may even hear them say that it doesn’t matter how well the doctor treats a patient as long as he or she is competent. These beliefs confuse me, especially when these same providers face their own health crises, then complain about the lack of empathy they, their partner, or child received. Do you notice the irony? When asked to focus on the patient experience, these providers dismiss it. Yet, when their doctors don’t communicate with them or show compassion, they are frustrated.

The truth is, doctors and other health care providers really do care about the patient experience. I think the frustration arises from the connotation associated with the phrase.  For some reason, many providers think of the patient experience as catering to unreasonable demands or ignoring the importance of clinical competence. That’s simply not true. When I think about what the patient experience is and is not, the following list comes to mind.

The patient experience is about…

  • ·      Listening
  • ·      Showing compassion
  • ·      Treating patients as we ourselves would want to be treated
  • ·      Explaining so our patients understand
  • ·      Spending time with our patients
  • ·      Asking for and answering questions
  • ·      Helping to facilitate care
  • ·      Working with our staff to streamline processes
  • ·      Continuing our commitment to maintain clinical competence
  • ·      Practicing according to evidence based standards
  • ·      Taking time to explore patient fears
  • ·      Engaging in collaborative goal setting
  • ·      Discussing difficult issues in a compassionate way

The patient experience is NOT about…

  • ·      Catering to every whim and desire
  • ·      Turning physicians into concierges
  • ·      Choosing treatment options that go against evidence based medicine
  • ·      Buying patients’ loyalty through rewards and perks
  • ·      Refusing to discuss difficult issues
  • ·      Only making recommendations that are pleasing to hear
  • ·      Prescribing unnecessary medications
  • ·      Subjecting ourselves to verbal abuse
  • ·      Devising treatment plans that completely exclude patients/families from the decision making process
  • ·      Creating an environment where one must work within our health care system or know someone who does to have a good patient experience

In the end, I believe if providers have a better understanding of what the patient experience truly is (and what it is not), they’ll be more willing to embrace it. If everyone in health care commits to this goal, doctors, nurses, and providers won’t feel the need to name drop/intervene/call in favors for our loved ones simply to ensure they have a good patient experience.  

 

    Author

    Trina E. Dorrah, MD, MPH, is a board-certified internal medicine physician who practices at Baylor Scott & White Health in Round Rock, TX. In addition to her clinical work, Dr. Dorrah is the medical director of quality and the physician champion for the patient experience. Dr. Dorrah is passionate about improving the patient experience and she loves to share her expertise with others. 


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