August 30th, 2011
Progressive hospitals keep it real. Investing in meaningful strategies that tap the passions of working cultures is the only way to deliver persuasive differentiators and drive preference in any industry. Especially hospitals, where the lifting is heavy, the work is long, and the high call is “personal”. Effective brand and patient experience programs must first find consensus within the organization.
BlackDog recognizes the work of Leebov Golde & Associates as a critical alignment tool linking strategy and expression. We fell in love with Wendy Leebov’s plain talk approach and her practical insights- both of which you’ll find below, in our 45 minute interview with the queen of patient care herself…
What does ‘patient-centered care’ mean to you?
Simply: I am here FOR YOU. YOUR best interest is my first priority. I WANT to partner with you to ensure that your best interest and voice are at the center of everything I do.
If you could teach every hospital one lesson, what would it be?
Caring and COMMUNICATING caring are two different things. We need to help the caring people on our teams EXPRESS their caring in every interaction.
What about your work do you find most rewarding?
Seeing the wonderful people who enter healthcare professions revive their passion for the work by communicating with caring and CONNECTING with the people they serve. So beneficial for patients and families and so gratifying for the service provider/caregiver!
What are the most common mindsets and protocols you have to help hospitals overcome in order to help achieve patient-centered care?
The most difficult mindset is task-orientation. People have racing minds. Their to-do lists are flooding their consciousness. This makes it impossible for them to connect to the PERSON behind the patient.
What do you say to skeptics who think focusing on patient experience distracts from hospital efficiency?
What good is an efficient hospital without satisfied patients, patient loyalty, a good reputation and referrals from satisfied consumers? Also, happily, now hospital reimbursement depends in part on patient experience scores… so leaders are shooting themselves in the foot by NOT focusing on patient experience. They will lose money.
Do you have a favorite example of a before and after patient experience scenario that helps articulate why patient-experience matters?
A patient cries out in pain, and a nurse says, “How would you rate the pain from 1 to 10?” The Nurse WANTS to come up with the FIX for the pain, but does not communicate with empathy. The patient experiences the nurse as hardened and unfeeling even though the nurse proceeds to remedy the pain. If the nurse had said, “I’m sooo sorry you’re in pain and I want to help! So, tell me, how would rate the pain, etc.”, then the patient would feel cared about and would perceive the nurse as caring and supportive.
How do you foster an internal hospital culture that shifts the collective focus from task-oriented to patient-centered at every nook and cranny touch point?
It takes a combination of work with leadership as standard setters and role models, revised job descriptions, performance review forms, etc., aligning recognition and reward, TRAINING because the skills for making your caring felt are not obvious even if you are TRYING to communicate your caring, reinforcement, practice, and a long-term attention to hardwiring caring communication into everyday routines.
What are some of the oddball touch points that hospitals and caregivers frequently overlook?
Touchpoints where patient and family ANXIETY is significant. Anxiety reduction is the most powerful driver of improvements in patient satisfaction. Patients and families are fraught with anxiety and few organizations have pointedly developed communication protocols designed to prevent anxiety or ease it if it can’t be prevented. Most communication protocols are fact and content-oriented….. and miss the boat on providing emotional support.
One example is handoff communication. Usually there isn’t much of this, for instance, when a nurse is leaving and another coming on for their shift. Patients become anxious. “Who will be taking care of me now? When will they show up? Will they know what’s happening with me today?” There needs to be (and increasingly there are) protocols for the handoff between shifts: “Mrs. Harper, I’ll be leaving in a half hour. Nancy Ford will be taking over for me and she is TERRIFIC! Also, rest assured that I will talk with her before I leave so she knows what’s been going on for you today. You’ll be in good hands with Nancy!”
What advice do you have for hospital employees who are advocating for changes in patient care and experience within the organization?
It’s usually either nurses or executive leaders who begin pushing for changes in patient care and experience. Nurses and other patient-care advocates within the hospital are burdened with the task of making the case for how the organization will benefit from the changes, how the patients and families benefit, AND how the employees will benefit.
Patient-care advocates need to make the case that improving patient experience is a sustainable win-win for the people they serve and well as the organization.
Communicating caring and great patient care experiences promote healing are shown to produce clinical results. Care and communicating helps patients and their families feel more confident with the quality of care they’re receiving, feel better informed about the care and treatment they’re receiving, feel better prepared to speak up, and feel more able to participate in treatment and recovery planning and decision-making.
GREAT patient experiences also maximize value-based purchasing for the organization, builds a great reputation within the community which helps retain and attract patients and helps the hospital become provider of choice. For employees, Great patient care experiences and communicating caring helps make their work more gratifying, makes them more likely to devote energy and enthusiasm to their duties, and considerably improves job satisfaction and retention.
Tell me a bit about the role anxiety plays in determining patient experience.
In the past, too many improvement strategies were designed to make people happier, but when you’re sick you can only be so happy. At Disney, it matters that customers feel happy; in healthcare, what matters is that patients and families feel cared for.
Research conducted by the Jefferson University Hospital has shown the importance of anxiety reduction to patient experience. When patients’ anxiety levels are reduced they can concentrate on the information they’re being given, they’re able to ask better questions, they’re better able to retain information, they feel more confidence in their caregivers, and they’re more likely to partner with caregivers. Additionally, anxiety has been shown to interfere with healing and recovery- it matters for patient experience and HCAP scores, but it also matters for clinical outcomes.
Are there tools other than communicating caring that you frequently recommend to help reduce patient and family anxiety?
The specific skills that show caring help reduce anxiety. When the patient feels that you’re genuinely paying attention to their needs, they feel respected and they feel confident in their caregivers- they don’t feel judged, they feel safer.
Non-verbal communication is also very important. Sometimes people say things they think are caring but their non-verbal communication is conveying something else entirely- which creates anxiety. This is an especially common problem because medical professionals tend to be very task and outcome oriented- which can make them seem cold and hurried. Patients are getting a double message. Aligning non-verbal behavior with caring and communicating helps create trust, reduce anxiety, and improve patient experience.
Explaining Positive Intent is also important. Positive Intent means explaining how the activity a caregiver is about to perform is in the patient’s best interest. Saying you’re here to take vitals doesn’t say anything about how that activity is in the patient’s best interest- then the patient has to worry if something is wrong, or if they’re just being inconvenienced by a standard policy. If the caregiver instead explains that they’re here to check on you and make sure you’re well throughout the evening, the patient doesn’t have to experience anxiety- someone is paying attention to their specific needs, they aren’t lost in a big cold busy hospital system, and so on. Expressing emotional intent creates trust and reduces anxiety- it communicative that caring activities aren’t just policy- they’re caring activities in the patient’s best interests.
One of your specialties is “Horizontal hostility; coworker relationships”. Tell us a bit about horizontal hostility and how it affects GREAT patient care.
Staff members are relating to each other all day long, and the quality of those actions affect how staff members feel about their jobs all day long, which affects how they feel about patients.
Hostility and relational aggression among staff members has a disproportionate affect on the working culture- what helps is labeling it with the team. Managers need to explicitly address the issue and teams need to create signals so they can address horizontal hostility when it occurs. Team building strategies and communication routines within work teams help reduce horizontal hostility by addressing accountability with managers, creating a working culture that addresses issues proactively and is unintimidated to address the issue, and by creating a zero tolerance mentality.
We have one associate on our team who is a specialist in horizontal hostility specifically to work within hospital teams to help create a culture that’s supportive, that positively contributes to each others’ working experience, and works with a constructive team mentality.
What admirable staff characteristics help facilitate GREAT patient experiences?
I always assume people are caring people, and people just need to express their caring and make it felt. Emotional intelligence is an extremely valuable characteristic in great patient care, as is the ability to be emotionally generous (which requires that they be able to get outside themselves and listen to the needs of other people and act genuinely on behalf of other people). Also: the ability to connect in a non-judgmental manner, the ability to listen, mindfulness, the ability to communicate effectively and providing effective explanations, responsiveness, the ability to take initiative and be proactive, the ability to anticipate people’s needs- because patients shouldn’t HAVE to asked for everything they need, and the ability to connect with other people and help patients feel less alone.
Your website explains that “Nurse Communication” is the factor with greatest impact on patients’ overall hospital experience ratings. What are other common factors that have major influences on patient experience?
Great patient care is much more than confidently performing the tasks, and handling the information and treatment and plans in an effective way, it’s also the emotional aspects- the emotional aspects are vital to great patient care. People are relying on us for more than effective care, they’re relying on us for effective caring- because it makes them feel safe and confident. There are lots of things that we can’t fix, and people in healthcare are fixers by nature, but some medical conditions can’t be fixed. What we can always do is help people feel cared about, cared for, and less alone- it’s a vital part of providing great care.
That’s why, when you address caring and communication you DO see patient experience scores improve.
What questions are you asked most frequently by new and prospective clients?
1. “How do you hold people accountable?”
The answer is that managers on the front lines need to be engaged and be prepared to raise the bar with their staff. Managers need to be clear that they’re expecting more than clinic excellence- managers need to expect that clinical excellence be combined with caring and communicating caring. Managers also need to be responsible for coaching and feedback. Accountability is in the hands of frontline managers. So we do considerable coaching for mangers who are having trouble getting the results that the organization is looking for.
2. “How do you know you’re having an impact?”
Mostly our patients prove impact with their experience scores, and you can supplement that feedback with patient stories and a real-time feedback system so interventions can be made immediately when problems do arise to help make things right. It’s important to decide the methods you’re going to use to monitor impact and to set up the systems in advance so they work.
3. “Are these results sustainable?”
Everyone cares about sustainability. Communicating caring usually sustains itself because IT WORKS.
To achieve sustainable results hospitals need to incorporate caring and communicating into job descriptions, they need to evaluate for it when they’re hiring, managers need to hold employees accountable, and ongoing training and focus on caring is essential. Managers absolutely need to refocus on caring and communicating, because the more you communicate with caring the better you get at it and the more satisfying your job becomes.
For more insights from Wendy, and more info on patient-centered care, we recommend signing up for Wendy’s monthly newsletter: HeartBeat on the Quality Patient Experience