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The Beryl Institute invites members and guests to submit posts on patient experience related topics. For guidelines and information on submitting a post for consideration, contact michelle.garrison@theberylinstitute.org.

 

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The Invaluable Gift of Clarity

Posted By Mark VanderKlipp, 19 hours ago

With the holiday season over, your thoughts have undoubtedly turned from gift giving and New Year’s resolutions to “getting back to daily life.” As you do so, I’d encourage you to consider a resolution to provide a gift to your staff, patients and their families that keeps on giving: clarity.

In over 30 years as a designer, I’ve seen clients focus more on the tool (the identity, communication, policy, wayfinding system, mobile app, architecture, etc.) than they do on the anticipated behaviors of the people that support or interact with those tools.

To be sure, these are critical elements designed to support any patient experience initiative. My goal in writing this post is to help you see the value of designing for human interactions (engagement, connection, expectation, interaction, enlistment, orientation, learning) as well as the tools themselves.

In a 2015 HBR article1, the authors assert that “with very complex tools, the design of their ‘intervention’—their introduction and integration into the status quo—is even more critical to success than the design of the tools themselves. The more complex and less tangible the designed tool is, the less feasible it is for the designer to ignore its potential ripple effects.”

For most healthcare employees and consumers, there is no more complex, less tangible experience than a bewildering, impenetrable and continually changing health care system. The tools created to help engender clarity need to be thoughtfully designed, tested and integrated to assure they don’t add to the stress, both for caregivers and patients.2

Here’s an example: a formerly independent hospital merges with a much larger faith-based institution. The wheels are set in motion to design tools to support this merger: internal and external brand communications, updated facilities, wayfinding signage, EMR systems, billing systems, relationships with insurers, ambulatory clinic networks, HR policies and procedures, the list goes on and on.

As a clinical or clerical provider, I need clarity:

  • As an ambassador for this new faith-based brand, ostensibly very different from the old one, how is my behavior expected to change?
  • Will I be able to help design the process to successfully navigate the transition?
  • As new tools are designed and integrated, how will I be prepared to use them?
  • How can I, in my day to day role, bring clarity to our patients and their families?

As a patient or community member, I need clarity:

  • How will this impact me? How will it benefit me?
  • How will expectations of me, as a patient or community member, change?
  • How will the organization help make the transition easier?
  • Will there be physical changes? Will I be able to park and enter in the place I always have?
  • Who will help me? Will the people I’ve come to know and trust still be there?

The gift of clarity establishes the roots needed to visualize, design and deliver a a human centered healthcare experience: to understand the potential points of confusion, then meet individuals at each step in their journey with simple, consistent and well-supported tools. Whether these are designed to support small initiatives or large-scale transitions, anticipating the “ripple effects” of human interactions is critical to achieving sustainable success.

Creating an effective caregiving culture happens by design, not by default. It’s up to us as practitioners to break down silos, see gaps in communications, then test and iterate the tools designed to bring clarity to the questions that our staff, patients and their families bring to this world of healthcare experience.

Truly, there is no greater gift we can give. Happy New Year!

1. Design for Action, Harvard Business Review, September 2015 by Tim Brown and Roger L. Martin
2. 
Creating a Culture of Health: Design that Goes Beyond the Mobile Application by Dr. Joyce Lee MD, MPH “Doctor as Designer “ @joyclee

Mark VanderKlipp is an experience and systems designer, working in human-centered graphic design for over 30 years. He helps clients visualize the systems within which they function, empowering staff to deliver an experience that’s clear, relevant and human. He previously spent 24 years with a world-class wayfinding design firm, 13 as its president, where he was the lead strategist for diverse assignments in healthcare, higher education, civic, corporate, trails and tourism throughout North America. Mark is a 1987 graduate of the University of Michigan. In 2012 he earned his evidence-based design certification (EDAC) through the Center for Health Design, and in 2017 became certified in Systems Practice through +Acumen. He is also a founding partner of the customer experience consulting firm Connect_CX.

Tags:  clarity  design  engagement  expectations  interactions  tools 

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Using Shared Governance to Improve the Patient Experience

Posted By Gen Guanci, Thursday, January 4, 2018
Updated: Thursday, January 4, 2018

Those in health care know all too well that the patient experience is a top pain point for executives and therefore a top organizational priority. There is also no shortage of initiatives, programs and activities that focus on improving that experience. Committees and task forces are formed with participation from leaders across the entire organization. Education and action plans are developed and rolled out. Patient experience scores are closely watched for the anticipated improvement. Then, reality often sets it: There is no—or only minimal—improvement. How can that be? And what can be done about it?

What if you were to take the traditional approach to improving the patient experience—the approach where initiatives, programs and activities are developed by those outside the point of care and rolled out to those who must operationalize them—and flip it? Shared governance is a leadership model that does exactly that. In a shared governance culture, staff members are empowered to make decisions that meet a set of articulated expectations shared by leadership. Shared governance has proven to be a highly successful partner in crafting strategies that yield sustained improvements. Shared governance is built on a set of four overarching principles:

Partnership
Staff and leaders work together to improve practice and achieve the best outcomes.

Equity
Everyone contributes within the scope of her or his role as part of the team to achieve desired outcomes.

Accountability
Staff and leaders share ownership for the outcomes of work and are answerable to colleagues, the institution, and the community served.

Ownership
Participants accept that success is largely dependent on how well they do their jobs.

Using shared governance, groups of staff members (councils) are charged with the development of the specifics of the plan to address the opportunities for improvement. Let’s take the desire to have purposeful rounding be a standard of care. While the desired outcome is purposeful rounding, it would be up to the individual councils, groups, departments, or units to determine how this could be best operationalized in their area.  Here are some examples of what could happen when the people closest to the work in each department are empowered to make decisions about how to make rounding purposeful for their specific patient populations.

The Maternal-Child department determines that rounds will be done hourly between 6:00 a.m. and 11:00 p.m., then every two hours between 11:00 p.m. and 6:00 a.m.  They have made this decision to meet the needs of their patients to have a period of uninterrupted sleep.

The Surgical unit decides rounds will be a shared responsibility between the RN and the Clinical Assistants (CA).  RNs round on the even hours and CAs on the odd hours. For the same reasons as the Maternal-Child department, they too decide hourly rounding hourly will be done between 6:00 a.m. and 11:00 p.m., then every two hours between 11:00 p.m. and 6:00 a.m.

The Patient Experience council, made up of a mix of staff members from across the organization (i.e., environmental services, clinical, nutritional services, etc.) work together to develop a meaningful rounding experience for patients and staff members that includes addressing the best practices in rounding conversations. 

The expectation for each of the above groups was to craft a meaningful rounding experience that worked for the patient as well as the specifics of the individual units/departments. The plans, developed by staff members, are supported by colleagues as peer developed and rolled out the plans. Peers create the accountability with each other, and this in turn lessens the need for leadership to “manage” the plan. It also moves organizations from “us” and “them” to “we.” 

There is an ancient Chinese proverb that states “An owner in the business will not fight against it.” Using shared governance to craft a plan for sustainable improvement creates ownership at all levels of the organization.

Gen Guanci is a consultant with Creative Health Care Management where she works with organizations as they build a culture of excellence. Her work with Magnet® and Magnet® aspiring organizations focuses on improving the patient experience, work environment, clinical practice, and patient outcomes. Her expertise in shared governance has enable her to empower staff to generate outcomes that exceed national benchmarks.

Tags:  empowerment  expectations  governance  leadership model  ownership  Patient Experience  rounding 

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When Hospitality Meets Healthcare: A Personal Reflection

Posted By Sven Gierlinger, Thursday, November 9, 2017

It happened to me - first came a tingling in my fingers and toes; and within days, I was paralyzed. A husband and father of two young children at the start of a new assignment with The Ritz-Carlton Hotel Company - I was diagnosed with Guillain-Barré syndrome, a rare condition in which a rapid-onset muscle weakness caused by the immune system attacks and temporarily damages the peripheral nervous system. Suddenly, and for 90 days and nights, I was 100% dependent on my doctors, nurses and therapists.

Believe it or not, I’m actually grateful for this experience, as it showed me that as a patient, you are challenged to heal in many ways – physically, mentally, and emotionally. My experience in these moments helped me understand the power of embedding both service and empathy into the clinical processes that truly can make or break a patient or family experience. Every moment counts. 

My years at The Ritz-Carlton opened my perspective to what guests really want – and it’s much more than crystal chandeliers, marble floors and fancy ocean views. The Ritz-Carlton takes culture very seriously and believes it should be fully ingrained in all its employees, even by memorization. This credo provided the gold standards of service that were the focus of my everyday work, and until this day I can recite each word.

The Ritz-Carlton Credo:  The Ritz-Carlton is a place where the genuine care and comfort of our guests is our highest mission. We pledge to provide the finest personal service and facilities for our guests who will always enjoy a warm, relaxed, yet refined ambience. The Ritz-Carlton experience enlivens the senses, instills well-being, and fulfills even the unexpressed wishes and needs of our guests.

Based on my own professional and personal healthcare experiences, and as the Chief Experience Officer at Northwell Health, I knew I had to look at the experience through a very different lens. We have seen that the hospitality industry has established a precedent of best practices that can directly correlate to the healthcare industry. Let’s take the crossover themes from this credo for example: providing genuine care and comfort, personalization, a warm yet refined environment, and delivering on unexpressed wishes. I often wondered what this same credo would look like if ‘Ritz-Carlton’ was replaced with ‘Healthcare’, and if ‘guests’ were replaced with ‘patients’. 

Let’s read the credo again…

The Healthcare Credo:  Healthcare is a place where the genuine care and comfort of our patients is our highest mission. We pledge to provide the finest personal service and facilities for our patients who will always enjoy a warm, relaxed, yet refined ambience. The Healthcare experience enlivens the senses, instills well-being, and fulfills even the unexpressed wishes and needs of our patients.

Now, isn’t this what we all want and deserve from our own healthcare experience? It’s not only about first impressions; it’s about lasting impressions and creating that consistency in the patient experience. As experience leaders, it is imperative we understand how to enliven all the senses – what patients see, hear, touch, taste and feel. This understanding can greatly affect the patient experience, as well as the overall healing process.

At the end of the day, I think we can all agree that healthcare is about helping people through their most vulnerable time, and there is no greater honor.  So, I challenge each of you to think about healthcare differently. Reflect on this healthcare credo and ask how you can translate these concepts into practice to truly make every moment matter.

Sven Gierlinger serves as the VP, Chief Experience Officer at Northwell Health. With a focus on providing exceptional customer service and delivering the highest quality care, Mr. Gierlinger is responsible for building an engaging, innovative and collaborative culture that drives organizational growth and customer loyalty through the patient/customer experience. He is also an Executive Board Member for the Beryl Institute and a member of the Institute for Innovation, Founding Executive Council. Northwell Health, headquartered in New Hyde Park, New York, is the largest healthcare provider and private employer in New York State. The system serves over 8 million patients in metro New York and the surrounding areas with its 22 hospitals and more than 550 outpatient practices.

Tags:  culture  hospitality  impression  patient experience  personalization 

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Service Recovery in Healthcare

Posted By Rhonda Ramos, Wednesday, November 1, 2017

Service recovery is no foreign concept to the business world. It is a fundamental practice that can turn a negative situation into a positive statement about a company. Simply put, it is the process of making things right after something has gone wrong with the consumer’s experience. You see this common occurrence in retail, restaurants, and even airlines. Yet how can we adopt service recovery in healthcare?

Let’s face it, we’re not perfect. We fail to meet our patients’ expectations in numerous ways: excessive wait times, appointment scheduling problems, room/environment issues, miscommunication, and the list goes on. In the food service world, if I go out to dinner and a steak is not prepared the way I ordered it, the restaurant would probably remove the entrée from my bill. In healthcare, can we give a free prescription because a patient had to wait, or provide a coupon for a lab draw if the patient requires multiple needle sticks? Probably not.

In order to curb bad public relations since dissatisfied customers tend to tell others about their negative experiences, we’ve had to get a bit creative in healthcare. We know that the basis of all our interactions is communication; therefore, our service recovery program is grounded in the way we communicate during a complaint. We developed the acronym GIFT:

  • Gather – Listen to the individual’s concern and validate their feelings
  • I’m sorry – Offer a genuine apology for not meeting their expectations
  • Feedback – Explain what you plan to do and follow up
  • Thank – Thank them for sharing their concerns

These four simple steps provide a mental pathway as you’re attempting to diffuse a complaint. At UPMC Pinnacle Hanover, we carefully incorporated the Heart-Head-Heart communication method, which we adopted from the Language of Caring philosophy. By offering a blameless apology, we express ownership yet not necessarily assume fault. We involved our Patient/Family Advisory Council in the creation of this program, and they advised us that a genuine apology is the most critical element. The goal is to allow the complainant to feel heard, validated, and respected.

While most concerns can be resolved simply with proper communication, there are instances when it might be beneficial to offer something “extra” such as a gift card or other small token. CMS guidelines state that a service recovery item presented to a patient cannot exceed $10 per person or $50 in an aggregate year. (This is also under Department of Health and Human Services - OIG Advisory Opinion No. 08-07.) If a department chooses to obtain a supply of gift cards to various local vendors (restaurants, gas stations, etc.), they track them using our internal reporting system. Reports can be run, by patient, on a monthly basis to ensure that we are compliant.

One of the most important elements of this entire program is empowerment. Rather than only allowing a department head to resolve concerns, which could happen after a patient has already left the facility, we wanted to educate and empower each employee to utilize service recovery. By immediately responding to concerns and complaints we can create loyalty with our “customers.” We can create a learning culture that treats complaints as gifts, or opportunities for improvement, that steers away from a negative connotation to something more positive and patient-centered.

When an issue is identified and addressed before the patient is discharged, theoretically it will also help to reduce the number of formal grievances we receive. Unfortunately, it is difficult to quantitatively prove that our service recovery program has confidently reduced our number of formal grievances. However, we do know that there has been a shift in our culture and employees feel empowered to take ownership to provide quick and decisive action when something has gone wrong. And at the end of the day, that’s a win.

Rhonda Ramos is the Patient Experience Manager for UPMC Pinnacle Hanover and has worked for the organization for ten years. She is fluent in Spanish and started her career in healthcare as an interpreter and patient advocate. Rhonda grew up in Ellicott City, MD and currently resides in Hanover, PA with her husband and two children, ages 3 years and 6 months.

Tags:  communication  complaint  empowerment  grievance  patient advocacy  service recovery 

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How Staff Engagement and Stress Management Can Impact the Patient Experience

Posted By Martijn Hartjes, Monday, October 30, 2017
Updated: Monday, October 30, 2017

One of the major transformations occurring in healthcare today is the shift toward seeing the patient as a consumer. Similar to other industries that are driven by customer service, health systems are recognizing the impact the patient experience has on consumer loyalty, institutional reputation and topline financial results. The business case is clear. And rather than being an industry push, patient experience now has a meaningful pull – 82% of health systems recognize patient experience as a top priority, and 89% of consumers reported that their experience is extremely important, according to The Beryl Institute’s recent research, The State of Patient Experience 2017: A Return to Purpose.

The lesser understood story about patient experience is its potential to improve patient engagement, staff engagement and even clinical value for patients. In my field of diagnostic imaging, the patient experience has been shown to be a critical component to getting the image right the first time. In MR imaging, the biggest impediment to a diagnostic quality scan is patient movement. When patients move – due to stress or discomfort – imaging quality is likely to be compromised. That can mean repeat scans and delayed time to treatment for patients. It can also mean frustration for staff and radiologists and consternation for radiology administrators who need to do more with less. 

Staff Engagement is Key to Patient Experience

A patient’s care experience is directly dependent on the engagement of their caregiver. Staff involvement plays an essential role in how the patient views their exam and subsequent treatment as cited in the Institute’s report that 68% of health systems recognize that highly engaged employees are key to the patient experience. When it comes to a magnetic resonance imaging (MRI) exam, there is a human-to-human interaction that no machine can replace, and technologists are on the front lines of guiding patients and their families through this often stressful situation.

However, if the staff finds themselves overworked, stressed or burdened with reporting tasks or technical complexity, it is the patient who will ultimately be at risk. Having technology that supports a positive patient experience by making the technologist’s job easier can create a stronger patient-staff dynamic. 

Reducing Patient Stress to Improve Imaging Outcomes

As consumers of healthcare, today’s patients are making decisions on where to receive treatment based on their expectations of service and preferences. We are seeing patients choose imaging locations that provide a less stressful situation over those that are far more convenient. Based on our experience, we know patients travel hundreds of miles to experience a more comfortable scanner experience with open scanners, rather than going to a more convenient location with smaller, closed scanners.

In addition to impacting their facility choices, patient stress in MR exams inflicts a high clinical, operational and financial toll, leading to reduced workflow and patient dissatisfaction. When patients feel apprehensive, they are more likely to move and distort the exam. Such motion complications cause 1 in 5 MRI exams to require a rescan, which can cost an institution an estimated $592 per hour, and a $115K loss per scanner every year. In this way, patient comfort is fundamental to guaranteeing high-quality diagnostic images.

One way to reduce patient stress is to humanize the experience by providing consistent communication throughout the process and create an interactive atmosphere from start to finish. Communicating the smallest details, like how the scanner table will move or how long the scan may take, will help set expectations and dramatically reduce patient anxiety. It’s not just the patient that needs empathy and comfort but the patient’s family as well. The Beryl Institute’s research confirms that the majority (80%) of respondents believed patient experience efforts have a positive impact on reducing patient and family anxiety to a great extent.

Letting Patient Experience Lead the Way

Across the industry, patient experience efforts are becoming an integral part of the fabric of care delivery and are being recognized as drivers for measurable outcomes. In the imaging field in particular, real insights from real patients are increasingly important to understanding their needs. By focusing on the people behind the images and by creating a calming, supportive environment, technology vendors and clinicians across the continuum of care can join forces to improving imaging outcomes and clinical value for patients. 

Martijn Hartjes is an experienced healthcare executive with a professional track record in multiple disciplines of the medical device industry. Currently, he serves as senior director, head of global MR product marketing at Philips. In this role, he is responsible for the global MRI marketing function, leading product management, clinical portfolio management and product marketing.

Tags:  care experience  consumer  imagining  loyalty  patient engagement  Patient Experience  staff engagement 

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Effective Patient Communication Builds Trust for Better Outcomes

Posted By William Maples, M.D., Monday, September 25, 2017
Updated: Monday, September 25, 2017

For physicians, a significant factor leading to optimal outcomes is to engage patients early on as part of the decision-making process. Understanding patients’ needs, along with their values and preferences, is critical to the success of your healthcare team.

However, we at The Institute for Healthcare Excellence have found that many times physicians don’t understand what their patients need or want from them. It takes effective patient communication—leading to an alignment of goals and expectations—to bring about positive outcomes and a stronger bottom line.

Patients need doctors who listen

What patients want most from doctors is to be respected and listened to. Technology and medical procedures may continue to evolve, but certain human needs will never change. Patients evaluate their relationship with a provider by asking: “Am I really being listened to? Am I being respected? Do you truly care about my health? Do you have enough time for me?” To get to “Yes” starts with doctors who listen well and build trust with patients.

The lost art of listening to patients

Physicians seem to have lost the art of listening to patients. On average, we interrupt our patients with an 18 seconds and often change what they really want to tell us. Research has found that up to 30% of the time, we completely miss why the patient is there to see us.1 It’s vital that we rekindle the skill of listening, of recognizing the emotions in the room and responding in a way that builds a trusting relationship with the patient and ultimately improves outcomes.2

In our work with health systems and hospitals to improve their patient satisfaction scores and medical outcomes, we’ve learned that creating an exceptional experience can lead to a culture of safety. As that culture of trust and teamwork grows, patient-adverse events begin to decline.

Physician leaders improve communication

The first step is to identify physicians who are ready to support initiatives that improve communication with patients. After all, the caregivers are the best choice to lead the effort, rather than having it dictated to them. Let’s not leave physicians out of the equation when they can play a major part in creating a high-quality experience for patients.

Of course, there’s never a perfect time to implement best practices for communication in healthcare. It takes patience and a deep commitment to nurturing a culture that’s built on relationship-based, patient-centered communication. It may be nine to 12 months before you see a measurable impact, and up to four years to realize the maximum benefit. Once that’s achieved, however, you can expect a fivefold return on your investment.

Better communication helps prevent physician burnout

One more factor to consider is that poor communication can increase the chance for preventable errors. When a physician is frustrated by inadequate communication with a patient, it can cause burnout—and that correlates to medical errors.

To help bring back the joy of practicing medicine physicians must build a meaningful relationship with patients. That involves learning to listen to patients, establishing a culture of trust and committing to executing a relationship-based communication plan. Often this approach surprises us as it does not take any longer. Meeting those objectives can transform the patient’s experience and lead to measurable, positive outcomes for you and your care team.

References

  1. Lipkin M, Putnam S, Lazare A. eds. The Medical Interview. Clinical Care, Education and Research. NY. Springer-Verlag.1995.p.531.
  2.  The importance of physician listening from the patients’ perspective: Enhancing diagnosis, healing, and the doctor–patient relationship. Justin Jagosha, , , Joseph Donald Boudreaub, Yvonne Steinerta, Mary Ellen MacDonaldc, Lois Ingramd doi:10.1016/j.pec.2011.01.028

William Maples, M.D. serves as PRC's Chief Medical Officer. Before joining PRC, Dr. Maples served as Senior Vice President and Chief Quality Officer at Mission Health in Asheville, North Carolina. Additionally, Dr. Maples serves as Executive Director of The Institute for Healthcare Excellence, where he and his consulting faculty employ a variety of strategies to improve patient experience and impact quality outcomes.

Tags:  communication  outcomes  patient engagement  patient's needs  physicians 

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What About Deaf Patient Experience?

Posted By Kate O'Regan, Friday, September 22, 2017
Updated: Monday, September 25, 2017

I recently read Dr. Cordovano’s compelling case for a patient centric comprehensive medical records system in her recent blog. She opened with:

A patient was recently discharged from an exceptional hospital after a 2-day stay. During those 2 days, he saw endless doctors, attendings, residents, fellows, interns, nurses, nurse practitioners, nursing students, TV and phone service staff, physical therapists, social workers, case managers, housekeeping staff, spiritual chaplains, food and beverage staff, transport staff and discharge planners. Forgive me if I’ve missed anyone. All of these hospital employees play an essential role in a patient’s care at the hospital. There was just one person missing…

As my eyes honed in on the words “there is just one person missing,” I immediately think of the historically marginalized deaf community who continue to receive unequal and ineffective communication access to healthcare, something that can be achieved by using an effective and trusted interpreter. But the most critical piece, is an effective and trusted system of communication access that is patient-centric.

I want to recognize The Beryl Institute truth that healthcare can change by advancing an unwavering commitment to the human experience. I witness, too often, the deaf experience that is framed as less than human and that is fundamentally problematic.

Every day globally, deaf people experience a lack of an effective system, of awareness and of respect as humans. It is time to start to listen, advocate with and provide (give back) leverage to deaf patients, leverage that is often taken away from them at first glance.

To achieve a successful and sustainable care plan for deaf patients, here is what should be happening:  budget for communication access, create an internal department or find a vendor who can manage your services locally and work with the local deaf community. Also, every deaf patient should have the opportunity to be greeted by a local deaf[1] community advocate. This advocate will guide the deaf patient and medical professionals throughout the healthcare experience.

Every deaf person have different unique preferences to communication access. One deaf person with more moderate hearing loss might communicate using spoken English, but  use an interpreter to effectively receive spoken English. Another deaf person with profound hearing loss might have a PhD in Business Administration, not fluent in spoken English and accesses health care best with an interpreter. A person who was raised in another country who just moved to America may not be fluent in ASL and would rather speech to text technology called CART.

Deaf people have different communication access needs and a lack of system to recognize this diversity leads to a lack of health care access. Health care organizations need to contract with an agency that understand the needs of deaf patients when it comes to access. If they don’t, there is a high risk of liability under federal law. Some hospital administrators choose to contract with national level technology companies to provide Video Relay Interpreting (VRI) services without the consult of the deaf individual which are consistently unreliable, ineffective, unlawful, and cause further oppression of deaf people lead to gross negligence of patient experience and numerous hospitals have been brought to court by the US Department of Justice. If healthcare providers truly value patient experience, we need ask deaf patients what is effective and then implement those services. 

[1] A deaf person needs to be employed in this position or from a trusted locally deaf-centric advocacy organization.  See DEAF GAIN #googleit

Kate O'Regan grew up in Montpelier, VT and is the Founding President of Civic Access. She believes in social entrepreneurship as a form of economic empowerment. She lives in Charlottesville, VA with her three children.

Civic Access, was founded with the philosophy that legally mandated services of communication access can support forward progress for deaf access in the public sector.  

 

Tags:  access  communication  deaf patient experience  interpreter 

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Changing the Lens: Bringing Medical Records to the Patient Bedside

Posted By Grace Cordovano PhD, Wednesday, August 23, 2017
Updated: Wednesday, August 23, 2017

A patient was recently discharged from an exceptional hospital after a 2-day stay. During those 2 days, he saw endless doctors, attendings, residents, fellows, interns, nurses, nurse practitioners, nursing students, TV and phone service staff, physical therapists, social workers, case managers, housekeeping staff, spiritual chaplains, food and beverage staff, transport staff and discharge planners. Forgive me if I’ve missed anyone. All of these hospital employees play an essential role in a patient’s care at the hospital. There was just one person missing: someone from the medical records department. It’s time to change the lens we are using to view the importance of medical records to patient success and health.

No one visited the patient to discuss the importance of having a copy of his medical records post-discharge and maintaining a personal medical history file. No one verified authorization for the release of medical records. No one asked what medical records the patient needed upon discharge. No one confirmed what doctors needed a copy of the patient’s medical records: like his primary care doctor, his cardiologist or his neurologist. There wasn’t a single person that walked through the revolving door of the patient’s room that mentioned anything that resembled “medical records”. As a private patient advocate, this is no surprise. I’ve accompanied clients to my fair share of hospitals, medical facilities and cancer centers. I’ve yet to see a medical records representative visit with a patient during their time at the hospital. Electronic Health Records (EHR) are not the answer as they weren’t designed with the patient as the priority. Patient portals, if a facility has them, aren’t effectively adopted or utilized and have many shortcomings.

Here’s what should be happening at hospitals. A medical records representative should visit patients in the hospital with a smart tablet. The representative should discuss a patient’s care goals and discuss care coordination with respect to medical records. Medical record authorizations should be pulled up on the smart tablet and patients should be able to electronically authorize releases from their bed. At minimum, the medical records representative should verify the contact information of doctors that should be receiving a copy of medical records for follow-up. All doctors who regularly treat the patient need to have a copy of the medical records for seamless communication, coordination of care, and patient success post-discharge. At discharge, patients should at least receive a copy of every test performed during their stay at the hospital. There is absolutely no reason any patient should be discharged without a basic copy of their records. None. Release authorizations and strategic planning of the use of records for patient success need to be done at the bedside while the patient is in the hospital.  Medical record acquisition needs to become an active part of the discharge process, not a hunt thereafter. Let’s stop this insanity of needing to walk to the medical records office, usually in the basement of a different building than where the patient’s room is, to fill out a form or print one online and mail or fax it.  We need to bring the medical records department to the patient’s room while they are in the hospital’s care: a simple change with potential for profound, patient-centric results.

Grace Cordovano PhD, founder of Enlightening Results, is dedicated to fostering private, personalized patient advocacy services, specializing in the cancer space. She is a firm believer in the continuous advancement and improvement of patient experiences through the infusion of empathic design and thinking into current healthcare paradigms. Follow her on Twitter @GraceCordovano.

 

Tags:  EHR  medical records  patient experience  post-discharge 

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Empathy as an Office Culture

Posted By Erin K. Brandt, Monday, August 21, 2017
Updated: Wednesday, August 16, 2017

The patient experience movement is one of astounding energy, driven in large part by the realization that fellow humans respond positively when empathy and partnership are at the forefront of care decisions. The majority of those employed in healthcare are not working tirelessly to manufacture a product; their purpose lies in improving the human condition. Sure, there are thousands of innovations marketed every day with the goal of providing solutions to our health problems, but it’s the human connection that has such a monumental impact on how patients respond to our efforts. Human connectedness builds trust, opens lines of communication and creates an environment capable of health and healing. While our hospitals and health systems have made significant gains, I must ask where independent medical practices stand in this storm of pressing innovation.

I consider my work with small medical practices a grassroots effort to inspire empathy as an office culture. How many providers or staff members have taken time to sit in the waiting room or exam room? I believe it’s imperative to consider what message we are sending through our actions and our environment. Are the chairs uncomfortable, the floor dirty, reading material outdated and torn? When the MA calls you back does she smile and call you by your preferred name? Do we have policies that build barriers instead of bridges between our patients and providers?

Today’s medical landscape is crowded with challenges related to payment models, quality metrics and frustrating non-compliance. How can we help patients who don’t appear to want to help themselves? In my experience, the answer lies in a culture of empathy. Understanding the broader scope of social health determinants and their impact on a patient’s ability to follow through can mean the difference in treating a patient with apathy versus compassion. Make no mistake; patients read body language, tone and other social cues while visiting their providers. These impact their decision-making and behavioral attitude towards where they will go to receive care. This, in turn may determine a patient’s follow through with filling prescriptions, imaging, labs or referrals to specialists. 

While we have done extensive work in the hospital and outpatient setting related to patient experience. We also see that primary care clinics and specialty offices remain the frontline of a fragmented system in rural America. Visit on a typical business day and you’ll observe massive stacks of facsimiles, incessant phones ringing, paperwork shuffled and names being called. The medical assistants, schedulers and receptionists I work with admit they become incensed by the lack of understanding on behalf of the patient. They forget they are experts in their role and patients are navigating foreign territory, sometimes scared or too embarrassed to ask further questions. Add the ever evolving changes for the latest software update and every one is confused and less than patient. 

Many small medical practices continue to work under fee-for-service payment models. Many I speak with are put off by the pressures to utilize EHRs and perceive value-based payment systems as another way for payers to gain control over their quest to do what is best for the individual patient. They feel many of the technology solutions are beyond their reach due to issues of interoperability and gaps in IT prowess and staffing.  

While I have a healthy appreciation for the innovation entering the healthcare space, I would like to point out this is not an “all or nothing” ultimatum. My vision includes guiding small and mid-size practices to understand the value of adopting small changes to achieve empathy as an office culture. If we make a commitment to weave compassion and understanding into our communication, our policies and our daily decisions, we position ourselves to help patients in a way indifference cannot. Practices I speak with often feel discouraged by the barrage of high tech investments pitched to them as the sole pathway toward improving patient experience. No amount of technology can replace humanness. So while I dream of large-scale changes to the systems of heath care, I am encouraged by the efforts of independent practice managers working low-tech solutions to create a much needed culture of empathy.  

 

Erin K. Brandt is a public health advocate, facilitator and passionate patient experience leader. Her start as a grassroots health educator working with inmates, the homeless and those suffering from addiction ignited a deep passion for facilitating change through the human connection. Erin currently works with organizations developing leadership pathways, coaching and supporting the patient experience movement. Along with her role as a Patient Experience and Care Advocate at Yuma Regional Medical Center, Erin teaches courses for Arizona Western College Community Health Worker program and designs custom training content for local businesses and healthcare practices. 

 

Tags:  culture  empathy  human experience  medical office 

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OpenNotes: Doctors, Patients and Caregivers on the Same Page

Posted By Liz Salmi, Wednesday, July 19, 2017
Updated: Wednesday, July 19, 2017

After dating me for only 18 months, my now husband became my health care partner. I was 29. He was 31.

In mid-2008, I suffered a massive seizure, landed in the ER, and a scan revealed I had a mass in my brain. Brett suddenly found himself in love with a 29-year-old gal with brain cancer.

After my first hospitalization, Brett jumped into caregiver mode. If I needed clothes for the hospital, Brett packed the bag. When a nurse missed one last stitch in my scalp, Brett finished the job with tweezers. When I needed help coordinating a complex regimen of medications, Brett designed a color-coded spreadsheet that matched my giant pillbox organized by days of the week and times in the day.

Meanwhile, I jumped on the Internet to research treatment options on PubMed, joined Facebook Groups and Twitter communities for people with brain tumors, and started blogging about my experience for family and friends.

There is no right way to respond to illness. My way was to respond with curiosity. I cared about understanding the how and why of my diagnosis and the what of my treatment. Brett’s way was to respond with unconditional love and support. And he cared about taking care of me.

But there is one thing we both needed and continue to need to be active and engaged participants in my care: access to the details of my ongoing care plan—information that is a part of my medical record and embedded in my doctor’s notes.

Brett and I didn’t even know notes were a thing until earlier this year when a change in health insurance forced me to uproot my care from one health system to another. While in the process of collecting my medical records I stumbled across a large PDF document that revealed an insider’s view of my last eight years of living with brain cancer—my notes.

Doctor’s notes (or visit notes, progress notes, clinical notes) are the most important information in our record. This information is readily available to doctors and other members of the health care team to remind them about a patient’s condition and plan for care.

I received great care from my previous health system, but like 96 percent of Americans, my clinical notes were not shared through the online patient portal. This made me wonder… why hide my notes?

I want this to change—for me, for my husband, and for every patient facing a health challenge or working to stay well. 

OpenNotes is a national movement encouraging doctors, nurses, and other health professionals to share the notes they write with the patients they care for using secure, patient portals, with the ultimate goal of improving the quality and safety of care. Shared notes enhance the patient experience by improving communication and trust, and reading notes helps to empower patients to make more informed decisions.

Access to notes can help caregivers like Brett, too. In a 2016 study*, patients and care partners with access to open notes stated that they had better agreement about treatment plans and more productive discussions about their care, and patients were more confident in their ability to manage their health and felt better prepared for office visits. Even better, care partners reported improved communication with patients’ providers at follow-up.

In less than five years, the OpenNotes movement has grown access to notes from 20,000 to over 15 million people. That number is impressive, but it represents just 4 percent of the U.S. population.

When I, the patient, don’t have access to notes, neither does Brett—the person most invested in my care. I spend about two hours each year with my health care team, and over 5,000 waking hours in self-care or “Brett-care.” Access to my notes could help us remember what we need to do between now and the next appointment with my doctor.

So what’s the hold up? Why don’t more people have access to their full medical record and clinical notes?

Doctors and health systems claim people will not understand their notes, or be afraid of what is written in them. This makes no sense to me. I am already looking for information about my diagnosis on the Internet—shouldn’t my first search be based on information in my own medical record?

My husband and I are the most invested people in my care, and the notes are about me. Any information about my health and health care is important to us, and we want to know about it. We can handle it.

* Wolff J, Darer JD, Berger A, et al. Inviting patients and care partners to read doctor’s notes: OpenNotes and shared access to electronic medical records. J Am Med Inform Assoc (2017) 24 (e1): e166-e172.

Liz Salmi is the Senior Multimedia Communications Manager for OpenNotes. OpenNotes is a foundation-funded national movement advocating for clinicians to share their visit notes with patients via patient portals. She is also a patient who does not have access to her notes.

 

 

To hear more from Liz and about OpenNotes, join us August 29th for the upcoming webinar, The Power of Knowing. You will learn more about the OpenNotes movement and how your health system can participate, and hear from a doctor and a patient about their personal experiences with notes and transparency. 

Tags:  caregiver  notes  Patient Experience  transparency 

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