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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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Top tags: patient experience  healthcare  patient  culture  Leadership  patient engagement  HCAHPS  communication  physician  empathy  physicians  caregiver  employee engagement  family engagement  healing  Hospital  survey  community  compassion  data  pediatric  perception  person-centered care  voice  collaboration  consumerism  Continuum of Care  Customer Service  experience  family 

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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Paws and Presence: The Story of “I’m Here”

Posted By Marcus Engel, Monday, July 17, 2017
Updated: Monday, July 17, 2017

I can’t remember the impact, but I remember the headlights. Then, the pain. The all-encompassing horrors of broken jaws, crushed facial bones and desperate attempts to breathe.  I remember the metallic taste of blood mixed with gasoline. Then…the  blackness. But, how could I know that darkness was permanent? How could I know that I was now blind?

I can’t remember the medics, the crike, the ambulance speeding to Barnes Hospital, but I remember my clothing being cut off. And, I remember Jennifer. 

Throughout that wretched night in the ER, Jennifer held my hand and never left my side. Her presence and her words, “Marcus, I’m here…” were the only things she could have done to help…and they were exactly what I needed.

Throughout the hospitalization and recovery, rehab and 20 years of life, I knew nothing else of Jennifer. Her story is in my memoir and “I’m Here: Compassionate Communication in Patient Care.” But, beyond that night? I knew nothing. No last name, not her position in the ER. Nothing.

Two years after the trauma, as a 19 year old, I found myself in Morristown, New Jersey, training with my first Seeing Eye dog, a black lab named Dasher. Some people measure life in years. I measure life in dogs. Dasher was by my side for seven years. When he retired at age nine, I thought my heart would break. I’d lost my sight, so I thought I knew what loss was…but I was wrong.

Life goes on. We all know that. Dasher’s retirement ushered in another black lab, Carson, who was with me for another seven years. Then came Garrett; a yellow lab who, if you’ve heard me keynote since 2010, you’ll probably remember.

Soon after I picked up Garrett’s harness for the first time, we moved to New York City where I began my Narrative Medicine Master’s program at Columbia University. As I continued keynoting around the country, Garrett was by my side for countless flights, hotel rooms, hospitals and conference centers.    

Then, Barnes-Jewish Hospital, the facility that saved my life, invited me to speak. As always, I told the story of “I’m Here” and Jennifer. Afterward, a member of the patient experience team approached and said words I’ll never forget: “Marcus, we have a surprise for you… we found Jennifer.”

Shock. Disbelief. Confusion. I was nothing short of a blubbering mess as I, for the first time in 20 years, held her hands again. Finally, I got to say thank you.

Weeks later, Jenny and I were interviewed by the St. Louis Post-Dispatch.

The journalist asked lots of questions, including, “How long have you had Garrett? How long do Seeing Eye dogs work? Where will Garrett go when he retires?” 

Seeing Eye dogs work, on average, seven to nine years. Provided Garrett stayed healthy, we would be together around four more years.

“Will you keep Garrett when he retires?” she asked.

“No, I’ll then get another dog and need to focus all my bonding on the new pup. That’s not fair to Garrett, so I’ll find someone who wants to adopt him.”

Jenny practically jumped out of her seat declaring, “I want him!”

“For real?”

“Absolutely, I would love to have him!”

“Done,” I said. “I can’t imagine better hands.”

Last December. I laid on the floor of a hotel room, thanked Garrett over and over for being mine, for keeping me safe and for his unconditional love. Tears fell onto his velvet ears. Then, a knock at the door.

I hugged Jenny, fell to my knees and held Garrett one last time.

As Garrett and Jenny walked out, all I could think of was love. Love. Compassion. Presence. That’s what I received from Jennifer on the worst night of my life…and that’s what Garrett gave throughout his working life. It is a model of what all truly excellent patient experiences are comprised.

Marcus Engel, M.S., CSP, CPXP is a Certified Speaking Professional & author whose messages provide insight and strategies for excellent patient care. As a college freshman, Marcus Engel was blinded and nearly killed after being struck by a drunk driver. Through two years of rehab, over 350 hours of reconstructive facial surgery and adaptation through a multitude of life changes, Marcus witnessed the good, the bad and the profound in patient care. Marcus and his wife, Marvelyne, are the co-founders of the I’m Here Movement, a 501(c)3, which is changing the culture of care with two simple words.

 

To hear more from Marcus, join us August 15th for the upcoming webinar, Presence: Compassionate Communication Through Everyday Mindfulness or September 15th for our Regional Roundtable event in Ontario.

Tags:  compassion  empathy  patient experience 

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Why You Should Take Online Reviews Seriously

Posted By Tashfeen Ekram, MD, Monday, July 17, 2017
Updated: Monday, July 17, 2017

At the root of it, many physicians fear the impact and the effort it takes to manage online reviews. A Harvard study published this year showed 78 percent of physicians believed engaging with online patient reviews would increase their job stress, while a smaller group believed it would negatively affect the physician-doctor relationship. But in today’s digital world, the importance of online reviews is undeniable. After all, a staggering 77 percent of patients visit review sites before choosing a physician.

Healthcare is a Marketplace, and Patients Have High Standards

With the greater emphasis on smart decisions in today’s consumer-driven world, patients have high expectations before they walk through the door. Patients want to know what the experience is like in your practice. Did they read that the front desk staff was warm, welcoming, and thorough? Did they read how you took fifteen extra minutes to help a patient understand a drug’s side effects? Or how the bedside manner of some of your doctors was lacking? The answers are likely yes.

Patients who trust their doctors are more likely to experience satisfaction with them. Seeing a number of online reviews can help patients develop trust with a physician or practice.  Reading online reviews affirms confidence in your patient’s decision. Feeling empowered is a good start for many patients, especially when placed in a new situation, like visiting a referral specialist. Patients simply want a positive healthcare experience.

It’s Time To Be Intentional About MACRA

With the recent adoption of MACRA, the government is prioritizing quality of care. We hear again and again that the goal of value-based care is to lower healthcare costs while improving healthcare outcomes. An article from the Harvard Business Review states, “We must move away from a supply-driven health care system organized around what physicians do and toward a patient-centered system organized around what patients need.”

Unless all your patients have a very close relationship with you, you won’t always know exactly what your patients need—or where you can improve. Online reviews can show you just where your quality of care may be lacking.

What kind of information are patients looking for in your reviews? A statistic showed that 28 percent of patients searched for a practice’s care quality statistics. Star ratings, other patients’ experiences, and doctor backgrounds followed closely in importance. It seems that like the government, patients are looking for information about the quality of care you provide.

Using Reviews to Your Advantage

Online reviews can impact your practice, reputation, and even your relationship with your patients. While they can be a source of anxiety for some physicians, they can also be a tool to boost patient satisfaction and market your practice.  

According to one statistic, 90 percent of consumers read 10 or more reviews online before trusting a business. It’s simple: the more reviews you have, the more patients will perceive you to be credible and trustworthy. And the more they’ll be at ease when they visit you for the first time.

Of course, there will always come a time when the dreaded negative online review happens. The review may be pointing out an actual area of improvement for your clinic, or even something completely arbitrary and out of your control. However, responding tactfully and professionally to negative reviews is just as important as having positive reviews. After all, the internet’s eyes are watching.  

Additionally, there are a few tools out there that help minimize negative reviews. Luma Health is a patient communication platform, which sends text messages asking patients for feedback after appointments. If patients rate the visit an 8 or above, they get redirected to a review website of your choice (like Yelp, Google, Facebook, Healthgrades, RateMDS). If patients rate the visit 7 or below, they’re directed to a private feedback form that’s sent directly to your clinic. This minimizes public negative reviews, allowing you to address matters with patients directly to make it better.  

No matter what the complaint was, apologize to the patient and thank them for taking the time to leave a review. Then invite them for an offline discussion where you can get a better understanding of what they’re really concerned about. Readers—and the unhappy reviewer—will appreciate the openness, helping you build your transparency.

Tashfeen Ekram, MD, is a radiologist, self-taught coder, healthcare innovator and Co-Founder of Luma Health. Contact him on Twitter at @tashfeenekramMD.

 

Tags:  patient satisfaction  physicians  reviews  transparency 

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