Contributor: Elizabeth Ferguson – Graduate Intern, Emmi Solutions

Elizabeth Ferguson

Elizabeth Ferguson

The English language isn’t well known for allowing speakers to say clearly and concisely what they mean. We don’t have fifty words for snow (though meteorologists will try to convince you otherwise), and anyone who has ever watched a spelling bee or studied for the GRE will tell you we use only a fraction of the words that are at our disposal. Syntax offers no refuge: commas, commonly abused and neglected, have wreaked havoc on authors, journalists and Facebook posters alike.

The point is this: nuanced differences in language can dramatically change the meaning and the tone of what is understood, and nowhere is this more important than in healthcare. Imagine you are an emergency medicine physician attempting to diagnose a person with abdominal pain. You ask them to describe the pain they’re experiencing, knowing that different kinds of pain may indicate very different pathologies. It’s likely that their word choice, body language and expression of discomfort will differ from how you would attempt to describe the same feeling, or how others have described that pain in the past. Also, consider the number of patients that you as a physician will manage that hour, much less that day. Mix in the stress and emotion typically associated with requiring medical attention and how that might affect your patient’s ability to communicate. And of course, don’t forget the multicultural and multilingual nature of the United States—there’s a good chance that your first language isn’t the same as your patient’s. How confident are you that your patient understands what you’re asking, and that you understand what they’re trying to say?

The barriers to effective communication in healthcare settings are significant, but so are the stakes. Traditionally, the healthcare system has placed the responsibility for effective communication on clinicians and patients without offering any real resources with which to navigate such a difficult task. This is beginning to change. More and more, healthcare organizations are taking steps to empower both parties with the tools necessary for comprehension and communication. They are enabling what anthropologists would call “coming to terms,” or building a shared understanding of what certain language means and when to use it. By engaging patients in their own care, educating them about their own conditions and symptoms and offering them meaningful language to use when communicating with clinicians, hospitals are helping to bridge the gap between those receiving and those delivering healthcare. On the other side of the communication equation, clinicians are receiving more training in bedside manner (which includes communication), as well as support from care coordinators and patient advocates, who are specifically trained in effectively translating clinical language into meaningful explanations for patients, and vice versa. Continue Reading »

Contributor: Hailey Merk – Client Services Intern, Emmi Solutions

Hailey Merk

Hailey Merk

If there is one word in the entire English dictionary that my father tells me doesn’t really exist, it’s the word ‘free’. There always seems to be a catch, right? Yet, hospitals around the country have groups of highly motivated and caring people who want to make a difference in healthcare and the patient experience for zero dollar signs in return. This jumps out at me like a 3D pop up advertisement on my computer flashing, “ROI, you won, pick me!”

A study from the Nonprofit and Voluntary Sector Quarterly Journal looked at the cost benefits of volunteer programs and found an average of $6.84 in value from volunteers for every dollar spent—a return on investment of 684%.If hospitals can invest enough time to interview, train and engage a class of volunteers, while concocting new tasks that will transition alongside the shift towards patient and family centered healthcare, major benefits arise .

I have been a student volunteer over the past two and a half years working on mostly clerical tasks, including answering the phone and checking in visitors, or maintenance tasks like cleaning toys in the playroom and organizing shelves. While these tasks are very important, I always found myself completing every task about half way through my shift. Could this remaining hour and a half be time spent working on something other than waiting for the occasional opportunity to talk with a patient? What if hospitals trained volunteers on patient experience metrics and patient engagement technology so their efforts could be bettered focused on really improving a patient’s experience as well as their ability to take an active role in their care in and outside of the hospital?

A huge aspect of patient engagement is messaging and communicating with patients to ensure that they are making informed decisions and are becoming more involved in their healthcare. Patient engagement technology is becoming a major tool to assist healthcare professionals to close the gaps in health literacy and communication between providers and patients. Volunteers can attend a training session about the technology, and then transfer their knowledge directly to patients. Volunteers can take advantage of a refurbished laptop or tablet and bring it to patients to show them, step by step, how to use the technology. They can be responsible for giving the patients printed instructions as well as verbally messaging to the patient about the tool to avoid any confusion. Continue Reading »

Contributor: Courtney Hummel – Senior Client Services Specialist, Emmi Solutions

Courtney Hummel

Courtney Hummel

The only time I visit museums is when visitors come into town. At that point, I can don my hostess cap and show my “they-aren’t-from-around-here” tourist friends around town. Secretly (don’t tell anyone), I’m giddily enjoying all the sights and sounds while pretending that I know what I’m talking about.

My most recent adventure took me to a museum exhibit about Walt Disney, his impact on the film industry, and his incredible insight into, quite simply, what makes people happy. Imagineering, anyone? Disney had guest service — never customer, always guest — down to an art, from the spotless streets, to his special brand of “assertive friendliness,” and even the psychology behind waiting in line. People visit the happiest place on earth and spend 30, 45, 60 minutes for a 2 minute ride, all the while leaving happier than they started.

While the end result of an encounter with the American healthcare system isn’t as exhilarating as a trip down Space Mountain, we experience similar guests – guests, not patients – playing the waiting game. Whether it’s waiting in the ER to be triaged, calling for a primary care appointment and finding no openings for 5 days, or hitting the refresh button on our patient portal (surely my lab tests were uploaded today!), the passivity of waiting is a frustrating, unsatisfying experience.

With patient satisfaction scores tied to CMS reimbursements, healthcare institutions are looking at any additional tools to improve the patient experience. One of these targets, especially in areas such as emergency rooms, is reducing wait times. This is quite the challenge, considering patient satisfaction is not a product of the clinical experience, but a result of perception. For example, patients vastly overestimate the objective length of wait times, often by up to 36%.

There are a few important factors to remember when considering the time a patient is waiting.

1. Occupied time feels shorter than unoccupied time. Executives at a Houston airport were experiencing an inordinate amount of patient complaints about the wait time in baggage claim. After throughput analysis, they discovered that the arrival gate was only one minute from the baggage claim area, but it took seven additional minutes for the bags to arrive. The solution? Reroute the bags to the carousel furthest from the arrival gate. The result? Zero complaints. By filling time with an activity, whether that is walking to baggage claim at the airport or watching a program that explains the triage process in the Emergency Room, waiting time can magically disappear. Continue Reading »

Contributor: Sherri Loeb – Patient Engagement Strategist, Emmi Solutions

Sherri Loeb

Sherri Loeb

(Piece originally published at HospitalImpact.org)

Patient engagement, patient-centered care, shared decision-making, patient experience and centers of excellence–all the latest buzzwords in healthcare. But do our industry leaders really understand what they mean or how to implement them, and how critical they are not only to the patient and family, but also to the ultimate goal of patient safety? From my recent experience I would say it’s rare.

I’m a nurse of 30-plus years who has worked in various healthcare settings. I have always been patient-centered and treated each patient as if they were family. Then, on Aug. 4, 2011, my life changed dramatically when Jerod, my husband of 25 years, as well as an internationally known patient safety and quality expert, was diagnosed with stage IV metastatic prostate cancer. Life as we knew it ceased to exist.

Sherri and her husband had to transition from “the giving side of the healthcare equation to the patient side,” and encountered a challenging patient experience. Read her full story at Hospital Impact.

Sherri Loeb, R.N., BSN, is a registered nurse of more than 30 years. Before, during and after her husband’s death from prostate cancer in October of 2013, Sherri has worked to ensure all patients receive compassionate care. She has presented at the conference for the Hennepin County Medical Center, the Joint Commission Ambulatory Care Conference, CMS, the NQF annual conference as well as the WEDI Innovations in Health Care Conference and American College of Physician Executives. She is a member of the Patient and Family Advisory Council for Quality and Safety for MedStar in Baltimore, Maryland, and a member of the National Quality Forum steering committee for person- and family-centered care.

A Summary of Findings from the Shared Medical Decision Making Conference in Europe

One of the main challenges of creating decision support tools for patients is the lack of any guidelines to inform the development of values clarification exercises. One way people often try to help patients clarify their own values are with patient stories, also known as narratives. They share stories of what others chose, whether or not they were happy their decision or how they compared the different options with their values.

After all, shouldn’t this help other make better decisions? It seems intuitive, but is it a good approach?

Researchers are beginning to find that narratives can hinder decision making instead of helping it.

For example, one study presented by Anthony and Dena Cox at the SMDM Europe conference in Antwerp, Belgium looked at the anecdotal vs. statistical messages for HPV vaccine intentions among young women. Interestingly, in women whose clinicians had recommended they get the HPV vaccine, a patient narrative actually made them less likely to act. This was termed a “boomerang effect,” meaning they seemed to react against the narrative.

Why this happened is unclear. Perhaps they felt manipulated, or were simply pushing back against what they felt was additional pressure to get the vaccine, but there was a clear biasing effect and generally in the direction against what sounded like an intended nudge to get it.

Blog-Graphic-(06.24.14)

Similarly, in a UK study by Bekker and colleagues, an internet-based decision aid for dialysis choices was evaluated by renal patients and staff. The site contained video narratives of patients’ experiences about different dialysis treatments. Patients had no problem accessing the videos but most spent only seconds on the video page and simply moved on without viewing them.

It’s not clear why this occurred. Were people simply not interested? Did they feel pressured or manipulated by the videos? Did they not connect with the first one or two videos they selected? Continue Reading »

There is often discussion about how to enhance the patient experience – how can interactions with the patient and overall care be improved to increase satisfaction?

While improvements such as speaking in plain language and taking the time to hear concerns and answer questions are helpful, there is one factor (sometimes overlooked) that has tremendous impact on a patient’s experience – how their family is cared for.

Receiving care can generate anxiety for both the patient and their loved ones. Yet, it can be very comforting for a patient when they know their family members are also being supported by their care team.

And while patient experience is often confined to conscious interactions, there has been evidence of improvements to the patient experience when the patient is not fully aware.

For example, as Geri Lynn Baumblatt explained on the blog for the Association of Patient Experience:

“What do patients experience as they drift in and out of awareness in an ICU?

Recently, a couple of long-term ICU patients both described how even when they weren’t fully conscious, the mood of the staff as they moved in and out of their room was still apparent to them. They could tell if people were present or smiling, and how even the one-sided conversations staff had with them were meaningful.

Blog-Graphic-(06.17.14)

One patient also described how he had a very strong sense of his parents’ stress as they kept watch by his bed and how it reduced his stress to hear how the staff was caring for his parents.

It’s impossible to always be “up,” but care, hospitality, and mindfulness of close family and friends may reduce patient stress, even when we think they’re not aware. After all, while everyone is worried for the patient, their worry is often for their partner and family.”

As we go about our everyday activities, it can become easy to forget the impact our actions (even our smallest ones) may have on others.

In the realm of healthcare, it is possible that even our smallest smiles or upbeat comments create newfound positivity for patients and family members.

What do you think? What else impacts the patient experience beyond individual interactions? Let us know your thoughts in the comments.

Editorial Director, Geri Lynn Baumblatt, attended and presented at the 15th Biennial European Meeting of the Society for Medical Decision Making in Antwerp, Belgium this week.

From the beautiful scenery, to awesome speakers – she wanted to provide our Engaging the Patient readers a personal look into her trip, including her favorite highlights from the conference.


 

At the Meeting of the Society for Medical Decision Making, you would expect that I would hear a lot about how to facilitate shared decision making and its importance. These sessions were of course interesting, but I was excited to see numerous research studies that quantifiably demonstrated the ongoing need for better communication with patients about treatment options and decision making.image1

Here are the results of a few studies that I found intriguing:

1.) One study looked at non-small cell lung cancer treatment selection and the role of the patient in decision making. It revealed that:

• 35% of patients felt uninformed
• 30% self-reported a lack of knowledge and
• 10% of patients reported alternatives weren’t discussed during their treatmentimage

And even while 56% of patients reported feeling they were involved in their treatment decision, this self-reporting may actually be overly positive. There is a proven need to improve conversations so patients can make informed decisions.

2.) Similarly, an observational study of long-term elderly care in Netherlands saw decisions about living conditions were largely ignored during the monthly case review. For example, important day-to-day issues like the quality of the food and laundry, which patients and family often complain about, were rarely broached.

3.) During the Meeting, there was also an interesting study looking at terminal patients and end-of-life care decisions. The study, focusing specifically on hospice vs. life-prolonging treatment decisions, found that those who chose life prolonging treatment were less likely to regret their decision. Continue Reading »

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