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

Courtney Hummel

Courtney Hummel

In his TEDtalk, “The Riddle of Experience vs. Memory”, behavioral economist Daniel Kahneman tells a short story about a man listening to a symphony. The man experiences such joy throughout the entire performance , intensely feeling and relating to the music. As the recording meandered to its finale, the music suddenly stopped, replaced by a horrible screeching sound. This ruined the entire symphony, the man solemnly remembered. But, had it? He experienced 20 minutes of glorious music, jarred by a few seconds of madness. But those 20 minutes were now irrelevant; the experience was ruined, replaced with a marred memory.

One key takeaway from this scenario is the human memory is significantly and consistently biased. We must understand that a memory is merely the end result of an experience and the processing of that experience. It’s helpful to think of each person as two selves: an experiencing self (the one that is fully present in the moment and experiences every sight, sound, smell, taste, and feeling) and a remembering self (the one which sifts through the detritus of that entire experience, retains a few key nuggets, and forms a “memory” of it).

And these aren’t just random nuggets. We form memories based on very specific aspects of an experience: the most extreme aspect (the highest high or the lowest low) and the final moments. Shakespeare must have unknowingly donned his behavioral economist cap when he wrote “All’s Well That Ends Well.”

What does this mean for the patient experience? As healthcare systems constantly monitor patient satisfaction scores in both inpatient and outpatient settings, how do we account for what patients care about? What makes them form happy memories? Kahneman actually studied these phenomena, by comparing ‘experienced’ and ‘remembered’ pain levels during colonoscopy exams. Each patient participating was asked to rate his/her pain intensity every 60 seconds on a scale from 0 to 10, (0=no pain, 10=intolerable pain).* Let’s look specifically at two patients in his study:

pain intensity

Photo Credit: Donald Redelmeier; Daniel Kahneman

 

One would assume by total shaded area that Patient B had more pain than Patient A. Poor guy. However, when the team compared patients’ overall ratings of their pain, they remarkably found the opposite to be true. Patient A and those like him described their experience, both immediately following the procedure and much later, as more painful. Herein lays the difference between the experiencing self and the remembering self. Continue Reading »

gbaumblatt

Geri Lynn Baumblatt

Contributor: Geri Lynn Baumblatt – Executive Director of Patient Engagement, Emmi Solutions

At hospitals across the country, the patient experience is coming into its own. No longer just the healthcare term for customer service, the substance of its goals, to humanize every interaction, are at the heart of medicine.

This year at the Beryl, Cleveland Clinic, and Next Generation Patient Experience conferences one theme kept emerging: engaged and satisfied patients are the result of engaged providers and employees. So before the office of patient experience starts assessing the culture or the processes or the quality of care and implementing changes, how can they ensure clinicians and employees are engaged?

Start by Remembering “The Why”
Everyone wants to feel their work matters. And for most people in healthcare, it’s not just a job it’s a vocation: to care, treat, and heal. So start by helping everyone remember their “why”. Ask everyone to tell the story of why they went into healthcare or a story where they felt they made a difference. As former emergency nurse Liz Jaswiec put it, “One of the biggest crises in healthcare today is that caregivers no longer feel heroic.” People want to go home at the end of the day and know they helped save lives and made a difference. Learn their stories and bring that back into focus.

Once providers and all employees feel the focus is on what really matters (and not on better HCAHPS scores or the hospital’s brand), they feel less threatened because the focus isn’t on criticizing what isn’t working. Instead, it’s about recognizing how changes like spending time with each individual isn’t just a better experience for patients and families, but it’s also more fulfilling for the caregiver or employee on the other side of that interaction.

The term “patient experience” is part of the vernacular now. However, looking closer at the best way to accomplish this means humanizing and improving the experience for everyone, starting with the people providing the care.

Geri Lynn Baumblatt is the Executive Director of Patient Engagement at Emmi Solutions. She is on the board of the Journal of Patient Experience, a contributor to the Association for Patient Experience, and regularly participates in health literacy and shared decision making conferences and panels for organizations like AHRQ, the Institute for Healthcare Advancement, the Society for Medical Decision Making, Health Literacy Missouri, Stanford Medicine X, the Health Sector Advisory Council at Duke, and the Center for Plain Language. You can follow her on Twitter at @GeriLynn

Contributor: Emily Azari – Senior Health Writer, Emmi Solutions

Emily Azari

Emily Azari

Our health care system is complicated. So why don’t we have a way of helping people understand how it works before they find themselves in the hot seat? Instead of trial by fire, wouldn’t it be helpful to have some form of Health Care 101?

Blissful ignorance
If we’re fortunate, we’re blissfully unaware of how the medical system works as we’re growing up. When you get sick, a parent whisks you away to the pediatrician and your only concern is whether to accept the lollipop from the stranger in the white coat. If your luck continues as a young adult, you bump into the health care system rarely, if at all, perhaps relying on Mom’s suggestions or the student health service a few blocks away.

But at some point you find yourself selecting health insurance, choosing a doctor, and making appointments. Maybe you have to help a loved one navigate the system. Or you get sick, injured, or develop a chronic illness. Whatever the reason, many of us are unprepared when circumstances push us into health care’s deep end, and we don’t have a coach to show us how to swim.

Stumbling into a foreign world
When I had to choose insurance the first time, I didn’t understand the lingo, and I didn’t know who to ask. It was kind of like how I didn’t know what a car’s transmission was — even though everyone else in the adult world seemed to know. (To be fair, I didn’t buy my first car until I was 25. But if I’m being honest, years have passed and I still don’t know.)

Lingo is a barrier, but at least we’ve got Google. What if you don’t even know who’s who in health care? It took me years to learn that a gynecologist can double as your primary care physician. And how would anyone know an internal medicine doctor can treat problems in the eyes, ears, and skin (which aren’t “inside” the body)?

Young adults might find themselves moving or switching jobs every couple years, which means finding a new doctor — for many, that’s little more than a shot in the dark. To be a savvy patient, you also need to maintain a list of your medications, articulate your symptoms, and keep your medical records organized (and for that matter, you need to realize that’s your job in the first place).

In other words, there’s a long list of skills and knowledge we need, but we’re left to learn it by high-stakes trial and error. Continue Reading »

Values & Vaccines

Contributor: Diana Dilger – Health Writer, Emmi Solutions

Everybody buckle your seatbelts. I’m about to get into something that, until recently, wasn’t a controversial topic but now brings out the boxing gloves at its mere mention: vaccines. As I’m sure anyone who’s been alive the last ten years can testify, vaccines have become one of the most heated discussion topics in everyday healthcare.

Diana Dilger

Diana Dilger

Regardless of the side you fall on, I wonder if there isn’t a way to tackle this debate without putting off people who might otherwise be brought around to your way of thinking. Rather than trying to refuse your doctor’s perspective or strong-arm your patient into something he or she doesn’t believe in, why not try the same approach as shared decision making?

Sure, typically shared decision making is used when there are treatments that are more or less equally valid in dealing with the condition. However, the true basis of it is listening to the patients’ values and ensuring that they understand the benefits and risks of each of their options. Why can’t this same tactic be applied to vaccines?

Think about it. Let’s say a patient, Amy, comes into Dr. Smith’s office. Amy does not want to vaccinate her child. Perhaps she thinks it may cause autism. Perhaps she is of the mindset that Big Pharma is pushing unnecessary drugs on her child and she prefers clean living. All of which is understandable with the information she has access to and the values she holds.

Meanwhile, Dr. Smith is adamant that vaccines are proven to keep diseases at bay that can render a child very ill, cause permanent damage to the child or even lead to death. He feels it is his responsibility to inoculate Amy’s child.

But let’s say Dr. Smith can put those thoughts aside for a moment when Amy tells him she doesn’t want to vaccinate her child. Let’s say he asks, “May I ask why?” instead. That one little question shows interest, allows Amy to explain herself without feeling attacked and allows her to feel her doctor is listening to what’s important to her. Continue Reading »

Contributor: Kelly Hawthorne – Medical Advisor Program Manager, Emmi Solutions

Kelly Hawthorne

Kelly Hawthorne

My father will tell you that one of his greatest accomplishments is having named me. When he said it out loud to my mom, it just fit. My family has always believed that there’s power in words and by claiming something, you give it authority, meaning. As a rule of thumb, you don’t claim the negative things, especially as it relates to your health.

Growing up, I watched my dad labor intensively to provide for us. Having a business in transportation meant driving for hours upon end, and ultimately sitting and eating in an upright position all day. He was so busy that he barely had time for himself and rarely saw a primary care physician. I often wondered what his occupation was doing to his health. But he didn’t feel as if he could just stop or slow down, when there was always a mountain of bills to pay.

So when my mother phoned recently to say he’d been hospitalized overnight, the wondering was over—something was really wrong.

I got to his hospital room as soon as I could and found him looking idly at the TV screen. He was surprised (and happy) to see me, but exclaimed that he was fine and there was nothing to worry about. When the nurse came to check on him, I pulled my mother aside to get the latest info. Apparently, his blood sugar was 3x what it should’ve been and tests were still being run. “They haven’t pronounced him with anything!” she quickly added. Yet, as I scanned the pale walls everything had D-I-A-B-E-T-E-S spelled out. His inpatient meal menu, for example, literally said “NEW DIABETIC” at the top. Right beside it, there were papers on the importance of carb counting for Type 2 Diabetes. Even as the nurse left to switch shifts, there was talk of Metformin and glucose monitoring, but no one ever looked us in the eye to confirm what seemed pretty evident to me. Why wouldn’t anyone just say it?

Now, I could’ve been jumping the gun since some test results weren’t in, but knowing there’s a history of not wanting to accept illness in my family, this seemed like a potentially dangerous situation. By keeping quiet, how would that affect my dad getting better? How would not “claiming” a diagnosis prevent us from tackling this head on? Continue Reading »

Contributor: Dani Alcorn – Health Writer and AMR Coordinator

Do you know someone worried about Ebola? Chances are good that you do.

Dani Alcorn - Health Writer, Emmi Solutions

Dani Alcorn

But there are actually many reasons why we don’t need to be as concerned as the news anchors might lead us to believe. Sometimes it’s tough to find the facts when the fear is so strong. Here’s some key info to help tamp down the hype.

It’s true Ebola is a scary disease. It belongs to a class of viruses called “hemorrhagic fevers” (even the name is frightening) that damage organ systems, blood vessels, and impact the body’s ability to regulate itself.

To date, there have been about 13,500 cases of Ebola (a little more than half of them laboratory-confirmed) and almost 5,000 deaths.

The vast majority of cases have been reported in 3 West African countries: Liberia, Guinea, and Sierra Leone.

Only 3 cases have been diagnosed in the US (plus a handful of healthcare workers evacuated from West Africa).

Media outlets have kept Ebola at the forefront of America’s mind. A Harvard School of Public Health poll found that more than 50% of US adults are concerned about a large Ebola outbreak in the US within the next 12 months.

While this concern is understandable, here are 3 reasons why we don’t need to be worried about an Ebola outbreak in the US.

1. Ebola patients aren’t contagious until they’re symptomatic.
People with Ebola are only contagious once they are symptomatic. So during the incubation period (the time between exposure and developing symptoms) the person can’t pass the virus along. Symptoms of Ebola include: fever, severe headache, muscle pain, weakness, fatigue, diarrhea, vomiting, stomach pain, and unexplained bleeding.

With some other diseases, people are able to pass the illness on to someone else before they know they are sick. For example, people with the flu can pass it to other people 1 day before symptoms begin. So even a coworker who stays home once they’ve started sniffling and sneezing can spread the flu before realizing they’ve got it.

2. The Ebola virus can be stopped with disinfectants.
Fortunately, the Ebola virus can be halted with typical hospital disinfectants (like household bleach).

When traveling to and from Ebola-affected countries (a low-risk activity), the World Health Organization recommends using an alcohol rub throughout the day and washing your hands with soap and water when they are visibly dirty.

3. Ebola is NOT airborne.
Ebola is spread by contact with bodily fluids (like blood, urine, or feces). It is NOT spread through the air or by water. According to the CDC, there is NO evidence Ebola is spread by coughing or sneezing. Continue Reading »

Contributor: Geri Lynn Baumblatt – Executive Director of Patient Engagement

Hemodialysis. Opioids. Blood Transfusion. Statins. Transplant. Surgery. Immunomodulators.

The list could go on but the overarching question we face is: when are these options too much or too little treatment?
When are medications like statins and opioids truly beneficial? And where does the trade-off between benefits and side effects drop off for an individual? Clearly, helping people understand their condition, the treatment, the tradeoffs and so on can lead to more appropriate utilization of care with improved outcomes.

This is easier said than done.

As Gary Schwitzer wrote, people are barraged with media messages that are hard to filter and often misleading, while Bruce Lambert described how the combination of low health literacy, complexity and fragmentation of healthcare information makes it increasingly difficult to make good care decisions. Similarly, Lygeia Ricciardi shared her own personal challenges trying to understand health coverage despite having extensive experience with health policy.

So what can we do?

Beccah Rothschild of Consumer Reports explained how national campaigns like Choosing Wisely offer free resources to help people decide whether a screening is right for them. Expert Patient or ePatient, Casey Quinlan shared her own tips for being a savvy patient while Renata Schiavo explained how participatory planning is another available tool to help address the health literacy needs of vulnerable populations. Related, health writer Emily Azari theorized on how a system built on everyday language might offer a more humane experience and lead to more appropriate use of preventive care with less reliance on Emergency Room visits. Insights like these are good starting points for devising applicable strategies.

Paul Barr discussed how something that seems as straightforward as a blood transfusion may often be overtreatment. The average person is not equipped to know to ask whether a transfusion is truly needed at the time of treatment.

Looking from the provider perspective, clinicians don’t know how quickly or severely conditions like Crohn’s may progress. Dr. Corey Siegel asks: ‘In those cases, what is “just right” treatment?’ Educating patients about their disease and options and working with them to make these decisions is essential.

Health Literacy and Under-utilization
Under-treatment and under-utilization is also a serious problem. Karen Mulvihill explains how common misconceptions about palliative care results in many people not taking advantage of the opportunities available to them to improve their quality of life. I also looked at the need for education and candor to improve utilization. When we help people with conditions like end stage renal disease fully understand their health while also being candid about their prognosis, they’re more likely to take advantage of options like hospice care.

But educating patients about these complex issues shouldn’t happen right before it’s time for a decision. As Angie Newman says in her piece on dialysis, “If conversations around treatment options start early enough, there’s plenty of time to discuss things over weeks and months.” Kevin Fowler looked at the next phase of renal disease and why kidney transplant outcomes aren’t better in the United States. He also included one of the things that we all know we can do better which is “education and counseling about immunosuppressant medications should be a continual process rather than a 10 minute discussion while being discharged from the hospital.” Continue Reading »

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