Recently a neighbor of mine was in our local hospital for several weeks undergoing treatment for MRSA and dehydration. Polly is a woman in her late seventies who is completely alert and oriented. She lives an active and independent lifestyle and is fully capable of understanding and communicating clearly with others.
I asked her adult daughter how her mother’s experience had been so far. Given that this is a hospital that widely advertises its ‘patient-focused approach’ I hoped for more positive news. Her daughter sighed and told me they had suffered several disappointments. She felt that her mother had been patronized, ignored and overall disrespected so frequently by hospital staff that they looked forward to sharing that information on the forthcoming HCAHPS survey.
Given my work as a medical educator my ears perked up. I asked her to share her specific concerns about her mother’s care. The behaviors and communication oversights she described could easily have a negative impact on quality of care and patient safety.
Since I’ve heard these types of complaints many times, I felt moved to address some of the common, everyday courtesies that health care providers can deliver which could have a very positive impact on quality of care. In Polly’s case, these courtesies were frequently ignored … resulting in a less than satisfying hospital experience:
Greet and get to know your patients. Few health care providers who came to see Polly introduced themselves, explained why they were there, and told her what their role was at the hospital. Some didn’t make eye contact or attempt to establish any semblance of rapport with her. Several ignored Polly completely. They appeared to prefer interacting solely with her daughter.
This behavior was disconcerting to both mother and daughter. It gave them the impression that they considered Polly incapable of understanding what they were saying. From Polly’s perspective she felt she was being treated more as a “butt in a bed” than as an individual with a history, feelings, concerns and knowledge that could help her health care providers to help her.
Such behavior shows disrespect toward the patient. Moreover, it indicates a lack of awareness and regard for how important a role the patient can potentially play if invited to be a partner in the diagnostic and treatment process.
Make yourself known to patients. The failure of health care providers to identify their names and respective roles can have dire consequences. Patient advocate Helen Haskell talks about how, in her now deceased son Lewis Blackman’s case, the physicians who came to see him never disclosed their identities. As the 15-year-old became sicker and sicker Haskell kept asking for a senior-level attending to come see him. Over the course of an entire weekend, no one ever identified himself. Nor did anyone affirm or deny their specific medical roles at the hospital.
Tragically she found out days later, after Lewis died due to medical neglect and error, that for the entire weekend that Lewis suffered, a board certified physician never showed up to see him. Virtually everyone who came in was a resident, not an attending.
In another example, Polly and her daughter were eagerly awaiting radiology test results to find out how far into her spine the MRSA infection had spread. They were told by hospital staff that the radiologist would see Polly that day. As the day wore on, and no one arrived, they kept asking nursing staff when the doctor would show up. Finally, someone from the nursing staff checked, and it turned out that the radiologist had, indeed, seen Polly earlier in the day. However, he hadn’t identified himself to the patient, nor had he provided information about her test results — leaving Polly and her daughter to wait, worry and wonder unnecessarily.
Consider communicating with patients during procedures. While in the hospital Polly underwent a procedure during which she was awake and aware. Typically under such circumstances a physician will talk to the patient and keep them informed about what is occurring. Polly’s daughter recently had a procedure at another hospital in which she was alert and communicated with by the surgeon the whole time. She recalled how reassuring it was for her to be ‘kept in the loop’ and how it made the whole process less stressful.
Unfortunately, her mother didn’t have a similar experience. Despite the fact that Polly was also awake and alert during her procedure, the surgical staff ignored her and talked amongst themselves. Could it be that they assumed Polly was too old to understand, or care about what was happening? What stopped them from asking her if she would like to know what was going on? Or, if the medical staff prefers quiet during procedures, why not share this with her beforehand so she would know what to expect? From Polly’s point of view, some communication from the medical staff would have made the process a lot less stressful.
The connection between patient satisfaction and desired medical outcomes. It’s well established that patient satisfaction has a significant impact on medical outcomes. What is perhaps less clear are exactly which specific behaviors and attitudes are necessary for caregivers to embody in order for patients to actually experience such satisfaction.
A study conducted at a Canadian teaching hospital sheds light on this subject. The research revealed that patients equate perceived emotional support with overall patient satisfaction. They identified eight factors that significantly contribute to patient satisfaction:
- Empathy: How care is delivered is vital to patients’ desire to feel understood, secure and reassured.
- Informative communication: Patients want to receive and provide information and to ask questions. They want to be listened to and to feel that their input matters to their caregivers.
- Being present and available: Patients want to feel connected to their caregivers.
- Providing inspiration and hope: Patients want their caregivers to have a positive influence on them.
- Personalization: Patients want to feel like they count as human beings to their caregivers, not just as cases, or as Polly said, “as butts in beds.”
- Supportive gestures: Patients are sensitive to behaviors that convey caring, emotional support and openness. This includes eye contact, physical touch, smiling and physical proximity (sitting down versus standing over them).
- Humor: Appropriate humor by caregivers helps patients to heal anxieties and feel less stressed.
- Ambient environment: The mood of the hospital is important to patients. A good environment is a friendly environment. Knowing the names of their caregivers helps patients feel more at home.
Reflecting back on Polly’s dissatisfaction with her hospital stay, how different would her experience have been if her caregivers had demonstrated these important behaviors and attitudes? It appears that all of the eight dimensions simply reflect common sense etiquette that is not difficult to learn and which can be easily practiced.
As we know, common sense is not always common practice. However, if we make it a priority to create an environment in which these common courtesies are nurtured patient satisfaction will grow, trust toward caregivers will expand and adherence rates will rise.
Effective two-way communication between caregivers and patients can contribute much toward the overriding goal of delivering efficient, cost-effective, high quality and safe care that achieves desired medical outcomes. And, from the perspective of health care providers, it’s likely that this type of relating would go a long way toward helping restore and support a sense of joy and meaning in their work.
Joan Lowery is a medical educator and founder, Lowery Communications.