Motivated to serve their communities well and improve their satisfaction scores, hospitals and physicians are focusing on improving the patient experience. Many tackle the challenge by targeting one survey item at a time. For instance, if a hospital gets a low score on the question "How often do nurses do everything possible to help with my pain?" it might focus on better pain management.
Of course, the survey includes many questions, and focusing on one item at a time leads to a revolving door of strategies. I call this method — tackling one survey item after another — the shotgun approach. Certainly, hospitals have improved their performance this way, but the shotgun approach often proves overwhelming to the staff.
The other method I call the bowling approach. When you bowl, you aim for the sweet spot — the front pin, and when you hit it well, the other pins fall. So you aim at one improvement goal that will have an impact on many others. You go after that one goal and you end up producing a positive impact on many others as well.
The Sweet Spot
The Leebov Golde Group has demonstrated that caring communication or, as we call it, "the language of caring," is indeed the sweet spot for improving the patient and family experience. When you help physicians and staff build their skills in communicating their empathy and you inspire them to use these skills consistently to make their caring felt, scores improve on many survey items, even those that appear to have no connection.
Communicating caring is a single breakthrough objective with an enormous impact on the patient and family experience. It also strengthens physician and staff satisfaction, because it earns patient trust and cooperation and helps our care teams feel fulfillment from their caring work.
Why, you might ask, is caring communication a breakthrough objective?
For more than 30 years, I’ve been helping health care organizations provide healing environments and healing communication for patients, families and everyone on the health care team. During these years, the only constant in health care has been change:
- a growing dependence on technology;
- computerized medical records;
- changing payment methods;
- changing consumer expectations;
- patient satisfaction scores on the Web for all to see;
- more paperwork;
- new regulations;
- pressure to do more with less;
- much more.
For health care employees and physicians, these changes have been wrenching.
Solving the Mystery
A few years ago, a chief nursing officer friend called me with news that she had moved to a new organization where patient satisfaction scores were very disappointing. She couldn’t figure out why and she asked me to visit and see if I could shed any new light.
I wandered around. I slowed down in hallways so I could overhear conversations between nurses and patients. I shadowed a transporter to experience his interactions with patients. And I interviewed patients and their family members about their care experience.
To make a long story short, I saw very nice, competent, focused, busy caregivers going from task to task with deliberateness and competence. But there’s one thing I didn’t see: demonstrations of caring. People were primarily task-oriented — focused on their activities and their to-do lists. I saw shockingly little in the way of caring behaviors — personal connecting, empathy, handholding or warmth. I saw caregivers who undoubtedly were caring on the inside appear to be all business, impersonal or even detached on the outside. And my interviews with patients and families bore this out. Patients and families were touched by a select few caregivers but, more often than not, they were taken aback at the lack of personal connection and caring shown by members of the care team.
It’s good to be caring by nature — caring on the inside — but if you don’t express it in your interactions with patients, families and coworkers, it’s as good as absent.
Patient: "I’m in terrible pain. I need more medicine now!"
Nurse: "Tell me more about the pain. Where is it exactly? And how would you rate your pain from 1 to 10?"
The nurse wants to address the patient’s need, but her response is entirely task-oriented, not caring. She is caring but isn’t making her caring felt.
A better example:
Patient: "I’m in terrible pain. I need more medicine now!"
Nurse: "I’m so sorry about your pain and I want to help! So, tell me more about it. Where is it exactly? And how would you rate it from 1 to 10? I want to ease your pain!"
Why better? Because in the second example, the nurse made certain to express her caring. And no doubt, the patient trusts that the nurse really wants to help!
People in health care are caring people. But their focus on the multitude of tasks, requirements and pressures causes this attribute to recede into the background. It needs to be expressed. And not only do we need to expect every member of the health care team to communicate their caring, we also need to help them strengthen the skills for making their caring felt.
The Red Thread
Scripting doesn’t cut it. Making your caring felt is something that needs to be like a red thread that you weave throughout all of your interactions. It affects the quality and effectiveness of everything else you do.
Take the common process of rounding — a powerful, evidence-based best practice. Why are so many leaders disappointed in their results from instituting hourly rounds by nurses? Because of the task-oriented way it’s sometimes implemented. A nurse can pop in and say "Need anything?" and check off that they have rounded. But rounding has powerful effects only if the nurse enters the room, tunes in to the patient fully, looks for clues about how the patient is feeling and what he or she needs, asks directly what will help the patient (using protocols such as the four Ps: pain, position, potty, possessions), then listens and responds with task-related actions and caring.
Hundreds of interactions occur between staff and patients from arrival to admissions: Transporter takes patient to room. Nurse greets patient, orients to room and takes history. Physician stops in to touch base. Physician or nurse explains care plan. Respiratory therapist coaches patient through breathing exercises. Housekeeper cleans room. Food service delivers dinner. Nurse holds discharge-planning conversations. Care manager makes follow-up phone calls. And many, many more.
The red thread needs to run through every spoken and unspoken conversation between caregiver and patient, 24/7.
Caring communication is the next big thing and needs to be an enduring focus for improving the patient and family experience.
Wendy Leebov, Ed.D., is the president of the Leebov Golde Group in Philadelphia. She recently authored (with Carla Rotering, M.D.) The Language of Caring Guide for Physicians: Communication Essentials for Patient-Centered Care.