Empathy. Innovation. Communication.
Maybe not words that you would immediately associate with the healthcare industry, but at Cleveland Clinic’s annual Patient Experience and Innovation Summit these themes ruled the three-day gathering, held last week.
The summit was established four years ago, but this year’s summit had the biggest attendance to date with more than 2,100 registered attendees from 49 states and 39 countries; undeniable proof that improving the patient experience is recognized as fundamental across healthcare systems, from hospital administrators to physicians, clinicians and other caregivers.
James Merlino, MD, chief experience officer at the Cleveland Clinic and founder of the Association for Patient Experience, concluded the opening keynote with questions to the audience that encouraged collaborative discussions around the topics of empathy and innovation. One question that recurred throughout the conference: how we can make empathy-based care more of a reality? Not just for the patient, but for all work interactions and relationships. Empathy and understanding at work creates a community and is essential to creating a work environment that will more naturally deliver coordinated and high-quality care.
Collegial empathy and culture
This theme of staff engagement and collegial empathy resurfaced many times. We need to begin by examining the culture at work – at the hospital, and not just with clinicians. If everyone feels motivated by and part of the common goal of giving better care and improving the experiences of patients and families, work is more meaningful, staff is happier and more fulfilled, which creates a positive feedback loop. The methodology has to start with the way we treat and work with, not only fellow clinicians, but everyone in every role at the hospital. Everyone working at a hospital or care center is a caregiver, and caregivers have stories too. They take emotional hits as they become part of patient and family stories.
Jenn Lim, CEO of Delivering Happiness, a company she and Tony Hsieh (CEO of Zappos) co-created to inspire happiness in work, community and everyday life, delivered an especially compelling keynote on culture. Drawing on her work at Zappos, Ms. Lim talked about culture not as something mandated by management, but a collaborative process driven by employees, so they aren’t just asked to buy into a corporate culture. Instead, they help to create a workplace with common goals that they find meaningful. Jeff Rohrs of the Salesforce ExactTarget Marketing Cloud echoed this belief by saying, “make sure all employees know their function and their purpose.” In short, the best way to ensure patient happiness is to start with employee and caregiver happiness.
The power of stories and the lines of emotional involvement
The power of stories was another evident theme throughout the conference. Patients, families and clinicians shared their “patient experience” journeys. Demonstrably, the impact of story-telling resonates across every part of the care continuum, improves care and inspires a more empathetic experience.
This theme might be best summarized by a memorable surprise interview with 15-year-old patient blogger, Morgan Gleason. Diagnosed with Juvenile Dermatomyositis at age 11, Morgan has seen more hospitals and clinicians than most of us would ever care to, but she takes it in stride. During a particularly tough visit earlier this year, she and her mom posted a short video about her frustrations and it went viral. (If you haven’t seen it, check it out on YouTube). Morgan talked about the struggles of being a pediatric patient (i.e. physicians talking to her mom as if she’s not there, and what a significant difference it makes when clinicians and staff ask her about herself). The simple act of being able to talk about her interests helps make her feel human again and these moments of empathetic interaction make her multiple hospitalizations more bearable.
While considering the power of patient stories, the providers’ track examined the boundary between empathizing with the patient and remaining unbiased so as not to influence diagnosis treatment decisions or contribute to clinician burnout. But the recurring answer was: it is okay to have and show emotion. It humanizes the experience on both sides. Clinicians can still be objective; the answer is to maintain boundaries, but not to be distant and unemotional. Patients need to feel cared about and cared for, and no amount of clinical expertise is going to meet that need without the emotional connection.
Huddles and rounding
Another strategy to reduce patient and family anxiety through more regular contact is the act of hourly rounding, which brings the clinicians to the bedside in a more visible, involved way. Kim Henrichsen, vice president of clinical operations and CNO at Intermountain Healthcare, talked about how her team had also implemented joint bedside reporting at shift change. This approach enables patients to hear what’s going on and see that a handoff is happening between staff members.
Carrying forward the theme of visibility, Ms. Henrichsen also talked about the innovative approach of leadership rounding, a way for hospital leadership to hear from patients and employees directly. Intermountain treats the sessions as a protected time that can’t be scheduled over with meetings. Different individuals from various departments head out in pairs so they can identify positive behaviors and offer counseling to staff as needed.
Huddles include people from every department and are another great way to break down departmental silos to engage staff in problem solving. One CNO described how by including a facilities department member in their huddle allowed for them to quickly pinpoint why their nurse call lights weren’t working¬¬¬ and the problem was more quickly resolved.
Involving and engaging physicians
Physicians are sometimes the most challenging group to engage. Much is demanded of physicians. A panel on the challenge of involving physicians noted it’s important to recognize that physicians suffer too; it can be a job filled with loneliness and uncertainty.
Adrienne Boissy, MD, the medical director at the Cleveland Clinic who created a communication training program for physicians, found empathy is key and the need to acknowledge what physicians are going through. To engage them and gain their trust, she identified respected physicians and leaders to attend the first round of communication training. This gave credibility to the training and helped them see that it was simply “fluffy stuff” the hospital wanted to force them to learn.
Also part of this panel, Thomas Lee, MD, CMO of Press Ganey emphasized the need for reliable and actionable data. It’s a matter of engaging doctors on terms that they can understand. Dr. Lee described the impact of posting patients’ comments about their physicians on the physician’s external web profiles helped to quickly improve patient satisfaction scores. The doctors took the positive and negative comments to heart as they were personally responsible for the feedback, versus a general survey on the patient’s experience.
The value of this kind of specific data was echoed by the CNO panel who described how going to physicians and simply saying “too many of you are prescribing a more expensive medication when a generic is available” was met with denial and dismissal. But when they returned with actual data on which physicians were prescribing it and how frequently, the conversation was immediately more engaging and productive.
The overarching question all these efforts lead to is: How do we create empathy when a nurse, physician, or anyone on staff hasn’t had the experience of being a patient?
On the second day of the conference, a seasoned CNO panel delved into how difficult it can be to “teach” empathy as many different healthcare roles are trained in simulations. One emergency department tried an innovative approach of endowing their new employees with the real sense of being a patient. They had new employees show up at ED for training, put their belongings in lockers, and were told to wait in a room. They were left to wait for four hours without an explanation. Finally, they were brought to sit behind a curtain where people on the other side of the curtain talked about them in hushed voices. At the end of the day, frustrated and annoyed, they’re reminded, ‘this is what many patients go through every day. Try to remember how you feel right now for your future interactions.’
Why these discussions are a must
Empathy is driven by experience and interaction. The entire healthcare industry will benefit if hospitals work with staff to create work cultures built on purpose and meaning, and if they create opportunities to break down silos so staff can work together and understand each other’s roles and challenges. As purpose and empathy are internalized by the staff, and as they become mindful of it, it will also emerge more organically in patient and family interactions. While we still need to identify more strategies to help all caregivers empathize and connect with the very personal and usually stressful experience of being a patient, the summit’s discussions are evidence that we’re getting closer to success.
Geri Lynn Baumblatt, MA, is the editorial director at Emmi Solutions. For over 10 years, she’s overseen the creation of a large library of multimedia patient engagement, education, shared decision making and behavior change Emmi programs and interactive phone calls. These programs have won numerous awards including Freddie Awards, the IHA Health Literacy Award, the Frank Netter Award, ClearMark Plain Language Awards, and the 4th Annual Leonard G. Doak Health Literacy Innovator Award.