Healthcare providers often overlook healthcare's fundamental goal — to alleviate suffering — amid the stress of increasing regulation, decreasing reimbursement and heightened attention to quality ratings.
However, eliminating suffering can improve outcomes for patients and their caregivers, according to Christy Dempsey, MSN, CNO of Press Ganey and author of the book, The Antidote to Suffering: How Compassionate Connected Care Can Improve Safety, Quality, and Experience.
Ms. Dempsey is no stranger to patient suffering, as both a breast cancer survivor and the family member of a police officer shot in the line of duty. She draws on these experiences in her book, as well as her 30 years in the healthcare industry, to highlight the shortfalls that lead to preventable suffering for patients and providers.
"There are a lot of people who are taking care of patients today who have never actually been a patient," she says. "Having that perspective completely changes the way you think about healthcare."
Ms. Dempsey spoke with Becker's Hospital Review about the different types of suffering that pervade healthcare and shared how hospitals can improve the healthcare experience for both patients and caregivers.
Editor's note: Responses were lightly edited for length and clarity.
Question: How did your own experience as a patient inform your views on healthcare?
Christy Dempsey: My own journey with breast cancer made me realize there are two kinds of suffering. The first is inherent suffering — clinicians can't keep chemotherapy patients' hair from falling out or prevent them from being scared to death about what the rest of their life will be like. But then there's an awful lot of suffering we actually impose on people when they come to the hospital for care. Things like making patients wait to be seen, not providing clean, quiet healing environments, or not being courteous and respectful. It's not about being nice or making people happy — it's about understanding there's no line between clinical quality, patient safety and the patient experience. It's all the same thing.
Q: How did your experience as the family member of a patient shape your views on healthcare?
CD: My son-in-law was a police officer who got shot in the head in the line of duty in 2015. My daughter had to ride with two police officers to the hospital, not knowing if her husband was alive or dead. My husband, who had convinced my son-in-law to be a police officer, and I had to go to the hospital and sit in a small, windowless room where they give you bad news. The neurosurgeon came out, took my daughter's hands and said, "We've taken out half his skull to let his brain swell, and he's lost his eye. We've placed him in a medically induced coma and best case scenario, he'll never speak again, but have limited use of his right side."
As clinicians, we go into healthcare as "fix-it" people. We see problems, and we want to fix them for our patients. In this case, I couldn't fix anything for my daughter or son-in-law. I was completely powerless. Every single patient in a bed, on a gurney or in the waiting room feels exactly the same way. I always tie everything back to Maslow's hierarchy of needs, which ranks safety second only to basic physiological needs. Safety is critically important. But it's not just about keeping patients safe, it's about making them feel safe. A clinician may do a good job of keeping me from falling or getting a bloodstream infection, but if I don't think you know me and what's important to me, then I don't trust you. And if I don't trust you, I'm not likely to be compliant with care guidelines or give you a great score on patient experience.
Q: Do patients suffer in ways that healthcare providers may not even know about? On the flip side, how do caregivers suffer in the healthcare environment?
CD: In healthcare, clinicians don't like to even use the word suffering because it makes us feel guilty. Healthcare has become very checklist-oriented and task-driven, thanks to regulation, designation and all of the technology we use. That's not to say those things are bad, but they can't be the only way we care for patients. We have to make a connection with people so they trust us to care for them. People in healthcare don't think they have time to do that. But it only takes, on average, 56 seconds to make a connection with a patient. We have to help the people who take care of patients today understand how to do that. We don't really teach that in nursing school or medical school today. As a result, we have people who are really great with the technical skills, but they don't know how to connect with patients and that causes suffering.
For clinicians, there is inherent joy and meaning in feeling like healthcare is a calling and that we're making a difference in patients' lives. But on the flip side, there is inherent stress when patients suffer or die. And then there are things that add to that stress and distress, like when the clinical team doesn't work well together or there are EHR issues. Providers already feel like they don't have enough time to execute their existing responsibilities, so they can also become overwhelmed when given additional responsibilities or expectations.
Q: How can hospitals identify and measure patient and caregiver suffering?
CD: When we set out to measure suffering in 2012-13, Deirdre Mylod, PhD, my colleague at Press Ganey, started thinking about what patient needs were being met or not. We decided if those needs were not being met, that's suffering. We developed a Compassionate Connected Care framework that lets healthcare providers look at their data and performance at compassionate connected care sites. The framework categorizes addressable sources of suffering into four areas: clinical excellence, operational efficiency, caring behaviors and culture. Putting data into an action framework like this allows providers to target improvement efforts where they will make the most difference.
Healthcare providers intuitively know patients perceive a different experience based on age, gender, ethnicity, etc. But they also have a different experience just based on the reason they are in the hospital. For example, congestive heart failure patients have different needs than pneumonia patients taken care of by the same nursing team. They need more information about their medications and a quicker response to call lights. This knowledge can help caregivers better understand the needs of their patient populations. That's the kind of granularity we need to truly meet patients' needs, because otherwise, we're just throwing spaghetti against the wall and hoping it sticks.
Q: What can nurses or other caregivers do to improve the care process for all involved?
CD: Nurse managers have a tremendous impact on both nurse and patient outcomes. But we don't always prepare nurse managers for how to be successful. We pluck great healthcare providers out of their clinical role and put them in a management role, expecting them to automatically be great managers, too. We show them how to budget and schedule and then say, "Go to it." But we're not teaching them how to lead, mentor and develop a team. So I think focusing on leadership development is important.
Team building is also important. We unite people with different experience levels and cultural norms all together in a unit or office and challenge them to achieve quality outcomes, but we don't give them a chance to become a cohesive team. This goes back to making sure leaders understand team members have to be at the table to help them. In a hospital unit, you can't just get the nurses together. You also have to include all the people who help take care of patients on that unit, including environmental services, the lab and pharmacy.
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