The Patient Experience Lives in the Details
February 19, 2016
We are buried in the patient experience metrics, advice, processes, workshops, and standards.
And, while the HCAHPS survey has reduced the patient experience to its 31 multiple choice questions, much of what matters to the patient can be better understood in the questions not asked.
HCAHPS asks: “During your stay, how often did nurses treat you with courtesy and respect?”
Patient answers: “Never, sometimes, usually, or always.”
Patient Thinks: “That is not all that happened!”
Inside of this exchange is an assumption that the terms “courtesy and respect” are universal terms, and that there are singular actions that can be done to ensure patients understand that they are being treated a specific way. Moreover, the patient collects all the events, small and large, into a perception of care that defies multiple choice questions.
Every interaction has its own context and participants. The circumstances and personal stories of each person involved always come into play. For example, what assumption would we make if we saw a nurse tending to a patient’s wound while the patient screamed in pain?
We might think that the nurse is acting insensitively or in an uncaring way to the patient. But what if the nurse, knowing that changing the bandage on this particular wound is painful, told the patient to scream or laugh in order to deal with it?
Another HCAHPS question, “During your hospital stay, how often did nurses listen carefully to you?” How is that evidenced?
I’ve had people look me right in the eye as I spoken with them, knowing they were not listening to me. “Hearing” is qualitatively different that “listening.” And, it is experienced in unique ways.
The ongoing ambiguities regarding HCAHPS are never ending. However, nurses and clinical staff can “design” the experience to minimize the chance of a patient feeling neglected or dismissed.
Here are some thoughts on how to do that:
1. Put Yourself in the Patient’s Skin
Know that you cannot know how patients and family members feel. But you may know what they need. For example, you may observe that your patient is in pain, but you cannot know how the pain feels. You may observe that the family does not show up as much as the patient wants, but you cannot know how that feels. Nonetheless, you can do what you can for them. You can acknowledge the situation and express concern and care.
2. Be Sensitive to the Patient
As Florence Nightingale wrote, “Always sit down when a sick person is talking business to you, show no signs of hurry, give complete attention and full consideration… Always sit within the patient’s view, so that when you speak to him he has not painfully to turn his head round in order to look at you. Everybody involuntarily looks at the person speaking. If you make this act a wearisome one on the part of the patient you are doing him harm. So also if by continuing to stand you make him continuously raise his eyes to see you. Be as motionless as possible, and never gesticulate in speaking to the sick.”
3. Remember that you and your patient are peers
There is already a difference in power, between the patient who is ill and the hospital who carries all the hope of recovery. In our increasing diversity, cultural and ethnic differences are also common among patients and staff. However, difference or uniqueness should not be mistaken for inequality and inequality is not what heals. Pat Linton said, “The only difference between the patient and the caregiver is acuity.” Further, Jean Watson, in the first Caritas process as part of Caring Science states to “Cultivate the Practice of Loving-Kindness and Equanimity Toward Self and Others.” If we start here, many of the challenges we currently have would become easier.
4. Keep Your Eye on the Clock because your patient is living by a different clock
Your own experience of how fast the clock moves is not at all the experience of your patient’s. When I was recovering from E-Coli Septicemia, time was not in my favor. Waiting was agony and agony was worsened by waiting.
The only antidote to waiting is information and attention. Send someone else to the patient’s room if you’re not available. Doing nothing is an insult.
And what about the gap between “being in the room” and “leaving the patient in the room?” The patient experience has no gap. The C.A.R.E. Channel’s beautiful nature images and soothing music are one way to bridge that gap.
Music helps us pace time. It can fill the heart and mind and suspend the endless cycle of worry. Images of nature do the same thing. Together, they are a powerful combination.
Remember, the patient experience is continuous, it never stops. How it is experienced and then remembered is less about clinical interventions and more about the details of how they were treated.
No one can meet the test of always or never in real time. However, patients may perceive their caregivers to “always be kind, helpful, and responsive” because they tended to the details of their experience.
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