Honing the Patient Experience

It only takes 56 seconds to make a meaningful human connection with a patient

How do you manage a nursing staff to help drive patient experience to optimum levels? You start by putting the horse before the cart. Christy Dempsey, MSN, MBA, CNOR, CENP, SVP, chief nursing officer at Press Ganey Associates, recalls a hospital CEO telling her, “My vision is that we will hit the top decile for patient satisfaction and quality and safety.” And that would be the cart.

Dempsey was quick to ask, “‘What does that look like?’ As leaders it is our responsibility to translate those numbers into something that is tangible and tactical for the people who are taking care of patients every day; those numbers likely don’t mean much to them. If being in the 90th percentile is your goal, you’ve got the wrong goal. Instead, let’s talk about what is important to the patient, and how to optimize the experience. Take care of that and the numbers will follow.”

Experience over Satisfaction

Clearly, the mythical horse pulling the cart must be patient experience. Defining “experience” as opposed to “satisfaction” is key to Dempsey’s management philosophy.

“I talk about patient experience because it is the totality of what we do — it’s the clinical, it’s the operational, it’s the cultural, it’s the behavioral,” she explained. “Patient satisfaction, rightly or wrongly, is looked at as something fluffy — trying to make people happy, and being nice — smiling, making eye contact, pulling a curtain for privacy, warm greetings in the hallway. When you think about patient experience, there is no gap between clinical quality and safety and patient experience – it’s all the same thing. And when you start talking about patient experience in that way, it really changes the conversation.”

The newer term has been embraced by Denise Brenner, RN, BSN, CWCA, nurse manager of Ambulatory Services and co-chair of Outpatient Patient Experience Committee, Morristown (N.J.) Medical Center. “Patient satisfaction is only part of the patient experience. Patient satisfaction is one point in time, one episode of care,” she explained. “But patient experience is a reflection of continuity of care received in any care setting within a health system.”

But how can facilities really drive that overall experience to new heights outside of the pleasantries that comprise “satisfaction”?

Safety First

Dempsey is long on useful cargo for that metrics cart being pulled by the horse of experience. “In healthcare the most important thing we do, no matter where you work or what you do, is to make our patients feel safe,” she said. She explained that if, for example, a patient sees a clean and tidy room, the perception follows that the entire organization is clean, and that makes a patient feel safe. If a patient sees a care team working well together to provide care, a patient feels safe. If providers involve a patient in care decisions, a patient feels confident and safe.

But Dempsey said the most important factor of all is for patients to feel their care providers really and truly know who they are as human beings. “You will never improve the patient experience or the caregiver experience if you can’t connect with them as people,” she said.

Noting that most nurses believe they don’t have enough time on the job to delve into a patient’s personal history, Dempsey said it is up to nurse managers, as well as other leaders, to demonstrate the fact that it can be done — and must be done.

“There’s a lot of churn in that frontline nurse manager’s role. It is arguably the hardest role in the hospital,” Dempsey said. “Yet so often we take someone who was a wonderful clinician and put them in a manager role and teach them how to schedule and staff and hire and fire. But we don’t teach them how to coach and lead and mentor. How do we coach around nurse rounding — an absolutely wonderful technique to connect with patients? So many times we see that metric pertaining to how many times are we physically rounding on the patient; are we getting in 90% of the time? But the real question should be, ‘What are we doing when we are in that room?” Reality is that nurses are always rounding every hour, but if once in a patient’s room they are surly or rude, patients are still going to have a negative experience despite achieving that ‘90% rounding’ metric.”

The 56-Second Rule

Dempsey said nurse managers must impress on their team that it takes a very short time span to really connect with patients. In fact she has practiced a soft interrogation technique and has concluded it takes just 56 seconds to make a human connection and make that rounding visit count.

“I have done presentations on this literally thousands of times and have timed it over and over … I’ll pull someone out of the audience to role-play the patient. I introduce myself, ask them their name and how they’d like me to address them, mention that I have been updated on their condition during shift report. Then I ask, ‘When you are not in the hospital, what do you like to do?’ They will talk about a hobby or family or work or whatever, and there is always something I can relate to. They might mention children or grandchildren, or a sport, etc., and we strike up a conversation that has nothing to do with the reason they are in the hospital.

“And that’s the point. So often when patients come into the hospital not only do they lose all control, they also lose all their identity. They become their room number, or their diagnosis or their treatment plan. In order to feel safe, patients need to know you know them — who they are, not just their diagnosis. I tell managers, ‘When you talk to your staff, ask them to tell you one thing about their patient that has nothing to do with the reason they are in the hospital. If they can do that, you know they are connecting. If they can’t, they are not — and you are never going to improve the patient experience if you can’t connect with the patient.”

Having taught this technique to a leadership and management class in the nursing program at Missouri State University, Dempsey received impressive and convincing feedback from a student who tried it out. “She had talked to a patient about fishing … a little more than 56 seconds, but not much. But the amazing thing that followed was, he never used his call light the rest of the day. And he didn’t ask for pain medicine the rest of the day. The next day, someone in his family sought her out out to say thank you. Think about that and multiply that by all of the other patients and consider the amount of time that could be saved by taking that 56 seconds of quality time.”

Culture, from Top to Bottom

Similarly, Brenner said, “The most success I personally have seen in raising our employees’ motivation comes with celebrating upward movement and success. Sharing in the pride they feel when a patient makes a personal comment regarding a particular unit or individual not only gives that person or unit a pat on the back, but everyone else also feels a sense of pride — pride in our organization. Sharing these moments and providing the recognition it deserves instills the drive to give more.”

She also noted that patient satisfaction is a critical part of the strategic mission at her facility and within its parent company, Atlantic Health System. “Healing culture is embedded in our hospital’s philosophy. We’ve committed ourselves to building a trusting relationship with our community of patients; this includes the C-Suite. Senior leadership is involved in ensuring that ongoing efforts are made to raise awareness, communicate success and necessary improvements, and to champion initiatives to improve patient experience.”

Sharing successes is one of Brenner’s go-to tools for coaching her staff.

Dempsey agreed that C-level involvement is critical to success, and offered actionable insight. “We know that if leaders are visible and accessible, and listen and seriously review ideas that come from staff, the engagement scores are higher. And leaders who model behaviors they want from staff drive success. If I am a CNO and I say to my staff, you must make connections with your patients, yet during rounds I stand in a doorway and ask yes and no questions, and basically do a fly-by, then I am not modeling the correct behavior,” she explained. “Therefore, when I’m gone, the staff is not going to do it either because if it were REALLY important, I would have done it too. Modeling the behavior, being visible and remaining accessible are all critically important.”

Another Strategy

There is yet another way for managers to drive patient experience, said Dempsey: make it a required competency.

“We talk all the time about competency and check people off every year on things like IV-pumps and equipment. But how is patient experience any less important than those? We need to make sure that people are competent where compassion and care are connected. One of the things we might think about is adding the patient experience to the competency check-off every year. Or do we build patient experience around every competency?

“For example, to be sure people know how to use the IV pump, we need to educate around that and say, ‘This is the way you talk to patient about the IV pump. And this is the way you talk to the family about the IV pump. And this is how you make sure the patient’s experience with this IV pump is the best it could be.’ There is a patient experience component to every competency, and we need staff to understand the impact every task has on the patient experience. It’s not about making people happy. No one in the hospital waiting room is happy about being there. It is about optimizing their experience clinically, operationally, culturally and behaviorally.”

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