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What toddlers at Disney can teach about improving patient experience

Posted Jul 01 2013 4:03pm

by Doug Della Pietra

How might the answer to "What most captures the attention of toddlers and infants at Disney World" guide caregivers in improving the patient experience?

Kare Anderson, in her fascinating HBR blog post , described what she and a cultural anthropologist discovered as they observed toddlers and infants at Disney:

"After a couple of hours of close observation, we realized that what most captured the young children's attention wasn't Disney-conjured magic. Instead it was their parents' cell phones, especially when the parents were using them." She continued, "When parents were using their phones, they were not paying complete attention to their children."

Anderson's deduction: "Giving undivided attention is the first and most basic ingredient in any relationship."

Now, let's turn to the patient experience. Although most hospital patients are adults, we can certainly experience a dependence on caregivers similar to that of toddlers and infants for their parents. If Anderson and the cultural anthropologist made observations in your hospital, what would they determine most captures the attention of your patients?

Would it be the computer (a checklist, a whiteboard) that occupies caregiver attention during a patient assessment? Could it be the loud, obnoxious and fear-inducing machine beeping as it monitors the patient's blood pressure, pulse rate, ECG, etc.

Or, would the quality of the caregiver's mindful-presence, listening, active involvement, engagement and supportive empathy, compassion and care most capture the patient's attention?

To increase the likelihood of caregiver mindfulness consider the following (partial list of) clinical and nonclinical/personal practices.

Clinical Practices

  • "Acknowledge patients are not subjects in the healthcare process or 'something' you should talk about or plan for in third person." 1
  • Pull up a chair and sit for five minutes (instead of standing).
  • Use the open-ended patient dignity question (PDQ): "What do I need to know about you as a person to give you the best care possible?"
  • Even if patients take additional time to form and express their thoughts, avoid the urge to interrupt. Studies show "in only 26 percent of (doctor) visits are patients allowed to complete their opening statement (agenda) without interruption (by the doctor)."
  • Round for care (instead of by checklist).
  • Engage the patient and family "to identify health and life goals, prioritize which of those goals (are) most important, and then work with clinicians to find treatments that best (align) with (their) goals and values." 2
  • Employ continuer (versus terminator) statements show n to improve satisfaction and adherence to treatment.
  • In the midst of the "what" and the "how," don't forget the "why"--the most important letter of healing alphabet .
  • Conduct change of shift report at the bedside rather that at the nurse's station.
  • Create the expectation for call lights that the closest caregiver--nurse, housekeeper, maintenance worker, volunteer, etc.--to the room when the call light blinks immediately enters the patient's room.

Nonclinical/Personal Practices

  • Establish "rapport quickly by introducing yourself to everyone in the room ... and conveying knowledge of the patient's history." Be "open to a patient's emotions and (make) at least one empathetic comment (e.g. 'That sounds really difficult')." 3
  • Create a checklist of 'Always Eventsâ„¢' that restore humanity back to healthcare. 4
  • Communicate from your mind and your heart--" heart-head-heart " model.
  • Develop your capacity to be mindful : to pay attention and listen "in a particular way--on purpose, in the present moment and nonjudgmentally." 5
  • Address compassion fatigue head-on.
  • Value the sacred and healing nature of the physician/nurse and patient relationship. 6
  • Raise your emotional intelligence . Embrace healthy relationships outside of work, "at least one activity that makes you feel absolutely wonderful when you do it, and do it regularly, preferably every day."
  • Demonstrate the 10 behaviors of respect , the foundation for quality care, such as listening to understand.

And that's how the answer to "What most captures the attention of toddlers and infants at Disney World?" can guide caregivers in improving the patient experience.

1 Wolf, Jason, PhD. (6 June 2013). Patients are Partners in Experience, Not Just Recipients of One. [Web log post.] Retrieved June 15, 2013, from http://www.theberylinstitute.org/blogpost/593434/165322/Patients-are-Partners-in-Experience-Not-Just-Recipients-of-One
2 Naik, Aanand R. (26 Feb. 2013). Patient-centeredness is the Intuitive Grasping of Health Care Quality. [Web log post.] Retrieved June 15, 2013, from http://www.geripal.org/2013/02/patient-centeredness-is-intuitive.html
3 Weinacker, Ann, M.D. (February 2013). Press Ganey again? Strategies for improving the patient experience. [Web log post.] Retrieved June 16, 2013, from http://medicalstaff.stanfordhospital.org/ms/medstaffupdate/articles/201302_strategies_for_improving_the_patient_experience.html
4 Duffy, Bridget, M.D. (18 June 2013). 10 Steps to Humanizing Medicine and Restoring Joy Back to the Profession. [Web log post.] Retrieved June 19, 2013 from http://experiahealth.wordpress.com/2013/06/18/10-steps-to-humanizing-medicine-and-restoring-joy-back-to-the-profession/
5 Kligler, Benjamin, M.D. (13 December 2012). Mindfulness Meditation: Helping Doctors in Training Find Calm. [Web log post.] Retrieved June 15, 2013, from http://blogs.einstein.yu.edu/?p=3028#sthash.8IylRxbW.dpuf
6 Duffy.

Doug Della Pietra is the director of Customer Services and Volunteers for Rochester General Hospital in New York, where he directs an intentionally-designed patient- and family-centered volunteer program , oversees the front-line valet and guest services teams, and co-chairs the hospital's Patient Experience Team. Follow Doug @DougDellaPietra on Twitter.

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