From the horses mouth…
Welcome to our ongoing series based on the characters created in my book, Heroes Need Not Apply, “How to build a patient-accountable culture without putting more on your plate.” The book shows how focusing on what matters most to patients, having the right mind-set and having a common direction can bring two people together to ignite an entire organization.
If you’re just joining us, meet our fictional characters CEO Jane Carolli and her new, game-changing VPMA, Dr. Jack Martin as they focus the culture at Angels of Seattle hospital around what matters most to patients. Our last issue left us with Jane and Jack talking about one of Angel’s most proficient physicians who lacked a skill that was more impactful on patient care than any of his clinical skills… his ability to listen… to anyone.
From diagnosing a patient to working on a surgical team, his inability to listen to who he considered subordinate, cost him the ability to run a team… costing his patients even more. We left the conversation with Jane’s realization that the path to improve communication and developing productive relationships depends on establishing trust, which begins with improving your ability to listen.
As Jack and Jane continued drilling down on the trust building process and shared the importance of team listening, Jack asked Jane about what she was learning during her patient rounds.
Note: In the book, Jack introduced Jane to the importance of regularly getting to the bedside to talk to patients. Since they determined that all of their efforts were based on giving patients what matters most to them, it only made sense to regularly check in on what they had to say…
“So Jane,” said Jack, “What have you been hearing from our patients?”
“It’s a mixed bag Jack - and it really through me for a loop because I really feel like we’re turning a corner, but some of the comments I got yesterday made me pretty upset.”
“Jane, there are hundreds of doctors and nurses on staff and we haven’t reach even a quarter of them yet… we’ll get there… so what did you hear?”
Jane picked up her notebook and began to read.
“This 59 year old female was in the cardiac unit and said: “I’m glad I’m getting released because I feel just like another number here - I don‟t remember being called by my name in the six days I was here. My name was listed on the board, but they didn’t use it.”
Jane continued,” Can you believe that Jack, six days and nobody took the time to call her by her proper name.”
“Unfortunately I do Jane.”
“What’s interesting Jack, is that I heard things that made my skin crawl, like when a woman was complaining about having had an epidural and being scared because she couldn't feel her legs, and the nurse just said, ‘Relax and enjoy that your pain is relieved.’ That just burned my chaps, and I’m in the process of tracking that nurse down… but what really gets me is the simple statement a young man shared - he said that he felt like he was interrupting them when he asked for help.”
Jack paused for a minute to let Jane sit in it and asked, “So what do you want to do about it?”
She thought. “Well, we’re moving in the right direction, but its just not spreading fast enough. A large part of the staff are lacking the most basic of skills.”
Jack asked, “What kind of skills Jane?”
“That’s a big list Jack - but to start with, how about how to give patients your full attention, how to listen to everything a patient has to say before responding, how to make eye contact… like I said,these are basic and there are a ton of them.”
“Interesting,” said Jack, “The patients are saying the same things about our staff that our staff says about each other… “
“Yeah, you’re right Jack. The last assessment we took pretty much mirrored my patient comments. So I guess we just have to keep plugging away with teaching them all how to ask the right questions and truly listen to the answers.”
“And Jack, the next time I hear a patient tell me that they feel that asking a question is like interrupting, I’ ll remind them that that we want them to ask us questions, and that we are receptive and responsive to the questions… that it’s the only way to build stronger relationships. And if anyone makes them feel bad about it, they’ll have me to deal with.”
“I like it Jane. But be prepared for the naysayers who are skeptical about listening - they’ll say they don’t have time, they're too busy… you know the drill.”
Jane smiled, “I know Jack, I’ll just remind them about the high cost of not listening - delay in diagnosis, incorrect diagnosis, poor patient experience, not to mention avoidable patient harm amongst others.”
“Hey Jane, its just like that old Fram Oil Filter commercial, “You can pay me now or you can pay me later.”
“You’re dating yourself Jack, but you’re right - they can listen now, or they can spend a ton of effort and resources later. Their choice.”
Listening is the fastest way into the shoes of our patients. Although we have to treat patients as intelligent partners, we also have to recognize that they’re in a foreign, often scary environment that creates feelings of helplessness, fear and anxiety.
So how do we give them confidence and build trust? We ask the right questions and listen. That may mean repeating what my patient has asked me to ensure my understanding of their question, explaining what I am saying slowly and in small doses, giving my patient adequate time to process the information and ask more questions, and assisting my patients to be true partners in their care by giving them access to information about their disease process. Whatever it takes to build a trusting relationship.
Is your culture aligned to what matters most to patients?...