CNO perspective: We Must Keep Patient’s Voice in Mind

A veteran chief nursing officer and administrator shares some thoughts we all must remember.

Patient Experience Week is an annual April event that acknowledges the relationship between health care professionals and those who seek their help.

lisa romano

Lisa Romano

With more attention being placed on patient experience, as it increasingly becomes tied to a health care organization’s bottom line, industry leaders are moving to create workplaces that allow professionals to work together more efficiently. Ultimately, their efforts can influence outcomes — and how patients regard the care they receive.

Lisa Romano, RN, MSN, has been on the front line of this evolution. Currently the chief nursing officer of CipherHealth, a New York-based health care technology company, she previously was a nurse and hospital administrator in Pennsylvania, where she was responsible for all patient flow and transfer center operations as well as quality and patient satisfaction initiatives.

In 2018, she talked with the American Association for Physician Leadership about some issues surrounding the patient experience.

Q We talk a lot about creating great patient experiences, but as team-based care takes deeper root, we still deal with clashes of perspectives among the individual professions within it for the good of the patient. What must leaders — CNOs, CMOs and CEOs alike — do to ensure the cultures blend?

A Much of the disconnect between care providers and patients is borne from lack of communication between care providers. Conflict arises between doctor vs. nurse vs. pharmacist when the rifts in communication manifest and one feels frustrated by lack of follow-through from their team member. Patients become frustrated when they have communicated a need, often repeatedly, and it is not met or a new care provider is hearing it for the first time. Care is not team-based if essential patient information is not communicated internally and a plan of care is not developed with the “voice of the patient” as front and center.

While nurse leader rounding is a wonderful strategy to communicate, it becomes diminished if the physician is not on the same page with the patient needs. Physician visits to the patients must be more than clinical intervention. Communication beyond just the illness is essential. That patient must feel that the doctor cares about the events surrounding this illness that may impact their ability to care for themselves after discharge. They must trust that the physician who cares for them in the hospital will pass the torch to their primary care physician or be available for questions after the acute episode.

Q What gets in the way of that?

A Unfortunately, many care providers believe the progress health care has made in electronic records and being able to rapidly communicate test results and other clinical intervention is enough.

WHITE PAPER

The American Association for Physician Leadership and The Beryl Institute jointly have produced a special report that explores the “optimal patient experience” — which requires better communication between both parties. “Connected: Improving the Patient-Physician Relationship — and Health Care Itself — Through Communication” is available for download at no charge. Get it at physicianleaders.org/connected.

The patient however, already assumes that is occurring. They are not giving the care team kudos for what is an expected action. What they need to hear is that when they told us of a need, we acted upon it. The patient needs to feel immediate action has been taken and that it has been effectively resolved.

Those patient needs become especially critical in the day and hours approaching discharge. The patient and their family become anxious when they know they are leaving the hospital and feel as if they have no "life line."

Following up with the patient by phone is an easy and effective approach that many hospitals simply do not complete. … Team-based care begins with planning for admission, throughout the patient stay, and does not stop at discharge. In fact, it becomes even more important in the days following discharge.

Q It’s true that better patient experiences improve patient engagement. What can health care organizations do to create better experiences? What can individual health care professionals do?

A Health care professionals are often frustrated when they perceive patient complaints as trivial, considering they may have just saved their life. Culture change, within the organization, needs to occur which begins with addressing this issue with open dialog and facing hard truths that "saving their life" does not equate to a satisfied patient.

The loss of control, anxiety and pain a patient may endure is often felt after they are past the life-threatening stage. They may not even remember the initial event, and they may also believe that “saving my life” is why hospitals exist. Whether or not a patient is satisfied with how that occurred is often a product of the experiences surrounding those life-saving interventions.

Nurses and physicians as well as ancillary team members can make a profound impact with some very simple behaviors: Listen to the patient. Understand what it is important to them. Do what you say. If the patient communicates a concern, make sure it is addressed timely and effectively. Demonstrate caring behavior.

No matter how busy you are — the patient doesn't need to feel rushed — let the patient know you are their advocate, that you care, and will make sure they are taken care of. Once the patient feels that caring message, it is critical that follow-through occurs or they will lose trust.

Q It’s said patient loyalty develops from good patient experiences. But as we see the larger marketplace changing — people aren’t as loyal to retailers or brands as they once were — is it realistic to expect loyalty in health care, especially when the options are plentiful? Why does this matter?

A Patient loyalty is a fascinating concept. Do the patients owe the provider or hospital loyalty? Is loyalty defined as high patient satisfaction rankings and choosing that provider again for future care needs?

BUILDING TEAMWORK

From the CNO perspective, Lisa Romano offers  strategies for stronger team-based care.

  • Multidisciplinary rounds, with real-time sharing of communication, review of clinical information and information collected through patient rounding.
  • Physician rounds that include "personal" conversations with patients about specific supportive care needs while in hospital and after discharge.
  • Real discussion with patients on care needs, and fluid care plan that allows for changes to care needs, rather than “just checking the box.”
  • Creating  environment in  inpatient setting where care providers demonstrate to patient that information is shared and acted upon in timely manner.
  • Timely, efficient resolution of issues and opportunities for improvement in care.
  • Conversation with patient after discharge that is personalized to patient’s needs, builds on what team has learned throughout the patient's journey.

The reality is that health care has become very much a business, and if you shopped at a retail store and received a poor product or had to wait or were made to feel that you weren't valued, would you go back to that store again?

If, during that shopping experience, you were embarrassed and anxious and the retailer only heightened those feelings, would you ever choose to go there again?.

While health care isn't retail, there are similarities. You selected a location for a service, and whether or not you choose to go back is dependent on the quality of that service and the experiences surrounding it. I do believe that the majority of patients are grateful for the life-saving intervention and are very forgiving of what might be thought of as the little things that weren't ideal. However, repeated exposure to less-than-ideal [circumstances] or having easy choices for alternate care providers makes it easy for patients to say they’re going to try a new provider or hospital.

Providers and hospitals need to recognize that the old model of "this is my doctor and this is my hospital" are gone. Patients have choices and access to education to help them make informed decisions and be in control of their health. It is unrealistic to think that in this new age, with so many options available to patients, that they will tolerate what they perceive as inconvenience, lack of consideration for their voice and poor resolution of identified issues.

We must earn loyalty through exceptional service both clinically and emotionally. We must earn that patient's trust and never lose it. We must keep them safe and make sure they feel respected as a person and that we care. When that happens, there will be no one more loyal than the person on the receiving end.

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