It’s Been 20 Years…

It was Christmas in a pandemic.

With no big family gatherings or plans with friends, this past Christmas was the first time I’d ever watched It’s a Wonderful Life from start to finish without interruption. I’ve seen the film, but always in bits and pieces here and there, never all at once. I really enjoyed it and it stayed with me for several days afterwards. I kept thinking about the life of George Bailey and all he did and I wondered how many of us could relate. I mean, I’ve never pulled someone out of a hole in the ice and saved their life. How many of us have? We hear stories of people pulling others out of burning buildings or out of the way of a speeding car, but how many of us have actually done it? I started to wonder, “Are there any people alive today because of me? Have I really made a difference in the world?”

That was my thought one January evening as I was heading home and it occurred to me that maybe I could take credit for at least one person being alive.

I thought about my days in the mid-90s and early 2000s, working in organ donation and transplant, speaking with the families of patients who had just been declared brain dead and offering them the option to donate the organs. I know there were people whose lives were saved because of the generosity of those families. But would that have happened without me? The answer is probably yes. There might, and I mean might, have been a family that only agreed because of how they connected with me. Maybe. 

So that would have to be good enough. Not quite as dramatic as pulling my brother out of the ice, but it would do.

Now here’s where my story gets weird. 

The very next day, I got a message on Facebook from someone I wasn’t connected to, trying to send me a private message. I recognized his name immediately and accepted the friend request. It was a man I had met at a suburban Chicago hospital many years ago. His message was short, “Hi Kate – it’s been such a long time – just wanted to reach out to you and say hi – (my wife) and I will never forget you – it’s been 20 years since (my daughter) is gone – God Bless – “ 

I nearly fell out of my chair. 

And then it hit me. Does your impact on this Earth depend on those big dramatic moments or can you make just as big an impression in those tiny acts of human kindness? The simple act of being present, of staying out of judgement, of listening, of helping someone who is going through an unbelievably difficult experience… this is how we make a difference in the world. Twenty years later and this family still remembered me. Remembered me enough to want to reach out and tell me. 

This is what it means to work in healthcare. This is why I lead patient experience in healthcare systems. This is why I tell nurses, and food service workers, and housekeepers, and physicians, and registration teams, and telephone operators, and valet parkers, and security guards, and hospital presidents that how they treat people matters. 

We have no idea what our patients and their families are going through when we see them. We only know they’re scared, sad, sick and coming to us for help. How can we be anything but kind to them?

After 20 years, the kindness you showed someone will still be remembered and appreciated. Those people may not reach out over Facebook but they’ll still be grateful to you. You’re their George Bailey. And you absolutely made a difference in the world.

Am I an Essential Worker?

Like many people, I’ve been looking at the job market since COVID-19 struck. I look at the types of jobs being posted, I talk to people interviewing for patient experience roles, and I’ve seen in my own community the kinds of positions being filled. In a pandemic, who is an essential worker?

Being in healthcare, I’ve taken a great interest in which hospital positions are prioritized and which are put on the back-burner until we get our arms around COVID. Sadly, it came as no surprise to me that patient experience postings were put on hold or completely eliminated. I fear we still have a lot of work to do when it comes to demonstrating our value. 

But what really struck me was how the tourist and hospitality industries are hiring like mad for servers, front desk staff, housekeepers, and even concierge roles. I’m not knocking the concierge, but in the age of the internet, I’m very capable of making my own dinner reservation. Is a concierge more essential than a patient experience director?

I currently live in a tourist town and the local luxury hotel has been on a hiring spree ever since they re-opened in mid-May, after closing for six weeks due to COVID. We had no idea at the time how much longer we’d be sheltering in place, and people were starting to think maybe it was okay to start going out again, have dinner at a restaurant, maybe even take a quick vacation. From what I understand from the staff, ever since June, every day has been like the 4th of July. That resort has been at full capacity every night. They can’t hire enough people fast enough to keep up with the incredible demand. 

At the same time, I was talking with my healthcare colleagues about their staffing and learning that many, many positions were facing reduction in hours, furlough, and even becoming completely eliminated. A few friends who were interviewing for patient experience leadership roles were learning those positions were being placed on hold indefinitely.  

So in order for a luxury hotel to operate effectively, they need to hire a team of concierges, but a large healthcare system feels it can do alright without anyone leading the patient experience effort? Am I an essential worker?

Certainly, I understand the difference between the two. One is a luxury, paid for directly by the consumer. The other is a complex myriad of third-party payers with a lot of charitable care in the mix, not to mention a reduction in more profitable elective surgeries. I get it. But what I’m left with is the feeling that we in the patient experience sector still haven’t yet convinced the establishment how valuable we are.

In addition to just being the right thing to do, when done right, patient experience improves the bottom line in a number of ways. 

  1. Higher H-CAHPS scores mean better reimbursement. Like it or not, better scores mean more medicare dollars. There’s 20% of 2% being withheld from CMS that hospitals can earn back through their patient experience results. 20% of 2% doesn’t sound like a lot, but trust me, it is.
  2. Better patient experience starts with better employee engagement. Hospitals with engaged employees experience less turnover. Recruiting, hiring, training, and on-boarding is expensive.
  3. Better patient experience means fewer patient safety incidents. Engaged, caring staff make fewer medication errors, and have more proactive measures in place to prevent events like pressure ulcers and unattended falls. 
  4. Better patient experience means fewer lawsuits. Patients are far less likely to sue if they like their care team, feel they’ve been treated respectfully, and were communicated with in a compassionate, transparent manner. 
  5. Great patient experience means higher Yelp and other social media reviews, which creates an increase in new patients. An increase in market share not only increases revenue but helps a hospital’s purchasing power, as well.
  6. Great patient experience creates loyalty and repeat business. Patients are far less likely to change providers or hospitals when they’ve had a good experience previously.

I’m sure there are plenty more I’ve forgotten- more evidence that we have work to do when it comes to stating our case. This isn’t window dressing. We are no longer a nice-to-have, we are a have-to-have. We are essential employees. At least as essential as the concierge. 

It’s Not Just Another Screening Test to Me

Every six months I have some kind of test on my breasts. Every summer, it’s a mammogram; every winter, it’s an MRI. 

While cancer runs in some families, it gallops in mine. There are only two relatives I know of who died of something other than cancer, and one of them really shouldn’t count. My maternal grandfather was born premature and his heart wasn’t quite ready. He had heart problems his whole life and died of a heart attack, so I don’t think it’s fair to include him in the mix. 

In fact, my father had three different kinds of cancer. Not cancers that started in one place and metastasized to another, but three different primary tumors. Very unusual. So I think he should count as three.

When every female relative of yours dies of breast cancer, you start to think it may just be a foregone conclusion. As much as I try to keep a positive attitude, I don’t really wonder if it’s going to happen, but when

So when it came time for my latest breast MRI, I was once again filled with the same familiar mix of anxiety and dread. Just six months earlier, my mammogram became an ultrasound that became a biopsy. It turned out to be nothing, but it scared the daylights out of me.

I was mentally preparing for something like that to happen again and reminding myself that whatever they find, they will have found it early. Early is good. Early is something none of my other relatives had. 

I always wonder when I go in for these tests if the people at the front desk or the techs running the machines have any idea what’s going on inside the patients’ heads. To them, it’s just another routine screening, but to me, it’s something much more.

Every time I go in, I think of my maternal grandmother, my mom and my sister. I watched breast cancer metastasize to brain cancer in my grandma. At the end, she thought she was a kid again, back on her farm in Iowa, and she didn’t know me at all. I was so mad at God for not letting her go out a little more gracefully.

I watched breast cancer metastasize to liver cancer in my mom. She went through some horrible treatments to shrink the tumors but they wreaked havoc on the rest of her. She got weaker and weaker until she couldn’t even walk and died in the one place an RN of over 50 years doesn’t want to die: a hospital. 

I watched breast cancer take my sister just six months after her diagnosis. She thought she was merely experiencing really bad back pain but it was actually compression fractures from the cancer eating away at her spine. As an unmarried woman who had no insurance, she needed someone to navigate the healthcare system for her, and I, as her only sister, did just that. She, at least, had the ending she wanted, on her terms. But it was still an ending.

So when I go in for these tests every six months, they aren’t just routine maintenance for me. They are a reminder of how devastating this disease is, not only for the patients, but for those who love and care for them. I am terrified every six months. It hasn’t gotten any easier.

And I’m on high alert for service failures. I am extra-sensitive to how I’m spoken to, how things are explained, the tone of voice they’re using with me, the degree of kindness and gentleness they show, all of it. 

This was a place I’d not been to before and I didn’t know what to expect from them. I’m very happy to report they did a wonderful job. Although they couldn’t possibly know what was going through my head or how anxious I was, they did a great job of caring for me from the moment I walked in to the moment I walked out. 

If you’re working in imaging, please keep this in mind. For you, it’s just another day at the office. For the rest of us, it’s something much, much more.

Tell Me Again What it is You Do?

It’s funny trying to explain to people what I do for a living. 

I get a lot of blank stares, puzzled looks, or people who ask if I’m a decorator. (Decorator? Really?) But mostly, people think I’m the complaint department. And I am to some degree. Complaints and grievances are a big part of the job, to be sure. But there’s so much more to it than that.

In several hospitals at which I’ve worked, there’s a patient relations team and a patient experience team. The patient relations team handles the complaints like poor service, lost belongings, and miscommunication. They do the internal investigation, follow up with patients, and resolve the grievances within 30 days. There is always more than enough to keep them busy. The patient experience team is there to change the culture with the hope of one day making the relations team obsolete. 

The experience team puts together the Standards of Behavior for the entire organization. They overhaul new employee orientation to be primarily about service. They do one-on-one coaching for staff and physicians. They create and lead a Patient and Family Advisory Council. They look at all the shiny new technology aimed at improving patient satisfaction and make recommendations about which ones to invest in and which ones to avoid. They analyze the survey data and devise plans for improvement. And they take the heat if scores don’t go up.

Culture change is hard. It takes a really long time and yet so many executive teams are results-driven. They want to see the numbers move right away. I don’t blame them, but that’s really not how it works. I once had a CEO who wanted daily patient experience scores on his desk every morning. Daily. I obliged, but told him I wasn’t going to take any action on daily scores, only the things we saw as trends over time. I didn’t last long there. 

But it gets back to what I do for a living. The short answer is, “I create systems in healthcare designed to provide the very best in service excellence.” That includes a lot of things, most of them proactive, rather than reactive. 

When the systems are designed well, the right people are in place, and they have the tools and support they need, great things happen. That’s what I do for a living.

A Tale of Two Hospitals

A few months ago, before just about everything was shut down due to COVID-19, a good friend of mine was suffering with some horrible, and all too familiar pain. He knew he had a kidney stone and went to the nearby emergency department to get some relief.

After a few hours and several imaging tests, the news wasn’t good. The stones were too big to pass and he needed surgery to have them removed. The physician went ahead and admitted him, hoping the surgery could be done in the morning. 

Although it was located in the middle of nowhere, this hospital had recently been acquired by a larger health system, one with a wonderful reputation in the community, not only for clinical excellence, but for exceptional patient care. I felt relieved that he was in good hands.

We spoke about a week and a half later. As it turned out, he didn’t have the surgery at that hospital. He had been there for a few days, waiting, but was unexpectedly released. His daughter then brought him to the hospital near her.

“What on earth happened?” I asked him.

“I have no idea,” he answered. “The whole time I was there, I didn’t know what the hell was going on. There didn’t appear to be any coordination or communication between any of the staff, like nobody was running the ship, and plenty of conflicting information.” 

He continued. “They wouldn’t let me eat anything because I was waiting for an OR, which was understandable, but this went on for two days. I kept asking when I’d be going in to have these things removed, and no one had an answer. Then, finally, they took me down to surgery and the doctor came in and said I was getting a stent.” 

“A stent?” I asked. “Why not remove the stones?”

“That’s exactly what I asked,” he answered. “Something about them not having the equipment to be able to do it, but they were telling me this while I was lying on a gurney right outside the OR. The whole time I was on the unit, I kept hearing them talk about removal. No one said anything about a stent”

“Afterwards,” he continued, “they gave me a prescription for some pain pills and told me to make an appointment for a follow up visit in two weeks. That was it. I felt like I was getting the ‘bum’s rush’ out of there. My daughter was furious and took me directly to the hospital near her and that’s when everything changed.”

“What happened there?” I asked. I had a feeling I knew what he was going to say.

“The physician there was amazing. He was confident without being arrogant and at some point he put his hand on my shoulder and said, ‘It’s okay. Everything is going to be fine.’ That felt great. Very reassuring. It was like night and day between those two places.”

He went on to tell me that it felt like everything was running smoothly; everyone knew the plan of care, and he never felt like he was being a bother when he asked for help. He even noticed that behind everyone’s ID badge, there was a plastic card listing ‘Always Behaviors’, similar to AIDET, something he’d heard me talk about a lot.

As happy as I was for him that he got the care he needed and was just fine, I was a little disappointed. I was really hoping for something new, some magic nugget of information that would turn the patient experience movement on its ear. Something we never knew, never tried. Something revolutionary that would solve it all.

Alas, it all came down to the same old things: listen well, communicate clearly, convey kindness. All those things we’ve been talking about and training on for years. No new shiny bit of technology, nothing terribly complicated. 

It really can be that simple.

No Words

A lot is happening in the world right now. I’ve spent the last few blogs writing about COVID-19 and, while many cities are opening back up, new cases are still being diagnosed every day.  And in the midst of all the division and politicizing about mask-wearing and whether or not certain businesses can reopen, we’ve had at least three high-profile cases of police brutality and blatant, unrepentant racism. 

This is far from the first time an innocent man of color was murdered while in police custody or chased down by white vigilantes and killed in the middle of the street. Our country has a long and ugly history of these very things. But more and more people are speaking up and demanding change. It’s important.

It’s important that all people, not just African-Americans, speak up, join the fight, donate money, support the cause. But it’s even more important that we start doing a better job of listening.

I’m no expert on race matters. I can’t pretend to know what it feels like to be black in America. So if I am to understand and be more effective in trying to change the system, it’s time to do more listening. There are thousands of voices out there, screaming to be heard. They don’t need our opinion, they need our support, and you can best support by listening. Listen for truth, listen to understand, listen with humility.

These are the same skills I use when I work with patient complaints. I wouldn’t dream of arguing with a patient who tells me they had a bad experience with us. I would never say, “Well yeah you had a bad time, but so did that patient over there; be glad that wasn’t you.” I would never tell them they were blowing it out of proportion or that it doesn’t happen all that often or it’s a lot better than it used to be. 

I would never tell them that the system works just fine and then not do anything to remedy their complaint. And I would never blame the people who bring us the concerns and think it was their problem, not ours.

It’s difficult to hear negative things about the place you work or the people you work with or even about yourself. The first reaction is typically to get defensive and gather up as much evidence as you can to prove the opposite. But that doesn’t bring you any closer to solving the problem. 

When a person who has difficulty walking tells me that navigating the hallways of our hospital is nearly impossible, I don’t brush it off thinking, “Hey most people can walk just fine and don’t have any problems,” and then do nothing. 

When we want to get a better handle on what it’s like to be a parent of a newborn in the ICU, we don’t all sit around the table and try to imagine it, ourselves. We contact people who have lived that experience and when we ask them what we can do better, we listen to them. Sometimes, their solutions are easy. Most of the time, however, they’re tough, time-consuming, expensive. 

But we do them because we know it’s the right thing to do. We take responsibility for having caused the issue in the first place and we work to fix it.

Novelist and activist James Baldwin said, “Not everything that is faced can be changed, but nothing can be changed until it is faced.” Such an obvious concept when it comes to customer service, patient experience, or process improvement, but so difficult when it comes to race relations and systemic oppression. 

Certainly, rules and laws are needed but they alone won’t solve the problem. We need to face the fact that we have a problem. We need to change people’s hearts. It begins with listening.

Don’t Let Your Mood Dictate Your Manners

Most of the nation is still cooped up in the house, working out of their living rooms and holding the majority of their meetings through Zoom. It’s been two and a half months. We’re getting restless. We’re getting anxious. And we’re getting a little cranky.

Until recently, I’d been living apart from my husband and daughter, working in California while they stayed behind at our home in Northern Nevada. It was a 2-3 hour drive, depending on traffic, so I rented a place near the hospital and came home on the weekends. As hard as it was being away from them, it definitely had its advantages. 

It was quiet when I got home. The place was just as clean as I’d left it that morning. There was no discussion about what to have for dinner or what to watch on TV. No thermostat wars. No sharing of closet space. How much we talked to each other depended entirely on the length of our phone calls. 

But I actually did miss my family. When my engagement with that hospital ended, it was nice to be back home. I really enjoyed things like having dinners together every night and not having to cram all the family time into the weekends.

And then came COVID.

No one is leaving the house. After 14 months of living apart, we are on top of each other. All day. Every day. We love each other, but we’re starting to get a little tired of each other. And I’m reminded of something I learned early in my career: don’t let your mood dictate your manners. 

I was a new manager, trying to build a department from nothing, and working for a very demanding boss. I was having a particularly stressful day when someone I worked closely with asked me what I thought was a really obvious question and I just snapped. I don’t remember exactly what I said, but it wasn’t kind and the instant I said it, I wanted to take it back. I apologized, of course, but you can’t take back the words you’ve said. Once they leave your lips, they’re not yours anymore.

When we work in healthcare, or any industry in which you have to serve people, but especially healthcare when people are at their most frightened and vulnerable, we absolutely cannot our mood dictate our manners. Whatever bad day we’re having, whatever argument we had with our spouse before we left the house, whatever personal issue is going on, we can’t bring it to work with us. 

And even while we’re at work, whatever conflict is happening with another co-worker, whatever policy is driving you crazy, none of it matters when you’re with a patient or guest. 

It’s difficult to keep our mood in check, especially now with the additional stress of so many very sick patients and the families who are upset they can’t be there with them. We’re short on masks, we’re worried about space and ventilators and getting sick, ourselves, or bringing this virus home to our own families. It’s easy to let our mood take over and snap at the people around us.

But we can’t. 

We have to remember that they’re not the ones we’re mad at. If we take a moment to breathe, name the thing that’s actually upsetting us, and remind ourselves that this person in front of us needs our help, we stand a better chance of continuing to be kind instead of saying something we’ll regret later. 

It’s a good thing to remember, even after this pandemic is behind us.

What Are We Learning From COVID-19?

This is my 100th blog entry. I couldn’t have predicted I’d still be writing after all this time, but it turns out I have a lot to say about how to care for patients and employees. 

Things have changed dramatically since COVID-19 hit and I’ve been thinking a lot about how to best care for staff who are showing up every day and working hard to save lives. 

The name Lorna Breen has been in the news a lot lately. She was an emergency medicine physician and the medical director of the emergency department at New York-Presbyterian Hospital in Manhattan. I never met her, never even heard her name until her story hit the news a few weeks ago. But I think it’s important to write about her. There is so much we as healthcare leaders can learn from her story. 

According to an April 27th New York Times article, Dr. Breen had contracted the coronavirus, stayed home for just a week and a half, returned to work, was sent home, then went to stay with her family in North Carolina to recuperate. Upon arriving, she was hospitalized for exhaustion for 11 days, and once discharged, went to stay with her mom, then her sister. Two days later, Dr. Breen died by suicide. 

By all accounts, Dr. Breen was a fun-loving extrovert who enjoyed skiing, salsa dancing, throwing parties, and volunteering at a home for older adults. She was well liked, well respected and was always looking out for her colleagues, making sure they had enough personal protective equipment and were doing okay. 

Her family said that working in the trenches with so many patients dying from the virus changed her. She would be at the end of a 12-hour shift and stay to continue helping. With patients dying in the waiting room before they could even get into the ER, Dr. Breen had said they couldn’t keep up, she couldn’t go home, she had to stay and help. 

When you go into a profession in healthcare, you are compelled to help. When you run in when others run away, it’s normal to think that if you don’t do it, it won’t get done. But we have to start helping these professionals see that there’s no shame in putting the oxygen mask on your own face before helping others with theirs. 

I’m not going to lay blame at anyone’s feet. I’ll just say that we have to look out for each other and insist that people go home. Rest. Recharge. I’ve worked in so many environments that just don’t allow for that. If someone admits they’re exhausted or struggling to keep going, others turn their backs and make them feel guilty. We as leaders have to change that. 

Right now, we have healthcare workers, physicians, nurses, food service workers, housekeepers, IT professionals, and patient experience teams who are feeling vulnerable, frightened, and tired. We have to reach out. We have to let them know how much they mean to us and we do that not by hanging banners that say Hero, but by spending time with them. Let them talk. Listen without interrupting. Insist they go home and not stay past the end of their shift. Create programs that nurture and support them. Give them hazard pay and additional sick days. Don’t just tell them, show them how much we care.

I feel terrible that Dr. Breen took her own life. I’m hopeful that we learn from this and start creating a culture that acknowledges that physicians and nurses aren’t superheroes. They’re people who care. Let’s care for them.

Reach Out and (Virtually) Touch Someone

It’s been a month and a half and we are, for the most part, still sheltering in place and working remotely. There are those who have grown weary of the restrictions and are anxious to get outside and back to work; I’m observing fewer people wearing masks and keeping a six foot distance from others, but most experts agree it’s still too soon to open everything back up. 

I’m concerned for those who are truly struggling; whether it’s because of isolation or working in intense conditions caring for the sick. COVID-19 is taking its toll on us, emotionally and physically, and many of us are running out of coping mechanisms. 

Which is why it was such a wonderful surprise to get a message from a friend I had in junior high. She and I didn’t go to the same elementary school and we ended up in different high schools, but for two years in Emerson Junior High, she and I were inseparable. 

We’d kept in touch over the years through various social media channels and even met for lunch several years ago, but hadn’t actually spoken for quite some time. Then, out of nowhere, she sent a message asking if I wanted to do a video call and catch up.

It was wonderful. 

It was so wonderful, in fact, that it prompted me to reach out to friends I see fairly regularly (or used to, before all this started) and set up video calls with them, too. I’m calling my brothers more often than I did and am much more active on sites like Facebook to keep in touch. 

And this is significant because I’m not a person who generally craves a lot of social interaction. I love my alone time and need some peace and quiet in order to recharge. But this pandemic has made me realize that, when all is said and done, I’m not going to look back on my life wishing I’d spent less time with my family and friends. 

Our patients, their families, and our staff are no different. 

When trying to provide the very best experience, nothing beats a personal connection: someone reaching out to you, asking how you are, what they can do to help, and offering a shoulder to lean on. 

It isn’t always our clinical and technical expertise that makes an impression on people, but the way in which we interact with them that they remember. Taking a moment to reach out with genuine concern, actively listening, and giving people a non judgemental space to talk can make a world of difference. Even after 30 years.

How Leading Remotely is Changing Company Culture

As of this writing, most of us are sheltering in place and working from home due to COVID-19. Non-clinical hospital leaders, including the patient experience professionals, may be coming to the hospital a couple of days a week, but we’re doing most of our work from our living rooms over Zoom. So without being there, how do we know things are getting done?

Early in my career, I worked under several bosses who felt they needed to micromanage everything my colleagues and I did. Every moment between 8:30am and 5:00pm had to be accounted for or the assumption was we were slacking off. I always had a pretty good work ethic and wasn’t motivated to work out of fear. I did the job because I enjoyed the job and wanted to keep learning. I realize not everyone thinks that way.

But those colleagues of mine who didn’t have that same attitude didn’t do great work under that kind of micromanaging. They found ways to game the system and make it look like they were working. And they mostly got away with it. At some point, they might have gotten found out but that only brought the hammer down harder. I had to ask myself why they didn’t just let them go? Why spend your whole day surveilling your staff when you could be doing more important things?

When I came into leadership, one of the best things I did was hire people who appeared to have a work ethic like mine. People who got the job done without having to be watched like a hawk. People who had a passion for the work and who wanted to keep getting better at it. People I knew I didn’t need to micromanage.

And guess what – work got done. I had a great team who understood the expectations, had the tools they needed, knew they could come to me with questions, and were recognized and celebrated for doing a good job. I could spend my time setting the strategic direction of the department instead of yelling at them for coming in ten minutes late.   

And now that I’m not physically in the hospital, watching to be sure leader rounds are happening and staff are using AIDET in every interaction, I have to trust that they’re doing it because they know it’s the right thing to do, not because they’ll get in trouble if they don’t. 

For those managers who came up thinking that they always had to be looking over their employees’ shoulders, always there monitoring their every move lest they start goofing off, this new normal should be proof positive that that style of leadership doesn’t work. It never has. Anyone can get compliance, what matters is commitment. 

I don’t know what work will look like when this is over, but working remotely has forced micro-managers to trust their employees and change their style of leadership. It’s about time. I’m sorry it took a pandemic to do it.