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.

The Virus

One of my very best friends says, “Hardship doesn’t develop character, it reveals it.” I’ve never really agreed with him on that. Until recently.

At this writing, COVID-19 has changed nearly everything in our world. We cannot leave our homes unless it’s to get essential supplies like food and medicine. Family members can’t drop in for Sunday dinner. Seniors in retirement centers aren’t allowed visitors. School is cancelled. And most people are working from home. 

Healthcare workers, on the other hand, are showing up every day to care for the sick and putting their own lives at risk to do so. There is a lot of concern about capacity, staffing, and equipment like ventilators, masks, and gloves. At a time when most people are hoarding all the hand sanitizer and toilet paper, healthcare workers are walking onto the front line, risking exposure, and caring for those who need them.

In hospitals all over the United States, there is a sense of unity and teamwork. Employees are reaching out across departments to offer help where it is needed most. No longer is anything “not my job”. 

Even the non-clinical staff are finding ways to help. Many have created Relaxation Rooms in which staff can take a quick 10 minute break for some healthy snacks, low lighting, and calming music to recenter and recharge in order to keep going in the middle of a long shift.

It’s inspiring.  

A close friend and former colleague who is a Director of Risk and Patient Safety said, “I’m observing improvement in communication and teamwork that I hope holds after the pandemic is over.”

And that’s the question, isn’t it: will it last? I’ve seen the people of this country pull together many times, be it after a hurricane like Katrina, a mass shooting like Las Vegas, and especially after 9/11. We were one nation coming together, helping one another. 

Do we forget about kindness and selflessness when times are good? Do we only check in on our loved ones when we’re fearful? Volunteerism shouldn’t just happen in the face of tragedy. That little old lady at the end of the block could use our help grocery shopping even when there isn’t a deadly virus out there. 

We still have a long way to go before this is over. We have many more weeks of sheltering in place and staying home ahead of us. But once that’s over, I’m hoping we still remember to call our family members and tell them we love them, visit our grandparents in the retirement center, offer to run to the store for those who have trouble doing so, put service before self. 

If hardship really did develop character and not reveal it, should it really take a pandemic to bring that out in us?

Communication Styles in Action

Last time, I wrote about the company retreat I helped facilitate that focused on empathy, kindness and communication styles. As a person who is very focused on caring for people, it was interesting to me to talk with those who focus on the action of fixing the problem, not so much the feelings of the people involved. 

Timing is everything. Just a few days later, I got a phone call from one of our hospitalist physicians asking for my help. There was a patient on our med/surg unit who was very unhappy. This physician had done his best to make things better, but the patient really wanted to complain to someone in administration. “I’m on my way.” 

I got off the elevator and made my way to the nurses’ station where he was waiting for me, and along with him was the director of the unit. He had been telling her about this unhappy patient and when I said I was going in to speak with him, she offered to come, too.

“Let’s do this together,” she said. “I don’t do the touchy-feely stuff, that’s not really what I’m good at.” “Sometimes, that’s not what’s needed,” I answered, remembering what we had covered in that retreat the week before. “Maybe he’s not a touchy-feely type. Let’s see what he says.”

We entered his room and introduced ourselves. He proceeded to tell us all about the things he was unhappy with. We listened intently. Everything he complained about, she wrote down and when he was finished, she immediately sprang into action. She told him all the things she was going to do and how long she’d be gone and then went off to get started. I stayed behind.

He told me how much he appreciated people like her. It was clear that she cared and was going to do everything she could to fix the issues, but to him, what was done was done. 

Rather than feel powerless, I decided to go after the touchy-feely. I’d noticed a Happy Birthday balloon in the corner of the room and asked if it was his birthday. “Yesterday. My daughter brought me that.”

“You had to celebrate your birthday in the hospital? I’m so sorry to hear that. That’s not a fun way to spend your birthday!” 

“Yeah, well I don’t know how many more I’m going to have so I’m happy to spend them anywhere,” he said. The tone of the room changed and his face went from serious to sad. “I don’t mean to be one of those patients who complains about everything,” he said. “I just want people to care, to do a good job, to deliver what they promise. You have people here who just don’t seem to care. This director, she cares. You can tell things matter to her. Look, she solved my problem in two seconds. But others… they’re just sleepwalking.”

I told him how sorry I was that this was how he had experienced us. “That’s not who we are,” I said. “That’s not how we want you to think of us.” He reached for my hand. “Thank you. I know you two are doing your best.” He sort of half smiled and closed his eyes. 

At that point, the director came back in and told him what she had done to fix his complaint. He thanked her, smiled at me, and closed his eyes again. 

The two of us walked back to the elevator, happy that she was able to address the action items and I was able to address the touchy-feely part. 

The whole time, I kept thinking about what I’d experienced in that retreat and how important it is to work with people who fill in your holes, who can do the things that you can’t. Instead of seeing another’s strengths as better than or inferior to yours, think of them as complementary to yours. Instead of competing, try collaborating.

It’s probably the best thing you can do for your patients.

What’s Your Approach to Problems?

One of the cool things I get to do within my health system is co-facilitate half-day retreats focused on kindness and empathy. These retreats are designed to reiterate our values with staff after they’ve been us for 3 to 4 months. We talk about ways they’ve seen these values play out along with ways they, themselves, can make their hospitals better places to work.

One of the exercises explores communication styles and how we deal with patient complaints. We boil it down to 4 main types: 

  • The how: these people are process-driven and want to understand how things unfolded as they did and how we can make changes so they don’t happen that way again.
  • The why: these are the visionaries. They are future-focused and imagine the possibilities of designing a system that supports the people and the process.
  • The who: the people-people.Their main concern is taking care of people’s feelings. They can’t change what happened so they focus on caring for the people involved.
  • The what: these folks take action. They’ll make a list of the issues, rank them in order of importance and get busy fixing them.. 

As a facilitator, I’m supposed to remain dispassionate and espouse the virtues of each group, but it’s plain to see that I’m a ‘who’ person. I am fully invested in the people and how they feel. It’s not better or worse than any other group, but it’s clearly me. 

I spent a few moments with each group, helping them through the exercise and facilitating the discussion. The group I found most interesting was the ‘what’ group. These are the action-oriented people who want to get to the business of fixing things as quickly as possible. 

They acknowledged they can be seen as cold by the ‘who’ people but they felt they were the most helpful; they’re going to fix the problem. And isn’t that why people complain in the first place, to get things fixed? It’s not a therapy session, it’s a grievance. 

Now I understand why some families roll their eyes at me when I say things like, “I can’t imagine how difficult this must have been for you,” or “I see your frustration, I’m sure I’d feel the same way if this had happened to me.”  They aren’t about the feelings. They want it fixed. 

I get it. 

And that’s what the real point of the exercise was: we are all different in how we approach problems so we all need to work together to fix them. We can miss things when we work alone but working together gives us a more complete solution. 

This part of the retreat is often the most highly-rated section. It helps the participants appreciate other people’s communication styles and understand the limits of their own. It’s a nice example of teamwork and being part of something bigger than yourself. I’m so glad I get to be a part of it.

Sensitive

Ever since I was a little kid, I remember my parents telling me I was too sensitive. When I was in 2nd grade, my Brownie troop took a trip to the movies where we saw “For The Love of Benji.” For those of you unfamiliar, Benji, the family dog, gets lost when they all take a trip to Greece and they spend the whole movie trying to find him. 

I cried and cried. Poor Benji, he’s lost in a foreign country and can’t find his way back to his family… it was more than my 7-year-old heart could take. The Brownie troop leader had to take me out to the lobby and sit with me until I could pull myself together. The other Brownies had no idea why I was so upset.

My tender heart got a little tougher as I got older but I still find myself being the only one in my family moved to tears at a rescue shelter, a Broadway show, or even a home-for-the-holidays-themed commercial. In the family reunion of my stoic, stiff upper lip northern European relatives, I’m a sensitive soul. 

I’ve learned, though, that sensitive doesn’t just mean cries at the drop of a hat. Sensitive also means I pick up on things that others often miss, and it has served me well in this line of work.  

When I’m talking with an upset family, I scan the room and notice everything. From the personal belongings in the patient room to the amount of eye contact the family members make with one another, I take it all in and use it to help me better understand and connect with them. Even with my colleagues, I’m usually the first to notice when someone is not quite themselves and I’m quick to change my communication style to suit the tone of the meeting. I’m sensitive. I notice.

Not everyone does. There have been plenty of meetings after which I left feeling emotionally drained while everyone else was just fine, unaffected, oblivious to the tension in the room.

True, it’s not always easy. It’s hard to be in tune with how other people feel and then take on those feelings, myself. But if I’m going to convey kindness, compassion, and empathy in my work, I need to. It seems only natural. If I can’t understand why they’re so upset, how can I be moved to action to make it better? So many people will listen to a complaint, say all the right things, promise to make some improvements, then simply walk away and do nothing more. When you feel what they feel and understand how important it is, you do something. 

Sensitive, to me, doesn’t mean touchy, emotional, or weepy. It means I see things that some other people don’t. I pick up on things that others may not notice. I feel things more deeply than others. I’ve found it valuable in patient experience work. Not so much at the Benji movie.

Some Positive Thoughts on Positivity

Earlier this morning as I was doing my daily patient rounding, one of the nurses I’d said ‘good morning’ to smiled and told me how much she enjoyed seeing me every day. “You always have such a positive energy around you,” she said. “It really brings the mood up when you come and talk to patients and to us. I really appreciate you.”

Wow. What a lovely thing to hear.

I sort of blushed and said thank you but what I really wanted to tell her was that it was a very deliberate decision every morning to show up with a smile. 

We patient experience directors have to walk a tricky line. On the one hand, we’re trying to dispel the outdated thinking that patient experience is ‘fluff stuff’ led by a bunch of vapid do-gooders who have no clue about real life. And at the same time, we can’t appear jaded and cynical or give in to all the forces that tell us that other things are more important.

I’ve taken a bit of heat in my career trying to be positive. I’ve encountered plenty of eye rolls, arms folded firmly across chests, sarcasm, and open hostility. I’ve been dismissed from meetings with a flick of the wrist, interrupted, had my data challenged in every conceivable way, and told ‘that’s nice, but we have real work to do.’

I’ve even had patients tell me to leave when I’ve come to round on them after learning I wasn’t a physician or a nurse. If I can’t give them pain meds then what good am I?

I have to choose to be positive. But honestly, why would I choose to be anything else? 

I’ve been angry, frustrated, outspoken, sarcastic, and cynical myself and you know where it got me? No further than being positive. Being positive just makes me feel better. Noticing the good, recognizing when something goes well, celebrating people who give a little extra… these things make me happy. And knowing that by doing them I can make someone else happy makes me even more happy. 

Staff perform better when the culture is positive. The world has enough desk pounders, enough cynics, enough people who are eager to rain on your parade. If I expect staff to be supportive and friendly and caring to patients, how can I not be that way to them?

So yes, when I walk in the front door, step off the elevator, and onto a med/surg unit, I am smiling. I am positive. Even if I have to fake it for a few minutes. Fluff stuff? No way. I’m changing healthcare.

For the Non-Clinical PX Leader

Last time, I asked the question: “Do you have to be a nurse to be a good patient experience professional?”

I know a lot of great patient experience leaders who are nurses but I don’t think an RN is a prerequisite. Sure, being a nurse gives you some street cred when you first walk onto a unit and nurses might be a little more inclined to listen to you because they know you know what their job is like. But it’s not everything.

So what should we non-clinical patient experience leaders do?

  1. Listen to and support the clinical staff. This is the most important part of the job. Happy nurses make for happy patients.
  2. Never immediately assume that the patient is telling you the whole story. The patient is telling you the story as he sees it. ALWAYS get the story from the nurse, too.
  3. Remove ridiculous and repetitive work. As an administrator, you have the power to make things easier for nurses. Ask them to tell you what makes their work difficult and then do everything you can to get rid of those things.
  4. Recognize and reward. Tell them, show them, do whatever you need to do to demonstrate how much you appreciate them.
  5. Hold them accountable for bad behavior. Let’s be honest, every now and again people are going to say or do something they shouldn’t but make your expectations clear and hold them to that standard. We should never meet rudeness with rudeness.
  6. Keep what’s best for the patient as your “True North” when faced with a difficult decision. It’s not about making them happy, it’s about doing what’s best for them.
  7. Spend some time on the floors shadowing a nurse. If you really want to know what it’s like, schedule a few hours out there with them. It’s an eye-opener.
  8. Talk to clinical staff as partners, not subordinates. After all, you can’t do the work yourself. All those ideas you have about improving things for patients, they are the ones that are going to be carrying those out. Talk with them, not at them.
  9. Recognize the science behind good service. Positive patient experience is in fact tied to better clinical outcomes. Be sure your clinical staff understands that.
  10. Keep learning. Consider getting certified. The exam for the CPXP designation isn’t easy. Demonstrate your commitment by continuing to keep up with the research.

The days of patient experience being a “nice to have” but not “have to have” are over. This is no longer fluff stuff; there’s actual science behind a better experience leading to better clinical outcomes.

A good patient experience leader can’t be just a pollyanna, always spreading sunshine and roses (although those don’t hurt). We have to know how to inspire, how to engage hearts and minds, and how to stay positive through difficult times. We have to be able to meet people – patients and staff – where they are and make a connection.

Do You Need to be a Nurse?

“Are you a nurse?” It’s a question I get asked a lot, mostly by nurses, and I wonder sometimes if it would have made a difference in my career.

When it comes to patient experience, the service trainings and other improvement efforts we spearhead are geared primarily toward nurses. Nurses comprise the largest percentage of the workforce in hospitals and they are typically the ones patients remember, even more than physicians. Of course we have training for ancillary staff and non-clinical teams but most of our conversations about patient experience involve nurses.

I’m sure if I had RN after my name it would change my perspective. I’d be a lot more comfortable on the floors, going in and out of patient rooms, and knowing what to do in case of a medical emergency. I’d have a much better understanding of what it’s like to work on a med-surg floor, trying to manage the many demands of patients, their families, and physicians, not to mention entering everything into the electronic medical record and the countless other things nurses have to do for 8-12 hours straight.

Am I really qualified to tell them how to deliver better care and service?

You might think not, but more and more, the people we’re hearing from in the patient experience conversation these days are the patients, themselves. We read their comments from the surveys and bring them in to tell their stories of what it was like when they were lying helpless in a hospital bed.

Many keynote speakers at Patient Experience conferences are not nurses, but patients, who talk about how frightened they were and how much they needed the hospital staff to show them more compassion and kindness. Patient and Family Advisory Councils and Focus Groups are widely used to suggest changes and improvements to the way care is delivered. And you know what? Nurses listen.

So I ask the question: do you need to be a nurse to be a good patient experience leader?

My opinion, of course, is no. While being an RN would give me a different perspective, it wouldn’t necessarily give me a better one. When you’re a hammer, everything tends to look like a nail and patient experience is more than nursing care.

I work with physicians, housekeepers, billers and coders, security guards, registrars, telephone operators, and many others, all of whom are involved in patient experience efforts. While I need to understand their perspective, I don’t need to have lived it, myself. I’ve never been a server in a restaurant but I know good service from bad.

I think what’s at the root of the question, “Are you a nurse?” is that nurses want to know that we understand how difficult their job can be. I think they’re worried that some administrative pencil pusher is going to try to tell them they how to do their job.

That is not my style.

I think what makes for a good patient experience professional has less to do with the initials after your name and more to do with the love inside your heart.

  • Can you stay calm when people are yelling?
  • Can you listen to criticism without getting defensive?
  • Can you de-escalate a tense situation?
  • Can you resolve a problem without throwing another person or department under the bus?
  • Can you inspire people to action around a common goal?
  • Can you figure out a way to present dry, dull data in an engaging way?
  • Can you genuinely connect with another person, especially one in some kind of pain, and convey sincere kindness and caring?

I believe that’s what makes for a good patient experience professional, nurse or not.

Two Eyes, Two Ears, One Mouth

I think we’re wired to want to fix things, to try to make things better. Certain professions in particular are all about fixing things: mechanic, plumber, physician, to name a few. It’s great to be a fixer. You can take something that’s broken and make it work again, you have skills that others don’t have, you can do things that others can’t. We all want to feel like we have some special ability to fix something and made it better.

What’s difficult is knowing when to step in and fix and when to hold back and support. Parents are faced with this all the time; it’s easier to just tie your kid’s shoelaces every morning, but at some point, you have to let her do it herself. Spouses, too, are faced with this when their partner comes home from work and wants to vent. It’s tempting to jump in with a solution to the problem, but that’s usually not what the other wants.

When you work in Patient Experience, especially if you’re a Certified Patient Experience Professional (CPXP) you’re the subject matter expert. You’ve done your homework, you know what works, and you’ve probably seen your share of failed attempts so you know what not to do. The thing is, you’re not supposed to be a fixer. Your role is to work collaboratively with the team, not to come in and take over.

That can be a really difficult role. You’re being paid for your expertise, but, unlike a mechanic or a plumber, patient experience is a team sport. Many people have to participate in order for the improvement efforts to work. Coming in and taking over isn’t the way to get people on board.

When I was little, my mom used to tell me that I had two eyes, two ears and one mouth for a reason: before you speak, look around and listen. Pay attention to what’s going on around you and really listen to what others are saying before you start talking. That’s easier said than done most times, but it’s a good reminder that sometimes it’s best to wait.  When you need to enlist the support and participation of a group, two eyes, two ears, one mouth.

Lean Into Conflict

I hate conflict.

I’m about the most conflict-avoidant person I’ve ever met. I’m bad at confronting people, especially at work. I never want to be the bad guy. I’m all about harmony and everybody getting along. I know the world generally doesn’t work like that, but I wish it did. I hate it when there’s tension between people.

Years ago, when I was working in organ donation and transplant, my job was to go in and speak to people who had just suffered a loss and ask them if they’d be willing to donate their loved one’s organs. As you might imagine, not everyone was receptive.

One case in particular that stands out in my memory was of a young girl, around 17, who had fallen off the back of a moving car. She’d had a pretty bad head injury but was starting to make a recovery. However, a day or so before she was to be transferred to rehab, she suffered a respiratory arrest and was declared brain dead. The family was devastated.  

The hospital staff gave our organization a call and when I arrived I was warned by the nurses that the father was really angry. (Well, yeah, that’s pretty much what I expected). They led me into a room to talk to the parents and wished me good luck while they rolled their eyes.

To no one’s surprise, the father was very upset, difficult to talk to, and not terribly interested in talking about how this tragedy could turn into something positive for another family. After some period of time, however, he calmed down and talked to me about his daughter, how beautiful and smart she was, and how he couldn’t imagine their lives without her.

They eventually made the decision to donate but not because of anything I said. I just spent some time listening. As difficult as it was to go into that room knowing I had an angry dad waiting for me, I did it. I sat with him. I listened to him. I didn’t try to fix it or say anything to make it better. I was just there.

I saw the same things while I was working in an acute care hospital. Patients or their family members would be really upset about what’s happening and instead of moving toward the complaint, so many staff members would move away, avoid, focus on quieting them down instead of hearing them.

Again, and again they’d say things like, “Don’t go in there, he’s really angry.” While I understand that it’s difficult to deal with an angry person, they’re exactly the people we need to be dealing with. If they can verbalize their frustration, if they can tell us what the problem is, then we have a chance of fixing it. And even if we can’t, we will have made their experience a little better just by having heard them.

Don’t be afraid of conflict. See it as a chance to make a bad situation a little better.