Final Impressions

You’ve got a pet peeve, right? That thing that really irritates you. Nothing huge, just something that gets under your skin.

When it comes to doctor appointments, I think my latest pet peeve is not knowing what to do when you think the visit is over.

It used to be (and maybe sometimes still is) that, once you saw the physician and he or she told you what the problem was, a nurse came in, answered any additional questions you might have, and told you to check out at the desk before you left the office.

These days, you see the physician, a nurse comes in afterwards to answer any additional questions and tells you to have a nice day. I always find myself stopping at the desk on my way out to be sure there isn’t something else I need to do before I go. Usually, the person at the desk is very sweet about it and says something like, “You’re all set. Take care!”

Sometimes, though, that person looks really annoyed and says, “Well, did the doctor say you needed something else?” in that condescending tone that screams “I hate my job”. “No,” I reply. “I just wanted to be sure we were good to go,” which is often met with a fake, dismissive smile.

And THAT will be my final – and lasting – impression about my visit.

As a Patient Experience trainer, I spend a lot of time talking about the greeting: that first impression that’s so important to people when they walk in the door. But lately, I’ve started spending just as much time on that final acknowledgment, the last thing patients see and hear before they walk out the door. You can undo a lot of good in those final moments, negate the things that had gone well up to that point. Or you can reaffirm your commitment to patient experience and continue to be helpful and kind, even after the visit is over.

The end is just as important as the beginning. Develop a good exit greeting and make a wonderful final – and lasting – impression.

The Story of Your Patient

We’re storytellers. With every human interaction, we’re telling a story about what we see and hear. Depending on the narrative that we create in our heads, the actions of others can be a mild annoyance or completely exasperating. 

Consider the patient who arrives late to an appointment. Do you immediately assume he is inconsiderate, unreliable, and just plain rude, or do you assume he made every effort to get there on time but circumstances beyond his control got in his way?

Maybe he was involved in an accident. Maybe he stopped to help someone in an accident. That little bit of narrative will absolutely affect your interactions with him and if you choose to be annoyed instead of gracious, he will sense it.

Consider, too, the patient that doesn’t lose any weight even after you’ve counseled her, told her that her health problems are only going to get worse. Every time she’s in your office, her test results are more and more of a concern. Blood pressure, cholesterol, kidney and liver function all headed in the wrong direction. She’s clearly not taking your advice. What story are you telling about her? She’s lazy? She doesn’t care about her health? She just won’t put down the bag of chips or box of cookies?

One or more of these may be true, but have you taken a few moments to find out anything about her living conditions, asked about any unresolved trauma, or learned of any family history of addiction?

It’s true we tend to be much more forgiving and gracious when we learn a little bit of the why, or the story behind the story. And although you may never know the actual truth, you can choose to like your patients more when you choose to tell a different story about their behavior.

They will be more likely to open up to you and be honest about their habits when they aren’t sensing your judgement and distain. And when patients like their doctors and feel that their doctors like them, they are more likely to comply with instructions and advice. They may even get healthier. 

If you want to change your patients, start by changing the story you tell yourself about them. Change you.

The Art Lesson

A few years ago, my department planned one of those bonding events in which employees are supposed to get together as a team outside of work hours and do something fun. Admittedly, I had my doubts about just how much fun it was going to be, but, in retrospect, I’m really glad I went.

We all gathered at a local place where a professional had paibottle_treented a beautiful picture and we each had an easel and some paint and a brush and, most importantly, wine.

There were a few in my group who were really quite good painters. They were incredibly focused on the task at hand and tried to make their painting as close to the original as they could, right down to the number of snowflakes and the exact placement of each.

I took a different approach.

I liked the picture the artist had painted but I didn’t want to create one that looked just like it. I remembered what I had told my daughter about art when she was in second grade, “Don’t ask what it is, ask how it makes you feel.”

I tapped into something deep inside and painted how the picture made me feel. It was a suggestion cropped-cropped-cropped-Kates_Tree.jpgof the original, different colors and a different feel. It was my version of the artist’s work.

At the end of the night, we all posed for a photo, each of us holding our works of art. Everyone in my group was holding a painting that looked very much like the original. Mine was decidedly different. And I was never more proud.

Okay, what does this have to do with patient experience?

It has everything to do with finding your voice in your approach to work. This is still an emerging field and while there are many best practices out there that we can learn from, there is still plenty of room for innovation, creativity, thinking differently about how to get to the heart of patient engagement.

In short, you don’t have to simply do what others are doing. You can be inspired by the work that’s being done and then tap into something inside of you and create something new. Test it, try it out, but never stop looking inside of you for answers. If there’s a voice in your head that’s telling you there’s a better way, listen to it! Design a pilot program around it and try it out!

There’s a reason you went into this field. You’re passionate about it. You know more than you think you do. Don’t be satisfied to simply copy and paste. Network. Discuss. Share. Create. Innovate. Do how it makes you feel.

Tactics vs. Culture

I had a conversation with a senior leader not long ago; we were talking about what kind of an organization we wanted to be, what kind of talent we wanted to draw, what we wanted patients to think of us. I mentioned that I’d worked for a hospital with many clearly defined expectations and standards that at first seemed uncomfortable but eventually became habits.

Certain things were so ingrained at that hospital that they became a natural part of me even in other places. For example, if we saw any kind of trash on the floor – paper, wrappers, anything – we were expected to pick it up instead of walk past it and hope that someone from environmental services came around soon. I haven’t worked for them for several years but I still can’t imagine walking past a piece of trash on the floor. I still pick it up when I see it.

The vice president I was speaking to said, “But does that really matter? If it doesn’t impact patient experience, I don’t want to waste any time training staff to do it.”

And that’s when I knew it was going to be an uphill struggle.

When we think of patient experience as a series of tactics designed to raise scores, we’ve not only missed the point, we’ve put the cart in front of the horse. We were trying to shape our organization’s future, define want we want to become. That can’t be expressed merely in a series of things you can measure, it’s more than that.

It starts by having employees take pride in where they work. Part of that means acting like an owner and taking action when you see something wrong, like trash on the floor. It may seem like a small thing but it’s those small things that add up to create your organization’s culture.

When you step outside of your expressed job responsibilities and take action when something is wrong, you’re more engaged, you’re part of something larger than yourself. That’s a big part in creating a positive, patient-centered culture with employees who feel connected to purpose.

The employees still walk past trash on the floor. Patient experience scores haven’t improved. Think there’s a connection?

Pre-Arrival: Building Loyalty Before They Even Get There

There are certainly a lot of factors that go into patient loyalty: convenience, location, friendliness, clinical outcomes, but one area that is often overlooked is that of pre-arrival. I saw a study this morning about how pre-arrival is becoming more important to patients than the admission process when answering the question “How likely are you to recommend this hospital?”

This really surprised me, given all the energy we’ve spent trying to reduce wait times, hire friendly staff, simplify the admission questions, and generally make the process go as quickly and smoothly as possible.

As is often the case in healthcare, I actually realized just how valuable pre-arrival was through my experience with another industry. This past summer, my daughter and I started visiting college campuses. We were planning a trip out west from Chicago and decided to hit four colleges in a week. With plane tickets, hotel stays, rental cars, and mapping everything out online, there was a lot to do and the whole thing was a bit of a blur.

One college really stood out, however. While all of them gave step-by-step directions from the nearest airport to their front door, one had a video. It was shot from the passenger seat of a car and it showed exactly what it looked like while you were heading their way. They zoomed in on the exit signs, let you see just how quickly that right turn that most people miss comes up, showed you where the parking garage was, and then which direction to walk to find the correct building to check in for the tour. It was wonderful.

A few days later while I was driving there, I was comfortable and relaxed. It felt familiar, like I had been there before, even though I hadn’t. With all the money hospitals are spending on interior and exterior signage, it’s astounding to me that they aren’t shooting a video and showing patients what it looks like when you get near their site.

We’ve become accustomed to using our car’s GPS to find a hospital, but what a huge dis-satisfier to then have no idea where to park, which door to go in, and how to find the registration area. How many front desk receptionists would be delighted to not have to spend the first few minutes dealing with angry, frustrated patients and apologizing for the lack of helpful signs or clear directions?

I’m sure more will come out about pre-arrival factors and how they contribute to patient loyalty. This one seems like a good start to me.

What is your hospital doing to make pre-arrival easier for patients?

Manage Up

One of my pet peeves (and it appears I have a lot of them) is being led to an exam room by a receptionist who puts me in exam room 4 saying, “Someone will be with you shortly.”

Someone? Someone who? Who will be with me shortly? I sit and I wait. For someone.

It would be so much nicer if the receptionist said, “Okay you’re going to be right here in exam room 4. Tom will be your medical assistant today and he’ll be in to take care of you in just a few minutes. Tom is great. He’s one of the best we have here and patients love him. You’re in good hands.”

Three great things come from those simple words.

  1. A nervous patient starts to relax. She has heard that this other care provider is good at his job and is good with patients. She feels better already.
  2. Employees actually do a better job after a set of expectations has been set. I step up my game when I know someone has heard that I’m good at my job. If someone says I’m warm and friendly, I am turning up the warm and friendly for sure.
  3. Co-workers get along better when they get into the habit of speaking well of one another. Less gossip and more praise mean higher morale. And by the way, patients pick up on that, too.

But what are you supposed to do if you’re handing a patient off to Tom and you don’t like Tom? Do you lie and make something up so the patient feels better? Of course not. Find out a little something about Tom, like how long he’s worked here or how many years of experience he has.

Maybe patients like Tom just fine, even if you don’t. Try this, “Okay, here we are in room 4. Tom is going to be your medical assistant today. He’s been with us for about three years now and patients love him. I’m sure you’re going to love him. He will be here in just a few minutes.”

That wasn’t so hard, was it?

And you know, there’s a very good chance that after hearing you say nice things about him every day, Tom might actually become easier to work with. You might start to genuinely like him. You’ll like coming to work, patients will pick up on the energy and collegiality around the office, and nervous patients aren’t so nervous anymore.

All because you managed up.

What’s stopping you?

Just Show Up

I saw a video a couple of weeks ago from one my very favorite authors, Brene Brown.  She was talking about sympathy and empathy and something she said really stuck with me:

“When someone shares something really painful, maybe the best response is, ‘I don’t even know what to say right now, I’m just so glad you told me.’ Because the truth is, rarely can a response make something better. What makes something better is connection.”

I’ve been in many painful situations and some of my worst memories aren’t of the situation, itself, but of the thoughtless things well-meaning people say when they think they’re being helpful.

  • Don’t worry, there’s light at the end of the tunnel
  • You won’t be given more than you can handle
  • You’re strong, you can get through this
  • You think this is bad, I know someone who has it way worse than you

People can say some incredibly idiotic things when they’re trying to help but I tend to cut them some slack because I know they don’t know any better.

For many of us, the more difficult situation is the one in which we are with someone who is suffering and we don’t know what to say. We struggle for just the right words that will make that person feel better. We can’t bear the uncomfortable silence so we say something, anything, hoping it’ll be better than nothing.

The truth is, just simply being with another person can make all the difference.

When a person is suffering, he or she feels alone. It’s not the kind of alone like ‘no one understands what I’m going through or how I’m feeling.’ The truth is, no two painful events are the same and no one can truly know how you feel, whether they’ve been through it or not. It’s the kind of alone like ‘no one wants to walk with me while I go through this.’

Simply having someone next to you, to hold your hand, sit with you, just be there… that’s one of the most meaningful gifts you can give a person.

Don’t worry about what to say. Silence and Presence may be all you need. Just show up.

 

 

I Did My Job

Lately, I’ve been part of some skills training that focuses a lot on checklists. I think there’s a lot to be said for being very specific when you’re trying to teach someone how to interact professionally and compassionately with people. For many, these are skills that don’t come naturally and we need to show some concrete actions that demonstrate warmth and caring. Simply telling someone to be nice often isn’t very helpful. Everyone thinks they’re nice.

There’s no shortage of checklists out there for behavioral standards and ways to make patients feel more comfortable, but what if you do all the things on the checklist and patients are still unhappy?

I had a coaching session with someone for this very thing. He couldn’t understand why, after doing everything he was taught to do, patients still complained about him. He made sure he said hello, introduced himself and his role, he explained how long the tests would take and what was going to happen. He even said thank you at the end of every patient encounter. His manager was having a very difficult time giving him some helpful feedback because he was doing everything on the checklist and still not getting very good survey scores from patients.

To me, the answer was obvious. He wasn’t connecting.

I was looking at a perfectly competent employee with very good technical skills who was simply going through the motions without any sincerity. He was focused on his to-do list, there to do a job and complete a series of tasks, doing just enough to not get fired.

When we put the focus solely on ourselves and our actions, we forget that experience is a two-way street. Simply doing the items on a checklist doesn’t guarantee that the other person understands what we’ve said or interprets those things as helpful. It takes a genuine connection, even if it’s brief, to demonstrate caring to a patient.

Simply saying hello doesn’t convey a warm greeting but “Say Hello” was an item on the checklist. Should we have written “Sincerely and warmly greet every person with whom you come in contact”? Well, if that’s what you want, then that’s what you need to write if you’re going to use a checklist.

A better way is to hire people for whom this comes naturally. Warmth is tough to teach.

Thankfully, my coaching story does have a happy ending. This employee used to display warmth and sincerity with patients, but over time, he got jaded, bored, and burned-out. All it took was a little reminder from me about why he went into this field and he was able to reconnect with that part of himself he’d let go dormant. For those that never had it to begin with, I wonder if you can teach it. I’d rather spend my training budget helping people with the right kind of interpersonal skills and a desire to get even better.

What kinds of criteria are you using to hire your employees?

Patient-Centeredness

A few weeks ago, I got a phone call from an administrative assistant in one of our imaging offices. She asked about the courtesy van that the hospital provides to those who are in need of transportation but are unable to afford cab or bus fare.  A patient who had been in the day before said she had no way to get home but had used that service previously and found it very helpful. This administrative assistant didn’t have the voucher she needed and starting hunting one down.

The hospital had recently changed its policy about which departments were authorized to give these vouchers out to patients. Apparently, people were taking advantage of them. Funny, I thought the whole idea of the program was for people to take advantage of it…

She called another department – one that was authorized – and asked if she could have a voucher for patient who was here and needed to get home. The director responded with, “I don’t know, will I get in trouble if I give this to you?”

She had been in a meeting where the senior leadership team was ranting about how much money it costs us every time someone uses this service. She got the message loud and clear that anyone caught giving the service to someone who didn’t really need it would be in a whole lot of trouble. It was clear that managing the budget was more important than meeting a patient’s needs.

I had to ask myself, what kind of a hospital is this? What do we truly value? The buck kept being passed until someone decided that helping this patient get home was more important than potentially getting yelled at by an executive.

Thankfully, this all happened behind the scenes; the patient had no idea there was such a scramble to find a simple voucher, but as I was listening to this story it became crystal clear to me that we have sent our employees the wrong message. All this talk about patient experience and putting the patient first… it’s just talk.

Until employees – all employees – are empowered to take action that helps patients, you do not have a patient-centered organization.

Your patient experience efforts will go nowhere. And your patients will go elsewhere.

Other People

Other People

I’ve been talking about creating this blog for a long time but I grew up with parents who, while generally supportive and encouraging, always had a way of making me feel like there was a limit on how far I could go. They encouraged me to do my best at school but let me know that getting a B was still really good. They were excited to see me audition for the high school musical and, while I really wanted the lead, they were quick to say, “Well that supporting character would be a good part.”

When I was 10, there were auditions for the musical “Annie” at the Chicago Theatre. I relentlessly hounded my parents to take me and I remember very clearly them saying, “Honey, we don’t do things like that. That’s for other people.”

Other people.

“Don’t try to be the boss, just be a really great employee. Being the boss is for other people.”

“Other people become professional singers. You just keep singing in the church choir.”

“Everybody has an opinion. What makes yours so special? Let the experts create a website called ‘I Am The Patient Experience.'”

The hardest part about starting this blog was convincing myself that I had something to contribute: that my voice, my experience, my perspective mattered.

If you’re wondering if you should take that leap and do something that you think only other people do, remember: no one else has your background, your style, your personality, your accomplishments. Don’t underestimate what you can bring to the conversation.

Next time we’ll talk Patient Experience.