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The Leaders Perspective: What Matters Most

Monday, July 09, 2018
Kim Pyles, M.Ed, FACHE, CPXP
System Vice President
Ochsner Health System

Kim Pyles
Kim Pyles,  M.Ed, FACHE, CPXP
 

I recently received this remarkable letter from a physician;

 

“I wanted to share a recent experience with all who have the privilege of working with patients. I write this feeling quite humbled.  Please allow me to give a little background about my medical history so that one may better understand my perspective. It’s been quite some time since the table was reversed for me that is from doctor to patient yet this recently happened. I have had several admissions as a child due to a chronic GI condition and I think I may have forgotten what is what like or perhaps my perspective was different as a child.  This recent experience involved a malady from a recent travel abroad and found me three days (as an inpatient on a) Medsurg floor. As I reflect upon my experience I realized a recurring theme that changed the whole experience from the moment I entered the ED to my discharge.   Simply put people were kind. They were kind enough to move the tray when I couldn’t, kind enough to take extra time to explain the treatment plan, contact my doctors and involve needed consultants, kind enough for my housekeeper to keep my room clean but also make a joke that made me smile when I didn’t want to, kind enough cover an iv site so I could shower, kind enough to look at some photos of my dogs when I’m sure they had important things to tend and kind enough to refill my water without asking because they cared that I needed to drink.
I simply can’t tell you how these kind acts made all the difference, acts that were not prompted and knowing myself took some extra time which is so precious.
I thank you all who helped me at (this hospital) and hope I thanked you enough but I’m sure this is inherent to these special individuals. They probably are having an impact on someone else as we speak.
I will go on to fully recover but will remember to take a few moments to be a little kinder, take an extra minute to perhaps just move a tray, ask how my patient’s day is going, get an extra pillow.
Thank you again. I am privileged to work with such caring professional team.”
~ Grateful Physician & Patient (used with permission)

 

“People were kind”


I am struck by the power and simplicity of this statement.  This physician was so moved and impacted by the caring actions of his healthcare team during his moment of personal vulnerability that he would change his own behavior.   As a leader dedicated to influencing leaders, physicians, and multiple other colleagues working in healthcare to seek to connect with the patients and families they care for on a human level, this testimony perfectly illustrates THE POINT. 


Demonstration of empathy (ability to imagine what someone else might be thinking or feeling)  and kindness (a spontaneous gesture of goodwill toward another)  matters in healthcare. We all know this – in our brain. Yet, demonstration of empathy, compassion (desire to help when confronted with another’s suffering) , and kindness seems such a challenge in healthcare environments.  In fact, oftentimes provider response to discussion of the need for greater demonstration of empathy, compassion, and kindness is one of sharp resistance.  Perhaps it’s the push for greater productivity, burdensome processes (one provider described her typical day as “being murdered by a duck”), or that technical skills are the primary focus of clinical training? I have worked and talked with hundreds of physicians who tell me that demonstration of empathy and compassion were not part of their training.  Sound medical knowledge and technical skills have historically received higher esteem…but does this dichotomy make sense? And what is the cost for the patient and the clinician? Multiple studies reveal that effective interpersonal communication and connection between clinicians and patients increases trust, understanding, outcomes, and loyalty. In fact, the post emergency department visit experience of care survey question “staff treated me like a person” is strongly correlated to overall rating of emergency department care (correlation coefficient 0.84).

 

“ …these kind acts made all the difference, acts that were not prompted and knowing myself took some extra time which is so precious”

To meet this challenge and gap, most healthcare organizations and systems have developed specific patient experience workshops, trainings, programs, and strategies designed to increase the effectiveness of provider and staff connection with patients and families.  We have created acronyms to help us remember courteous communication principles, toolkits and behavior checklists.  This is good work, as it demonstrates our burgeoning understanding that minimizing the healing value of human connection does not make sense. However, the catalyst that compelled this physician to reflect upon, and change, the way he interacts and connects with patients was his personal experience. He was overwhelmed by the care-team’s individual acts of kindness, and reconnected to the meaning in his work.  


“They were kind enough to move the tray when I couldn’t, kind enough to take extra time to explain the treatment plan, contact my doctors and involve needed consultants, kind enough for my housekeeper to keep my room clean but also make a joke that made me smile when I didn’t want to…”


So how have we arrived at this place…where demonstration of kindness, empathy and compassion have become outlier behavior in our care settings?  In 2015, 50 percent of physicians reported symptoms of burnout , such as emotional exhaustion, depersonalization, and low professional fulfillment .  A couple years earlier in 2013, a Lucian Leape Institute study found that thirty-three percent of new registered nurses seek another job within a year .  In 2017 The Institute for Healthcare Improvement (IHI) sought to bring light and solutions to the alarming incidence of clinician burnout and disengagement with the IHI whitepaper, Framework for Improving Joy in Work .  The authors assert that joy in work can and must be restored, and that this can be accomplished in healthcare when leaders open candid dialogue with clinicians with the focused intent to discover what matters most to them, what specifically is impeding joy in their daily work, and by committing to systems solutions to make joy in work a priority from the top with shared responsibility .  It doesn’t seem unreasonable to connect rising emotional exhaustion, depersonalization, low professional fulfillment, and high turnover to a type of disengagement can certainly build a wall between healthcare professionals and their patients; effectively eroding demonstration of kindness, empathy, and compassion. 

“(I) will remember to take a few moments to be a little kinder, take an extra minute to perhaps just move a tray, ask how my patient’s day is going, get an extra pillow”


We will all most likely walk literally in the shoes of the patient one day. As powerfully illustrated by the experience of this physician/patient, reconnection to meaning in work, with a response of recommitment to the larger, human purpose can transform us. It is incumbent upon us, as leaders in healthcare, to make meaning and joy in work for our physicians and staff a strategic priority and focus.  The benefits of an engaged, productive, healthy workforce are well-documented and known. Beyond this, leading and enabling a culture that makes way for, and expects demonstration of kindness, empathy, and compassion as the norm in our interactions is fundamentally right thing to do.

[1] https://greatergood.berkley.edu/topic/empathy/definition 
[2] kindness.com.au/what-is-an-act-of-kindnesss.html 
[3] https://compassion.com
[4] Based on 1,685,534 Emergency Department patients from 2,135 facilities in the All PG Database peer group returned between January 01, 2017 and December 31, 2017.
[5] Shanafelt TD, Hasan O, Dyrbye LN, et al. Changes in burnout and satisfaction with work-life
balance in physicians and the general US working population between 2011 and 2014. Mayo Clinic
Proceedings. 2015 Dec;90(12):1600-1613.
[6] Perlo J, Balik B, Swensen S, Kabcenell A, Landsman J, Feeley D. IHI Framework for Improving Joy in Work. IHI
White Paper. Cambridge, Massachusetts: Institute for Healthcare Improvement; 2017. (Available at ihi.org)
[7] Lucian Leape Institute. Through the Eyes of the Workforce: Creating Joy, Meaning, and Safer
Health Care. Boston, MA: National Patient Safety Foundation; 2013.
[8] Perlo J, Balik B, Swensen S, Kabcenell A, Landsman J, Feeley D. IHI Framework for Improving Joy in Work. IHI White Paper. Cambridge, Massachusetts: Institute for Healthcare Improvement; 2017. (Available at ihi.org)
[9] Ibid.

 


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