Improve outcomes, promote trust, and keep patients safe.
- Creating meaningful, compassionate connections with patients can improve outcomes, promote trust, and help patients feel safe while their hospitalized.
- Effective communication happens when we listen carefully to patients, treat them with courtesy and respect, and share information in a way that’s understandable.
- The approach is simple: Get to know the person behind the patient.
Creating meaningful, compassionate connections with patients can improve outcomes, promote trust, and help patients feel safe while they’re hospitalized. Patients want to feel valued and respected by healthcare providers, and we can accomplish this by establishing caring, empathetic, patient-centered relationships. Effective communication happens when we listen carefully to patients, treat them with courtesy and respect, and share information in a way that’s understandable.
What the research says
Research supports the theory that providing effective communication and taking the time to build trusting, caring relationships improves patients’ perceptions of care and outcomes.
In an effort to improve communication with patients and among staff, Beaumont Health in Southfield, Michigan, launched a pilot project to encourage employees to take time to sit, listen, and make connections with patients during each shift. The results include improved patient satisfaction scores and employee morale.
Why was the project needed?
For several months, our organization faced challenges reaching target scores related to patient communication with doctors and nurses. We examined the Press Ganey priority indices across the system and the top four items common among all of our hospitals were:
- Communication with doctor’s domain: “Doctors listen carefully to you.”
- Communication with doctor’s domain: “Doctors treat you with courtesy and respect.”
- Communication with nurse’s domain: “Nurses treat you with courtesy and respect.”
- Communication with doctor’s domain: “Doctors explain things in a way you can understand.”
In other words, communication with doctors and nurses, providing information with courtesy and respect, and listening and helping patients understand care plans are most important to patients.
Drilling down a bit further, we examined our complaint and compliment system and identified that the top issues noted by employees also centered on behaviors—primarily, lack of courtesy and respect. This validated the need to pursue communication training that emphasizes compassion and empathy.
How does it work?
The approach is simple: Get to know the person behind the patient by sitting at the bedside for 1 minute or less to make a compassionate connection, learn a fun fact about the patient, and share it with other staff.
Staff invited to the 30-minute training sessions (lecture followed by simulation) included nurses, nursing assistants, physicians, secretaries, and physical and occupational therapists. We began each training session by reviewing the organization’s mission, vision, and values, and discussing the core concepts, key principles, and benefits of patient- and family-centered care. We then explained that simply asking a patient what he or she likes to do when not in the hospital (a fun fact) helps us make a connection.
After the lecture, employees broke out into groups of three, taking turns being the patient, employee, and observer. The observer videotaped and timed each encounter, and the groups debriefed afterwards and offered feedback. The simulation proved to be the most effective training method as each person saw his or her actions in real time. At the conclusion of the training, each employee signed a pledge to reinforce the importance of this work and the need for his or her engagement.
What was the return on investment?
Staff time to attend a 30-minute training session was essentially the only cost incurred. The return on investment was high as these compassionate connections helped establish a more trusting encounter with patients. Staff also expressed a renewed sense of value and purpose.
What are the outcomes?
At the conclusion of the 3-month pilot:
- overall patient satisfaction ratings showed that 33% of the pilot units met the pilot aim (sitting with patients to make a connection).
- communication with nurses and doctors ratings showed that 56% of the pilot units met the pilot aim.
Three months after the pilot concluded, patient satisfaction scores demonstrated the following:
- Communication with nurses: Three of the units noted positive changes in scores in October 2017 as percentile rank was statistically significantly high (above upper control limit).
- Communication with doctors: Two of the units noted positive changes in scores in July 2017 and October 2017, also as percentile rank was statistically significantly high (above upper control limit).
- Rate hospital overall: One unit noted positive changes in scores in January 2017 and was maintained through June 2017.
Site visits occurred at the 60-day mark to provide ample time for hardwiring. Interviews with staff (nurses and nursing assistants) and patients provided valuable feedback and insights. One nurse mentioned that she gets to know her geriatric patients quite well since they like to reminisce. Through this project, she discovered that she’s able to better appreciate other generations of patients, which she found very rewarding.
What problems should others watch for when implementing a similar program?
As was expected with any type of test, we encountered several barriers. The first was in physician training. Most physicians didn’t attend training sessions, but they knew about the effort and supported it. To encourage physician attendance, offer training at regularly scheduled meetings.
Other barriers noted by staff were in the inability to sit due to no chair in the room, patients with altered mental status, and patients sleeping or not wanting to interact. Staff also encountered time constraints and interruptions.
We appreciated staff being transparent about barriers they encountered and discussed methods for overcoming them. If a patient doesn’t want to participate or is nonresponsive, the employee can speak to family members to make a compassionate connection. If a chair isn’t available, the employee can get a chair from another room or simply kneel. If interrupted, consider another time to come back during the shift.
What other advice can you share about implementing this program?
Be prepared to meet resistance with any type of innovation or change, include the entire care team in training, and don’t be surprised when you encounter unanticipated developments. Several creative ideas and actions emerged during our pilot project.
- We added “Fun Fact” labels to patients’ white boards to help others connect with them.
- We posted a board at the nurses’ station with a collage of patient fun facts.
- A nurse manager chose to sit at the bedside during leader rounding.
- A nurse manager asked staff to share a personal connection or inspiring patient story at staff meetings and huddles.
- Staff and the director of nursing wore Commit to Sit buttons.
This project was challenging, but it resulted in a renewed focus on patient- and family-centered care and reminded hospital staff about the importance of listening and connecting.
Diane DiFiore is director of care management development and education at Beaumont Health in Southfield, Michigan.
ADVANCE staff. Honing the patient experience. Advance Healthcare Network for Nurses.September 15, 2016. health-system-management.advanceweb.com/honing-the-patient-experience/
Lidgett CD. Improving the patient experience through a commit to sit service excellence initiative. Patient Exp J. 2016;3(2):66-72.
Nursing is definitely not the same, as more responsibilities and roles have developed over the years. Nurse to patient ratio has increased, charting has changed, time constraints have increased, and a nagging task list is in the mind at all times of the nurse to complete before the end of each shift. Some nurses are there for the paycheck while others are there to truly make a difference in each of their patients’ lives. The nurses who make a difference engrave an image in their patients’ minds overcoming the “monotony” of the hospital. It is a scary, fearful place with many sleepless moments due to regulations each hospital has. Making that connection with your patients will make a difference in the recovery that will affect the patient in future outcomes. The fact is the unwanted memories of the care a patient receives stays with them as well. Personally speaking, I can recall wonderful nurses who were persistent in providing care to myself and children, and there are also the unwanted memories from physicians to nurses who provided care to myself.
Allowing nurses to provide care and open up with each patient requires a technique that cannot be taught. One thing facilities can do to aid in the care provided is limit nurse to patient ratios, and ensure that nurses understand that nursing is continuous care, not shift based. When one nurse does not complete a task, the next nurse taking report can complete that task. Nurses having a maximum of four to five patients on a floor for a 12-hour shift to allow the time to sit in the room for ten to fifteen minutes each to develop a relationship with each patient. The idea that is mentioned in this article about a “fun-fact” is a great idea. Learning a patient, their desires in their care, and in life. Learn a little about them and their family, as well as provide a little information about yourself. This will allow for a little connection to be felt. Allow conversations to continue with each encounter throughout the shift with medication passes and assessments. This will allow for a relationship to continue to grow. Nursing leadership also needs to consider allowing patients and nurses to stayed paired, especially if they are back for a set of shifts in a row. This will allow for continued to care and to pick up where conversations were left off.
Sincerely, Kayla W. RN, BSN
I was instantly engaged when I read the article “Compassionate Connections” by author Diane DiFiore in the March 2019, volume 14, number 3 issue of American Nurse Today. I was immediately reminded of my own personal experiences as a nurse, and the impact that a compassionate connection has made for several of my patients. When I reflect on why I became a nurse 21 years ago, I realize it was because I was called to help. I quickly realized, however, that I could not truly help patients unless I connected with them as a person. I would like to share one of my own stories to reiterate the importance of this issue.
Early in my nursing career I was working at a long term care facility. I was a primary nurse on an Alzheimer’s unit, however, I received a new admission on my unit that was a Hospice patient. The patient was initially being admitted for respite care, as his wife was exhausted. It didn’t take long for me to realize why. The patient had terminal lung cancer and he wasn’t happy about it. He was rude, demanding, and took every opportunity to make his wife and the nursing staff feel inadequate. He was never satisfied. Over the course of time, I swallowed my pride, put on my best smile and attended to his every need. His call bell rang constantly. During that time, I found out through conversations with his wife that he had been a CEO at a large business. He was used to being a boss, being in control and dictating the course of events. He could no longer do that. He was dependent on his oxygen, he became short of breath with just speaking, he was in pain and he was bedbound. He had lost almost all control and independence.
I cared for this patient for about six months. He started out as my “worst” patient, but over time, I admit, he became my “favorite”. I realized that he didn’t want to be a patient, but instead he just wanted to be a person again. He really wasn’t hard to please; he just wanted a voice. Our conversations did not revolve around his illness, but rather they became conversations between friends. I learned more in that six months about patient care than nursing school ever taught me. I learned the importance of a human connection. The evening that the patient was on his death bed, his night nurse called me to let me know he wanted me there. He was calling for me by name. He was calling for ME! Of course, I went. I comforted him and stayed by his side until he passed. Then I cried like a baby. I knew in that moment what it meant to be a nurse and that I was meant to be one.
In conclusion, thank you for publishing the article “Compassionate Connections”. I enjoyed reading the article and reflecting on my own experiences of connecting with patients. My story is just one of many, I’m sure, that contribute to the importance of establishing a compassionate connection with patients. I hope to see more research and publicity regarding this issue in the future, as I feel all nurses need to be aware of the impact this skill can have on the quality of patient care. As nurses, we cannot truly help our patients unless we connect with them as an individual. As DiFiore states in her article, “The approach is simple: Get to know the person behind the patient.”
Erika B. McHenry, RN