Page 91 – American Nurse

Improve outcomes, promote trust, and keep patients safe.

Takeaways:

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.

Lidgett notes that committing to sit goes beyond the medical diagnosis by creating a caring relationship.
These actions bridge the gap between safety, quality, and the patient experience.

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.