As many of you know, my firm has been doing mystery shopping as well as other forms of qualitative research on the patient experience for a number of years. I have a deep fascination in learning as much as I can about patients’ expectations as well as their emotional responses to situations and interactions – all of which determine their attitude toward, and confidence in, the provider organization. By learning more about the patients’ expectations and responses, we can identify, teach, and rehearse the most patient-centered interactions.
One of the best ways to learn what the patient is thinking and feeling is to ask. There are lessons to be learned all around us every day. One of the best teachers I have had about the patient experience is my sister Elizabeth. Since her early 20’s she has endured numerous physical hardships including more than 17 major surgeries and now cancer. She has spent as much as 6 weeks at a time as an inpatient, often at hospitals hundreds of miles away from family. Fortunately, now in her 50’s she is a fighter who refuses to be shut down by her physical ailments. Two days ago, I accompanied her to her new home for six weeks during her chemotherapy – a Hampton Inn and eventually Hope Lodge.
During our 4 hour journey I asked her what she needs at this point from her providers and the entire organization. Not surprisingly, she said, “Trust. I need to be able to trust that they are acting in my best interest, that they care, and that they know what they are doing.” With her help, I will be chronicling her journey through her 6- week chemo regimen including interactions with doctors, nurses, techs, receptionist and everyone else who will play a role in shaping her experience. Her insights are rich, and as a professional writer, she is able to articulate them very clearly.
Day #1 – Tests
This morning I was taken aback by an interaction with a nurse. First because she was about to have me do a routine urine test when I knew that I was supposed to have a catheterized urine test. It could have meant a delay in my chemo and it made me realize that, even here, with doctors who I trust, and staff who are almost always kind, I can’t just relax and assume they know what they’re doing all the time. I have to stay on top of my own treatment no matter where I am.
When the same nurse complained about the chance of snow here tonight, I mentioned that since I’d be here for six weeks, I had to pack for three seasons. She asked why I’d be here for so long and I offhandedly said “chemo”. She looked at me as if this were tragic, told me she was so sorry, and started treating me as if I were fragile. For a second I bought into it. I wondered if maybe I wasn’t taking this cancer thing seriously enough, and actually started feeling tragic. Then I realized what was happening, and quickly shifted gears into a more positive frame-of-mind. If she had been an acquaintance or a clerk in a store, I don’t think her reaction would have thrown me so much. I know that common folk still see cancer as a death sentence, so when they ask how I’m doing I just give them a breezy “fine” and move on. But she was a nurse – a professional and at a world-renowned medical facility, yet. Her status as a nurse made her opinion seem more significant. I had expectations that a nurse here has to see patients with cancer all the time and would know that it was treatable. So my second lesson of the day was to toughen-up about this kind of reaction. I think that this kind, well-meaning nurse would be upset if she knew that her reaction caused me distress.
In my training sessions, I often talk about words that wound, words that work, and words that WOW. Hearing Elizabeth describe this situation made me realize that this nurse was probably trying to be empathetic, but fell short. Her words and actions fell somewhere between ones that wound or just barely work.
I asked Elizabeth if she could re-wind the setting in her mind and tell me if she might have felt differently if the nurse had responded to her by placing her hand on her arm, looking into her eyes, and saying, “You are in excellent hands. We have the best minds in medicine here. And Elizabeth, we’re going to take good care of you.” In doing so, she could demonstrate empathy and work to instill confidence.
When I offered this alternative scenario to Elizabeth to consider, her response was affirmative. She said, “Wow, Kris – you hit the nail on the head. If that nurse had said ‘You’re in excellent hands here,’ coupled with eye contact, I would have felt confidence surging through me. If she had also touched my arm or my hand, it would have felt like a hug. When I re-lived the experience of that nurse just now in my mind, I felt much better. It stands out stronger in my mind than the original experience.”
I wonder if I had been the nurse manager witnessing this encounter if I would have seen the coaching opportunity. I may have seen a nurse demonstrating empathy and thought nothing of it. In fact, I may have classified it as “words that work.” But dig a little deeper. Listen as patients reflect on their feelings and each situation may not be what it seems. Take the opportunity to talk with your patients and delve deeper into their needs, expectations and reactions. What you learn may surprise you, and it will certainly provide a learning opportunity.