"The more you engage with customers, the clearer things become, and the easier it is to determine what you should be doing." ~John Russell
The AHRQ website has an amazing article on engaging patients in their own safety. The IOM “Crossing the Quality Chasm,” states that: “patient centered care should be respectful of and responsive to the individual patient preferences, needs, and values, and ensure that patient values guide all clinical decisions.”
Not OUR needs and values, but the patients.
It is really where our industry needs to go to keep patients safe. With engagement and motivation and active participation in one’s own health comes knowledge of caring for oneself. Patients will learn how to care for themselves away from us when we teach them our “secret“ language while they are with us.
This subject is fraught with issues. For one, the patients may feel that they cannot possibly confront a care provider with their own needs. That is the paternalistic view of medicine and all who work in its realm. Not only do we, as care providers, work under that assumption, but we have trained patients over hundreds and thousands of years in a “Mother and Father know best” sort of way.
From a provider perspective, there may be clinicians who feel that they have learned the “secret language" over many years, and it needs to be secret for a reason. It takes too long to teach others to care for themselves. It’s just easier to do it yourself.
First, of all the patients need to know that they are in a place that welcomes them as individuals, and people. AHRQ’s program “Questions are the Answer,” and JCAHO’s “Speak Up” are two great programs. Or, create your own with your own branding.
At the Capstone Leadership Summit, and with our partner hospitals, we teach Positive Patient Communication Standards. Five of these standards relate directly to patient engagement and keeping patients safe:
- Having a standard patient communication acronym that all staff use when interacting on a daily, or hourly, basis with parents. Encourage the patient in this introduction that you, as a safe clinician, want them to tell you that they feel unsafe. You welcome being told to wash your hands at the door. This needs to be a very sincere commitment.
- Filling out whiteboards in the rooms with reminders about letting staff know if a patient or family member sees anything unsafe happening. Also, using part of the white board to instill a therapeutic relationship piece with patients. Asking, “What do you care about?” ensures that staff can truly convey a message that everyone in your department and organization does truly care about them, and what matters to them.
- Managing up other caregivers. Saying, “I want you to report to me if you ever feel unsafe, and so do every other staff member in my department. Your next nurse is Suzy, and she is amazing. She will also want you to do this.”
- Narrated Care. This is simply “connecting the dots” for patients about why we do what we do in healthcare. Start with words like, “I want you to be safe, so I need to check your name band and ask you your name before I give you medications every time.”
- Finally: Teach Back. Implement this amazing safety mechanism for every single patient interaction. Often, errors happen with patients because of a lack of knowledge and understanding, and being afraid to say so.
Another staff action that engages and motivates patients to participate in their own care and safety is frequent and purposeful rounding. When staff are rounding on patients, they can explain the process of purposeful rounding. This includes a promise to return within an hour. During this explanation, staff can explain to patients that the staff member really does want to keep them safe, therefore they need assistance with a reminder to make sure the walk to the bathroom is clear of trip and fall hazards, and a reminder that hand washing takes place every single time the staff member comes in and out of the room, no matter what.
Leadership actions for patient engagement in their care and safety is what we call Validation Rounding. As a leader, think of the impact on patients and their families when you walk in the room to determine how their care is going. Make sure when you round on the patients that you include a rounding question about how safe they feel. Include key words such as, “It is my job to make sure you are very satisfied with your care, and that you always feel safe in the care of my staff. We want to make sure your care is tailored to meet your needs, and that we are caring for you the way you need us to. Is there anything we can do to make you more comfortable here? Is there anything we need to do to make you feel safe in our care?”
You can also add a validation rounding question that leads the patients to notice safety initiatives. For instance, “My staff and I want to make sure that hand washing happens 100% of the time prior to any staff members working with you. My staff and I are very open to you telling us when hand washing does not happen. I promise you it is not intentional, but we are human and sometimes lapses happen. Please let my staff know if they need to wash their hands. They will thank you for it! “(Make sure they do!)
It may seem like a daunting task to put patient engagement initiatives in place. It is not! You, as a leader, and your staff may be taking these steps already. Using certain words to “Connect the Dots" for the patients when interacting with them will allow their true fears and feelings about their care to come out!
Thanks for the read! Our Capstone Leadership Summit has a host of patient experience Solutions you can put in place the day after you attend! Consider joining us in Michigan in October! Jane
It strikes me as odd that the research and writings on therapeutic communication are really only aimed at Nursing and Behavioral specialists.
Nurses face great conflict each and every day as they struggle to provide safe, quality care. Yet, when their organization makes a decision to have an opioid free ER, nursing is the face that patients see with that decision.