It is sometimes the simplest things that get left out in the hustle and bustle of a health professional’s busy shift; things like not introducing themselves to the patient or not acknowledging their son, aunty or friend sitting at the bedside.
“No health professional comes to work not meaning to do a good job,” says Dr Lynne Maher, nurse and director of innovation at Counties Manukau DHB’s Ko Awatea Centre. “But sometimes our focus gets diverted with the busy-ness of the job.” And she says usually when that happens it is the ‘niceties’ that can fall by the wayside.
It’s good communication– including introducing oneself – that Maher says patients and family members surveyed, both nationally and worldwide, consistently rank as the most important factor contributing to the quality of their patient experience – higher even than compassion and dignity.
“I think communication has a particularly strong link (with all the other factors) including compassion and dignity,” says Mayer. “Because if I’m a patient or family member and I feel that you are taking time to communicate well with me – so I understand what is happening and have time to ask questions and think about it – then I really feel I’m being treated like a whole person.”
Communication a focus
Ko Awatea, the South Auckland-based centre for health system innovation and improvement, hosted the first Patient Experience Week at Counties Manukau in 2013. This year the focus week was repeated and broadened, with all three DHBs in the region taking part.
The Health Quality & Safety Commission’s national patient surveys, which commenced last year, indicate that the vast majority of patients are happy with their experience, including communication. The surveys, now carried out regularly, show DHBs scoring highly across all four indicators: communication, partnership, physical and emotional needs, and co-ordination
But Maher says that while communication is predominantly good, it’s when it’s not so good that patient experiences can go awry.
“They don’t feel that they are cared about as much, they don’t feel they are respected, and they are nervous because they don’t know what is happening – and those are the typical feelings of patients and family members.
“What we’re trying to do with nurses and other staff is to help them to really focus on the person’s experience,” says Maher.
It is a matter of reassuring clinicians, she says, that “it doesn’t take hours out of their day” to take the time to introduce themselves properly to patients and their family members.
“And when taking a pulse or blood pressure, using that opportunity to talk about discharge and answer questions a patient might have, rather than whizzing in and whizzing out again.”
Introducing oneself well is a popular issue at present, with the UK’s “Hello, my name is…” movement; Waitemata’s recent “3Ms” programme; and Counties Manukau’s use since 2012 of an “AIDET” approach (see sidebar).
Walking in a patient’s shoes
But ensuring a good patient experience extends further than just introductions and the Patient Experience Week events across the region showcased some of these other issues.
All three DHBs invited patients to come in and share their stories, either in person over lunchtime or teatime sessions, and also through photos, videos and storyboards.
Waitemata DHB organised a “Have your say” live video booth in the hospital’s foyer and Auckland DHB arranged “Share it” stations for people to share their experiences of DHB services in words or drawings.
A session presented at Auckland DHB by Air New Zealand on enhancing the customer experience was video-linked with the two other DHBs, and a regional event, largely organised by Waitemata DHB, saw young people converge on Counties Manukau DHB for a lively session on the youth mental health consumer experience, featuring the Phoenix Performing Arts group.
Waitemata DHB also held a hands-on “I’m not a tick box” interactive expo for health professionals and Counties-Manukau set up an “empathy zone” to give staff a taste of what it was like to walk in their patient’s shoes.
“It was fantastic to show how difficult it was to get dressed or put jackets on when you’ve got both arms splinted [to simulate what it was like if you had damaged both arms or had arthritis in your wrists or elbows],” says Maher.
Wearing special gloves that mimicked the loss of sensation in fingertips that is quite common in diabetes, staff then attempted to thread beads onto cotton. People were also able to experience walking up and down stairs using crutches.
Compassion and mindfulness under pressure
Maher says Waitemata also used the week to showcase some of the findings of 12 staff projects initiated last year on different facets of the patient experience, including seeking patient feedback on the advanced care planning process and working with transgender youth and their families.
A further project looked at teaching compassion. Maher acknowledges once again that stretched staff on a busy day may be more focused on waiting bells and pending tasks than on communication and compassion.
She says one response at Counties-Manukau was investing in mindfulness training to help staff to look after themselves and be present in the moment. They could then think about ways to reduce time spent on unnecessary tasks and increase the time spent on things that were going to give them and their patients “higher reward and higher value”. According to Maher, staff constantly comment on the positive feedback they get when things go well.
“Then we got the team who did that [mindfulness training],” she says, “to look at another training opportunity around compassion; to really help people ground themselves and understand what we’re here for is to be compassionate and compassion is a really important part of our role.”
A pilot of the one-day training in compassion was held during Patient Experience Week and an initial review of the evaluations was very positive. Maher says more training sessions are likely to follow in the programme that aims to raise awareness of compassion, and understanding and tolerance of people who may not reciprocate that compassion.
“It is dead hard out there. We are asking people to do everything at once, so how do we help people to sort that out – and that is what we’re trying to do with this [mindfulness and compassion] training and projects.
“We can’t chose what’s thrown at us but we can absolutely, with help, choose how we respond to that situation. I think it’s a really important part of a nursing role to be compassionate – not just for patients but for staff as well.”
Hello, my name is…
Terminally ill doctor Kate Granger* began the “Hello, my name is” campaign in the United Kingdom. It was prompted by a hospital stay in 2013 when many staff looking after her didn’t introduce themselves before delivering care. So she and her husband began a campaign to encourage and remind healthcare staff about the importance of introductions.
“It is about making a human connection, beginning a therapeutic relationship and building trust,” says Granger. “In my mind, it is the first rung on the ladder to providing compassionate care.”
The campaign is now backed by around 90 National Health Service organisations and the twitter hashtag #hellomynameis has been used 75 million plus times. Find out more at www.hellomynameis.org.uk or Twitter @GrangerKate*
Postscript: Kate Granger died in 2016. Her husband Chris Point is continuing the campaign and can be found on twitter @PointonChris The anniversary of her death (July 23 2016) is International #hellomynameis day
Another approach to improving clinician communication with patients and families is known by its abbreviation AIDET.
The “A” is for acknowledging the people in the room (patient, family members or other visitors; the “I” for introducing themselves to the patient before they outline what they are planning to do. This outline should include how long the procedure should take or that the patient may need to wait for an appointment, test or results (i.e. “D” for duration) and then explain (the “E” of AIDET) what the procedure/test etc would involve. The final “T” is for thank-you.
The “3Ms” is another campaign that aims to get clinicians communicating better with patients as they forge a therapeutic relationship. In the 3Ms case the “M” stands for “My name is… My role is… May I… ”