Kathleen K. Borenstein, DNP, RN CCRN February 2018

Transcription

1 Kathleen K. Borenstein, DNP, RN CCRN February 2018

2 Define expectations and satisfaction Explore factors that influence patient encounters Patients perspectives Caregivers perspectives Identify strategies to improve interactions Discuss how the strategies can improve outcomes

3 Understanding patient experience is key to cultivating patient-centered care that is: Respectful of and responsive to individual patient preferences, needs, and values Integral to comprehensive, high-quality care As valuable as assessing outcomes and safety

4 The Medical Exam*: Not Designed to Engage Patients The Medical Exam Greetings and Pleasantries In an Average, 10-minute Visit Patient s Opening Remarks History and Physical Exam Diagnosis Treatment Closing This is the only time during the medical exam that patients may talk freely. * The goal of the medical exam is to establish a Dx to treat Dx Steve Wilkins

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6 Experience Versus Satisfaction To assess a patient s experience, one must find out from patients whether something that should happen did happen (i.e., clear communication with a provider) Did it happen? How often? Satisfaction is about whether a patient s expectations were met Two people who receive the exact same care with different expectations may give very different satisfaction ratings based on their expectations

7 2013 UK Study of 833 patients, including a survey to evaluate the impact of patient expectations on patient satisfaction before and after visits with a general practitioner or clinic Convenience sample that matched the general population by ethnicity, age, and gender Survey What are your ideal expectations of what would occur during the visit vs realistic expectations before the visit? Were your expectations met and how satisfied were you? Collected demographics, health status, quality of life, and socioeconomic status Defined Expectation: the anticipation that given events are likely to occur during the visit or as an outcome Satisfaction: the patient s evaluation of those expectations

8 There was no significant difference by gender Ideal expectations were similar across groups There were significant differences when stratified by age Levels of initial expectations, both ideal and realistic, were not significantly associated with satisfaction Factors associated with satisfaction included: Having control over one s life Being older Female White British Seeing a general practitioner

9 The study examined emotional support to improve patient satisfaction Although emotional support is not the focus of care/satisfaction, it is a key measure of patient expectations and preferences Qualitative, descriptive approach using grounded theory Semi-structured interview of 25 patients before discharge from a teaching hospital in Ontario Patient encouraged to share thoughts about the emotional care he/she received Researchers identified 8 themes

10 1. Empathy: the way care was delivered was vital in making the experience satisfying Secure and reassured 2. Informative communication: participate in 2-way communication with provider Important to understanding treatment, outcomes, and expectations Helped reduce anxiety 3. Being present and available: providing a sense of connectedness through responsive behaviors Impression of never being alone 4. Inspiration and hope: caregiver having a positive influence on patients minds and uplifting their spirits Providing a positive outlook and conveying a good outcome

11 5. Personalization: individualized care that meets patients unique needs Treating him/her as a human being 6. Supportive gestures: conveying empathy, openness, and support Physical touch, eye contact, smiling, and sitting down 7. Humor: a therapeutic tool Healed anxieties, turned patients thought from grief and worries brought on by the illness 8. Ambient environment: mood generated through interactions of everyone in the setting Kindness, politeness Introducing oneself when entering the room and stating why they are there

12 Introduce yourself Convey warmth and gentleness when interacting Acknowledge the patient s anxieties Sit down! Exchange information Give information and allow time for the patient to ask questions Actively listen and engage in conversation Directly answer questions Show empathy Verbally and nonverbally Check ins Be present and anticipate patient s physical and emotional needs

13 Ask the patient about her/his needs Provide information about POC, future expectations Talk the patient through her/his challenges Encourage a connection to their higher power or spirituality Be responsive Encourage the patient with statements that help her/him realize she/he will improve Make the patient feel special and recognize something unique about her/him Normalize the situation Demonstrate that you are familiar with the illness/treatment Treat the patient holistically and have a conversation that is not solely focused on her/his illness Sit down, make eye contact, and make physical contact

14 Give supportive gestures Smile Consider the patient s social circumstances in treatment plans Make appropriate referrals for further emotional support and concerns Use humor Jokes can help establish a connection and diminish anxiety Recognize that an emotional burden during illness may be as difficult as a physical burden Patients need to be guaranteed a minimum level of emotional support

15 Providers should: Recognize their own expectations and how they may impact patient interactions Identify situational factors that may impact the interaction Be aware of personal prejudices and biases As many as 15 % to 30% of family physician visits are considered difficult Factors may be related to the Physician Patient Situation Combination of some or all

16 Characterized by a disparity between Expectations Perceptions Actions What does this mean? It s the provider s job is to facilitate and support a level of engagement when the patient walks through the door Avoid diminishing or totally deflating the engagement

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18 Patient Engagement Initiatives

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20 Communication is key Verbal Non-verbal Technology Humanizing the experience Make it personal Touch Humor Take a seat and make eye contact Practitioners must be aware of their biases Patient satisfaction depends on the patient s perception that her/his expectations are met Ask the patient what she/he expects from the visit Check in at the end of the visit to see if expectations were met

21 The first step in exceeding your customers expectations is to know those expectations. Roy H. Williams

22 Thomson, Donna. The Caregivers Blog. Accessed 1/10/18. Wilkins, Steve, The medical exam wasn t designed to engage patients. Accessed 1/10/18. Patient Engagement Survey: Far to Go to Meaningful Participation. Insights Report Accessed 1/10/18.