Because We "Always" Care

When a patient leaves our office or the hospital we want them to feel that they have received the “best” care by the “best” physician, by the “best” surgeon, by the “best” OB or the “best” diagnostician. It does not require in depth explanations or detailed lists of reasons to `understand why. Performing flawless surgeries, perfect deliveries and making brilliant diagnoses are inherent in our goals as physicians. When we feel a patient’s care went smoothly, we walk away with a sense of fulfillment and think “well done.” But, do we ever ponder whether our patient feels the same way?
Our patients’ perceptions of care are not solely influenced by clinical components. Their impressions are shaped by a number of non-clinical encounters they face during each visit. One of the most powerful factors impacting their experience is the quality of communication they receive. Patients feel doctors do well when they explain things clearly, listen carefully and treat them with courtesy and respect. “Always” experiences in these areas add up to a patient’s sense of feeling well cared for. Focusing on these essential elements is critical to creating the patient perception of the “best” care.
HCAHPS is an Acronym for Hospital Consumer Assessment of Healthcare Providers and Systems survey. The Centers for Medicare and Medicaid Services (CMS) developed this measurement tool to collect information from the patients' perspectives on the care they received while in the hospital. HCAHPS data is collected by hospitals and reported to CMS who publicly posts results on its website http://www.hospitalcompare.hhs.gov/. Patients are able to compare the patient satisfaction scores of several facilities at one time to determine which healthcare provider might best meet their needs.
HCAHPS’ physician section focuses on doctors’ communication with patients. A composite score is reported under the heading of “How often did doctors communicate well with patient.” It is calculated by the total percent of “always” answers to the following questions:
YOUR CARE FROM DOCTORS
During this hospital stay, how often did doctors treat you with courtesy and respect?
Never
Sometimes
Usually
Always
During this hospital stay, how often did doctors listen carefully to you?
Never
Sometimes
Usually
Always
During this hospital stay, how often did doctors explain things in a way you could understand?
Never
Sometimes
Usually
Always

In 2009 and beyond our goal is to make Good Samaritan an “always” hospital where physicians deliver the “best” care. Physicians can achieve this by focusing on the essential elements of communication that clearly enhance how our patients experience care. We are already on the right path. Let’s continue our journey toward perfection.

Technology: Best Friend or Worst Enemy

Technology—Best friend or worst enemy: avoiding digital overload

I recall in 1980 when I started my internship, the annoying sound of my screeching pager that caused me to jump out of my call room bed. I’d run to the phone to see what urgent message or task awaited. When I was off call, I was relieved to be free from this intrusion on my serenity. I viewed my time away from my pager in a similar way to the traditional Wednesday morning golf game of the physicians of yore—a chance to relax and refresh.

As time moved on, pagers became more sophisticated and omnipresent. There were voice pagers and text pagers, all with an array of options. I remember my first cell phone. It was like a large walkie talkie. I thought it was great. I could take my kids to the park and answer a page without having to run to find a pay phone. And then cell phones got smaller, with more functions: text, e-mail, reference and calendars. You could be reached anytime, anywhere and have almost any feature available in your pocket, at your fingertips.

Parallel to the pager and the cell phone boom, fax machines became a common way to transmit information and the internet became the rule. I remember thinking how amazing it seemed to send information through the airwaves to a screen or a piece paper. We were able to receive and send information remotely 24 hours of the day. What has all this meant to me as a physician and an officer of the Medical Staff?

Technology has facilitated my ability to function in my leadership role while still keeping up with an active practice. Clinically it is easy to get lab results, contact colleagues while referencing clinical guidelines and information. In addition to accessing materials at a whim, I can be found at anytime, in any place. I can do my presidential work even at midnight, as evidenced by my late night e-mails.

All of this may seem like an improvement, but there is also a down side. The anytime, any place mentality removes all boundaries between work and leisure. The risk is that work takes over. We can end up with not only over-work but also digital overload. We need to remember to find time to re-energize, shut off the digital world and be present in what we are doing in the current moment. We need balance to avoid burnout. Take a moment to talk face-to-face with someone who matters. Take a walk together or just sit quietly in meditation. In doing so, your life will be more satisfying, energizing and fulfilling.

The Captain of the Ship

“Doc, without you I wouldn’t have known or understood what to do.” Many of us hear this statement from our patients as they reflect upon their need to have a physician they trust during one of the most vulnerable times of their lives. They may first come to one of us through the recommendation of their insurance plan or the hospital, but more often, patients turn to friends or family for their choice. Patients who have a long-standing relationship with a physician already know on whom they can rely. This may be their internist, family physician, pediatrician, gynecologist, or even a specialist that they have seen on numerous occasions. As a result, a great deal of responsibility is placed on the shoulders of the chosen physician to be the “Captain of the Ship.” Cultivating teamwork between physicians, nurses, and all aspects of the hospital milieu creates a high degree
of collaboration between providers. Facilitating these synergistic relationships has been the focus of today’s health care. This approach accompanied by improved communication has led to superior outcomes. The importance of “the team” should not be underestimated, but obtaining the most effective results requires a navigator who can synthesize all information and events while leading the patient through these stormy waters. Patients believe their physician is, or should be, that navigator, the “Captain.” With this in mind, as physicians, we should accept and take pride in the role of “Captain” and search for ways to continually optimize our effectiveness. For me personally, the following are a few simple practices I follow to achieve this goal: I ensure I know my patient’s history, test results and the recommendations of consultants before visiting with the patient. This may seem self-evident but not knowing this information can be the quickest way to lose a patient’s confidence.
I explain my interpretation of the data and give my recommendations / plan. I ask the patient if they
understand the results, as well as, both my and the specialist’s impressions / recommendations. If there are gaps in the patient’s understanding, I fill them. If information is missing, my staff and I search for it and communicate it to the patient as soon as possible. We should not be afraid to let the patient know when we need to obtain further data and get back to them. At the end of the visit, the goal is for the patient to have a clear understanding of their condition and next steps in their treatment. Even as they face the difficulty of any illness, patients and their families feel their care
is being delivered according to a clearly defined and understandable diagnostic treatment plan when there is a “Captain” with them directing and navigating the ship.

Recapturing Meaning in Medicine

"I have never seen a doctor more dedicated and show such compassion for her patients."
—A CCU nurse comments on her physician’s care at Advocate Good Samaritan Hospital.

While reading Dr. Stephen Beeson’s book, "Practicing Excellence: A Physician’s Manual to Exceptional Health Care," I realized that one essential question must be answered before we can effectively focus on new strategies for improving care: What do physicians really want out of our careers and lives?
The simple truth is that we want to fulfill our common, compelling purpose of making a real difference in our patients’ lives. To heal and care for them and when recovery is not possible, provide the best care available while relieving their suffering. If they are destined to die, we want to ease their passing, comforting their loved ones with the assurance that everything that could have been done, was done.
The personal benefit of providing such care reaches beyond fulfilling our obligation as healers and extends deeper into our human need for happiness. Evidence for this can be found in a book titled, "The How of Happiness: A Scientific Approach to Getting the Life You Want," where Sonja Lyubomirsky compares happiness to a pie. Research shows that 50 percent of the pie is determined by the inherent happiness tendencies we were born with, for better or worse, which is the level we naturally gravitate toward. Surprisingly, only 10 percent of happiness is determined by our circumstances such as how much money, fame and fortune we have. As the old story of the lottery winner goes, after the initial thrill, the winner will eventually adapt to the situation and go back to their happiness baseline. The remaining 40 percent of the pie is ultimately the most critical part of our happiness and is dependent on our intentional actions, things we actually do in our daily lives.
When we apply these facts to patient care, it is clear that how we interact with and satisfy our patients through our intentional actions will directly affect how happy our practices and lives will be.
The main case, therefore, for cultivating behaviors that increase patient satisfaction is the fulfillment and happiness they facilitate for physicians. Some added bonuses are increased patient compliance, decreased malpractice lawsuits and business promotion, since word of mouth is still the No. one source of new patient referrals.
I thought I knew everything about bedside manner and perhaps I did know a lot. But I found that there were some simple practices highlighted in Dr. Beeson’s book that could be implemented to enhance patient satisfaction. If these are done on a consistent basis, with every patient encounter, I found that they really do make a difference.
The following steps are easy and I encourage everyone who deals with patients to try them:
Knock—announce yourself before entering

Acknowledge and greet patients with a smile, handshake or touch on the shoulder
Introduce yourself—for established patients connect with questions about family or work
Sit at the beside or in a chair at or below eye level to make good contact
Always let patients speak first without interruption
Take history and perform exam—explain steps and ask encouraging questions
Explain workup and treatment thoroughly using common language—ask patients to paraphrase information
Elicit questions that have not been answered and anything else you can do
Thank patients—end with another hand shake or touch on the shoulder

At first I was nervous about eliciting further questions from patients. Overcoming this fear, I began asking. I found there were three ways in which patients responded. Surprisingly, the vast majority of patients told me there was nothing else they needed. This assured me that I had done a pretty thorough job of explaining. The next was with additional questions, which were usually simple and easily addressed. The final way was the rare occasion when a crucial issue surfaced. For example, a patient visiting for high cholesterol and blood pressure, when asked about additional questions, abruptly said, "If you really want to know why my blood pressure is up, it’s because I’ve been having rectal bleeding." Such revelations could be central to averting colon cancer or providing an early diagnosis and could have been missed without this final question.
Saying "Thank you," to patients, was initially a mystery to me. I thought, why should I say thank you to a patient? The reason is now clear. "Thank you" is an expression of gratitude, for their support, presence and cooperation. In addition, showing gratitude is one of the most powerful intentional actions we can take to improve that 40 percent of their happiness.
The beauty of including these simple practices is in the results they create. Beginning and ending visits focusing on the patient facilitates their empowerment and greater sense of satisfaction. This translates into a more gratifying physician experience and, believe it or not, fewer phone calls.

Further details can be found in Dr. Beeson’s book, "Practicing Excellence: A Physician’s Manual to Exceptional Health Care." To obtain your copy visit http://www.studergroup.com/.

Community, Collegeality, Communication

What is often lacking today in our professional lives in a sense of community. When I first started practice in 1983, physicians would meet daily in the cafeteria and spend time talking about practice, patients and family. Although this type of interaction still occurs in the Doctor's lounge, many of the younger physician are not part of this socialization. With the stress level that exists in medical practice, mutual support among colleagues is essential.

The goal of our medical staff leadership is to create a environment where all physicians feel comfortable and supported. Through improved and more consistent communication, we will move closer to accomplishing this result. Please feel free to share your thoughts and ideas with your department chairman, vice chairman, medical director and your officers of the medical staff. especially me!!! BL

I am honored to begin my term as President of the Medical Staff. I have chosen a theme—“Together, Transforming, Tomorrow”—which represents a commitment to cultivating an even stronger physician community than already exists at Advocate Good Samaritan Hospital.
This transformation began taking place under Dr. Kee Shin’s leadership, as evidenced by this year’s Physician Satisfaction survey. It shows that our medical staff rated the hospital at the 90th percentile nationally as compared to the 66th percentile last year.
We will begin our year with a leadership development retreat for the current officers, chairman and medical directors. The retreat will focus on physician involvement and medical staff goals. We will also look at the new Joint Commission guidelines for peer review. Investing in the development of our leadership empowers us to be more effective in guiding our future. As a result, we will have a more meaningful impact on the environment in which we practice.
As many of you are aware, Good Samaritan has earned a number of awards over the last several years. These awards speak to the high quality of care provided by our hospital and
medical staff. Recently, Dr. Shin and I were proud to accept another, the Advocate Gavel. It represents Good Samaritan as the top performing hospital in the Advocate system over the
last year. Good Samaritan keeps the Gavel for the next year and hopefully longer, as we are actively involved in the journey of continued excellence. Looking at the bigger picture, it is my wish that every physician continues to feel they are part of the great work.

Honor of Providing Care

One night a phone call came to inform me that the husband of a long time Advocate associate had suddenly died. I have known this employee for over 20 years and worked with her, side by side on numerous occasions. She and her now late husband attended my wedding less the 2 years ago. I was shocked, distraught and left unable to sleep by the news.

As my husband and I lay in bed after the call, we stared at each other and hugged each other, not really sure of how to take or react to this tragic news. Her husband was similar in age to us. We thought “too young to die.” All we could think of was how can anyone come to terms with such a loss.

After a long silence, my husband, in the darkness, asked me a question. “If you knew you only had one day to live, how would you spend it?” I paused and thought. I answered. “ I would spend it with our family laughing, crying and talking about life, love and things that mattered. I’d take them with me to places that mattered. I’d share as much as I could and tell them how much they mattered and how much I loved them.”

I turned to my husband and asked “ how about you?” “ My answer is very similar to yours.” He went on and enumerated who he would spend time with and how. Then he added, “One thing I’m sure of, is that I wouldn’t be going to work.” I chimed in “I guess I wouldn’t either.”

Silently lying there, I began to think even more deeply. I asked myself, “ How do I know this is not my last day?” And how, in spite of not knowing the answer, can I get up and go to the hospital every day? Was I wasting my precious time going to work each day?

This came as a very tough question.
Again after thinking for an even longer time, I realized that I would probably never know when my last day was coming, so yes I need to treasure each day, but is there is something more?

Another answer then came. We and all our colleagues that work in health care, have a special gift outside of ourselves to share. By doing what we do, we can make big differences in the lives of people. Differences that help then live longer, safer and healthier. This translated into more time for them to spend with people that matter to them. This special space in which we work is a sacred space that enriches our own lives and gives us a special sense of peace. If we hold on to this we have the strength to see beyond human tragedy to greater success.

So I realized that yes I should hug my family harder and longer. I should listen to them more alertly and be more responsive to their needs and they to mine, but not forget or neglect the wonderful role we play in healthcare and go with it.