Yesterday, my friend Steve’s post prompted me to write about finding and protecting time for patient engagement. Specifically, I wrote about how we, as healthcare leaders, need to change our metrics, priorities and reward structures for people providing patient care. I also wrote about finding time in the patient flow for providers to be empathetic; to meaningfully engage with patients. I’m lucky to have such forward-thinking friends. Today, in a discussion spanning Facebook and comments on this post, my friend and healthcare culture champion, Liza Bernstein pointed out two very important things: actions are more powerful than scripts, and empathy within healthcare organizations matters too.

I’ve been wanting to build on this theme of making room for empathy, so we’ll call this the third in what appears to be an ongoing series.

I’ve seen many healthcare organizations put a lot of time and effort into scripting customer service interactions. There are several problems with the scripting approach. Chief among the weaknesses is how transparently impersonal scripting is. For instance, one of the things I see scripted quite a bit is listening to someone and then repeating their line back to them in an attempt to fake active listening. The idea works, it's the execution which usually comes off as lack luster, since it's scripted, people tend to repeat back exactly what they heard.

I outlined that root of this problem in my last post - when time is short and demands and rewards focus on number of patients seen per day (or hour) rather than experience, guess what gets cut? The script. Or, at least when lines are delivered, they are done so unconvincingly.

We’ve all had that experience - the one where the telephone rep rambles off a line at the beginning of the call and you can tell they’ve said it a million times. We see it in restaurants, and with airlines. Really? You are over the moon that I chose to fly with you today? Perhaps I’m being a tad cynical. But the point is, we all can tell when someone is feeding us a line, so why would we think our staff will deliver a line any differently? Well, as it turns out, there’s a key to all this: stop scripting.

Scary, right? What if someone goes rogue? What if they say something we haven’t approved? And that is exactly the point. It turns out, people are generally better at coming up with their own wording and actions than those we script for them. At one large health system I worked with, we found that suggesting phrases and actions was a good start. Although, ultimately, we had to give people the latitude to do what they thought was in the best interest of the patient. Sure, that means giving up some control, but the rewards far outweigh the risks.

A lot of organizational culture is about what organizations and leaders reward. As I mentioned previously, if we ask staff to repeat customer service phrases, but pay and reward based on something else, we are sending mixed messages. Sometimes the messages we send are loud and clear, even if they are the wrong messages. I remember one hospital I consulted in years ago where there were the message to employees was clear. If employees deviated from the process established to promote throughput in the OR, it meant a trip to the boss’s office for a reprimand. It’s nice you want to hold that patient’s hand, but we’ve got other cases stacked up, and that’s not what you are here for. That’s a pretty extreme example, but illustrates how we can build cultures which actively discourage empathy.

The right way, it turns out, may be in doing exactly the opposite of the hospital I referenced above — we need to reward the mavericks and promote the kinds of patient-centered actions we are trying to script. For instance, at Bon Secours, twice a week, our daily huddles featured stories about staff going above and beyond. We sought those stories out. The point was two-fold: First, reward the independent action someone took. My co-worker, so-and-so parked a patient's running car because they ran into the ER to find a family member… or Nurse Smith called me after my visit just to ask how I was (sometimes it’s the small things). The second reason we shared those stories was to model the behavior. In reading them across the entire organization, we told every other employee you are allowed to do things like this, in fact, we want you to! That’s how you protect mavericks.

Now, just imagine if we paid bonuses based on those kinds of stories rather than raw productivity? But that’s another post for another time…

The second part of Liza’s comment plays directly off of this idea of independent, empathetic action I’m proposing we protect and reward. Liza suggests there is something very important about being empathetic to those who work in healthcare. It turns out people value autonomy in how they conduct themselves. In his excellent TED talk, Barry Schwartz discusses what happens when we strip employees of practical wisdom, or latitude to think for and conduct themselves within reasonable parameters. (Hat tip to Lisa Fields for hipping me to Mr. Schartz’s work). In a paradoxical way, isn’t valuing and rewarding people for their independent empathetic actions a form of empathy itself?

What I mean is this: if we care about how the work of delivering care is done, we need to allow the people who were drawn into the field because they care, enough room to actually be caring. And, we need to encourage, reward and protect them for caring.