Viewing entries tagged
patient experience

What if … there was a scale for patient-identified outcomes?

pain scale

After every knee surgery I’ve had, there’s this strange period where you float in and out of awareness. Those moments where my eyes are open rearrange themselves in time, like one of those puzzles where you have to slide a tile out of the way to make room for another one. But one of the constants is the first question: “How’s your pain level? On a scale of one to ten, how do you feel?”

The patient pain scale is has been called the fifth vital sign. Today, we often see the scale as a range of faces — from grimace to smily —on the walls of inpatient rooms. Asking about pain, on a scale of one to ten, is a pretty good assessment of how someone is feeling in that moment.

Unlike pain, we don’t have a great way to indicate our true goals, the outcomes we want. In fact, the term outcome has different meanings depending on our frame. To a provider, a successful, safe, infection-free surgery could reasonably constitute a great outcome. Oncologists may see the completion of radiation therapy, particularly when a patient is in remission, as a successful outcome.

But what about skiing?

For me, being cleared to ski has always been the canonical milestone after knee surgery. Six months, that’s the minimum amount of time which must pass, regardless of surgical site healing or amount of physical therapy, before someone can ski after an ACL repair. Making those first turns, hopefully on hollywood snow on a blue bird day, is what I call a successful outcome.

When my dad and I stood at the top of Vail Mountain, in February 2012, we hugged and cried. That was the end of being a cancer patient for him. That milestone, skiing again, was his goal during treatment.

Goals vs Outcomes

Are goals and outcomes different? I suppose, on some technical level, yes they are. If you believe in dictionaries and particulars and whatnot. Still, fundamentally there’s an important connection.

Rehab therapies have been practicing goal attainment for a long time. When you start PT, a therapist is likely to ask: “so, what activities do you want to be able to do again?”

That’s an important question for two reasons. First, it’s part of motivational interviewing. The patient is establishing their own goal, rather than being told what to do by the provider. It’s like deciding I’m going to eat better vs being told by your doctor you need to diet and lose 20 lbs. We’re more likely to work towards choices we make ourselves.

Secondly, it builds an important bond between the provider and the patient. If I tell you I want to ski again, you know skiing is important to me. You know a little about me now too. I probably like adventure sports and travel. (Actually, I just like the aprés ski part). Now we’re working towards something together.

why scales matter

The nice thing about a scale is it allows for a range. Our idea of ideal goals for outcomes change depending on our circumstances. If you arrive at the hospital via ambulance, during an emergency, your goal may simply be to receive the best clinical care possible - to have your life saved.

After a week-long inpatient stay, your goals may be to return home. It may be to attend your child’s wedding, or to hold your grandchildren. It may be to have your own children.

The circumstances around a visit might also effect our answer - type of visit, type of doctor, check up vs chronic vs acute.

Having a scale allows us to reframe our goals based on our health circumstances.

The patient goal scale

What if there was a patient goal scale? On a scale of save my life to climb Mount Everest, what are your goals? What moment or activity are you most looking forward to after treatment or discharge? And what would happen if that scale were as visible as the pain scale to both you and your doctor? Would it help build a deeper connection between you both? How might your treatment plan be affected, based on your goal, your definition of a successful outcome?

I polled twitter and Facebook about the idea of goals and what matters:

I’m no graphic designer, but it might look something like this…

goal scale

What if…

  • it was in every waiting room, and you could ponder your goals and identify them before each visit?
  • it was on the bedside of every inpatient room, and you could write out your goal, so everyone entering your room knew what you were working towards?
  • there was an app with examples from others and simple questions to help you identify goals?
  • and you could share your outcome goals with your doctors, friends and family?

How else might this work?

Orthopedic Surgeon and healthcare social media expert, Howard Luks, MD, wrote a blog post pondering a similar theme. Its well worth a read to understand the physician’s perspective.

What would you list as your outcome goal?


Edited to include this absolutely brilliant idea:

From Elsewhere: Lean Blog Podcast & Making room for Empathy

One of my favorite phrases is making room for empathy. Room for empathy is about giving staff the time in their workflows to be compassionate and to deliver care which is not only clinically competent but emotionally uplifting as well. But that’s hard to do.

It’s hard because the work of providing care is increasingly complex. We’ve got EMRs with screens of data. We’ve got sign off sheets, time outs, forms, papers, phone calls, results, and, frankly, CYA work. Those things take time. So what get’s cut? Empathy. We cut out the simple things like walking someone to their destination rather than pointing. We cut out sitting with someone who looks concerned (so we look at our shoes or iPhones in the hallway). It’s a problem

There are two main ways to make more room for empathy. First, we could hire more staff. More staff (nurses, care givers, techs, managers, administrators even) mean more bandwidth. Many hands make light work. But we probably aren’t going to get more staff. Reimbursement is dropping, and there is a push to be more efficient. Hospitals are trying to see if they could survive on Medicare reimbursement rates. (Remember, Medicare pays, on average, about 80% of what treatment costs, so we have to cut about 20% of cost out of hospitals).

The other way we can make room is by eliminating work which does not add value. Productivity gurus say we should work smarter, not harder. I’m increasingly interested in the Lean methodology as a framework for evaluating how we do our work and determining if it adds value, or simply takes up valuable time. So, I’ve been trying to learn more about Lean.

I found Mark Graban’s Lean Blog which led me to his Lean Blog Podcast, a regular, downloadable audio show about Lean. In the most recent episode, Dr. John Toussaint of ThedaCare, discusses the importance Lean methodologies in healthcare.

It’s a fantastic listen and should inspire anyone looking for ways to make room for empathy and return the focus to patient and staff experience.

In Healthcare, Experience Matters

A few weeks ago I had the privilege of being asked to write a guest blog post for Odom Lewis, a healthcare communications staffing and recruiting firm. Angelia from Odom asked me to comment on Dr. Bridget Duffy's ever-inspiring presentation from the 2009 Gel Conference. Some may recall that I wrote about Dr. Duffy's talk here on this blog in June 2010.

In short, since most of us are not doctors, or may not even be conscious while we are being attended to, it is very hard to gauge the quality of the clinical attention we are receiving. However, every person has the ability to gauge their healthcare experience. When providers make the patient experience a strategic goal, everything else will follow: clinical outcomes, revenue, market share, etc.

For most of us, auto mechanics are a bit of a mystery. The oil light comes on, we drive to the dealership, they work some voodoo and we drive away under the impression that things are running smoothly under the hood. Unless you have the know-how, there isn’t a way to verify the quality of the work that is done. That is probably why savvy dealerships started offering fancy waiting areas – coffee, danishes, flat screen TVs and high speed Internet. If we can’t judge the craftsmanship, maybe we’ll make our service decisions based on the waiting experience. The interesting thing is that medicine is not much different.

Want to read the rest? Head over to the Odom Lewis blog.

Code Lavender - making the patient experience a strategic goal

"Most patients want the high tech and a great quality outcome, but they can't judge the quality of the [treatment] they can judge the quality of the experience..." - Bridget Duffy, MD This inspiring video came to my attention by way of Dr. Howard Luks. Every time I watch it - I have done so several times - I become more inspired. Dr. Bridget Duffy, the Chief Patient Experience Officer for the Cleveland Clinic (how great is that title!) presented this talk at the Gel Conference. Dr. Duffy makes the case for elevating the patient experience to the same level of importance as clinical outcomes.

There are two concepts in particular that resonate with me from this talk. The first occurs around 21:45 when Dr. Duffy talks about "Code Lavender". In her words, TV medical dramas have made us all familiar with a Code Blue, a patient in cardiac and/or respiratory arrest. A Code Lavender is when someone is emotional arrest - a patient, visitor, doctor, nurse, anyone in the hospital. Calling a code Lavender means that "everyone in the hospital stops and sends healing intention or prayer..." It is a powerful concept.

The second point that I find especially apt is an overall theme of the talk: creating a meaningful, positive, healing patient experience is the most important strategic goal a provider can have. "If you focus on that, [hand washing, clinical outcomes, quality, performance improvement] will come."

At the end of her talk, Dr. Duffy slips in a key part of this plan, "listening to their needs." I recently had cause to say to someone "I'm working with a patient to resolve a concern they have, this is the best part of my job, social media is just a way to get there." Using these real time tools to connect with patients and improve their experience is truly what #HCSM is about to me. I am fortunate to work for an organization that has made experience a strategic goal. I get to see every day the impact it has.

Bridget Duffy at Gel Health 2009 from Gel Conference on Vimeo.