Even if they’ve never stayed at a Motel 6, most people remember the hotel chain’s iconic ads that ended with Tom Bodett’s friendly reminder, “We’ll leave the lights on for ya.” While hospitals certainly always “leave the lights on” for patients in need, “come back and see us soon” is not something you’ll typically hear from hospital staff.
The emphasis on reducing preventable hospital readmissions has focused a spotlight on effective transitions from hospital to home. When this process falters, the potential is high for medication confusion and error, as well as unnecessary hospital readmissions. Aside from the financial penalty to hospitals, there is a human cost in adverse patient experiences and clinical outcomes.
According to a Joint Commission Enterprise (JCE) report, three major root causes appear most often in medical literature for ineffective care transitions and hospital readmissions: breakdowns in communication, patient education and accountability.
Connecting with patients is key
Central to avoiding these breakdowns in care is the ability to effectively, compassionately connect with patients and their families throughout their stay. Patients often feel overwhelmed, emotionally stressed and/or intimidated by the complexity of the discharge process. This stress often hijacks patients’ ability to effectively listen or follow what is said. These patients are at higher risk of falling through the cracks in the health care system.
According to Jodi Halpern, MD, PhD, a psychiatrist and faculty member in bioethics at UC Berkeley, “With empathy we can connect with our patients, we have an understanding of what it is they are going through, and by acknowledging their emotional state and listening attentively, we can engage our patients and empower them to be proactive and in charge of their health care.”
How a new visitor changed everything
From my years as an inpatient rehabilitation hospital executive, I remember one patient particularly well. This 82-year-old woman had suffered a stroke, and the acute care hospital referred her for inpatient neurorehabilitation. However, the patient was determined to go home. Over the patient’s objections and with a power-of-attorney, the patient’s family transferred her to my facility.
During the first two days of her stay she refused therapy, which was her legal right. Continued therapy refusal was grounds for discharge to a lower level of care under Medicare rules. That could put her at risk of clinical complications. I sat down next to the patient’s bed with her daughter and noticed a picture of a cat on the table. As I spoke with her about the cat, she began to cry. The daughter said her Mom and that cat were inseparable.
We spent some time discussing our pets (I’m a dog person). Then I suggested that the daughter start bringing the cat in to visit her Mom. Soon after that the patient was participating in therapy and smiled for the first time since she arrived.
“Empathy is more than sympathy. It involves the ability to tune into others and sense what they are feeling.” This quote comes from the book by Alan Alda, If I Understood You, Would I Have This Look on My Face?: My Adventures in the Art and Science of Relating and Communicating, which was highlighted in a Stamp & Chase blog post on December 8, 2017.
If our goal is to improve care transitions, empathy has to be one of the competencies we recognize and nurture among our teams. Following are several specific recommendations from Stamp & Chase’s CAREmunication® skill-building curriculum and our work with leading health care organizations across the country.
Start building rapport with the patient and family immediately on admission
Many case managers advocate the strategy of starting to plan for discharge the day of admission. Perhaps the better recommendation is to start building a relationship and encouraging open communication about discharge immediately. Caregivers report that when they quickly build trust, it improves both the care experience and outcomes for the patient.
Ask questions that draw out the patient’s real concerns, fears and points of confusion
“Do you have any more questions?” That’s the way we usually inquire about additional patient or family concerns. The problem with that closed-ended, yes/no question is that it rarely encourages a real conversation. A better approach: “What other questions or concerns do you have that we should talk about?” This open-ended question is an invitation for the patient to share their issues and questions that could potentially be standing in the way of an effective discharge.
Recognize that message delivery is only one half of effective communication
Members of the care team usually have lots of information to relate – and forms to sign – prior to discharge. When staff share this barrage of information near the end of the stay, patients often feel overwhelmed and confused. Active listening is essential to achieve true empathy, which is at the heart of conversations that characterize effective transitions.
To reduce avoidable hospital readmissions, hospitals often turn first to tactical strategies such as “meds-to-beds” and post-discharge appointment scheduling. These types of programs are often necessary. But they alone are rarely sufficient to help patients transition confidently home or to another level of care. How we connect to patients and empathize with their real concerns and feelings provides a foundation that makes all care transition strategies more successful and sustainable.
Stamp&Chase offers up-to-date, effective strategies for healthcare organizations to build high-performing teams and improve patient experience. To learn more about our approaches based on empathy and appreciation, send us a message, download one of our white papers or check out Burl Stamp’s book “The Healing Art of Communication.”