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, unlike the hospitality industry, “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, unnecessary diagnostic tests and preventable emergency room visits or inpatient readmissions. Aside from the financial penalty to hospitals with higher patient readmission rates, there is a human cost in adverse patient experiences and clinical outcomes.
According to the Joint Commission Enterprise (JCE) report “Transitions of Care: The need for a more effective approach to continuing patient care,” there are three major root causes mentioned most often in medical literature for ineffective care transitions: breakdowns in communication, patient education and accountability.
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, which hijacks their 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.”
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, which could put her at risk of clinical complications. I sat down next to the patient’s bed with her daughter in the room and noticed a picture of a cat on the table. As I spoke with her about the cat, she began to cry and the daughter said her Mom and that cat were inseparable. We spent some time discussing our pets (I’m a dog person), and 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 truly connect with patients and 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 the patient and family quickly gain confidence in and trust the care team, it improves not only the care experience but also outcomes and compliance.
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 often seems to be asked rhetorically and 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 be signed – prior to discharge. When this barrage of information is thrust upon patients near the end of their stay, it is overwhelming … and rarely understood. Active listening is essential to achieve true empathy, which is at the heart of conversations that characterize effective transitions in care.
To reduce avoidable readmissions, hospitals often turn first to tactical strategies such as “meds-to-beds” and post-discharge appointment scheduling. While these types of programs are often necessary, they alone are rarely sufficient to ensure the patient is transitioned confidently and comfortably home or to another level of care. How we connect to patients and empathize with their real concerns, fears 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.”