Perspectives on the Acute Care Continuum

The Acute Care Continuum is the integration of urgent, emergent, inpatient and post-discharge care of patients with acute medical conditions. 

Storytelling as a Tool for Rebuilding a Patient-Centered Culture

1/20/2014 8:29:50 PM | 1 comments

Last year, 2013, was a strange one for healthcare. With full implementation of the Affordable Care Act looming, hospitals across the country were laser-focused on acronyms and numbers. Discussions of TAT-D, LOS and HCAHPS dominated department meetings and huddles. So much was riding on these metrics that some departments took to posting them in the break room — or even the bathrooms — to keep their teams focused on quality goals.

Now don't get me wrong. Better, safer, more affordable healthcare is certainly a worthy aim. But this focus on numbers also comes at a price, because it's been easy to lose sight of why we got into healthcare in the first place. Too often, we've forgotten that behind all these measures and metrics are human beings — patients and families — going through some of the most stressful, painful and profound experiences of their lives.

To most of us, this hyper-focus on the numbers feels unnatural. After all, we're healthcare providers, not statisticians. We went into medicine, nursing, healthcare and so on because we felt a certain calling to relieve the suffering of others.

At CEP America, we've decided that 2014 is going to be the year we enhance our focus. Going forward, our motto is, "It's all about the patient." Having survived the most turbulent phase of reform, we're hoping to build on a patient-centered culture and bring into focus what really matters.

But of course, that's easier said than done. The pressures of reform may be more familiar now, but they haven't disappeared, and it's easy to get discouraged. I sure was.

Then, a few months ago, I had an amazing experience at one of the facilities I work with. I feel it held the basic ingredients to help providers to reconnect with patients and families and to rekindle their joy and sense of mission.

I was attending an emergency department meeting at Pomona Valley Hospital Medical Center near Los Angeles. As you might expect, metrics and measures were on the agenda. But after the discussion of patient satisfaction scores concluded, something happened that completely changed the tone of the meeting.

Dr. Phil Piccinini, CEP America's regional director for the Los Angeles area, introduced the concept of the "noble cause." He pointed out that no one in the room went into emergency medicine to make "tons of money" or to "have a big house and drive a fancy car." All of us felt a certain calling to serve.

Next, Dr. James Kim, ED medical director, reminded us that as ED providers, we have the opportunity to touch 25 to 30 people and their families every day we come to work. The clinical care we provide eases their physical pain, but it's the human connection that truly makes a difference. By reaching out and connecting, we help to ease patients through some of life's most stressful and frightening moments.

To illustrate, Dr. Kim told the story of a five-year-old Hispanic girl whom he'd recently diagnosed with kidney cancer. He was at the bedside when he broke the news to the family. He told the family their daughter would need follow-up immediately with pediatric specialists. Naturally, they were devastated.

At that moment, Dr. Kim reached out to them and asked if they wanted to pray. They said yes, and so they all prayed together in the hospital room.

A month later, at 11 p.m., Dr. Kim was at home and received a text from an unknown number: "Thank you for taking care of our daughter. She's on her way to recovery, and it all started that night with the prayer."

His story moved me deeply and silenced the room I thought of stories from my nursing career, how certain moments with patients stuck with me years later. How my daughter, a new RN working in CCU/CVICU, comes home with similar stories left and right. Indeed, talk to anyone who works with the acutely ill, and the stories just come spilling out.

Here's another example. I recently went to a site to deliver an operations assessment. The team was struggling with their metrics, and everyone was bracing for bad news. But then the medical director shared a story that transformed the whole mood of the meeting.

The MD had worked the night shift before the meeting and had started his shift with a Code Blue in Labor and Delivery. Naturally, as he responded to the code, he prayed a visitor had pushed the Code Blue button in error. That was not the case; the room was full of practitioners all shouting orders and true chaos was occurring. The physician took immediate control of the situation and successfully resuscitated the new mother.

The doctor returned to the ED. During the remainder of his shift, two more patients coded and were successfully resuscitated. The son of the last patient wanted to thank the physician for saving his father's life and also to tell him his father remembered the physician as a child. This physician, you see, had grown up so poor that he and his family lived in a neighbor's garage. As it happened, the third patient had been the long-ago garage-owner, the man who had been kind to the doctor's family when they needed it most.

That story really took the edge off the meeting. That team was still concerned about their numbers and keen to improve. But I have to think they left with a renewed sense of meaning and purpose.

So where am I going with this? Well, I think that sharing our stories — and refocusing on our noble cause — could be a powerful tool for rebuilding a patient-centered culture in our hospitals and emergency rooms, not to mention boost our job satisfaction.

What if we started every shift huddle with a story? We've certainly got plenty to share. It doesn't have to be anything big and grand.. Just a human reminder that we have the opportunity to touch lives every day. By thinking about the face behind the numbers, we might just be able to improve operations and meet those performance metrics required by state and federal regulators.

So let's say goodbye to 2013, the year of metrics and acronyms. They've been helpful, but they're not the real reason we come to work every day. It's human interaction that leads to truly compassionate, high-quality care. And the stories of those interactions are just begging to be told.



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Perspectives on the Acute Care Continuum
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