Please note that the opinions in this piece, which was co-written by Patient Experience Consultant Micah Solomon, President, Four Aces Inc. and Hope Greig, FACHE, Mayo Clinic Patient Experience Operations Administrator, are of the authors, and do not necessarily represent their respective institutions.
Even in normal times, let alone in the face of today’s extraordinary added stressors, medicine is a heads-down endeavor, a concentrated, science-driven quest for healing. No patient comes to a healthcare setting primarily for the touches of hospitality they’ll find on offer. They’re not here to enjoy the thread count of our clearly non-Egyptian bedsheets, or to test the local knowledge of the concierge desk, or to try a slice of the cafeteria’s not-so-famous cheesecake.
Of course not. They’re here for the medicine.
Nonetheless, embracing a hospitality mindset can make that medicine go down a whole lot smoother. The fact that “hospital” and “hospitality” share the same root [the Latin hospitalis] deserves to be treated as more than a historical footnote. When we conceive of healthcare as offering “hospitality with healing” (or, to keep the priorities in the right order, “healing with a touch of hospitality”), life becomes better for everyone.
At least that’s what the two of us believe, and what we’ve seen proven in the course of our professional lives—Hope at Mayo Clinic, where she touches most everything related to improving the patient experience, and Micah as the lead patient experience and customer service consultant for his consulting firm, Four Aces, Inc.
With so many other imperatives tugging at us for attention, let’s get right to the hot spots. We’ve distilled what bring hospitality to the healthcare patient experience down to seven focal points that spell (with our hats tipped to Aretha Franklin and Otis Redding) RESPECT:
S: Start on the right foot.
P: Part well.
E: Empower everyone to help.
C: Cue that you care.
T: Clarify the Timeline.
Before we go any farther, we want to stress that the responsibility for living up to our RESPECT framework cannot fall only (or even predominantly) on the frontlines of healthcare. While the proximate manifestations of the RESPECT framework will be seen in the actions of those who touch patients directly, the ability of these employees to succeed here depends on the institution and its leadership. Only in the face of institutional support for a mindset of hospitality, and only with support for the wellbeing of the employees who are tasked with delivering it, coupled with the sufficient staffing, breathing space and recognition–the respect, in fact–that hospitality requires, can such a framework have meaning.
R: Recognize (Element 1)
Patients and their loved ones often arrive in our orbit bearing a heavy burden. Recognition makes it clear that this burden is acknowledged and shared.
In the healthcare context, recognition means conveying that “I see you, and I recognize you as an important person to me and to this institution.”
Ideally, this light of recognition will shine on every patient, and every patient’s loved-one, whom we encounter: When a patient nervously calls to schedule an appointment, on what may feel like the worst day of their life, recognition can be delivered by a person on the phone who, instead of sounding like this is the 25th similar call of the day (which it may be), clearly realizes that this call is about your procedure–and for you, that’s all that matters. When this patient meets the technician who will be prepping her for an unfamiliar procedure, recognition can be conveyed by (literally) leaning in, making eye contact, and slowing down to explain the procedure without using jargon, leaving sufficient time for the patient to be heard.
Getting serious about providing recognition comes down to a couple factors:
• Training for reframing: If an employee has had 4500 similar interactions in their career, and 20 already on the day in question, it takes conscious reframing–a skill that can be taught and reinforced in patient experience training–to recognize the uniqueness (to the patient) of the moment at hand, a moment which may seem, on the face of it, routine.
• Modeling by peers: When a new employee arrives in a new environment, they’re going to quickly learn from example that “this is the way things are done around here.” If everyone around them is striving to be “professional”–aloof, efficient, matter-of-fact–then that’s the new employee is likely to act as well.
Telemedicine tip: To give the impression of visual recognition on a video call, look directly at the camera, not at the image of the patient on the screen.
E: Empathize (Element 2)
When patients are worried and confused, or in pain or discomfort, almost nothing is more helpful than an empathetic connection with a healthcare employee or provider. Yet multiple factors can get in the way of employees being able to feel and convey empathy, specifically what psychologists call “situational empathy”:
A nonclinical employee working in a support role may never run into a single patient in the course of a typical day. To compound the disconnection, a large percentage of those who work in a hospital have never been sick to the point of hospitalization, so the feelings that patients (inpatients, in particular) are battling–dislocation, fear, and fatigue–may be as alien to these employees as they are commonplace among the patients they serve.
(What training solution is best to overcome these challenges? We’ve found that re-enacting clinical moments, videotaping them, and having the non-clinical staff view them together with a trainer is a better way to help them empathize with patients and close the disconnect, than a traditional, inevitably cursory, orientation walk-through.)
There are also “empathy destroyers” that telegraph the opposite of empathy, even when the employee involved is actually feeling (and believes themselves to be conveying) empathy:
• Dismissive and degrading language
Saying “Name?” instead of “May I have your name, please?”
Telling a patient, “Please hold,” instead of offering a choice in the matter
Referring to a human being as “part of my caseload.”
Using baby-speak with adult patients: “Are we ready for our bath?” or “Potty.”
• Jargon. Medical jargon unites the healthcare industry via a common language but it can have the side effect of making a patient or a patient’s loved one feel like an outsider, like they’re “other.” It’s important to take the time to translate.
• Neglecting to let the patient know who, specifically, we are. Every one of our patients shares so much of themselves with medical staff; it’s important that employees let the patient and their loved-ones know who we are as well. There are hundreds of job types in healthcare and many require a similar type of uniform or attire; ID badges, notoriously, tend to be flipped over for much of the day. Patients want to know who is helping them–and even more, who is touching them.
• Use the elements at your disposal to convey elements. Not only word choice, but tone of voice, vocal volume, and [perceived] eye contact.
• Keep in mind that environment at the patient’s end of the line may be affecting the patient in ways that they find challenging or that make them self-conscious. Acknowledge such issues when needed, but always in a way that sets them at ease.
S: Start on the right foot. (Element 3)
It’s hard for a patient or their loved-one to recover their equilibrium, and their level of comfort with your institution after they’ve been subjected to an abrupt or uncomfortable beginning to the encounter. Because of how the human memory works, any missteps at the beginning of a patient’s experience will likely form a disproportionate part of the overall impression. This quirk of memory is called the “primacy effect,” the psychological finding that early impressions are, on average, the ones most easily remembered.
Here are also some missteps to watch out for at the beginning of the patient experience.
• Inconsistencies in the training and supervision of volunteers or subcontractors who are helping with non-medical tasks, such as helping patients on and off a shuttle or valeting their cars.
• Confusing signage in the lobby, compounded by employees rushing past the newly arrived visitor in spite of their obviously bewildered “where am I and where am I going?” expression and body language.
• Insufficient or poorly thought-out parking situations, or parking lots that only accept cash; confusing (or nonexistent) directional signage.
• Information desk attendees who continue their collegial chat for some time after a visitor walks up to the counter, implying that the new visitor is an interruption of their day, rather than the reason for it.
The “beginning before the beginning” is important as well. A patient’s experience with us begins before they step onto our premises, via the scheduling experience, website, and the like. Get these right, and it will pay disproportionate dividends in the level of comfort a patient has in entrusting us with their care.
Telemedicine tip: Start off with small talk and getting the technology confirmed as working before diving in to the crux of the conversation.
P: Part well. (Element 4)
As with the start of an encounter, the conclusion of a patient’s interaction with your institution can form an outsized portion of their overall impression, due to another quirk of memory: the “recency effect”—the tendency of the final moment in any sequence to persist inordinately in memory.
Most often, though, the importance of a thoughtful ending is overlooked in healthcare. (At least in human healthcare. As animal lovers, both of your authors have come to expect that when our dog, cat, horse, or fish–okay, maybe not fish–comes home from the vet, we’ll get a call that evening asking how the patient is settling in. Yet when the patient is a human, it’s unlikely the phone will ever ring post-discharge. Instead, while that phone stays silent, the mailbox fills up in its place: with survey or two, multiple bills, and, perhaps, a fundraising attempt.)
What if the ending of every healthcare encounter were choreographed to play a positive role in the patient’s overall experience? What if the patient were walked to the car by someone [volunteer or employee] trained in the finer points of hospitality? (Remember: This often-mishandled moment may literally be the patient’s final onsite touchpoint at the institution.) What if a physician, nurse, or perhaps a non-clinical employee followed up by phone and email with every patient after discharge? What if patients were mailed self-explanatory bills, lacking in surprises and mystifying jargon? We’d argue that making any of these improvements is going to give you a lot of memory bang for your buck, facilitating positive memories that can go a long way toward building and supporting your institutional reputation.
E: Empower everyone to help. (Element 5)
For well over a century, the central operating philosophy at the Mayo Clinic has been, “The needs of the patient come first.” [JC1] Seven simple words that can be heard throughout the day on all of our campuses. At the Mayo Clinic, every employee learns early on–during employee recruitment, orientation, and onward–that the needs of each patient come before everything, including hierarchy.
Every housekeeper, cafeteria worker, administrative employee, as well as every clinical employee–is empowered to assist patients and their loved-ones, if an employee overhears or witnesses something that is troubling to or troubling for someone we serve. For example, a housekeeper who encounters a family member who’s distressed about their loved one’s treatment has the power and the permission to provide comfort and assistance, either directly or by bringing the situation to the attention of someone with the resources and training to help the person in need.
For doing so, this housekeeper will be respected and even celebrated rather than being given a hard time later on because they ended up lacking in the number of bedsheets changed out that day. Furthermore, the housekeeper can be reassured that as long as they do what they believe to be best for the patient, they don’t have to fear repercussions, and will be supported by the institution for the choice they made in that situation.
C: Cue that you care. (Element 6)
A patient or family member gathers much of their impressions from verbal and nonverbal “cues to caring” and “cues to uncaring” that we may not even be aware that they’re receiving.
Cues to caring (and uncaring) include:
• Use of language: Language is one of the basic cues that reveals whether we do or don’t care about a patient or their loved-ones. Yet our language usage at work tends to be catch as catch can. By failing to consciously consider word choices, many negative language cues can come across to patients throughout the day. To bring the subject into conscious focus, our training sessions include time spent discussing the words and phrases that are likely to be off-putting to patients and their loved-ones, and suggesting superior replacements.
• “Words without words”: tone of voice, body language, and more: shuffling papers related to the last patient even after calling a new patient up to the registration desk; using a tone of voice for that telltale half-second at the beginning of a phone call that cues to a patient they’re perceived as an interruption or inconvenience; rushing a patient rather than slowing down to ensure they understand the medical information we’ve just shared.
• Visible exclusions: When administrative and clinical staff avoid eye contact (instinctively or out of habit) with non-professionals in the hospital, acting as if the latter–the outsiders–are invisible.
• Architecture, design, and furnishings: At its best, an institution puts thought into the cues it conveys via its buildings, design choices, and furnishings. A striking example was Mayo Clinic’s decision to locate the children’s cancer ward in the center of one of its campuses, to make the statement that this oft-dreaded disease is not something to be hidden outside of the general view of visitors. Likewise, because Mayo Clinic offers bariatric surgery, it has plus-sized chairs scattered throughout its waiting rooms. And because limited seating in an exam room can prevent family members from being comfortably accommodated, Mayo Clinic designed and manufactured a hybrid couch/chair that can seat a grouping of family members who are accompanying their loved-one to an exam or consultation.
The government-mandated introduction of EMR [electronic medical records] has brought a host of “cues to uncaring” in its wake. Understandably so: the burden on attention demanded by this daunting development poses a major challenge indeed. An initial patient consultation that takes place while the provider is focused on inputting diagnostic codes and dismissing endless screen prompts is both frustrating for the provider and off-putting to the patient. Various solutions have been proposed, and let us offer one more: a modest low-tech approach that we’ve seen taken by some practitioners who are intent on wrestling their bedside manner out of the claws of the EMR beast: Leave your screen dim. Get out a long, yellow, lined note pad and take notes as if we’re still in the halcyon pre-EMR days. Only after the patient is out of view, key everything into the EMR. This way, a provider need no longer feel torn between accurate entry, quality listening, and appropriate eye contact.
T: Clarify the Timeline. (Element 7)
When patient-provider communication breakdowns are studied and categorized, a high percentage come down to issues of time. When experiencing the unknown, an unexpectedly long wait can seem like an eternity, whether in the lobby, waiting room, exam room, or in the interval before receiving results.
Communicating estimated–even roughly estimated–wait times improves a patient’s satisfaction. Oftentimes, though, employees are reluctant to give out such estimates, for fear that their kindness will come back to bite them if an estimate proves to be overly optimistic.
Yet, communication is essential, or patients will make their own guesses, which may be wildly off the mark due to their misreading of the situation. For example, in a Med-surg unit, inpatients rarely understand that the doctors are frequently off-premises. So when they ask a nurse to convey a question to their doctor, they’re going to expect a speedy response time based on the mistaken assumption that the doctor is on hand to provide a timely answer. Remember: Even though you have limited ability to predict the future, your patient has even less.
The © to this article resides with Micah Solomon, President and Lead Patient Experience Consultant and Training Designer, Four Aces Inc. and Hope Greig, FACHE, Mayo Clinic Patient Experience Operations Administrator.