Your Patient, Your Customer

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By Jennifer Larson, contributor

August 11, 2014 - Some hospitals are adding flat-screen televisions, wireless internet access and gourmet food options with 24/7 room service to convince health care consumers to choose their facility over a competitor’s. Many more are asking nurses and other staff to take a fresh look at how they can provide personalized care that improves patient satisfaction scores.

So, is the health care consumer movement changing nursing--in a good way?

Experts say that good nursing practice is good nursing practice, regardless of where it’s delivered. And

in this context, excellence in nursing care must be accompanied by a positive attitude and focus on the patients’ needs.

“The most beautiful physical layout in the world cannot fix poor attitudes by staff,” said Kiki Orski, RN, MBA, founder of Peak Performance Consulting in New York. “Nothing takes the place of kindness, courtesy and respect.”

Health care consumers are still patients 

Does the phrase “health care customer” or “health care consumer” sound strange, or a little off-putting? Health care indeed is a business, yet many aspects differ from the regular business world.

Christina Dempsey: Small changes can improve patient satisfaction scores.
Christina Dempsey, RN, MSN, MBA, said small things like sitting down and making a connection with patients can improve the patient experience.

“While patients are definitely consumers of health care, nurses do not typically view their patients the same way you would view a shopper at a retail store,” said Christina Dempsey, RN, MSN, MBA, chief nursing officer for Press Ganey. “Nurses who provide exceptional patient care are much more focused on the quality of the patient experience than a score or, frankly, the reimbursement.”

“’Consumer’ doesn’t have to be a bad word,” said Deanna Frings, director of learning and professional development with The Beryl Institute. “It’s about putting it in the right context.”

That means always putting the patient at the center of everything that you do--and what nurses do best. That’s what this type of customer service is about, said Beth Ann Swan, PhD, CRNP, dean of the Jefferson School of Nursing at Thomas Jefferson University.

“It’s going to be the nurse delivering the care in that context,” she said.

And the setting shouldn’t dictate a higher or lower level of customer service.

“Nursing practice should be consistent across the board and across the country,” said Nancy Brook, MSN, RN, CFNP, who works as a nurse practitioner for Stanford Hospital and Clinics' Orthopedic Tumor Surgery in the San Francisco Bay Area. “VIP should not really be a word that changes how we provide care or make clinical decisions.”

Is the health care customer always right? 

We’ve all heard the old adage, “The customer is always right.” But does this apply to health care customers?

BethAnn Swan: Nurses must keep health care customers safe.
Beth Ann Swan, PhD, CRNP, said there is often a healthy tension between what a patient wants a nurse’s professional responsibility to provide the safest care.

Nurses may have years of education and experience that their patients may not have.  Nurses also have the unique opportunity of spending time with patients, learning about their families and support systems and their abilities to handle the management of their own health.

“Nurses are in a good place to look at the interest of the person as being at the center of their care, but also acknowledging there’s going to be this healthy tension that might exist between what the person wants and needs and our professional responsibility or our organization’s responsibility to provide safe care for that person,” said Swan.

Author and consultant Micah Solomon wrote in a December 2013 column for Forbes magazine, “The customer isn’t always right. But you want to make her feel like she is.” In health care, that means, once again, remembering to put the patient at the center of your efforts.

At Walnut Hill Medical Center in Dallas, being patient-centered means being willing to really listen to a patient while he or she expresses concerns or fears or opinions--even calling in a leader from the executive staff, if need be.

“They just want to be heard, and a lot of times it’s just sitting there and listening to them and letting them get it off their chest,” said Cory Countryman, the hospital’s chief executive officer, who says his hospital emphasizes a culture of being “warm and welcoming.”

Nurses also need to understand what the patient really needs and what they are hoping to get from their nurses. For instance, consider those oft-cited patient satisfaction scores from the Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) survey, and look closely at some of the questions about nursing care:

•  “During this hospital stay, how often did nurses treat you with courtesy and respect?”
•  “During this hospital stay, how often did nurses listen carefully to you?”
•  “During this hospital stay, how often did nurses explain things in a way you could understand?”

Those questions aren’t asking patients to assess the quality of the care they received. They’re asking the patients how they feel about how they were treated.

“Most patients can’t judge the clinical care that we give. They’re not the experts,” said Orski. “So patient satisfaction, in my opinion, should not affect the clinical care that we give. That should always be excellent.”

Instead, patient satisfaction focuses on the patient’s experience.  “How did we make that patient feel?” she continued. “Did we show them patience and respect and caring?

Frings suggested taking a step back and focusing before entering a patient’s room. Ask yourself “How am I conveying all these things to my patient?” she said.

It’s worth the investment of time, according to Dempsey. “We know that if a nurse sits down and makes the connection with the patient, the result is call lights are reduced, pain medication requests may go down and the patient perceives the encounter as both longer and more meaningful than if the nurse spent the same amount of time with the patient but was standing instead of sitting,” she said. “That’s a very small investment for the nurse and makes a huge difference for the patient.”

These findings underlie the importance of the nurse focusing on working with patients, not just providing care to and for them, said Karen Drenkard, PhD, RN, executive director of the O’Neil Center, a resource center focusing on patient engagement.

“Patients are the experts on their own bodies, and nurses are the experts with scientific and medical evidence, so an open exchange of information is critical to ensure a jointly created care plan that will get patients to the level of health where they want to be,” Drenkard said.

“An important element of this information exchange is for nurses to connect to their patients at the human level in order to truly understand what the patient’s needs, preferences and values are,” she added. “Nurses must really understand what it is that the patient is trying to achieve, as a nursing care plan can’t be put together without knowing what the patient’s goals are.”

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