Patient Service Archives

Communications Skills – Be Hard and Exact

Trying to make those passes hard and exact
My son Jack, making those passes hard and exact.

My son Jack is 7 1/2 years old and playing his third season of soccer. He has a terrific coach this year, Coach Laurie. She’s led them through the season without a loss (though we’re not supposed to be counting points). Last week they won 4 to 1. That’s been their closest game.

How does she do it? Her mantra is “Hard and exact!”–with everything they do–”do it hard and exact”.

You don’t just move the ball downfield. You anticipate where your teammate will be and you kick it there hard and exact. You don’t just find an open space for the throw from the sideline, you move down the line. You don’t just do anything; you do something in particular, and you do it precisely .

That’s what we want from a coach of athletic sports, isn’t it?  That’s what makes legends of men like Vince Lombardi, the coach who led the Packers to the NFL’s first two Superbowl titles–demanding discipline. That’s what Coach Laurie provides, and it pays off for the team every week.

That’s what great communications takes? It may sound melodramatic, but it’s true. Here’s an example. Read the rest of this entry

Stuart Bradford's Illustration in the NYTTara Parker-Pope, a journalist and blogger for the Well Blog on the New York Times, has been writing post after post this week on the growing recognition of how deep the rift is between doctors and their patients. Every post she writes get upwards of 150 comments. Her article summarizing the problem has attracted over 300 comments since she posted it Monday. There’s so much spleen being vented by readers on the web pages of the Times right now that it brings new meaning to the old joke, “what’s black, white, and red all over?”

Patients are upset, yes,

To the Doctors who say their patients don’t trust their medical knowledge I, as patient, say stop acting like you know everything – you don’t, so admit it and we patients may stop distrusting your quick off the line, glib diagnosis.
— Posted by Tom in California

but not just patients. Tara cites a Reader’s Digest article that excerpts doctors’ comments about dealing with patients. Much of it is poignant or insightful.

Though we don’t cry in front of you, we sometimes do cry about your situation at home.
Pediatrician, Chicago

And there’s impatience with patients as well.

So let me get this straight: You want a referral to three specialists, an MRI, the medication you saw on TV, and an extra hour for this visit. Gotcha. Do you want fries with that?
Douglas Farrago, MD

There’s almost too much to process and comment on. I’ve spent years training doctors and other medical staff to have conversations with patients that are both efficient and empathetic, though, and two things ring out to me, one about the healthcare industry and another about the fundamental nature of this conflict.

First, there’s the insightful comment by Shelley Holloway, a global customer service analyst. “Guess what folks?” she says, ” The medical field is a Customer Service Industry! … When I or my employer pays for a service, I want excellent treatment/response just as I would for any product/service I might buy.”

I think Ms. Holloway is right on. The healthcare industry is a customer service industry. If you need proof, here are just two observations.  According to a 2004 Harris poll, what patients valued most—even more than their doctors’ training and knowledge of new medical treatments—was their interpersonal skills: treating patients with respect, listening  carefully, being easy to talk to, taking patients’ concerns seriously, spending enough time with them, and really caring. (1) And a Harvard study of 44,821 patients found that only 1 of every 5 malpractice suits arise from medical negligence. What drives the majority of law suits, is the way patients are treated. (2)

Yet as important as customer service is in healthcare, medical schools still don’t train staff in service skills. Health systems spend millions on measuring patient satisfaction and then struggle, by and large, with what to do with low scores. Here’s Mary Malone, Executive Director of Consulting Services for Press Ganey, one of the two largest patient satisfaction measurement firms in the industry. “There is a big difference between paying “lip service” to service in a meeting and doing the hard work that’s needed to implement organizational and behavioral change. And I’m still astonished by how many health care professionals fail to make this connection.”(3)

The  healthcare industry will keep building animosity until senior management realizes they are in the business of serving patients and they happen to do it by fixing bodies, and not the other way around.

The second thing to notice, that’s important for those of us who are in relationships with others is the remarkable destructiveness of mutually perceived threat. I conducted a needs analysis years ago for an oncology department in a large hospital that was prestigious for good reason. The core of the analysis was this: your staff feels threatened by your patients and your patients feel threatened by your staff. Not everyone, not all the time, but often enough that you need to take active steps to turn the situation around. Unbeknownst to me, the analysis flew around the hospital. What started as one training turned into 16 throughout the organization. Even though staff in other departments knew the analysis wasn’t written for them, they could feel a tension that they recognized in the document.

There’s a dynamic of domination that comes up seemingly whenever people approach each other across an examination table, or a cash register, or whatever it is in your industry that separates you from those you serve. Your customers have to come to you to get service and they fear you’ll take advantage of them. You have to serve your customers, and you fear that they’ll stomp and shout and demand an unsustainably high level of service. And if you leave those mutual fears unspoken and unexamined, they fester and escalate. Joe Peschi’s famous line, “They @$%> you in the drive through!” morphs into a lawsuit over coffee served too hot.

Tim’s Takeaway:

What’s the tension in your industry with your customers? Are you courageous enough to say it outloud? Or do you assume the conversation would just be too sensitive. If you’re not addressing it openly. It’s not going away.

References:

 1. Humphrey Taylor, Chairman of The Harris Poll, in The Wall Street Journal Online, Health Care Poll, Vol. 3, Iss. 19, October 1, 2004

2. Medical malpractice as an epidemiological problem, Social Science & Medicine, Volume 59, Issue 1, July 2004, Pages 39-46, Michelle M. Mello and David Hemenway

3. Press Ganey, The Satisfaction Monitor, Sept/Oct 2000, Service InSight: Connecting the Dots, Another in the Latest & Greatest Series, Mary P. Malone, MS, JD, Executive Director, Consulting Services

Saying I’m Sorry – How to do it right

There’s a nice story in the New York Times about a doctor who made one big mistake in his career (at 74, yet) and how he fared by apologizing.

It’s a good example of how to apologize in business, a topic that’s seen increasing play in the healthcare industry press for the past 5 years or so.

The husband of the woman whose rib was partially shaved off by mistake (not the picture above, that’s an electrode left in Maria Del Rossario Valdez after a Ceasarian section) gave a pretty succinct recipe:”be completely candid, completely honest, and so frank…that the anger was gone.”

Here were the offending doctor’s actual words:

“After all these years, I cannot give you any excuse whatsoever. It is just one of those things that occurred. I have to some extent harmed you.”

 It happens in healthcare that more patients sue for poor communication than for actual medical mistakes. There’s probablly a lesson in there for you even if you aren’t in the healthcare industry.

References:

Medical malpractice as an epidemiological problem, Social Science & Medicine, Volume 59, Issue 1, July 2004, Pages 39-46, Michelle M. Mello and David Hemenway  

We feel fine montageThe image at the right is from the wonderfully revealing “We Feel Fine” project. Scouring the internet for expressions of emotions, It is a project in mass, anonymous,  intimacy. Not only is the site poetically and artistically moving, on a practical level it gives us a sampling of the utterances we scrabble together or craft with exquisite care in an attempt to make our inner experience available to others.

If we look carefully at groups of these utterances, they give us a picture of how we express our emotions around the world, and how the expressions we choose make clear communications so difficult.

The statements the engine finds, as it searches blogs every 10 minutes, are often banal (I feel sooo good), yet sometimes quite touching (i’m alone with you you make me feel like i am clean).

You’ll find a variety of interfaces on the site, including a set of montages of single posts like the one above as well as visual representations of groupings of expressions, like this one to the left.  Tools We feel happy(programming API’s) on the site allow you to collect groups of statements along with images from the blogs and whatever demographic information the engine has been able to find on the sites where the entries are posted. 

Below, you’ll find a list of utterances I collected as they came into the site at about 9:30 p.m. PST last night. Read the rest of this entry

Kudos to Jim Estill. His blog “ceo blog – time leadership” was just named among the top 10 leadership Jim Estill Cover Page from his blogblogs by HR World. Coincidentally, one of his posts, What Gets Measured Gets Done, was also named among the top 5 blog posts of the week by Wally Block.  Jim is right, of course, what gets measured gets done. And he provides the nifty example in his dedication to his fitness routine (which is impressive in itself). But he doesn’t go far enough.

A good lesson comes from Atul Gawande, a 2006 MacArthur Fellow and general surgeon at Brigham and Women’s Hospital in Boston. In his book titled simply BETTER, Gawande tells the story of the most innocent of measurement scales–the Apgar scale–that spawned one of the greatest advances in the American system of health.

Dr. Virginia Apgar created the scale in 1953 in response to the terrible observation that all the great advances in medicine in the previous hundred years had been unable to reduce rate of infant death at the time of birth. Though mothers were much more likely to survive the birth of their children, the child still faced a 1-in-30 chance of dying while struggling to come into the world.

Apgar’s solution was simple and stunningly effective. Read the rest of this entry

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