Put “Caring About People” Back in Healthcare

Everyone’s jobs have become more demanding. We all seem to do more with fewer human or material resources and those we serve have higher expectations. Healthcare is the same but with two additional factors... increased regulation/reporting requirements and their ultimate outcome... the health of its consumers.

So how can we in healthcare be expected to do more with less?  Compete with hospitals across the nation on HCAHPS and positively influence the Value Based Purchasing dollars our hospitals will ultimately receive or not receive?  I think the answer lies in how we deliver care.

Personal Experiences in Healthcare Settings

Over the past 4 months, I have visited or been with friends and family members in a variety of hospital settings—an Emergency Room, an Observation Unit, and a Surgical Intensive Care Unit (SICU). From my perspective as a nurse, the physical care provided in each setting was appropriate, and in some situations the medical advancements were astounding. But as I thought about the HCAHPS survey in each of these situations or thought about how the patients and their family/friends were treated, the technological advancement or appropriate care did not come into mind. As an observer I saw the following indications of “Caring or not caring” about the individual patients and their family member.

What Caring Looks Like

In the SICU, my friend was recovering from open heart surgery. He had 12 medications piggy-backed into his IV site… but I expected that. What impressed me was how they cared about my friend and his wife. Here are the examples of caring that I saw during my visit:

• His wife’s cell phone number being listed on the white board in his cubicle. This reassured me that they would call her immediately if his condition changed, and I knew it would give her and him some peace of mind during his long hospital stay.
• The staff also seemed to almost listen to the visitor conversation while they were in the room adjusting meds or making my friend comfortable. And while we did not ask anything directly of the staff they “answered the unasked questions” about what was typical in this situation, such as when he would get out of bed, how long these types of patients stay, and other non-PHI related questions.
• The staff did get my friend out of bed for the first time while we were visiting that day after they were sure that his pain medication was given and he was as comfortable as possible before doing so.
• They also spoke to him about the importance of taking the pain medication regularly during the first couple of days and advised him not to wait until he had pain. As my friend is not a complainer this was a very critical conversation. We asked whether staff on other shifts would follow the same pain protocol, and we were assured that they would.
• They also made sure that his backside was properly covered when they got him out of bed that day...in spite of the 12 piggybacked IV meds, the drain and other tubing, they cared about maintaining his dignity.

Another friend was brought to the Emergency Department at a local community hospital and received the proper tests, examination, and explanation from the doctor about what was possibly causing her symptoms. They clearly explained why they were going to have her stay in the Observation Unit for the next 23 hours. The ED care was very good and all the staff kept her informed as to the next steps throughout.

What Not Caring Looks Like

The Observation Unit was another story. Here were some of the examples of not caring about the patient:

• All rooms on that unit are double bedded. My friend was admitted to a room with an elderly patient who was confused. The room across from where she was admitted was empty and would have been a better place to admit my friend. Throughout the night, the elderly woman cried out. As staff came in to settle or treat this patient, they would flip on the room lights, walk past my friend, and never acknowledged her in any way. The staff would then speak to the elderly patient very loudly to get her attention and gave no regard or apology to my friend who was trying to sleep. She was finally offered earplugs at 4 AM.
• Since my friend came to the hospital with neurological symptoms, her bed in the Observation Unit had a bed alarm on it. She was completely unaware of this but kept hearing a distant buzzing sound in the mattress until she hit it or waited it out. She actually thought it was something with the air mattress. As my friend was being discharged, the nurse explained what the sound was and why her bed has such an alarm on it. Obviously, it would have been better to have this explained as part of the admission process and it would have effectively served its purpose as an alarm if someone had responded when it rang at the desk throughout the night. The explanation at discharge was futile and left my friend feeling as if staff hadn’t responded as they should have.
• At 10 AM the doctor told my friend that she was going to be discharged. At 11 AM the nurse came in and knew nothing about the discharge order and proceeded to complain about how this doctor “does this all the time.”  The nurse’s comments created a feeling of poor coordination of care and lack of teamwork on that unit.

In spite of the very positive experience in the Emergency Department, my friend has indicated that she would not want to use that hospital again because of the Observation Unit experience. In fact, while she liked the consulting neurologist, she decided to use another doctor affiliated with a hospital that she is more comfortable with.

In each of these situations, the patient and family members’ experiences and impressions of care were created more by how staff cared or didn’t seem to care about them rather than by the actual medical care they provided. I think this is much more common than we think and something we can positively affect without increasing human or material resources in our hospitals. We have to refocus on care from the patient perspective and imagine ourselves walking in the shoes of those that love them.