Monday, June 19, 2017

The Fastest DX in TX

“The good physician treats the disease; the great physician treats the patient who has the disease.”
-          William Osler

The following is a story told to me by David Dworski, my colleague and good friend:

Consider This

My college class has a reunion every 5 years. When I went back for the 15th reunion, I ran into an old friend who had gone to medical school and established a very prosperous practice in Texas. He went to great pains to tell me how successful he was, how fast a diagnostician.

“Patients come into my exam room” he said, “and in 60 seconds I can tell ya’ what they got… I am the fastest DX in TX.”

I was amused by that. I thought that was kind of terrific, he must be quite a scholar.  We ran into each other 10 years after that, at our 25th reunion. We sat down again to renew acquaintances, and I said “Are you still the fastest DX in TX?”

He kind of sobered up, and replied “No, I don’t play beat the clock any longer. I had a near miss; there was an adverse effect, and I almost lost a patient because I was too quick on the trigger. I learned an important thing, and I stopped trying to be faster than a speeding bullet in making diagnoses. It made patients feel it was incumbent on them to repeat their story because they didn’t believe I got it the first time, or seek a second opinion, because I might not really be listening. Having nearly lost a patient, I decided I had to take my time and listen to the patients’ stories, ask a few questions to flesh things out, and then make my diagnosis. My clients feel more confident about my skills these days, and so do I.”

Working in healthcare, that was an important lesson for me.

“We are dealing with individuals who are scared and uncertain. They can’t tell if you are a good caregiver or a bad caregiver. What they can tell is: are you kind? Are you listening?”
-          Harold Krumholz, Yale School of Medicine

The Take Away

Being a physician is not a timed event – there are no medals for fastest diagnosis. Don’t sacrifice excellence in the name of speed. It is more important to listen to the patient, make them feel heard, and remember that they are a person, not just a disease.

Follow Us on Twitter
Like Us on Facebook

Monday, June 12, 2017

Boredom Kills: How to Stay Invested and Improve Communication

Believe me when I say: boredom kills.

When we get bored, we get sloppy. I understand that it can be tough to stay interested when you have to give medication instructions for the nine hundred and forty seventh time in your career, but you must remain diligent. You have to keep it fresh for every patient, every time.

Consider This

Stay Involved
If you find medication education becoming routine, use the technique of stage actors. They get bored after a while, too, having to repeat the same lines every night.
Re-invigorate interest! What color are her eyes? What’s distinctive about her hair? What’s unique about his voice? His mustache?
Find a way to stay present in the moment. 

Reward Good Habits
My colleague Michael LeBoeuf said, “What gets recognized and rewarded gets repeated.” The best way to hardwire good communication is to recognize it when you observe it! The worst thing we can do is ignore something extraordinary. Pull the RN aside right away and say, “I noticed you went an extra mile, I’m so proud of you.” Be spontaneous and specific! Don’t save it until the Christmas party.

Years ago, I was speaking in Louisiana, chatting with a new employee, who’d been there four or five months. I asked her how she liked working with her boss, and she replied “I love my boss.” How often do you hear that? I asked why, and she told me: “When I started here, I worked on a project for about a month; I had to stay and work an entire weekend. I didn’t tell my boss about it, but she found out. When I came in on Monday morning, there was a jar of jelly beans with a handwritten thank you note.” 

I asked how her boss knew she would like jelly beans. She said, “When I was hired, my boss asked me to write down little things that I liked on a piece of paper. One of the little things that I like are jelly beans.” Well, that story inspired me to create a form called “My L.I.S.T.” We’ve been giving this out for years, and people love it. My L.I.S.T. stands for “List of an Individual’s Special Things” – an effective leader should have one from every direct report.
Stop giving your staff baseball caps and t-shirts they’ll never wear in public - give them something meaningful. 

“When do you actually find time to do all this training, coaching, and precepting you’re talking about? We’re busy!”
If there’s one thing I’ve learned, it’s that staff love training. They never object, because they want to know more. Lack of interest is not an issue here.
There was a lady in one of my seminars who said, “Yeah, but you don’t know how busy we are, how lean we are. There’s no way we could fit this training in.” I replied, “Tell me what you do when compliance training is mandatory.” She said, “Well, we do it.” We all make time for our priorities.
Custom Learning Systems has a client that sets time aside on Wednesday mornings, once a month, for every unit to schedule education. If you watch professional sports, you’ve seen timeouts that are only twenty seconds or a minute long. In that time, a coach gives instructions to the players, tells them what to do. You don’t need two hours to coach someone - sometimes all you need is sixty second corrective coaching.

“What do you do about doctors? Doctors who are disruptive and disrespectful; who act out if they’re challenged on prescriptions or patient care.”
Whenever I’ve asked nurses about physician relationships, I’ve had to have Kleenex on the table. In many ways, I think nurses are conditioned to accept whatever doctors dish out – but this in not effective communication, and we need to shift the paradigm. I witnessed one very impressive nurse say to a doctor (who was inappropriate in his communication): “I didn’t give you permission to talk to me that way.”

You could see that he was startled, and I thought “Wow, what a classy example of assertiveness.” It’s the responsibility of the nurse (or supervisor, manager, director) to have a non-accusatory conversation with a problematic physician. Whether they are employed by you or not: their behavior toward coworkers is noticed.

Have a good citizenship policy for doctors, one that has teeth. Set the boundaries for good behavior on the part of doctors. This also protects nurses who have a reason to question the doctor; asking a legitimate question for the benefit of a patient is always appropriate. At a hospital with one of these policies in place, the system worked like this: if the nurses felt they were being ignored or verbally abused, they used the code word was “red light.” “Red light” meant the doctor was overstepping his bounds, and should adjust his attitude. 

The Take Away
The truth is that a fifteen or thirty minute training session can be accommodated almost anytime. . If you make effective communication a priority, people will make time for it. Give your staff the opportunity to master communication skills for patients and coworkers, and then recognize those behaviors in a meaningful and personal way
Follow Us on Twitter
Like Us on Facebook

Monday, June 5, 2017

The Patient Medication Education Team

“Too often, hospitals seem to look at talking about drugs with patients as a formality. But it’s not! It’s essential to keep patients safe in hospital and at home. And failure to do a better job of communicating with patients about drugs is one of the reasons hospital errors in this country are so unacceptably high.”
- Dr. John Santa, Director of the Consumer Reports Health Ratings Center.
For a medication education initiative to be successful, you need a team of champions to lead the charge. Keep in mind that poor communication leads to medical errors. 

Consider This
In addition to the people mentioned in previous blogs (CNO, CMO, nurses, IT, pharmacists, etc.), ancillary departments like PT and Dietary and crucial to patient medication education. Who spends more time with patients than RN’s? RN’s are in and out, while a PT may spend thirty to forty minutes in a physical therapy session. They’re not just talking about stretching quadriceps and hamstrings – they talk about diet, exercise, and many other aspects of a patient’s overall health. This is a great chance to make ancillary departments aware of their participation in patient education.
Members of the Patient Medication Education Team should be examples for everyone responsible for medication education by practicing the correct behaviors of medication education.

The PME Team must:
  • Organize/supervise all new RN medication education training, and continue preceptor-ship (so staff members can educate patients with confidence)
  • Focus on medication reconciliation at all transition points
  • Establish patient rounding
  • Issue actionable recommendations as needed
  • See that all RN’s are empowered to question prescriptions/dosages as warranted

Members of the PME Team should define their Charter based on these responsibilities. The CEO absolutely needs to empower this team, so they can begin their initiative right away.

Inspiring Leadership Competency
  1. Assemble a Patient Medication Education Team, with a Charter and a prioritized Action Plan.
    • Have at least one senior RN on each floor (preferably a medication guru) become a medication education-trainer.
  1. Make medication education workshops available.
    • Focus on how to get your point across effectively – remember the handy anagram D.E.A.T.S.
  1. Use role-playing whenever you can; it’s a powerful staff education tool.
  2. Don’t hesitate to drill staff on their “teach back” skills.
  3. Empower nurses to question prescriptions if there is reason for a second look – and make sure providers understand why.
  4. Emphasize the benefits of “conversation-starters.”
    • Encourage staff to customize and make them their own.
  1. Ensure you have a protocol for medication reconciliation at all transition points.
  2. Schedule pharmacist rounding on an “as needed” basis.
  3. Remember to recognize and reward staff (innovators and steady performers alike).
The Take Away
Without exception, effective leaders are great communicators. Institute a Patient Medication Education Team, with members across all departments, to promote the training and behaviors necessary for effective communication about medications.
Follow Us on Twitter
Like Us on Facebook

Monday, May 29, 2017

Sentence Starters for Strategic Medication Education

Sometimes when a patient says they understand a new medication, it’s because they’re reluctant to ask a question they think is silly. It’s your job to take the initiative and overcome that resistance.

Consider This

Keep It Simple: talk to them in “everyday” language, not technical terms – it’s so easy to get caught up in technical jargon.
            “This medicine will reduce the swelling in your knee, and help it heal.”
Get The Family in the Room: for many patients, family members serve as care-givers at home. Seat family members close to you for educational sessions. Make sure they digest the information, techniques, and skills that are needed - especially if they are translating for the patient.
“Who would you like to be included in this teaching-session?”
“Who will be your main care-giver at home?”

Be Empathetic: sometimes small, sincere gestures make the biggest impact.
“I can tell you’ve had a tough time.”
“I can see why you would be discouraged.”
“I can tell you’re disappointed.”

Ask Them to Ask You Questions: one thing I know about human nature is: people love to be asked questions. Give them permission to ask (without being embarrassed) by leading the conversation.
“What questions do you have about this medication?”
“What would you like to ask me about this medication?”
“Many patients wonder how this medicine…” or “I’ve had patients express concerns about…  Do you feel that way?”

The Teach-Back Method: politely ask patient to repeat back what you’ve taught him/her. Make the teach-back method a game, make it fun if you can! You don’t want it to be a test that puts stress on patients.
“Mrs. Jones, I want to be really sure that you understand all the important information about this new medicine. May I ask you a few questions?”

If patient’s answers are shaky, ask some questions and clarify.

The Take Away

Cultivate an environment that encourages questions - no concern is foolish in a hospital. We always want our patients to be safe; we have to make absolutely sure that they are understanding what we tell them, rather than just nodding and smiling.
Follow Us on Twitter
Like Us on Facebook