Patient Experience Journal (PXJ, The Beryl Institute)
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Patient engagement in action: Timing and intensity of strategies used to engage low income depressed mothers of infants and toddlers
Get PDFThe purpose of this study was to illuminate the process of patient engagement and to determine how components of patient engagement were operationalized in the nurse-patient interpersonal relationship with low income, depressed mothers, a traditionally underserved population. Using a descriptive quantitative design, we examined how components of patient engagement were executed across three phases of the nurse-patient interpersonal relationship. We assessed for differences in engagement strategies used in different phases of the interpersonal relationship and with mothers with varying levels of engagement. Through this study, we observed that patient engagement has several dynamic components varying in intensity and frequency, depending on the phase of the nurse-patient relationship. Mothers varied in their degree of engagement. Lack of engagement by mothers limited the nurses’ use of engagement skills and strategies, thus underscoring the importance of effort and time spent in the orientation phase. Findings from this study can inform and advance the science of patient engagement by expanding the knowledge base and understanding as to the rhythm and flow of patient engagement in practice. Patient engagement requires persistence and variation of engagement strategies to establish an ongoing interpersonal relationship with patients.
Experience Framework
This article is associated with the Patient, Family & Community Engagement lens of The Beryl Institute Experience Framework. (http://bit.ly/ExperienceFramework) Access other PXJ articles related to this lens. Access other resources related to this lens
Does an empathic pre-visit conversation with another team member improve perceived surgeon empathy?
Get PDFOrthopedic surgeon specialists can help alleviate symptoms and reduce self-reported activity limitations by addressing stress, distress, and unhelpful cognitive biases regarding pain (e.g., “hurt equals harm”). But noticing mental and social health opportunities in specialty care can harm the patient-surgeon relationship. This study evaluated the ability of an empathic pre-visit conversation by another team member to improve the patient-surgeon relationship measured as perceived empathy. Factors associated with pain intensity, magnitude of self-reported activity limitations, symptoms of depression, and satisfaction with the surgeon were also studied. We enrolled 100 patients visiting an orthopedic surgeon for the first time. Prior to the visit with the surgeon, 50 patients met with another team member and had a pre-visit discussion about a sense of purpose and meaning in life, availability of loving relationships, and things that elicit laughter—a discussion intended to honor what matters most to an individual—and the other 50 patients did not. At the end of the visit we recorded perceived surgeon empathy, pain intensity, magnitude of self-reported activity limitations, symptoms of depression, and satisfaction with the surgeon. The pre-visit discussion did not affect perceived surgeon empathy (p=0.81), pain intensity (p=0.75), magnitude of self-reported activity limitations (p=0.63), symptoms of depression (p=0.46), or satisfaction with the surgeon (p=0.79). Patient experience with a surgeon does not benefit from a positive milieu created by a non-surgeon team member. Future studies can address relationship-building tactics used by the surgeon.
Experience Framework
This article is associated with the Patient, Family & Community Engagement lens of The Beryl Institute Experience Framework. (http://bit.ly/ExperienceFramework) Access other PXJ articles related to this lens. Access other resources related to this lens
Patient Experience Rounds (PER): Real-time feedback to improve the patient experience and quality of care
Get PDFWhile patient feedback is critical to improving the patient experience and clinical care, we are currently limited in our ability to collect feedback in real-time from hospitalized patients. This paper describes our experience and outcomes implementing Patient Experience Rounds (PER). Our model uses trained former patients or family members as volunteers to collect feedback in real-time. Through this feedback, we were able to identify areas for improvement, make adjustments in the moment, and provide targeted feedback to providers. A total of 321 patient encounters were recorded by eight PER advisors. Nursing staff received the highest percentage of positive comments. 49% of patients offered a special mention to recognize a staff member. 33% of patients offered a comment in response to the question, “What is one thing that would improve your experience.” In 16% of encounters, the advisor identified an issue or concern that required near-term follow up. This work has the potential to improve the patient experience and may be beneficial to hospitals seeking novel methods for rapidly improving the patient experience.
Experience Framework
This article is associated with the Patient, Family & Community Engagement lens of The Beryl Institute Experience Framework. (http://bit.ly/ExperienceFramework) Access other PXJ articles related to this lens. Access other resources related to this lens
Moving forward to the future of healthcare
Get PDFTo say this moment in our shared global history feels shaky or uncertain for so many is not a statement of despair. Rather, it is acknowledging a reality through which we can best act and hopefully step through. As of the time this editorial will publish, well over 50 million cases of COVID-19 will have been reported. This is a reality all of humanity is sharing together; it is a challenge that healthcare is being called on to tackle. The work of people around the world to care for the sick, to find the right treatments and vaccines and the efforts of so many of our global citizens trying to do what they can to care for their families, friends and communities by doing the basics – wearing a face covering, maintaining physical distance, limiting the size of gatherings and more – is heroic. More so, I suggest it is human. Over the seven years of publishing PXJ, never could we have dreamt of this moment; but in many ways, we were always preparing for it. For in bringing together the diverse voices of our world, in weaving together ideas, stories and evidence we knew and now espouse, we are ready to support one another. We are truly stronger together. There is a time of work ahead as well as a time for healing, for working tirelessly to close gaps, to lower the temperature of rhetoric, for conversations on common ground and finding a path forward. Through your work in reading, contributing and engaging, we each can and will do our part. There are great possibilities ahead as we seek “a light of meaning,” and those possibilities must forever guide us.
Experience Framework
This article is associated with the Culture & Leadership lens of The Beryl Institute Experience Framework. (http://bit.ly/ExperienceFramework) Access other PXJ articles related to this lens. Access other resources related to this len
Leadership matters: A conversation with Dr. James Hildreth
Get PDFI was extremely honored at this moment in the midst of our current health crisis to have a conversation with Dr. James Hildreth, president and chief executive officer of Meharry Medical College. The focus and commitment expressed by Dr. Hildreth reflects the very mission statement of Meharry Medical College itself, to advance health equity through innovative research, transformative education, exceptional and compassionate health services and policy-influencing thought leadership. As equally important is the alignment of Meharry’s purpose with our very own at the Institute, as Meharry’s mission continues to empower diverse populations to improve the well-being of humankind. Dr. Hildreth challenges us to find common context, follow the science and recognize that leadership matters. He calls on us to stop making assumptions and find a place of understanding, acknowledgment and action.
Experience Framework
This article is associated with the Culture & Leadership lens of The Beryl Institute Experience Framework. (http://bit.ly/ExperienceFramework) Access other PXJ articles related to this lens. Access other resources related to this len
TeleBoard: The move to a virtual family advisory board
Get PDFRestrictions on in-person meetings were going to hamper the ability for the well-established Family Advisory Board (FAB) for our pediatric hospital to continue meeting unless a virtual meeting platform was introduced. The FAB was moved to a virtual platform for the April and May 2020 meetings. Attendance rates from family members and staff were measured and compared to the previous 14 in-person meetings. Contributions during the virtual meetings from each attendee type were recorded to analyze engagement during virtual meetings. There was no statistical difference in average attendance for virtual compared to in-person meetings, 75% versus 64.3% for family members (p-value = 0.20) and 70% versus 56.2% for staff (p-value = 0.38). Family members offered more new ideas (11 to 31) and verbal contributions (24 to 53) from April to May, respectively. Staff gave more affirmations than family members in April (56 staff vs. 15 family), but this inverted in May (35 staff vs. 113 family). The variety of voice from family representatives increased for all contribution types except verbal from April (100%) to May (50%). In our setting, we found Family Advisory Board meeting attendance was equivalent to in-person meetings with the potential added benefit of being more inclusive to marginalized or under-represented groups.
Experience Framework
This article is associated with the Patient, Family & Community Engagement lens of The Beryl Institute Experience Framework. (http://bit.ly/ExperienceFramework) Access other PXJ articles related to this lens. Access other resources related to this lens
Family Connect: Keeping families informed during the COVID-19 pandemic
Get PDFFamily Connect programs to enhance communication with families and care partners who were unable to visit their inpatient loved ones during the COVID-19 crisis. While they differed in composition, the Family Connect programs at both institutions leveraged providers who had decreased clinical activity during the pandemic. The Family Connect team became integrated with the team. At both institutions, Family Connect teams perform virtual chart review, discuss patient status and care plan with the primary provider and communicate with the patient’s designated family member or care partner daily. Conversations are documented in the electronic medical record (EMR), which allows for metric tracking and clear communication to all team members. All Family Connect providers undergo a comprehensive training program focused on workflow, communication, and EMR training. Family Connect can be tailored to the needs of specific health systems based on patient volume and staffing. The NYULH Family Connect model incorporated medical student mentorship, on-site nurse liaisons to assist patients with virtual visits with families, and a 24/7 call center for family support. The YNHHS model was separate from the YNHHS COVID-19 call center and utilized attending and trainee physicians. The program is highly portable and can be easily reinitiated if needed.
Experience Framework
This article is associated with the Patient, Family & Community Engagement lens of The Beryl Institute Experience Framework. (http://bit.ly/ExperienceFramework) Access other PXJ articles related to this lens. Access other resources related to this lens
Johns Hopkins Medicine responds to COVID-19: Adjusting patient- family- and staff-centered care
Get PDFThe extraordinary impact of the novel coronavirus disease 2019 (COVID-19) on the health care industry included a major, nearly immediate paradigm shift in the visitation policy for Johns Hopkins Medicine. This large health system, comprising six hospitals, a home care group, community physician practices and satellite outpatient sites moved from essentially open visitation to no visitation, creating an entirely new set of needs for our staff, patients and their loved ones. We developed new ways of communicating and connecting staff members, staff and patients, staff and the patient’s loved ones, and patients and their loved ones. Our intent was to maintain our commitment to patient- and family-centered care, to alleviate the anxiety and stress from this devastating pandemic to the extent possible. This article describes approaches taken by the health system’s Patient Experience leadership team and others to develop resources that educate patients, loved ones and staff about the process changes and facilitate incorporation of these new ways of communicating and connecting. The content is organized into three areas: including staff resources, consumer resources and resources that support consumer engagement. Many of the changes have been well received, enhancing our pre-COVID-19 ability to connect with one another and will be assimilated into our culture for the long term. We plan to develop objective measures of the effectiveness for approaches that outlive COVID-19 and enhance patient-centered care.
Experience Framework
This article is associated with the Patient, Family & Community Engagement lens of The Beryl Institute Experience Framework. (http://bit.ly/ExperienceFramework) Access other PXJ articles related to this lens. Access other resources related to this lens
Flattening the curve of distress: A public-facing webinar for psychoeducation during COVID-19
Get PDFThis case report describes the development, implementation and evaluation of a public-facing webinar that provided psychoeducation addressing the emotional distress that has accompanied the coronavirus pandemic. Using a webinar was an effective strategy for reaching a large, public audience and making content from expert clinicians accessible. Participants were likely to recommend the webinar to friends or family. Participants appreciated that the webinar acknowledged the presence of distressing emotions and provided practical advice for reducing the negative psychological sequelae of the coronavirus pandemic. Areas for improvement included addressing technical issues and incorporating additional information into the webinar.
Experience Framework
This article is associated with the Patient, Family & Community Engagement lens of The Beryl Institute Experience Framework. (http://bit.ly/ExperienceFramework) Access other PXJ articles related to this lens. Access other resources related to this lens
A comprehensive call center supporting safe, efficient operations during a pandemic
Get PDFResearch has shown that a comprehensive call center can support a safe, efficient, and quality experience for patients and their families. When a patient receives a cancer diagnosis, the stakes are already high. Add a pandemic to an immunocompromised patient population and fear escalates. In order to accommodate the ever-changing information and ease patients’ anxieties surrounding their cancer diagnoses, it is necessary that an institution be available 24/7 to inform, help navigate systems, and manage symptoms because the emergency room, and many times the clinics, have too many inherent risks.
MD Anderson expanded the hours of operation for askMDAnderson, a comprehensive call center staffed by operators, health information specialists, registered nurses, and advance practice providers, to cater to all the needs, and to support safe and efficient operations during the pandemic. This highly skilled team serves as a critical information link to patients and their loved ones for all transitions in care needs, such as guidance on food delivery, parking, medication renewals and side effect management.
The askMDAnderson staff educates our stakeholders about MD Anderson services, programs, treatments and clinical trials during and after the pandemic until we return to the new normal. Our employees are available for all levels of “hand holding” and provide a constant flow of timely, factual information. In this case study, you will learn how MD Anderson expanded this newly evolving system and how our team’s efforts led to a safer, more efficient, less expensive, and more satisfying care experiences for patients and their families.
Experience Framework
This article is associated with the Infrastructure & Governance lens of The Beryl Institute Experience Framework. (http://bit.ly/ExperienceFramework) Access other PXJ articles related to this lens. Access other resources related to this lens