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Closing Keynote, February 11, 2019

Susan B, Hassmiller, PhD, RN, FAAN, Senior Adviser for Nursing, Robert Wood Johnson Foundation (@suehassmiller)

Technology and the Human Connection: A Personal Perspective

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Susan B. Hassmiller, PhD, RN, FAAN

Has no real or apparent conflicts of interest to report.

Conflict of Interest

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• Describe my husband’s hospital stay in the intensive care unit

• Describe how a positive patient experience is integral to building a Culture of Health

• Make the business case for cultivating positive patient experiences

• Share best practices for improving the patient experience

• Discuss the need to improve the caregiver experience

Agenda

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• Describe how promoting well-being and positive patient

experiences are part of building a Culture of Health in the

U.S.

• Outline the business case for enhancing the patient

experience and share best practices for improving the

patient experience

• Describe ways to reduce caregiver suffering at the

individual, team, organizational and systems level

Learning Objectives

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Bob and Me

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Bob and Me

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• Technology

• Paperwork

• Staffing ratios

• Personal issues

• Work culture

My ICU Observations

Compassionate care is not always the norm

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• Understand and agree with the care being provided

• Have ample opportunities to offer input

• Be able to express hopes and fears

• Be understood and acknowledged

Patients and Their Families Need to:

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The Nurses Who Cared for Bob and Me

Kathy and Abby with me at RWJF

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We, as a nation, will strive together to build a Culture of Health enabling all in our diverse society to lead healthy lives, now and for generations to come

RWJF Vision: A Culture of Health

Includes consumer

experience with care

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• ACA mandated hospitals would be reimbursed on scores that measure clinical care and patient experience

• Hospitals are rewarded or penalized based on their patient experience scores

Patient Experience and Quality

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When patients believe they have a good care experience, health care organizations have:

• Lower re-admission rates

• Shorter lengths of stay

• Fewer hospital-acquired conditions

• Higher Patient Safety Indicator scores

• Higher Patient Engagement scores

Costs decrease and outcomes improve

Making the Business Case

Mark Smith et al., eds. Best Care at Lower Cost: The Path to Continuously Learning

Health Care in America Washington, DC: Institute of Medicine, 2013

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• A 55 study meta-analysis found that patient experience is positively associated with clinical effectiveness and patient safety*

• Two studies found that hospitals with better patient experience scores have higher quality measures for acute myocardial infarction and aspects of surgical care**

The Evidence

*Doyle, Cathal, Laura Lennox, and Derek Bell. "A systematic review of evidence on the links between patient

experience and clinical safety and effectiveness." BMJ open 3.1 (2013): e001570

**Lyu H, Wick EC, Housman M, Freischlag JA, Makary MA. Patient satisfaction as a possible indicator of

quality surgical care. JAMA Surg. 2013;148(4):362-367

**Glickman SW, Boulding W, Manary M, et al. Patient satisfaction and its relationship with clinical quality and

inpatient mortality in acute myocardial infarction. Circ Cardiovasc Qual Outcomes. 2010;3(2):188-195

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Higher patient

experience scores

Better patient

follow-up

Better teamwork, leadership, and quality

More new and repeat

visits

Fewer physicians

sued

The Evidence

Mehta, Shivan J. "Patient satisfaction reporting and its implications

for patient care." AMA journal of ethics 17.7 (2015): 616

15--The Beryl Institute “Consumer Perspectives on the Patient Experience 2018”

Patient experience based on what

consumers shared is not a nice thing to

do, but rather it is a tangible and

practical commitment that will have both

an immediate and lasting impact on

organizations

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Positive and Negative Experiences

The Beryl Institute “Consumer Perspectives on the Patient Experience 2018”

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Compassionate Connected Care Model

Clinical Excellence

Connecting clinical excellence with outcomes

Operational Efficiency

Connecting efficiency with quality

Caring Behaviors

Connecting behaviors with action

Culture

Connecting mission, vision and values with engagement

Compassionate Connected Care

Dempsey, Christina. The Antidote to Suffering: How Compassionate Connected Care Can

Improve Safety, Quality and Experience. New York: McGraw Hill Education, 2018

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The provision of exceptionally skilled clinical care

In an environment that is efficient and effective

By engaged and resilient caregivers

In a culture driven by a shared purpose to achieve the optimal outcome for all involved

The Pathway to Compassionate Care

Dempsey, 2018

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• Interviewed 25 nurse leaders on best practices to improve patient experience

• Engaging families resulted in increased patient experience scores and decreased lengths of stay and medication errors

Journal of Nursing Administration Article

Hassmiller, Susan B. and Ani Bilazarian. “The Business Ethics and Quality Case for

Consumer Engagement in Nursing” Journal of Nursing Administration, March 2018

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Clinically minded volunteers meet with patients and

families

Shared decision making tools

Patient activation measures

Open visiting hours/rounding

White boards

Patient education videos

Clinical nurse leader rounding

Bedside charting that enables

patient accessCode Lavender

Best Practices

Hassmiller and Bilazarian, 2018

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Inviting families to participate in rounds:

• Supports their involvement in decision-making

• Gives them an opportunity to ask questions and share information

• Engages them as partners in the care of their family member

• Improves safety and quality

Including Families on Rounds

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Rounds Without Patient and Family

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Rounds With Patient and Family

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What Matters to You Today?

www.whatmatterstoyou.scot/

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Best Practice: Organizational Change

Changing workplace

culture

• Establish shared set of expectations between providers and patients and their families

Strong nursing

leadership

• Need singular, consistent, and visible leadership for organizational change

Engaged staff

• Ingrain values and mission of organization in each employee’s sense of purpose

Hassmiller and Bilazarian, 2018

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• Time and need for efficiency*

– *Reframe to consider it a means towards more effective clinical care

• Technology**

– Use open charting and educational videos

• Hesitation and fear***

– Invite patients and families to play a role in their care

Barriers to Positive Patient Experiences

*Bishop, JP, Perry JE, Hine A. Efficient, Compassionate, and Fractured: Contemporary Care in the ICU. Hastings Center

Report 2014; 44(4): 35-43

**Zhang, J, Chen Y, Ashfaq S., et al. Strategizing EHR Use to Achieve Patient-centered Care in Exam Rooms: a Qualitative

Study on Primary Care Providers. Journal of the American Medical Informatics Association. Oxford Academic. OUP Academic.

Published November 13, 2015

***Bear, RA, Stockie, S. Patient Engagement and Patient-centered Care in the Management of Advanced Chronic Kidney

Disease and Chronic Kidney Failure. Canadian Journal of Kidney Health and Disease. Published October 21, 2014

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• Long hours

• Large caseloads

• Regulations and documentation

• Reimbursement pressure

• Physician and nurse shortages

• Patient complexity and acuity

• New technology

• Unsupportive work environment

Caregivers Also Suffer

Many are overworked, exhausted and unhappy

Dempsey, 2018

Kovner, C. T., & Brewer, C. S. (2011). RN work project. Robert Wood Johnson

Foundation. Retrieved from http://rnworkproject. org

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• When nurses recommend their place of work, patients are also more likely to recommend the organization as a place when care is needed*

• When workplaces reward compassionate acts and support staff during tough times, more patients rate the care they experience highly**

Patient and Caregiver Suffering Are Connected

Takeaway: Reduce

caregiver suffering,

and you reduce

patient suffering*Dempsey, 2018

**McClelland, Laura E., and Timothy J. Vogus. "Compassion practices and HCAHPS: does rewarding and

supporting workplace compassion influence patient perceptions?." Health services research 49.5 (2014):

1670-1683

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Reducing Caregiving Suffering

• Health leaders should acknowledge the complexity and gravity of the work provided by caregivers

• Management should offer material, human and emotional resources

• Teamwork is vital to success

• Empathy and trust should be fostered and modeled

• A positive work-life balance reduces compassion fatigue

• Communication is crucial

Dempsey, 2018

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Healthy Work Environments

Fontaine, D. K., Haizlip, J., & Lavandero, R. (2018). No Time to Be Nice in the

Intensive Care Unit. American Journal of Critical Care, 27(2), 153-156

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Best Practice: InterprofessionalCollaboration

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1. Put patient first

2. Demonstrate leadership commitment

3. Create level playing field

4. Cultivate effective team communication

5. Explore use of organizational structure

6. Train different disciplines together

Best Practice: InterprofessionalCollaboration

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Breaking the Rules for Better Care

Berwick, D. M., Loehrer, S., & Gunther-Murphy, C. (2017). Breaking the rules for better care.

Jama, 317(21), 2161-2162

Top Ideas for Improving Patient Care:

1. Eliminate visiting hours. Enable family members to visit as often as they want

2. Change CMS rule to allow patients to be transferred to skilled nursing facility without waiting for three days in an inpatient facility

3. Allow each member of the care team to operate at top of license to improve patient flow

4. Make same-day appointments available

5. Reduce waiting times

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Key Takeaways:

• Prioritize compassion from the C-suite on down

• Adopt best practices to promote consumer engagement

• Support staff to reduce caregiver suffering

• Promote interprofessional care and strong teams

• Change rules that detract from the care experience

What Nurse Leaders Can Do

35-- Maya Angelou

I’ve learned that people will

forget what you said, people will

forget what you did, but people

will never forget how you made

them feel

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Thank You!

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Contact Information:

Email: shassmi@rwjf.org

Twitter: @suehassmiller

Linked In: Susan Hassmiller

Questions