We are at the front line of medicine. In fact, in many of our hospitals, the majority of admissions come through the emergency department. And in some cases, up to 90 percent of patients who are admitted begin their care in the emergency department. This gives us an opportunity to have a huge impact on the trajectory of their care. But it also lets us set the tone for the rest of their experience of that care.
Hospital Care Quality Information from the Consumer Perspective (the Hospital Consumer Assessment of Healthcare Providers and Systems or HCAHPS) scores are publicly reported, and they are being progressively linked to hospital reimbursement. For these reasons, it is imperative that we begin to shape the patient’s perception of care from the very beginning of the episode.
The following tips are focused on getting to the heart of each patient’s complaint quickly and tactfully. Using these strategies, you will be able to rapidly assess the patient’s concerns so that you can begin to address them early on.
The (Sometimes) Hidden Agenda
I remember hearing a wise and experienced nurse manager once say, “Patients in the ED have come here because they have just had enough.” It is our job to determine exactly what it is they have had enough of. Sometimes it is obvious, like the pain of a kidney stone. Often, however, the answer is more subtle. Maybe they have had enough of their daily headaches or back pain. And it’s always possible that they’ve had enough stress from work or life, or maybe enough of being ignored by friends or family.
If you ask open questions and behave in a non-judgmental way, patients are more likely to open up and let you know their real concerns. A good way of approaching this is to ask, “I know you have had this problem for quite a while. What was new or different about it that caused you to come in today?” Let patients know that the more information they provide, the better chance you will be able to provide the best care. This is an effective way to improve a patient’s experience, which will translate into favorable scores and comments on the surveys–which will translate into a good day for the CEO and a long career for you
The “Inner” Voice
The following list is a guide to not letting your “inner voice” come out. We all want to ask these questions but nothing good can come from them, so here is the “Don’t ask why” list:
- Don’t ask why they haven’t seen their PMD about this problem already
- Don’t ask why they came back to the ED for the same problem…again
- Don’t ask why this couldn’t have waited until tomorrow. or next week, or…
- Don’t ask why they didn’t take the Tylenol at home
- Don’t ask why they did something inappropriate or reckless to cause this problem.
Again, we are all thinking about these questions, but we can use more tactful ways to get answers to them.
It is our responsibility to the patient, the hospital and the healthcare system to provide a healing environment and create a therapeutic relationship. Kindness, understanding and addressing the hidden agenda are key elements in achieving those goals.
Marc A. Milano, MD, FACEP, is chief of the department of emergency medicine at Bayshore Community Hospital in Holmdel, N.J. He serves as physician head coach of the Patient Satisfaction Coaching Program at Emergency Medical Associates, an emergency medicine practice headquartered in Parsippany, N.J. Dr. Milano received his undergraduate degree from Rutgers University, his medical degree from St. George’s University in Grenada, and completed his emergency medicine residency at Newark Beth Israel Medical Center.