Lean Leap to Health Care #11 (click for Part #10)
by Scott McDuffee
“Have a nice day.”
When my daughters were younger, they would cheerfully wave at everyone as we drove around with the top down on my Jeep Wrangler. It didn't take long for them to notice a pattern – some people smiled and waved back while others ignored them or frowned. After a while, this turned into sort of a game where the girls classified those they tried to engage at a friendliness level of either “sweet” or “sour”.
At the hospital, greeting around a hundred people a day with a smile, I receive similar sweet and sour responses. As I sit at the information desk penning this post between “good morning”s and “how are you?”s, I wonder if I am saying the right things. If I ask – How are you doing? it may trigger some angst based on the trauma they or a loved one is experiencing. If I respond in turn that I am DOING GREAT! It could also be perceived as insensitive.
I may be over-analyzing this (I've been accused of this behavior more than once.) because most greetings are little more than formalities and if someone stops to ponder the question – How am I really doing? – it is rare. I guess in this volunteer role, it may be most important that I smile and be quick to offer help and support.
Although my contact is part of the total patient experience, what about the words chosen and shared with patients in direct care? As the surgical waiting area liaison, which is my second volunteer role, I hear a large variety of good-byes at discharge. Everything from Have a Nice Day (which seems sweet) to just Okay, Bye (which seems a bit sour). A few are discharged with some final instructions, words of encouragement, empathetic questions, and a suggestion to call if there are any questions.
When I asked about the variety, a hospital employee shrugged and responded with, “No two people do things the same way around here.” But there should be right words at the right time, I thought – not necessarily cloned comments but at least some standardization.
One of the many major differences between my previous enterprise endeavors and hospitals is – the customer is right there. Feedback is ready for the asking. Also knowing the customer total experience must have more to it than just sweet and sour, there must be best practices from those willing to see the patient's perspective. I looked again to the book Hardwiring Excellence, remembering a section called Key Words at Key Times.
“In building a culture on service and operational excellence, it is critical to let the patient, staff, and physician know why we do things. They want to know what is going on. They want us to connect the dots. We do this by using Key Words at Key Times.
For example, if you have curtains between beds and you walk into the room and pull the curtains closed without saying anything, what's the patient going to think about that? Anything he wants to:
- He might think you're rude.
- He might think you are trying to hide something.
Every day, thousands of curtains get moved. How many times is there an explanation to go along with this action? Here's what we recommend. When you close the curtains, say:
“Mrs. Medley, we want to make sure you have privacy here at our hospital. Let me close these curtains for you.”
A patient will often associate closed curtains with a hospital that cares. That's an example of Key Words at Key Times. However, you can also test key words with patients by asking permission, “Ms. Medley, would you like me to close the curtains?” (Note: Using key words also give patients an opportunity to respond and share their preferences and needs with you. If you offer to close a door for privacy for instance, one patient may express gratitude while another may say he feels lonely when he hears friendly voices in the hallway.)”
Relevant to this, I must confess my one phobia. Needles. You may recall in Hospital Badge the delays during the process (or lack of process) to become a hospital volunteer. Despite the pain of waiting, the experience with the nurse was exceptional. She spoke calmly; shared what was happening and why. Shared honestly I would experience a small pinch sensation for a short time. I was so relaxed by her demeanor, her empathy, and her reassurance; it was done before I knew it. I said out loud, “Are we done already?”
I thanked her profusely for an experience which is normally traumatic for me.
Quint Studer, in Hardwiring Excellence describes an A-I-D-E-T framework to remember the right things to say at the right times – as the nurse illustrated for me.
“A stands for “Acknowledge the patient.” You may want to acknowledge them by their last name if possible.
I is for “Introduce.” Introduce yourself, your skill set, your professional certification, and your training: “Hello, Mr. Clark. My name is Jackie and I'm a medical technologist. I will be taking your X-ray today. I have been a medical technologist for 10 years. In fact, I've done this procedure hundreds of times and I go back for additional training each year. I also have certification from the American Registry of Radiologic Technologists.”
D is for “Duration.” Describe the test: how long it's going to take; how long they're going to be there; and how long they'll have to wait on the results.
E stands for “Explanation.” Explain the tests, the pain involved (be very honest), and what happens next. Explain you are going to be looking at their wristband and why. Connect key words with patient safety and excellent care.
T stands for “Thank you.” “Thank you for choosing our hospital.”
Sweet is only a part of it. Using this type of framework for standardizing the right words at the right times at the hospital can make all the difference. Patients may not remember the specific procedures of their care but they definitely will remember the caring of their care.
Scott McDuffee is an experienced Lean professional who is currently searching for a new career opportunity. He is based in Mansfield, TX.
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Scott – thanks for highlighting an example where some scripting, a form of standardized work, can be very helpful from a patient perspective.
There's really no good reason to "Free wheel it" every time there is a patient interaction, whether it's at a registration desk or in clinical care.
And, no, we're not turning people into "robots." They can still be natural and use some judgment, but being consistent can make a big difference in many ways.
Studer has also highlighted how important it is to explain "why" — a key cultural concept in the Toyota Production System. It's a key part of the "Respect for People" idea. Thanks for highlighting it.