Adapted and expanded from Karen Hickman’s “Make a good impression on your patients. Here’s how”. Karen is founder of Professional Courtesy, Twitter @Karen_V_Hickman.
Patients form an opinion of our Emergency Department (ED), indeed our hospital, within moments of arrival. These first impressions are powerful and difficult to reverse. If we can influence these initial impressions to be positive ones, that will not only smooth our delivery of care, it will actually enhance the quality of care we are able to deliver.
Our late and revered colleague, Leo Marneros, often quoted Theodore Roosevelt: “People don’t care how much you know until they know how much you care”. Perception is reality for those in the picture – how our patients perceive us becomes the reality for their experience in receiving care, and that then also influences our ability to deliver it.
Many processes and systems within our ED are influenced by higher level administration. It is tempting to deflect any deficiencies to factors that are beyond our control. However, there are many aspects of our operation that we can influence powerfully and positively. Here are some suggestions:
1. Continually refer back to our core business of providing health care for our patients and our community
Our oneED mindfulness program is themed around compassionate care of our patients (via compassionate care of ourselves and our colleagues). Our organisational values encourage us to do this with accountability, integrity, excellence and mutual empowerment.
During a visit to the NASA space center in 1962, President John F. Kennedy noticed a janitor carrying a broom. He interrupted his tour, walked over to the man and said, “Hi, I’m Jack Kennedy. What are you doing?”
“Well, Mr. President,” the janitor responded, “I’m helping put a man on the moon.”
Wouldn’t it be great, if our CEO or Health Minister stopped by in our ED, asked the same question of a cleaner or food service deliverer and the response was “I’m helping care for our patients”?
2. Onboard new staff not just in the practicalities of the job, but in the culture that we foster
Mark Fields (President at Ford) made famous Peter Drucker’s quote that “Culture eats Strategy for breakfast”. The message that we put out is that we are an ED that practices with respect and courtesy – it’s just who we are. This counts not just for the way we interact with our patients, but for the way we interact with each other within our ED, and with services external to us.
3. Respect and trust every single member of the ED team
A component of our team that continually impresses me with their kindness, compassion (and immense skill!) is our wardspersons. These key people perform countless jobs but while they push trolleys along corridors and into lifts, they truly connect with the patients lying upon them – asking how they are feeling, making light but meaningful conversation.
Last week, towards the end of an evening shift, I observed a “wardie” walking through our treatment area stopping at each patient bay to ask if the patient was warm enough or needed an extra blanket. I have no doubt that this care was equivalent to any medication or procedure we might have performed.
I’m going to make an extra effort to learn the names of all my colleagues.
4. Dress with respect
In Australia, our sense of egalitarianism happily leads us to consider ourselves to be a simple and grounded people. We need to be careful that this does not translate into a shabby appearance in our healthcare workplace. When we dress and groom ourselves with care, we show respect – for ourselves, for the job we do, for our colleagues, and of course for our patients. It means that we take pride in what we represent.
5. Be generous, even about those factors we can’t control
Apologise profusely for waiting times or for delays in test results or treatment. Most patients are incredibly forgiving. Put genuine warmth into your introduction. Extend the exchange of introductions to others in the patient bay – they are key to the perception of care.
Use respectful titles – my rule of thumb is that anyone older than me (and the cohort is shrinking!) gets called “Mr” or “Mrs”.
At the end of a treatment episode I ask “Does this all make sense? Are you happy with the plan? Is your family happy with the plan? Is there anything else you need from us?” Say it all in a way that matters.
Often, patients or families who are “difficult” are simply worried about themselves or their loved one. One evening, I saw an elderly man with two weeks of blood ooze from his ear due to him cleaning out the wax with a metal hook. I arranged for him to come back to ENT clinic the next morning. He was dissatisfied with this as he’d “been putting up with it for two weeks”. I gently assured him that I wasn’t as concerned about the ooze as he was. He replied “That’s because it’s not your ear”. I needed to balance my authoritative confidence with a bit more empathy.
6. Be truly present with the patient in front of you
This is challenging in a busy ED environment. Try to sit down if able, or at least lower the bedrail or lean over it. (Of course, be aware of hygiene factors).
7. Make our work environment a happy place but not party central
Our patients are sick and they want to know that we take our job seriously. Humour brings levity to our interactions – with our colleagues and with our patients. But we need to get the balance right: Brief chats in the staff pods are okay (and should be encouraged). A big long huddle and raucous laughter are not. And we need to ensure that we don’t discuss other patients, colleagues or our workplace where we may be overheard.
The vast majority of patients in our ED really don’t want to be there and are very keen to get well and get home. Our job is to truly care for them while they are with us.
Another of Leo’s favourite quotes was by 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”.
Let our aim be that every patient (and family member) that we see in our ED leaves it feeling truly cared for.
