Autumn Reflection: AGING GRACEFULLY

A PORTRAIT IN LIVING A BEAUTIFUL LIFE AT THE END OF LIFE

 

Throughout our lives, we are drawn to beautiful places and peaceful landscapes. We find meaning in meadows and forests, expression in murals and museums, and comfort and joy in furnishing our own abodes including photographs, paintings.

We relax by listening to music, by attending concerts, going to our church, synagogue, mosque or other community gathering space.

And we heal faster when we are provided comfort which goes far beyond the necessary medical treatments, pharmaceuticals, and other measures enabling us to live healthier, longer lives.

In the Autumn of our lives, we cannot always control where we live or who cares for us, depending on our physical and mental conditions, and yet – with thoughtful preparation and embracing innovation in the field of aging and caregiving – can find ways to create environments where our elders (and ourselves) can experience every moment with dignity and joy.

In the first in a series of articles on innovators in this space, I am sharing with you the miraculous story of Pilgrim Place, a community based in Claremont, California where a good friend’s Mom is being cared for in loving and creative ways.

Licensed by the State of California as a Continuing Care Retirement Community (CCRC), Pilgrim Place refers to itself as “the collective spirit of those who value living in an active, spiritually-fulfilling, reflective community, and who have dedicated their lives (locally and globally) as advocates for social change.”

Started in 1915, it has been a home to thousands of who “desire to be active contributors in a reflective vibrant community, who exemplify genuine care for others, who have demonstrated a sustained commitment of service to others through a local or global cause and who value living in a diverse and inclusive community.”

Serving others is what Pilgrim residents have been doing throughout their lives, and once one understands the joy created by serving others, they never want to stop giving, even as they become frailer physically.

Keeping the spirit alive is one of the values that pervades this community which is now over 100 years old itself.

“Residents at Pilgrim Place demonstrate that elders are a rich social resource and in retirement continue to be leaders for justice, peace and environmental activism,” and within the hundreds of homes located within the beautiful neighborhood, and in the assisted living apartments, and in the Health Services Center where skilled nursing, physical therapy and other medical care is provided, community members know they will always be cared for and included, even as they move from the Autumn into the Winter of their lives, and onto the next domain whatever they believe it to be, or not.

All faiths and belief systems are welcomed at Pilgrim Place, which is also a part of the larger Claremont community vibe, where the entire town, including the many Claremont Colleges, are made friendly to older adults, physically challenged, and economically diverse.

We cannot overestimate the impact beauty and peacefulness have on not only the healing process for patients, but on the sense of purpose, belonging and commitment to service felt by the medical, caregiving and administrative team members across the entire healthcare industry.

Over the next several weeks, I will be sharing examples of visionaries like Pilgrim Place – hospitals, rehabilitation centers, long-term care organizations, cancer treatment centers and more—who take a holistic approach to creating a truly beautiful environment through art, architecture, gardens, galleries, music, creative activities and more and the proven impact investments in truly healing environments generate.

100 Years of Innovation and Compassion: The United Hebrews in New Rochelle and the Power of Beauty in Healing

In 1919, The United Home for Aged Hebrews was founded by the Krakauer Charity and Aid Society, a group of charitable Austrian Jews, whose president, Solomon J. Manne, proposed sponsorship of a home for the aged. A house on Pelham Road in New Rochelle became home to residents in 1921.

 

Over the decades, the resident population grew, as did the facilities. Another milestone was marked in 2003 when The Beverly and Alfred J. Green Pavilion for assisted living opened 126 apartments and an array of amenities for supportive living.

Winner of the National Association of Home Builders Platinum Achievement Award, the residence includes a two-story, glass-enclosed dining atrium, community rooms, a 24-hour café, and the Phoenix Memory Care Neighborhood, a secure, specialized unit for residents with Alzheimer’s and related disorders.

Three years later, the Lucile and Joseph Skalet Pavilion opened its doors; this stunning, state-of–the-art, 143 thousand square-foot facility brought skilled nursing facility County, innovating in new ways to serve seniors in Westchester County in a non-institutional, resident-centered way.

In 2009, United Hebrew announced The Harry and Jeanette Weinberg Campus, named for The Harry and Jeanette Weinberg Foundation, which endowed the organization with a very generous gift. With the combined Kramer Pavilion and new Skalet Pavilion, United Hebrew is now a 296-bed state-of-the-art nursing and rehabilitation center.

In 2014, a certified home health agency was launched, and in 2014, United Hebrew held their “Breaking Down the Walls” ceremony, kicking off a $23 million renovation of their nursing pavilion to create Willow Gardens Memory Care, Westchester’s first nonprofit residence devoted exclusively to people affected by Alzheimer’s and other dementias, and Meadow Lane, an independent senior housing complex for low-income adults.

 

The growth did not stop there. In 2016, Willow Gardens Memory Care and Meadow Lane Apartments was introduced, expanding United Hebrew’s campus of comprehensive care with 32 new senior housing apartments and 41 new units devoted to support for individuals with memory impairment.

Why is this journey important? Because it sets a new standard for care, including the integration of architecture, design and the arts into the creation of experiences for older adults, and the families who love them, contributing to a more beautiful end of life.

I was honored recently to be given a tour of United Hebrew by a friend of a friend, after it was recommended I visit to see an example of what I believe in after years of working in the healthcare industry.

Last week, I wrote about a similar facility on the West Coast, Pilgrim Place, which over approximately the same span of time, evolved entire neighborhoods in Claremont, California designed to provide not just basic support but truly inspired, visionary and visually stunning surroundings through a similar combination of architecture, interior design, fine art, music, and more.

Combined with compassionate care, natural and man-made beauty can make a huge difference on an individual’s happiness and related ability to heal and live longer, more meaningful lives.

This includes those with dementia, Alzheimer’s and other cognitive conditions, which United Hebrew has been innovating in including through the exploration of technologies which help reverse memory loss and extend memory care.

Over the next few months, I’ll be sharing more examples of organizations like these, visionaries whose work, sponsored by generous donors, are making lives better every day.

We can learn and replicate to reach more lives.

In closing, I’m honored to share the Mission and Vision of United Hebrew here:

Mission

Our mission statement is simple:

We Are Kind People Who Care for You Like Family.

We are dedicated to this principle, and treat everyone—residents, their families, our staff, and the community—with kindness and respect. Our mission guides all that we do in providing quality care while helping our residents live their lives to the fullest.

Values

Our values guide us in our work each and every day. Our commitment to caring for everyone on our campus like family is informed by our belief in our H.E.A.R.T. values.

We commit to:

Hear You

Embrace You

Appreciate You

Respect You

Trust You

 

The Impact of Stress on Human Factors in Nursing: Five Tips to Managing Pressure Filled Days

“Human factors examines the relationship between human beings and the systems with which they interact by focusing on improving efficiency, creativity, productivity and job satisfaction, with the goal of minimizing errors,” according to a paper released by the World Health Organization, and “a failure to apply human factors principles is a key aspect of most adverse events in health care.”

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This is a stunning fact, but an understandable one given the increasing pressures on nurses and other health care providers operating in environments where there are shortages of resources – time, money and qualified professionals.

It’s time for the industry to place new emphasis on human factors, to find ways to make it easier to serve patients and get work done in the right way, reducing and eliminating errors, and driving the best possible outcomes.

While technology has been created to make the provision of quality care easier, in fact the requirement for nurses to now interact with technology as much as they interact with patients (or more, depending on the facility) is adding to stress, and causing unintended consequences including “hiding behind the computer.”

Human factor professionals help organizations, usually through patient safety initiatives, to make sure teams are using safe prescribing practices, communicating efficiently, processing digital information properly and creating “workflows” that can ease the transitions between shifts, ensuring the patient experience is also more pleasant.

There are programs, and then there are practical tips that can help nursing staff deal with pressures, especially on those days when the patient-nurse ratios increase, when trauma centers are overwhelmed with mass casualties, when new programs are rolled out which may cause confusion and sense of “more work,” and when there are issues outside of work that may be impacting the ability of an individual nurse to concentrate.

Here are five recommendations for reducing stress on the hardest days, knowing that for many nurses, every day is not easy.

1.Create friendly boundaries and learn to just say no!

Nurses, by their nature, are caregivers and generous often to a fault. With a natural inclination to jump in and help, it is not easy for nurses to turn down requests for time and energy. There are friendly and professional ways to say no, including “I’d love to help, but I’m overwhelmed myself right now,” or “I can see you could use some support, and I’d be happy to help in the future, but today I am responsible for other duties.”

When you do have free time, you can go back to that person and offer support then.

2.Exercise and eat well.

Take your breaks – you will thank yourself later, and so will your patients! When you do take a break, enjoy a good, fast-paced walk, and enjoy a tall glass of water and healthy snack. You’re physical being fundamentally tied to your psychological and emotional well-being and keeping your whole system in top shape will allow you to feel better, and stress less.

3.Don’t keep it all in; communicate when you feel you are not able to function as well as you normally do.

When you start to feel taken advantage of, or when you start to feel your workload is too much and that this is leading to a sense of constant, underlying frustration and even anger, take a moment to think about what is causing you to feel bad. Fear, uncertainty, anger and other emotions can take their toll on your ability to think clearly.

Communicating with your supervisor is not complaining, when it is done with the right attitude, tone and honesty. Talking through your perceptions and feelings in a calm setting will do wonders; make sure to be specific about what is troubling you and come with constructive ideas on how you and the entire team can function better, and you may be surprised by the results!

4.Find a quiet place for meditation and bring your tools with you.

There are amazing mobile apps today for relaxation and meditation. Even without an app, bring your headphones with you and find a quiet place to listen to your favorite music, or listen while you’re taking a brisk walk on your break.

Find photos you love, of beautiful natural settings, paintings, flowers, animals and more, and keep those in your own “peace folder” on your smartphone, and simply “go there.” There are also many relaxation techniques including stretching, breathing (inhaling and exhaling works!), and mantras in mind for example repeating “Don’t think, don’t think, don’t think” so you can clear out the mental clutter even if only for five or ten minutes at a time.

5.Forgive yourself and others.

Perfection is a myth, and constantly aiming for perfection is fundamentally flawed as a result. There will be days when you come to the end of your rope, and you lash out at somebody almost instinctually. It happens, and it doesn’t make you a bad nurse, or a bad person. It actually helps you grow into a more capable and loving person, including when you make amends and grow closer to the same person who only moments ago was driving you a little crazy.

According to a 2014 study conducted by the American Sociological Association, nurses who viewed their job as a calling—primarily because they wanted to help others—experienced more nursing job stress and burnout than those who considered their job a career. And why? Because nurses are deeply empathetic and go beyond where average humans go to care for others.

This is beautiful and fulfilling on normal days, but on extremely harried days, busy days, stressful days – it’s important to learn to turn down the empathy and refocus on getting the work done in a safe and proper way.

And while we covered five tips, I’m going to add one more and that is this: do something wonderful for yourself every day. This doesn’t have to cost a penny and doesn’t have to take much time. Remember to love yourself, as that self-love, that self-empathy regenerates all the best of what is in you, and what attracted you to nursing in the first place. Love a nurse – yourself.

What is Human Factors and Why is it Important to Patient Safety?

Human factors crosses over many disciplines (anatomy, physiology, physics and biomechanics) to understand how people perform under different circumstances, and when studied and applied systematically, can contribute to more productivity and job satisfaction for healthcare professionals.

Human-Factors-Blog

An awareness of human factors, and a commitment to invest in understanding and improving those human factors leads organizations to design processes that improve the ability of individuals and teams to deliver not only the highest quality of care, but the safest.

Comprehensive human factors programs support safe practices, ensure accurate and appropriate prescribing of medications, and provide for clearer communications and information management.

While they have always played a role in productive and effective healthcare, at times, given the increased complexity and fragmentation of services and systems, there can be “unintended consequences” when too much time is spent with machines leaving not enough time to really connect with humans.

The healthcare industry, and the health of society depends on humans, doctors, nurses, nurse practitioners, specialists, pharmacists and others.

A well-designed factors program can make it easier for healthcare providers to care for patients, but only when those programs are created in the context of change (including regulatory and economic change, new software systems, new medical equipment and more).

Human factors practices can be adapted to reduce or eliminate mistakes often associated with lack of communications or miscommunications, and applied in different settings, from trauma centers where acting quickly can save lives, to the ICU where care is provided by larger teams of experts, to ambulatory care with less extreme cases and real-time pressures.

Excellent human factors design takes into consideration both the ideal situation, when a patient is cared for by a well-rested, experienced professional, but also applies when a patient is being served by a professional who may be exhausted, overwhelmed or otherwise stressed out.

Whether designed for human-to-machine or human-to-human communications, when quality human factors are instilled in the operations of healthcare facilities and – most importantly – embedded into the culture – we can find the right balance teaming technology and people together to get the work done more successfully.

This leads to better medical outcomes, better patient experience, better economics, and happier professionals who can be productive while still enjoying the reason most doctors and nurses chose healthcare as a profession – to care compassionately for others.

Human beings are not machines.

Machines, when maintained, are predictable and reliable.

Human beings, while not as predictable and reliable simply due to the limitations of our energy and memory, are more creative, self-aware, flexible and comforting than machines will ever be.

Pt Safety

It is at the intersection of machines and humans, of software and systems, that we have unlimited opportunities to create the right mix to deliver the best care and drive the best outcomes for all.

In summary, a quality human factors system implementation can:

  • Reduce errors
  • Improve overall patient outcomes
  • Save money
  • Improve clinician productivity
  • Enhance the patient and family experience
  • Reduce stress and burnout of healthcare professionals
  • Be implemented in coordination with health data systems (EMRs, etc.)
  • Be a key part of patient safety initiatives
  • Improve chances of Joint Commission certification

With More Healthcare Communications Technology, Let’s Turn More Time Into Human Factors

All those of us who work in medical settings are deeply familiar with the increasing requirements for more documentation and administrative work designed to comply with government regulations and healthcare insurance rules.

In theory, major frameworks like the Joint Commission (JC) in the US are setting common standards to improve the quality and safety of care, with an understandable focus on reducing returns to the hospital for infections or other complications. The JC has been so successful, as far as measured results, that hundreds of hospitals and medical centers around the world are investing in educational and management programs enabling them to be certified, opening new doors to international patients with reimbursement at a lower cost to public and private payors.

Human-Factors-Importance

In theory, comprehensive privacy compliance, like HIPAA, and standard system protocols, like HL7, enable software that allows for system integrity and software integration so the process of providing care can be strengthened, errors reduced, and costs controlled.

In practice, however, the pervasive nature of the combination of all these technologies, combined with overlay Electronic Medical Records (EMR), e-prescribing, real time voice, video and messaging applications runs the risk of turning doctors, nurses and others who entered the medical profession to help human beings into “humanoids” who spend more time at keyboards, computers, smartphones and other devices, typing and tapping throughout their shifts.

For many, so much time spent on the “digital paperwork” (along with actual paperwork which may also be required) contributes to burn-out and a sense of being overwhelmed by tasks so much so that there is less and less time for interacting with patients and thinking through problems with colleagues to serve those patients better.

As software improves following decades of this major move to the digitalization of providing and paying for care, we believe it is a perfect time to step back and rethink the critical importance of “human factors” in healthcare.

Human factors bring us back to the fundamentals of quality care – starting with listening, engaging in conversation, showing compassion, and being able to read the non-verbal clue patients share.

As more mundane tasks are automated, and new models for teamwork and management of necessary administrative functions are innovated, we have a moment in time to rediscover the joys and benefits of being able to spend time with patients and their families during traumatic times and over the long haul when managing chronic conditions.

Medical Tourism and Travel: A Movement

In this 2017 study published by the Medical Tourism Association (MTA), this non-profit association shared the latest trends associated with traveling internationally for quality medical care.

The methodology of the report included research with over 1,000 prequalified global buyers of services, defined as individuals or companies that either refer patients to healthcare destinations or are involved in the selection of healthcare providers for the networks offered to traveling patients.

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“The demographic and geographic sampling was diverse, yet the responses weighed heavily from buyers in the MENA nations, United States and Asia managing patients predominantly emanated from MENA, UK, Germany, and the United States,” the report begins, with patients traveling to the same destinations listed in addition to India, Turkey and Thailand.

The research showed over half of patients spent USD $10,000-50,000 and 16 percent spending USD $50,000-100,000, with half of patients’ fees being paid fully or partially by insurance of government coverage.

Prior studies reflect the largest volume of patients consuming dental and cosmetic services however the most recent study reflects 72 percent traveling for orthopedics and oncology that likely contributed to the higher per patient spend.

Medical tourism has been active for decades, and initially was done for elective procedures. Destination health, wellness, cosmetic surgery, dental procedures and other elective actions drove the early days of international travel care.

Today, however, more and more insurance companies, providers, and government agencies are seeing the value of providing lower-cost but still high-quality care to patients for major surgeries, which has driven great interest in achieving U.S. Joint Commission certification, qualifying global hospitals to participate in this relatively new medical travel industry.

“In recent years, we see the increase in movement of healthcare organizations to ‘internationalize’ their brand or services for an expanded consumer base, often crossing borders and cultural competencies,” the introduction to the report says on the MTA’s website, and goes on to say “medical tourism or medical travel can be measured by the economic impact appropriately documented to include each consumer and payer category to meet the realities of these individual markets around the world. The combination of the spending at a health center, combined with wellness complementary to health and tourism/travel, plus the hospitality, travel and per diem spending associated with this trip, is in fact the true economic impact of the industry.”

 

How Big Is This Industry?

Visa estimates 11 million tourists travel each year for medical care. This is 3-4% of the world’s population.

Patients Beyond Borders provides a more conservative estimate of the industry’s worth at USD 45.5-72 billion with 14 million travelers spending approximately USD 3,600-7,600 per medical visit. This figure includes travel and/or medically related expenses.

The Medical Tourism Association estimated at USD 100 billion.

An earlier 2015 MTA Medical Tourism Patient Survey found that nearly 27% of patients had previously traveled to a foreign country to receive medical care. Most of the travelers were female and all were between ages 45 and 64. The majority were White/Caucasian. All were American. Additionally, they were all college educated with 50 percent having household incomes between USD 50,000 and 100,000. Additionally, 50 percent of them had health insurance.

These patients required a savings of between USD 4,900 and 8,600 USD to pursue medical tourism as an option.

The Importance of Patient Safety and Experience

Patient safety was the most important factor in choosing a destination and 20 percent stated they were willing to air travel one to five hours to reach their medical destination. They are mainly motivated by cost savings (61%) then quality (21%) according to the report.

Visa projects the medical travel industry will grow 25 percent each year, particularly if safety, experience and overall quality can be delivered and certified.

Deloitte expects medical traveler numbers to increase 35 percent annually.

“While much work is to be done in defining the metrics for measuring medical tourism, collaboration amongst stakeholders is the key to its sustainability,” the MAT report states, and “in order to meet the demand, this industry needs to set some foundational and core principles right away. For example, setting standard medical facility and physician certifications is encouraged.”

Joint Commission International programs are in place to do just that. The JCI offers expert consultants and certification programs, critical to the development of a truly systematic approach to medical travel.

As this movement grows, there are opportunities for entrepreneurs (for example medical travel brokers and facilitators) to medical facilities (hospitals partnering to provide lower cost options) to travel agents.

“Every region of the world has medical tourism success stories to share and be inspired from,” the MTA report says. “India has been most prolific in publishing case studies and best practices. These global patient experiences may be a worthy investment of your time to read and learn from. It is common knowledge Southeast Asia has been the most aggressive and successful in their endeavor to attract medical tourists as six of the world’s top ten medical tourist destinations lie in that region.”

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Other destinations are still in the beginning phases of development, including Central and Latin American countries, Sri Lanka, Philippines, and Puerto Rico.

“The service this industry provides is a noble one,” the report concludes. “It is making people healthy, whole and happy again thus is worth the effort to develop and grow. If we work together we certainly will find our way there successfully.”

Opportunities to make safe, high quality, and compassionately delivered medical treatments to our growing population are manifest; the key will be a vision for bringing more systematic approaches, collaborations and partnerships to bear as the medical travel industry matures and grows.

Neuroscience based set Sound Design & Music for Modern Memory Care

As the population continues to age, and as we all try to imagine what our lives will be like – mind, body and spirit – as we enter the autumn and winter of our lives – tremendous progress is being made in understanding Alzheimer’s and many forms of dementia.

SUZANNE FALLA Memory Care 3-4

Even as we become more forgetful or experience cognitive declines beyond forgetfulness, we still retain our ability to feel joy and happiness, and enlightened communities serving older adults are increasingly implementing “Memory Care” programs that include music, paintings, sculpture, garden design, film, dance and more.

Recent research studies are now proving the impact of these programs. For example, an April 2018 study reports that “objective evidence from brain imaging shows personally meaningful music is an alternative route for communicating with patients who have Alzheimer’s disease.” The research, published by a team at University of Utah Health in Salt Lake City in The Journal of Prevention of Alzheimer’s Disease, provided evidence that familiar music “may facilitate attention, reward and motivation, which in turn makes it more possible to manage emotional distress in Alzheimer’s.”

Another 2018 study, published in conjunction with Dr. Stephen Post of Stony Brook University in Dementia: The International Journal of Social Research and Practice presented data indicating “personal music intervention improves swallowing in individuals with advanced dementia, making eating easier and potentially diminishing reliance on feeding tubes and PEG intervention.”

And last year, Brown University published an article in The American Journal of Geriatric Psychiatry, comparing behavioral and psychological resident outcomes before and after a Music & Memory program. Ninety-eight nursing homes were studied along with 98 matched-pair comparisons and proved that discontinuation of antipsychotic medications increased in Music & Memory facilities (23.5% to 24.4%), while decreasing among comparison facilities (24.8% to 20.0%).

Facilities using Music & Memory also demonstrated increased rates of reduction in behavioral problems (50.9% to 56.5%) versus comparison facilities (55.8% to 55.9%). Implication for practice concluded that “effective, non-medicalized, low-cost interventions such as Music & Memory, are critical to address the needs of the growing ADRD population.”

With scientific evidence in, and our intuitive understanding that music from one’s culture or past can trigger positive responses in those challenged by cognitive decline, we are now seeing technologies evolve, including the use of artificial intelligence, that can personalize programs for individuals, based on their backgrounds their preferences, and their ongoing response to specific stimulation.

A very specific song can help people living with dementia access memories, emotions and connections that their families and caregivers may assume they are no longer able to grasp.

 

I was fortunate to visit one amazing facility in the NYC metro area where I live, United Hebrew in Westchester County, thanks to a colleague who has been working on memory care innovations with their team.

They, like other enlightened providers, integrate music into many programs, and integrate visual art as well, including an art gallery on their campus.

Music and visual art in modern memory care can help soothe older adults, often opening new ways for them to communicate and express themselves, and lead to beautiful, calm moments between the staff and patients, and family members.

An old man in his 80s listening to his music on a new headset

The challenge, as the older population grows, is how to deliver personalized, highly effective experiences with music and the arts, which is where technology can come in. Imagine a system where content is curated for each patient, enjoyed by that patient, and improved over time as patterns are recognized.

This can assist in the patient experience by providing support to often limited caregiving staff and can also involve family members and friends who often feel helpless.

Imagine a day when those loved ones can help “program” experiences, including photographs, videos, special songs, poems and more to bring joy “on demand” in highly personal and effective ways.

We will continue to explore this exciting area, blending technology and the arts to create new awakenings unlike anything we could have imagined before.

What Hospitals Can Learn From the Hospital Industry

What Hospitals Can Learn From the Hospital Industry

It’s no coincidence that the words “hospital” and “hospitality” are so similar. The word hospital comes from the Latin word hospitalia, which means an apartment for guests.

Hospitality is rooted in human kindness. Before hospitals became medical centers, travelers and pilgrims were received and cared for in a version of hotels thousands of years ago. When people from many different faiths were encouraged to make pilgrimages to the many holy places of the Middle East travelers from Western Europe made their way into that part of the world.

Many of these pilgrims were poor, and some were sick, seeking healing and miracles in sacred places.  Many hospitals were established, including in remote and dangerous places. The service of early hospitality was perceived as a gift to others who shared the faith, or to those on journeys generally needing food and shelter.

Many Christian hospitals can be traced to around 325 A.D., when the bishops of the church were instructed to go out into every cathedral city in Christendom and start a hospital.

As time went by, medical treatment gradually played a bigger and bigger role in hospitals. From the 16th century onwards, hospitals began to take on its modern meaning as we know it today.

The earliest hospital in Islam is believed to have been a mobile dispensary following the Muslim armies, dating from the time of Prophet Mohammed. By the 12th century, the hospital had become a very advanced institution.

In 650, the “Hôtel-Dieu” was found in Paris and is considered as the oldest worldwide hospital still operating today. It was a multipurpose institution which catered for the sick and poor, offering shelter, food and medical care, again predating the notion of the massive, global hospitality industry we enjoy today.

SUZANNE FALL Compassionate NurseThe Common Thread: Kindness and Service

Over the span of my career leading patient experience and quality initiatives in some of the largest hospitals in the US, I have often shared with teams I mentored a vision for hospitality in hospital settings. This has changed their perception and even their cultures, particularly when the pause to consider the human concerns of those who are admitted to hospitals.

They are ill, they need treatment. They are afraid, their families are worried. They are away from their homes, away from their work, and can feel confused and bombarded by information, people, procedures, and choices.

There are so many ways we can interpret “five-star” experiences in hospitals, and this does not mean spending more money. It means focusing on the things that matter most to patients and their loved ones: above all, sensitivity and kindness.

Good listening is likely the most profound, quiet skill team members in hospitals and hotels and restaurants, cruise ships and spas can practice. When we listen, and connect, we can comfort and avoid problems. We can improve our delivery of care – or our delivery of a better meal, a more comfortable bed, a more beautiful view.

Here are five ways hospitals can interpret best practices in hospitality to not only increase patient satisfaction, but the joy of providing care amongst an aligned and collegial team, and the benefit of creating a more competitive offering that can have lasting economic benefits.

Extend a Very Warm Welcome

This is the first impression for hotel guests and hospital patients. The experience of entering the hospital, being greeted at reception, being made comfortable and being helped with belongings and directions to their destination can mean a world of difference. Patients entering hospitals are under much more stress than hotel guests, and the right person – the right tone of voice – the right listening and assurances start the experience overall and can reduce anxiety and even surprise the patient and their accompanying friends or family. This is priceless.

Select, Engage With and Train the Best Possible Team Members

Picture of guests getting key card in hotel

Just as the hospitality industry is now selecting from the best educational programs and competing for the most highly rated and genuinely passionate for service employees, hospitals can do the same.  World-class hotel brands view employee selection as the single most important factor in strengthening and developing the organization’s service culture which is quite often their greatest “brand asset.” Applicants are carefully selected, and trained immediately, with extensive orientation programs including creative and vibrant presentations on the brand’s mission, vision, standards, ethics, service orientation and culture. This is a continual process linked with motivational mentoring and rewards systems for awesome employees who go the extra mile for guests.

Use Technology Quietly and Respectfully in the Background

Hotels, cruise lines, restaurants, spas and other hospitality venues respectfully ensure the specific, personalized needs of their customers are captured in customer records. When we arrive, today, at the Ritz Carlton, we are greeted by name, located on our preferred floor with our preferred view, have hypoallergenic pillows with the softness or firmness we prefer, extra towels, and fruit and water delivered to our rooms. We are delighted in a gentle way by this personalized service. And with technology, this kind of “royal treatment” is not restricted to ultra-expensive, five-star places. Even moderately priced hotel chains and cruise lines, for example, offer loyalty programs that are data driven to bring the best experiences and the most personalized services at affordable prices. Hospitals can expand their data strategies beyond basic EMRs and can do simple but powerful things, including noting a patient’s food preferences, allowing for example a nutritionist to appear in the hospital room with a tablet that can enable a friendly conversation, for example “How was your salad yesterday, Ms. Brown?” and “Ginger Ale again today for lunch?”

Anticipate Needs

The ability to intuitively observe, listen, sense and respond is one of the most powerful talents found in high quality hospitality settings. We all remember those individuals who notice, for example, that we may be thirsty on a hot day, and hand us a bottle of cold mineral water. We all remember those servers in hotel restaurants who notice when we are dining alone and strike up a conversation that makes us feel a lot less lonely. We all remember those room attendants who notice we are jet lagged and work their schedule around ours. These often simple, basic gestures add up to great memories and build loyalty. This is no different in a hospital. The nurse assistant who brings a cup of tea to a wife at her husband’s bedside can have a tremendously positive impact on her state of being. The physician who stays longer to engage in friendly conversation after completing his or her examination will be remembered for years to come as a real human being who really cared. Having empathy and expressing kindness is a differentiator and simply the right thing to do.

Ask for Feedback

Hospitality professionals never hesitate to ask how guests are feeling. In fact, the more senior the professional, the more often they ask and the more open they are to input, even if and especially if the input is not positive. This feedback is also systematically gathered and shared, in team meetings, in business reviews, and is cycled back into improvement programs which continue to drive excellence – customer loyalty – revenue – and profit. Hospital teams can learn a great deal about how they are doing and how their “guests” are feeling, and given open hearts and minds, and a refusal to become defensive or immune to criticism, can breakthrough to new levels of experience ALL feel better about.

In Summary

Let’s all keep in mind how we love to be treated, regardless of where we are – at a hotel, restaurant, shop, theatre, clinic, hospital or cancer center. The golden rule here applies across the full range of “being hospitable” – “Do unto others as you would have them do unto you.” Listen – learn – and love. Then watch your culture and business bloom.

Global Gratitude to Nurses Everywhere: Health is a Human Right

Global Gratitude to Nurses Everywhere: Health is a Human Right

Today is International Nurses Day, an annual event which occurs on the birthday of Florence Nightingale, an innovator in global nursing during her lifetime (born May 12, 1820, Florence, Italy; died August 13, 1910, Mayfair, London, United Kingdom).

 

Nurse Nightingale wrote: “How very little can be done under the spirit of fear.”

 

We cannot fear politics, diversity of religious beliefs, or demagoguery of any sort when it comes to the consideration of the health and well-being of every individual on the planet.

 

This year, the International Council of Nurses (ICN) has chosen a perfect theme: “A Voice to Lead: Health is a Human Right.”

 

In their publication on this year’s them, which includes extensive research and a range of innovative ideas, the ICN writes they are “at the forefront of advocating for access to health and nurses are the key to delivering it. All over the world, there are individuals and communities who are suffering from illness due to a lack of accessible and affordable health care. But we must also remember that the right to health applies to nurses as well! We know that improved quality and safety for patients depends on positive working environments for staff. That means the right to a safe working environment, adequate remuneration, and access to resources, and education. We must add to this the right to be heard and have a voice in decision making and policy development implementation!”

 

Together, all healthcare professionals – nurses, doctors, specialists, administrators, social workers, insurers, policy makers, and more – can join together to support those nurses who are transforming their profession so that no person is left behind – not a single child, mother, father, family or community.

 

Dr Tedros Adhanom Ghebreyesus (Director General of the World Health Organization) wrote:

 

“For me, the key question of Universal Health Coverage is an ethical one. Do we want our fellow citizens to die because they are poor? Or millions of families impoverished by catastrophic health expenditures because they lack financial risk protection? Universal Health Coverage is a human right.”

 

In June 2017, Dainius Puras, the United Nations Special Rapporteura presented his report on the right of everyone to the enjoyment of the highest attainable standard of physical and mental health to the Human Rights Council of the United Nations.

 

The report focused on mental health care to which the Rapporteur concluded “nothing short of a ‘sea change’ will end years of neglect in mental health care.”

 

This report highlighted decades of neglect, abuse and violence against socially challenged groups including persons with intellectual, cognitive and psychosocial disabilities suffered either because of the absence of care and support or receiving care that was ineffective and harmful.

 

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Why are nurses so vital in increasing the momentum towards health as a human right?

 

Nurses are often the most critical member of care teams. They choose the nursing profession because they genuinely wish to help others. They are at the forefront of patient-centered care, and the advocates along with the physicians they work with for quality care and quality experience of that care regardless of an individual’s financial or social circumstances.

 

Nurses go about quietly helping patients and families through the most difficult days of their lives.

 

When we support nurses in their missions – including missions around the world, where they often travel to deliver care after natural disasters, where they travel to help refugees keep their families together and keep mothers and their babies healthy, where they go to turn cleft palates into smiles…we are support the entire world.

 

Health systems are an essential element of a loving and equitable society. When health is viewed as a human right, we are all positioned to enable access.

 

I will leave you with a few facts, thanks to the ICN:

 

• At least 400 million people on our planet lack access to one or more essential health services, according to research.
• Each year 100 million people fall into poverty paying for essential services.
• 40% of the world’s population lacks social protection.
• For $44 per person per year, every person on our planet can be provided care when systems are built to deliver that care efficiently.

 

Health is the most basic human right. Services should be accessible to all without discrimination, including those living in poverty, minorities, indigenous peoples, women, children, people with disabilities, the growing number of elderly and babies being born into our world. We owe it to them all.

 

Nurses know this, they feel it in their hearts, and today they are our greatest advocates.

 

Happy International Nurses Day 2018 and thank you from the bottom of my heart for all the nurses who have done so much for me and my family.

 

Suzanne

What is human factors and why is it important to patient safety?

“Human factors examines the relationship between human beings and the systems with which they interact by focusing on improving efficiency, creativity, productivity and job satisfaction, with the goal of minimizing errors,” a World Health Organization publication suggests. “A failure to apply human factors principles is a key aspect of most adverse events in health care.”

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Human factors crosses over many disciplines (anatomy, physiology, physics and biomechanics) to understand how people perform under different circumstances, and when studied and applied systematically, can contribute to more productivity and job satisfaction for healthcare professionals.

An awareness of human factors, and a commitment to invest in understanding and improving those human factors leads organizations to design processes that improve the ability of individuals and teams to deliver not only the highest quality of care, but the safest.

Comprehensive human factors programs support safe practices, ensure accurate and appropriate prescribing of medications, and provide for clearer communications and information management.

While they have always played a role in productive and effective healthcare, at times, given the increased complexity and fragmentation of services and systems, there can be “unintended consequences” when too much time is spent with machines leaving not enough time to really connect with humans.

The healthcare industry, and the health of society as a whole, depends on humans, the doctors, nurses, nurse practitioners, specialists, pharmacists and others.

The right human factors platforms can make it easier for healthcare providers to care for patients, but only when those programs are cognizant of providing care in the context of change (including regulatory and economic change, new software systems, new medical equipment and more). Human factors practices can and should differ from one hospital or clinic to the next, based on the particulars found within different neighborhoods serving different populations with different levels of resources.

Human factors principles can be adapted in order to ultimately reduce or eliminate adverse events often associated with lack of communications or miscommunications, and applied in different settings, from trauma centers where acting quickly can save lives, to the ICU where care is provided by larger teams of experts, to ambulatory care with less extreme cases and real-time pressures.

Excellent human factors design accommodates all the participants in a care system, and thoughtfully lays out the best practices based on specific circumstances and specialties.

Excellent human factors design takes into account both the ideal situation, when a patient is cared for by a well-rested, experienced and confident physician, but also when a patient is being served by a professional who may be exhausted, overwhelmed or otherwise stressed out.

Whether designed for human-to-machine or human-to-human communications, when quality human factors are instilled in the operations of healthcare facilities and – most importantly – embedded into the culture – we can find the right balance teaming technology and people together to get the work done more successfully.

This leads to better medical outcomes, better patient experience, better economics, and happier professionals who are able to be productive while still enjoying the reason the majority of doctors and nurses chose healthcare as a profession – to care compassionately for others.

Human beings are not machines.

Machines, when maintained, are predictable and reliable.

Human beings, while not as predictable and reliable simply due to the limitations of our energy and memory, are more creative, self-aware, flexible and comforting than machines will ever be.

It is at the intersection of machines and humans, of software and systems, that we have unlimited opportunities to create the right mix to deliver the best care and drive the best outcomes for all.