The Antidote To Suffering: How Compassionate Connected Care Improves Quality, Safety, and Experience. Christy Dempsey Chief Nursing Officer

Transcription

1 The Antidote To Suffering: How Compassionate Connected Care Improves Quality, Safety, and Experience Christy Dempsey Chief Nursing Officer

2 Advancing the Industry Toward Transformation 2018 Press Ganey Associates, Inc.

3 The Book An Epidemic of Suffering The Roots of Suffering Quantifying Suffering Compassionate Connected Care The Compassionate Connected Caregiver Compassionate Connected Teams The Compassionate Connected Organization A Compassionate Connected Industry Press Ganey Associates, Inc.

4 A 360 Degree Perspective

5 A 360 Degree Perspective Press Ganey Associates, Inc.

6 A 360 Degree Perspective Press Ganey Associates, Inc.

7 A 360 Degree Perspective Press Ganey Associates, Inc.

8 The Roots of Suffering

9 Suffering is Inherent and Avoidable Press Ganey Associates, Inc.

10 What Do Patients Really Value? 19% of patients Low: Confidence in Provider 74.6% Fail to Recommend All Patients 15.7% Recommendation Failure Rate 81% of patients High: Confidence in Provider 1.9% Fail to Recommend 14% of patients 5% of patients 8% of patients 72% of patients Low: Worked Together 90% Fail to Recommend High: Worked Together 28% Fail to Recommend Low: Worked Together 11% Fail to Recommend High: Worked Together 1% Fail to Recommend 11.4% of patients Low: Courtesy 92.8% Fail 2.5% of patients High: Courtesy 78.2% Fail 0.8% of patients 3.4% of patients Low: Listens Carefully 45.7% Fail High: Listens Carefully 24.7% Fail 2.4% of patients 5.9% of patients Low: Concern for Worries 22.3% Fail High: Concern for Worries 6.3% Fail 3% of patients 68.4% of patients Low: Concern for Worries 5.6% Fail High: Concern for Worries 0.6% Fail High Risk Low Risk Press Ganey Associates, Inc.

11 Drivers of Likelihood to Recommend - Inpatient Press Ganey Associates, Inc.

12 What is Correlated with Likelihood to Recommend? Press Ganey Associates, Inc.

13 Higher Patient Experience Reliability Scores Link to Higher Quality (quintiles of performance) Press Ganey Associates, Inc.

14 Compassionate Connected Care

15 Compassionate Connected Care Press Ganey Associates, Inc.

16 Compassionate Connected Care Themes Acknowledge Suffering We should acknowledge that our patients are suffering, and show them that we understand. Body Language Matters Non-verbal communication skills are as important as the words we use. Anxiety is Suffering Anxiety and uncertainty are negative outcomes that must be addressed. Coordinate Care We should show patients that their care is coordinated and continuous, and that we are always there for them. Autonomy Reduces Suffering Autonomy helps preserve dignity for patients Caring Transcends Diagnosis Real caring goes beyond delivery of medical interventions to the patient Press Ganey Associates, Inc.

17 Harm Job Role What Stress & Harm Do Providers Cope With? Stress of clinical role - complexity, high stakes activities Sympathy overload - secondary traumatic stress of witnessing suffering Emotional labor of caregiving role Inherent Emotional labor of employee demands Stress of interruptions, multitasking and task switching Stress of pace of change in organization and larger industry Lack of education/support to prevent/address compassion fatigue Moral distress arising from inability to provide level of quality desired Lack of appreciation Lack of resources Communication break downs, lack of needed information Lack of trust in leadership Lack of respect Emotional abuse (bullying, humiliating, demeaning behaviors) Back or musculoskeletal injuries Unprotected exposure to blood-borne pathogens Physical violence Lack of safe refuge to report physical and psychological harm Avoidable Press Ganey Associates, Inc.

18 The Burden of Emotional Labor Emotional labor or emotion work is an element of job that requires an employee to display required emotions toward customers or others. Creates an emotional cost embedded in the role. Requirement to not display (turn off) an emotion you are feeling Stress, surprise, disgust, fear, uncertainty, sadness, grief Requirement to display an emotion you are not feeling Deference, optimism, assurance, compassion Much of clinician training requires the turning off of felt emotions and then we compound that emotional work by asking to simultaneously turn on the positive emotional displays Press Ganey Associates, Inc.

19 The Process of Emotional Labor Emotional labor or emotion work is an element of job that requires an employee to display required emotions toward customers or others. Surface Acting - the process of displaying behaviors that would be congruent with the required emotion. Associated with burnout Deep Acting - the process of creating an internal emotional state that is congruent with the required action Press Ganey Associates, Inc.

20 How Caregivers Experience Care Press Ganey Associates, Inc.

21 Compassionate Connected Care for the CareGiver We should acknowledge the complexity and gravity of the work provided by caregivers It is the responsibility of management to provide support in the form of material, human, and emotional resources Teamwork is a vital component for success Empathy and trust must be fostered and modeled Caregivers' perception of a positive work/life balance reduces compassion fatigue Communication at all levels is foundational Press Ganey Associates, Inc.

22 The Institute of Medicine The IOM charges us all to achieve these competencies: Provide patient centered care Work in interdisciplinary teams Employ evidence based practice Apply quality improvement Utilize informatics Press Ganey Associates, Inc.

23 Caregiver Best Practices 56 Seconds Round With Connection Narrate Care Offer Choice Talk About Pain Consistency Critical Thinking Press Ganey Associates, Inc.

24 Optimizing Teams and What They Do Trust and follow through Rounding Individual Manager Senior Leader Interprofessional *** Bedside Shift Report Unit Based Councils Discharge Patient/Family Advisory Council (PFAC) Press Ganey Associates, Inc.

25 Culture Mission: Why You Exist? Vision: Where Are You Going? Values: How Will You Get There? Press Ganey Associates, Inc.

26 Staffing and Work Environment

27 Patient Likelihood to Recommend (For Treatment) Mean Score Patient Loyalty and Nurse Loyalty Are in Sync 100 Patient Likelihood to Recommend vs RN Likelihood to Recommend R² = RN Likelihood to Recommend (For Employment) Mean Score Press Ganey Associates, Inc.

28 Patient Likelihood to Recommend Mean Sore Nurse Job Enjoyment Is Related to Patient Loyalty Patient Likelihood to Recommend vs RN Job Enjoyment 30 th percentile (the cliff) Above 25th Percentile for Low Job Enjoyment Levels Higher Job Enjoyment Levels RN Job Enjoyment Score - Percentiles Press Ganey Associates, Inc.

29 Safety and Surveillance

30 Safety and Job Enjoyment Job Enjoyment Safety Surveillance Press Ganey Associates, Inc.

31 Safety and Intent to Stay Intent to Stay Safety Surveillance Press Ganey Associates, Inc.

32 Safety and Meaningful Work Meaningful Contribution Safety Surveillance Press Ganey Associates, Inc.

33 The Impact of the Nurse Manager Press Ganey Associates, Inc.

34 Work Environment Mediators Effectiveness Varies by Unit Mediators of Nurse Manager Effect on Job Enjoyment Autonomy & professional development are primary drivers of performance on job enjoyment across the care settings included in the research study Press Ganey Associates, Inc.

35 Qualitative Interviews: Key Themes Unwavering focus on high quality, safe care Support huddles to improve communication and teamwork Create a culture of respect Leverage data and evidence to support decisions and practice Promote inter-professional rounds and team-building Utilize safe and appropriate staffing Press Ganey Associates, Inc.

36 Leadership Personally affirming a culture of excellence Focus on quality and safety Identify and address performance issues Perceive that excellence in service quality, and safety is a strategic advantage Passion for quality, safety, and service Authentic and hands on style Press Ganey Associates, Inc.

37 High Reliability = Consistency Consistency Is Key!! Press Ganey Associates, Inc.

38 Before You Go Been There. Done That. Nothing New. Heard It Before. BUT Are You Actually DOING It? Knowing what to do Consistent Application Optimal Experience & Engagement Scores Tactics Strategy Culture Connection 100% of the people 100% of the time Lower turnover Loyalty Higher Reimbursement Press Ganey Associates, Inc.

39 Why It s Important

40 You Will Never Know. How Important You Are Press Ganey Associates, Inc.

41 Thank You! Christy Dempsey, MSN MBA RN CNOR CENP FAAN SVP, Chief Nursing Officer