Bridging the Chasm

Communicating With, Not Simply About the Patient

Patient engagement is hot. However, a critical chasm exists between the way medical folks and patients perceive it. Therein lies some of the difficulty in trying to create a great patient experience. Medical folks generally define patient engagement as collaboration with the patient, providing information and respecting the patient’s desires. The locus is external to the patient and directed toward him. Patients look at engagement as emanating from the patient. Dave deBronkart believes, and I would agree, that the engaged patient is “involved, active, responding,” and empowered – knowing what he/she wants and speaking up to get it. But the patient needs a way to speak up. If they can’t communicate, they can’t engage – meaning “occupy the attention or efforts of a person”. If patients can’t engage someone, they can’t be engaged.

Looking for Avenues to Communicate

Comforting his loveMy husband and I repeatedly encountered the magnitude of this communication deficiency. 1994 started our parade through hospitals to which his many health issues took us throughout the United States and abroad – from large, famous teaching hospitals to small-town satellite hospitals. Hospitals did not have an avenue to efficiently communicate with the correct person or service. They lacked a variety of input modes and devices, making it even worse for the voice impaired, hearing impaired, blind or language (foreign or other) impaired. Engagement was obstructed, and dangerously so.

After his heart transplant in 1999, John was intubated and in hand restraints in intensive care. Although his nurse call button was within his reach, it was broken.His charts were taped to the glass walls, blocking all view of him. When something went wrong, he couldn’t get anybody’s attention to help him. Here, in one of the finest teaching hospitals in the world, he experienced a dramatic breech of patient safety – because communication was ineffective.

In that era, here was a typical sequence of events when trying to get help:

  1. Try to find the call button – and hope it’s not broken.
  2. Push the button and wait, wondering if anyone received your signal on the other end.
  3. Push the button again because nobody responded.
  4. Listen to someone ask what you want – if you can understand them through the speaker – of course waking the person in Bed #2
  5. Give your request which you hope the nurse can understand, trying to speak privately so Bed #2 doesn’t hear you – though he now knows you’d like an enema.
  6. Wait for the nurse to come to clarify what you requested.
  7. Wait while the nurse goes to get equipment.
  8. Nurse gets sidetracked by another request, and forgets your request.
  9. Push the button again because the nurse doesn’t arrive after 10 minutes.
  10. Nurse arrives with the enema kit.

High Tech: Hardly Adequate

Now 2014 and we have great advances in medicine, and digitalized records which flow pretty freely between and among medical staff within and outside the hospital. Doctors and nurses can text each other, send messages and alerts to each other and so on. But where is the patient in all of this? Most of this high tech communication is about the patient, not with the patient.

Last year I had robotic surgery, yet I still just had a call button. Sure, it looked a little fancier, but it still worked the same – steps 1-10 as above – twenty years later! To this day, any time you or your loved ones are hospitalized, you face the possibility of frightening and dangerous circumstances because patient communication methods are still sorely inadequate. This shouldn’t happen to you, nor to those you love and care about.

No matter your age, hospitals can be lonely and frightening. Loved ones need to be part of your healing process, to enhance your patient experience. Yet visits aren’t always allowed, particularly for children and non-relatives. Safe, secured, virtual visits need to be available within the hospitals – enhancing the patient experience, while reducing hospital traffic, noise and danger to patients and staff.

Putting the Patient in Control

When we put the control for a morphine drip in the hands of a patient, they use less. This is partly because they know it’s at the ready which gives them a sense of security. When patients are given more control of their communication, we can actually anticipate fewer calls to the nurse. Put the patient in the picture with effective communication tools and you’ll create a superior patient experience and better functioning hospitals.


Editor’s Note: A determined patient advocate, Ms. Denholm developed a patient concierge/nurse-call system which is spotlighted in her nomination for the John Q. Sherman Award for Excellence in Patient Engagement. You can read about it here.

Diana B. Denholm, PhD A caregiver for 11-plus years, Diana is author of the critically acclaimed "The Caregiver Wife's Handbook." Based on her personal experiences, she designed a nurse call/patient concierge system to enable patients to interact effectively with care staff.

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