Wednesday, April 1, 2009

Compassionate Communication and Patient Safety

PULSE of NY just completed day 2 of our workshop on apology and compassionate communication. The workshop was facilitated by Leslie Farrington MD, PULSE of NY newest board member. The idea was to learn if an apology can be delivered without saying the words “I’m sorry”. To some, the words I’m sorry have to do with “my” responsibility. It is a play on words but as we learned in these two, two hour sessions, words matter.

14 people participated; a perfect amount for a small focus group. There were 3 physicians, 2 in quality /risk, 2 nurses, 4 patient and / or family members and 3 observers / community members.

After introductions last week we watched the video ‘Beyond Blame” about a little boy who died during surgery in the mid 90’s. The film had us sympathize with the medical staff and learn some of their turmoil when something goes wrong. We also needed to remember the family and the pain they endured. The film set the mood.

We looked at the ‘disclosure” process from a registered nurse who is also a risk manager and very familiar with the disclosure and apology process throughout the country. She explained how physicians and hospital staff are being trained in disclosing bad outcomes to the patient and / or family. We then had a presentation about compassionate communication, how it is used to connect and listen and a discussion followed.

We ended on a good note last week to come back again and learn more.

Tonight we introduced ourselves again and reflected about last week. Many shared that they view compassionate communication as important but lacking in their training as medical professionals and in the patient’s experience in the healthcare setting. Someone suggested that they didn’t realize how just listening is so important.

Anne, a compassionate communication facilitator read a story about a medical injury and how compassionate communication helped the young girl who previously awoke during a painful procedure, through her next surgery.

Tonight we did some exercises practicing listening and reflecting and then Leslie did a role play with a woman who had a medical injury many years ago, Much of compassionate communication is about listening. We are accustomed to asking questions, giving advice or filling in blanks. Tonight we are introducing the skill of just listening, connecting with some feelings and the needs which are universal such as trust, sympathy and respect.

Leslie, a physician for over 25 years, listened as the woman shared her experience of years ago in the hospital. Leslie reflected back her feelings of anger betrayal and as someone said later, disrespect in not feeling heard. One of the people in the room commented on how it is so common to want to give advice. It came naturally for the people who worked in health care. The patient didn’t need advice, she needed to be heard. And Leslie offered her that.

One physician commented that doctors don’t get paid for “listening” there is no time. But we were assured that in Leslie’s practice, she encourages the patient to make a second appointment. Or, as Anne explained, the listening can come from anyone.

Our listening process took less than 10 minutes and the patient felt heard, respected and empowered.

The healing and connection that a patient experiences after being heard, helps the healthcare provider to gather important information, make the patient more compliant and trusting and will make the whole experience for all parties more productive and timely.

We then heard from Steve, also a board member of PULSE who is a nurse by training but a mediator for 7 years. He described how mediation can be for patients and families who have had a bad outcome. The discussion that followed showed me that we seem to all have a different view on mediation. For financial compensation, healing, closure, answers? With no exact mutual definition or even a reason for using mediation, it’s even harder to figure out what people want. I still say we can offer mediation as a third party who comes to the table with 2 parties willing to discuss what happened. Reporting the outcome to the National Practitioners Data Bank was a concern for a physician in the room. Not sure if that should matter. If the parties agree, it should be made available. Some people felt mediation is already being done through the disclosure process in hospitals. Others said that it is the patient representative who is there for the patient and / or family. Others commented that mediation is a tool for those who get turned down from the legal system because of the lack of financial compensation.

Mediation, as a form of communication would help parties come to an agreement following an unplanned outcome. We have a long way to go.

This 2 part workshop was just an introduction. We have so much more to explore and to learn. I would like to see an all day workshop. I would also like to raise the money to make this a paper that can be expanded on. Someone suggested this be offered in medical or nursing schools. At PULSE we have begun teaching forms of compassionate communication as part of our family advocacy training . Listening, connecting and really hearing the patient’s needs and feelings is as important as hearing what the healthcare provider is suggesting.

It was good to hear the differences which helped me see some of the obstacles. I won’t always agree but as Steve explained about mediation when we hear the word conflict, it has a negative tone. Conflict does not have to be negative. Disagreements are OK. It is how we resolve the conflict that matters. It can be done with compassion, with connection.

1 comment:

mrln said...

Words do matter, and I believe that the right kind of communication would have made all the difference 35 years ago when I had an unexpected medical outcome. Perhaps I wouldn't have lost my confidence and sense of self. Perhaps I wouldn't have experienced so much self doubt. Maybe it wouldn't have taken me 35 years to begin trust my intuition--those "gut" feelings you get that warn you that something isn't quite right. I lost all that when I was disregarded, disrespected and even lied to by the medical personnel in charge of my care. That (mis)treatment created confusion and cognitive dissonance that impaired my ability to deal with what was happening to me.

For me, last night was a healing experience. I finally heard the words of compassion I had needed to hear back then. It was very powerful to be able to relate my experience and really be heard. I know I was heard because of the feedback I received, and I felt the empathy in the room. I know now the power of compassionate communication, and that it can never be too late to experience it. Thank you, Ilene, for all the wonderful work you do.