What Matters Most

Terri Nuss, MS, MBA, CPXP is Vice President of Patient Experience for Medical City Healthcare, a division of HCA. With 30 years in leadership across 5 leading healthcare systems, she began as an exercise physiologist, moved into cardiovascular operations, supported population health and advanced to patient experience in 2005.

Through this article, Nuss is emphasizing the importance of personalized, compassionate care for improving patient and colleague experiences while driving better healthcare outcomes.

Joyful birth, early birth, miscarriage. Trauma victim, life saved. End-of-life, quantity or quality? Med, rehab or surgery, will discomfort cease? Medical, clinical, compassionate care, expected or exceptional journey? Helping patients with their experience journey is not new—women, children’s and oncology services—have long known the value of reducing fear and engaging patients. Care, infused with compassion, produces quality outcomes.

New nurse or resident, anxious and uncertain, trained in a predominately virtual environment, good with devices, unsure how to talk with patients. Tenured nurse, seasoned yet still adjusting to post-pandemic expectations. Preceptor, still learning himself. Clinical leader, limited experience, elevated above peer. Compassionate care experience for colleagues is the dependent trust variable to delivering safety, timely, effective, efficient, equitable and patient-centered care (Institute of Medicine, 2001).

In 2005 Centers for Medicare and Medicaid Services (CMS) launched the Consumer Assessment of Healthcare Providers and Systems (CAHPS) program. Results show the impact of compassionate care on quality outcomes and readmissions, moving the ROI of patient experience from ‘nice to have’ to ‘must do.’  We no longer debate why this work matters, but how to execute in a constrained, high-demand, variable system of care.

Access to care is a first priority – finding the right care as quickly as possible (quality clocks start ticking!) requires multiple channels and an urgency to personalize the channels. As systems continue to consolidate and capitalize on scale, AI will be a critical differentiator.

Meet them where they are. The quality journey depends on the patient’s acuity, engagement in their own health, social support, life goals and resources. This is highly individualized, right? Not just person to person, but even for the same person, from encounter to encounter. This is a compassion-driven treasure hunt – what matters, right now, to this person or their loved one? How will this course of care serve them? Even when healthcare colleagues become a patient, vulnerability manifests. Once fear sets in, people stop processing information, emotions and planning. Silence looks like understanding when it may be confusion. We round frequently, keep care plans refreshed on communication boards and review these frequently with the patient through shift reports. We are respectful, introducing and including care team and family members. We must use teach back effectively, especially when there is limited language proficiency. We must verify this work, with keen oversight. 

Validate, does use of translation services match your registration demographic? Randomly observe your teams in huddles and shift reports, are they executing to methods? Walk through your ERs and listen in the halls – do you hear compassionate? A great introduction and acknowledgment of concern?

We all want the same things. See me. Know me. Care about me. Help me. Relieve my pain and fear. Keep me safe. Guide me.

We must respond to patients’ needs, values and whenever possible, their preferences (IOM, 2001). Personalized compassion is the differentiator, pursuing what and who matters to the patient; nesting this information in their EMR and on communication boards, asking for it throughout their care journey, updating it often. Value-based care aligns with diagnostic groups and services – the medical care needs of a population aggregate. It’s about systems and processes requiring precise alignment and collaboration to capture safe and timely care, reducing harm, optimizing quality outcomes. Individualizing care elevates value-based care, but quality is lost if we cannot factor what the patient values.

Technology helps. Electronic education, music, gaming, coloring, puzzles equip and soothe. Detecting decibels of sound to validate ‘quiet;’ white, pink and green noise help with rest. Zoom chats bring families into urgent decisions when time equals tissue. WhatsApp – I had the COVID experience of watching via video my mom pass, a nurse in a moon suit attending when I was not allowed to. What a gift. Virtual bedside care, registration, translation services. Kiosks to expedite check-ins. Portals and group-messaging to keep patients and colleagues connected, engaged.

Supporting healthcare teams to deliver high-quality care in high-demand conditions requires evidence-based methods. Select great people—hungry, humble and smart. Onboard well—set expectations, trust but verify skills, assign a buddy, help them ‘belong.’ Peer interviews give team ownership, define culture. Recognize their successes, help chart a growth path early. Help them discover their passion – what fills their tank? And then do more of that! Create a culture of coaching. Share your own coaching lessons to accelerate learning, reduce fear of failure.

Then connect the dots, so every colleague knows how important they are creating great outcomes. Spend time along the continuum, walking a mile with them to learn the work.

The privilege of caring for patients and families is a sacred vocation, we stand in the gap when they are vulnerable. We must help identify inefficiencies to restore meaningful time for colleagues to connect. Then not only will the patients have a great experience, our colleagues will as well.