The Trillion Dollar Bedside Manner Question

Does the happiness of your caregiver matter to your health?
One of the obvious, yet vexing truths about healthcare is that it is a business.  In fact, it is a highly complex and technical operation that is uniquely delivered using 1:1 personal interactions in intimate settings.  There is precious little discussion about the fact that people matter more in healthcare than technology or science. 
So in a very real sense, your very life depends more on your caregiver in this 1:1 intimate setting, than it does on the science or technology that is being used.  This is one lens through which we can view the utter disaster that describes the relationships between the United States’ medical outcomes, our cost of healthcare and the paradox of the “most advanced technology” in the world that is put to use in its delivery.  What’s lost is the enormous impact of the people delivering the service.  In other countries and cultures that have far less technology there seem to be better outcomes.  How can this be so?  
In a retail environment, service quality is important to loyalty, brand value and many drivers of bottom-line profit and growth.  Yet in retail, as in nearly every other industry, service quality does not impact the very lives of customers.  Food manufacturing, distribution and preparation, and drug manufacturing (arguably a healthcare related industry) may be notable exceptions.  Aviation and some related mass transportation industries may also be notable exceptions.  We depend on our “drivers” to keep us safe.
Yet impossibly we continue to treat healthcare delivery in many ways, with the same “disconnect” and “third person separation” as retail service industries when it comes to the relationship between quality of service and the small things… such as life and death.
We exaggerate here because these are real issues that are only now being addressed by law, mandate and accountability.  
And that’s a wonderful new direction.
Before more good news, a few startling statistics:
The leading causes of accidental death in the United States and Canada:
Auto accidents?  Falls?  Drowning?  Good guesses.  Those are up at the top.
Coming in 1st place however we find a surprising trio:
     -Hospital acquired infections
     -Medical errors
     -Pharmaceutical errors 
That’s right.  It's called "iatrogenic"causes. The very organizations tasked with saving lives are number 1 in the accidental killing business.  Above handguns. This is according to Medical News Today,  the National Safety Council and JAMA.  This absurd paradox is misleading.  Of course healthcare facilities and teams save lives and cure disease. But there are big risks that must be managed aggressively.  And they all come back to human error.
According to William Charney at Canadian Dimension Magazinesystematic factors lead to most errors. “although there are many causes for errors and hospital-acquired infections, I like to look at the impact of people, process, and technology. And while technology can clearly help, patient outcomes today are clearly driven by the quality of people and process.” 
What Charney is describing is the root of this new focus on caregivers, and the bright spot in being able to create real improvement in outcomes and reduction of errors and costs — “the quality of people and process.”
How is your caregiver treated on the job?  It should matter to you.
Of course we want all caregivers to be treated well by their employers.  Especially on the day we visit them.  But is there more to this than the difference between a sweet smile and a brusque attitude?  Is “bedside manner” a “nice to have” or is it vital?  Think of it this way:  as Barbara Balik, Senior faculty member of the Institute for Healthcare Improvement (IHI), puts it “we can only treat patients as well as we treat one another.”
A 2009 Forum Group report titled “The Relationship between Employee Satisfaction and Hospital Patient Experiences,” goes further by finding that efforts to create higher employee satisfaction have a very desirable outcome on patients, including increased patient satisfaction, improved care quality, and increased patient loyalty.”

The report suggested that one effective way of meeting the needs of employees, with the goal of ultimately satisfying patients, is “viewing employees as internal customers.”   Some people suggest that the tables should be turned, and insist on hospital executives receiving their regular medical treatment anonymously at their own facilities.  That’s one way to have executives alerted to the level of healthcare worker engagement and job satisfaction. 
There are better, more positive ways.  And new laws, policies and mandates are driving this faster.  Technology can help.
But first one more example of what may be a familiar dilemma.  Staffing.  Or rather, staffing dysfunction.
Where’s my doctor?  Where’s the shift nurse?
Have you ever wondered, while shivering in the paper gown in the treatment room, why you have been left there for such a long time?  Have they forgotten about you?  If you peek out the door into the hallway there is nobody in sight.  You were here half an hour early and sat in the waiting room for 20 minutes past your appointment time.  You will be late back to work.  Do they keep you naked and cold so you won’t wander around?.  You’re trapped. Waiting.  You can’t check email because your cell phone gets no reception in the building.  You hear a voice in the hallway and open the door to ask “where’s my doctor?  Where’s the shift nurse?”  All you get is a shrug.
This matters a lot more than you think.
Where staffing is inadequate, the potential for medical error actually increases. William Charney’s review of the scientific literature has found a direct link between medical error and infection. For each additional patient over-assigned to an RN, the risk of death increases by 7 percent for all patients. Patients in a hospital with a 1:8 nurse–patient ratio have a 31 percent greater risk of dying than patients in hospitals with a 1:4 nurse–patient ratio 1.  
(For non-math majors that means understaffed healthcare organizations make more mistakes, and that means increased risk to patients--- you and me) 
Penny-wise and pound foolish compromises in shift scheduling and staffing levels
Longer shifts have become popular over the last several years.  They can save payroll expense.  However they also create a higher rate of medical error. 
“Physicians-in-training who are scheduled to work long hours make 36 percent more serious medical errors with five times as many serious diagnostic errors. Fatigue-related error data is plentiful in the scientific literature. Fatigue-related preventable adverse events associated with death of a patient increased by +/- 300 percent in interns working more than five extended-duration shifts per month.”
The takeaway there:  If you seen an intern--- send him or her away to get some sleep.
The good news- accountability is driving real focus on quality and engagement
The Affordable Care Act, also known as “ObamaCare” makes pay for performance the law of the land through the Hospital Value Based Purchasing Program. This puts billions of dollars of medical reimbursements into play at healthcare delivery organizations.  And it’s not something that Congress or The States are likely to be able to avoid or repeal.  Like it or not, we all have to live with its rules.
As healthcare organizations are coming to understand, 1% (growing to 2%+) of all Medicare reimbursements are being withheld for consideration under pay for performance.  Performance is being defined as patient satisfaction, improved outcomes and overall better quality of service delivery.  But how do healthcare organizations improve?  What are the drivers and measurement basis?  What are the benchmarks and predictors?  Those are just a few of the questions asked by healthcare executives today.
The relationship between caregiver engagement, satisfaction and working conditions, and the quality of outcomes is no longer in question for the healthcare industry.  Caregiver engagement drives outcomes and patient satisfaction.  This is the direct link and the key insight that healthcare organizations are coming to understand.  And now it’s directly linked to financial payments.
The great news is that this is much easier to impact these factors of care than acquiring multi-million dollar treatment devices or waiting for new vaccines or DNA treatments or advances in disease management.
By comparison, it’s ridiculously simple and inexpensive.  But it’s not something that has been aggressively and mindfully managed, monitored and turned into action, policy and benchmarks.
Again, lots of great news.
Technology helps
New mobile services like the NursesCount service and the companion service PatientCount (from the company WorkersCount) provide immediate insights into service quality, identification of problematic processes, and service areas, and turn them into actionable insights and benchmarks for leaders to see daily, in real-time.
The NursesCount and PatientCount services change the game by delivering the first healthcare-specific worker sentiment measurement service, delivered on mobile devices. These services move measurement and management of engagement from a yearly or periodic basis to a daily basis. The friendly mobile application asks employees two simple questions each day: how do you feel about your life at work today and a question of the day. 
The value to employees comes from seeing daily the results for their organization (as well as peer group across the industry). For healthcare managers, results are summarized into dashboards showing aggregate sentiment changes over time and comparing sentiment and questions of day to benchmark data. This way executives and managers can quickly discern where improvement is needed, and where actions and initiatives are working. 
In conclusion, the answer to the original question of “Does the happiness of your caregiver matter to your health?”  --yes indeed. 
So the next time you visit your healthcare organization’s facility, take a look around and try to get a sense as to whether things seem “happy” or “sad” – and if the people you encounter seem overworked, cranky and disengaged, or if they seem positive, happy and engaged. 
If things don’t “feel” so great, consider making a change to another healthcare provider. 

Your very life could depend on it.
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