With A Nursing Bundle in Your Hands, Everything Looks Like a CAHP

Pardon the play on Maslow's hammer-and-nail metaphor. Let’s begin with a bit of context, qualifiers and disclaimers.?

While I am older, I am not Old School (except when it makes so much sense). Healthcare’s service bar is still pretty low. However, I strongly believe the nature of those in healthcare is compassionate, caring, kind, and full of service. We just don't always make it easy for those traits to shine. I also think Value-Based Purchasing is a good thing. Why not us if virtually every other industry is judged through the Quality+Service / Cost = Value equation?

Attention to the experience of our patients and guests will not be the “demise of Western medicine,” as a provider said to me recently. There are plenty of things plaguing healthcare—that is for a hundred or so other essays. But listening to our patients, explaining things in a way they can understand, including them in decisions about their care, explaining meds and their side effects, treating them with courtesy and respect, and more are not among them.?

When we add inquiry about other elements of the healthcare experience that are?much more closely tied to what matters most in choosing hospitals and providers, we can craft and implement operational and highly personalized responses. Strategic measurement partners (e.g., Press Ganey, NRC, PRC, etc.) are really good at building inquiry systems for those things that?mean the most?to patients (e.g., staff working together, response to emotional needs, time spent, attitudes, inclusion, responsiveness to more than just a call light, and more). These elements have implications for healing, health literacy, personal connections, and more. They are NOT about "satisfaction," as so many naysayers profess.?

Please don't get me wrong; I think HCAHPS has tremendous value in understanding various elements of care that have clinical and experiential effects. But if we only focus on HCAHPS and designing our solutions around it, we are teaching to the test and possibly missing out on what matters most when it comes to choice.

One of my favorite definitions was shaped by peeps in our experience thought village years ago: to feel cared FOR and cared ABOUT. We can absolutely do both.?

With all that as a primer, just as patient experience will not be a downer to Western medicine, the classic Nursing Bundle employed by virtually every hospital in the land is?not the answer?to creating the most memorable and positive experience for those we serve. I'm sorry; it just isn't.

Now, before the Bundle Apostles begin to experience heart palpitations and charge me with experience blasphemy,?I am an ardent supporter of the classic tactics of bedside shift report, communication boards, and purposeful rounding. However, they are not?the?solution for what drives patient perceptions and choices.

They are chassis. They are foundational. They put us in?proximity?to the patients and their loved ones. They provide a space and time for something special to happen.

Hardwiring the steps of these and other models is a good thing. But I have seen hospitals for almost two decades still trying to teach two or three solutions spawned by the epoch-making work of the iconic Quint Studer and his posse of Experience Evangelists all those years ago. Let me be clear: I would still drop in Studer's original nine principles just as much today as powerful contemporary guideposts for working on what matters most: Culture. Just sayin'.

So many hospitals are asking the question, “Are we?doing?bedside shift report?” “Are we rounding hourly or in some cadence?” and “Are we?completing?the whiteboard?” This is a good thing, but if that is where we land in terms of experience outcomes success, we might just miss the real destination.

Creating a culture of empathy, listening, compassion, reduced suffering (thank you, Dr. Lee), presence, personal connection, and responsiveness is bundle-agnostic. Consider extra attention to building human connections through a positive and affirming workplace; looking for what is right in our days and nights; experimenting often; celebrating life and our place in nurturing it; grieving for loss and lovingly helping others through it, and working together for a common aim, not a metric.?

Consider the Bundles as vehicles for proximity. The pieces are a means to a human-connection end, not an end in and of themselves.

Creating a culture of empathy, listening, compassion, reducing suffering (thank you, Dr. Lee), presence, personal connection, and responsiveness is bundle-agnostic. Consider extra attention to building human connections through a positive and affirming workplace; looking for what is right in our days and nights; experimenting often; celebrating life and our place in nurturing it; grieving for loss and lovingly helping others through it, and working together for a common aim, not a metric.

Consider this as we advance our bundles:

Emphasize?understanding?over?completing?whiteboards. Before exiting the board update, ask the patient, “Does what we've written up here make sense?” Another great question might be, "Is it clear what we've written on the board?" You might even employ a bit of teach-back by asking them to read what is on the board to you.

Bedside Shift Report is not limited to a clinical exchange. It's just as much, if not more, about dialogue and engagement. Telling the patient to ask any questions if they have them is NOT an invitation to participate. Be intentional by asking them to add to the discussion. Invite them in. Apply the mantra, "Nothing about me without me."

Some organizations have added other “P’s” to the classic four in Purposeful Rounding (Pain, Potty, Position, Possessions). I’ve seen clever ones. Consider this one: Presence. And here’s a tip for adding it to any element of the bundle. Employ a “Presence Pause” before entering the room or treatment area. It’s simple. Pause, close your eyes, and ask yourself, “Am I ready for this patient?” It might just put you in the head and heart spaces for what is about to happen.

Here’s to bundles of care. And here is to the bigger picture. Look, I added another “P.”

Sean.