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Patient-Centered Care E-Newsletter January 2016

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   January 2016     Issue No. 6

Patient-Centered Care News


We hope that you find this complimentary monthly e-newsletter informative. Below are excerpts with links.  Also included is a downloadable PDF version for readers who prefer that format.


Please feel free to send any questions or comments to comm@healthcarechaplaincy.org.


Rev. Eric J. Hall

President & CEO

HealthCare Chaplaincy Network, Inc.





Patient Experience


The Hidden Patient Experience (Health Leaders Media)

How well-meaning and clinically unimportant actions can make or break the patient experience, and how leaders at Cleveland Clinic and Mount Sinai Health System are refocusing efforts.

During her hospital's monthly executive leadership rounds, Cleveland Clinic's executive chief nursing officer, K. Kelly Hancock, MSN, RN, NE-BC, met a patient who didn't seem quite happy, despite his insistence that everything was OK.

"We could just tell that he was a bit hesitant in his answers," Hancock says. So before she and her fellow executives left him, they probed a little more, asking, "Are you sure there's nothing else we could do to make your experience better?"

Actually, something was bothering him. Someone had come in to change his gown, and instead of addressing him by name, such as Mr. Smith, they called him "honey" and "sweetie."

"For him, he was offended," Hancock says.

It may have seemed like a small thing, but it really rubbed him the wrong way, and totally colored his experience as a patient. It was clear that it had been bothering him for quite some time.

"You've really got to dig when you're with the patients and the families," Hancock says. "What's important to that patient [is something] you may miss."

Clinicians might check off all of the important clinical boxes when caring for a patient, but it's often the small-perhaps nearly imperceptible-nonclinical elements of a hospital stay that most affect whether a patient has a good experience.

"I think that patients come to us expecting to get really good clinical care," agrees Sandra Myerson, MBA, MS, BSN, RN, senior vice president and chief patient experience officer at New York's Mount Sinai Health System. "The only way they can really judge us is on the rest of it."

With all the effort, money, and attention that's currently being paid to the patient experience, it's important for clinicians to understand how to get to the real heart of how a patient is feeling, and to do it in real-time.



A Physician Writes: Hospitals Need a Checklist for Patient Experience (KevinMD.com) 


More than twenty years ago, when I was a medical student, I jotted down another surgeon's suggestions. To us students, chief of surgery Dr. Frank Spencer was an intimidating, blunt-spoken, larger-than-life figure who not infrequently hollered at his residents. With patients, he was a different man, and he exhorted us again and again to follow a set of rules - a checklist, really, although he didn't call it that. It was a step-by-step guide to acting humanely with patients, because, after all, the chaos of the hospital makes it so easy to forget:

  • Treat the patient like a family member, with dignity and respect.
  • Be gentle and honest.
  • Don't rush.
  • Make them comfortable.
  • Acknowledge their fear.
  • Don't sit behind a desk.
  • Encourage them to ask questions.
  • Grade yourself by how you feel when you leave the room. If you leave with a smile, give yourself an A.

To be sure, it may be distressing for patients to think that hospital staff need such reminders. But the whole point of checklists is to ensure that we don't overlook the most obvious tasks, like checking temperatures and blood pressures or making sure we are in fact talking to (or taking a scalpel to) the right patient. Or treating a patient like a family member, with dignity and respect, and acknowledging their fear.



Download and View Complimentary Webinar & Slides: "The Critical Role of Spirituality in Patient Experience"


(Presented by: Jason A. Wolf, PhD, President, The Beryl Institute and Rev. George Handzo, BCC, CSSBB Director, Health Services Research and Quality HealthCare Chaplaincy Network™)


Many hospitals have partnered chaplaincy and patient experience or even put chaplains in charge of patient experience. And yet, spiritual care and chaplaincy care remain underutilized in helping to improve patient experience. Sharing insights from The Beryl Institute white paper published in collaboration with HealthCare Chaplaincy NetworkTM, The Critical Role of Spirituality in Patient Experience, this webinar explored the emerging focus of spiritual care and chaplaincy in patient experience excellence and provide a core set of central themes and concepts for organizations to consider regarding spiritual care. Participants will identify key practices on integrating spiritual care into healthcare and understand the impact the professional healthcare chaplain role has on patient experience excellence.



Note: Membership and promotional codes are not required.


Spirituality and the Terminally Ill Patient

A Lesson in Spirituality (e-hospice International & Journal of Pain & Palliative Care Pharmacotherapy)


It is not easy to understand how spiritual support works in a multi-religious environment unless one has lived in such a society.

In a culture where diversity of faiths and spiritual practices exist, there is potential for a complicated situation if a religious leader of one faith provides care to a person who follows another faith. Sometimes, though, the spiritual needs at the end of life can be surprising.

In the narrative entitled: 'A Lesson in Spirituality', published in the Journal of Pain and Palliative Care Pharmacotherapy, Dr Vidya Viswanath describes the story of a Hindu man with advanced cancer. His illiterate wife, in the author's words, turns out to be a "perfect" spiritual caregiver. The woman asked the husband: "If something happened to you suddenly, what would you want me to do?" The man replied that since childhood he has liked the rituals of church, and so would like a Christian funeral and burial. When he died, he was buried the way he wanted. The extended family then performed Hindu rituals.

I find the story so very uplifting - the merging of religious beliefs, all tending to connect the dying person and the family "to nature and the significant or sacred." This story reaffirms that the essence of spirituality is the coexistence of harmony and humanity, transcendent of religion.

The Journal of Pain and Palliative Care Pharmacotherapy in which this story is published, is an indexed journal that has made the narratives free access. That is a noble act on the part of the publishers, who have taken this step to help tell the story of suffering and relief to the world.




Why Hospitals Must Be Hospitable; Why Health Care Must Be Healing -- And Why Chaplains Must Lead the Way -- PlainViews® 


The words "hospital" and "hospitable" and the words "health" and healing" are obviously derived from the same roots.[i] And yet, patient surveys repeatedly demonstrate that there is a significant disconnect between what goes on in a hospital and the idea of being hospitable, and between the modern health care system and any common sense notion of healing.[ii]




Modernity pays lip service to this idea of holistic care, but generally does not practice what it preaches. Increased specialization has led to more rigid separation of these aspects of the person. A hospital patient today can look forward to being seen by innumerable practitioners; only rarely does anyone have panoramic vision of the overall impact of the various discrete interventions upon the patient as a whole.




Returning a Sense of Wholeness


I give them a chance to return to their sense of wholeness. To their sense of empowerment. I reduce their feelings of isolation. I advocate for them (lawyer's genes) and I encourage them to advocate for themselves.

I can't offer drugs, tests or procedures. I offer empathy, warmth, connection, relationship. I diminish loneliness and fear and feelings of vulnerability with information and reassurance. I do not cure people (at least not directly), but I facilitate their healing. I believe people who heal have a much better chance of being restored to health (which may or may not mean being cured). Not only that, I believe they have a much better chance of restoring themselves to health.


What role, then, can chaplains play in enhancing the health care experience of patients and their families.



Chaplains have a unique opportunity to promote positive, constructive and caring relationship for the benefit of patients, families and staff. We are well-equipped to bring hospitality back into our hospitals and healing into health care, and to exhort others to join us. To be sure, there is still much work to be done, even at my small community hospital and certainly in the modern health care system generally. And it is not easy work. On the contrary, changing individual attitudes and institutional culture is a slow, tough slog, fraught with real frustrations and setbacks along the way.


Though our progress may not be linear, it can and must be forward progress nonetheless. The Mishna teaches, "You are not required to finish the work, but neither are you free to desist from it."[x] Chaplains are not responsible for changing the entire system or even an entire workplace, but we are nevertheless obligated to do our part and to lead when and where we can.   


[i] The words "hospital" and "hospitable" are derived from the Latin hospes, meaning "host," "guest," or "stranger." Charlton T. Lewis, 

An Elementary Latin Dictionary (Oxford University Press, 2000), p. 371. The words "health" and "healing" are derived from the Old English"hal," and the Old High German, "heil," meaning "whole." See Byron L. Sherwin, 

In Partnership with God: Contemporary Jewish Law and Ethics (Syracuse University Press, 1990), p. 81.


[ii] See, e.g., Peter Pronovost, "The Patient Wish List," US News and World Report, October 15, 2015; Harvey Chochinov, MD, Dignity in Care.


Author: Karen Lieberman, JD, BCC is a staff chaplain at Columbia St. Mary's Hospital in Mequon, Wisconsin. She received her Juris Doctor from Stanford Law School and her Master of Science in Jewish Studies from Spertus Institute for Jewish Learning and Leadership. Karen is board-certified by both Neshama: Association of Jewish Chaplains and the College of Pastoral Supervision and Psychotherapy.


This piece is dedicated to the memory of her teacher, Rabbi Dr. Byron L. Sherwin, ZT"L.



Palliative Care

A Physician Writes: Timing of Palliative Care Consultations -- Is Earlier Better? (GeriPal Blog)


I think there are three main take home points from this study ("The Costs of Waiting: Implications of the Timing of Palliative Care Consultation among a Cohort of Decedents at a Comprehensive Cancer Center"):

1) If you want to significantly improve early access to palliative care, you must deliver this care outside of the hospital setting. We've seen this with our own data at our medical center. The second we opened up a palliative care clinic nearly a decade ago, our time from consult to death increased from a little less to a month to now over half a year.

2) If you improve early access to palliative care by developing an outpatient clinic, you will see a drop in inpatient deaths. Again, we've seen this in our own medical center. The drop in inpatient deaths though creates problems if quality metrics are only measuring what happens to inpatient deaths (the easiest deaths to capture). For high quality metrics, all deaths need to be captured, something that is difficult in a fragmented health care system.

3) The delivery of high quality of care can also be cost-effective care. This study further adds to the growing list of studies that palliative care can not only can improve the quality of care for patients with serious illness, but can do it in a way that also reduces total health care costs.



Palliative Care Cuts Costs for Cancer Patients With Other Health Problems (HealthDay)


Previous research has found a link between palliative care and lower health care costs, but this is the first study to focus on patients with multiple health issues, the researchers said.

The study included terminally ill cancer patients with a number of coexisting chronic conditions (comorbidities). When they were admitted to the hospital, some were seen by a palliative care team while others received usual care.

Hospital costs for those in the palliative care group were 22 percent lower than for those in the usual care group. Also, costs were up to 32 percent lower for palliative care patients with the greatest number of health problems, according to the study in the January issue of the journal Health Affairs.
"We already know that coordinated, patient-centered palliative care improves care quality, enhances survival, and reduces costs for persons with cancer," said study lead author Dr. R. Sean Morrison, professor of geriatrics and palliative medicine at the Icahn School of Medicine at Mount Sinai in New York City.

"Our latest research now shows the strong association between cost and the number of co-occurring conditions. Among patients with advanced cancer and other serious illnesses, aggressive treatments are often inconsistent with patients' wishes and are associated with worse quality of life compared to other treatments," Morrison, who is also director of the National Palliative Care Research Center, said in a hospital news release.

It is "imperative" that policymakers act to expand access to palliative care, he added.



A Thank You Letter to David Bowie From a Palliative Care Doctor


Dear David,

Oh no, don't say it's true - whilst realization of your death was sinking in during those grey, cold January days of 2016, many of us went on with our day jobs. At the beginning of that week I had a discussion with a hospital patient, facing the end of her life. We discussed your death and your music, and it got us talking about numerous weighty subjects, that are not always straightforward to discuss with someone facing their own demise. In fact, your story became a way for us to communicate very openly about death, something many doctors and nurses struggle to introduce as a topic of conversation. But before I delve further into the aforementioned exchange, I'd like to get a few other things off my chest, and I hope you don't find them a saddening bore.



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